TABLE OF CONTENTS

 

 

Paragraph and Subject                      Date       Trans. No.

 

Chapter 2-0800 Eligibility Criteria for Silicosis

 

     Table of Contents. . . . . . .        09/04      04/06

  1  Purpose and Scope. . . . . . .        09/04      04/06

  2  Identifying a Claim

     for Silicosis. . . . . . . . .        09/04      04/06

  3  Proof of Covered

     Silicosis. . . . . . . . . . .        09/04      04/06

 

1.   Purpose and Scope.  This chapter describes the policies and procedures for adjudicating a claim for silicosis.

 

2.   Identifying a Claim for Silicosis.  The Claims Examiner (CE) must identify whether a claim for compensation is being made for chronic silicosis.  If the EE-1 or EE-2 is marked for chronic silicosis, then the CE should develop for silicosis.

 

3.   Proof of Covered Silicosis.  42 U.S.C. §7384r(e) describes the medical evidence that must be presented in order to establish a diagnosis of chronic silicosis.  It is the responsibility of the CE to verify that all the necessary medical evidence is presented in accordance with the requirements listed in the statute.  The following are the statutory requirements for establishing a diagnosis of silicosis.

 

a.   A written medical narrative from a qualified physician that includes a diagnosis of chronic silicosis and the date of initial onset.  In addition, one of the following must be submitted:

 

(1)  A chest radiograph, interpreted by an individual certified by the National Institute for Occupational Safety and Health (NIOSH) as a B reader, classifying the existence of pneumoconioses of category 1/0 or higher;

 

(2)  Results from a computer assisted tomograph or other imaging technique that are consistent with silicosis;

 

(3)  Lung biopsy findings consistent with silicosis.

 

b.   The initial occupational exposure to silica dust preceded the onset of silicosis by at least 10 years.

 

c.   Upon review of the evidence presented in a claim, the CE should verify the presence of the necessary medical and diagnostic evidence to support a diagnosis of silicosis.  If deficiencies are noted, the CE must request evidence from the claimant.