Attention: This circular has been superseded and is inactive.
EEOICPA CIRCULAR NO. 15-04 Date: November 1, 2014
SUBJECT: Review of Cases Involving Exposure to Trichloroethylene (TCE) and the Development of Kidney Cancer
The purpose of this Circular is to notify all Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff of a set of cases to be reviewed under Bulletin No. 13-02, “Systematic Review of Denied Part E Cases.”
An important component of adjudicating claims under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) is the Site Exposure Matrix (SEM). SEM identifies toxic substances that were present at Department of Energy (DOE) facilities and Radiation Exposure Compensation Act (RECA) uranium mines and mills. Moreover, the information contained in the SEM identifies scientifically known relational connections between particular chemical or biological agents and specific illnesses. The SEM labels these relational connections as toxic “health effects.”
The source of health effect findings referenced in SEM is the National Library of Medicine’s (NLM) Haz-Map database. Haz-Map is an occupational health database designed to provide information about the adverse effects of workplace exposures to chemical and biological agents. These links derive from current scientific evidence.
Recently, Haz-Map was updated to reflect the latest scientific recommendations of the International Agency for Research on Cancer (IARC). The subject of this Circular is kidney cancer because Haz-Map now identifies exposure to TCE as being causally linked to kidney cancer. The DEEOIC has assembled a pull list of all denied Part E kidney cancer claims.
The cases on this list are to be reviewed as per the policies and procedures outlined in Bulletin No. 13-02, and in conjunction with the instructions provided in this Circular, including completion of the worksheet provided in Attachment 1. Additionally, staff are to use the guidance for ECS coding described in Bulletin No. 13-02. The “Initial Screening Reason” to be selected with the Initial Screening date and result (and “No Action Necessary,” if needed) is “Rvwd per Circular 15-04, Kidney Cancer Part E.” The completed worksheet and related SEM search(es) are to be placed in the case file.
A review of the scientific studies used to conclude that there is a link between TCE and kidney cancer shows that a statistically significant association between exposure to TCE and cancer of the kidney was identified in workers with a minimum level of exposure to TCE of 5 consecutive years. The scientific literature shows statistically significant results for TCE exposed workers who developed kidney cancer 20 or more years following first exposure (latency).
As part of implementing this Circular, the CE needs to assess whether there is evidence of employee exposure to TCE. TCE was heavily used for metalworking and vapor degreasing and, from an exposure perspective, working directly in these tasks are those for which exposure was likely to be at the level evaluated in scientific studies. Attachment 2 is a list of Department of Energy (DOE) facilities at which TCE use occurred extensively prior to 1990. Specifically, the attachment lists the DOE facilities at which TCE was most likely used for vapor degreasing and metalworking. The CE is to review the evidence and determine whether the employee:
· worked at a facility on Attachment 2;
· worked at the facility prior to 1990;
· worked in a labor category in which SEM indicates a potential for TCE exposure.
If all three bulleted conditions are met for 5 consecutive years, then the CE can presume significant exposure to TCE for those years. For employees not meeting these conditions, but for whom there is some evidence of potential TCE exposure, these cases are appropriate for an IH review to assess whether there was significant exposure to TCE. For cases in which a review of the case file and SEM does not show a potential for TCE exposure, code “ISU” for “unlikely acceptance,” but continue with review of the case as per the last paragraph of this Circular.
Bulletin No. 13-02 states (at action Item 7) that in addition to a finding of exposure, cases require a finding of medical causation for cases reviewed under this guidance. However, because of the scientific evidence regarding the nature of the link between TCE and kidney cancer, the requirement of a medical opinion on causation is waived for cases meeting the following criteria:
· Workers who have 5 or more consecutive years of significant exposure to TCE at a covered facility prior to 1990 and
· who have a latency period of 20 years from first exposure to TCE as a covered employee with a diagnosis of kidney cancer.
Cases that meet these bulleted criteria are to be coded “ISL,” which means “likely acceptance,” and then the district office is to proceed with reopening the case, as outlined in Bulletin No. 13-02, Item 9.
For cases that have some indicators of TCE exposure and a diagnosis of kidney cancer, but do not have exposure to TCE for 5 or more consecutive years in conjunction with a 20 year latency period, the CE is to obtain a medical opinion on causation.
With regard to cases requiring a medical review, the assigned Claims Examiner (CE) is to input “ISD” for “development needed” in ECS.
Bulletin No. 13-02 calls for a thorough review of all cases on the list for all denied Part E diagnoses, not just kidney cancer. DEEOIC continues to update SEM with new data regarding toxic substances used or located at covered facilities. As such, SEM searches from the past may now be obsolete, which requires the CE to perform updated exposure research. CE review under this Circular, while focused on kidney cancer, is also to include a comprehensive review of Part E case adjudication. CEs are to review the case to determine if any updates to SEM or new evidence submitted is sufficient to alter past findings or decisional outcomes. The worksheet at Attachment 1 is provided in conjunction with this circular to help guide staff through the process of case reassessment.
RACHEL P. 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