EEOICPA CIRCULAR NO. 18-01

 

 

 

 

Attention: This circular has been superseded and is inactive.

 

 

 

 

 

 

EEOICPA CIRCULAR NO. 18-01 DATE: December 6, 2017

 

SUBJECT: Idiopathic Disease Diagnosis

 

This Circular notifies Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff of the updated procedures for adjudication of claims where the diagnosed condition is idiopathic in nature.

 

Chapter 18.15.c(2) of the Federal (EEOICPA) Procedure Manual states that “idiopathic” means that the causative agent is unknown. DEEOIC staff periodically receive claims involving an idiopathic diagnosis for an employee, frequently in survivor claims where a physician diagnosed an idiopathic condition years before the death of the employee. For claims that present with the employee’s diagnosis of an idiopathic condition, with no qualified physician opinion that the condition has an affiliation to an occupational toxic substance exposure, DEEOIC procedure instructs the Claims Examiner (CE) to deny the claim.

 

In the case of several commonly referenced idiopathic conditions, DEEOIC maintains health effect data that could allow a physician to render an opinion on the potential work-relatedness of the underlying medical condition[1]:

 

· Peripheral neuropathy/polyneuropathy

· Pulmonary fibrosis

· Interstitial pneumonitis

 

To address this, DEEOIC is announcing that for claims that present with medical evidence characterizing one of the above medical conditions as idiopathic, the CE is to treat it as potentially work-related and he or she is to evaluate the condition without consideration given to the idiopathic designation. For example, a surviving spouse files a claim for her husband, who passed away in 1990. The medical evidence establishes the employee’s diagnosis of idiopathic pulmonary fibrosis. The CE proceeds with his or her exposure and causation analysis based on the condition of pulmonary fibrosis, including examination of the employee’s work history to establish any potential occupational exposures to toxic substances with a pulmonary fibrosis health effect. With the identification of any potential exposures associated with the employee’s work at a covered site, an Industrial Hygienist’s referral, followed by a review of the claim by the claimant’s treating physician or a Contract Medical Consultant, as appropriate, must occur.

 

Regardless of whether or not DEEOIC maintains health effect data on a medical condition labeled as idiopathic, CEs may not presume that the condition is unrelated to toxic substance exposure and deny it without development. For a medical condition labeled as idiopathic, with no available health effect data relating to the underlying condition, the CE is to undertake development. For guidance on developing a claim in this circumstance, the CE may reference the procedures in Chapter 15 - Establishing Toxic Substance Exposure and Causation of the Federal (EEOICPA) Procedure Manual. The chapter provides guidance stating that the CE is to ask the claimant to submit any medical or health effect information that could associate the claimed medical condition to the employee’s exposure to a toxic substance.

 

 

 

 

RACHEL P. LEITON

Director, Division of Energy Employees

Occupational Illness Compensation

 

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