Attention: This bulletin has been superseded and is inactive.
| U.S. Department of Labor | Office of Workers’ Compensation Programs Division of Energy Employees Occupational Illness Compensation Washington, DC 20210 |  |
Issue Date: February 20, 2020
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Effective Date: February 20, 2020
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Expiration Date: February 20, 2021
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Subject: Updated Exhibit to Federal (EEOICPA) Procedure Manual Chapter 15, Exhibit 15-4, Exposure and Causation Presumptions with Development Guidance for Certain Conditions: Non-Hodgkin’s lymphoma.
· Background: The International Agency for Research on Cancer (IARC) has reviewed studies of non-Hodgkin’s lymphoma and determined that there is sufficient evidence in humans for the carcinogenicity of lindane and pentachlorophenol. From this information, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) has determined that available medical health science data support the establishment of two causation presumptions for addition to Exhibit 15-4 of the Federal (EEOICPA) Procedure Manual.
DEEOIC staff can presume causation for non-Hodgkin’s lymphoma when all (a-c) of the following criteria have been satisfied:
a. Medical:
The employee has a diagnosis of non-Hodgkin’s lymphoma.
b. Exposure:
The employee was employed in a job that would have resulted in significant exposure with lindane (1,2,3,4,5,6-Hexachlorocyclohexane[1]) for at least 56 days.
Or
The employee was employed in a job that would have resulted in significant exposure with pentachlorophenol for at least 2 years.
c. Latency:
For exposure to lindane, the diagnosis of non-Hodgkin’s lymphoma was made at least 20 years after initial exposure to lindane (1,2,3,4,5,6-Hexachlorocyclohexane) in covered employment.
For exposure to pentachlorophenol, the diagnosis of non-Hodgkin’s lymphoma was made at least 10 years after initial exposure to pentachlorophenol in covered employment.
References: Federal (EEOICPA) Procedure Manual Version 4.0.
Purpose: To provide notice of an update to Exhibit 15-4 to the Federal (EEOICPA) Procedure Manual Chapter 15 – Exposure and Causation Presumptions with Development Guidance for Certain Conditions (Version 4.0).
Applicability: All staff.
Actions:
1. DEEOIC claims staff is to cease using Federal (EEOICPA) Procedure Manual Version 4.0 Exhibit 15-4 and discard any remaining hard or electronic copies of all documents contained in that exhibit. This bulletin provides a new version of Exhibit 15-4 (Attachment 1). DEEOIC staff is to rely on the version of the exhibit attached to this bulletin until the Division publishes the next version of the Federal (EEOICPA) Procedure Manual.
2. In conjunction with the issuance of this bulletin, the DEEOIC has prepared a list of non-Hodgkin’s lymphoma cases denied for causation prior to January 1, 2020. All cases on the list must be reviewed by Claims Examiner (CE) staff in the district offices to determine whether the new guidance potentially affects the outcome of the case. The DEEOIC National Office will coordinate the distribution of the list to the district offices. The district office is responsible for coordinating review of any of its cases undergoing adjudication at the Final Adjudication Branch (FAB) if the issue before the FAB is unrelated to the items outlined for review in this bulletin. The FAB is responsible for reviewing any cases pending a review by FAB involving issues related to this bulletin to ensure that the outcome is consistent with the guidance contained in this bulletin.
3. Attached to this bulletin (Attachment 2), DEEOIC developed a screening worksheet to assist CEs in assessing each case listed. The CE will need to complete a worksheet for each case identified. When reviewing the cases against the screening worksheet, the assigned CE conducts an analysis of the existing case evidence to determine whether the new presumptive standards for non-Hodgkin’s lymphoma affirmatively affect the claim.
Depending on the case undergoing screening, the CE’s analysis of the case evidence must include an affirmative review of the date of medical diagnosis of non-Hodgkin’s lymphoma; evaluation of exposure data including the DAR and an updated search of the Site Exposure Matrix (SEM) relating to the new toxins for which there is a causative presumption linked to non-Hodgkin’s lymphoma; and satisfaction of exposure and latency criteria for the application the new presumptions. The CE is to employ standard exposure development techniques in making such a finding, including a review of case evidence and the outcome of relevant SEM search parameters. The CE is to bronze all SEM searches related to this guidance into the OWCP Imaging System (OIS) and identify them in the “description” field as “new SEM search per non-Hodgkin’s lymphoma bulletin.” Cases where the CE has made a connection between the employee and potential exposure to one or both of the toxins will ultimately need assessment by an industrial hygienist (IH) to determine the extent, nature and frequency of exposure.
4. Based upon the initial screening performed and completion of the worksheet, the cases on each list will be grouped into three categories:
Likely: For any case resulting in “likely,” (that is response to #6 and #7 on the worksheet are yes for either lindane or pentachlorophenol) the CE should initiate reopening. These cases must then be referred to an IH for an assessment of whether the employee’s potential exposure to 1,2,3,4,5,6-Hexachlorocyclohexane (lindane) or pentachlorophenol was significant.
Once the IH has made an assessment of the degree of exposure, the CE assesses whether the duration of that exposure meets the minimum period of time needed for the presumption to apply (at least 56 days for lindane or at least 2 years pentachlorophenol). If the IH does not find sufficient significant exposure, the CE will obtain a medical opinion on causation.
Unlikely: If the screening finds no potential for exposure to either toxin (#4 of the worksheet) or that either the duration of exposure (#6 of the worksheet) and/or the latency (#7 of the worksheet) is not met, these cases do not require a reopening or further review. The reason for this is that although the causative presumptions are new, the causal links between these two toxins and non-Hodgkin’s lymphoma are not new to SEM, having been first included in SEM in 2013.
Development needed: Any time a case is reviewed under EEOICPA, there is always the potential for the discovery of something in the case file that, with additional development, might change the outcome. If, in the review of a case, information pertaining to medical or employment documentation, for example, leads the reviewer to think more development is needed, this option is selected and the case is reopened.
5. At the completion of each screening, the CE is to image the completed worksheet into OIS for the case so it becomes part of the official record. The CE indexes the worksheet in OIS as follows:
Category: Other Documents
Subject: Internal Forms/Worksheet
Review Status: Review Complete
Description: Non-Hodgkin’s lymphoma screening worksheet
6. In the exercise of the DEEOIC Director’s discretion in the reopening process, the Director is delegating authority to the four district directors to sign the Director’s Orders for reopening of all cases affected by this new guidance. At the discretion of the District Director, the Assistant District Director may sign the Director’s Order.
7. Once a District Director reopens a claim under the guidance referenced in this bulletin, the assigned CE reviews and adjudicates the claim based on all existing procedures outlined in the current version of the Procedure Manual, including updates to Exhibit 15-4, and proceeds in the usual manner for making a recommendation to accept or deny the claim.
8. Based on the outcome of “Likely”, “Unlikely”, or “Development Needed” on the screening worksheet(s), the CE must record the finding in ECS on the “Screening (SEC/PER/Other)” screen. The finding of “Likely”, “Unlikely”, or “Development Needed” must be recorded along with the screening date from the screening worksheet. The “Reason” field must also be completed, which will be “Rvwd per Bulletin 20-02, Updated Exhibit 15-04: Non-Hodgkin’s lymphoma.”
Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.
RACHEL POND (LEITON)
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, and District Office Mail and File
[1] In the DEEOIC Site Exposure Matrix (SEM), lindane is identified as 1,2,3,4,5,6-Hexachlorocyclohexane.