EEOICPA BULLETIN NO.02-13
Issue
Date:
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Effective
Date:
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Expiration
Date:
________________________________________________________________
Subject:
Chronic Lymphocytic Leukemia Cases
Background:
Section 20 CFR 30.115(a) of the interim final
regulations currently provides that the Office of Workers Compensation Programs
(OWCP) will refer all non-SEC cancer claims to NIOSH for dose reconstruction
before the probability of causation is determined.
On
Given the HHS guidelines, referring a non-SEC claim for CLL to NIOSH for dose reconstruction serves no useful
purpose. Accordingly, an exception to
the normal process for determining the probability of causation is needed. The procedures described in this bulletin
explain how claims solely for non-radiogenic cancers
like CLL are exempt from undergoing a dose
reconstruction with NIOSH.
Reference: Interim final regulations 30 CFR 30.115(a) and 42 CFR Parts
81.21 and 81.30.
Purpose:
To explain the process for handling Chronic Lymphocytic
Leukemia claims.
Applicability: All staff.
Actions:
1. Upon review of a new claim for compensation,
the CE should identify any instance where (CLL) has
been claimed or identified through the review of medical records.
2. If CLL has been
claimed or otherwise been documented in the case file, the CE should undertake
appropriate claim development according to established policy and procedure.
The evidence of record must be sufficient to establish the necessary medical
and employment components for any covered claim under the program.
3. Once
steps have been taken to establish a diagnosis of CLL
and covered cancer employment, the CE must insert in the case file a letter
from NIOSH (Attachment 1). This letter
will serve as the dose reconstruction for all instances of CLL.
4. The CE must then assess whether any other
covered cancer has been established in the case records.
5. If the CE determines that a diagnosis of CLL exists in conjunction with another type of cancer, a
NIOSH referral summary should be prepared.
The CE should reference CLL as a diagnosed
cancer along with any other cancer established in the case record. The referral
summary should then be sent to NIOSH.
6. NIOSH will conduct the dose reconstruction on
each cancer aside from CLL and provide the dose
reconstruction report. In determining
the probability of causation, the CE must apply the results of the dose reconstruction
for all established cancers except CLL in the IREP. Given the
outcome of the probability of causation calculation, the CE should then prepare
a recommended decision including separate findings for each claimed
cancer.
The CE should
include a finding in the recommended decision that explains that the diagnosis
of CLL was valid, but given the HHS published
guidelines, it has been assigned a probability of zero and, as such, the
condition is denied from coverage under the program. The CE should cite the appropriate
regulations pertaining to this finding. In particular, the CE should cite 42 CFR 81.30.
7. If the CE determines that CLL
is the sole cancer established, it is not necessary to prepare a NIOSH referral
summary or to refer the case record to NIOSH.
As NIOSH has identified CLL as a non-radiogenic cancer, a dose reconstruction is
unnecessary. Once this determination is
made, the CE should input claim adjudication code "NR" (NIOSH Dose
Reconstruction Received) in ECMS. For the IREP
Version entry, the CE should list "N/A."
8. The CE should then prepare a recommended
decision denying compensation benefits for the reason that per NIOSH
regulations, the diagnosis of CLL has a zero
probability of causation. The CE should
cite the appropriate regulations for this finding in the recommended decision.
9. NIOSH has
prepared a list of case files presently undergoing review for dose
reconstruction that contain references to CLL. This list will be presented to the District
Office (DO) under separate cover. The
list identifies claim records where CLL is the sole
condition claimed. In addition, it
identifies case records that contain some sort of discrepancy concerning CLL. Each DO is to
review this list to determine the case records for which they are responsible.
10. If the DO
reviews the list and finds a case record where CLL is
the only diagnosed condition, a letter is to be prepared to NIOSH. The letter should explain the finding of the
DO and advise that a dose reconstruction is unnecessary. NIOSH should also be advised to return all
case file records. The DO may then
proceed with the issuance of a recommended decision denying benefits given the
diagnosis of CLL.
11. If NIOSH has identified a discrepancy in the
medical evidence pertaining to a diagnosis of CLL,
the DO should examine the case file to determine what corrective action is
necessary. In some instances, the CE merely has to ensure that the appropriate
ICD-9 code has been applied to a diagnosed CLL. Once this action would be completed, the CE
can prepare a letter to NIOSH noting the corrective action taken by the CE and
stating whether a dose reconstruction is necessary.
Other
discrepancies noted by NIOSH may require additional development of the evidence
by the CE. If this is the situation, the
CE should prepare a letter to NIOSH advising that no further action on the dose
reconstruction should occur until clarification is provided. The CE should then take whatever steps are
necessary to resolve the factual or medical discrepancies raised by NIOSH. Once any outstanding issue has been resolved,
NIOSH should be advised of the outcome and whether to proceed with a dose
reconstruction.
Disposition:
Retain until incorporated in the Federal (EEOICPA) Procedure Manual
PETER
M. TURCIC
Director,
Division of Energy Employees
Occupational
Illness Compensation
Distribution
List No. 1: Claims Examiners, Supervisory Claims Examiners, Technical
Assistants, Customer Service Representatives, Fiscal Officers, FAB District
Managers, Operation Chiefs, Hearing Representatives, District Office Mail &
File Sections