E-700 Eligibility Requirements for Certain Uranium Workers

1. Purpose and Scope. This chapter describes the policies and procedures for processing Part E claims involving uranium miners, millers, and ore transporters who worked at facilities covered by Section 5 of the Radiation Exposure Compensation Act (RECA) and, where applicable, the survivors of such employees. With the exception of specific guidance set out under this chapter, development and adjudication of Section 5 RECA claims will be conducted as set out under EEOICPA PM 2-900 as revised by EEOICPA Transmittal 04-06 (September 2004).

2. Identifying a Section 5 RECA Uranium Worker. As with claims submitted under Part B, the CE can identify a Part E claim submitted by a Section 5 RECA uranium worker, or an eligible surviving beneficiary of such uranium worker, by reviewing the information provided on the EE-1 or EE-2. If the claimant has indicated on the EE-1 or EE-2 that the employee was a uranium worker, or that a Section 5 RECA award has been approved, the claim is to be developed in accordance with EEOICPA PM 2-900 and the guidance set out under this chapter.

a. The Department of Justice (DOJ) has Determined that the Claimant is a Covered Uranium Employee. DOJ has determined that the uranium worker or his or her survivor is entitled to payment of $100,000 as compensation due under Section 5 of RECA for a claim made under that statute and has issued a Section 5 RECA award. Receipt of payment is not required.

(1) Proof of Survivorship Eligibility Required. RECA Section 5 survivors of award recipients or who are award recipients in their own right are approved for benefits under Part B of the EEOICPA. However, such acceptance under Part B does not automatically translate to an acceptance under Part E. Survivors of Section 5 RECA award recipients or survivors who are award recipients in their own right must submit the requisite documents to establish survivorship eligibility under Part E. Please see E-600 (Establishing Survivorship) to this Part for further guidance, as all Part E survivorship rules apply to RECA survivors as well. The CE develops all necessary requirements to establish survivorship eligibility as it is defined under Part E of the EEOICPA.

(2) Awarded Illness. The illness awarded under RECA by DOJ must also be awarded under the EEOICPA. In cases involving deceased uranium workers, the awarded illness must be found to have caused, contributed to, or aggravated his or her death in order for the eligible survivor to be awarded monetary compensation.

b. Employment Criteria for Defining Part E RECA Section 5Uranium Workers. A RECA Section 5 uranium worker is an individual who was employed in a uranium mine or mill located in Colorado, New Mexico, Arizona, Wyoming, South Dakota, Washington, Utah, Idaho, North Dakota, Oregon or Texas (covered states) at any time during the period from January 1, 1942 through December 31, 1971 (covered time period), or was employed in the transport of uranium ore or vanadium-uranium ore from such a mine or mill during that same period. Employment will be verified as set out below. In general, only one day of employment is required, but additional employment may be necessary to satisfy certain causation criteria regarding exposure as outlined in the Evidentiary Requirements for Causation chapter to this Part.

(1) Uranium Miners. Individuals who were employed in aboveground or underground uranium mines located in the covered states during the covered time period.

(2) Uranium Mill Workers. Individuals employed in uranium mills located in the covered states during the covered time period.

(3) Uranium Ore Transporters. Individuals employed in the transport of uranium ore or vanadium-uranium ore from mines or mills located in the covered states during the covered time period.

(a) Establishing Exposure. The CE assesses exposure for a uranium ore transporter based upon that individual’s confirmed presence at a uranium mine or mill. Claimed exposure in transit will not be considered when conducting a causation analysis. Only the time in which an ore transporter is actually present at a mine or mill will be counted as covered employment.

3. Communicating with DOJ. Communication with DOJ is a key component to the development and adjudication of claims submitted by Section 5 RECA uranium workers and their survivors. Exhibit 1 to this chapter provides an example of the letter generated by the CE to DOJ requesting responses and in certain instances evidence.

a. Letter to DOJ. Once a Section 5 RECA claim is identified, the CE prepares the letter to DOJ (Exhibit 1) requesting information concerning whether the claimant either received an award or filed a claim under Section 5 of the RECA. As discussed below, no further information is required of DOJ if a Section 5 RECA award has been approved. If a Section 5 RECA claim is pending, the letter requests that DOJ send a letter verifying employment. If the Section 5 award is denied, the letter requests the following: a) if denied for employment, a copy of DOJ’s decision and all employment and exposure evidence available to DOJ; b) if denied for any other reason, the letter requests that DOJ send the employment verification letter. If no Section 5 RECA claim exists, the letter requests that DOJ send the employment verification letter. Upon receipt of any and all requested documentation from DOJ, the CE can request whatever additional evidence deemed necessary for development at a later date via follow up email communication with DOJ pursuant to present procedures. The CE attaches a copy of the EE-1 or EE-2 to the letter in all instances. The EE-1 or EE-2 signed by the claimant serves as a Privacy Act waiver allowing DOJ to release information to DOL regarding specific individuals.

b. Ineligible Survivors. In the case where the claimant(s) is clearly ineligible under Part E (adult child), no letter is generated to DOJ. No further development is required, as the case is in posture for denial based upon the survivorship issue.

4. Verifying Employment. DOJ administers the RECA and maintains detailed employment and exposure data for use in verifying employment. As noted above, the letter to DOJ requests verification of the uranium worker’s employment and verification that the mine or mill claimed as the place of covered employment was in operation during the period of claimed employment. See ECMS section below for guidance on coding.

a. DOJ Employment Verification. Upon receipt of the notification letter that DEEOIC has received a RECA claim, DOJ searches its employment and exposure records in an attempt to provide DOL with an opinion as to whether the employee at a uranium mine or mill, or a uranium ore transporter, meets the definition of a covered uranium worker under 20 C.F.R. § 30.230. DOJ issues a factual statement regarding employment and informs DOL of its findings. This factual statement is conveyed in the form of a letter from DOJ to DOL that serves to either confirm or deny the existence of covered employment.

(1) Employment Verified. In instances where employment is verified by DOJ, or a Section 5 RECA award is confirmed, the CE accepts this as proof establishing covered employment under the EEOICPA. Once employment verification is received the CE proceeds to develop the medical and exposure aspects of the claim for a causation determination.

(2) Employment Not Verified. In cases where DOJ has denied a Section 5 award based upon employment, DOJ provides the CE with all evidence at its disposal that was used to determine that employment could not be verified. In instances where DOJ denies a Section 5 RECA claim because employment can not be verified, or where no Section 5 RECA claim exists, the CE must independently develop employment pursuant to the steps outlined in the Employment Verification chapter of this Part.

(a). Reasons for Failure to Verify. DOJ can not verify employment if no record of employment exists or if claimed employment at a certain mine or mill falls outside of the period in which the mine or mill was in operation or outside of the EEOICPA covered time period. In such instances, the CE conducts further development and obtains additional evidence where available in an attempt to verify employment.

5. Development Steps. The CE must evaluate the status of the Part B and Part E claims in order to proceed with further adjudication. In all cases where employment verification is required, the CE proceeds under the guidance set out above.

a. Confirmation of Section 5 RECA Award. The first step a CE takes when adjudicating a RECA Section 5 claim is to determine whether or not the employee/claimant filed for or received a Section 5 RECA award. This is accomplished by the letter generated to DOJ requesting information.

(1) DOJ Approves the Section 5 Award. DOJ advises DOL of Section 5 RECA awards in writing. Once the CE receives confirmation of the award, a Part B acceptance is in posture as outlined in EEOICPA PM 2-900. In all instances other than awards involving survivors, an acceptance under Part B will correlate to an acceptance under Part E and the CE can prepare a recommended decision to accept the claim for benefits under the Act and proceed with whatever other development that is required (i.e. impairment and wage loss, if claimed).

(2) DOJ Award Adjudication Pending. If a Section 5 RECA claim is filed with DOJ and pending DOJ adjudication, DOJ provides DOL with the factual statement of employment as indicated above. The CE proceeds to develop for benefits under Part E. The factual record of employment suffices to verify employment. DOJ employment evidence of file is only requested if a denial based upon DOJ employment requirements is issued prior to DO adjudication as outlined below.

(a) In Posture for Denial. If after complete development, the CE determines that the case is in posture for denial, no recommended decision denying benefits is issued until DOJ has issued its decision regarding the Section 5 award, because a DOJ acceptance may prompt an automatic approval under Part B and Part E (except in certain survivorship cases). In such cases where the EEOICPA claim is in posture for denial and is pending adjudication at DOJ, the CE may administratively close the claim for timeliness purposes and reopen once DOJ issues its decision. Please see the ECMS coding portion to this chapter for further guidance.

(b) Acceptances. If after complete development the CE determines that any part of the EEOICPA claim is in posture for acceptance, a recommended decision is issued accepting the claim under Part E in part or in full.

(3) DOJ Denies Section 5 Award. A DOJ Section 5 award denial automatically translates into a DOL denial under Part B. However, due to the expanded definition of a covered uranium worker and expanded covered conditions under Part E, a DOJ Section 5 award denial has no affect on Part E adjudication, and the CE continues to develop for coverage regardless of any negative determination or pending action on the part of DOJ. DOJ may deny Section 5 awards based upon employment timeframes required under the RECA that have no bearing on the EEOICPA. Additionally, DOJ denies Section 5 awards if the claimed condition is not a covered condition under the RECA. Expanded covered conditions under Part E might allow for an acceptance where DOJ has denied a claim. Accordingly, the CE proceeds to develop for Part E benefits, obtains all information relevant to DOJ’s adjudication process from DOJ and evaluates all available evidence to reach a determination as to coverage under the Act.

(a) Employment Denial. In instances where DOJ bases its denial on employment, DOJ sends all employment and exposure information in its possession and a copy of the denial decision to DOL and the CE reviews all such evidence, in addition to other evidence obtained through case development, to determine coverage under the EEOICPA.

(b) Denial on Other Grounds. If DOJ denies a Section 5 RECA claim for any other reason than employment, DOJ’s only obligation is to provide the CE with the employment verification statement letter. Should the CE require additional information from DOJ, the CE proceeds under current guidelines for following up with DOJ.

(4) No DOJ Section 5 Claim Filed. In cases where no DOJ Section 5 claim is filed, the CE proceeds with development of medical and employment evidence and the adjudication of the Part E claim immediately upon receipt of the EE-1 or EE-2 in the DO. In such cases, the CE requests employment verification from DOJ (Exhibit 1). The CE completes development and issues a recommended decision as soon as all the required facts are examined and a coverage determination made.

b. Evaluating and Obtaining Evidence from DOJ. As noted above, in most cases DOJ initially provides verification of RECA Section 5 employment in the form of a factual statement of employment. The initial communication with DOJ (Exhibit 1) indicates that additional evidence may be sought as claim adjudication proceeds. The DO CE seeks additional evidence from DOJ as necessary by contacting DOJ in writing (either by letter or email) requesting whatever additional documentation is required to adjudicate the claim. In cases where DOJ does not grant a Section 5 award based upon employment, the CE requests all employment evidence in DOJ’s possession and renders an independent finding as to employment. CEs also request exposure evidence from DOJ, if necessary, that outlines the employee’s occupational exposure. Additionally, the CE requests other file material as needed, such as medical records and survivorship documentation that may be in DOJ’s possession. The CE reviews all evidence obtained from DOJ to reach a decision regarding the acceptance or denial of benefits under the EEOICPA.

(1) Concurrent Development. While obtaining information from DOJ is important, the CE concurrently conducts independent development to obtain employment, medical, and exposure evidence that assist the CE in adjudicating the claim.

(2) Other Sources. The CE pursues additional evidence from the claimant, treating physicians, other health care providers, employers, and exhausts all other sources of information when developing for adjudication. The CE reviews and weighs all evidence obtained through the development process before issuing the recommended decision.

6. Verifying Exposure. The CE develops exposure and causation for uranium worker claims as outlined in the Evidentiary Requirements for Causation chapter to this Part and evaluates exposure based upon the exposure matrices and/or other data described in Chapter E-400. The CE initiates the verification of an employee’s exposure to certain toxic substances by contacting DOJ. The CE also verifies exposure through employment exposure records and supporting evidence submitted by the claimant. In addition, the RC conducts occupational history development on RECA claims to obtain information regarding exposure. Please see (Exhibit 2) for the Occupational History Interview for Miners, Millers, and Ore Transporters. ECMS coding for RC occupational history development is consistent with the guidance set forth in Chapters E-300 and E-400.

a. NIOSH/PHS Data. DOJ maintains an extensive database that contains exposure data on certain uranium workers (especially uranium miners) collected by NIOSH through former and current worker studies conducted contemporaneously within the covered periods under the EEOICPA. The CE prepares a letter to DOJ (Exhibit 1) requesting detailed information regarding potential toxic substances at the mine or mill where employment is claimed. Specific exposure information regarding the employee is also requested if available.

b. Employment Evidence. The CE uses employment records, where available, to evaluate for exposure. The CE obtains such evidence from either the claimant or the employer and reviews in totality with the evidence of file to determine whether or not it is established that the employee was exposed to a toxic substance or radiation.

c. Occupational History Development. As noted above, the RC conducts occupational history development on most RECA claims involving the worker or eligible survivor. An occupational history interview (Exhibit 2) is designed specifically for RECA claimants to develop information regarding workplace exposure.

7. Interagency Consistency. As noted above, since uranium workers and their survivors are treated and defined differently under Part E than Part B, and the universe of covered conditions has expanded significantly under Part E, uniform consistency in agency decision making is not always possible. Nonetheless, DOL and DOJ will inform each other when decisions are to be issued that are inconsistent with the other agency’s findings. Both DOJ and DOL will work to issue consistent decisions where employment verification findings are concerned, but this may not always be possible. As such, FAB supplies DOJ with copies of final decisions issued to RECA claimants. DOJ will provide DEEOIC National Office (NO) with copies of those decisions inconsistent with DEEOIC findings. Additionally, the DO will inform DOJ via email when a recommended decision is being issued that is inconsistent with a DOJ decision.

8. ECMS Coding. This section addresses specific ECMS coding requirements for RECA claims handled under this chapter.

a. ‘Recvd RECA Ind’ – The RECA indicator must be completed on all EEOICPA claims (Part B and Part E for all district offices). Use of this field is outlined in EEOICPA PM 02-1500 (ECMS).

b. Employment Verification Coding. As noted above, employment verification and other information is obtained through communicating with DOJ. When the initial letter (Exhibit 1) is sent to DOJ/received from DOJ the CE enters the following codes:

(1) ES - ‘Employment Verification Sent to DOJ.’ When a new RECA claim is received in the DO and the initial contact letter (Exhibit 1) is sent to DOJ requesting an initial factual statement regarding RECA Section 5 employment, the CE enters the ‘ES’ code in ECMS. The CE selects RECA employment from the reason cd drop-down box. The status effective date in ECMS is the date on the letter sent to DOJ.

(2) ER - ‘Complete Employment Verification Received from DOJ.’ - When DOJ’s response to the DO’s initial RECA Section 5 employment verification request (Exhibit 1) is received in the DO, the CE enters the ‘ER’ code in ECMS. The CE selects RECA employment from the reason cd. The ‘ER’ date in ECMS equals the date the response is date-stamped in the district office.

*Note: The letter sent to DOJ (Exhibit 1) requesting Section 5 RECA award status now also serves to request employment verification and to place DOJ on notice that employment and exposure evidence might be sought in the future. Due to the omnibus nature of this letter, the ‘ES/ER’ coding scheme is used for tracking purposes. The ‘DJ’ code, a code devised when the DOJ letter’s sole purpose was to request Section 5 award status, is now obsolete and its use is discontinued with these procedures.

c. Administrative Closure for Claims Pending at DOJ. As noted above, the CE develops for benefits under the EEOICPA if a claim is pending adjudication at DOJ but does not issue a decision denying benefits until DOJ has issued its decision. In such instances where it is necessary to administratively close a claim in posture for denial due to pending DOJ action, the following ECMS coding is used.

(1) C9 -‘Closed-RECA Claim.’ - Use this claim status code if a RECA claim is in posture for denial under the EEOICPA and a decision is pending at DOJ and an administrative closure is necessary due to timeliness issues. The CE sends a letter to the claimant, advising of the closure of the claim. The ‘C9’ is coded with a status effective date equal to the date of the letter to the claimant.

(2) RD - ‘Development Resumed.’ The ‘RD’ code is used in conjunction with the ‘C9’ closure code, when a pending decision from DOJ has ultimately been received at DOL. The ‘RD’ is coded with a status effective date equal to the date-stamp of receipt of the DOJ decision.

TABLE OF CONTENTS

Paragraph and Subject Date Transmittal No.

E-700 Eligibility Requirements for Certain Uranium Workers