Energy Employees Compensation: Many Claims Have Been Processed, but Action Is Needed to Expedite Processing of Claims Requiring Radiation Exposure Estimates
Published: 2004-09-10T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Subtitle B of the Energy Employees Occupational Illness Compensation Program Act, administered by the Department of Labor (Labor), provides eligible workers who developed illnesses from their work, or their survivors, with a onetime total payment of $150,000, and coverage for medical expenses related to the illnesses. For some claims, Labor uses radiation exposure estimates (dose reconstructions) performed by the National Institute for Occupational Safety and Health (NIOSH), part of the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC), to determine if the illness claimed was "as least as likely as not" related to employment at a covered facility. GAO was asked to determine (1) how well Labor's procedures and practices ensure the timely and consistent processing of claims that are not referred to NIOSH for dose reconstruction but are being processed by Labor and (2) how well Labor's and NIOSH's procedures and practices ensure the timely and consistent processing of claims that are referred for dose reconstruction. GAO did not assess the quality of Labor's claims decisions.
section_title: What GAO Found
paragraphs: In the first 2 and 1/2 years of the program--July 31, 2001, through January 31, 2004--Labor had fully processed 83 percent of the nearly 30,000 claims that had not been referred to NIOSH for dose reconstruction; these claims correspond to nearly 23,000 cases for individual workers. (Multiple claims can be associated with a case as eligible survivors may each file claims.) Labor took an average of 7 months to fully process these claims. About 42 percent of claims with final decisions were approved, resulting in $625 million in lump-sum compensation payments. The remaining 58 percent of claims with final decisions were denied--the majority because they did not meet medical or employment eligibility criteria. Labor generally met its timeliness goals for processing claims and is working to ensure that claims are processed consistently by conducting accountability reviews and creating a task force to update its procedure manual. In the first 2= years of the program, Labor and NIOSH had fully processed about 9 percent of the more than 21,000 claims (which correspond to about 15,000 cases) that were referred to NIOSH for dose reconstructions, taking an average of 17 months to fully process claims. Fifty-one percent of the processed claims were approved, and Labor has paid out about $65 million in lump-sum compensation. Forty-nine percent were denied because it was determined that the claimed illness was not at least as likely as not related to employment at a covered facility. A backlog of claims needing dose reconstruction developed because NIOSH needed time to get the necessary staff and procedures in place to complete the dose reconstructions and develop site profiles. Efforts are under way to develop site profiles that contain facility-specific information that is useful in completing dose reconstructions. However, processing claims associated with facilities that do not have site profiles, in some instances, has essentially stopped, and NIOSH has not established a time frame for completing these remaining site profiles because of limited expert resources and site complexities. As a result, some claimants could wait a considerable period of time to have their claims fully processed. To help ensure the consistency of claim decisions, HHS's Advisory Board is conducting an independent external evaluation of dose reconstruction decisions and site profiles.

section_title: Letter
paragraphs: For the last several decades, the Department of Energy (Energy) and its  predecessor agencies and contractors have employed thousands of  individuals in secret and dangerous work in the nuclear weapons  production complex. Over the years, employees were unknowingly  exposed to toxic substances, including radioactive and hazardous  materials, and studies have shown that many of these employees  subsequently developed serious illnesses.
The Energy Employees Occupational Illness Compensation Program Act  of 2000 (EEOICPA), enacted as Title XXXVI of Public Law 106-398 of the  Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001,  was signed into law on October 30, 2000. EEOICPA established two  programs to help secure compensation for certain workers who developed  occupational illnesses or for their survivors. The first program, established  by Subtitle B, is administered by the Department of Labor (Labor). Under  this program, eligible workers who were exposed to radiation or toxic  substances and who subsequently developed specific kinds of cancers and  other named conditions, or their survivors, receive a onetime total  payment of $150,000. Living and eligible Energy employees also receive  coverage for future medical expenses related to the illness. Compensation  of $50,000 and payment of medical expenses from the date a claim is filed  is also available for employees exposed to uranium previously awarded  benefits by the Department of Justice under Section 5 of the Radiation  Exposure Compensation Act (RECA). The second program, established by  Subtitle D, is administered by Energy. This program allows Energy to help  its employees file state workers’ compensation claims for illnesses  determined by a panel of physicians to be caused by exposure during  employment at an Energy facility.
Several different federal agencies are involved with the implementation of  the Subtitle B program, including Labor, the Centers for Disease Control  and Prevention’s (CDC) National Institute for Occupational Safety and  Health (NIOSH), and Energy. Labor has primary responsibility for  administering the program; Labor receives the claims and determines  whether the claimant meets the eligibility requirements. Labor may receive  multiple claims associated with a single worker, as multiple survivors may  each file a claim. When considering the compensability of certain claims,  Labor relies on estimations of the levels of radiation particular workers  were likely exposed to when working for Energy; these estimations are  known as “dose reconstructions” and are developed by NIOSH. To avoid  gathering similar information for each claim associated with a particular  facility, NIOSH compiles facility-specific information in “site profiles.”  These site profiles assist NIOSH in completing the dose reconstructions.  Dose reconstructions are not needed for certain workers from four  designated locations, who constitute the “special exposure cohort.”  Certain workers from these sites were designated as members of the  special exposure cohort in legislation because it was believed that  exposure records were insufficient and the reasonable likelihood was that  the workers’ radiation exposure caused their cancers. Finally, Energy  provides employment and radiation records, where available, to Labor and  NIOSH as appropriate.
While most of the concerns about EEOICPA have focused on Energy’s  implementation of Subtitle D, concerns have also been raised about  Subtitle B claims, such as the length of time involved in completing dose  reconstructions. Now that the program has been in place for a few years,  you asked that we assess how well the program is working. We focused  our work on two key areas: (1) how well Labor’s procedures and practices  ensure the timely and consistent processing of claims that are not referred  to NIOSH for dose reconstruction but are being processed by Labor and  (2) how well Labor’s and NIOSH’s procedures and practices ensure the  timely and consistent processing of claims that are referred for dose  reconstructions.
To perform our review, we analyzed both Labor’s and NIOSH’s procedures  and practices used to process claims. Specifically, we obtained and  analyzed information on the goals used to assess timeliness and the quality  assurance procedures. Also, we obtained information on NIOSH’s efforts  to complete site profiles needed to assist with the dose reconstruction  process and on a recently introduced regulation for considering special  exposure cohort petitions. We also interviewed officials from Labor’s  Office of Workers’ Compensation Programs and its four district offices as  well as NIOSH’s Office of Compensation Analysis and Support. In addition,  we interviewed several NIOSH contracted staff, claimants, and EEOICPA  experts regarding their knowledge of, or experiences with, Subtitle B  claims processing. Further, we analyzed data extracted from Labor’s and  NIOSH’s case management systems for claims filed from the beginning of  the program—July 31, 2001—through January 31, 2004. We determined  that the data we used were sufficiently reliable for our purposes by  performing electronic testing for obvious errors in accuracy and  completeness, reviewing available documentation, and interviewing  agency officials and contractors knowledgeable about the data. Using  these data, we determined the number of claims received, the status of the  claims, the average time taken to process the claims, and the approval  rates of the claims. We did not assess the quality of Labor’s decisions. In  addition, we interviewed Labor and NIOSH officials to obtain updated  information on the approval rates for cases that required dose  reconstructions as of July 2004. We also interviewed NIOSH officials to  obtain information on the average time taken to draft dose reconstructions  as of July 2004 and the number of dose reconstructions completed in the  first 9 months of fiscal year 2004.
We conducted our review from October 2003 to September 2004 in  accordance with generally accepted government auditing standards. For a  more complete explanation of our methodology, see appendix I.
subsections: section_title: Background
paragraphs: Several different federal agencies are involved with the implementation of  EEOICPA’s Subtitle B program, including Labor, CDC’s NIOSH, and  Energy. Labor’s Office of Workers’ Compensation Programs is responsible  for adjudicating and administering claims filed by workers, former  workers, or certain eligible survivors under the act. NIOSH, as part of the  Centers for Disease Control and Prevention within the Department of  Health and Human Services, is responsible for performing several  technical and policy-making roles in support of Labor’s program, including    establishing by regulation methods for arriving at reasonable estimates  of radiation doses received by an individual at a covered facility;    establishing by regulation guidelines to be used by Labor to determine  whether an individual sustained a cancer in the performance of duty  for purposes of the compensation program if, and only if, the cancer  was “at least as likely as not” related to the radiation dose received by  the employee;    establishing procedures for considering petitions to be added to the  special exposure cohort; and    providing the Advisory Board on Radiation and Worker Health with  administrative and other necessary support services.
EEOICPA specified that the President appoint an Advisory Board to advise  the Secretary, HHS, on its activities under the act. The Advisory Board,  which is composed of scientists, physicians, and workers, advises the  Secretary, HHS, on  the development of methods used to perform dose reconstructions and  guidelines to be used to assess the likelihood that an employee’s cancer  is “at least as likely as not” related to work-related radiation exposure,  the scientific validity and quality of dose reconstruction efforts  performed, and   the addition of employees to the special exposure cohort.
Energy is responsible for providing Labor and NIOSH information to assist  with processing claims. This information includes such things as  employment verification, information specifying the estimated radiation  dose of that employee during each employment period claimed, and  facilitywide monitoring data.
Several requirements must be met for a claimant to be eligible for  compensation under Subtitle B. For a worker (or eligible survivor) to  qualify for benefits, the worker must have worked at a covered Energy  facility or at a beryllium vendor facility, or for an atomic weapons  employer during a covered time period, and developed one of the specified  illnesses associated with exposure to radiation, beryllium, or silica.  Covered medical conditions include all cancers (except chronic  lymphocytic leukemia), beryllium disease, and chronic silicosis.
When a claim is filed, it is assigned to one of Labor’s four district offices— Jacksonville, Florida; Cleveland, Ohio; Denver, Colorado; or Seattle,  Washington—based on the geographical location of the covered worker’s  last employment. Upon receipt of a claim, Labor determines whether the  Subtitle B claimant meets eligibility requirements for one of three claim  types: RECA Section 5 supplement claims; beryllium, silicosis, and special  exposure cohort cancer claims; and cancer claims not covered by special  exposure cohort provisions. For the purposes of our report, we have  grouped these three types of claims into two categories, based on whether  or not the claims are referred to NIOSH for dose reconstruction during  processing. As figure 1 shows, claims that are not referred to NIOSH for  dose reconstruction include RECA Section 5 supplement claims and  beryllium, silicosis, and special exposure cohort cancer claims. Claims  that are referred to NIOSH for dose reconstruction include cancer claims  not covered by special exposure cohort provisions.
Depending on the type of claim, Labor must complete certain claims- processing tasks before a decision can be made as to whether the claimant  should receive compensation. Claims for the $50,000 RECA Section 5  supplement are the least complex. For these, Labor verifies with the  Department of Justice that an award determination has previously been  made and documents the identity of the claimant. For claims involving  beryllium disease, silicosis, or a specified cancer for workers at a special  exposure cohort facility, the employment and illness are verified. After  the verification is completed for a claim, Labor develops a recommended  decision that is issued to the claimant. The claimant may agree with the  recommended decision or may object and request either a review of the  written record or an oral hearing. In either case, the Final Adjudication  Branch (a separate entity within Labor’s Office of Workers’ Compensation  Programs) will review the entire record, including the recommended  decision and any evidence or testimony submitted by the claimant and will  issue a final decision. A claimant can appeal the decision in the U.S.  District Courts or have the case reopened if new evidence is provided to  Labor.
Other claims are referred to NIOSH for dose reconstruction. Such claims  include those involving a claimed cancer not covered by the special  exposure cohort provisions. Before a determination of compensability  can be made, a dose reconstruction must be conducted for the probability  of causation to be established. In these instances, once Labor determines a  worker was a covered employee and that he or she had a diagnosis of  cancer, the case is referred to NIOSH. Using scientific and other collected  information, NIOSH performs a dose reconstruction and provides the  results to Labor. Labor uses these results to assess whether the employee’s  cancer was “at least as likely as not” related to the radiation dose received  by the employee in order to determine compensability.
The purpose of a dose reconstruction is to characterize the extent to  which workers were exposed to radiation present in the workplace and to  assist Labor in determining the probability that a person’s cancer was “at  least as likely as not” caused by radiation. Dose reconstructions rely on  information that was periodically collected to monitor radiation levels by  Energy or other covered facilities and on information collected during  interviews with the claimant. For example, when such information is  available, NIOSH officials gather information that was collected to monitor  a worker’s radiation exposure, such as readings from a worker’s  monitoring badges, urinalysis results, and radon monitoring results. They  also obtain information from workplacewide monitoring readings, such as  general air-sampling results, radon monitoring results, and work-required  medical screening x-rays. NIOSH officials also conduct interviews with  claimants to obtain information on their employment history, how they  were monitored for radiation exposure, whether they were aware of any  particular incidents during which they may have been exposed to  radiation, and whether medical screening had indicated they may have  been exposed to radiation. In cases where NIOSH officials cannot fully  characterize the likely level of radiation exposure, they estimate the level  of exposure using reasonable scientific assumptions that give the claimant  all the benefit of the doubt, according to NIOSH officials.
Compensation is limited to $150,000 per worker for all claims that are not  related to RECA Section 5 supplements. When multiple survivors of the  same worker file claims, the compensation amount is divided among  eligible survivors. Moreover, while multiple claims associated with a single  worker may be filed with Labor, only one dose reconstruction is needed in  such instances. See appendix II for detailed information about the claim- processing steps used by Labor and NIOSH.
section_title: Labor Processes Claims Not Referred to NIOSH for Dose Reconstructions in a Timely Manner and Has Taken Steps to Ensure Consistency
paragraphs: In the first 2½ years of the program—July 31, 2001, through January 31,  2004—Labor had fully processed 83 percent of claims not referred to  NIOSH for dose reconstruction. During the first year of the program, Labor  was not able to meet one of its primary Government Performance and  Results Act of 1993 (GPRA) timeliness goals, but since then GPRA goals  have been met and Labor has set higher goals for the future. Labor also  established interim goals for processing claims. In addition, Labor has  instituted various procedures to promote consistency, including  conducting accountability reviews and updating its procedures manual.
subsections: section_title: Labor Has Fully Processed Most Claims Not Referred to NIOSH for Dose Reconstructions and Has Generally Met its Timeliness Goals for Claims Processing
paragraphs: As of January 31, 2004, Labor had fully processed 83 percent of the nearly  30,000 claims for benefits under Subtitle B that had not been referred to  NIOSH for dose reconstruction. As shown in figure 2, an additional 16  percent of claims were in processing, and less than 1 percent had not yet  begun processing. Of the claims that were fully processed, 94 percent had  final decisions, and the remainder had been closed without a final  determination for administrative reasons. Forty-two percent of claims  with final decisions were approved, resulting in more than $625 million in  lump-sum compensation payments. The remaining 58 percent were  denied, in most instances because they did not meet medical or  employment eligibility criteria. On average, it took about 7 months to fully  process claims not needing dose reconstruction.
As of January 31, 2004, the majority of approved claims that were not  referred to NIOSH for dose reconstructions reported cancer as a claimed  illness, and Labor had reimbursed claimants whose claims were approved  nearly $22 million in medical and travel-related expenses. About  55 percent of approved claims not referred for dose reconstruction  claimed cancer, 12 percent reported chronic beryllium disease, 10 percent  reported beryllium sensitivity, and 4 percent reported chronic silicosis.  Approved claimants with ongoing medical and travel-related expenses  related to the occupational illness for which they were compensated under  Subtitle B are entitled to reimbursement for these expenses. As shown in  figure 3, more than half of the nearly $22 million paid was reimbursement  for claimants’ hospital expenses.
Labor has generally met the two broad GPRA goals it established for  timeliness of processing Subtitle B claims, as shown in table 1. These goals  were (1) to complete the initial processing of claims within specified time  periods, depending upon the type of claim, 75 percent of the time, and (2)  to complete the final decision processing of claims within specified time  periods 75 percent of the time. Labor did not establish different GPRA  goals for claims not referred to NIOSH for dose reconstruction versus  those needing dose reconstruction; rather, the GPRA goals are overall  goals that apply to Labor’s processing of all Subtitle B claims. The initial  processing time frames and the final decision processing time frames  encompass all of the activities Labor must complete to fully process a  claim. In its fiscal year 2002 annual report, Labor stated that it set these  GPRA goals to provide a clear indication to claimants that their claims  would be processed efficiently. The report further stated that the agency  wanted to send a strong message to the new program’s staff that they  should share this strong commitment in processing claims. In its 2003  strategic plan, Labor indicated that it planned to set higher processing  goals through 2008 by increasing the goals by 2 percentage points each  year.
Labor officials cited several factors that contributed to not meeting the  GPRA goal for initial processing in fiscal year 2002. For example, in the  program’s first year, the district offices received more than 34,000 claims  and actually had a backlog of claims to process even before they began  operating the program on July 31, 2001. In addition, several start-up  problems, most notably unanticipated delays in obtaining the employment  information from Energy necessary to proceed with initial claims  processing, also prevented Labor from achieving this goal during the first  year, according to Labor officials. Labor officials also stated that they have  addressed many of these initial problems and Energy has greatly improved  its responsiveness rate. Labor officials report that Energy is typically  responding to a request within 30 days, which exceeds Labor’s goal of  obtaining a response from Energy within 60 days. Labor officials have also  used other sources, such as labor unions, to help provide necessary  employment verification.
To assist Labor officials in knowing how well claims are being processed,  and ultimately meeting its GPRA goals, Labor has also established a  number of interim processing goals. These interim processing goals  specify time frames for completing activities such as initiating the  employment and illness verification process and issuing the lump-sum  payments. Initially, the district offices had difficulty meeting some of these  interim goals. However, over time they have been better able to meet these  goals. For example, in fiscal year 2002, Labor set an interim goal to initiate  the employment and illness verification process within 25 days 90 percent  of the time. While the district offices achieved only a 76 percent rate in  fiscal year 2002, they improved their rate to over 98 percent in fiscal year  2003. Similarly, in fiscal year 2002, an interim goal was set to issue a lump- sum payment to a claimant within 15 days of approving a claim 90 percent  of the time. District offices achieved a 77 percent rate in fiscal year 2002  but improved their performance to achieve a 93 percent rate in fiscal year  2003.
section_title: Labor Has Taken Steps to Ensure Consistency, Including Accountability Reviews and a Major Update of its Procedures Manual
paragraphs: Labor has taken several steps to help ensure that Subtitle B claims are  processed consistently. For example, Labor requires that claim decisions  undergo several levels of review.  After a claims examiner develops a  recommended decision, a senior claims examiner reviews that  recommended decision, and a claims manager, who reviews a sample of  such decisions, might review it as well. Labor’s Final Adjudication Branch  then reviews the recommended decision before making a final decision  and awarding compensation, if appropriate. If during any of these reviews  the reviewer determines that there was not enough information to make a  decision, the case is sent back to the claims examiner for further  development.
To further promote consistency, Labor performs accountability reviews  each year on the EEOICPA program as it does with its other similar  compensation programs. In completing the reviews, Labor samples claims  in each of its four district offices as well as its Final Adjudication Branch  offices. The purpose of the reviews is to assess the quality of work being  performed in each office and to guide managers in developing training and  implementing any needed corrective actions. The reviews focus on such  tasks as processing claims in a timely manner, making payments  appropriately, assigning staff to appropriate roles, and coding claims  appropriately in the case management system. The accountability reviews  have proven very useful in identifying training needs, according to Labor  officials. For example, after an accountability review showed that actions  had been taken in some claims but were not reflected through status codes  in the case management system, some district offices held training courses  to help their claims examining staff better understand how to use codes  properly. In addition to providing training, the district offices are required  to correct any problems identified during the reviews. Labor officials told  us they expect to continue to conduct accountability reviews each year.
Labor has also taken steps to improve staff access to updates in claims- processing procedures. Some district offices raised concerns that the  procedures manual, originally issued in January 2002, did not always  reflect Labor’s most recent guidance and needed to be revised. For  example, a supervisor in one of the district offices said that the bulletins  announcing changes to the system are not available from a central source  and that he has struggled at times to determine the proper procedure.  According to Labor officials, because the program is relatively new and  the law was vague in some areas, Labor has issued many different policies  to define how staff should handle different situations. In addition,  guidance was not always centrally located because, in issuing policy  clarifications, Labor did not consistently use one format; rather, it issued  policies in bulletins, e-mails, and documentation of telephone calls. To  address the district offices’ concerns, Labor created a task force  composed of 10 team members, including staff from the four district  offices and headquarters. The task force is working to develop a  comprehensive procedures manual that would include all the bulletins,  teleconference calls, and other communications containing policy changes  that have been issued since the beginning of the program. Officials said  that they are in the final stages of completing the manual.
section_title: Claims Needing Dose Reconstructions Face Large Processing Backlog
paragraphs: In the first 2½ years of the program—July 31, 2001, through January 31,  2004—Labor and NIOSH fully processed about 9 percent of the claims  referred to NIOSH for dose reconstruction, leaving a large backlog of these  claims. NIOSH officials report that the backlog resulted because time was  needed to develop the necessary regulations and get staff and procedures  in place for performing dose reconstructions. NIOSH now has its staff and  procedures in place and has an extensive effort under way to complete  site profiles that expedite the dose reconstruction process. However,  NIOSH’s time frame for completing the remaining profiles is uncertain,  and as a result, some claims associated with facilities that do not have site  profiles may take a considerable period of time to be fully processed. To  ensure the consistency of claim decisions, NIOSH’s Advisory Board is  overseeing an effort to evaluate dose reconstruction decisions and site  profiles. Finally, with the recent issuance of special exposure cohort  regulations, the backlog of claims needing dose reconstructions may be  reduced if additions are made to the special exposure cohort, thereby  eliminating the need for performing dose reconstructions on these claims.
subsections: section_title: Relatively Few Claims Needing Dose Reconstructions Have Been Fully Processed, and NIOSH Cites a Number of Factors Affecting Its Ability to Complete Dose Reconstructions
paragraphs: As of January 31, 2004, Labor, using dose reconstructions provided by  NIOSH, had fully processed relatively few of the claims referred to NIOSH  for dose reconstruction. Of the more than 21,000 claims requiring dose  reconstruction, 9 percent were fully processed, 91 percent were in  processing, and less than 1 percent had not yet begun processing, as  shown in figure 4. Of the 9 percent that had been fully processed, 64  percent had final decisions, while the remaining claims were closed for  administrative reasons. Our analysis showed that dose reconstructions  had been started for about one-third of the claims that were in processing.  The remaining claims were either waiting or undergoing development  prior to the initiation of the dose reconstruction. In some cases where a  site profile has not yet been developed, these claims are essentially on  hold until the site profile is developed.
Fifty-one percent of claims with final decisions as of January 31, 2004,  were approved, resulting in $65 million in lump-sum compensation  payments. Forty-nine percent were denied because the results of the dose  reconstruction were used by Labor to determine that the claimed illness  was not “at least as likely as not” to have been caused by work-related  radiation exposure. However, approval rates for cases with final  decisions have subsequently decreased, and as of July 2004, Labor officials  reported that the approval rate for cases that required dose reconstruction  was about 30 percent.
Claims referred to NIOSH for dose reconstruction have taken longer to  fully process than those that do not require dose reconstruction, and some  claims in processing at NIOSH may face a long wait for dose  reconstruction before returning to Labor for decisions. Of the Subtitle B  claims that were fully processed, as of January 31, 2004, those that  required dose reconstruction took an average of about 17 months to fully  process, compared with about 7 months for claims that did not require  dose reconstruction. However, the claims requiring dose reconstruction  that had not yet been fully processed had already been pending for an  average of 19 months. Approximately 15 of these months, on average, had  been spent in processing at NIOSH and 4 months had been spent in  processing at Labor.
All approved claims that had required dose reconstruction reported  cancer, and Labor reimbursed claimants for more than $3 million in  medical and travel-related expenses as of January 31, 2004. Almost all of  the reimbursements were for hospital and physician expenses, as shown in  figure 5.
Unlike Labor, which was able to immediately begin processing claims at  the start of the program on July 31, 2001, NIOSH needed time to develop  the necessary regulations and to get staff and procedures in place to  perform dose reconstructions. Two necessary regulations were finalized in  May 2002. In a May 2004 report to Congress, NIOSH reported that many  of the key program pieces, such as recruiting and training staff, were not  completed until 2003, contributing to the delays in its ability to complete  dose reconstructions. NIOSH also highlighted the difficulties it has  encountered in collecting information from Labor, Energy and other  employers, and claimants. For instance, NIOSH reported that information  such as employment history and cancer diagnosis provided by Labor is, at  times, inaccurate or incomplete. NIOSH also reported that obtaining  information from Energy or other employers has been difficult because  individual exposure records cannot always be located. Finally, while the  intent of conducting an interview with the claimant is to obtain useful  information, NIOSH officials report, however, that this will not hinder a  dose reconstruction.
NIOSH has been working to improve its ability to develop dose  reconstructions and address its backlog of claims needing dose  reconstruction. In March 2004, the Director of NIOSH testified that NIOSH  has steadily increased its capacity to complete dose reconstructions and  that much of the program’s development is complete. NIOSH officials  stated that they continue to work with Labor staff to establish a better  understanding of what information, such as ethnicity and smoking history,  is needed by NIOSH to perform a dose reconstruction, and officials stated  that Labor is now typically providing this information. In addition, NIOSH  has worked with Energy facilities to provide requested information in a  more timely fashion. Improvements have been made in this area, and  officials report that Energy generally provides the information within  NIOSH’s time frame of 60 days. While NIOSH officials are working with  claimants to better educate them about the information NIOSH wants to  collect during the interview, NIOSH officials said that it was important to  realize that these interviews are voluntary and are not the sole source of  information. Information provided during the interviews is helpful, but a  dose reconstruction is not dependent upon an interview being conducted,  according to NIOSH officials.
While NIOSH reports that it has improved its ability to complete dose  reconstructions, it has not established any performance goal for the  overall timeliness of processing the claims referred to NIOSH for dose  reconstruction. Specifically, no GPRA goals were established in fiscal year  2002 or 2003 for NIOSH’s processing of Subtitle B cases, but a GPRA goal,  covering part of the dose reconstruction process, was established for  fiscal year 2004. Despite not having GPRA goals earlier in the program,  NIOSH did establish and track some interim processing goals. NIOSH did  not want to establish any overall timeliness goal for completing dose  reconstructions, but rather wanted staff to complete them in as  scientifically sound and efficient a manner as possible. NIOSH’s GPRA  goal for fiscal year 2004 is to have draft dose reconstructions sent to 80  percent of all claimants within 60 calendar days of the claim being  assigned to staff to perform a dose reconstruction. As of July 2004, NIOSH  officials reported that currently, an average of 70 days was required to  conduct a dose reconstruction after a case was assigned to a dose  reconstructionist. While NIOSH has developed innovative solutions to  process claims from more than 70 different sites regardless of whether a  site profile exists, the majority of these claims typically involve facilities  that do have a site profile either completed or partially completed.  However, since claims associated with facilities that do not have site  profiles are typically not assigned to staff for dose reconstruction, it is  possible that NIOSH could meet the GPRA goal and that some claimants  could still wait a considerable period of time to have their cases fully  processed.
NIOSH has accelerated the rate at which it is completing dose  reconstruction. For example, it took NIOSH a little more than 2 years from  when it received its first referral from Labor to complete the first 1,000  dose reconstructions. In contrast, NIOSH completed the second 1,000 dose  reconstructions in less than 4 months and the third 1,000 dose  reconstructions in 11 weeks. NIOSH established a target of completing  8,000 dose reconstructions in fiscal year 2004. To assist in meeting this  goal, NIOSH is aiming to complete 200 dose reconstructions per week. As  of June 2004, NIOSH was averaging about 150 dose reconstructions a week  and had completed about 2,100 dose reconstructions in the first 9 months  of fiscal year 2004.
section_title: Completed Site Profiles Have Helped Accelerate Claims Processing, but NIOSH Has Not Established Time Frames for Completing the Remaining Profiles
paragraphs: To facilitate the dose reconstruction process, NIOSH is developing site  profiles that compile information such as hazardous materials present at  the site, facilitywide monitoring information, and information on workers  at the site who may have been exposed to radiation. NIOSH officials  believe that these site profiles will enhance the efficiency of performing  dose reconstructions by eliminating the need to duplicate efforts in  gathering information. The site profiles for larger sites consist of six  documents, which are called Technical Basis Documents: an introduction,  a site description, an occupational medical dose document, an  occupational environmental dose document, an occupational internal dose  document, and an occupational external dose-monitoring document.  NIOSH officials are also compiling worker profiles, which provide  information on the worker’ job, work location within the facility, and time  periods worked. NIOSH sometimes uses the worker profiles to obtain  proxy information when some information is not available for a particular  claimant.
NIOSH initially expected to conduct dose reconstructions while  developing site profiles for the facilities involved but encountered  difficulties in doing so. By pursuing both efforts at the same time, NIOSH  officials had hoped to avoid facing a backlog of claims by completing a  substantial number of dose reconstructions. However, NIOSH determined  that it was necessary to first complete the site profiles to complete a high  volume of dose reconstructions because it was too inefficient to collect  general site-related information on a case-by-case basis. In addition, while  Energy has supported NIOSH’s efforts in locating site-specific information,  there have been some delays in providing this information, particularly  when the information requested is from classified documents. When  requests for classified documents are made, delays have occurred because  of the time needed for Energy to comply with procedures for ensuring  national security.
NIOSH currently has an extensive effort under way to develop site  profiles, and this effort has helped expedite the processing of claims.  NIOSH has established over a dozen teams, each composed of three to six  experts, and made each team responsible for developing a different site  profile. NIOSH prioritized its efforts by targeting those facilities that have  the largest number of claims needing dose reconstruction; 15 of the 30  sites NIOSH anticipates completing a site profile for represent about 80  percent of the claims submitted for dose reconstruction. As of June 2004,  11 site profiles were fully completed, while 9 other site profiles were  partially completed (see table 2).
In cases where a site profile has been completed, NIOSH has been able to  better process the claims needing dose reconstruction associated with  those facilities. For instance, since the first of six Technical Basis  Documents for the Savannah River site profile was approved, in July 2003,  NIOSH had completed about 500 dose reconstructions for that site by  January 31, 2004, whereas NIOSH had completed fewer than 10 dose  reconstructions for that site prior to July 2003. While some site profiles are  only partially completed, NIOSH is still able to use the completed  Technical Basis documents, as applicable, to develop dose  reconstructions. For example, at the Idaho National Engineering and  Environmental Laboratory (INEEL), the occupational internal dose  document is still being finalized. However, if NIOSH has a claim that only  needs the use of other INEEL site profile documents that are finalized,  such as the occupational medical dose document or the occupational  external dosimetry documents, a dose reconstruction can be developed  for this claim. In addition, completed site profiles may be modified as  additional relevant information is identified and incorporated. Claims  originally denied based upon a prior version of a site profile are re- examined to determine the effect that the new information may have on  the compensability of the claim. In turn, Labor can make any appropriate  modifications to its earlier claim decisions.
Despite efforts to complete the remaining site profiles, NIOSH officials  said that their time frame for completing these profiles is uncertain. The  site profiles that have been completed have taken on average 4 to 6  months to complete. NIOSH reported that the pace at which it can  complete additional site profiles is constrained by the limited expert  resources available to conduct this specialized work and by the  complexity of the history and variety of operations at particular sites. In  addition, NIOSH officials said that it generally takes longer to complete  site profiles for atomic weapons employer sites because many of these  sites are no longer operating or are privately owned, making it difficult to  locate records. Because the number of available staff needed to complete  site profiles is very limited, NIOSH officials stated that they have had to  balance their use of these resources. As site profiles are completed,  resources are reallocated to assist with the completion of additional site  profiles.
section_title: HHS’s Advisory Board Is Conducting an Evaluation to Ensure Claims Decisions Are Consistent
paragraphs: HHS’s Advisory Board has a major effort under way to ensure claims  decisions are being made consistently. Specifically, HHS’s Advisory Board  is responsible under the statute for (1) reviewing a reasonable sample of  individual dose reconstructions for scientific validity and quality, (2)  advising on the development of guidelines to determine probability of  causation and methods for dose reconstruction, and (3) reviewing special  exposure cohort petitions. To assist the Advisory Board, HHS entered into  a contract with an organization in October 2003 to carry out some of these  tasks. The contractor is currently developing its plans for completing these  tasks and expects to conduct the evaluation over the next 5 years and to  provide interim status reports each year.
Performing an independent review to examine the consistency of  individual dose reconstructions decisions is an important aspect of  effective program management for the Subtitle B program. In the past,  GAO reported concerns that a similar program that compensates veterans  with diseases caused by radiation exposure did not have an independent  review of its dose reconstructions. Such a review could result in greater  public confidence and mitigate concerns about dose reconstructions.
NIOSH officials have also stated that the evaluation of the individual dose  reconstructions and site profiles is an important exercise to complete. The  Chair of the Advisory Board said that while the board is confident in what  NIOSH’s findings have been to date, it is important to have an independent  review completed in order to validate these findings.
section_title: HHS Issued Regulations That Would Eliminate the Need for Dose Reconstructions for Claims Granted Special Exposure Cohort Status
paragraphs: After HHS had twice received public comments on proposed regulations  concerning how individuals or groups could apply for special exposure  cohort status, the agency issued final regulations on May 28, 2004. The  Secretary of HHS is responsible for developing procedures for considering  petitions to be added to the special exposure cohort. HHS originally  published a proposal for these procedures on June 25, 2002, and  subsequently received a number of public comments. Many of these  comments pertained to the feasibility of completing dose reconstructions  and establishing time limits for completing dose reconstructions. Because  HHS needed to make substantial changes to the procedures to address  public comments, the agency issued a second notice of proposed rule  making on March 7, 2003, and solicited public comments through  May 6, 2003. Again many of the comments related to completing dose  reconstructions in a feasible and timely manner.
HHS’s regulations establish procedures that describe how petitions can be  submitted and reviewed for special exposure cohort consideration. These  requirements are intended to ensure that petitions are submitted by  authorized parties, are justified, and receive uniform, fair, and scientific  consideration. The procedures are also designed to give petitioners and  interested parties opportunities for appropriate involvement in the  process. The procedures are not intended to provide a second opportunity  to qualify a claim for compensation, once NIOSH has completed a dose  reconstruction and Labor has determined that the claimed cancer was not  “at least as likely as not” to have been caused by the estimated radiation  doses.
With the implementation of the regulations, some of the claims in NIOSH’s  backlog could be eligible for special exposure cohort status and  consequently reduce the backlog of claims requiring dose reconstruction.  If a petition to add a particular group to the special exposure cohort is  submitted and approved, NIOSH would not need to develop an individual  dose reconstruction for such a claim. Rather, Labor would verify the  claimant’s employment and illness and follow the review process currently  used for existing special exposure cohort groups. As of July 30, 2004,  NIOSH had received eight special exposure cohort petitions and was  determining whether the petitions were eligible for consideration.
section_title: Conclusions
paragraphs: Labor’s procedures and practices have helped the agency to fully process  most of the claims that had not been referred to NIOSH for dose  reconstruction. Because this program is relatively new, Labor has issued  many different policies to define how staff should handle different  situations and is working to develop a comprehensive procedures manual  that would contain these policies. In addition, the accountability reviews  performed each year have allowed Labor to identify and correct problems  as they occur and provide additional training to staff as needed. To ensure  consistency in the processing of claims during this period of change, it will  continue to be important for Labor to maintain these ongoing efforts.
In contrast, relatively few claims requiring dose reconstructions have been  fully processed. NIOSH faces the challenge of balancing multiple  objectives—scientific soundness and timeliness—in completing dose  reconstructions. However, while NIOSH has placed considerable focus on  ensuring scientific soundness, it has not established a clear vision for  claimants or the Congress with regard to the time frames within which  they can expect dose reconstructions to be completed. NIOSH established  a GPRA goal for fiscal year 2004 that specifies a time frame for completing  draft dose reconstructions once a claim is assigned to staff to perform a  dose reconstruction. However, claims associated with facilities that do not  have site profiles are typically not assigned to staff for dose  reconstruction, and this waiting period is not reflected in the GPRA goal.  NIOSH learned from its initial implementation experience that completing  site profiles is a critical element for efficiently processing claims requiring  dose reconstruction. While NIOSH had completed 11 site profiles and  partially completed 9 profiles as of June 2004, it had not established any  time frames for completing these 9 site profiles or the remaining 10 site  profiles that it expects to develop. Without such time frames, claimants do  not have a good understanding of when their dose reconstruction might be  completed. While it is important to avoid the extreme of establishing time  frames that are unreasonable and would set up NIOSH for failure, it is  equally important to avoid the other extreme of not setting any  expectations for the timely completion of dose reconstructions for which  site profiles have not been completed. Moreover, now that NIOSH has  more experience in developing site profiles, it is in a better position to  identify and take account of factors that can lead to differences in the  amount of time required to complete site profiles for different facilities.
section_title: Recommendation
paragraphs: To enhance program management and promote greater transparency with  regard to the timeliness of completing dose reconstructions, we  recommend that the Secretary of HHS direct CDC officials to establish  time frames for completing the remaining site profiles.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to both Labor and HHS for comment.  Labor did not have any comments on the report. HHS said that the report  was balanced, thorough, and constructive, and that it agreed with GAO’s  recommendation to establish time frames for completing the remaining  site profiles. HHS also provided updated information on the number of site  profiles already completed and the total number of site profiles that it  anticipates compiling, and we revised the report to incorporate this  information. HHS added that it has used innovative solutions to complete  dose reconstructions in some instances in which site profiles do not exist  and we modified the report to incorporate this information. Moreover,  HHS provided additional information to explain how completed site  profiles function as “living documents” and are modified as additional  relevant information is identified. Finally, HHS raised questions about the  accuracy of certain statistics we cited about cases that had been fully  processed by Labor, while acknowledging that Labor is a more  authoritative source on this topic. We believe that these statistics  accurately describe what they were intended to measure, and Labor did  not raise any issue about their accuracy; hence, we did not revise the  figures. HHS’s comments are provided in appendix IV. HHS also provided  technical comments, which we have incorporated as appropriate.
Copies of this report are being sent to the Secretary of Labor and the  Secretary of Health and Human Services, appropriate congressional  committees, and other interested parties. The report will able be made  available at no charge on GAO’s Web site at http://www.gao.gov. If you  have any questions about this report, please contact me at (202) 512-7215.  Other contacts and staff acknowledgments are listed in appendix VI.
section_title: Appendix I: Scope and Methodology
paragraphs: To determine how well the Department of Labor’s (Labor) procedures and  practices ensure the timely and consistent processing of claims that are  not referred to the National Institute of Occupational Safety and Health  (NIOSH) for dose reconstruction but are being processed by Labor, we  reviewed Labor’s regulations, procedures, and practices related to  processing claims. In addition, we interviewed officials from Labor’s  Office of Workers’ Compensation Programs and its four district offices in  Cleveland, Ohio; Denver, Colorado; Jacksonville, Florida; and Seattle,  Washington to discuss their procedures and practices. In addition, we  obtained and analyzed information on Labor’s Government Performance  and Results Act (GPRA) goals and interim processing goals for fiscal year  2002 through the second quarter of fiscal year 2004. We also obtained and  analyzed accountability review documents for fiscal years 2002 and 2003.  We interviewed Labor officials to obtain information on the department’s  efforts to revise its procedures manual used by staff in processing claims.  Last, for background purposes, we interviewed several claimants and  Energy Employees Occupational Illness Compensation Act (EEOICPA)  experts regarding their knowledge of or experiences with Subtitle B  claims processing.
To determine how well Labor’s and the NIOSH procedures and practices  ensure the timely and consistent processing of claims that are referred to  NIOSH for dose reconstruction, we reviewed Labor’s and NIOSH’s  regulations, procedures, and practices related to processing claims. Along  with the work we performed at Labor as described earlier, we interviewed  officials from NIOSH’s Office of Compensation Analysis and Support  (OCAS) to discuss their procedures and practices. In addition, we  obtained and analyzed information on NIOSH’s GPRA goals and interim  processing goals for fiscal year 2002 through the second quarter of fiscal  year 2004. We also reviewed several of the completed site profiles and  obtained information on NIOSH’s time frames for completing additional  site profiles needed to assist with the dose reconstruction process. We  reviewed recently introduced regulations for considering petitions to be  added to the special exposure cohort as well as different pieces of  legislation introduced that would establish additional sites as special  exposure cohort sites. We also interviewed the Advisory Board chair and  reviewed key documents pertaining to the evaluation of dose  reconstructions that the Advisory Board is overseeing. Last, for  background purposes, we interviewed several NIOSH contract staff,  claimants, and EEOICPA experts regarding their knowledge of or  experiences with Subtitle B claims processing.
To determine the number, status, and other characteristics of Subtitle B  claims filed through January 31, 2004, we analyzed administrative data  extracted from Labor’s and NIOSH’s case management systems for  applications filed from the beginning of the program—July 31, 2001— through January 31, 2004. Neither agency publishes standardized data  extracts from their systems, so we requested that they provide customized  extracts for our analysis. Specifically, we received an extract from the  NIOSH Office of Compensation Analysis and Support Claims Tracking  System (NOCTS) and several files extracted from Labor’s Energy Cases  Management System (ECMS) and Energy Medical Bill Processing  Subsystem (EMBPS).
Because multiple claims can be associated with a single worker, the  systems and the extracts received from both agencies contain data  collected at two levels—the case level and the claim level. For example, if  multiple children of a deceased worker file claims, all claims will be  associated with a single case, which is linked to the worker. At the case  level, the extracts contained information about the worker, such as date of  birth and date of death (if applicable), the facilities at which the employee  worked, the employee’s dates of employment, and the status of the case as  it moves through the development process. At the claim level, the extracts  contained information related to the individual claimants, such as the date  the claim was signed, the claimant’s relationship to the worker, and the  status of the claim as it progressed through processing.
The Labor files were merged to produce claim- and case-level data files  and were subsequently merged with the NIOSH extract. Throughout this  report, we have reported our statistics at the claim level. Where case-level  statistics have been reported, they have been merged with the claim-level  data so that they could be reported at the claim level.
We interviewed key Labor and NIOSH officials and contractors and  reviewed available system documentation, such as design specifications  and system update documents. We tested the data sets to determine that  they were sufficiently reliable for our purposes. Specifically, we performed  electronic testing to identify missing data or logical inconsistencies. We  did not assess the quality of Labor’s claims decisions. We then computed  descriptive statistics, including frequencies and cross-tabulations, to  determine the number and status of claims received as of January 31, 2004.
In order to provide more current information, we interviewed Labor and  NIOSH officials to obtain updated information on the approval rates for  cases that required dose reconstructions as of July 2004. We also  interviewed NIOSH officials to obtain information on the average time  taken to draft dose reconstructions as of July 2004 and the number of dose  reconstructions completed in the first 9 months of fiscal year 2004.
section_title: Appendix II: Labor’s and NIOSH’s Claim- Processing Steps
paragraphs: requirements? is it?
Claims is referred to NIOSH for  dose reconstruction NIOSH obtains worker's and workplace   monitoring information from Energy and other   sources as appropriate decision?
Labor’s Final Adjudication   final decision?
section_title: Appendix III: Comparison of Claim- and Case-Level Information Regarding Claims Referred to NIOSH for Dose Reconstructions as of January 31, 2004
paragraphs: While Labor makes and reports its decisions on the claim level, NIOSH  reports its dose reconstruction results on the case level because only one  dose reconstruction is completed for each worker regardless of the  number of claims filed by survivors. Table 3 presents information on the  status of claims referred to NIOSH for dose reconstructions at both the  claim and case levels as of January 31, 2004.
section_title: Appendix IV: Comments from the Department of Health and Human Services
section_title: Appendix V: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: In addition to the above contacts, Melinda L. Cordero and  Rosemary Torres Lerma made significant contributions to this report.  Luann Moy and William Bates assisted with methodology and data  analysis, Margaret Armen provided legal support, and Amy E. Buck  assisted with the message and report development.