U.S. DEPARTMENT OF LABOR   OFFICE OF WORKERS' COMPENSATION PROGRAMS
DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL
ILLNESS COMPENSATION
FINAL ADJUDICATION BRANCH		   DOL Logo

 

Case Information
EMPLOYEE: [Name Deleted]
CLAIMANT: [Name Deleted]
FILE NUMBER: [Number Deleted]
DOCKET NUMBER: 20140122-69339-1
DECISION DATE: April 7, 2014

 

NOTICE OF FINAL DECISION

This decision of the Final Adjudication Branch (FAB) concerns your claim for benefits under the Energy Employees Occupational Illness Compensation Program Act of 2000, as amended (EEOICPA), 42 U.S.C. § 7384 et seq. For the reasons set forth below, your claim for additional impairment benefits under Part E of EEOICPA based on your covered illnesses of multiple skin cancers is denied.

STATEMENT OF THE CASE

On April 25, 2008, FAB issued a final decision accepting your claim for benefits under Part E for multiple skin cancers and awarded you medical benefits for those skin cancers. That decision established that you are a covered Department of Energy (DOE) contractor employee and that your skin cancers are covered illnesses under Part E. On June 8, 2009, FAB issued another final decision in which it determined that based on your May 4, 2009 impairment evaluation performed by a District Medical Consultant (DMC), your covered illnesses resulted in a 1% whole-person impairment. You were therefore awarded $2,500 in impairment benefits based on your skin cancers under Part E.

On August 17, 2009, the district office issued a letter accepting your claim under Part E for four additional skin cancers and awarding you medical benefits under Part E for those four additional skin cancers. On October 6, 2011, FAB issued a final decision in which it determined that based on an updated August 2, 2011 impairment evaluation performed by Dr. Blake H. Moore, your covered illnesses resulted in a 9% whole-person impairment; this represented an 8% increase from your previous evaluation. As a result, you were awarded $20,000 in increased impairment benefits based on all of your then-accepted skin cancers under Part E.

On April 19, 2012, the district office issued another letter accepting your claim under Part E for one additional skin cancer and awarding you medical benefits under Part E for this one skin cancer. On October 7, 2013, you filed a claim for additional impairment benefits under Part E and selected Dr. Moore to perform an updated impairment evaluation. By letter dated October 15, 2013, the district office authorized Dr. Moore to perform the requested impairment evaluation.

On January 21, 2014, the district office received an impairment evaluation report from Dr. Moore, dated December 28, 2013, in which he used the 5th Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA’s Guides) and calculated your whole-person impairment rating based on all of your accepted skin cancers. Dr. Moore acknowledged that he had performed your previous impairment evaluation, and determined that you are at maximum medical improvement (MMI) with respect to your covered illnesses. Dr. Moore consulted Table 8-2 on page 178 of the AMA’s Guides and determined that you have a Class 1 impairment based on your current clinical status, as well as the impact of your skin cancers on activities of daily living. Dr. Moore noted that the “disease burden does not yet rise to the level to meet a Class 2 standard,” and opined that your whole-person impairment rating for multiple skin cancers is 9%.

On January 22, 2014, the Jacksonville district office issued a recommended decision in which it concluded that the evidence of record was insufficient to establish an increase in your whole-person impairment. The district office thus recommended denial of your claim for increased impairment benefits under Part E.

Based on an independent review of the evidence of record, FAB hereby makes the following:

FINDINGS OF FACT

  1. On April 25, 2008, FAB issued a final decision accepting your claim for benefits under Part E for multiple skin cancers.
  1. On June 8, 2009, FAB issued a final decision which determined that your skin cancers had resulted in a 1% whole-person impairment, and awarded you $2,500 in impairment benefits.
  1. On August 17, 2009, the district office issued a letter accepting your claim under Part E for four additional skin cancers.
  1. On October 6, 2011, FAB issued a final decision which determined that all of your accepted skin cancers had resulted in a 9% whole-person impairment, and that this represented an 8% increase. You were awarded $20,000 in impairment benefits for this 8% increase.
  1. On April 19, 2012, the district office issued a letter accepting your claim under Part E for one additional skin cancer.
  1. Dr. Moore, a qualified physician, determined that you have reached MMI in relation to your covered illnesses and concluded that your whole-person impairment rating for your multiple skin cancers in accordance with the AMA’s Guides is still 9%.

Based on these findings of fact, FAB hereby also makes the following:

CONCLUSIONS OF LAW

Under Part E, a covered DOE contractor employee with a covered illness is entitled to impairment benefits based on his or her “minimum impairment rating.” 42 U.S.C. § 7385s-2(a)(1). A minimum impairment rating is the extent of whole-person impairment of all organs and body functions that are compromised or otherwise affected by the employee’s covered illnesses. 20 C.F.R. § 30.901(a) (2014). Finally, a minimum impairment rating must be determined by a qualified physician, using the 5th Edition of the AMA’s Guides, after the covered illnesses have reached MMI. Federal (EEOICPA) Procedure Manual, Chapter 2-1300.4c-d (September 2013).

The record establishes that you are a covered DOE contractor employee and that your multiple skin cancers are covered illnesses under Part E. Moreover, Dr. Moore, a qualified physician, determined that you have reached MMI in relation to your covered illnesses and provided a well-rationalized medical opinion in which he concluded that your whole-person impairment rating for your multiple skin cancers using the AMA’s Guides is 9%. As such, the record establishes that your minimum impairment rating as a result of your multiple skin cancers is still 9%.

A covered DOE contractor employee will receive $2,500 for each percentage point of the minimum impairment rating that is a result of a covered illness. 42 U.S.C. § 7385s-2(a)(1)(B). However, when calculating the amount of an award for additional impairment benefits, FAB only awards those benefits based on the increase in whole-person impairment. See EEOICPA Fin. Dec. No. 10013332-2007 (Dep’t of Labor, April 7, 2008).

As noted above, FAB previously issued final decisions accepting your claims for impairment benefits under Part E due to your covered illnesses in the total amount of $22,500 based on a 9% whole-person impairment rating. The present whole-person impairment rating based on your covered illnesses, as determined by Dr. Moore, is still 9%. Accordingly, because the present rating is the same as the previous rating, there is no increase in your minimum impairment rating. As such, your claim for increased impairment benefits under Part E is denied.

Washington, D.C.

Ryan Jansen

Hearing Representative

Final Adjudication Branch