Energy Employees Compensation: DOL Generally Followed Its Procedures to Process Claims but Could Strengthen Some Internal Controls
Published: 2016-03-10T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: EEOICPA was enacted in 2000 to compensate employees and contractors of the Department of Energy whose illnesses are linked to their work in the nuclear weapons industry. Part E of the Act, enacted in 2004, compensates these contractor and subcontractor workers, or their eligible survivors, for medical expenses, impairments, and lost wages up to $250,000. GAO was asked to review DOL's management of this program.
GAO examined (1) the extent to which DOL follows its procedures to adjudicate Part E claims, (2) how DOL captures new links between toxic substances and diseases and applies them to adjudication, and (3) what DOL's monitoring indicates about the adjudication process and whether any corrective actions have been taken to address identified problems. GAO reviewed a generalizable stratified random sample of 200 Part E claims filed from 2010 through 2014; reviewed applicable federal laws, regulations, guidance, internal audit reports, and other agency documentation associated with internal monitoring; and interviewed DOL officials.
section_title: What GAO Found
paragraphs: The Department of Labor's (DOL) adjudication process for compensating Department of Energy contract workers or their survivors for illnesses linked to work in the nuclear weapons industry generally follows guidance and procedures implementing Part E of the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA). Although GAO's analysis of a generalizable sample of 200 claims filed by workers from 2010 through 2014 found the adjudication process generally followed DOL's guidance and procedures, GAO identified some inconsistencies in an estimated 10 percent of the claims, including errors in correspondence to claimants and in development of claims. The procedure manual stipulates that written decisions should clearly convey information that led to the decision and that decisions are to be reviewed by the appropriate signatory. GAO found that decisions sometimes contained inaccurate, conflicting, or incomplete information, such as listing the wrong medical condition. DOL also did not always run accurate searches of its Site Exposure Matrices (SEM)—an online electronic database of facilities, toxic substances, and associated illnesses—when processing claims, or responding to requests for reopening claims. In addition, GAO found that supervisory review is at the discretion of each district office and, as a result, recommended decisions on claims were not always reviewed. This may increase the likelihood of poorly written decisions, which is inconsistent with procedures and which, in turn, increases the potential for claimant confusion and delays in adjudication.
DOL uses the SEM to, among other things, document newly identified causal links between toxins and diseases on the basis of medical research. According to DOL officials, since 2006 the number of such links listed in the SEM has increased from about 300 to over 3,000. They said that due to the large volume of information updates, DOL provides limited notification to claims examiners and the public when they occur. It has issued 10 notices specifically on new links since 2006. Therefore, it is usually incumbent on claims examiners and claimants to make themselves aware of new links by continuously checking the SEM for updates. As a result, new links are applied to claims largely to the extent these checks are performed. However, claims examiners are not always required to document that they checked whether the SEM had been updated prior to issuing a recommended decision to deny a claim. This gap in documentation hinders DOL's ability to monitor program performance, consistent with federal internal control standards.
According to DOL's monitoring, its process for adjudicating Part E claims is working satisfactorily, but persistent deficiencies remain. DOL conducted reviews from fiscal years 2010 through 2014 based on random sampling and found that the process for adjudicating claims met DOL's acceptability standards in any given year. Nonetheless, DOL consistently found deficiencies in certain adjudication steps across all years, including insufficient use of program resources to fully develop claims and improperly written decisions, as GAO also identified in its claim file review. DOL took corrective actions, such as training for claims examiners, to address deficiencies in 2010 through 2012, but determined that corrective actions were not warranted in 2013 and 2014.
section_title: What GAO Recommends
paragraphs: GAO recommends that DOL take steps to ensure all decision letters receive supervisory review, and require that claims examiners document that they checked whether the SEM had been updated just prior to issuing a decision to deny a claim. DOL agreed with the recommendations and indicated it would take steps to implement them.

section_title: Letter
paragraphs: For many decades, the Department of Energy (Energy) and its  predecessor agencies and contractors have employed thousands of  individuals in potentially secretive and dangerous work associated with  nuclear weapons production. Due to the nature of their work, workers  may not have been properly advised of or protected from workplace  hazards. Over the years, especially early on, many workers were  unknowingly exposed to toxic substances, including radioactive and  hazardous materials, and studies have shown that many of these  individuals subsequently developed serious illnesses. To provide  compensation to these workers, the Energy Employees Occupational  Illness Compensation Program Act of 2000 (EEOICPA) was enacted.  The Department of Labor’s (DOL) Office of Workers’ Compensation  Programs has primary responsibility for administering Parts B and E of  this legislation, as amended, with assistance from several other federal  agencies. The Part E program, which is the focus of this review, provides  financial compensation to employees of Energy contractors and  subcontractors, as well as their survivors, for wage loss, impairments, and  medical expenses resulting from work-related illnesses linked to exposure  to toxic substances. Since the creation of Part E in 2004, DOL has made  over 33,000 payments totaling about $3.6 billion.
Within a few years of EEOICPA’s enactment, claimants and members of  Congress began raising questions about the program’s implementation.  Since 2003, GAO has issued a number of reports and testimonies  identifying needed improvements, as applicable, to the program. In our  most recent report in 2010, we found that EEOICPA did not require  external review of the Part E program and, as a result, adjudication of  Part E claims was not informed by any independent expertise outside the  department’s purview. The Advisory Board on Toxic Substances and  Worker Health was subsequently created and was expected to improve  transparency, accuracy, and efficiency of processing claims under  EEOICPA. GAO was asked to review the consistency with which DOL  follows its own procedures to process Part E claims, and the consistency  and transparency of information that claims examiners rely on to identify  new links between toxic substances and diseases.
Accordingly, we addressed the following questions related to the Part E  program:  1.  To what extent does DOL follow its procedures to adjudicate Part E  claims?  2.  How are new links between toxic substances and diseases captured  and applied in DOL’s adjudication process?  3.  What does DOL’s monitoring indicate about Part E adjudication and  what, if any, corrective actions have been taken to address problems  identified?
To determine the extent to which DOL followed applicable policies and  procedures in adjudicating Part E claims, we reviewed a stratified random  sample of 200 Part E claims that were filed within the last 5 years,  between January 2010 and December 2014, and assessed consistency  with selected procedures pertaining to the development of the claim  through issuance of a Recommended Decision and Final Decision. Our  overall sample included employee as well as survivor claims, and  accepted as well as denied claims. Our population of claims was stratified  into two groups and 100 claims were selected within each. The first group  consisted of claims associated with three selected medical conditions  that, according to DOL and other sources, were potentially more  challenging to adjudicate—hearing loss, chronic beryllium disease, and  Parkinson’s disease. One hundred claims were randomly selected  across these three conditions, in proportion to their population sizes. The  second group consisted of claims not associated with those three medical  conditions and 100 claims were randomly selected within this group. In  addition, we reviewed the EEOICPA Procedure Manual and other  guidance, such as Bulletins and Circulars, used by claims examiners to  adjudicate Part E claims. We also interviewed DOL officials to obtain a  better understanding of how Part E claims are adjudicated.
To determine how new links between toxic substances and diseases are  captured and applied in the adjudication process, and to understand what  DOL’s monitoring efforts indicate about the Part E adjudication process,  we interviewed agency officials and reviewed relevant reports. We also  reviewed adjudication guidance issued by DOL, including DOL’s  EEOICPA Procedure Manual, Circulars, and Bulletins. In addition, we  reviewed findings from DOL’s annual Accountability Reviews and other  audits conducted by DOL since 2010. We also reviewed available  corrective action plans and interviewed agency officials to determine how  deficiencies found during these internal audits are resolved. Lastly, during  the course of our work we compared the steps taken during DOL’s  adjudication of Part E claims against federal standards for internal  control.
We conducted this performance audit from May 2014 through February  2016 in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives. For more information on  our scope and methodology, see appendix I.
subsections: section_title: Background
paragraphs: EEOICPA, as amended, generally provides compensation to employees  of the Department of Energy (Energy) and its contractors employed in the  production of U.S. nuclear weapons who developed illnesses related to  their exposure to radiation and many other toxins at Energy facilities.  During and shortly after World War II, the United States sponsored the  development and production of nuclear weapons using a network of  facilities. During the Cold War, this network expanded into a complex of  as many as 365 industrial sites and research laboratories throughout the  country that employed more than 600,000 workers in the production and  testing of nuclear weapons. Some of the production sites were owned by  Energy or its predecessor agencies, and in many instances contractors  managed operations at the facilities. Workers in these facilities used  manufacturing processes that involved handling very dangerous  materials, and they often were provided inadequate protection from  exposure to radioactive elements, although protective measures have  increased over time. Because of national security concerns, they also  worked under great secrecy, often facing severe criminal penalties for  breaches of secrecy. Workers were often given minimal information about  the materials with which they worked and the potential health  consequences of their exposure to the materials. In some cases, the  extent of the potential negative effects of the toxins may not have been  fully understood at the time of workers’ exposure. Active production of  nuclear weapons was halted at the end of the Cold War, and federally  sponsored cleanup of some of these sites has been underway since that  time. Other sites remain active for research, storage, uranium production,  and weapons assembly and disassembly. In passing EEOICPA,  Congress recognized that many of these employees were unknowingly  exposed to radiation, beryllium, and other toxic materials at Energy  facilities.
subsections: section_title: Program Structure
paragraphs: EEOICPA, as amended, consists of two compensation programs, Part B  and Part E. The Part B program generally provides for $150,000 to  eligible workers or their survivors, as well as coverage of future medical  expenses associated with certain radiogenic cancer, chronic beryllium  disease, and chronic silicosis. Part E provides up to $250,000 for wage  loss and impairment, as well as coverage of medical expenses, to  claimants with any illness who demonstrate that it is at least as likely as  not that 1) exposure to a toxic substance at an Energy facility was a  significant factor in aggravating, contributing to, or causing the illness,  and 2) the exposure to such a toxic substance was related to employment  at an Energy facility. If the employee is deceased, certain eligible  survivors can also claim benefits.
section_title: Implementation of EEOICPA
paragraphs: While the Division of Energy Employees Occupational Illness  Compensation (DEEOIC) within DOL’s Office of Workers’ Compensation  Programs has primary responsibility for administering the compensation  program, other federal agencies, including the Department of Health and  Human Services and Department of Energy, also have a role in  implementing the program.
The National Institute for Occupational Safety and Health (NIOSH)  conducts activities to assist claimants and support the role of the  Department of Health and Human Services under EEOICPA. Some of  these activities include developing scientific guidelines for determining  whether a cancer is related to the worker’s occupational exposure to  radiation, developing methods to estimate worker exposure to radiation  (dose reconstruction), using the dose reconstruction to develop  estimates of radiation dose for workers who apply for compensation, and  overseeing the process by which classes of workers can be considered  for inclusion in the Special Exposure Cohort.
Energy’s role, in part, is to ensure that all available worker and facility  records and data are provided to DOL and NIOSH. This includes  information related to individual claims, such as employment records to  establish periods of covered employment and facilities, and exposure  records for use in adjudicating claims.
section_title: Claims Development and Adjudication
paragraphs: DEEOIC’s four district offices, located in Cleveland, Denver, Jacksonville,  and Seattle, are responsible for claims development, determining  causation, and issuing a Recommended Decision. Claims examiners  within each district office can also authorize compensation and medical  benefits, respond to inquiries from interested parties, and maintain case  files. Claims examiners rely on the EEOICPA Procedure Manual, among  other resources, to process and develop claims. The Procedure Manual is  supplemented by EEOICPA Bulletins and Circulars and is updated  periodically. In addition, DOL has issued regulations that set forth the  general policies and guidelines governing its administration of  EEOICPA.
DOL also has 11 resource centers to assist with claims processing. The  resource centers, situated in key geographic locations throughout the  United States, are responsible for providing assistance and information to  the EEOICPA claimant community and other interested parties. They  provide claim development support and program outreach as well as  initial claim intake. While the resource centers gather substantial  information and documentation, and perform certain initial development  and limited follow-up tasks, they do not make any decisions regarding the  claim. The district office further develops the claim and issues an initial  Recommended Decision. Since Part E’s creation in 2004 and through  December 2015, just over 123,000 claims have been processed by DOL.
The process starts when the employee or their survivor(s) files a claim  with a district office or resource center (see fig. 1). If the claim is filed with  a resource center, a center employee conducts outreach and initiates  actions to verify employment. Once complete, the resource center  forwards the claim to the district office for further development. Upon  receipt of a claim from the resource center, or directly from a claimant, the  district office assigns it to a claims examiner, who develops the claim and  issues a Recommended Decision. During this process, the claims  examiner will often request additional information from the claimant to  verify employment, document a diagnosed claimed illness, and determine  survivor eligibility, as applicable. The claims examiner will also verify the  claimant’s employment history with Energy, the Social Security  Administration, or other organizations.
After the district office has established that the claimant meets the  employment criteria and has a diagnosed illness, it determines if the  illness was a result of exposure to radiation or other toxic substances  during the claimant’s contract employment with Energy. To do this, the  district office requests and reviews additional information, as applicable,  from NIOSH, medical consultants, the claimant’s treating physician,  certified toxicologists, and industrial hygienists, as well as web-based  information regarding the relationship between the illness and toxic  substances. Based on a review of all the evidence gathered, the claims  examiner—determining if it was at least as likely as not that the exposure  was a significant factor in causing, contributing to, or aggravating the  illness—issues a Recommended Decision to accept or deny the claim.  The claims examiner then notifies the claimant and the Final Adjudication  Branch (FAB) of the Recommended Decision. Claimants have 60 days  from the date the district office issues the Recommended Decision to  object and request a hearing.
The FAB reviews the Recommended Decision and the claimant’s  objections, if any, and reaches a Final Decision to accept or reverse the  Recommended Decision, or remand the claim to the district office for  further processing. If the claimant provides new evidence before a Final  Decision to deny the claim is issued, FAB may return the claim to the  district office for additional development or, if the new evidence warrants  reversal in favor of the claimant, FAB may issue a reversal. After the Final  Decision is issued, claimants can request reconsideration within 30 days  of the Final Decision, or a reopening of the claim at any time. For such  requests, DOL will consider the claimant’s reason for the request and  either accept or deny the request.
section_title: Site Exposure Matrices
paragraphs: DOL claims examiners determine workers’ eligibility for Part E  compensation in part by using a centralized database of information on  Energy facilities, toxic substances, and their related illnesses. Known as  the Site Exposure Matrices (SEM), the web-based database was  developed by DOL’s contractor to organize, display, and communicate  information on the toxic substances workers were potentially exposed to  at specific Energy sites, buildings at the sites, and during specific job  processes conducted in those buildings. It also cross-references the  toxins with diseases for which there is an established link. DOL officials  noted that although the creation of the SEM is not mandated, the agency  developed it partly as a tool to help claimants establish a link between a  facility and possible exposure to toxins. The SEM is continually updated  as new exposure data are obtained and is publicly available on the  Internet for anyone seeking this type of information.
Claims examiners will typically use SEM information during the  adjudication of a claim, while a public citizen can use it as a research tool.  Upon accessing the SEM, the claims examiner will retrieve relevant  information by entering search terms specific to the claim being  processed. For example, by entering the facility where the employee  worked, the examiner will generate a list of toxins known to have been at  the site. By entering the illness being claimed, the examiner will generate  a list of toxins known to be linked with that illness. Public users retrieve  SEM information in a similar fashion, and the information they obtain may  factor into their decision to file a claim for benefits under EEOICPA Part  E. However, a claimant need not obtain nor consider SEM information  before filing a claim.
section_title: DOL Generally Followed Its Procedures, but Was Deficient in Performing Some Steps When Preparing Correspondence and Developing Claims
paragraphs: Based on our review of a stratified random probability sample of 200  EEOICPA Part E claims filed from 2010 through 2014 by employees or  their survivors, we found DOL claims examiners generally followed  established adjudication procedures. Overall, we estimate that  approximately 90 percent of adjudicated claims were consistent with the  selected procedures we tested that are contained in DOL’s EEOICPA  Procedure Manual. The remaining estimated 10 percent of  adjudicated claims were inconsistent with at least one procedure, and the  nature of the inconsistency varied. While our sample may not  necessarily reflect the reasons for inconsistency across the entire  population of Part E claims, we found many examples of deficiencies in  DOL’s written correspondence to claimants. In other instances, we found  deficiencies in how the claim was developed. However, in the vast  majority of occurrences, the inconsistencies we identified in our sample  would likely not have affected adjudication outcomes because DOL  officials verified that most of the affected claims were accepted or denied  for reasons unrelated to the problems we found.
subsections: section_title: Deficiencies in Quality of Correspondence to Claimants
paragraphs: Our claim file review found that most of the inconsistency with the  Procedure Manual pertained to deficiencies in written correspondence to  claimants, such as in Recommended and Final Decision letters, and in  one instance, a letter requesting additional evidence. The Procedure  Manual explicitly states that claims examiners must ensure that written  decisions, in particular, are clear, concise, and well written, with language  that clearly communicates the necessary information. It specifically  cautions that a poorly written Recommended Decision increases the  likelihood that a claimant will not understand the outcome of the claim and  the probability of objection. Our sample identified letters to claimants that  included inaccurate, inconsistent, or incomplete information, though these  deficiencies may not necessarily be reflective of the general population of  claims.
Inaccurate information: Some written correspondence from DOL to  claimants, such as the letters accompanying the Recommended  Decision, contained factual errors, as illustrated by the following  examples:
For a claim that covered myocardial infarction, a heart condition,  DOL’s decision letter erroneously stated that the condition was  “hyperthyroidism,” a glandular condition.
One decision letter was dated incorrectly.
One letter requesting additional evidence listed the incorrect address  for the district office. This error resulted in the claimant mailing  evidence to the incorrect address, which we found led to processing  delays.
Inconsistent information: Some Recommended Decision letters to  claimants included inconsistent information within the same letter, or  contradicted other information sent to the claimant, such as the Final  Decision letter. Examples include:  In some parts of a Recommended Decision letter, the claimant’s  condition was correctly cited as “bladder cancer,” while in other places  it was incorrectly cited as “prostate cancer.”
One Recommended Decision letter initially stated there was a medical  diagnosis of the claimed condition, but later stated there was no  diagnosis.
Another Recommended Decision letter stated there was no diagnosis  for any of the seven conditions claimed, but the Final Decision letter  stated there was a diagnosis for four conditions. Moreover, the same  Final Decision letter stated, in a latter part of the letter, that there was  a diagnosis for six conditions.
In two instances, the claimant’s employment dates differed between  the Recommended and Final Decision letters sent to the claimant.  Further, dates listed on letters sent to claimants sometimes differed  from what the claims examiner entered into DOL’s electronic case  management system.
Incomplete information: We also found that some Recommended  Decision letters omitted the required notice to the claimant informing them  of their right to request a copy of the Contract Medical Consultant (CMC)  report if the Recommended Decision used the opinion of a CMC. More  specifically, we identified 47 claims in our sample in which a CMC report  was used to substantiate a Recommended Decision to deny the claim,  but of that group, 17 did not include the required notice. DOL officials  informed us that, subsequent to our file review, a July 2015 email from  DOL headquarters instructed district offices to automatically attach any  CMC, industrial hygienist, or toxicologist reports to Recommended  Decision letters for claims that were denied.
section_title: Deficiencies in Claims Development
paragraphs: In addition, our review revealed deficiencies associated with claims  development, which pertains to steps the claims examiner must take to  verify employment and medical condition, and establish causation. While  the deficiencies among claims in our sample may not reflect those within  the general population of Part E claims, we found examples of incorrect  or missing SEM searches, no evidence of a referral to a specialist, and  untimely response to claimant requests for reopening:  In a hearing loss claim, the claims examiner ran an incorrect SEM  search on “maintenance mechanic” although the claimant actually  worked as a maintenance supervisor.
In a claim for sarcoidosis, the Procedure Manual directs the claims  examiner to determine whether the claimant may have been exposed  to beryllium. However, we saw no evidence that a SEM search, or  other type of determination, had been performed.
In a Parkinsonism claim, the claims examiner was uncertain as to  whether that condition was linked to exposure to a certain toxin.  Established adjudication policy suggests claims be referred to an  industrial hygienist or toxicologist under these circumstances;  however, we saw no evidence that such a referral had been made.
A claim was denied for lack of causation but there was no evidence  that a request was made to the claimant or a physician asking for  more causation evidence.
Two claimants had requested reopening of their denied claim but the  district office had not responded to their request.
Upon their reexamination of the claims involved, DOL officials agreed  procedural inconsistencies had occurred and said they would flag certain  issues for additional review and for claims examiner training, such as  those related to development of sarcoidosis and hearing loss claims. For  the claim we determined should have been referred to an industrial  hygienist or toxicologist, DOL officials said the claim would be referred to  both in order to determine if it warrants reopening.
As part of our examination of claim files, we also found evidence that a  review of the file was often not performed. Under the Procedure Manual,  claims examiners are to route the Recommended Decision and case file  to the “appropriate signatory” for review, signature, date, and release. The  Procedure Manual does not, however, clarify who an “appropriate  signatory” is, or when such a review would be necessary. DOL officials  said there is no national policy on performing such reviews and that they  occur at the discretion of the district office. Officials added that the  decision is often based on the claims examiner’s level of experience,  meaning that claims adjudicated by senior claims examiners would not  typically undergo a review. We estimate that 50 percent of adjudicated  claims did not undergo this review. Reviews are one of DOL’s quality  controls, but their inconsistent application may increase the likelihood of  issues with the Recommended Decision, which in turn increases the  potential for claimant confusion and delays in adjudication.
Lastly, review by the Final Adjudication Branch (FAB), required after the  issuance of the Recommended Decision, also acts as a quality control to  help identify and correct any issues with adjudication. For example, we  estimate that FAB remands 1 percent of claims back to the district office  due to development errors, including incorrectly performed SEM  searches. However, it is notable that while FAB’s role includes  identifying and correcting procedural errors, it had not detected the  several instances of procedural inconsistency we had identified during our  review. As a result, none of the deficiencies we identified during our claim  file review had led to the claim being remanded and corrected.
section_title: DOL Consistently Captures New Linkages Between Toxins and Illnesses, but Lack of Documentation Hinders Monitoring of their Application to Claims
subsections: section_title: DOL Uses the SEM to Document New Linkages
paragraphs: DOL continuously captures new links between toxic substances and  illnesses as they are identified and documents them in the SEM. New  links are primarily drawn from a database of hazardous toxins and  associated diseases—known as Haz-Map—maintained by the National  Library of Medicine. According to DOL officials, as new links are added  to Haz-Map, they are also added to the SEM for claims examiners’ use,  and added to the public SEM on the Internet about every 6 months. In  general, the SEM contains only causal links that are based on  epidemiological studies, and for which there is consensus within the  medical and scientific communities. In addition, on its public SEM  website, DOL encourages the public to submit site- or disease-related  information to be considered for inclusion in the SEM. According to DOL  officials, to determine whether publicly submitted information should be  added, DOL relies on two individuals: a toxicologist it employs and the  National Library of Medicine’s physician responsible for updating Haz- Map. Both monitor ongoing research on toxin-illness causation. Users can  check the public SEM website for the status of proposed submissions to  see if they have been accepted for inclusion in the SEM.
According to DOL officials, the amount of information contained in the  SEM has dramatically increased since 2006 when it became available to  claims examiners for adjudication purposes. For example, they estimated  that from 2006 to 2015, the number of links between toxins and illnesses  has increased from around 300 to over 3,000. Officials said the SEM  represents the largest collection of information ever assembled by a  government entity for the purpose of assessing occupational hazards at  nuclear weapons facilities, both current and past.
Despite its scope, the SEM has come under scrutiny from claimant  advocacy groups and the Ombudsman for the Energy Employees  Occupational Illness Compensation Program, both of whom expressed  concerns about its accuracy and completeness. DOL officials said that  the complex nature of the information associated with the SEM makes it  challenging to ensure absolute completeness, due in part to lack of  consensus about whether there is a link between a specific substance  and an illness. Further, in response to a request by DOL to evaluate the  scientific rigor of the SEM, the Institute of Medicine published a 2013  report that also questioned the SEM’s completeness. The report noted  several examples of potential causal linkages missing from the SEM.  Further, it questioned the SEM’s exclusive dependence on Haz-Map as  its source for disease and causal link information, and suggested other  sources be considered, such as the U.S. Department of Health and  Human Services and the World Health Organization. During our  interviews, DOL officials said the SEM is therefore not complete, and the  agency states this on the SEM website.
DOL officials said they have taken several steps over recent years,  largely in response to the recommendations of an external and internal  review, to improve the SEM’s content and usefulness. These include  continuous updates and refinements to the information contained in the  SEM and increasing functionality, such as enhancing the user’s ability to  filter search results according to certain terms. They also highlighted  several efforts to engage the general public, including increasing the  public’s access to the SEM, publishing SEM resource documentation, and  responding to individuals who submit suggestions for new causal links or  other information. In addition, a law was enacted in December 2014  requiring the establishment of an advisory board to, among other things,  advise the Secretary of Labor on the SEM. According to DOL officials,  the agency has appointed a Designated Federal Officer, hired staff and a  contractor to help support the board’s work, and is in the process of  recommending board members representing the scientific, medical, and  claimant communities. DOL estimates that the board’s membership will  be in place in early 2016.
section_title: Latest Linkages Must Be Applied during Adjudication but Lack of Documentation of This Step Hinders Monitoring
paragraphs: DOL provides limited notification to claims examiners and the public  regarding new links between toxic substances and illnesses due to the  large volume of information being continuously added to the SEM,  according to officials. Therefore, it is usually incumbent upon claims  examiners and the public to make themselves aware of new links. DOL  officials said claims examiners typically become aware of new links when  they check the SEM as part of the adjudication of an individual claim.  Since each claim necessitates tailored searches of the SEM based on the  specific facility, toxic substances, and illnesses associated with the  particular claim, the claims examiner will learn of a new link if it is relevant  to that claim during adjudication.
DOL also conveys information on some new links through notices issued  to claims examiners and posted on its public website. From fiscal years  2006 through 2015, DOL issued six Circulars and four Bulletins pertaining  to new links. Five of these notices announced plans to reopen claims  thought to be potentially affected by the information contained in the  notice. For example, Circular 15-04, issued in fiscal year 2015, informed  claims examiners that the substance trichloroethylene had been linked to  kidney cancer and that Haz-Map had been updated to reflect this new  link. The circular also announced that DOL had compiled a list of  previously denied Part E kidney cancer claims and instructed claims  examiners on the reopening of those claims for reevaluation in light of the  new link. DOL officials told us that such steps are limited to instances in  which it is believed a relatively large number of claims are potentially  affected.
Other than these notices, claims examiners typically learn of a new link  and apply it to adjudication to the extent they check the SEM for updates.  However, if the SEM is not searched regularly for the latest information on  new links, claims examiners could be rendering decisions using outdated  information. For that reason, DOL’s Procedure Manual instructs claims  examiners to check the SEM for any updates just prior to issuing a  Recommended Decision to deny a claim, however, documentation of that  step is not always required. According to the Procedure Manual, the SEM  will show the latest date it was updated. If that date has changed since  the prior search was conducted, the claims examiner must search the  SEM again and document the results of the query. On the other hand, if  that date is unchanged since the original search was conducted, the  claims examiner will know that no new information was added to the SEM  and, consequently, no new search is required. However, examiners are  not required to document this latter check in which they determined that  no new information was added to the SEM that might affect adjudication.  The absence of such documentation impedes the ability to effectively  monitor whether this critical step is carried out. Since effective internal  controls require monitoring be conducted to assess the quality of program  performance, the need for such documentation is essential. Our file  review showed evidence of some claims in which the claims examiner  clearly documented an updated SEM search just prior to issuing the  Recommended Decision, but we could not assess the full extent to which  claims examiners followed this final step due to the lack of  documentation. In addition, DOL officials said that independent SEM  searches required to be performed by FAB also serve as a check of those  performed by district office claims examiners. As with district offices, FAB  must also ensure the SEM record is the most complete and updated data  available, and that no significant changes have been made before FAB  issues its decision on the claim. Unlike district offices, if an updated SEM  search is not needed, FAB makes an entry in the electronic case  management system to indicate that no significant changes have been  made in the SEM that would alter the Recommended Decision.
Similarly, claimants must usually rely on repeatedly checking the SEM to  learn of any newly added causal links. The online SEM available to the  public is identical to the one claims examiners use when adjudicating  claims, differentiated only by a time lag of around 6 months, according to  DOL officials. This lag is primarily because Energy needs to review and  approve all SEM information before it is made public. New public versions  of the SEM are announced online, but details accompanying the specific  updates are limited. In its 2013 report on the SEM, the Institute of  Medicine noted that although a SEM record indicates when it was last  updated, there is no indication as to what specific information or field was  updated. The report added that this lack of information makes it  extremely difficult for the user to know if the most current information has  been incorporated. For example, the public SEM version dated May 18,  2015, was accompanied by a notice on the SEM website that data for 29  worksites had changed since the previous update, although details were  displayed for only two of the sites. Moreover, it was not possible to  determine whether any new causal links had been added because this  information was not contained in the notice. Absent a check of the SEM  for specific illnesses or toxic substances, claimants could remain unaware  that a new link had been added that may warrant the reopening of their  claim. This could be a significant issue given that claimants are  authorized to request the reopening of a previously denied claim.
section_title: DOL’s Monitoring Has Identified Some Ongoing Concerns With Claims Adjudication
subsections: section_title: DOL Continuously Monitors the Adjudication Process
paragraphs: In general, DOL’s monitoring from fiscal years 2010 through 2014 of how  well EEOICPA Part E claims are adjudicated concluded that the process  is working satisfactorily and meeting DOL’s established acceptability  standards. However, there were also some areas of concern that were  consistent with those we identified during our review. DOL has monitored  the adjudication of EEOICPA Part E claims primarily using its annual  Accountability Reviews. In 2015, it also reviewed referrals to CMC and  Second Opinion Medical Specialists, which focused on the use of  physician opinions during the adjudication process to assist in the  resolution of claims, and deemed both referral processes satisfactory.
subsections: section_title: Annual Accountability Reviews
paragraphs: DOL conducts Accountability Reviews annually to evaluate its  performance in processing and adjudicating EEOICPA claims under Parts  B and E. According to DOL, the objective of the reviews is to provide  management with an effective means to evaluate program performance  and consider corrective action both program-wide and in individual district  offices. Each year, DOL typically reviews five entities: two selected district  offices, the two corresponding FABs co-located in these offices, and the  national FAB in Washington, D.C. The claims subject to review are  randomly selected from all claims adjudicated by these entities during the  review period, generally a period of 365 days prior to the date of the  review. The Accountability Reviews encompass the entire claims  process, from the time a claim is filed to when benefits are paid. For  example, in addition to claims adjudication, the reviews also look at data  entry accuracy, post-decision actions, calculation of benefits, and  payment processing. (See appendix II for additional information on the  specific areas of focus for the Accountability Reviews for fiscal years  2010 through 2014.)
While some aspects of adjudication are examined each year, each year’s  review is also targeted to assess areas of the claims process in which  there may be deficiencies based on input from policy personnel from the  national office, district office and FAB representatives, and other DOL  stakeholders. DOL officials told us that focusing on different areas from  year to year allows the reviews to be targeted to areas needing attention  while avoiding re-evaluation of areas that have already shown  improvement. Shifting the focus also helps minimize the predictability of  the review questions, though it precludes the ability to track trends over  time. In addition, the sample size of claims in DOL’s review has also  varied from year to year depending on the area of emphasis for that year.  Because of the changing areas of focus and sample sizes, it was difficult  for us to determine whether the percentage of errors has increased or  decreased over time and, therefore, we did not make comparisons across  years.
Although DOL’s monitoring concluded that the claims adjudication  process was generally working satisfactorily, DOL identified some  recurring deficiencies among the elements it reviewed each year.  However, many of these recurring deficiencies were deemed by DOL to  be significant only for the Accountability Reviews conducted in fiscal  years 2010 to 2012. The recurring deficiencies identified in all the  Accountability Reviews were primarily in three components of the  adjudication process: claims development, written quality of the  Recommended Decision letter, and written quality of the Final Decision  letter.
With regard to claims development, DOL found:  Instances in which the claims examiner did not undertake full  development of claimed employment, medical condition, and  survivorship. For example, the examiner did not use all available  resources to develop the claim, such as requesting additional  information or clarification from claimants, former employers, the  Social Security Administration, and other appropriate sources to help  substantiate the claim.
Development letters requesting additional information from claimants  were not clear about the evidence needed. In some cases, the letters  were lengthy and confusing or very broad, requesting a copy of all  medical records.
Lack of sufficient use of appropriate program resources to determine  causation, such as referring the case to appropriate experts,  requesting additional information from claimants, and properly using  the SEM.
With regard to the Recommended Decision letter to claimants, DOL  found:
Many cover letters did not properly summarize medical conditions that  were accepted or denied. This includes missing or incorrect accepted  or denied conditions. For example, in one year both district offices  reviewed had errors in over 60 percent of the Recommended Decision  cover letters which were examined.
Various other sections of the decision letter contained errors,  inconsistencies, conflicting information, or excluded relevant  information. For example, some letters contained incorrect identifying  information, such as the claimant’s name, address, filing dates, and  claimed medical condition. Other letters contained contradictory  statements in different sections of the letter regarding what was being  accepted and denied, or even the decision itself, or did not address all  medical conditions, or explain how the evidence was evaluated to  arrive at the decision.
For correspondence that communicated the Final Decision, DOL’s  reviews of FAB found:  Instances in which FAB did not summarize what conditions were  being accepted or denied under Parts B or E in the cover letter.
Various sections of the decision letter contained errors, conflicting  information, or excluded relevant information. For example, one  claimant provided a diagnosis for chronic bronchitis but the letter  noted the diagnosis was insufficient to support the claimed condition  without explaining why. Moreover, a subsequent section of the same  letter stated that there was no diagnosis.
section_title: Audit of Referrals to Consulting and Second Opinion Physicians
paragraphs: In 2015, DOL completed an audit to assess the quality of the process  used by claims examiners to make referrals to certain physicians—CMCs  and Second Opinion Medical Specialists. In making these referrals, DOL  procedures noted that claims examiners are responsible for ensuring that  all the necessary components of a referral are prepared accurately, the  content of the referral is appropriate and specific to the issue under  determination, and sufficient factual documentation is prepared so that  the physician clearly understands the medical questions to be addressed.  Furthermore, the procedures noted the referral should include a  Statement of Accepted Facts, which summarizes the facts of the claim,  such as the accepted medical conditions and potential toxic substance  exposure encountered by the employee.
DOL’s audit was designed to assess two main elements of the referral  process:
Quality of district office inputs: This element assessed the  appropriateness of the claims examiner’s referral, the quality and  completeness of the Statement of Accepted Facts, and the  appropriateness of the questions posed by the claims examiner.
Quality of the medical review and opinion: This element evaluated  whether the physician’s written medical report was complete and  appropriate, and assessed whether a physician’s response was well- rationalized and consistent with the totality of the evidence in the  case.
With respect to CMC referrals, DOL concluded that the process was  working satisfactorily and did not require a formal corrective action plan.  However, DOL did identify four specific areas for improvement:
More effort is needed to better interact with the claimant’s physician  before proceeding with a CMC referral. Under DOL policy, the claims  examiner is to seek the input of a treating physician before deciding to  make a referral to a CMC. The audit uncovered instances in which  CMC referrals were made without first properly interacting with the  treating physician.
Claims examiners need to undertake more development of exposure  data to offer better explanations of the nature, extent, and duration of  exposure in their referrals for causation. According to DOL, providing  CMCs with better information on exposure will produce more  probative and compelling medical causation outcomes.
Claims examiners need further guidance on making proper referrals.
There must be an “obvious defect” in case evidence to necessitate  obtaining a medical opinion. According to DOL, when medical  evidence clearly contains a diagnosis of a medical condition, for  example, a CMC referral for diagnosis is unnecessary.
Claims examiners need to evaluate the rationale presented by the  CMC to ensure that it presents a clear, compelling, and medically  substantiated position. According to DOL, a medical opinion based on  a poorly justified medical analysis of the relevant evidence reduces  the probative value of the opinion and reduces the likelihood that the  program will be able to use the opinion.
With respect to referrals to Second Opinion Medical Specialists, DOL  concluded that its process was also working satisfactorily. However, it  recommended that these physicians be provided better guidance from the  district office regarding the format of the specialist’s written medical report  and rationale for their conclusion. DOL’s audit report also noted that  because the Second Opinion physician’s report affects the outcome of a  claim, it necessitates a more concise response with reasonable  explanation of their rationale.
section_title: DOL has Taken Steps to Address Deficiencies but Some Persist
paragraphs: DOL took steps to address the significant deficiencies identified in the  Accountability Reviews from fiscal years 2010 through 2012, but  determined that deficiencies in 2013 and 2014 were not significant  enough to warrant corrective action. However, our review of DOL’s  monitoring indicates that the deficiencies have persisted nonetheless.
To address the significant deficiencies found in Accountability Reviews  conducted in years 2010 through 2012, DOL’s corrective actions included  providing office-wide training to claims staff on (1) properly written  development letters, Recommended Decisions, and Final Decisions; (2)  claims development and the use of appropriate resources in establishing  exposure and causation; and (3) the need to clearly explain to claimants  what evidence is needed to adjudicate their claim. Despite the additional  training for claims examiners, these deficiencies have persisted. For  example, in the Accountability Reviews conducted in fiscal years 2013  and 2014, DOL found similar problems with the quality of  correspondences sent to claimants. DOL officials stated that because  these problems did not reflect specific trends, they did not require a  corrective action plan. Nonetheless, according to DOL, the managers of  the district and FAB offices followed up on specific errors to ensure that  training or other actions were taken as appropriate.
DOL officials acknowledged that parts of the adjudication process remain  challenging. According to officials, it is particularly challenging to establish  toxic substance exposure and determine causation, which involves  establishing a causal link between the claimed medical conditions and a  known exposure to a toxic substance. Verifying employment is also  difficult, partly because of the need to retrieve employment records from  as far back as the early 1940s. Officials also said that errors or other  issues with correspondences still occur, including listing the wrong  medical condition in the decision cover letter. They added that while this  is usually due to carelessness on the part of the claims examiner and  typically has no impact on the decisions, officials acknowledged that  deficiencies in any correspondence to the claimant may affect customer  service as well as claimants’ overall impression of the program.
section_title: Conclusions
paragraphs: EEOICPA was enacted to compensate workers who carried out the  nation’s nuclear weapons production. These workers were often unaware  of the extreme personal hazards they faced while serving their nation and  many became fully aware only when they were later stricken by illness. In  light of this, it is imperative their claims for compensation be given the due  attention and care they deserve. Though we found DOL’s EEOICPA Part  E adjudication process was generally consistent with the steps outlined in  its procedure manual, we identified the need for improvements in two  areas, one of which DOL also identified through its own monitoring. First,  all decisions are to be clearly written, but without additional actions to  help identify and correct mistakes within claimant correspondence, such  problems may persist and claimants may experience confusion or  processing delays. Second, although claims examiners are required to  check the SEM for updates just prior to issuing a Recommended Decision  to deny a claim, they are only required to document this step if the check  reveals that the SEM had been updated since the examiner’s last check.  This gap in required documentation hinders the ability to monitor,  consistent with federal internal control standards, whether claims  examiners are performing a final check of the SEM to ensure that their  decisions are based on the most up-to-date information. Given the  importance of this program, which serves so many who sacrificed for their  nation, it is vital that DOL has controls in place to help ensure that  compensation claims for workers and their survivors are being handled  correctly.
section_title: Recommendations for Executive Action
paragraphs: To enhance consistency with DOL policy and procedures in adjudicating  EEOICPA Part E claims, we recommend that the Secretary of Labor  strengthen internal controls by:
Requiring district offices to take steps to ensure that all claimant  correspondence for Recommended and Final Decisions receives  supervisory review;
Requiring district offices to document that the SEM was checked for  updates just prior to issuing a Recommended Decision to deny a  claim in cases in which the date of the last SEM update has not  changed since the claims examiner’s prior check.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to the Secretary of Labor for review and  comment. DOL’s comments are reproduced in full in appendix III. DOL  also provided technical comments, which we have incorporated as  appropriate.
In its comments, DOL agreed with our recommendations and said that  they will ultimately allow the agency to better fulfill its mission of making  timely, appropriate, and accurate claims decisions. With regard to our  recommendation to ensure all decisions receive supervisory review, DOL  stated it will evaluate the current signatory process, work with its district  offices to implement a second level review, and conduct an internal  review following implementation. With regard to our recommendation to  document that the SEM was checked for updates before issuing a  decision to deny a claim, DOL stated it plans to implement this  recommendation and will assess its options for capturing and  documenting the final SEM search, such as in its electronic case  management or its digital imaging system.
In addition, the report will be available at no charge on the GAO website  at http://www.gao.gov.
If you or your staff have any questions about this report, please contact  me at (202) 512-7215 or sherrilla@gao.gov. Contact points for our Offices  of Congressional Relations and Public Affairs may be found on the last  page of this report. GAO staff who made key contributions to this report  are listed in appendix IV.
section_title: Appendix I: Objective, Scope, and Methodology
paragraphs: To assess the extent to which the Department of Labor (DOL) follows its  adjudication procedures for Part E claims, we examined a stratified,  random sample of 200 claims, which is generalizable to all Part E claims  in our sampling universe. We derived our sampling universe from Energy  Employees Occupational Illness Compensation Program (EEOICP) data  contained in DOL’s electronic case management system. The data were  the most recent available at the time we selected our sampling universe  in March 2015. On the basis of our analysis of these data, and through  discussions with DOL, we determined this data source was sufficiently  reliable for the purposes of identifying a sampling universe.
Our sampling universe consisted of 15,932 Part E claims filed within 5  calendar years, between 2010 and 2014. Because we wanted to  determine if DOL processes Part E claims in accordance with key aspects  of its adjudication procedures, we excluded certain types of claims that  would not allow us to review all steps. Specifically, we excluded claims  that were still in process and for which a Final Decision had not yet been  issued. We also excluded claims that had already been accepted under  Part B, since such claims are automatically accepted under Part E.  Similarly, we excluded “Special Exposure Cohort” claims, which are  associated with certain designated facility locations and do not undergo  typical adjudication. Because the Part E sampling universe is based on  recent calendar years and included only claims that received a Final  Decision, the selected sample may exclude a greater number of claims  from more current years and claims that take longer to adjudicate.
From our sampling universe, we randomly selected 200 claims. These  200 claims were selected separately within each of two major groups.  One major group contained all claims associated with three selected  medical conditions—hearing loss, chronic beryllium disease, and  Parkinson’s disease—defining three substrata, and the second group  contained the remaining universe of claims not associated with these  three medical conditions. We selected the three particular medical  conditions for the first group based on document reviews and interviews  with DOL officials. We determined that although such claims comprise a  relatively small portion of the sampling universe (about 9 percent), they  are potentially more challenging to adjudicate. Due to the possible  unique nature of claims associated with these three medical conditions,  and to ensure our file review included each of these claim types, we  further divided the first group into three separate sub-strata, one for each  specific medical condition (i.e. hearing loss, chronic beryllium disease,  and Parkinson’s disease), and then randomly selected claims for review  within each sub-stratum. We allocated the sample of 100 claims across  these three sub-strata according to their relative frequency. Combining  this sub-sample of claims with selected medical conditions with the  sample of general claims allowed us to address our objectives in a  manner that maximized return on limited resources while still allowing for  an independent and objective analysis of the entire universe of claims  that met our selection criteria.
Table 1 shows the breakdown of our stratified random sample. The way  we selected our sample size for claims associated with specific medical  conditions increased the likelihood of encountering these types of claims  during our review (known as oversampling). However, we used sampling  weights to ensure that our sample of 200 claims properly reflected the  sampling universe.
Our sample of claims reflected a variety of characteristics. For example,  approximately two-thirds of the claims (68 percent) were employee  claims, with the remaining third being survivor claims. Just under one-half  (48 percent) of the claimants had applied for benefits for one medical  condition and the rest (51 percent) had applied for benefits for multiple  conditions. In fact, nearly a third (32 percent) of the claims were for three  or more conditions. Across all 200 claims, the number of conditions being  claimed totaled 427. In addition to the claims that were associated with  the three specific medical conditions we selected, the sample contained  claims for a wide variety of medical conditions, including cancer (21  percent of all conditions), chronic obstructive pulmonary disease (6  percent), and asthma (4 percent).
Based on the results of our file review and the use of a weighted sample,  we were able to provide generalizable results for our sampling universe of  Part E claims. We were also able to provide generalizable results within  the two major groups—claims based on selected medical conditions and  claims based on all other conditions—as well as make generalizable  comparisons between the two groups. Due to relatively small sub-strata  sizes within select medical conditions, we cannot generalize results for  claims involving any of the selected medical conditions—hearing loss,  chronic beryllium disease, or Parkinson’s disease.
Because we used a probability procedure based on random selections,  our sample is only one of a large number of samples that we might have  drawn. Since each sample could have provided different estimates, we  express our confidence in the precision of our particular samples as a 95  percent confidence interval.
For each claim in our sample, we reviewed the case file materials and  documented whether the claims examiners followed DOL’s EEOICPA  Part E claim adjudication procedures from development to the  Recommended and Final Decisions. We reviewed claim files at all four  DOL district offices. Each office gave us access to the claim files in our  sample that had been adjudicated at that district office. Most of the  claims were in paper form, a few recent claims had been scanned into  electronic format, and some were a combination of paper and electronic  formats. To document our review, we developed and used an electronic  data collection instrument (DCI) that consisted of questions on the many  individual claim development steps outlined in DOL’s current Procedure  Manual. We evaluated older claims based on the policies and procedures  that were in effect at that time. Our review focused only on procedural  steps required by the Procedure Manual and we did not attempt to  evaluate the accuracy of the Recommended or Final Decisions, or the  scientific and medical judgements used to support them. For each  adjudication step noted in the DCI, the reviewer documented whether and  how the step was taken and each reviewer’s DCI responses were  checked and verified by another reviewer. Upon analyzing our DCI data,  we developed a list of 44 claims that we flagged as being potentially  inconsistent. DOL reviewed our list and agreed with our findings for many  claims. DOL also provided an explanation or clarification regarding other  claims that justified their removal from the list. As a result of this  verification step, we removed 11 claims from our list, leaving 33 that we  deemed inconsistent.
To determine how new links between toxic substances and diseases are  captured and applied in the adjudication process, we reviewed  adjudication guidance, including DOL’s EEOICPA Procedure Manual,  Circulars, and Bulletins. In all, we reviewed 80 Circulars and 147 Bulletins  and determined their relevance to our objective using two criteria: 1)  those that pertained to the development and adjudication of Part E  claims, and 2) those that provided guidance related to new links between  toxic substances or radiological exposure, and diseases, or that provided  guidance on whether the facility was covered under EEOICPA Part E.
In addition, we interviewed DOL officials and SEM contractor staff to  obtain an understanding about how the SEM was created, what it  contains, and DOL’s process for incorporating newly identified links into  the SEM and making the information available to claims examiners and  the public. We also asked about how the SEM has changed over time  and what efforts DOL has taken to improve the database. We reviewed  relevant reports, including past EEOICP Ombudsman’s reports, a report  from the Institute of Medicine, and reports from advocacy groups.
To understand what DOL’s monitoring efforts indicated about the Part E  adjudication process, we reviewed findings from DOL’s annual  Accountability Reviews and other audits. Specifically, we reviewed DOL’s  Accountability Review results from 2010 through 2014—corresponding to  the 5 calendar years of our file review—and focused on the procedures  that were within our scope. The procedures encompassed the steps  involved in claim development, adjudication, the Recommended Decision,  and Final Decision. We reviewed the procedure manual issued by the  Office of Workers’ Compensation Programs for planning and conducting  Accountability Reviews, as well as handbooks, manuals, and worksheets  developed by its Division of Energy Employees Occupational Illness  Compensation (DEEOIC) that are specific to EEOICPA Accountability  Reviews. We also reviewed the Office of Workers’ Compensation  Programs Accountability Review Procedure Manual to obtain an  understanding of DOL’s methodology for sample selection, accountability  review team selection, and reporting methods. We reviewed the DEEOIC  handbooks and other guidance to identify the areas of focus for each  year’s review, the specific questions used for each review, and scoring  criteria. We also reviewed DOL’s Contractor Medical Consultant and  Second Opinion Medical Specialist referral audit completed in 2015 to  obtain an understanding of the procedures examined during this audit and  its results.
Throughout the course of our work we compared the steps taken during  DOL’s adjudication of Part E claims against federal standards for internal  control.
In addition, we reviewed available corrective action plans and interviewed  agency officials to learn more about their monitoring of EEOICPA Part E  and the corrective actions taken resulting from the findings. Our  interviews specifically focused on the methodologies DOL used to  conduct its monitoring. We also asked for information on the specific  corrective actions DOL has taken to address program deficiencies  identified during these internal audits. Finally, we reviewed applicable  federal laws and regulations.
We conducted this performance audit from May 2014 through February  2016 in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
section_title: Appendix II: Categories and Elements Used by the Department of Labor to Conduct Accountability Reviews of the Energy Employees Occupational Illness Compensation Program for Fiscal Years 2010 through 2014
paragraphs: Basic Development (including Part E*)  and Part B Causation Development  Part E Causation Development*  Impairment Development
Wage Loss Development  and Written Quality)
Part E Causation* (Development and  Causation Assessment)
Recommended Decision* (Outcome
Decision Outcome Notification*
Claim Assessment and Narrative  Explanation*  Factual Findings of the Claim*  and Written Quality)
Development and Wage Loss  Reopening Requests*  (This category applicable only in FY 2013)
subsections: section_title: FINAL ADJUDICATION BRANCH (FAB) 2010 & 2011 Post Recommended Decision Objections
section_title: Appendix III: Comments from the Department of Labor
section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Meeta Engle (Assistant Director),  Susan Chin, Karen Granberg, David Perkins, Cody Raysinger, Walter  Vance, and Sonya Vartivarian made significant contributions to this  report. Also contributing to this report were Lucas Alvarez, Susan Baker,  Marcia Crosse, Jennifer Cook, Holly Dye, Alexander Galuten, Kathy  Leslie, Diane Lofaro, Mimi Nguyen, and Minette Richardson.
section_title: Related GAO Products
paragraphs: Energy Employees Compensation: Additional Independent Oversight and  Transparency Would Improve Program’s Credibility. GAO-10-302.  Washington, D.C.: March 22, 2010.
Energy Employees Compensation: Actions to Promote Contract  Oversight, Transparency of Labor’s Involvement, and Independence of  Advisory Board Could Strengthen Program. GAO-08-4. Washington,  D.C.: Oct. 26, 2007.
Energy Employees Compensation: Adjustments Made to Contracted  Review Process, but Additional Oversight and Planning Would Aid the  Advisory Board in Meeting Its Statutory Responsibilities. GAO-06-177.  Washington, D.C.: Feb. 10, 2006.
Energy Employees Compensation: GAO’s Prior Work Has Identified  Needed Improvements in Various Aspects of the Program. GAO-07-233T.  Washington, D.C.: Dec. 5, 2006.