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Rule: Energy Employees Occupational Illness Compensation Program Act Implementation: Functions Performance and Compensation Claims

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Friday,

December 29, 2006

Part II

Department of Labor
Office of Workers’ Compensation
Programs

20 CFR Parts 1 and 30


Performance of Functions; Claims for
Compensation Under the Energy
Employees Occupational Illness
Compensation Program Act of 2000, as
Amended; Final Rule
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78520 Federal Register / Vol. 71, No. 250 / Friday, December 29, 2006 / Rules and Regulations

DEPARTMENT OF LABOR claims that are pending on February 27, capacities with respect to the EEOICPA
2007. claims adjudication process. In
Office of Workers’ Compensation FOR FURTHER INFORMATION CONTACT: addition, the existing language of
Programs Shelby Hallmark, Director, Office of § 30.316(c) has been modified so that a
Workers’ Compensation Programs, recommended decision on a claim that
20 CFR Parts 1 and 30 Employment Standards Administration, is pending for more than one year after
RIN 1215–AB51 U.S. Department of Labor, Room S– the date it was reopened for issuance of
3524, 200 Constitution Avenue, NW., a new final decision will be considered
Performance of Functions; Claims for Washington, DC 20210, Telephone: a final decision on that claim as of that
Compensation Under the Energy 202–693–0031 (this is not a toll-free date, and § 30.400(a) has been modified
Employees Occupational Illness number). to reflect the current practice of OWCP
Compensation Program Act of 2000, as to pay for medically necessary treatment
SUPPLEMENTARY INFORMATION: The
Amended of a primary cancer in claims where the
Department of Labor’s interim final
accepted occupational illness or covered
AGENCY: Office of Workers’ regulations implementing its
illness is a secondary cancer.
Compensation Programs, Employment responsibilities under the Energy
When publishing a final rule
Standards Administration, Labor. Employees Occupational Illness
following a comment period, it is
ACTION: Final rule. Compensation Program Act of 2000, as
customary to publish only the changes
amended (42 U.S.C. 7384 et seq.), were
that have been made to the rule;
SUMMARY: On June 8, 2005, the published in the Federal Register on
however, in order to be more user-
Department of Labor (DOL) published June 8, 2005 (70 FR 33590). They took friendly, the Department is publishing
interim final regulations that govern its effect immediately and included a 60- the entire rule, including the parts that
responsibilities under the Energy day period for comment. During the have not been changed. By doing so,
Employees Occupational Illness comment period, the Department only one document containing all of the
Compensation Program Act of 2000, as received 533 timely comments: two regulations and commentary needs to be
amended (EEOICPA or Act). Part B of joint comments from 39 congressional consulted rather than multiple
the Act provides lump-sum payments of representatives; two from labor documents.
$150,000 and medical benefits to organizations; four from attorneys; four
covered employees and, where from advocacy groups; one from a lay I. Comments on the Interim Final
applicable, to survivors of such representative; one from DOE; one from Regulations
employees, of the Department of Energy a DOE contractor; and 518 from The section numbers used in the
(DOE), its predecessor agencies and individuals. The Department also headings of the following analysis are
certain of its vendors, contractors and received untimely comments from one those that were used in the interim final
subcontractors. Part B also provides physician, one attorney, one advocacy regulations. Unless otherwise stated, the
lump-sum payments of $50,000 and group, the Coconino County (Arizona) section numbers in the text of the
medical benefits to individuals found Board of Supervisors, one labor analysis refer to the numbering used for
eligible by the Department of Justice organization, the Navajo Nation and 23 the final regulations. No comments were
(DOJ) for $100,000 under section 5 of individuals; all of the points they raised received with respect to part 1.
the Radiation Exposure Compensation were also raised by the timely
Act (RECA) and, where applicable, to comments. Almost all of the timely Section 30.5
their survivors. Part E of the Act comments (521) addressed the issue of One individual suggested that the
provides variable lump-sum payments eligibility for survivor benefits under definition for the statutory term
(based on a worker’s permanent Part E of EEOICPA; 494 of the comments ‘‘Department of Energy facility’’ be
impairment and/or calendar years of addressed this issue alone. They also modified to more clearly identify the
qualifying wage-loss) and medical addressed a number of other issues, ‘‘list of facilities established by the
benefits for covered DOE contractor including the administrative claims Department of Energy’’ referred to in the
employees and, where applicable, process used to adjudicate claims under interim final regulation. To eliminate
provides variable lump-sum payments EEOICPA, entitlement qualifications, any confusion with respect to this list,
to survivors of such employees (based and the extent of coverage provided and as suggested by the comment,
on a worker’s death due to a covered under Part E. The Department’s section- § 30.5(x) has been amended in this final
illness and any calendar years of by-section analysis of the timely rule to specify which list of facilities the
qualifying wage-loss). Part E also comments it received is set forth below Department has adopted. Another
provides these same payments and (see sections I and II). individual believed that the five-year
benefits to uranium miners, millers and Some minor changes have been made latency period requirement for specified
ore transporters covered by section 5 of to the interim final regulations that did cancers listed in § 30.5(ff)(5) was ‘‘in
RECA and, where applicable, to not result from any comments. One such error’’ and suggested that it be deleted.
survivors of such employees. change is the addition of new language However, the latency period
At the same time the Department to § 30.112(b) to recognize that pursuant requirement is contained within section
published the interim final regulations, to § 30.106, entities other than DOE may 7384l(17)(A) of the Act and cannot be
it also invited written comments and be verifying alleged periods of modified in these regulations.
advice from interested parties regarding employment that claimants have Therefore, the suggested change was not
possible changes to those regulations. reported to OWCP. A second change is made. A third individual suggested that
This document amends the interim final the addition of language to § 30.301(c) § 30.5(gg) be modified to more clearly
regulations based on comments that the clarifying that OWCP will also not issue describe the requirements for eligibility
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Department received. a subpoena for the testimony of of survivors under Part E. Section
DATES: Effective Date: This rule will be employees of the National Institute for 30.5(gg) is only intended to inform
effective on February 27, 2007, and will Occupational Safety and Health readers that survivors must be alive to
apply to all claims filed on or after that (NIOSH) or contractors of either OWCP receive a payment. Because complete
date. This rule will also apply to any or NIOSH acting in their official descriptions of the requirements for

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Federal Register / Vol. 71, No. 250 / Friday, December 29, 2006 / Rules and Regulations 78521

eligibility of survivors under Part B and alleged permanent impairment based on or E of EEOICPA. Section 30.111(a)
Part E of EEOICPA already appear at the evidence in the case record. If describes the general burden of proof
§ 30.500, the suggested change is claimants were permitted to apply for that claimants must meet, ‘‘[e]xcept
unnecessary and was not made. an increased impairment rating sooner where otherwise provided in the Act
than two years after their prior award and these regulations,’’ with respect to
Sections 30.100, 30.101, 30.102 and
for impairment benefits, the claims all of the required elements involved in
30.103
processing system would inevitably a claim. As one of these labor
One attorney pointed out that while become less efficient and claimants who organizations noted, there are differing
employees and survivors can use Forms have not had their initial impairment burdens of proof between Parts B and E,
EE–1 and EE–2 to file their initial claims claims adjudicated and who have not as well as between different claimed
with OWCP, there was no form received benefits for their compensable illnesses within a single Part of the Act.
provided for filing a claim for an alleged permanent impairments would This fact, however, does not mean that
consequential illness or injury. The necessarily have to wait even longer to the description of the general burden of
absence of a specific form for claiming receive a decision from OWCP. proof in § 30.111(a) is incorrect. OWCP
an alleged consequential illness or Therefore, in order to maintain an is committed to helping claimants meet
injury is intentional since in those efficient system of adjudication for all their burden of proof and is aware that
situations, OWCP would already have claimants and to best use its limited some claimants may have difficulty
all of the necessary factual information resources, OWCP concludes that the proving both the presence of and their
that could be requested by a form. two-year waiting period should remain exposure to a toxic substance at a
Claimants need only submit written in place and none of the suggested particular facility under Part E. In an
‘‘words of claim’’ to OWCP, together changes to this section have been effort to remedy this situation, OWCP is
with the type of supporting medical adopted. currently developing exposure matrices
evidence described in §§ 30.207(d), One of these same advocacy groups that will compile information provided
30.215, 30.222(b), 30.226 or 30.232(c), to also noted that while § 30.103 requires by a variety of sources, including DOE,
file a claim for a consequential illness claimants to use approved forms when former worker medical survey programs,
or injury. Therefore, no new form has filing claims under Part E of EEOICPA, and epidemiological studies. For all of
been designed and the suggested ‘‘the present forms do not allow for the DOE facilities, extensive
changes to §§ 30.100 and 30.101 were claiming diseases other than cancer, documentation exists covering
not made. berylliosis or silicosis.’’ On June 20, thousands of toxic materials. The
Two individuals disputed the 2005, the Office of Management and matrices now being developed will be
provision in § 30.101(c) that a survivor Budget approved new versions of Forms posted on our Web site and will be
must be alive to receive a payment EE–1 and EE–2 that allow claimants to
under the Act and noted that if all of the available to claimants and their
file for all illnesses potentially representatives. While it is not possible
eligible survivors die before payment compensable under Part E. As noted in
can be made, no payment can be made to define precisely in a regulation how
§ 30.103(b), these forms are available on these complex matrices will be used in
to any other individual as the heir of a the Internet at http://www.dol.gov/esa/
deceased eligible survivor. However, each case, OWCP’s procedural guidance
regs/compliance/owcp/eeoicp/ documents will provide additional
this result is required under both Parts main.htm. Therefore, the suggested
B and E of EEOICPA pursuant to clarity in this regard, and those
change to § 30.103 is unnecessary and documents will also be available to the
sections 7384s(e)(1) and 7385s–3(c), has not been made.
which require that survivors under both public on our Web site. Nevertheless, it
Part B and Part E must be alive at the Section 30.106 would not be appropriate to relieve
time of payment, and cannot be altered One individual questioned whether claimants of their ultimate obligation to
by regulation. Therefore, the requested DOE was in possession of sufficient prove their claims, which is a standard
change to § 30.101(c) was not made. employment data to enable it to verify requirement of all state and federal
Three advocacy groups suggested that alleged periods of employment for workers’ compensation programs. Since
the provision in § 30.102 that OWCP ‘‘most’’ claims. OWCP does not dispute Part E was intended to substitute for the
will only adjudicate a claim for an that there are a number of facilities for state workers’ compensation benefits
increased impairment rating if it is filed which DOE does not have access to any that claimants could have sought DOE’s
at least two years from the date of the employment data. However, OWCP has assistance in obtaining under former
last award of impairment benefits is developed a number of alternative Part D of EEOICPA, OWCP’s application
unreasonable and proposed that the methods to be used for verifying alleged of standard workers’ compensation
waiting period to be reduced to either employment at those facilities. In principles is appropriate and no
one year or six months. The claim acknowledgement of this situation, changes were made to § 30.111(a).
development process that OWCP uses § 30.106 describes the various Another individual suggested that
when it determines a covered Part E alternative methods by which OWCP OWCP amend § 30.111(c) to state that an
employee’s minimum impairment rating may seek to verify alleged periods of affidavit submitted by a claimant is not,
is necessarily complex and usually takes employment at those facilities for which in and of itself, sufficient to establish a
a considerable amount of time to DOE has no employment data, and no period of alleged employment. Section
complete. For example, the medical change to this section was made in the 30.111(c) currently states that such
evidence submitted in support of an final rule. affidavits ‘‘may be relied on in
alleged rating may not contain all of the determining whether a claim meets the
information that OWCP will need to Sections 30.111, 30.113 and 30.114 requirements of the Act. * * *’’
determine an impairment rating. OWCP One individual and two labor However, since § 30.112(b)(3) already
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would then have to seek that organizations questioned the makes clear that OWCP may reject a
information from another source, or description of the general burden of claim when the only evidence of
obtain an impairment evaluation by proof that all claimants must meet in covered employment is a ‘‘self-serving
another physician before it would be order to establish their entitlement to affidavit,’’ the suggested change is
able to determine the extent of the any compensation under either Parts B unnecessary and was not adopted in the

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78522 Federal Register / Vol. 71, No. 250 / Friday, December 29, 2006 / Rules and Regulations

final rule. A third individual suggested commenters have not presented any Adjudication of Claims of Injury Due to
that language be added to § 30.111 arguments challenging the underlying Ionizing Radiation, issued by the
stating that when OWCP requests a bases for that decision. As for the Committee on Interagency Radiation
second opinion from a medical comment regarding OWCP’s Research and Policy Coordination of the
specialist, it will only provide such adjudication of non-specified cancer Office of Science and Technology
specialist with copies of the ‘‘medical’’ claims following an administrative Policy, Executive Office of the President
evidence in the case file to review addition of a class of employees to the (August 1988), ‘‘[a]nalysis of medical
instead of all ‘‘relevant’’ evidence in the Special Exposure Cohort, this question findings cannot separate the ‘radiogenic
file. This suggestion ignores the fact that involves the manner in which the cases’ from those unrelated to radiation
factual evidence from a case file may be Department of Health and Human exposure; no ‘biological markers’ have
highly relevant (e.g., evidence of Services (HHS) defines the new class of yet been identified that can
exposure levels, environmental employees and the unique factual basis unequivocally point to radiogenic
assessments, etc.) to the probative value for its addition to the Special Exposure cancers as distinct from non-radiogenic
of the specialist’s medical opinion and Cohort. However, since neither of these cancers. An excess incidence of cancer
as a result, the requested change was not matters are within the jurisdiction of is identifiable in a statistical sense
made. OWCP, they cannot be addressed in the only.’’
A third individual requested that context of this rulemaking (see It is, thus, not surprising that
§ 30.113(a) be changed to indicate that § 30.2(b)). For the above reasons, no Congress required the use of statistical
OWCP will accept various types of changes were made to § 30.115 in the probability in the determination
‘‘electronic’’ submissions in support of final rule based on these three whether to compensate an individual
claims for compensation under comments. with a claimed cancer under Part B.
EEOICPA, while an advocacy group Under Part B, an individual will be
suggested that § 30.113(c) be changed Section 30.213 determined to have sustained ‘‘cancer in
due to its belief that all statements OWCP received 19 comments the performance of duty for purposes of
regarding the substance of lost or regarding the operation of § 30.213 with the compensation program if, and only
destroyed factual or medical evidence respect to the 50 percent compensable if, the cancer [at issue] was at least as
would be ‘‘self-serving’’ and therefore level of probability of causation (PoC) it likely as not related to employment at
not acceptable. Both of these provisions will use to adjudicate claims for the facility’’ (emphasis added),
have been in effect since the issuance of radiogenic cancer under Part E of determined pursuant to guidelines
the first final rule on December 26, EEOICPA (three comments were based upon radiation dose and ‘‘the
2002, and have not proved problematic received from advocacy groups, 11 from upper 99 percent confidence interval of
in practice. Therefore, the requested individuals, two from congressional the probability of causation in the
changes were not made in this final representatives, one from a lay radioepidemiological tables published
rule. representative, and two from a single under section 7(b) of the Orphan Drug
A fourth individual disagreed with labor organization). These comments Act (42 U.S.C. 241 note),’’ as well as a
the general requirement in § 30.114 that requested that OWCP lower the number of other factors. The technical
claims for compensation under compensability level below the 50 documentation prepared by HHS to
EEOICPA be supported with medical percent level that is used for Part B explain the computer program used to
evidence that establishes the existence claims, but gave no scientific or other make this calculation similarly notes
of the alleged occupational illness under rationale for setting the compensability that ‘‘it is not possible to determine, for
Part B or covered illness under Part E. level at any particular point below 50 a given individual, whether his or her
However, these medical requirements percent. Rather, the commenters base cancer resulted from workplace
are derived from the statutory their arguments on the fact that the exposure to ionizing radiation.’’
requirements in the Act itself and statutory causation standard for Part E (NIOSH—Interactive
cannot be altered through the uses language that differs from the RadioEpidemiological Program (IREP)
rulemaking process. Therefore, the language used for Part B. For the reasons Technical Documentation, June 18,
requested change to § 30.114 was not set forth below, OWCP has determined 2002). Part B, thus, requires that a
made. that it is more consistent with claimed cancer be determined to be
congressional intent and current science ‘‘related to’’ employment at a covered
Section 30.115
to continue to use HHS’s regulations in facility if the radiation dose and other
Two individuals asserted that making the determination required by factors combined indicate that there is
application of the dose reconstruction section 7385s–4(c)(1)(A) of the Act a statistical probability that the cancer
process discussed in § 30.115 of the because those regulations provide the would not have occurred in the absence
interim final regulations to Part E cancer only reasonable factual basis upon of work-related exposure to radiation. In
claims would be neither just nor fair, which OWCP can determine if it is ‘‘at other words, the PoC determination
and one advocacy group asked how least as likely as not’’ that exposure to made for purposes of Part B is actually
OWCP planned to adjudicate the claims radiation at a DOE facility or RECA a determination that there is a 50
of employees with non-specified section 5 facility was a ‘‘significant percent or better chance that radiation
cancers (those not listed at § 30.5(ff)) at factor in aggravating, contributing to, or was a factor, however slight, ‘‘in
newly designated Special Exposure causing’’ radiogenic cancer for which aggravating, contributing to, or causing’’
Cohort worksites. With respect to the compensation is claimed under Part E. a claimed cancer because, in the
first of these two concerns, the It is clear from the scientific literature absence of work-related exposure to
discussion of § 30.213 in the preamble that it is not possible to definitively radiation, the cancer would not have
to the interim final rule described the attribute any individual’s cancer to any occurred at all.
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scientific and administrative reasons particular cause, and no commenter Because it is impossible to determine
why OWCP decided to use the existing identified a method of attribution. As the extent to which any individual
dose reconstruction process from Part B noted in Science Panel Report No. 6, factor contributed to the development of
to adjudicate certain radiogenic cancer Use of Probability of Causation by the cancer, OWCP has concluded that the
claims filed under Part E, and the two Veterans Administration in the only way to comply with the statutory

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mandate in Part E is, in effect, to all conceivable cancers that might have radiation exposure might be causally
interpret ‘‘a significant factor’’ as resulted from the radiation exposure. related to cancer occurrence.’’ The
including any factor. Accordingly, the This probabilistic approach is the only report described the Department of
determination made pursuant to HHS generally accepted scientific means of Veterans Affairs’ use of PoC calculated
regulations issued under Part B whether assigning responsibility for cancers in at the 99 percent credibility limit (the
there is a 50 percent probability that relation to radiation exposure. The term used in that report for confidence
radiation was a factor in the Department of Veterans Affairs and the interval) as ‘‘highly unlikely to exclude
development of cancer (i.e., that in the Defense Department also utilize persons with meritorious claims.
absence of work-related exposure to essentially the same statistical However it is likely to award many
radiation, the cancer would not have probability test to adjudicate benefits for persons whose true [PoC’s] are very
occurred at all) will be deemed potentially radiogenic cancer cases much less than 50 percent.’’ For
sufficient to establish that radiation was incurred by veterans exposed to example, as noted in that report,
not only a factor, but was also a radiation. because of the substantial margin for
significant factor ‘‘in aggravating, Further, it should be noted that the error established by use of the 99
contributing to, or causing’’ the cancer epidemiological method utilized in this percent confidence level, a cancer that
in question. determination is actually far more is actually nine percent likely to have
The position taken by the commenters favorable towards claimants than merely been caused by the alleged exposure,
appears to be based on a requiring a determination that radiation but for which data is limited, could
exposure was ‘‘at least as likely as not’’ yield a PoC of 82 percent under the HHS
misunderstanding of the test used by
a significant factor. The method PoC guidelines.
Congress in Part B of EEOICPA for
specified by Congress for Part B and OWCP also believes that utilizing the
determining coverage for cancer due to
adopted by OWCP for Part E requires 50 percent PoC process for Part E is
exposure to radiation. The standard
that OWCP use the upper 99 percent more likely to result in a scientifically
used is whether a cancer suffered by a
confidence interval to determine valid and consistent determination
worker is ‘‘related to’’ his or her
whether cancers of employees are to be process than attempting to reach a
employment at a covered facility. The
compensable. In essence, a confidence determination based on medical
commenters suggest that Part B awards
interval indicates the likelihood that a opinions from physicians that inevitably
benefits only for cancers caused by
statistical sample will reflect actual contain a significant speculative
exposure to radiation, while Part E was results and is often demonstrated in component. Use of the PoC guidelines
intended to award benefits where the terms of a margin of error (e.g., ±5 for claims under both Part B and Part E
cancer was either caused by or percentage points in a poll). The precise allows OWCP to adjudicate the
contributed to by exposure to radiation. statistical definition of the 99 percent entitlement of radiogenic cancers that
This misunderstanding may well stem confidence interval is that if a study or are potentially compensable under both
from use of the term ‘‘probability of poll were conducted 100 times, the Part B and Part E in a uniform manner.
causation’’ to describe the results of the results would be within the sample’s Any process for determining coverage of
statistical determination made by the margin of error 99 times and one time claims for radiogenic cancers that would
radioepidemiological tables used in the the results would be either higher or yield inconsistent results as to whether
process. By using the term ‘‘related to’’ lower. For purposes of the calculations that cancer is compensable under Parts
in Part B, however, Congress performed under Parts B and/or E of B and E is unlikely to be understood or
encompassed all cancers for which there EEOICPA, an upper 99 percent accepted by claimants and other
is a statistical probability that exposure confidence interval establishes a stakeholders.
to radiation was a factor in the significant margin of error in favor of The commenters’ argument that
development of the cancer. Despite the claimants for whether the exposures eligibility for a radiogenic cancer under
use of the word ‘‘causation’’ in the term that appeared at least as likely as not to Part E should be based on a lower than
‘‘probability of causation,’’ the cause cancer actually did. That is, use 50 percent PoC level apparently is based
determination reached is not an of this confidence interval means that on their interpretation of the language of
individual determination of the there is only a one percent chance that section 7385s–4(c)(1)(A), which requires
mechanism of cause and effect leading the exposure level has been a determination that it is ‘‘at least as
to a particular cancer, which as underestimated and a 99 percent chance likely as not that exposure to a toxic
explained above is not scientifically that it has been overestimated. Because substance at a Department of Energy
possible, but a statistical prediction of of this extremely claimant-favorable facility was a significant factor in
the probability that the cancer would margin of error, we believe that it is aggravating, contributing to, or causing’’
not have occurred in the absence of reasonable to conclude that the use of the claimed cancer. While Congress
exposure to radiation. Thus, the HHS this method for adjudicating radiogenic utilized different terminology to
technical documentation describes PoC cancer claims under Part E will provide establish the test for compensation in
as ‘‘the likelihood that an existing compensation in any case in which it is Part E and Part B, the differences reflect
cancer resulted from that [workplace at least as likely as not that an employee the fact that Part B was intended to
radiation] exposure.’’ (NIOSH–IREP would not have suffered cancer absent establish narrowly drawn tests for
Technical Documentation, June 18, his or her employment-related exposure specific medical conditions, such as
2002). Scientific analysis does not to radiation. radiogenic cancer or chronic beryllium
distinguish between cancers that are This conclusion finds further support disease. Part E, on the other hand, sets
caused or contributed to by radiation. in the Report of the NCI–CDC Working forth a broad test that must be used to
Since the actual mechanisms of cause Group to Revise the 1985 NIH determine the compensability of a
(or contribution) for a given cancer are Radioepidemiological Tables virtually unlimited array of illnesses
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not known, only probabilistic assertions (September 2003), which found that the potentially caused by exposure to the
can be made, and they address only PoC model was a viable method to tens of thousands of toxic substances
whether the cancer is more or less likely adjudicate claims for radiation-related present at Department of Energy
not to have occurred absent the instances of cancer that appropriately facilities. While there is no way to
exposure. The IREP approach identifies summarized ‘‘the likelihood that prior distinguish between causation and

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78524 Federal Register / Vol. 71, No. 250 / Friday, December 29, 2006 / Rules and Regulations

contribution in regard to cancer related Two comments from congressional relationship to an existing covered
to exposure to radiation (because it is representatives, three from advocacy illness. Accordingly, the suggestion was
only possible to determine the statistical groups and one from an individual not adopted in the final rule.
probability that, absent work-related asserted that it would be extremely
Section 30.300
exposure to radiation, the employee in difficult for claimants to satisfy their
question would not have incurred the burden of proof under § 30.231 to Two comments from individuals, two
cancer or cancers from which he or she establish both the presence of a toxic from congressional representatives and
suffered), Part E applies to other types substance and the employee’s exposure one from an advocacy group suggested
of illnesses for which the concept of to the substance without the that OWCP use Physicians Panels to
‘‘contribution’’ may be highly relevant. development of site exposure make determinations when there is a
Indeed, unlike the case of radiogenic assessments of toxic substances. OWCP dispute with regard to issues of
cancer, it is possible to determine that shares this concern and is committed to causation or the degree of impairment.
toxic exposure contributed to a number studying all of the available information After considering the use of Physicians
of other illnesses or that other pre- pertaining to these sites and making Panels in the adjudication of Part E
existing illnesses were aggravated by publicly available a listing of the toxic claims, OWCP decided in the interim
toxic exposure. Therefore, the difference substances present at such sites. The final rule to base the formal
in the statutory language between the information compiled from these adjudicatory and review structure for
standard in Part B and the standard in studies will be accepted as probative those claims on the same successful and
Part E does not indicate that Part E was evidence in determining the eligibility streamlined structure that has been used
intended to establish a more lenient test, of claimants, barring extraordinary and for Part B claims since 2001. The use of
but can be explained by the fact that it unusual circumstances, and § 30.231(b) Physicians Panels as deciding bodies for
was designed to cover a wide variety of has been modified to clarify OWCP’s claims submitted to DOE under former
situations and circumstances, as policies regarding this matter. However, Part D of EEOICPA proved to be both
opposed to the more narrowly drawn the remainder of the suggested changes inefficient and extremely time-
Part B radiogenic cancer standard, to the burden of proof described in consuming. Nevertheless, OWCP will
where no difference existed between § 30.231 have not been adopted. use a full range of qualified medical
causation and contribution. specialists to assist in the development
One advocacy group objected to the of claims, especially the kind of
It should also be noted that the
requirement in § 30.232(a)(2) that each complex cases these comments discuss.
regulation specifies that the PoC model
will be determinative under Part E only claimant under Part E provide a signed When a claim involves extreme
with respect to claims where the sole medical release authorizing the release complexity and multiple medical
alleged condition is radiogenic cancer. of any diagnosis, medical opinion or disciplines, OWCP may refer the
When a claim for cancer under Part E medical records documenting the claimant to a panel of physicians for a
cannot be accepted based on exposure employee’s alleged covered illness and medical evaluation. Once a report is
to radiation alone because the PoC was that it resulted from exposure to a toxic received, OWCP’s adjudicatory staff will
determined to be less than 50 percent, substance. The advocacy group is then consider it when they make a
the claimant is provided the concerned that in some cases such decision on the claim. OWCP continues
opportunity to establish that the cancer documents may no longer exist. OWCP to believe that this type of claims
was caused by a combination of is aware of this problem and has adjudication process provides for a
exposure to radiation and exposure to established procedures in § 30.113 by more efficient and expeditious handling
one or more other toxic substances. which a claimant can nevertheless meet of medical disputes and the application
OWCP will adjudicate those claims for this requirement through the of more uniform criteria to resolve such
cancer allegedly due to exposure to submission of affidavits attesting to disputes. Thus, the suggested changes
radiation combined with exposure to medical evidence that was contained in have not been adopted.
one or more other toxic substances documents that no longer exist. The same advocacy group suggested
using the eligibility criteria for other However, a signed medical release is that OWCP state in the regulations the
covered illnesses in §§ 30.230 through needed in all Part E claims so OWCP processes it will follow with respect to
30.232. As a result, no changes were may thoroughly investigate the claim. classified information that may be
made to § 30.213(c) in the final rule. Thus, the suggestion to drop this pertinent to a claim under EEOICPA,
requirement was not adopted. The same and urged that in situations where the
Sections 30.230, 30.231 and 30.232 advocacy group and another advocacy claimant or his or her representative
One labor organization suggested that group suggested that the requirement lacked the requisite security clearances,
the statutory terms ‘‘aggravated,’’ contained in § 30.232(c) that a claimant OWCP should ask the Ombudsman to
‘‘contributed to’’ and ‘‘caused’’ from one establish that a covered Part E employee provide a properly cleared lawyer or
portion of the Part E causation standard suffered an injury, illness, impairment qualified technical expert to evaluate
appearing in section 7385s–4(c)(1)(A) of or disease as a consequence of a covered the factual evidence and advocate on
EEOICPA be defined in § 30.230 of the illness be deleted. These commenters behalf of the claimant during the claims
final rule so it will be ‘‘possible to feel that OWCP claims examiners adjudication process. OWCP is also
determine how DOL will adjudicate should have enough documentation and concerned about the impact of using
claims.’’ However, these statutory terms medical evidence in the case file to classified information to adjudicate
have a long and settled history in made these determinations without claims under the Act. However, since it
workers’ compensation law, and OWCP requiring the submission of additional is not the classifying agency with
believes any attempt to further define medical evidence. However, the nature respect to such information, it cannot
those terms (which involve matters of of these consequential conditions is that allow greater access to the information
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administrative discretion and they only arise subsequent to the than is currently permitted. As for the
professional medical opinion) would development of an underlying suggestion that OWCP should ask the
only lead to increased confusion. As a condition, thus necessitating the Ombudsman to nominate or otherwise
result, § 30.230 has not been amended submission of more recent medical provide a person with the requisite
in the final rule. evidence establishing their causal security clearance to advocate for

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claimants, the Ombudsman is not development of claims under EEOICPA, sections currently provide that the
authorized to perform that function by and adding subpoena requests to this recommended decision and final
either the statute or Secretary’s Order assistance would not appear to be either decision be sent to the claimant, unless
1–2005 (70 FR 33328), which efficient or productive. Therefore, the he or she has a representative. In such
established the Office of the suggested changes to § 30.301 have not a case, the recommended decision and
Ombudsman within the Department. been adopted. final decision are to be sent only to the
The Ombudsman does not have any role One attorney suggested that § 30.302 representative. OWCP believes that
in the claims adjudication process be modified so that claimants will be these suggestions have merit, and also
administered by OWCP. Thus, the relieved of their obligation to pay the notes that this has been the
suggestions were not adopted in the costs associated with subpoenas they administrative practice of the program
final rule. have requested when the subpoenaed for some time. Thus, §§ 30.307(a) and
Another advocacy group suggested witness submits evidence into the case 30.316(e) have been amended in the
that the claims adjudication processes record that is relevant to the claimant’s final rule to provide that OWCP will
described in § 30.300 be altered to case and where the witness failed before send a copy of the recommended
include a review by an ‘‘independent the hearing to provide written evidence decision and the final decision on a
entity’’ like an administrative law judge. after being requested to provide such claim to both the claimant and the
This same suggestion was made by evidence by the claimant. OWCP claimant’s representative, if any.
several commenters with respect to this believes that the suggested modification
section as it appeared in the first interim erroneously presumes that there will Section 30.315
final rule governing its administration of likely be situations where a witness will One attorney suggested that § 30.315
the Act that OWCP published on May refuse to provide requested evidence be amended to permit, at the discretion
25, 2001 (66 FR 28948). As it noted without issuance of a subpoena by a of the FAB reviewer, a postponement of
when it subsequently published the first FAB reviewer. This has not been the a hearing if the claimant’s representative
final rule governing its administration of experience of OWCP in other benefit provides reasonable notice that the
EEOICPA on December 26, 2002 (67 FR programs it administers, and OWCP representative has a medical reason that
78874), OWCP believed that utilizing does not contemplate that it will occur prevents his or her attendance at the
administrative law judges or another in its future administration of Part B. Up claimant’s hearing. The interim final
type of independent review body would to the present time, OWCP has not rule permits such a postponement
unnecessarily complicate and delay the encountered significant difficulty where the claimant is prevented from
claims adjudication process to the obtaining the factual or medical attending the hearing for medical
detriment of claimants. The commenter evidence necessary for it to adjudicate reasons, and it is the current practice of
did not present any new reason not these claims, and there is no reason to OWCP to permit such postponements
previously considered by OWCP when think that these sorts of difficulties will for representatives whose attendance is
it originally decided to retain the occur in the future. Therefore, the prevented for the same reasons. Thus,
adjudicatory structure described in suggestion to modify § 30.302 was not § 30.315(b) has been amended as
§ 30.300, or any evidence of problems adopted in the final rule. suggested by the commenter.
with it since its inception in 2001. Section 30.320
Section 30.303
Therefore, the suggested change to this
section of the regulations was not DOE commented that the 60-day One attorney suggested that
adopted. period within which it was required to § 30.320(b) be amended to require the
respond to a request from OWCP for reopening of a final adverse decision on
Sections 30.301 and 30.302 information or documents relevant to a a claim if the claimant submits new
One advocacy group suggested that claim under Part E of the Act in § 30.303 evidence of a medical condition or
OWCP extend the ability to request was unreasonable, and noted that it discovers additional medical reports.
issuance of a subpoena to include Part would not be able to respond to such a The section currently requires the
E claims as well as Part B claims, and request in a timely manner if the Director for Energy Employees
that this ability should be extended to evidence needed to be reviewed for Occupational Illness Compensation to a
all stages of the claims adjudication declassification purposes. As an reopen a final decision on a claim if he
process. Section 30.301 indicates that a alternative, DOE proposed that the concludes that the claimant has
claimant may request that a Final standard for compliance with such a submitted new and material evidence
Adjudication Branch (FAB) reviewer request be ‘‘as soon as possible.’’ While with regard to either covered
issue a subpoena in connection with a it does not dispute the validity of this employment or exposure to a toxic
claim under Part B of EEOICPA. The concern, OWCP believes that the substance, or identifies either a material
statutory authority underlying this suggested proposal would effectively change in the PoC guidelines, a material
section is derived from section 7384w, remove the time period for response change in the dose reconstruction
which only applies to claims filed under from § 30.303. However, in order to methods or a material addition of a class
Part B; Part E does not contain a similar accommodate DOE’s belief that it of employees to the Special Exposure
provision. Therefore, OWCP does not requires additional time to comply with Cohort. The experience of OWCP with
have authority to extend the ability to these necessary requests, OWCP has respect to the processing and
request a subpoena to claimants under amended § 30.303(a) to provide DOE adjudicating of claims based on
Part E. Further, OWCP has found it to with 90 days within which to respond. occupational or covered illnesses is that
be more efficient to limit the use of new medical evidence of a condition is
subpoenas by claimants to the portion of Sections 30.307 and 30.316 easily obtained and, upon
the claims adjudication process that One attorney suggested that consideration, rarely sufficient to
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includes the right to request an oral §§ 30.307(a) and 30.316(e) be amended warrant the reversal of an earlier
hearing, i.e., the portion before the FAB. to provide that a copy of the determination regarding a claimed
OWCP claims examiners regularly assist recommended decision and the final condition. To permit an automatic
claimants in obtaining relevant decision be sent to both the claimant reopening of a final decision based on
documents and information in the early and the claimant’s representative. These such evidence would inevitably lead to

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numerous frivolous reopenings and the of the examination, § 30.410(b) and the definitions for these two terms that
attendant administrative inefficiencies § 30.411(c) set out the consequences of appear in section 7385s–3(d). Since
would deprive claimants with taking such actions, and have not been these terms cannot be altered through
meritorious claims of the opportunity to altered in the final rule. the rulemaking process, the suggestions
have those claims adjudicated in a This same advocacy group disagreed were not adopted and no changes were
timely manner. It should be noted, with § 30.411(b), which states that when made to § 30.500(a).
however, that claims may be reopened OWCP finds that a conflict in the The same lay representative and two
on the basis of new medical evidence by medical evidence exists, OWCP will of the same individuals also objected to
the Director under § 30.320(a), which select a third physician to conduct a the order of precedence for survivors
permits the Director, at his discretion, to referee examination that resolves such under Part E that is set out in § 30.501(b)
reopen a final decision at any time. For conflict. This process has been in place and argued that a surviving spouse
these reasons, the suggestion regarding since the inception of OWCP’s should not be required to share an
§ 30.320(b) has not been adopted. administration of Part B, and was not award with children of a deceased Part
altered in any way with the E employee under any circumstances.
Sections 30.400, 30.403, 30.404 and promulgation of the interim final rule.
30.405 This section states that if there is a
Further, this same process has been surviving spouse and at least one
OWCP received three comments from used successfully in other benefit ‘‘covered’’ child of a deceased covered
advocacy groups, one from an attorney programs administered by OWCP. Part E employee who is living at the
and two from congressional Accordingly, § 30.411(b) was not time of payment and who is not a
representatives objecting to the wording modified in the final rule. recognized natural child or adopted
in §§ 30.400, 30.403, 30.404 and 30.405 The same advocacy group and another
child of such surviving spouse, half of
that suggested that there was no way for advocacy group criticized the absence of
the payment is made to the surviving
a claimant to administratively challenge any ‘‘conflict of interest’’ provisions
spouse and the other half is shared
a denial of a particular medical benefit. with respect to physicians in the interim
The wording in question was intended equally among all ‘‘covered’’ children of
final rule. These comments asserted that
to describe the process that OWCP’s the employee who are living at the time
it was important that OWCP indicate
medical billing contractor uses to of payment. As was the case with the
that physicians involved in the claims
inform claimants of decisions on adjudication process who submitted survivor definitions discussed in the
medical bills that are submitted for medical evidence upon which OWCP preceding paragraph, the regulatory
payment. However, this wording claims examiners would make order of precedence for survivors under
incorrectly suggested that there was no determinations on claims would be Part E of the Act merely tracks the
administrative method by which a subject to some sort of constraints statutory order of precedence contained
claimant could challenge an adverse regarding such matters as prior in section 7385s–3(c)(3) of EEOICPA.
medical billing determination by involvement with a claimant, former Since the order of precedence for
OWCP’s contractor. To rectify this work for a claimant’s employer, etc. survivors under Part E cannot be
situation, and as suggested by the OWCP agrees with the general thrust of modified by regulation, the suggestion
commenters, §§ 30.400, 30.403, 30.404 these comments, and has added was not adopted.
and 30.405 have been changed to provisions to §§ 30.410 and 30.411 that Section 30.505
indicate that a claimant may indicate that physicians who perform
administratively challenge an adverse directed medical examinations at the Two advocacy groups suggested that
medical billing determination by request of OWCP in connection with the the unified benefit payment processes
utilizing the internal adjudicatory claims adjudication process will be for both Parts B and E described in
processes described in subpart D of the subject to ‘‘conflict of interest’’ § 30.505(a) be amended to require
regulations. standards devised by OWCP to ensure OWCP to issue a ‘‘partial’’ award of
their compliance with ethical standards $12,500 to covered Part E employees at
Sections 30.410 and 30.411 the time it determines that they have
of professional conduct.
One advocacy group asked that OWCP contracted a covered illness, and to
clarify the provisions in §§ 30.410(b) Sections 30.500 and 30.501 determine the balance of any
and 30.411(c) regarding disruptions of A total of 521 comments objecting to compensation due them within another
directed medical examinations. The the definitions of ‘‘covered’’ child and six months. Unlike Part B of EEOICPA,
provisions in question are intended to ‘‘surviving spouse’’ for the purposes of which compensates individuals upon a
remind employees and their Part E in § 30.500(a) were received from finding that a covered Part B employee
representatives that these medical 502 individuals and one lay contracted an occupational illness, Part
examinations are under the control of representative (several individual E monetary compensation can only be
medical professionals and are not, commenters submitted multiple awarded if OWCP further determines
therefore, a proper forum for disputing comments on this issue). While the that a covered Part E employee’s wage-
aspects of individual claim definition of a ‘‘surviving spouse’’ is the loss, impairment or death was due to his
adjudications. These physicians have same one that applies to Part B claims, or her covered illness. Thus, this
been asked to conduct an examination a ‘‘covered’’ child under Part E must suggestion would result in the issuance
at the request of OWCP in order to meet the same definition of a ‘‘child’’ of a monetary award to a claimant
further clarify aspects of an employee’s used in Part B and, as of the date of the before OWCP has determined that the
alleged medical condition, not to treat covered Part E employee’s death, be statutory entitlement criteria established
the employee, and therefore they do not either under the age of 18, under the age by Part E have been met, and that a
have the type of ethical obligations of 23 and a full-time student who was payment is due after any required
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regarding the employee that would continuously enrolled in one or more offsets have been calculated. Shortening
otherwise naturally arise with a normal educational institutions since attaining the monetary benefit payment processes
‘‘doctor-patient’’ relationship. Since any the age of 18 years, or any age and for Part E as suggested by these two
attempt to interfere with a directed incapable of self-support. These commenters would violate the explicit
examination would disrupt the purpose definitions merely follow, as they must, terms of EEOICPA, and therefore the

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suggestions to change § 30.505(a) have Sections 30.513 Through 30.517 provide a claimant with an ‘‘increased’’
not been adopted. One lay representative suggested that lump-sum award equal to the entire
One labor organization suggested that in § 30.517, OWCP should more amount payable under Part B. Section
§ 30.505(d) be amended to permit a specifically describe the circumstances 30.603(b)(2) in the interim final rule
claimant to receive up to the $250,000 under which it would decide to waive merely applies this same principle to
maximum aggregate compensation its statutory right to recover an Part E cases as required by the explicit
payable under Part E for both wage-loss overpayment pursuant to section 7385j– terms of the Act. Since lump-sum
and impairment, for each of his or her 2 of EEOICPA. While § 30.513 of the awards to covered Part E employees
covered illnesses. As OWCP noted in interim final regulations notes the may vary according to their level of
the preamble discussion of this general authority of OWCP to waive impairment and the extent of their
provision of the interim final rule, 42 recovery of an overpayment of EEOICPA wage-loss, there may be instances where
U.S.C. 7385s–12 ‘‘limits the aggregate benefits, §§ 30.514 through 30.517 an objection to a recommended decision
compensation (other than medical elaborate on that authority with a proposing to award benefits under Part
benefits) that OWCP may pay under Part substantial amount of detail. In light of E may result in a final decision
E to all claimants for each individual the variety of factual circumstances and awarding greater benefits. In such a
whose illness or death serves as a basis fairness considerations that may apply case, the gain to the covered Part E
for compensation or benefits under Part in any specific case, it is not possible to employee from the filing of the
E to a total of $250,000. This is the only identify particular circumstances rather objection will not be the entire lump-
reading of the statutory language that is than general principles concerning how sum award; the gain will the difference
consistent with the statutory this authority is to be exercised. between the lump-sum payment and the
requirement that the computation of Therefore, since §§ 30.513 through amount proposed in the recommended
both impairment benefits and wage-loss 30.517 in the interim final regulations decision. To be consistent with Part B,
benefits under [section] 7385s–2 be adequately identify the standards that as required by the statute, the attorney
based upon impairment or wage-loss OWCP will use to make these fees under Part E have to be limited to
that is ’the result of any covered illness.’ determinations without depriving the difference in lump-sum amounts.
This reading is also consistent with OWCP of sufficient flexibility to Thus, the suggested change has not been
congressional intent, as reflected in the administer this aspect of the program, adopted.
Conference Report for Public Law 108– the suggested changes have not been
375, which states that the ‘maximum This attorney and two other attorneys
adopted. also objected to the provision in
aggregate benefit available under [Part]
E of EEOICPA is $250,000.’ See H.R. Section 30.600 § 30.603(b)(1) that does not permit a
Conf. Rep. No. 108–767, at 894 (2004).’’ representative to charge a two percent
One individual suggested that
Thus, the suggested changes have not fee unless he or she was retained prior
§ 30.600(b) make it clearer that a
been adopted. claimant can grant a person a ‘‘power of to the initial filing of the claim. This
attorney’’ to act on his or her behalf, and provision, however, is based on the
Section 30.509 limitation contained in 42 U.S.C.
that such person can then designate a
Two advocacy groups asked why representative to pursue the claim under 7385g(b)(1), which states that a
§ 30.509(c) indicates that OWCP will EEOICPA. OWCP believes there is merit representative may only charge a two
only make an impairment determination in this suggestion. Thus, additional percent fee ‘‘for the filing of an initial
for a deceased Part E employee if an language was added to § 30.600(b) to claim for payment of lump-sum
eligible survivor makes an election to clarify that a person who has been compensation. * * *’’ OWCP believes
receive the compensation of the granted a power of attorney by a that it would violate the statute to
employee as permitted by section claimant under EEOICPA may designate permit a representative to charge a fee
7385s–1(2)(B) of EEOICPA, when the a representative to pursue that claim of two percent of the lump-sum award
Conference Report states that survivors before OWCP. Also, one attorney if the representative was retained after
under Part E are to receive a minimum suggested that OWCP change the claim was filed. One of these two
lump-sum payment of $125,000. These § 30.600(c)(2) to allow an attorney or other attorneys also suggested that the
comments are based on a representative to complete, but not sign, term ‘‘initial claim’’ be defined to
misunderstanding of the operation of a Form EN–20. OWCP believes that this include the filing of amended claim
§ 30.509, which describes the very suggestion has merit, and § 30.600(c)(2) forms, the submission of additional
limited universe of survivors who are has been amended as requested. documents or data, or the reopening of
eligible to make the election described the claim following the issuance of a
in section 7385s–1(2)(B), and the fact Section 30.603 final decision by the FAB; in the
that the only survivors entitled to utilize One attorney suggested that the 10 alternative, he also suggested that the
this election provision would not be percent limit for attorney fees for filing limitations described in the interim
entitled to survivor benefits because the objections to a recommended decision final rule not apply to claims that were
election is only available to survivors of should apply to the amount of the lump- filed prior to the effective date of that
a covered Part E employee who died sum awarded in the final decision. The rule, i.e., June 8, 2005. OWCP believes
‘‘from a cause other than the covered interim final rule currently applies this that an expansive definition of the term
illness of the employee.’’ Survivors who limit to the amount by which the lump- ‘‘initial claim’’ would be inconsistent
make this election will therefore not be sum award is increased as a result of the with the plain meaning of the statute,
eligible to receive any other objections, and is consistent with the which has not changed in this regard
compensation (such as the $125,000 mandate in section 7385s–9 to limit since section 7385g was amended on
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lump-sum payment) under the terms of such fees in Part E cases in the same December 28, 2001. For this same
section 7385s–3. Accordingly, the manner as Part B cases. Since Part B reason, OWCP also believes that there
provision discussed in § 30.509(c) is claimants either receive a full lump-sum would be no justification for applying
correct, and no changes were made to award or no award at all, successful the fee limitations described in § 30.603
this section in the final rule. objections to a recommended decision only to claims filed on or after June 8,

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2005. Thus, none of these suggested wage and/or the extent of compensable exposures. This provision was based on
changes were adopted in the final rule. calendar years of wage-loss than it the somewhat ambiguous language of
determined using § 30.805. However, section 7385s–2(a)(1)(A) of the Act,
Section 30.609
the labor organization did not put which can be read in such a way as to
Two advocacy groups disagreed with forward any discernable proposal to require the apportionment described in
the requirement in § 30.609 that address the purported problem it raised § 30.901(a) of the interim final rule.
claimants must report (for offset in its comment. While it is possible that However, after carefully considering
purposes) any payments that they some employees may incur difficulties both the dearth of support for such
receive due to medical malpractice in securing the type of records described apportionments in the medical literature
resulting from treatment of their as acceptable to OWCP in § 30.806, and the practical difficulties that claims
occupational illness or covered illness. these difficulties alone should not examiners would be faced with if they
Such medical malpractice payments relieve them of their burden to produce were required to make these particular
have as their genesis exposures for records that show a level of wage-loss types of determinations, OWCP agrees
which compensation is payable under sufficient to make them eligible for an with the commenter and has decided to
Part B or Part E of EEOICPA. Under award. OWCP claims examiners are interpret the statutory provision in
section 7385 of EEOICPA, benefits instructed to accept tax returns, pay question as not requiring such an
payable under Part B or Part E must be stubs, union records and pension apportionment. Thus, OWCP has
offset to reflect these types of payments. records as evidence of earnings. In modified § 30.901(a) in the final rule to
Thus, OWCP must be informed of these addition, claims examiners can request remove this requirement. Conforming
types of payments so it can perform the earning records from employers. changes have also been made to
statutorily mandated offset of EEOICPA Therefore, no change has been made to §§ 30.901(d), 30.902, and 30.908(b) and
benefits, and the suggestion to eliminate § 30.806 in the final rule. However, (c).
this section has not been adopted in the because of these concerns, § 30.805 has One lay representative, four
final rule. been amended in the final rule to more individuals and the same labor
Section 30.626 precisely define the term ‘‘wages.’’ organization also criticized the
Another labor organization asserted that description of the criteria for physicians
One lay representative and five some occupations are more likely to be
individuals objected to § 30.626, which to perform impairment evaluations set
affected by the business cycle than
describes the required coordination of out in § 30.901(b), and suggested that
others, and asked that the wages of
payments under Part E of EEOICPA with OWCP modify that description to make
employees in these occupations be
benefits from state workers’ the criteria less restrictive so as to
determined by looking to the average
compensation programs for the same increase the potential pool of physicians
wages of their ‘‘peer group’’ rather than
covered illness or illnesses. However, who can perform impairment
to their own individual wages. OWCP
OWCP is required to coordinate Part E evaluations acceptable to OWCP. After
does not believe that adjustments for
benefits in this manner by section considering several different potential
fluctuations in demand for labor in
7385s–11 of the Act. Thus, the criteria since the issuance of the interim
certain occupations can be made fairly
suggestion to eliminate this section has or efficiently, nor does it believe that it final rule, OWCP believes that it has
not been adopted. has the authority to make this type of developed criteria that will satisfy the
change to the statutory formulae for commenters’ concern that there will be
Sections 30.801, 30.805, 30.806 and few physicians who meet the criteria in
30.815 determining these matters by regulation.
As a result, this suggested change has a given locality, or that claimants will
One individual suggested that also not been adopted. not be able to use their local physicians
§ 30.801 indicate that compensation will One individual suggested a stylistic to perform the testing and
be provided to employees who have change for the wording of § 30.815(b), measurements upon which an
suffered occasional days of lost pay due which he felt was too confusing. Section impairment evaluation under Part E can
to their covered illnesses. However, Part 30.815(b) is merely intended to inform be performed by a physician who meets
E is not a program that provides readers that in most situations, OWCP the criteria. As changed, these criteria
compensation for any wage-loss, will determine the number of will now provide that a physician has
regardless of amount, that a covered Part compensable years of wage-loss in to establish (to OWCP’s satisfaction) that
E employee may experience due to his accordance with the procedures he or she possesses knowledge and
or her covered illness. Instead, Part E described in §§ 30.800 through 30.811. experience in using the American
only provides compensation under a The suggested change is not substantive Medical Association’s Guides to the
specific formula in section 7385s– in nature and would be, in OWCP’s Evaluation of Permanent Impairment
2(a)(2)(A) based on a qualifying amount opinion, more confusing than the (AMA’s Guides) and/or possesses the
of wage-loss sustained in a given language that currently appears in requisite professional background and
calendar year, and this formula cannot § 30.815(b). Therefore, the suggested work experience to conduct acceptable
be altered in this final rule. Thus, the change to this section has not been impairment evaluations. Further, while
suggestion has not been adopted. adopted in the final rule. a claimant’s local physician may not be
One labor organization asserted that it able to satisfy all of the criteria
is more difficult for employees who Section 30.901 described in § 30.901(b) and perform the
worked intermittently at DOE facilities One labor organization questioned impairment evaluation itself, the
to establish their average annual wage OWCP’s ability to make the type of claimant can still elect to have such a
and their alleged calendar years of apportionment determinations physician perform the underlying
wage-loss through reliance on wage data described in § 30.901(a) of the interim objective testing and other procedures
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received from the Social Security final rule and asserted that there was no that another physician who does satisfy
Administration, and that this will result reasoned basis for allocating the cause the criteria could rely upon in arriving
in employees having to use the methods of a permanent impairment of an organ at an evaluation of his or her
of § 30.806 to convince OWCP to or body function among both impairment. Since OWCP has changed
determine a different average annual compensable and non-compensable the policy to which the commenters

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objected, no changes were made to the suggestions to delete the to conserve scarce administrative
§ 30.901(b) in the final rule. requirement in § 30.905(b)(2) were not resources. OWCP does not agree that
adopted. their use in this context is either unduly
Sections 30.905 and 30.906 Two attorneys suggested that § 30.906 burdensome on claimants or inherently
One individual objected to the be amended to provide that OWCP will unfair in a system such as Part E.
provision in § 30.905(b)(1) that only pay for the cost of any additional Therefore, no changes were made to
impairment evaluations performed by impairment evaluation if such § 30.908 as a result of the comment.
physicians who meet the criteria impairment evaluation increases the
identified by OWCP will be considered minimum impairment rating. In the Section 30.910
probative. The comment suggests that interim final rule, this section states that Two comments from congressional
impairment evaluations performed by OWCP will pay for one evaluation if it representatives, four from advocacy
physicians of the Radiation Exposure meets the criteria set forth in groups and two from individuals
Screening and Education Program § 30.905(b), and that it will also pay for objected to the provision in § 30.910(a)
(RESEP) that is administered by the any additional impairment evaluations of the interim final rule that an
Health Resources and Services that it directs the employee to undergo impairment that cannot be assigned a
Administration within HHS be (and reimburse the employee for numerical percentage using the AMA’s
considered probative under Part E of reasonable expenses, as defined in the Guides will not be included in a covered
EEOICPA. OWCP has no objection to rule, that are associated with such an Part E employee’s impairment rating,
claimants submitting impairment evaluation). OWCP is not persuaded and noted that the Conference Report
evaluations performed by a RESEP that there is a reasonable basis for for Public Law 108–375 suggests that for
physician, so long as that physician paying for additional impairment those illnesses for which the AMA’s
meets the qualifications set forth by evaluations beyond those already Guides do not provide a method to
OWCP. The same would be true for described in § 30.906, and therefore the assign a numerical percentage, the
physicians who are affiliated with other suggestion was not adopted in the final Department should devise another
government-sponsored health clinics. rule. method to determine the amount of an
Not all physicians, however, have the impairment award to a covered Part E
necessary training to perform Sections 30.907 and 30.908 employee. See H.R. Conf. Rep. No. 108–
impairment evaluations (as noted above, Two advocacy groups asserted that 767, at 893 (2004). However, as the
claimants can utilize any physician to § 30.907(b) did not provide a process Department pointed out when it
perform the testing and measurements whereby a dispute regarding a covered promulgated § 30.910, the plain
upon which an impairment evaluation Part E employee’s impairment language of section 7385s–2(b) requires
can be performed by a physician who evaluation could be resolved. While OWCP to determine the amount of an
meets OWCP’s criteria). Thus, OWCP § 30.907(b) in the interim final rule impairment award to a covered Part E
must put into place certain criteria to noted that the procedures for ‘‘directed employee in accordance with the
identify those physicians who are medical examinations’’ set out in AMA’s Guides and does not contain the
qualified to perform impairment §§ 30.410 and 30.411 of the regulations exception referred to in the Conference
evaluations upon which it can base its applied to these types of disputes, Report for ‘‘an illness for which the
ratings. As a result, no changes to OWCP acknowledges that it did not [AMA’s Guides] do not provide an
§ 30.905(b)(1) were made in the final explicitly note that such procedures impairment rating. * * *’’ It should be
rule. Two other individuals objected to include the process by which OWCP noted that this suggestion appears to be
the requirement found in § 30.905(b)(2) resolves medical disputes in general. based on the assumption that the AMA’s
that an impairment evaluation must Therefore, in order to make this Guides cannot be used to determine an
have been performed within one year of provision more clear, § 30.907(b) has impairment rating for an illness unless
its submission to OWCP for it to be been modified slightly in the final rule they explicitly provide a method to
considered probative in determining the to explicitly note that OWCP will evaluate that particular illness.
permanent impairment of a covered Part resolve medical disputes regarding However, because the Guides evaluate
E employee and suggested that this impairment through the ‘‘referee the impairment of organs and body
requirement be deleted. OWCP does not examination’’ process set out in functions rather than illnesses per se,
find any merit to this objection because § 30.411. even a newly identified illness can be
the Act requires OWCP to determine the One labor organization objected to the evaluated using the Guides so long as its
minimum impairment rating of the provisions in § 30.908 requiring that effects on those organs and/or body
employee as of the time it is medical evidence of impairment functions are known and quantifiable.
adjudicating the claim for the award. In submitted to the FAB in opposition to As noted above, section 7385s–2(b) of
light of this requirement, OWCP the impairment evaluation that was EEOICPA requires that impairment
believes that it is reasonable to insist relied upon in a recommended decision ratings ‘‘shall be determined in
that the rating be based on an conform to the requirements set out in accordance with the American Medical
impairment evaluation that is no more § 30.905(b) in order to be afforded any Association’s Guides to the Evaluation
than one year old. Two advocacy groups probative value, and noted that of Permanent Impairment.’’ The
also suggested that this same claimants have the burden of proving discussion of mental impairments that
requirement be deleted because covered that the new medical evidence has do not originate from documented
Part E employees with previous greater probative value than the physical dysfunctions of the nervous
temporary impairments from which impairment evaluation relied upon in system in Chapter 14 (Mental and
they have recovered would not receive the recommended decision. Behavioral Disorders) of the AMA’s
compensation. OWCP believes that the Requirements of this sort that set out Guides states that ‘‘there are no precise
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reasoning behind these latter comments minimum standards for new evidence measures of impairment in mental
ignores the mandate in the Act to and the assumption of the burden of disorders. The use of percentages
compensate covered Part E employees proof when challenging a determination implies a certainty that does not exist.’’
for their permanent impairment rather made below are standard features of any Chapter 14 then explains that the
than their temporary impairment. Thus, adjudicative system, and are necessary authors of the current (fifth) edition of

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the AMA’s Guides are ‘‘unaware of data II. Miscellaneous Comments III. Publication in Final
that show the reliability’’ of any Several of the 533 timely comments The Department of Labor has
percentages for these particular types of the Department received raised issues determined, pursuant to 5 U.S.C.
impairments and that ‘‘the Committee that either were not addressed in the 553(b)(B), that good cause exists for
on Disability and Rehabilitation of the interim final regulations or involved waiving public comment on this final
American Psychiatric Association extraneous matters. The Department’s rule with respect to the following
advised Guides contributors against the analysis of these miscellaneous changes: (1) Corrections of
use of percentages in the chapter on comments follows: typographical errors; and (2) minor
mental and behavioral disorders of the wording changes and clarifications that
fourth edition, and that remains the The Ombudsman
do not affect the substance of the
opinion of the authors of the present OWCP received one comment from an regulations. For these changes,
chapter.’’ In support of their decision advocacy group pointing out that the publication of a proposed rule and
not to assign numerical percentages to interim final regulations did not address solicitation of comments would be
mental impairments that do not the role and functions of the neither necessary nor fruitful.
originate from documented physical Ombudsman provided for in section
dysfunctions of the nervous system, the 7385s–15 of EEOICPA. However, this IV. Statutory Authority
authors point out that ‘‘[n]o available omission was intentional and required Section 7384d of EEOICPA provides
empirical evidence supports any by the terms of section 7385s–15(d), general statutory authority, which E.O.
method for assigning a percentage of which requires that the Ombudsman be 13179 allocates to the Secretary, to
impairment of the whole person’’ to independent ‘‘from other officers and prescribe rules and regulations
these disorders. Since the AMA’s employees of the Department [of Labor] necessary for administration of Part B of
Guides clearly takes the position that engaged in activities relating to the the Act. Section 7385s–10(e) also
there is no basis to calculate numerical administration of the provisions of’’ Part provides the Secretary with the general
percentages of mental impairment due E of EEOICPA. Instead, the role and the statutory authority to prescribe
to mental disorders, attempting to do so functions of the Ombudsman are set out regulations necessary for administration
by devising a rating mechanism in Secretary’s Order 1–2005. Therefore, of Part E of the Act. Sections 7384t,
independent of the AMA’s Guides the final rule also does not address 7384u and 7385s–8 provide the specific
would violate EEOICPA’s requirement either the role or the functions of the authority regarding medical treatment
that impairment ratings be determined Ombudsman. and care, including authority to
‘‘in accordance with’’ the AMA’s The Rulemaking Process determine the appropriateness of
Guides. Thus, § 30.910(b) indicates that charges. The Federal Claims Collection
these types of mental impairments will OWCP received one comment from an
attorney on a specific aspect of the Act of 1966, as amended (31 U.S.C. 3701
not be included in an impairment et seq.), authorizes imposition of
rating; no change was made to this rulemaking process. Without identifying
any particular provision of the interest charges and collection of debts
section in the final rule. by withholding funds due the debtor.
regulations, the commenter opined that
Section 30.911 at least some of them would not be V. Paperwork Reduction Act
comprehensible to some members of the
Two comments from individuals, two public and should be rewritten in ‘‘plain This final rule contains information
from congressional representatives, two English.’’ OWCP acknowledges that collection requirements subject to the
from advocacy groups and two from some of the regulations for Part E Paperwork Reduction Act of 1995
attorneys questioned the involve complex medical matters or (PRA), 44 U.S.C. 3501 et seq. The
appropriateness of the provision in complicated arithmetic calculations. requirements set out in §§ 30.401,
§ 30.911(a) in light of the progressive However, while these concepts can be 30.404, 30.420, 30.421, 30.512, 30.518,
nature of the covered illnesses that difficult to comprehend, OWCP went to 30.700, 30.701 and 30.702 of this rule
would be compensable under Part E of great lengths in an effort to ensure that were both submitted to and approved by
EEOICPA. OWCP’s intent in the interim the corresponding regulations in OMB under the PRA in OMB Control
final rule was to apply the requirement subparts I and J were written in a clear Nos. 1215–0054 (expires June 30, 2007),
that an individual reach ‘‘maximum and understandable manner. Since the 1215–0055 (expires October 31, 2009),
medical improvement’’ in order for an commenter neither identified a 1215–0137 (expires March 31, 2007),
impairment rating to be determined in particularly incomprehensible provision 1215–0144 (expires October 31, 2009),
a manner that is appropriate for the of the regulations nor provided any 1215–0176 (expires January 31, 2007),
conditions covered by EEOICPA. OWCP suggested improvements, no additional 1215–0193 (expires March 31, 2007) and
recognizes that many of these covered changes were made to the regulations 1215–0194 (expires March 31, 2007).
illnesses are progressive, and that many based on this comment. The requirements in §§ 30.100, 30.101,
employees may find themselves in a 30.102, 30.103, 30.111, 30.112, 30.113,
situation where their accepted condition Coverage 30.114, 30.206, 30.207, 30.212, 30.213,
is not likely to improve but can be One DOE contractor and four 30.214, 30.215, 30.221, 30.222, 30.226,
expected to gradually deteriorate. The individuals made suggestions about 30.231, 30.232, 30.415, 30.416, 30.417,
intent in the interim final rule was to which workers or survivors should be 30.505, 30.620, 30.806, 30.905 and
allow for minimum impairment ratings covered by Part E of EEOICPA. 30.907of this rule were also both
to be calculated and compensated in However, the Act mandates the submitted to and approved by OMB
such circumstances. However, since the categories of workers and survivors under the PRA in OMB Control No.
wording of § 30.911(a) in the interim covered under Part B and Part E and the 1215–0197 (expires August 31, 2007).
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final rule did not convey this intent as regulations cannot be changed to either Following publication of this final
clearly as it could have, this provision expand or restrict these categories rule, the Department plans to seek OMB
has been modified slightly in the final unless the Act is amended. Therefore, approval of two new information
rule by changing the word ‘‘change’’ to the suggested changes have not been collections under the PRA and will
‘‘improve’’ in the final rule. made in this final rule. issue 60-day Federal Register notices

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seeking public comment on (1) a VI. Executive Order 12866 safety, or State, local, or tribal
collection that will annually request governments or communities, as defined
updated information relating to state This rule is being treated as a by section 3(f)(1) of E.O. 12866. This
workers’ compensation benefits ‘‘significant regulatory action,’’ within rule is also a ‘‘significant regulatory
received by EEOICPA Part E the meaning of E.O. 12866, because it is action’’ because it meets the criterion of
beneficiaries; and (2) a collection ‘‘economically significant’’ as defined section 3(f)(4) of that Order in that it
annually requesting verifying by section 3(f)(1) of that Order. The raises novel or legal policy issues
information on state workers’ payment of the benefits provided for by arising out of the legal mandate
EEOICPA through the program established by EEOICPA.
compensation benefits from state
administered pursuant to this regulatory Based on the factors and assumptions
authorities. These collections will
action has an annual effect on the set forth below, DOL’s estimate of the
implement the Department’s
economy of $100 million or more. aggregate cost of benefits and
responsibilities under section 7385s–11
However, this rule does not adversely administrative expenses of this
of EEOICPA.
affect in a material way the economy, a regulatory action implementing Part B
sector of the economy, productivity, and Part E of EEOICPA is, in millions
jobs, the environment, public health or of dollars:

FY2007 FY2008 FY2009 FY2010 FY2011

Admin ....................................................................................................... $162 $163 $147 $127 $111


Benefits .................................................................................................... 1,123 861 752 656 579

The Department’s estimate of the OWCP to date, future expected receipts, choices have no significant impact on
benefits to be paid pursuant to EEOICPA and the average Part B approval rate. the cost of this regulatory action. Such
and of the administrative costs of The benefit amounts for Part E are policy choices may affect who will be
providing those benefits is based on calculated based on an estimated entitled to receive benefits (such as
program experience to date, data distribution of approved claims with covered Part E employees with
collected from other federal agencies, varying degrees of compensable unratable impairments due to a covered
assumptions about the incidence of impairment and wage-loss, with an illness), but will not have a significant
cancer, covered beryllium disease, average benefit amount of $135,000 and impact on the number of eligible Part B
chronic silicosis and other covered average medical costs of $10,000 per or E beneficiaries or the level of benefits
illnesses in the claimant population, life year for each eligible living employee. to which they are entitled.
expectancy tables, dose reconstruction Additional Part E benefits for OMB has reviewed the rule for
acceptance rates, Physicians Panel individuals who are determined to be consistency with the President’s
acceptances under the former Part D of eligible RECA section 5 uranium priorities and the principles set forth in
the Act, the anticipated distribution of workers are computed based upon the E.O. 12866.
benefit amounts, and its experience in number of such claims received to date VII. Small Business Regulatory
estimating administrative and medical and the expected number of such claims Enforcement Fairness Act
costs of workers’ compensation in the future.
programs. The Department’s benefit As required by Congress under the
Administrative cost estimates were Small Business Regulatory Enforcement
estimates are not based on any developed based upon OWCP’s
projections regarding the number of Fairness Act of 1996 (5 U.S.C. 801 et
experience to date in administering Part seq.), the Department will report to
future additions to the Special Exposure B and the other workers’ compensation
Cohort (SEC). Congress promulgation of this final rule
programs that fall within its area of prior to its effective date. The report
For Part B benefits, estimates for administrative responsibility, using will state that the Department has
cancer claims are based on the actual calculations of the number of incoming concluded that this final rule is a ‘‘major
number of claims received by OWCP, claims and forecasting the necessary rule’’ because it will likely result in an
the anticipated number of future claims, full-time equivalents and other annual effect on the economy of $100
and the historical approval rates for resources that are necessary to million or more.
both SEC and non-SEC claims. Part B efficiently administer the program.
benefit estimates for beryllium exposure No more extensive economic impact VIII. Unfunded Mandates Reform Act
are based on the actual number of such analysis of this rule is necessary because of 1995
claims received by OWCP, anticipated this regulatory action only addresses the Title II of the Unfunded Mandates
future claims, and the historical transfer of funds from the federal Reform Act of 1995 (2 U.S.C. 1531 et
approval rate. Benefit estimates for government to individuals who qualify seq.) directs agencies to assess the
chronic silicosis are based on similar under EEOICPA and to providers of effects of federal regulatory actions on
factors. Benefit estimates for claims that medical services in that program. This state, local, and tribal governments, and
require receipt of an award from DOJ regulatory action has no affect on the the private sector, ‘‘other than to the
under section 5 of RECA are based on functioning of the economy and private extent that such regulations incorporate
historical claim receipts and include the markets, on the health and safety of the requirements specifically set forth in
amounts awarded by DOJ under RECA general population, or on the natural law.’’ For purposes of the Unfunded
but paid from the compensation fund. environment. In addition, because this Mandates Reform Act, this final rule
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Medical benefits for living employees rule implements a statutory mandate, does not include any federal mandate
eligible under Part B are computed there are no feasible alternatives to this that may result in increased annual
using an average of $10,000 per year. regulatory action. Finally, to the extent expenditures in excess of $100 million
Part E benefit estimates for Part E that policy choices have been made in by state, local or tribal governments in
cases are based on cases received by interpreting statutory terms, those the aggregate, or by the private sector.

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IX. Regulatory Flexibility Act a familiar cost control methodology, procedures that claimants under that
The Department believes that this rule OWCP has not altered the billing Part must follow in order to seek review
has ‘‘no significant economic impact environment with which pharmacies are of decisions on their claims, Part E
upon a substantial number of small already familiar. The methods chosen, specifies that claimants under that Part
entities’’ within the meaning of the therefore, represent systems familiar to have 60 days to file petitions for review
Regulatory Flexibility Act (5 U.S.C. 601 the providers. The third of these three of decisions on their claims in the
et seq.). The provisions of this rule that provisions does not have an effect on a United States district courts, and
apply cost-control measures to substantial number of ‘‘small entities’’ mandates the use of an ‘‘arbitrary and
payments for medical expenses are the under Small Business Administration capricious’’ standard of review. It is
only ones that could have a monetary (SBA) standards, since most hospitals reasonably likely that some EEOICPA
effect on small businesses, and have providing services for medical claimants will seek review of adverse
been in effect since OWCP began conditions covered by EEOICPA have decisions in United States district courts
administration of Part B of EEOICPA on annual receipts that exceed the set pursuant to 28 U.S.C. 1331 (for claims
July 31, 2001. The economic effect of maximum. under Part B of EEOICPA) or the
The implementation of these cost- EEOICPA itself (for claims under Part
these cost-control measures are not
control methods does not have a E). This rule should help minimize the
significant for a substantial number of
significant effect on any single medical burden placed on courts by litigation
those businesses who participate in the
professional or pharmacy since they are seeking to challenge decisions under
program under Parts B and E of
already used by Medicare, CHAMPUS, EEOICPA by providing claimants with
EEOICPA, however, because no one
and the Departments of Labor and an opportunity to seek administrative
business bills a significant amount to Veterans Affairs, among Government
OWCP for EEOICPA-related services, review of adverse decisions prior to
entities, and by private insurance resorting to the court system, and by
and the monetary effect on bills that are carriers. In actual terms, the amount by
submitted, while a worthwhile savings providing a clear legal standard for
which these provider bills are reduced affected conduct. The rule has been
for the Government in the aggregate, are does not have a significant impact on
not significant for any individual reviewed carefully to eliminate drafting
any one small entity since these charges errors and ambiguities.
business affected. are currently being processed by other
The cost-control provisions are: (1) A XI. Executive Order 13045 (Protection
payers applying similar cost-control
set schedule of maximum allowable fees provisions. The costs to providers of Children From Environmental,
for professional medical services; (2) a whose charges are reduced also are Health Risks and Safety Risks)
set schedule for payment of pharmacy relatively small because EEOICPA bills
bills; and (3) a prospective payment In accordance with E.O. 13045, the
simply do not represent a large share of Department has evaluated the
system for hospital inpatient services. any single provider’s total business.
The methodologies used for the first two environmental health and safety effects
Since the small universe of potential of this rule on children. The Department
of these provisions were explained in claimants is spread across the United
the text of the preamble to two earlier has determined that the final rule will
States and this bill processing system have no effect on children.
regulatory actions that implemented covers only those employees who have
EEOICPA in 2001 (66 FR 28948) and sustained an occupational illness or a XII. Executive Order 13132
2002 (67 FR 78874), which essentially covered illness and require medical (Federalism)
adopted payment systems that are treatment on or after October 30, 2000, The Department has reviewed this
prevalent in the industry. Their the number of bills submitted by any final rule in accordance with E.O. 13132
adoption for use in connection with one small entity which may be subject and has determined that it does not
OWCP’s administration of Part E of the to these provisions is likely to be very have any ‘‘federalism implications.’’
Act results in continued efficiencies for small. Therefore, the ‘‘cost’’ of this rule The final rule does not ‘‘have
the Government and providers. The to any one pharmacy or medical substantial direct effects on the States,
Government benefits because OWCP did professional is negligible. On the other on the relationship between the national
not develop new cost containment hand, OWCP reaps substantial aggregate government and the States, or on the
measures for Part E claims, but rather cost savings that benefit both OWCP (by distribution of power and
adopted existing and well-recognized strengthening the integrity of the responsibilities among the various
measures that were already in place. program) and the taxpayers to whom the levels of government.’’
The providers benefit because costs of the program are eventually
submitting a bill and receiving a charged. XIII. Executive Order 13211 (Actions
payment is almost the same as The Assistant Secretary for Concerning Regulations That
submitting it to Medicare, a program Employment Standards has certified to Significantly Affect Energy Supply,
with which they are already familiar the Chief Counsel for Advocacy of the Distribution, or Use)
and have existing systems in place for SBA that this rule does not have a In accordance with E.O. 13211, the
billing—they do not have to incur significant impact on a substantial Department has evaluated the effects of
unnecessary administrative costs to number of small entities. The factual this final rule on energy supply,
learn a new process because the basis for this certification has been distribution or use, and has determined
EEOICPA bill process for Part E claims provided above. Accordingly, no that this rule is not likely to have a
is identical to the bill process that regulatory impact analysis is required. significant adverse effect on them.
applies to Part B claims, and is not
readily distinguishable from the X. Executive Order 12988 (Civil Justice XIV. Submission to Congress and the
Medicare billing process. Similarly, Reform) General Accountability Office
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pharmacies are familiar with billing This final rule has been drafted and In accordance with the Small
through clearing houses and having reviewed in accordance with E.O. 12988 Business Regulatory Enforcement
their charges subject to limits by private and will not unduly burden the federal Fairness Act of 1996, the Department
insurance carriers. By adopting private court system. While Part B of EEOICPA will submit to each House of the
sector uniform billing requirements and does not provide any specific Congress and to the Comptroller General

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a report regarding the issuance of this Order No. 2–74 (39 FR 34722). The Benefits Act program are set forth in
final rule prior to the effective date set Assistant Secretary subsequently subchapter B of chapter VI of this title.
forth at the outset of this notice. The designated as the head thereof a Director (c) The rules and regulations of the
report will note that this rule constitutes who, under the general supervision of Employees’ Compensation Appeals
a ‘‘major rule’’ as defined by 5 U.S.C. the Assistant Secretary, administers the Board are set forth in chapter IV of this
804(2). programs assigned to OWCP by the title.
Assistant Secretary. (d) The rules and regulations of the
XV. Catalog of Federal Domestic Benefits Review Board are set forth in
Assistance Number § 1.2 What functions are assigned to Chapter VII of this title.
OWCP?
This program is listed in the Catalog
of Federal Domestic Assistance as No. The Assistant Secretary of Labor for § 1.5 When was the former Bureau of
Employment Standards has delegated Employees’ Compensation abolished?
17.310.
authority and assigned responsibility to By Secretary of Labor’s Order issued
List of Subjects the Director of OWCP for the September 23, 1974 (39 FR 34723),
20 CFR Part 1 Department of Labor’s programs under issued concurrently with Employment
the following statutes: Standards Order 2–74 (39 FR 34722),
Organization and functions (a) The Federal Employees’ the Secretary revoked the prior
(Government agencies). Compensation Act, as amended and Secretary’s Order No. 18–67 (32 FR
20 CFR Part 30 extended (5 U.S.C. 8101 et seq.), except 12979), which had delegated authority
5 U.S.C. 8149 as it pertains to the and assigned responsibility for the
Administrative practice and Employees’ Compensation Appeals various workers’ compensation
procedure, Cancer, Claims, Kidney Board. programs enumerated in § 1.2, except
diseases, Leukemia, Lung diseases, (b) The War Hazards Compensation the Black Lung Benefits Program and
Miners, Radioactive materials, Tort Act (42 U.S.C. 1701 et seq.). the Energy Employees Occupational
claims, Underground mining, Uranium, (c) The War Claims Act (50 U.S.C. Illness Compensation Program not then
Workers’ compensation. App. 2003). in existence, to the Director of the
(d) The Energy Employees former Bureau of Employees’
Text of the Rule
Occupational Illness Compensation Compensation.
■ For the reasons set forth in the Program Act of 2000, as amended (42
preamble, 20 CFR Chapter 1 is amended U.S.C. 7384 et seq.), except activities, § 1.6 How were many of OWCP’s current
as follows: pursuant to Executive Order 13179 functions administered in the past?
(‘‘Providing Compensation to America’s (a) Administration of the Federal
Subchapter A—Organization and
Procedures Nuclear Weapons Workers’’) of Employees’ Compensation Act and the
December 7, 2000, assigned to the Longshore and Harbor Workers’
■ 1. Part 1 is revised to read as follows: Secretary of Health and Human Compensation Act was initially vested
PART 1—PERFORMANCE OF Services, the Secretary of Energy and in an independent establishment known
FUNCTIONS the Attorney General. as the U.S. Employees’ Compensation
(e) The Longshore and Harbor Commission. By Reorganization Plan
Sec. Workers’ Compensation Act, as No. 2 of 1946 (3 CFR, 1943–1949 Comp.,
1.1 Under what authority was the Office of amended and extended (33 U.S.C. 901 et p. 1064; 60 Stat. 1095, effective July 16,
Workers’ Compensation Programs seq.), except: 33 U.S.C. 919(d) with 1946), the Commission was abolished
established? respect to administrative law judges in and its functions were transferred to the
1.2 What functions are assigned to OWCP? the Office of Administrative Law Judges; Federal Security Agency to be
1.3 What rules are contained in this
chapter?
33 U.S.C. 921(b) as it pertains to the performed by a newly created Bureau of
1.4 Where are other rules concerning OWCP Benefits Review Board; and activities, Employees’ Compensation within such
functions found? pursuant to 33 U.S.C. 941, assigned to Agency. By Reorganization Plan No. 19
1.5 When was the former Bureau of the Assistant Secretary of Labor for of 1950 (15 FR 3178, 3 CFR, 1949–1954
Employees’ Compensation abolished? Occupational Safety and Health. Comp., page 1010, 64 Stat. 1271), said
1.6 How were many of OWCP’s current (f) The Black Lung Benefits Act, as Bureau was transferred to the
functions administered in the past? amended (30 U.S.C. 901 et seq.). Department of Labor (DOL), and the
Authority: 5 U.S.C. 301, 8145 and 8149 § 1.3 What rules are contained in this
authority formerly vested in the
(Reorganization Plan No. 6 of 1950, 15 FR chapter? Administrator, Federal Security Agency,
3174, 3 CFR, 1949–1953 Comp., p. 1004, 64 was vested in the Secretary of Labor. By
Stat. 1263); 42 U.S.C. 7384d and 7385s–10; The rules in this chapter are those
governing the OWCP functions under Reorganization Plan No. 6 of 1950 (15
Executive Order 13179, 65 FR 77487, 3 CFR, FR 3174, 3 CFR, 1949–1953 Comp., page
2000 Comp., p. 321; Secretary of Labor’s the Federal Employees’ Compensation
Act, the War Hazards Compensation 1004, 64 Stat. 1263), the Secretary of
Order No. 13–71, 36 FR 8155; Employment
Standards Order No. 2–74, 39 FR 34722. Act, the War Claims Act and the Energy Labor was authorized to make from time
Employees Occupational Illness to time such provisions as he shall deem
§ 1.1 Under what authority was the Office
Compensation Program Act of 2000. appropriate, authorizing the
of Workers’ Compensation Programs performance of any of his functions by
established? § 1.4 Where are other rules concerning any other officer, agency, or employee of
The Assistant Secretary of Labor for OWCP functions found? the DOL.
Employment Standards, by authority (a) The rules of the OWCP governing (b) In 1972, two separate
vested in him by the Secretary of Labor its functions under the Longshore and organizational units were established
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in Secretary’s Order No. 13–71 (36 FR Harbor Workers’ Compensation Act and within the Bureau: an Office of
8755), established in the Employment its extensions are set forth in subchapter Workmen’s Compensation Programs (37
Standards Administration an Office of A of chapter VI of this title. FR 20533) and an Office of Federal
Workers’ Compensation Programs (b) The rules of the OWCP governing Employees’ Compensation (37 FR
(OWCP) by Employment Standards its functions under the Black Lung 22979). In 1974, these two units were

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abolished and one organizational unit, Evidence and Burden of Proof Eligibility Criteria for Claims Relating to
the Office of Workers’ Compensation 30.110 Who is entitled to compensation Chronic Silicosis Under Part B of EEOICPA
Programs, was established in lieu of the under the Act? 30.220 What are the criteria for eligibility
Bureau of Employees’ Compensation (39 30.111 What is the claimant’s responsibility for benefits relating to chronic silicosis?
FR 34722). with respect to burden of proof, 30.221 How does a claimant prove exposure
production of documents, presumptions, to silica in the performance of duty?
■ 2. Subchapter C consisting of part 30
and affidavits? 30.222 How does a claimant establish that
is revised to read as follows: the employee has been diagnosed with
30.112 What kind of evidence is needed to
Subchapter C—Energy Employees establish covered employment and how chronic silicosis or has sustained a
Occupational Illness Compensation will that evidence be evaluated? consequential injury, illness, impairment
Program Act of 2000 30.113 What are the requirements for or disease?
written medical documentation, Eligibility Criteria for Certain Uranium
PART 30—CLAIMS FOR contemporaneous records, and other Employees Under Part B of EEOICPA
COMPENSATION UNDER THE records or documents?
ENERGY EMPLOYEES 30.225 What are the criteria for eligibility
30.114 What kind of evidence is needed to for benefits under Part B of EEOICPA for
OCCUPATIONAL ILLNESS establish a compensable medical certain uranium employees?
COMPENSATION PROGRAM ACT OF condition and how will that evidence be 30.226 How does a claimant establish that
2000, AS AMENDED evaluated? a covered uranium employee has
sustained a consequential injury, illness,
Subpart A—General Provisions Special Procedures for Certain Radiogenic
impairment or disease?
Cancer Claims
Introduction
30.115 For those radiogenic cancer claims Eligibility Criteria for Other Claims Under
Sec. Part E of EEOICPA
that do not seek benefits under Part B of
30.0 What are the provisions of EEOICPA,
in general? the Act pursuant to the Special Exposure 30.230 What are the criteria necessary to
30.1 What rules govern the administration Cohort provisions, what will OWCP do establish that an employee contracted a
of EEOICPA and this chapter? once it determines that an employee covered illness under Part E of
30.2 In general, how have the tasks contracted cancer? EEOICPA?
associated with the administration of the 30.231 How does a claimant prove
Subpart C—Eligibility Criteria employment-related exposure to a toxic
EEOICPA claims process been assigned?
30.3 What do these regulations contain? General Provisions substance at a DOE facility or a RECA
section 5 facility?
Definitions 30.200 What is the scope of this subpart? 30.232 How does a claimant establish that
30.5 What are the definitions used in this Eligibility Criteria for Claims Relating to the employee has been diagnosed with a
part? Covered Beryllium Illness Under Part B of covered illness, or sustained an injury,
EEOICPA illness, impairment or disease as a
Information in Program Records consequence of a covered illness?
30.10 Are all OWCP records relating to 30.205 What are the criteria for eligibility
claims filed under EEOICPA considered for benefits relating to beryllium Subpart D—Adjudicatory Process
confidential? illnesses covered under Part B? 30.300 What process will OWCP use to
30.11 Who maintains custody and control 30.206 How does a claimant prove that the decide claims for entitlement and to
of claim records? employee was a ‘‘covered beryllium provide for administrative review of
30.12 What process is used by a person who employee’’ exposed to beryllium dust, those decisions?
wants to obtain copies of or amend particles or vapor in the performance of 30.301 May subpoenas be issued for
EEOICPA claim records? duty? witnesses and documents in connection
Rights and Penalties 30.207 How does a claimant prove a with a claim under Part B of EEOICPA?
diagnosis of a beryllium disease covered 30.302 Who pays the costs associated with
30.15 May EEOICPA benefits be assigned, under Part B? subpoenas?
transferred or garnished? 30.303 What information may OWCP
30.16 What penalties may be imposed in Eligibility Criteria for Claims Relating to request in connection with a claim under
connection with a claim under the Act? Radiogenic Cancer Under Parts B and E of Part E of EEOICPA?
30.17 Is a beneficiary who defrauds the EEOICPA
government in connection with a claim Recommended Decisions on Claims
30.210 What are the criteria for eligibility
for EEOICPA benefits still entitled to for benefits relating to radiogenic cancer? 30.305 How does OWCP determine
those benefits? entitlement to EEOICPA compensation?
30.211 How does a claimant establish that
Subpart B—Filing Claims; Evidence and the employee has or had contracted 30.306 What does the recommended
Burden of Proof; Special Procedures for cancer? decision contain?
Certain Cancer Claims 30.212 How does a claimant establish that 30.307 To whom is the recommended
the employee contracted cancer after decision sent?
Filing Claims for Benefits Under EEOICPA
beginning employment at a DOE facility, Hearings and Final Decisions on Claims
30.100 In general, how does an employee an atomic weapons employer facility or
file an initial claim for benefits? 30.310 What must the claimant do if he or
a RECA section 5 facility? she objects to the recommended decision
30.101 In general, how is a survivor’s claim 30.213 How does a claimant establish that
filed? or wants to request a hearing?
the radiogenic cancer was at least as 30.311 What happens if the claimant does
30.102 In general, how does an employee
likely as not related to employment at not object to the recommended decision
file a claim for additional impairment or
the DOE facility, the atomic weapons or request a hearing within 60 days?
wage-loss under Part E of EEOICPA?
employer facility, or the RECA section 5 30.312 What will the FAB do if the
30.103 How does a claimant make sure that
OWCP has the evidence necessary to facility? claimant objects to the recommended
process the claim? 30.214 How does a claimant establish that decision but does not request a hearing?
the employee is a member of the Special
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30.313 How is a review of the written


Verification of Alleged Employment Exposure Cohort? record conducted?
30.105 What must DOE do after an 30.215 How does a claimant establish that 30.314 How is a hearing conducted?
employee or survivor files a claim? the employee has sustained an injury, 30.315 May a claimant postpone a hearing?
30.106 Can OWCP request employment illness, impairment or disease as a 30.316 How does the FAB issue a final
verification from other sources? consequence of a diagnosed cancer? decision on a claim?

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30.317 Can the FAB request a further Payment of Claims and Offset for Certain 30.608 How does the United States
response from the claimant or return a Payments calculate the amount to which it is
claim to the district office? 30.505 What procedures will OWCP follow subrogated?
30.318 Can the FAB consider objections to before it pays any compensation? 30.609 Is a settlement or judgment received
HHS’s reconstruction of a radiation dose 30.506 To whom and in what manner will as a result of allegations of medical
or to the guidelines OWCP uses to OWCP pay compensation? malpractice in treating an illness covered
determine if a claimed cancer was at by EEOICPA a recovery that must be
30.507 What compensation will be
least as likely as not related to reported to OWCP?
provided to covered Part B employees
employment? 30.610 Are payments to a covered Part B
who only establish beryllium sensitivity
30.319 May a claimant request employee, a covered Part E employee or
under Part B of EEOICPA?
reconsideration of a final decision of the an eligible surviving beneficiary as a
FAB? 30.508 What is beryllium sensitivity
result of an insurance policy which the
monitoring? employee or eligible surviving
Reopening Claims 30.509 Under what circumstances may a beneficiary has purchased a recovery
30.320 Can a claim be reopened after the survivor claiming under Part E of the Act that must be reported to OWCP?
FAB has issued a final decision? choose to receive the benefits that would 30.611 If a settlement or judgment is
otherwise be payable to a covered Part E received for more than one medical
Subpart E—Medical and Related Benefits employee who is deceased? condition, can the amount paid on a
Medical Treatment and Related Issues Overpayments single EEOICPA claim be attributed to
30.400 What are the basic rules for different conditions for purposes of
30.510 How does OWCP notify an calculating the amount to which the
obtaining medical treatment? individual of a payment made on a
30.401 What are the special rules for the United States is subrogated?
claim?
services of chiropractors? 30.511 What is an ‘‘overpayment’’ for Effect of Tort Suits Against Beryllium
30.402 What are the special rules for the purposes of EEOICPA? Vendors and Atomic Weapons Employers
services of clinical psychologists? 30.512 What does OWCP do when an
30.403 Will OWCP pay for the services of 30.615 What type of tort suits filed against
overpayment is identified? beryllium vendors or atomic weapons
an attendant? 30.513 Under what circumstances may
30.404 Will OWCP pay for transportation to employers may disqualify certain
OWCP waive recovery of an claimants from receiving benefits under
obtain medical treatment? overpayment?
30.405 After selecting a treating physician, Part B of EEOICPA?
30.514 If OWCP finds that the recipient of 30.616 What happens if this type of tort suit
may an employee choose to be treated by an overpayment was not at fault, what
another physician instead? was filed prior to October 30, 2000?
criteria are used to decide whether to 30.617 What happens if this type of tort suit
30.406 Are there any exceptions to these
waive recovery of it? was filed during the period from October
procedures for obtaining medical care?
30.515 Is a recipient responsible for an 30, 2000 through December 28, 2001?
Directed Medical Examinations overpayment that resulted from an error 30.618 What happens if this type of tort suit
30.410 Can OWCP require an employee to made by OWCP? was filed after December 28, 2001?
be examined by another physician? 30.516 Under what circumstances would 30.619 Do all the parties to this type of tort
30.411 What happens if the opinion of the recovery of an overpayment defeat the suit have to take these actions?
physician selected by OWCP differs from purpose of the Act? 30.620 How will OWCP ascertain whether a
the opinion of the physician selected by 30.517 Under what circumstances would claimant filed this type of tort suit and
the employee? recovery of an overpayment be against if he or she has been disqualified from
30.412 Who pays for second opinion and equity and good conscience? receiving any benefits under Part B of
referee examinations? 30.518 Can OWCP require the recipient of EEOICPA?
the overpayment to submit additional
Medical Reports financial information? Coordination of Part E Benefits With State
30.519 How does OWCP communicate its Workers’ Compensation Benefits
30.415 What are the requirements for
medical reports? final decision concerning recovery of an 30.625 What does ‘‘coordination of
30.416 How and when should medical overpayment? benefits’’ mean under Part E of
reports be submitted? 30.520 How are overpayments collected? EEOICPA?
30.417 What additional medical 30.626 How will OWCP coordinate
Subpart G—Special Provisions
information may OWCP require to compensation payable under Part E of
support continuing payment of benefits? Representation EEOICPA with benefits from state
30.600 May a claimant designate a workers’ compensation programs?
Medical Bills 30.627 Under what circumstances will
representative?
30.420 How should medical bills and OWCP waive the statutory requirement
30.601 Who may serve as a representative?
reimbursement requests be submitted? to coordinate these benefits?
30.602 Who is responsible for paying the
30.421 What are the time frames for
representative’s fee? Subpart H—Information for Medical
submitting bills and reimbursement
30.603 Are there any limitations on what Providers
requests?
the representative may charge the
30.422 If an employee is only partially Medical Records and Bills
claimant for his or her services?
reimbursed for a medical expense, must
30.700 What kind of medical records must
the provider refund the balance of the Third Party Liability
providers keep?
amount paid to the employee? 30.605 What rights does the United States 30.701 How are medical bills to be
Subpart F—Survivors; Payments and have upon payment of compensation submitted?
Offsets; Overpayments under EEOICPA? 30.702 How should an employee prepare
30.606 Under what circumstances must a and submit requests for reimbursement
Survivors recovery of money or other property in for medical expenses, transportation
30.500 What special statutory definitions connection with an illness for which costs, loss of wages, and incidental
apply to survivors under EEOICPA? benefits are payable under EEOICPA be expenses?
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30.501 What order of precedence will reported to OWCP? 30.703 What are the time limitations on
OWCP use to determine which survivors 30.607 How is a structured settlement (that OWCP’s payment of bills?
are entitled to receive compensation is, a settlement providing for receipt of
under EEOICPA? funds over a specified period of time) Medical Fee Schedule
30.502 When is entitlement for survivors treated for purposes of reporting the 30.705 What services are covered by the
determined for purposes of EEOICPA? recovery? OWCP fee schedule?

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30.706 How are the maximum fees defined? employee’s initial period of compensable United States Department of Energy
30.707 How are payments for particular wage-loss? (DOE), its predecessor agencies and
services calculated? 30.812 May a covered Part E employee certain of its contractors and
30.708 Does the fee schedule apply to every claim for subsequent periods of subcontractors. Part B also provides for
kind of procedure? compensable wage-loss?
30.709 How are payments for medicinal the payment of supplemental
drugs determined? Special Rules for Certain Survivor Claims compensation benefits to other covered
30.710 How are payments for inpatient Under Part E of EEOICPA Part B employees who have already
medical services determined? 30.815 Are there special rules that OWCP been found eligible for benefits under
30.711 When and how are fees reduced? will use to determine the extent of a section 5 of the Radiation Exposure
30.712 If OWCP reduces a fee, may a deceased covered Part E employee’s Compensation Act, as amended (RECA),
provider request reconsideration of the compensable wage-loss? 42 U.S.C. 2210 note, and where
reduction? applicable, survivors of such persons.
Subpart J—Impairment Benefits Under Part
30.713 If OWCP reduces a fee, may a
provider bill the employee for the
E of EEOICPA Part E of the Act provides for the
balance? General Provisions payment of compensation benefits to
covered Part E employees and, where
Exclusion of Providers 30.900 Who can receive impairment
benefits under Part E?
applicable, survivors of such employees.
30.715 What are the grounds for excluding The regulations in this part describe the
30.901 How does OWCP determine the
a provider for payment under this part? rules governing filing, processing, and
extent of an employee’s impairment that
30.716 What will cause OWCP to paying claims for benefits under both
is due to a covered illness contracted
automatically exclude a physician or
through exposure to a toxic substance at Part B and Part E of EEOICPA.
other provider of medical services and
supplies?
a DOE facility or a RECA section 5 (a) Part B of EEOICPA provides for the
facility, as appropriate? payment of either lump-sum monetary
30.717 When are OWCP’s exclusion
30.902 How will OWCP calculate the compensation for the disability of a
procedures initiated?
amount of the award of impairment covered Part B employee due to an
30.718 How is a provider notified of
benefits that is payable under Part E?
OWCP’s intent to exclude him or her? occupational illness or for monitoring
30.719 What requirements must the Medical Evidence of Impairment for beryllium sensitivity, as well as for
provider’s reply and OWCP’s decision 30.905 How may an impairment evaluation medical and related benefits for such
meet? be obtained? illness. Part B also provides for the
30.720 How can an excluded provider 30.906 Who will pay for an impairment
request a hearing?
payment of monetary compensation for
evaluation? the disability of a covered Part B
30.721 How are hearings assigned and 30.907 Can an impairment evaluation
scheduled? employee to specified survivors if the
obtained by OWCP be challenged prior
30.722 How are subpoenas or advisory to issuance of the recommended
employee is deceased at the time of
opinions obtained? decision? payment.
30.723 How will the administrative law 30.908 How will the FAB evaluate new (b) Part E of EEOICPA provides for the
judge conduct the hearing and issue the medical evidence submitted to challenge payment of monetary compensation for
recommended decision? the impairment determination in the the established wage-loss and/or
30.724 How can a party request review by recommended decision? impairment of a covered Part E
OWCP of the administrative law judge’s employee due to a covered illness, and
recommended decision? Ratable Impairments
30.725 What are the effects of non-
for medical and related benefits for such
30.910 Will an impairment that cannot be covered illness. Part E also provides for
automatic exclusion? assigned a numerical percentage using
30.726 How can an excluded provider be the AMA’s Guides be included in the
the payment of monetary compensation
reinstated? impairment rating? for the death (and established wage-loss,
30.911 Does maximum medical where applicable) of a covered Part E
Subpart I—Wage-Loss Determinations
Under Part E of EEOICPA improvement always have to be reached employee to specified survivors if the
for an impairment to be included in the covered Part E employee is deceased at
General Provisions impairment rating? the time of payment.
30.800 What types of wage-loss are 30.912 Can a covered Part E employee (c) All types of benefits and
compensable under Part E of EEOICPA? receive benefits for additional conditions of eligibility listed in this
30.801 What special definitions does OWCP impairment following an award of such section are subject to the provisions of
use in connection with Part E wage-loss benefits by OWCP?
EEOICPA and this part.
determinations? Authority: 5 U.S.C. 301; 31 U.S.C. 3716
and 3717; 42 U.S.C. 7384d, 7384t, 7384u and § 30.1 What rules govern the
Evidence of Wage-Loss administration of EEOICPA and this
7385s–10; Executive Order 13179, 65 FR
30.805 What evidence does OWCP use to 77487, 3 CFR, 2000 Comp., p. 321; Secretary chapter?
determine a covered Part E employee’s of Labor’s Order No. 4–2001, 66 FR 29656. In accordance with EEOICPA,
average annual wage and whether he or Executive Order 13179 and Secretary’s
she experienced compensable wage-loss Subpart A—General Provisions
under Part E of EEOICPA?
Order No. 4–2001, the primary
30.806 May a claimant submit factual Introduction responsibility for administering the Act,
evidence in support of a different except for those activities assigned to
determination of average annual wage § 30.0 What are the provisions of the Secretary of Health and Human
and/or wage-loss than that found by EEOICPA, in general? Services (HHS), the Secretary of Energy
OWCP? Part B of the Energy Employees and the Attorney General, has been
Determinations of Average Annual Wage Occupational Illness Compensation delegated to the Assistant Secretary of
and Percentages of Loss Program Act of 2000, as amended Labor for Employment Standards. The
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30.810 How will OWCP calculate the


(EEOICPA or Act), 42 U.S.C. 7384 et Assistant Secretary, in turn, has
average annual wage of a covered Part E seq., provides for the payment of delegated the responsibility for
employee? compensation benefits to covered Part B administering the Act to the Director of
30.811 How will OWCP calculate the employees and, where applicable, the Office of Workers’ Compensation
duration and extent of a covered Part E survivors of such employees, of the Programs (OWCP). Except as otherwise

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provided by law, the Director of OWCP persons seeking benefits under OWCP medical fee schedule, as well as
and his or her designees have the EEOICPA, as well as personnel in the the provisions for exclusion of medical
exclusive authority to administer, various federal agencies and DOL who providers.
interpret and enforce the provisions of process claims filed under EEOICPA or (i) Subpart I: The rules relating to the
the Act. who perform administrative functions adjudication of alleged periods of wage-
with respect to EEOICPA. The various loss of covered Part E employees. It also
§ 30.2 In general, how have the tasks subparts of this part contain the includes provisions on the use by
associated with the administration of
following: OWCP of Social Security
EEOICPA claims process been assigned?
(a) Subpart A: The general statutory Administration earnings information
(a) In E.O. 13179, the President and administrative framework for and certain medical evidence to
assigned the tasks associated with processing claims under both Parts B establish compensable wage-loss.
administration of the EEOICPA claims and E of EEOICPA. It contains a (j) Subpart J: The rules relating to the
process among the Secretaries of Labor, statement of purpose and scope, adjudication of alleged permanent
HHS and Energy, and the Attorney together with definitions of terms, impairment due to the exposure of
General. In light of the fact that the information regarding the disclosure of covered Part E employees to toxic
Secretary of Labor has been assigned OWCP records, and a description of substances. It includes provisions
primary responsibility for administering rights and penalties involving EEOICPA relating to the medical evaluation of
EEOICPA, almost the entire claims claims, including convictions for fraud. ratable impairments, the rating of
process is within the exclusive control (b) Subpart B: The rules for filing progressive conditions, and
of OWCP. This means that all claimants claims for entitlement under EEOICPA. qualifications of physicians.
file their claims with OWCP, and OWCP It also addresses general standards
is responsible for granting or denying regarding necessary evidence and the Definitions
compensation under the Act (see burden of proof, descriptions of basic § 30.5 What are the definitions used in this
§§ 30.100 through 30.102). OWCP also forms and special procedures for certain part?
provides assistance to claimants and cancer claims.
potential claimants by providing (c) Subpart C: The eligibility criteria (a) Act or EEOICPA means the Energy
information regarding eligibility and for occupational illnesses and covered Employees Occupational Illness
other program requirements, including illnesses compensable under Parts B Compensation Program Act of 2000, as
information on completing claim forms and E of EEOICPA, respectively. amended (42 U.S.C. 7384 et seq.).
and the types and availability of (d) Subpart D: The rules governing the (b) Atomic weapon means any device
medical testing and diagnostic services adjudication process leading to utilizing atomic energy, exclusive of the
related to occupational illnesses under recommended and final decisions on means for transporting or propelling the
Part B of the Act and covered illnesses claims for entitlement filed under Parts device (where such means is a separable
under Part E of the Act. In addition, B and E of EEOICPA. It also describes and divisible part of the device), the
OWCP provides an administrative the hearing and reopening processes. principle purpose of which is for use as,
review process for claimants who (e) Subpart E: The rules governing or for development of, a weapon, a
disagree with its recommended and medical care, second opinion and weapon prototype, or a weapon test
final adverse decisions on claims of referee medical examinations and device.
entitlement (see §§ 30.300 through impairment evaluations directed by (c) Atomic weapons employee means:
30.320). OWCP as part of its adjudication of (1) An individual employed by an
(b) However, HHS has exclusive entitlement, and medical reports and atomic weapons employer during a
control of the portion of the claims records in general. It also addresses the period when the employer was
process under which it provides kinds of medical treatment that may be processing or producing, for the use by
reconstructed doses for certain authorized and how medical bills are the United States, material that emitted
radiogenic cancer claims (see § 30.115). paid. radiation and was used in the
HHS also has exclusive control of the (f) Subpart F: The rules relating to the production of an atomic weapon,
process for designating classes of payment of monetary compensation excluding uranium mining and milling;
employees to be added to the Special available under Parts B and E of or
Exposure Cohort under Part B of the EEOICPA. It includes provisions on (2)(i) An individual employed at a
Act, and has promulgated regulations medical monitoring for beryllium facility that the National Institute for
governing that process at 42 CFR part sensitivity, on the identification, Occupational Safety and Health
83. Finally, HHS has promulgated processing and recovery of (NIOSH) reported had a potential for
regulations at 42 CFR part 81 that set overpayments of compensation, and on significant residual contamination
out guidelines that OWCP follows when the maximum aggregate amount of outside of the period described in
it assesses the compensability of an compensation payable under Part E. paragraph (c)(1) of this section;
employee’s radiogenic cancer (see (g) Subpart G: The rules concerning (ii) By the atomic weapons employer
§ 30.213). DOE and DOJ must, among the representation of claimants in that owned the facility referred to in
other things, notify potential claimants connection with the administrative paragraph (c)(2)(i) of this section, or a
and submit evidence that OWCP deems adjudication of claims before OWCP, subsequent owner or operator of such
necessary for its adjudication of claims subrogation of the United States, the facility; and
under EEOICPA (see §§ 30.105, 30.112, effect of tort suits against beryllium (iii) During a period reported by
30.206, 30.212 and 30.221). vendors and atomic weapons NIOSH, in its report dated October 2003
employers, and the coordination of and titled ‘‘Report on Residual
§ 30.3 What do these regulations contain? benefits under Part E of EEOICPA with Radioactive and Beryllium
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This part 30 sets forth the regulations state workers’ compensation benefits for Contamination at Atomic Weapons
governing administration of all claims the same covered illness. Employer Facilities and Beryllium
that are filed with OWCP, except to the (h) Subpart H: Information for Vendor Facilities,’’ or any update to that
extent specified in certain provisions. medical providers. It includes rules for report, to have a potential for significant
Its provisions are intended to assist medical reports, medical bills, and the residual radioactive contamination.

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(d) Atomic weapons employer means (2) A written diagnosis of silicosis is was the employee or the deceased
any entity, other than the United States, made by a medical doctor and is employee’s survivor.
that: accompanied by: (t) Current or former employee as
(1) Processed or produced, for use by (i) A chest radiograph, interpreted by defined in 5 U.S.C. 8101(1) as used in
the United States, material that emitted an individual certified by NIOSH as a B § 30.205(a)(1) means an individual who
radiation and was used in the reader, classifying the existence of fits within one of the following listed
production of an atomic weapon, pneumoconioses of category 1/0 or groups:
excluding uranium mining and milling; higher; or (1) A civil officer or employee in any
and (ii) Results from a computer assisted branch of the Government of the United
(2) Is designated by the Secretary of tomograph or other imaging technique States, including an officer or employee
Energy as an atomic weapons employer that are consistent with silicosis; or of an instrumentality wholly owned by
for purposes of the compensation (iii) Lung biopsy findings consistent the United States;
program. with silicosis. (2) An individual rendering personal
(e) Atomic weapons employer facility (k) Claim means a written assertion to service to the United States similar to
means any facility, owned by an atomic OWCP of an individual’s entitlement to the service of a civil officer or employee
weapons employer, that: benefits under EEOICPA, submitted in a of the United States, without pay or for
(1) Is or was used to process or manner authorized by this part. nominal pay, when a statute authorizes
produce, for use by the United States, (l) Claimant means the individual the acceptance or use of the service, or
material that emitted radiation and was who is alleged to satisfy the criteria for authorizes payment of travel or other
used in the production of an atomic compensation under the Act. expenses of the individual;
weapon, excluding uranium mining or (m) Compensation fund or fund (3) An individual, other than an
milling; and means the fund established on the books independent contractor or individual
(2) Is designated as such in the list of the Treasury for payment of benefits employed by an independent contractor,
periodically published in the Federal and compensation under the Act. employed on the Menominee Indian
Register by DOE. (n) Contemporaneous record means Reservation in Wisconsin in operations
(f) Attorney General means the any document created at or around the conducted under a statute relating to
Attorney General of the United States or time of the event that is recorded in the tribal timber and logging operations on
the United States Department of Justice document. that reservation;
(DOJ). (o) Covered beryllium illness means (4) An individual appointed to a
(g) Benefit or Compensation means any of the following: position on the office staff of a former
the money the Department pays to or on (1) Beryllium sensitivity as President; or
behalf of either a covered Part B established by an abnormal LPT (5) An individual selected and serving
employee under Part B, or a covered performed on either blood or lung as a Federal petit or grand juror.
Part E employee under Part E, from the lavage cells. (u) Department means the United
Energy Employees Occupational Illness (2) Established chronic beryllium States Department of Labor (DOL).
Compensation Fund. However, the term disease (see § 30.207(c)). (v) Department of Energy or DOE
‘‘compensation’’ used in section (3) Any injury, illness, impairment, or includes the predecessor agencies of the
7385f(b) of EEOICPA (restricting disability sustained as a consequence of DOE, including the Manhattan
entitlement to only one payment of a covered beryllium illness referred to Engineering District.
compensation under Part B) means only in paragraphs (o)(1) or (2) of this (w) Department of Energy contractor
the payments specified in section section. employee means any of the following:
7384s(a)(1) and in section 7384u(a). (p) Covered Part E employee means, (1) An individual who is or was in
Except as used in section 7385f(b), these under Part E of the Act, a Department residence at a DOE facility as a
two terms also include any other of Energy contractor employee or a researcher for one or more periods
amounts paid out of the Fund for such RECA section 5 uranium worker who aggregating at least 24 months.
things as medical treatment, monitoring, has been determined by OWCP to have (2) An individual who is or was
examinations, services, appliances and contracted a covered illness (see employed at a DOE facility by:
supplies as well as for transportation paragraph (r) of this section) through (i) An entity that contracted with the
and expenses incident to the securing of exposure at a Department of Energy DOE to provide management and
such medical treatment, monitoring, facility or a RECA section 5 facility, as operating, management and integration,
examinations, services, appliances, and appropriate. or environmental remediation at the
supplies. (q) Covered Part B employee means, facility; or
(h) Beryllium sensitization or under Part B of the Act, a covered (ii) A contractor or subcontractor that
sensitivity means that the individual has beryllium employee (see § 30.205), a provided services, including
an abnormal beryllium lymphocyte covered employee with cancer (see construction and maintenance, at the
proliferation test (LPT) performed on § 30.210(a)), a covered employee with facility.
either blood or lung lavage cells. chronic silicosis (see § 30.220), or a (x)(1) Department of Energy facility
(i) Beryllium vendor means the covered uranium employee (see means, as determined by the Director of
specific corporations and named paragraph (s) of this section). OWCP, any building, structure, or
predecessor corporations listed in (r) Covered illness means, under Part premise, including the grounds upon
section 7384l(6) of the Act and any of E of the Act relating to exposures at a which such building, structure, or
the facilities designated as such in the DOE facility or a RECA section 5 premise is located:
list periodically published in the facility, an illness or death resulting (i) In which operations are, or have
Federal Register by DOE. from exposure to a toxic substance. been, conducted by, or on behalf of, the
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(j) Chronic silicosis means a non- (s) Covered uranium employee means, DOE (except for buildings, structures,
malignant lung disease if: under Part B of the Act, an individual premises, grounds, or operations
(1) The initial occupational exposure who has been determined by DOJ to be covered by E.O. 12344, dated February
to silica dust preceded the onset of entitled to an award under section 5 of 1, 1982, pertaining to the Naval Nuclear
silicosis by at least 10 years; and RECA, whether or not the individual Propulsion Program); and

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(ii) With regard to which the DOE has (ff) Specified cancer (as defined in last date on which a covered Part B
or had: section 4(b)(2) of RECA and in employee was exposed to radiation in
(A) A proprietary interest; or EEOICPA) means: the performance of duty in accordance
(B) Entered into a contract with an (1) Leukemia (other than chronic with section 7384n(b) of the Act or, in
entity to provide management and lymphocytic leukemia) provided that the case of a member of the Special
operation, management and integration, the onset of the disease was at least 2 Exposure Cohort, the last date on which
environmental remediation services, years after first exposure; the member of the Special Exposure
construction, or maintenance services. (2) Lung cancer (other than in situ Cohort was employed at the Department
(2) DOL has adopted the lung cancer that is discovered during or of Energy facility or the atomic weapons
determinations of the Department of after a post-mortem exam); employer facility at which the member
Energy regarding Department of Energy (3) Bone cancer;
was exposed to radiation; or
facilities that were contained in the list (4) Renal cancers; or
of facilities published in the Federal (5) The following diseases, provided (3) In regard to a claim arising out of
Register on August 23, 2004 (69 FR onset was at least 5 years after first exposure to a toxic substance, the last
51825). DOL will periodically update exposure: date on which a covered Part E
this list as it deems appropriate in its (i) Multiple myeloma; employee was employed at the
sole discretion by publishing a revised (ii) Lymphomas (other than Hodgkin’s Department of Energy facility or RECA
list of Department of Energy facilities in disease); and section 5 facility, as appropriate, at
the Federal Register. (iii) Primary cancer of the: which the exposure took place.
(y) Disability means, for purposes of (A) Thyroid;
(B) Male or female breast; (ii) Toxic substance means any
determining entitlement to payment of
(C) Esophagus; material that has the potential to cause
Part B benefits under section 7384s(a)(1)
(D) Stomach; illness or death because of its
of the Act, having been determined by
(E) Pharynx; radioactive, chemical, or biological
OWCP to have or have had established
(F) Small intestine; nature.
chronic beryllium disease, cancer, or (G) Pancreas;
chronic silicosis. (jj) Workday means a single workshift
(H) Bile ducts;
(z) Eligible surviving beneficiary (I) Gall bladder; whether or not it occurred on more than
means any individual who is entitled (J) Salivary gland; one calendar day.
under sections 7384s(e), 7384u(e), or (K) Urinary bladder;
7385s–3(c) and (d) of the Act to receive Information in Program Records
(L) Brain;
a payment on behalf of a deceased (M) Colon; § 30.10 Are all OWCP records relating to
covered Part B employee or a deceased (N) Ovary; or claims filed under EEOICPA considered
covered Part E employee. (O) Liver (except if cirrhosis or confidential?
(aa) Employee means either a current hepatitis B is indicated).
or former employee. (6) The specified diseases designated All OWCP records relating to claims
(bb) Occupational illness means, in this section mean the physiological for benefits under EEOICPA are
under Part B of the Act, a covered condition or conditions that are considered confidential and may not be
beryllium illness, cancer sustained in recognized by the National Cancer released, inspected, copied or otherwise
the performance of duty as defined in Institute under those names or disclosed except as provided in the
§ 30.210(a), specified cancer, chronic nomenclature, or under any previously Freedom of Information Act and the
silicosis, or an illness for which DOJ has accepted or commonly used names or Privacy Act of 1974.
awarded compensation under section 5 nomenclature.
of RECA. (gg) Survivor means: § 30.11 Who maintains custody and
(cc) OWCP means the Office of (1) For claims under Part B of the Act, control of claim records?
Workers’ Compensation Programs, and subject to paragraph (gg)(3) of this All OWCP records relating to claims
United States Department of Labor. One section, a surviving spouse, child, for benefits filed under the Act are
of the four divisions of OWCP is the parent, grandchild and grandparent of a covered by the Privacy Act system of
Division of Energy Employees deceased covered Part B employee. records entitled DOL/ESA–49 (Office of
Occupational Illness Compensation. (2) For claims under Part E of the Act, Workers’ Compensation Programs,
(dd) Physician includes surgeons, and subject to paragraph (gg)(3) of this Energy Employees Occupational Illness
podiatrists, dentists, clinical section, a surviving spouse and child of Compensation Program Act File). This
psychologists, optometrists, a deceased covered Part E employee. system of records is maintained by and
chiropractors, and osteopathic (3) Those individuals listed in
under the control of OWCP, and, as
practitioners within the scope of their paragraphs (gg)(1) and (gg)(2) of this
practice as defined by state law. The such, all records covered by DOL/ESA–
section do not include any individuals
term ‘‘physician’’ includes chiropractors 49 are official records of OWCP. The
not living as of the time OWCP makes
only to the extent that their a lump-sum payment or payments to an protection, release, inspection and
reimbursable services are limited to eligible surviving beneficiary or copying of records covered by DOL/
treatment consisting of manual beneficiaries. ESA–49 shall be accomplished in
manipulation of the spine to correct a (hh) Time of injury means: accordance with the rules, guidelines
subluxation as demonstrated by x-ray to (1) In regard to a claim arising out of and provisions of this part, as well as
exist. exposure to beryllium or silica, the last those contained in 29 CFR parts 70 and
(ee) Qualified physician means any date on which a covered Part B 71, and with the notice of the system of
physician who has not been excluded employee was exposed to such records and routine uses published in
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under the provisions of subpart H of this substance in the performance of duty in the Federal Register. All questions
part. Except as otherwise provided by accordance with sections 7384n(a) or relating to access, disclosure, and/or
regulation, a qualified physician shall 7384r(c) of the Act; or amendment of claims records
be deemed to be designated or approved (2) In regard to a claim arising out of maintained by OWCP are to be resolved
by OWCP. exposure to radiation under Part B, the in accordance with this section.

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§ 30.12 What process is used by a person federal or state criminal charges of Part E of EEOICPA be considered to be
who wants to obtain copies of or amend defrauding the federal or a state ‘‘filed’’ earlier than October 30, 2000.
EEOICPA claim records? government in connection with a claim (1) The employee, or the person filing
(a) A claimant seeking copies of his or for benefits under the Act or any other the claim on behalf of the employee,
her official EEOICPA file should address federal or state workers’ compensation shall affirm that the information
a request to the District Director of the law, the beneficiary forfeits (effective provided on the Form EE–1 is true, and
OWCP district office having custody of the date either the guilty plea is must inform OWCP of any subsequent
the file. accepted or a verdict of guilty is changes to that information.
(b) Any request to amend a record returned after trial) any entitlement to (2) Except for a covered uranium
covered by DOL/ESA–49 should be any further benefits for any injury, employee filing a claim under Part B of
directed to the district office having illness or death covered by this part for the Act, the employee is responsible for
custody of the official file. which the time of injury was on or submitting with his or her claim, or
(c) Any administrative appeal taken before the date of such guilty plea or arranging for the submission of, medical
from a denial issued by OWCP under verdict. Any subsequent change in or evidence to OWCP that establishes that
this section shall be filed with the recurrence of the beneficiary’s medical he or she sustained an occupational
Solicitor of Labor in accordance with 29 illness and/or a covered illness. This
condition does not affect termination of
CFR 71.7 and 71.9. required medical evidence is described
entitlement under this section.
Rights and Penalties in § 30.114 and does not refer to mere
Subpart B—Filing Claims; Evidence recitations of symptoms the employee
§ 30.15 May EEOICPA benefits be and Burden of Proof; Special experienced that the employee believes
assigned, transferred or garnished? Procedures for Certain Cancer Claims indicate that he or she sustained an
(a) Pursuant to section 7385f(a) of the occupational illness or a covered illness.
Act, no claim for EEOICPA benefits may Filing Claims for Benefits Under (d) For those claims under Part E of
be assigned or transferred. EEOICPA EEOICPA that were originally filed with
(b) Provisions of the Social Security DOE as claims for assistance under
§ 30.100 In general, how does an employee
Act (42 U.S.C. 659) and regulations file an initial claim for benefits? former section 7385o of EEOICPA
issued by the Office of Personnel (which was repealed on October 28,
Management at 5 CFR part 581 permit (a) To claim benefits under EEOICPA,
2004), a claim is considered to be
the garnishment of payments of an employee must file a claim in
‘‘filed’’ on the date that the employee
EEOICPA monetary benefits to collect writing. Form EE–1 should be used for
mailed his or her claim to DOE, as
overdue alimony and child support. A this purpose, but any written
determined by postmark, or on the date
request to garnish a payment for either communication that requests benefits
that the claim was received by DOE,
of these purposes should be submitted under EEOICPA will be considered a
whichever is the earliest determinable
to the district office that is handling the claim. It will, however, be necessary for
date. However, in no event will a claim
EEOICPA claim, and must be an employee to submit a Form EE–1 for
referred to in this paragraph be
accompanied by a copy of the pertinent OWCP to fully develop the claim.
considered to be ‘‘filed’’ earlier than
state agency or court order. Copies of Form EE–1 may be obtained
October 30, 2000.
from OWCP or on the Internet at
§ 30.16 What penalties may be imposed in http://www.dol.gov/esa/regs/ § 30.101 In general, how is a survivor’s
connection with a claim under the Act? compliance/owcp/eeoicp/main.htm. claim filed?
(a) Other statutory provisions make it The employee’s claim must be filed (a) A survivor of an employee who
a crime to file a false or fraudulent claim with OWCP, but another person may do sustained an occupational illness or a
or statement with the federal so on the employee’s behalf. covered illness must file a claim for
government in connection with a claim (b) The employee may choose, at his compensation in writing. Form EE–2
under the Act. Included among these or her own option, to file for benefits for should be used for this purpose, but any
provisions is 18 U.S.C. 1001. only certain conditions that are written communication that requests
Enforcement of criminal provisions that potentially compensable under the Act survivor benefits under the Act will be
may apply to claims under the Act is (e.g., the employee may not want to considered a claim. It will, however, be
within the jurisdiction of the claim for an occupational illness or a necessary for a survivor to submit a
Department of Justice. covered illness for which a payment has Form EE–2 for OWCP to fully develop
(b) In addition, administrative been received that would necessitate an the claim. Copies of Form EE–2 may be
proceedings may be initiated under the offset of EEOICPA benefits under the obtained from OWCP or on the Internet
Program Fraud Civil Remedies Act of provisions of § 30.505(b) of these at http://www.dol.gov/esa/regs/
1986 (PFCRA), 31 U.S.C. 3801 et seq., to regulations). The employee may compliance/owcp/eeoicp/main.htm.
impose civil penalties and assessments withdraw his or her claim by so The survivor’s claim must be filed with
against persons or entities who make, requesting in writing to OWCP at any OWCP, but another person may do so on
submit or present, or cause to be made, time before OWCP determines his or her the survivor’s behalf. Although only one
submitted or presented, false, fictitious eligibility for benefits. survivor needs to file a claim under this
or fraudulent claims or written (c) Except as provided in paragraph section to initiate the development
statements to OWCP in connection with (d) of this section, a claim is considered process, OWCP will distribute any
a claim under EEOICPA. The to be ‘‘filed’’ on the date that the monetary benefits payable on the claim
Department’s regulations implementing employee mails his or her claim to among all eligible surviving
PFCRA are found at 29 CFR part 22. OWCP, as determined by postmark, or beneficiaries who have filed claims with
§ 30.17 Is a beneficiary who defrauds the on the date that the claim is received by OWCP.
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government in connection with a claim for OWCP, whichever is the earliest (b) A survivor may choose, at his or
EEOICPA benefits still entitled to those determinable date. However, in no event her own option, to file for benefits for
benefits? will a claim under Part B of EEOICPA only certain conditions that are
When a beneficiary either pleads be considered to be ‘‘filed’’ earlier than potentially compensable under the Act
guilty to or is found guilty on either July 31, 2001, nor will a claim under (e.g., the survivor may not want to claim

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for an occupational illness or a covered covered spouse or covered child under must inform OWCP of any subsequent
illness for which a payment has been Part E, may submit a written request to changes to that information.
received that would necessitate an offset OWCP for a determination of whether (2) The employee is responsible for
of EEOICPA benefits under the that deceased DOE contractor employee submitting with any claim filed under
provisions of § 30.505(b) of these or RECA section 5 uranium worker this section, or arranging for the
regulations). The survivor may contracted a covered illness under submission of, factual and medical
withdraw his or her claim by so section 7385s–4(d) of EEOICPA. evidence establishing that he or she
requesting in writing to OWCP at any (1) Any such request submitted experienced another calendar year of
time before OWCP determines his or her pursuant to paragraph (f) of this section qualifying wage-loss, and/or medical
eligibility for benefits. will not be considered a survivor’s evidence establishing that he or she has
(c) A survivor must be alive to receive claim for benefits under Part E of the an increased minimum impairment
any payment under EEOICPA; there is Act. rating, as appropriate.
no vested right to such payment. (2) As part of its consideration of any
(d) Except as provided in paragraph request submitted pursuant to paragraph § 30.103 How does a claimant make sure
(e) of this section, a survivor’s claim is (f) of this section, OWCP will apply the that OWCP has the evidence necessary to
considered to be ‘‘filed’’ on the date that eligibility criteria in subpart C of this process the claim?
the survivor mails his or her claim to part. However, the adjudicatory (a) Claims and certain required
OWCP, as determined by postmark, or procedures contained in subpart D of submissions should be made on forms
the date that the claim is received by this part will not apply to OWCP’s prescribed by OWCP. Persons
OWCP, whichever is the earliest consideration of such a request, and submitting forms shall not modify these
determinable date. However, in no event OWCP’s response to the request will not forms or use substitute forms.
will a survivor’s claim under Part B of constitute a final agency decision on
the Act be considered to be ‘‘filed’’ entitlement to any benefits under Form No. Title
earlier than July 31, 2001, nor will a EEOICPA.
survivor’s claim under Part E of the Act (1) EE–1 Claim for Benefits Under the En-
be considered to be ‘‘filed’’ earlier than § 30.102 In general, how does an employee ergy Employees Occupational
file a claim for additional impairment or Illness Compensation Program
October 30, 2000.
wage-loss under Part E of EEOICPA? Act.
(1) The survivor, or the person filing (2) EE–2 Claim for Survivor Benefits Under
the claim on behalf of the survivor, shall (a) An employee previously awarded
the Energy Employees Occupa-
affirm that the information provided on impairment benefits by OWCP may file tional Illness Compensation Pro-
the Form EE–2 is true, and must inform a claim for additional impairment gram Act.
OWCP of any subsequent changes to benefits. Such claim must be based on (3) EE–3 Employment History for a Claim
that information. an increase in the employee’s minimum Under the Energy Employees
(2) Except for the survivor of a impairment rating attributable to the Occupational Illness Compensa-
covered uranium employee claiming covered illness or illnesses from the tion Program Act.
under Part B of the Act, the survivor is impairment rating that formed the basis (4) EE–4 Employment History Affidavit for a
responsible for submitting, or arranging for the last award of such benefits by Claim Under the Energy Em-
for the submission of, evidence to ployees Occupational Illness
OWCP. OWCP will only adjudicate
Compensation Program Act.
OWCP that establishes that the claims for such an increased rating that
employee upon whom the survivor’s are filed at least two years from the date
(b) Copies of the forms listed in this
claim is based was eligible for such of the last award of impairment benefits.
section are available for public
benefits, including medical evidence However, OWCP will not wait two years
inspection at the Office of Workers’
that establishes that the employee before it will adjudicate a claim for
Compensation Programs, Employment
sustained an occupational illness or a additional impairment that is based on
Standards Administration, U.S.
covered illness. This required medical an allegation that the employee
Department of Labor, Washington, DC
evidence is described in § 30.114 and sustained a new covered illness.
(b) An employee previously awarded 20210. They may also be obtained from
does not refer to mere recitations by the
wage-loss benefits by OWCP may be OWCP district offices and on the
survivor of symptoms the employee
eligible for additional wage-loss benefits Internet at http://www.dol.gov/esa/regs/
experienced that the survivor believes
for periods of wage-loss that were not compliance/owcp/eeoicp/main.htm.
indicate that the employee sustained an
occupational illness or a covered illness. addressed in a prior claim only if the Verification of Alleged Employment
(e) For those claims under Part E of employee had not reached his or her
EEOICPA that were originally filed with Social Security retirement age at the § 30.105 What must DOE do after an
DOE as claims for assistance under employee or survivor files a claim?
time of the prior award. OWCP will
former section 7385o of EEOICPA adjudicate claims filed on a yearly basis (a) After it receives a claim for
(which was repealed on October 28, in connection with each succeeding benefits described in §§ 30.100 or
2004), a claim is considered to be calendar year for which qualifying 30.101, OWCP may request that DOE
‘‘filed’’ on the date that the survivor wage-loss under Part E is alleged, as verify the employment history provided
mailed his or her claim to DOE, as well as claims that aggregate calendar by the claimant. Upon receipt of such a
determined by postmark, or on the date years for which qualifying wage-loss is request, DOE will complete Form EE–5
that the claim was received by DOE, alleged. as soon as possible and transmit the
whichever is the earliest determinable (c) Employees should use Form EE–10 completed form to OWCP. On this form,
date. However, in no event will a claim to claim for additional impairment or DOE will certify either that it concurs
referred to in this paragraph be wage-loss benefits under Part E of with the employment history provided
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considered to be ‘‘filed’’ earlier than EEOICPA. by the claimant, that it disagrees with
October 30, 2000. (1) The employee, or the person filing such history, or that it can neither
(f) A spouse or a child of a deceased the claim on behalf of the employee, concur nor disagree after making a
DOE contractor employee or RECA shall affirm that the information reasonable search of its records and also
section 5 uranium worker, who is not a provided on Form EE–10 is true, and making a reasonable effort to locate

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pertinent records not already in its § 30.111 What is the claimant’s not required to submit all of the
possession. responsibility with respect to burden of evidence listed above. A claimant may
proof, production of documents, submit other evidence not listed above
(b) Claims for additional impairment presumptions, and affidavits?
or wage-loss benefits under Part E of the to establish covered employment. To be
Act described in § 30.102 will not (a) Except where otherwise provided acceptable as evidence, all documents
require any verification of employment in the Act and these regulations, the and records must be legible. OWCP will
by DOE, since OWCP will have made claimant bears the burden of proving by accept photocopies, certified copies,
any required findings on this particular a preponderance of the evidence the and original documents and records.
issue when it adjudicated the existence of each and every criterion (b) Pursuant to §§ 30.105 and/or
employee’s initial claim for benefits. necessary to establish eligibility under 30.106, DOE or another entity verifying
any compensable claim category set alleged employment shall certify that it
§ 30.106 Can OWCP request employment forth in § 30.110. Proof by a concurs with the employment
verification from other sources? preponderance of the evidence means information provided by the claimant,
(a) For most claims filed under that it is more likely than not that the that it disagrees with the information
EEOICPA, DOE has access to sufficient proposition to be proved is true. Subject provided by the claimant, or, after a
factual information to enable it to fulfill to the exceptions expressly provided in reasonable search of its records and a
its obligations described in § 30.105(a). the Act and the regulations in this part, reasonable effort to locate pertinent
However, in instances where it lacks the claimant also bears the burden of records not already in its possession, it
such information, DOE may arrange for providing to OWCP all written medical can neither concur nor disagree with the
other entities to provide OWCP with the documentation, contemporaneous information provided by the claimant.
information necessary to verify an records, or other records and documents
(1) If DOE or another entity certifies
employment history submitted as part of necessary to establish any and all
that it concurs with the employment
a claim. These other entities may consist criteria for benefits set forth in these
information provided by the claimant,
of either current or former DOE regulations.
(b) In the event that the claim lacks then the criterion for covered
contractors and subcontractors, atomic employment will be established.
weapons employers, beryllium vendors, required information or supporting
documentation, OWCP will notify the (2) If DOE or another entity certifies
or other entities with access to relevant that it disagrees with the information
employment information. claimant of the deficiencies and provide
him or her an opportunity for correction provided by the claimant or that after a
(b) On its own initiative, OWCP may of the deficiencies. reasonable search of its records and a
also arrange for entities other than DOE (c) Written affidavits or declarations, reasonable effort to locate pertinent
to perform the employment verification subject to penalty for perjury, by the records not already in its possession it
duties described in § 30.105(a). employee, survivor or any other person, can neither concur nor disagree with the
Evidence and Burden of Proof will be accepted as evidence of information provided by the claimant,
employment history and survivor OWCP will evaluate the evidence
§ 30.110 Who is entitled to compensation relationship for purposes of establishing submitted by the claimant to determine
under the Act? eligibility and may be relied on in whether the claimant has established
(a) Under Part B of EEOICPA, determining whether a claim meets the covered employment by a
compensation is payable to the requirements of the Act for benefits if, preponderance of the evidence. OWCP
following covered Part B employees, or and only if, such person attests that due may request additional evidence from
their survivors: diligence was used to obtain records in the claimant to demonstrate that the
support of the claim, but that no records claimant has met the criterion for
(1) A ‘‘covered beryllium employee’’
exist. covered employment. Nothing in this
(as described in § 30.205(a)) with a
(d) A claimant will not be entitled to section shall be construed to limit
covered beryllium illness (as defined in
any presumption otherwise provided for OWCP’s ability to require additional
§ 30.5(o)) who was exposed to beryllium
in these regulations if substantial documentation.
in the performance of duty (in
accordance with § 30.206). evidence exists that rebuts the existence (3) If the only evidence of covered
of the fact that is the subject of the employment is a self-serving affidavit
(2) A ‘‘covered Part B employee with and DOE or another entity either
presumption. Substantial evidence
cancer’’ (as described in § 30.210(a)). disagrees with the assertion of covered
means such relevant evidence as a
(3) A ‘‘covered Part B employee with reasonable mind might accept as employment or cannot concur or
chronic silicosis’’ (as described in adequate to support a conclusion. When disagree with the assertion of covered
§ 30.220). such evidence exists, the claimant shall employment, then OWCP may reject the
(4) A ‘‘covered uranium employee’’ be notified and afforded the opportunity claim based upon a lack of evidence of
(as defined in § 30.5(s)). to submit additional written medical covered employment.
(b) Under Part E of EEOICPA, documentation or records.
§ 30.113 What are the requirements for
compensation is payable to a ‘‘covered written medical documentation,
§ 30.112 What kind of evidence is needed
Part E employee’’ (as defined in to establish covered employment and how contemporaneous records, and other
§ 30.5(p)), or his or her survivors. will that evidence be evaluated? records or documents?
(c) Any claim that does not meet all (a) Evidence of covered employment (a) All written medical
of the criteria for at least one of these may include: employment records; pay documentation, contemporaneous
categories, as set forth in the regulations stubs; tax returns; Social Security records, and other records or documents
in this part, must be denied. records; and written affidavits or submitted by an employee or his or her
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(d) All claims for benefits under the declarations, subject to penalty of survivor to prove any criteria provided
Act must comply with the claims perjury, by the employee, survivor or for in these regulations must be legible.
procedures and requirements set forth any other person. However, no one OWCP will accept photocopies, certified
in subpart B of this part before any document is required to establish copies, and original documents and
payment can be made from the Fund. covered employment and a claimant is records.

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(b) To establish eligibility, the or disease and the compensable medical Subpart C—Eligibility Criteria
employee or his or her survivor may be condition.
required to provide, where appropriate, General Provisions
(c) OWCP will evaluate the medical
additional contemporaneous records to evidence in accordance with recognized § 30.200 What is the scope of this
the extent they exist or an authorization and accepted diagnostic criteria used by subpart?
to release additional contemporaneous physicians to determine whether the The regulations in this subpart
records or a statement by the claimant has established the medical describe the criteria for eligibility for
custodian(s) of the record(s) certifying condition for which compensation is benefits for claims under Part B of
that the requested record(s) no longer sought in accordance with the EEOICPA relating to covered beryllium
exist. Nothing in this section shall be requirements of the Act. illness under sections 7384l, 7384n,
construed to limit OWCP’s ability to 7384s and 7384t of the Act; for cancer
require additional documentation. Special Procedures for Certain
Radiogenic Cancer Claims under sections 7384l, 7384n, 7384q and
(c) If a claimant submits a certified 7384t of the Act; for chronic silicosis
statement, by a person with knowledge § 30.115 For those radiogenic cancer under sections 7384l, 7384r, 7384s and
of the facts, that the medical records claims that do not seek benefits under Part 7384t of the Act; and for claims relating
containing a diagnosis and date of B of the Act pursuant to the Special to covered uranium employees under
diagnosis of a covered medical Exposure Cohort provisions, what will sections 7384t and 7384u of the Act.
condition no longer exist, then OWCP OWCP do once it determines that an These regulations also describe the
may consider other evidence to employee contracted cancer?
criteria for eligibility for benefits for
establish a diagnosis and date of (a) Other than claims for a non- claims under Part E of EEOICPA relating
diagnosis of a covered medical radiogenic cancer listed by HHS at 42 to covered illnesses under sections
condition. However, if the certified CFR 81.30, or claims seeking benefits 7385s–4 and 7385s–5 of the Act. This
statement is a self-serving document, under Part E of the Act that have subpart describes the type and extent of
OWCP may reject the claim based upon previously been accepted under section evidence that will be necessary to
a lack of evidence of a covered medical 7384u of the Act, or claims previously establish the criteria for eligibility for
condition. accepted under Part B pursuant to the compensation for these illnesses.
§ 30.114 What kind of evidence is needed Special Exposure Cohort provisions,
Eligibility Criteria for Claims Relating
to establish a compensable medical OWCP will forward the claim package
to Covered Beryllium Illness Under
condition and how will that evidence be (including, but not limited to, Forms
evaluated? Part B of EEOICPA
EE–1, EE–2, EE–3, EE–4 and EE–5, as
(a) Evidence of a compensable appropriate) to HHS for dose § 30.205 What are the criteria for eligibility
medical condition may include: a reconstruction. At that point in time, for benefits relating to beryllium illnesses
physician’s report, laboratory reports, development of the claim by OWCP may covered under Part B of EEOICPA?
hospital records, death certificates, x- be suspended. To establish eligibility for benefits
rays, magnetic resonance images or (1) This package will include OWCP’s under this section, the claimant must
reports, computer axial tomography or initial findings in regard to the establish the criteria set forth in both
other imaging reports, lymphocyte diagnosis and date of diagnosis of the paragraphs (a) and (b) of this section:
proliferation testings, beryllium patch employee, as well as any employment (a) The employee is a covered
tests, pulmonary function or exercise history compiled by OWCP (including beryllium employee only if the criteria
testing results, pathology reports information such as dates and locations in paragraphs (a)(1) and (a)(3) of this
including biopsy results and other worked, and job titles). The package, section, or (a)(2) and (a)(3) of this
medical records. A claimant is not however, will not constitute either a section, are established:
required to submit all of the evidence recommended or final decision by (1) The employee is a ‘‘current or
listed in this paragraph. A claimant may OWCP on the claim. former employee as defined in 5 U.S.C.
submit other evidence that is not listed 8101(1)’’ (see § 30.5(t) of this part) who
(2) HHS will then reconstruct the may have been exposed to beryllium at
in this paragraph to establish a
radiation dose of the employee, after a DOE facility or at a facility owned,
compensable medical condition.
such further development of the operated, or occupied by a beryllium
Nothing in this section shall be
employment history as it may deem vendor; or
construed to limit OWCP’s ability to
necessary, and provide OWCP, DOE and (2) The employee is a current or
require additional documentation.
(b) The medical evidence submitted the claimant with the final dose former civilian employee of:
will be used to establish the diagnosis reconstruction report. The final dose (i) Any entity that contracted with the
and the date of diagnosis of the reconstruction record will be delivered DOE to provide management and
compensable medical condition. to OWCP with the final dose operation, management and integration,
(1) For covered beryllium illnesses, reconstruction report and to the or environmental remediation of a DOE
additional medical evidence, as set forth claimant upon request. facility; or
in § 30.207, is required to establish a (b) Following its receipt of the (ii) Any contractor or subcontractor
beryllium illness. reconstructed dose from HHS, OWCP that provided services, including
(2) For chronic silicosis, additional will resume its adjudication of the construction and maintenance, at such a
medical evidence, as set forth in cancer claim and consider whether the facility; or
§ 30.222, is required to establish chronic claimant has met the eligibility criteria (iii) A beryllium vendor, or of a
silicosis. set forth in subpart C of this part. contractor or subcontractor of a
(3) For consequential injuries, However, during the period before it beryllium vendor, during a period when
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illnesses, impairments or diseases, the receives a reconstructed dose from HHS, the vendor was engaged in activities
claimant must also submit a physician’s OWCP may continue to develop other related to the production or processing
fully rationalized medical report aspects of a claim, to the extent that it of beryllium for sale to, or use by, the
showing a causal relationship between deems such development to be DOE, including periods during which
the resulting injury, illness, impairment appropriate. environmental remediation of a

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vendor’s facility was undertaken (c) If the evidence shows that (2) For diagnoses before January 1,
pursuant to a contract between the exposure occurred while the employee 1993, the presence of the following:
vendor and DOE; and was employed or present at a facility (i) Occupational or environmental
(3) The civilian employee was that would have to be designated by history, or epidemiologic evidence of
exposed to beryllium in the DOE as a beryllium vendor under beryllium exposure; and
performance of duty by establishing that section 7384m of the Act to be a covered (ii) Any three of the following criteria:
he or she was, during a period when facility, and that the facility has not (A) Characteristic chest radiographic
beryllium dust, particles, or vapor may been so designated, OWCP will deny the (or computed tomography (CT))
have been present at such a facility: claim on the ground that the facility is abnormalities.
(i) Employed at a DOE facility (as not a covered facility. (B) Restrictive or obstructive lung
defined in § 30.5(x) of this part); or (d) Records from the following physiology testing or diffusing lung
(ii) Present at a DOE facility, or at a sources may be considered as evidence capacity defect.
facility owned, operated, or occupied by for purposes of establishing (C) Lung pathology consistent with
a beryllium vendor, because of his or employment or presence at a covered chronic beryllium disease.
her employment by the United States, a facility: (D) Clinical course consistent with a
beryllium vendor, a contractor or (1) Records or documents created by chronic respiratory disorder.
subcontractor of a beryllium vendor, or (E) Immunologic tests showing
any federal government agency
a contractor or subcontractor of the beryllium sensitivity (skin patch test or
(including verified information
DOE. Under this paragraph, exposure to beryllium blood test preferred).
submitted for security clearance), any (d) An injury, illness, impairment or
beryllium in the performance of duty tribal government, or any state, county,
can be established whether or not the disability sustained as a consequence of
city or local government office, agency, beryllium sensitivity or established
beryllium that may have been present at department, board or other entity, or
such facility was produced or processed chronic beryllium disease must be
other public agency or office. established with a fully rationalized
for sale to, or use by, DOE. (2) Records or documents created by
(b) The employee has one of the medical report by a physician that
any vendor, processor, or producer of
following: shows the relationship between the
beryllium or related products
(1) Beryllium sensitivity as injury, illness, impairment or disability
designated as a beryllium vendor by the
established by an abnormal beryllium and the beryllium sensitivity or
DOE in accordance with section 7384m
LPT performed on either blood or lung established chronic beryllium disease.
of the Act.
lavage cells. Neither the fact that the injury, illness,
(2) Established chronic beryllium (3) Records or documents created as a
impairment or disability manifests itself
disease. by product of any regularly conducted
after a diagnosis of beryllium sensitivity
(3) Any injury, illness, impairment, or business activity or by an entity that
or established chronic beryllium
disability sustained as a consequence of acted as a contractor or subcontractor to
disease, nor the belief of the claimant
the conditions specified in paragraphs the DOE.
that the injury, illness, impairment or
(b)(1) and (2) of this section. § 30.207 How does a claimant prove a disability was caused by the beryllium
§ 30.206 How does a claimant prove that
diagnosis of a beryllium disease covered sensitivity or established chronic
the employee was a ‘‘covered beryllium under Part B? beryllium disease, is sufficient in itself
employee’’ exposed to beryllium dust, (a) Written medical documentation is to prove a causal relationship.
particles or vapor in the performance of required in all cases to prove that the
duty?
Eligibility Criteria for Claims Relating
employee developed a covered
to Radiogenic Cancer Under Parts B
(a) Proof of employment at or physical beryllium illness. Proof that the
and E of EEOICPA
presence at a DOE facility, or a facility employee developed a covered
owned, operated, or occupied by a beryllium illness must be made by using § 30.210 What are the criteria for eligibility
beryllium vendor, because of the procedures outlined in paragraphs for benefits relating to radiogenic cancer?
employment by the United States, a (b), (c), or (d) of this section. (a) To establish eligibility for benefits
beryllium vendor, or a contractor or (b) Beryllium sensitivity or for radiogenic cancer under Part B of
subcontractor of a beryllium vendor sensitization is established with an EEOICPA, an employee or his or her
during a period when beryllium dust, abnormal LPT performed on either survivor must show that:
particles, or vapor may have been blood or lung lavage cells. (1) The employee has been diagnosed
present at such a facility, may be made (c) Chronic beryllium disease is with one of the forms of cancer
by the submission of any trustworthy established in the following manner: specified in § 30.5(ff) of this part; and
records that, on their face or in (1) For diagnoses on or after January (i) Is a member of the Special
conjunction with other such records, 1, 1993, beryllium sensitivity (as Exposure Cohort (as described in
establish that the employee was established in accordance with § 30.214(a) of this subpart) who, as a
employed or present at a covered paragraph (b) of this section), together civilian DOE employee or civilian DOE
facility and the time period of such with lung pathology consistent with contractor employee, contracted the
employment or presence. chronic beryllium disease, including the specified cancer after beginning
(b) If the evidence shows that following: employment at a DOE facility; or
exposure occurred while the employee (i) A lung biopsy showing granulomas (ii) Is a member of the Special
was employed or present at a facility or a lymphocytic process consistent Exposure Cohort (as described in
during a time frame that is outside the with chronic beryllium disease; § 30.214(a) of this subpart) who, as a
relevant time frame indicated for that (ii) A computerized axial tomography civilian atomic weapons employee,
facility, OWCP may request that DOE scan showing changes consistent with contracted the specified cancer after
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provide additional information on the chronic beryllium disease; or beginning employment at an atomic
facility. OWCP will determine whether (iii) Pulmonary function or exercise weapons employer facility (as defined
the evidence of record supports testing showing pulmonary deficits in § 30.5(e)); or
enlarging the relevant time frame for consistent with chronic beryllium (2) The employee has been diagnosed
that facility. disease. with cancer; and

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(i)(A) Is/was a civilian DOE employee by an atomic weapons employer at an § 30.213 How does a claimant establish
who contracted that cancer after atomic weapons employer facility, or at that the radiogenic cancer was at least as
beginning employment at a DOE facility; a RECA section 5 facility, may be made likely as not related to employment at the
or by the submission of any trustworthy DOE facility, the atomic weapons employer
facility, or the RECA section 5 facility?
(B) Is/was a civilian DOE contractor records that, on their face or in
employee who contracted that cancer conjunction with other such records, (a) HHS, with the advice of the
after beginning employment at a DOE establish that the employee was so Advisory Board on Radiation and
facility; or employed and the time period(s) of such Worker Health, has issued regulatory
(C) Is/was a civilian atomic weapons employment. guidelines at 42 CFR part 81 that OWCP
employee who contracted that cancer (b)(1) Except as provided in paragraph uses to determine whether radiogenic
after beginning employment at an (b)(2) of this section, if the evidence cancers claimed under Parts B and E
atomic weapons employer facility; and shows that exposure occurred while the were at least as likely as not related to
(ii) The cancer was at least as likely employee was employed at a facility employment at a DOE facility, an atomic
as not related to the employment at the during a time frame that is outside the weapons employer facility, or a RECA
DOE facility or atomic weapons relevant period indicated for that section 5 facility, as appropriate.
employer facility; or facility, OWCP may request that DOE Persons should consult HHS’s
(3) The employee has been diagnosed provide additional information on the regulations for information regarding
with an injury, illness, impairment or facility. OWCP will determine whether the factual evidence that will be
disease that arose as a consequence of the evidence of record supports considered by OWCP, in addition to the
the accepted cancer. enlarging the relevant period for that employee’s radiation dose
(b)(1) To establish eligibility for facility. reconstruction that will be provided to
benefits for radiogenic cancer under Part (2) OWCP may choose not to request OWCP by HHS, in making this
E of EEOICPA, an employee or his or that DOE provide additional particular factual determination.
her survivor must show that: information on an atomic weapons (b) HHS’s regulations satisfy the legal
(i) The employee has been diagnosed requirements in section 7384n(c) of the
employer facility that NIOSH reported
with cancer; and Act, which also sets out OWCP’s
had a potential for significant residual
(A) Is/was a civilian DOE contractor obligation to use them in its
radiation contamination in its report
employee or a civilian RECA section 5 adjudication of claims for radiogenic
dated October 2003 and titled ‘‘Report
uranium worker who contracted that cancer filed under Part B of the Act, and
on Residual Radioactive and Beryllium
cancer after beginning employment at a provide the factual basis for OWCP to
Contamination at Atomic Weapons
DOE facility or a RECA section 5 determine if the ‘‘probability of
Employer Facilities and Beryllium
facility; and causation’’ (PoC) that an employee’s
(B) The cancer was at least as likely Vendor Facilities,’’ or any update to that
report, if the evidence referred to in cancer was sustained in the
as not related to exposure to a toxic performance of duty is 50% or greater
substance of a radioactive nature at a paragraph (a) of this section establishes
that the employee was employed at that (i.e., it is ‘‘at least as likely as not’’
DOE facility or a RECA section 5 causally related to employment), as
facility; and facility during a period when NIOSH
reported that it had a potential for required under section 7384n(b).
(C) It is at least as likely as not that (c) OWCP also uses HHS’s regulations
the exposure to such toxic substance(s) significant residual radiation
contamination. when it makes the determination
was related to employment at a DOE required by section 7385s–4(c)(1)(A) of
facility or a RECA section 5 facility; or (c) If the evidence shows that
the Act, since those regulations provide
(ii) The employee has been diagnosed exposure occurred while the employee
the factual basis for OWCP to determine
with an injury, illness, impairment or was employed by an employer that
if ‘‘it is at least as likely as not’’ that
disease that arose as a consequence of would have to be designated by DOE as
exposure to radiation at a DOE facility
the accepted cancer. an atomic weapons employer under
or RECA section 5 facility, as
(2) Eligibility for benefits for section 7384l(4) of the Act to be a
appropriate, was a significant factor in
radiogenic cancer under Part E in a covered employer, and that the
aggravating, contributing to, or causing
claim that has previously been accepted employer has not been so designated,
the employee’s radiogenic cancer
under Part B pursuant to the Special OWCP will deny the claim on the
claimed under Part E. For cancer claims
Exposure Cohort provisions is described ground that the employer is not a
under Part E, if the PoC is less than 50%
in § 30.230(a) of these regulations. covered atomic weapons employer.
and the claimant alleges that the
(d) Records from the following
§ 30.211 How does a claimant establish employee was exposed to additional
sources may be considered as evidence
that the employee has or had contracted toxic substances, OWCP will determine
for purposes of establishing
cancer? if the claim is otherwise compensable
employment or presence at a covered
A claimant establishes that the pursuant to § 30.230(d) of this part.
facility:
employee has or had contracted a (1) Records or documents created by § 30.214 How does a claimant establish
specified cancer (as defined in § 30.5(ff)) any federal government agency that the employee is a member of the
or other cancer with medical evidence (including verified information Special Exposure Cohort?
that sets forth an explicit diagnosis of submitted for security clearance), any (a) For purposes of establishing
cancer and the date on which that tribal government, or any state, county, eligibility as a member of the Special
diagnosis was first made. city or local government office, agency, Exposure Cohort (SEC) under
§ 30.212 How does a claimant establish department, board or other entity, or § 30.210(a)(1), the employee must have
that the employee contracted cancer after other public agency or office. been a DOE employee, a DOE contractor
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beginning employment at a DOE facility, an (2) Records or documents created as a employee, or an atomic weapons
atomic weapons employer facility or a byproduct of any regularly conducted employee who meets any of the
RECA section 5 facility? business activity or by an entity that following requirements:
(a) Proof of employment by the DOE acted as a contractor or subcontractor to (1) The employee was so employed
or a DOE contractor at a DOE facility, or the DOE. for a number of workdays aggregating at

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least 250 workdays before February 1, § 30.215 How does a claimant establish facility. OWCP will determine whether
1992, at a gaseous diffusion plant that the employee has sustained an injury, the evidence of record supports
located in Paducah, Kentucky; illness, impairment or disease as a enlarging the relevant time frame for
Portsmouth, Ohio; or Oak Ridge, consequence of a diagnosed cancer?
that facility.
Tennessee; and during such An injury, illness, impairment or
disease sustained as a consequence of a (c) Records from the following sources
employment:
(i) Was monitored through the use of diagnosed cancer covered by the may be considered as evidence for
dosimetry badges for exposure at the provisions of § 30.210 must be purposes of establishing proof of
plant of the external parts of the established with a fully rationalized employment or presence at a covered
employee’s body to radiation; or medical report by a physician that facility:
(ii) Worked in a job that had shows the relationship between the (1) Records or documents created by
exposures comparable to a job that is or injury, illness, impairment or disease any federal government agency
was monitored through the use of and the cancer. Neither the fact that the (including verified information
dosimetry badges. injury, illness, impairment or disease submitted for security clearance), any
(2) The employee was so employed manifests itself after a diagnosis of a tribal government, or any state, county,
before January 1, 1974, by DOE or a DOE cancer, nor the belief of the claimant city or local government office, agency,
contractor or subcontractor on Amchitka that the injury, illness, impairment or department, board or other entity, or
Island, Alaska, and was exposed to disease was caused by the cancer, is
other public agency or office.
ionizing radiation in the performance of sufficient in itself to prove a causal
duty related to the Long Shot, Milrow, relationship. (2) Records or documents created as a
or Cannikin underground nuclear tests. byproduct of any regularly conducted
(3) The employee is a member of a Eligibility Criteria for Claims Relating business activity or by an entity that
group or class of employees to Chronic Silicosis Under Part B of acted as a contractor or subcontractor to
subsequently designated as additional EEOICPA the DOE.
members of the SEC by HHS. § 30.220 What are the criteria for eligibility (d) For purposes of satisfying the 250
(b) For purposes of satisfying the 250 for benefits relating to chronic silicosis? workday requirement of § 30.220(a), the
workday requirement of paragraph (a)(1) To establish eligibility for benefits for
of this section, the claimant may claimant may aggregate the days of
chronic silicosis under Part B of service at more than one qualifying site.
aggregate the days of service at more EEOICPA, an employee or his or her
than one gaseous diffusion plant. survivor must show that: § 30.222 How does a claimant establish
(c) Proof of employment by the DOE (a) The employee is a civilian DOE that the employee has been diagnosed with
or a DOE contractor, or an atomic employee, or a civilian DOE contractor chronic silicosis or has sustained a
weapons employer, for the requisite employee, who was present for a consequential injury, illness, impairment or
time periods set forth in paragraph (a) number of workdays aggregating at least disease?
of this section, may be made by the 250 workdays during the mining of
submission of any trustworthy records (a) A written diagnosis of the
tunnels at a DOE facility (as defined in employee’s chronic silicosis (as defined
that, on their face or in conjunction with § 30.5(x)) located in Nevada or Alaska
other such records, establish that the in § 30.5(j)) shall be made by a medical
for tests or experiments related to an doctor and accompanied by one of the
employee was so employed and the time atomic weapon, and has been diagnosed
period(s) of such employment. If the following:
with chronic silicosis (as defined in
evidence shows that exposure occurred § 30.5(j)); or (1) A chest radiograph, interpreted by
while the employee was employed by (b) The employee has been diagnosed an individual certified by NIOSH as a B
an employer that would have to be with an injury, illness, impairment or reader, classifying the existence of
designated by DOE as an atomic disease that arose as a consequence of pneumoconioses of category 1/0 or
weapons employer under section the accepted chronic silicosis. higher; or
7384l(4) of the Act to be a covered
employer, and that the employer has not § 30.221 How does a claimant prove (2) Results from a computer assisted
been so designated, OWCP will deny the exposure to silica in the performance of tomograph or other imaging technique
claim on the ground that the employer duty? that are consistent with silicosis; or
is not a covered atomic weapons (a) Proof of the employee’s (3) Lung biopsy findings consistent
employer. employment and presence for the with silicosis.
(d) Records from the following requisite days during the mining of
(b) An injury, illness, impairment or
sources may be considered as evidence tunnels at a DOE facility located in
disease sustained as a consequence of
for purposes of establishing Nevada or Alaska for tests or
accepted chronic silicosis covered by
employment or presence at a covered experiments related to an atomic
the provisions of § 30.220(a) must be
facility: weapon may be made by the submission
(1) Records or documents created by of any trustworthy records that, on their established with a fully rationalized
any federal government agency face or in conjunction with other such medical report by a physician that
(including verified information records, establish that the employee was shows the relationship between the
submitted for security clearance), any so employed and present at these sites injury, illness, impairment or disease
tribal government, or any state, county, and the time period(s) of such and the accepted chronic silicosis.
city or local government office, agency, employment and presence. Neither the fact that the injury, illness,
department, board or other entity, or (b) If the evidence shows that impairment or disease manifests itself
other public agency or office. exposure occurred while the employee after a diagnosis of accepted chronic
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(2) Records or documents created as a was employed and present at a facility silicosis, nor the belief of the claimant
byproduct of any regularly conducted during a time frame that is outside the that the injury, illness, impairment or
business activity or by an entity that relevant time frame indicated for that disease was caused by the accepted
acted as a contractor or subcontractor to facility, OWCP may request that DOE chronic silicosis, is sufficient in itself to
the DOE. provide additional information on the prove a causal relationship.

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Eligibility Criteria for Certain Uranium (a) That OWCP has determined under (iii) An opinion of a qualified
Employees Under Part B of EEOICPA Part B of EEOICPA that the employee is physician with expertise in treating,
a Department of Energy contractor diagnosing or researching the illness
§ 30.225 What are the criteria for eligibility claimed to be caused or aggravated by
employee as defined in § 30.5(w), and
for benefits under Part B of EEOICPA for
certain uranium employees? that he or she has been awarded the alleged exposure; and
compensation under that Part of the Act (iv) Any other evidence that OWCP
In order to be eligible for benefits determines to have demonstrated
for an occupational illness;
under this section, the claimant must relevance to the relation between a
establish the criteria set forth in either (b) That the Attorney General has
determined that the employee is entitled particular toxic substance and the
paragraph (a) or paragraph (b) of this claimed illness.
section: to payment of $100,000 as
(a) The Attorney General has compensation due under section 5 of § 30.231 How does a claimant prove
determined that the claimant is a RECA for a claim made under that employment-related exposure to a toxic
covered uranium employee who is statute (however, if a deceased substance at a DOE facility or a RECA
entitled to payment of $100,000 as employee’s survivor has been section 5 facility?
compensation due under section 5 of determined to be entitled to such an To establish employment-related
RECA for a claim made under that award, his or her survivor(s), if any, will exposure to a toxic substance at a
statute (there is, however, no only be entitled to benefits under Part Department of Energy facility or RECA
requirement that the claimant or E of EEOICPA in accordance with section 5 facility as required by
surviving eligible beneficiary has section 7385s–3 of the Act); § 30.230(d), an employee, or his or her
actually received payment pursuant to (c) That the Secretary of Energy has survivor(s), must prove that the
RECA). If a deceased employee’s accepted a positive determination of a employee was employed at such facility
survivor(s) has been determined to be Physicians Panel that the employee and that he or she was exposed to a
entitled to such an award, his or her sustained an illness or died due to toxic substance in the course of that
survivor(s), if any, will only be entitled exposure to a toxic substance at a DOE employment.
to EEOICPA compensation in facility under former section 7385o of (a) Proof of employment may be
accordance with section 7384u(e) of the EEOICPA, or that the Secretary of established by any trustworthy records
Act. Energy has found significant evidence that, on their face or in conjunction with
(b) The covered uranium employee contrary to a negative determination of other such records, establish that the
has been diagnosed with an injury, a Physicians Panel; or employee was so employed and the time
illness, impairment or disease that arose (d)(1) That the employee is a civilian period(s) of such employment.
as a consequence of the medical Department of Energy contractor (b) Proof of exposure to a toxic
condition for which he or she was employee as defined in § 30.5(w), or a substance may be established by the
determined to be entitled to payment of civilian who was employed in a submission of any appropriate
$100,000 as compensation due under uranium mine or mill located in document or information that is
section 5 of RECA. Colorado, New Mexico, Arizona, evidence that such substance was
Wyoming, South Dakota, Washington, present at the facility in which the
§ 30.226 How does a claimant establish
Utah, Idaho, North Dakota, Oregon or employee was employed and that the
that a covered uranium employee has
sustained a consequential injury, illness, Texas at any time during the period employee came into contact with such
impairment or disease? from January 1, 1942 through December substance. OWCP site exposure matrices
An injury, illness, impairment or 31, 1971, or was employed in the may be used to provide probative
disease sustained as a consequence of a transport of uranium ore or vanadium- factual evidence that a particular
medical condition covered by the uranium ore from such a mine or mill substance was present at either a DOE
provisions of § 30.225(a) must be during that same period, and that he or facility or a RECA section 5 facility.
established with a fully rationalized she:
§ 30.232 How does a claimant establish
medical report by a physician that (i) Has been diagnosed with an that the employee has been diagnosed with
shows the relationship between the illness; and a covered illness, or sustained an injury,
injury, illness, impairment or disease (ii) That it is at least as likely as not illness, impairment or disease as a
and the accepted medical condition. that exposure to a toxic substance at a consequence of a covered illness?
Neither the fact that the injury, illness, Department of Energy facility or at a (a) To establish that the employee has
impairment or disease manifests itself RECA section 5 facility, as appropriate, been diagnosed with a covered illness as
after a diagnosis of a medical condition was a significant factor in aggravating, required by § 30.230(d), the employee,
covered by the provisions of § 30.225(a), contributing to, or causing the illness; or his or her survivor(s), must provide
nor the belief of the claimant that the and the following:
injury, illness, impairment or disease (iii) That it is at least as likely as not (1) The name and address of any
was caused by such a condition, is that the exposure to such toxic licensed physician who is the source of
sufficient in itself to prove a causal substance was related to employment at a diagnosis based upon documented
relationship. a Department of Energy facility or a medical information that the employee
RECA section 5 facility, as appropriate. has or had an illness and that the illness
Eligibility Criteria for Other Claims (2) In making the determination under
Under Part E of EEOICPA may have resulted from exposure to a
paragraph (d)(1)(ii) of this section, toxic substance while the employee was
§ 30.230 What are the criteria necessary to OWCP will consider: employed at a DOE facility or a RECA
establish that an employee contracted a (i) The nature, frequency and duration section 5 facility, as appropriate, and, to
covered illness under Part E of EEOICPA? of exposure of the covered employee to the extent practicable, a copy of the
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To establish that an employee the substance alleged to be toxic; diagnosis and a summary of the
contracted a covered illness under Part (ii) Evidence of the carcinogenic or information upon which the diagnosis is
E of the Act, the employee, or his or her pathogenic properties of the alleged based; and
survivor, must show one of the toxic substance to which the employee (2) A signed medical release,
following: was exposed; authorizing the release of any diagnosis,

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medical opinion and medical records or Part E of the Act, OWCP may issue policy administrators. For hearings
documenting the diagnosis or opinion a recommended decision on only part of taking the form of a review of the
that the employee has or had an illness that particular claim in order to written record, no subpoena for the
and that the illness may have resulted adjudicate that portion of the claim as appearance of witnesses will be
from exposure to a toxic substance quickly as possible. Should this occur, considered.
while the employee was employed at a OWCP will issue one or more (d) The FAB reviewer will issue the
DOE facility or RECA section 5 facility, recommended decisions on the deferred subpoena under his or her own name.
as appropriate; and portions of the claim when the It may be served in person or by
(3) To the extent practicable and adjudication of those portions is certified mail, return receipt requested,
appropriate, an occupational history completed. All recommended decisions addressed to the person to be served at
obtained by a physician, an granting and/or denying benefits under his or her last known principal place of
occupational health professional, or a Part B and/or Part E of the Act will be business or residence. A decision to
DOE-sponsored Former Worker Program forwarded to the Final Adjudication deny a subpoena requested by a
(if such an occupational history is not Branch (FAB). Claimants will be given claimant can only be challenged as part
reasonably available or is inadequate, an opportunity to object to all or part of of a request for reconsideration of any
and such history is deemed by OWCP to the recommended decision before the adverse decision of the FAB which
be needed for the fair adjudication of FAB. The FAB will consider objections results from the hearing.
the claim, then OWCP may assist the filed by a claimant and conduct a
claimant in developing this history); § 30.302 Who pays the costs associated
hearing, if requested to do so by the
with subpoenas?
and claimant, before issuing a final decision
(4) Any other information or materials on the claim for entitlement. (a) Witnesses who are not employees
deemed by OWCP to be necessary to or former employees of the federal
provide reasonable evidence that the § 30.301 May subpoenas be issued for government shall be paid the same fees
witnesses and documents in connection and mileage as paid for like services in
employee has or had an illness that may with a claim under Part B of EEOICPA?
have arisen from exposure to a toxic the District Court of the United States
substance while employed at a DOE (a) In connection with the where the subpoena is returnable,
facility or RECA section 5 facility, as adjudication of a claim under Part B of except that expert witnesses shall be
appropriate. EEOICPA, an OWCP district office and/ paid a fee not to exceed the local
(b) The employee, or his or her or a FAB reviewer may, at their own customary fee for such services.
survivor(s), may also submit to OWCP initiative, issue subpoenas for the (b) Where OWCP asked that the
other evidence not described in attendance and testimony of witnesses, witness submit evidence into the case
paragraph (a) of this section showing and for the production of books, record or asked that the witness attend,
that the employee has or had an illness electronic records, correspondence, OWCP shall pay the fees and mileage.
that resulted from an exposure to a toxic papers or other relevant documents. Where the claimant asked for the
substance during the course of Subpoenas will only be issued for subpoena, and where the witness
employment at either a DOE facility or documents if they are relevant and submitted evidence into the record at
a RECA section 5 facility, as cannot be obtained by other means, and the request of the claimant, the claimant
appropriate. for witnesses only where oral testimony shall pay the fees and mileage.
(c) An injury, illness, impairment or is the best way to ascertain the facts.
(b) A claimant may also request a § 30.303 What information may OWCP
disease sustained as a consequence of a request in connection with a claim under
subpoena in connection with his or her
covered illness (as defined in § 30.5(r)) Part E of EEOICPA?
claim under Part B of the Act, but such
must be established with a fully At any time during the course of
request may only be made to a FAB
rationalized medical report by a development of a claim for benefits
reviewer. No subpoenas will be issued
physician that shows the relationship under Part E, OWCP may determine that
at the request of the claimant under any
between the injury, illness, impairment it needs relevant information to
other portion of the claims process. The
or disease and the covered illness. adjudicate the claim. When this occurs,
decision to grant or deny such request
Neither the fact that the injury, illness, and at the request of OWCP, DOE and/
is within the discretion of the FAB
impairment or disease manifests itself or any contractor who employed a
reviewer. To request a subpoena under
after a diagnosis of a covered illness, nor Department of Energy contractor
this section, the requestor must:
the belief of the claimant that the injury, employee must provide to OWCP
(1) Submit the request in writing and
illness, impairment or disease was information or documents in response
send it to the FAB reviewer as early as
caused by the covered illness, is to the request in connection with a
possible, but no later than 30 days (as
sufficient in itself to prove a causal claim under Part E of EEOICPA.
evidenced by postmark, electronic
relationship. (a) The party to whom the request is
marker or other objective date mark)
after the date of the original hearing made must respond to OWCP within 90
Subpart D—Adjudicatory Process
request; days of the request with either:
§ 30.300 What process will OWCP use to (2) Explain why the testimony or (1) The requested information or
decide claims for entitlement and to provide evidence is directly relevant and documents; or
for administrative review of those material to the issues in the case; and (2) A sworn statement that a good
decisions? (3) Establish that a subpoena is the faith search for the requested
OWCP district offices will issue best method or opportunity to obtain information or documents was
recommended decisions with respect to such evidence because there are no conducted, and that the information or
claims for entitlement under Part B and/ other means by which the documents or documents could not be located.
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or Part E of EEOICPA that are filed testimony could have been obtained. (b) DOE and/or the DOE contractor
pursuant to the regulations set forth in (c) No subpoena will be issued for who employed a Department of Energy
subpart B of this part. In circumstances attendance of employees or contractors contractor employee must query third
where a claim is made for more than of OWCP or NIOSH acting in their parties under its control to acquire the
one benefit available under Part B and/ official capacities as decision-makers or requested information or documents.

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(c) In providing the requested record of such claim to the FAB. Any remaining part of the recommendation
information or documents, DOE and/or new evidence submitted to the district of the district office without first
the DOE contractor who employed a office following the issuance of the reviewing the written record (see
DOE contractor employee must preserve recommended decision will also be § 30.316).
the current organization of the requested forwarded to the FAB for consideration.
information or documents, and must § 30.313 How is a review of the written
Hearings and Final Decisions on Claims record conducted?
provide such description and indexing
of the requested information or (a) The FAB reviewer will consider
§ 30.310 What must the claimant do if he
documents as OWCP considers or she objects to the recommended the written record forwarded by the
appropriate to facilitate their use by decision or wants to request a hearing? district office and any additional
OWCP. evidence and/or argument submitted by
(a) Within 60 days from the date the
(d) Information or document requests the claimant. The reviewer may also
recommended decision is issued, the
may include, but are not limited to, conduct whatever investigation is
claimant must state, in writing, whether
requests for records, files and other data, deemed necessary.
he or she objects to any of the findings
whether paper, electronic, imaged or (b) The claimant should submit, with
of fact and/or conclusions of law
otherwise, developed, acquired or his or her written statement that objects
contained in such decision, including
maintained by DOE or the DOE to the recommended decision, all
HHS’s reconstruction of the radiation
contractor who employed a DOE evidence or argument that he or she
dose to which the employee was
contractor employee. Such information wants to present to the reviewer.
exposed (if any), and whether a hearing
or documents may include records, files However, evidence or argument may be
is desired. This written statement
and data on facility industrial hygiene, submitted at any time up to the date
should be filed with the FAB at the
employment of individuals or groups, specified by the reviewer for the
address indicated in the notice
exposure and medical records, and submission of such evidence or
accompanying the recommended
claims applications. argument.
decision.
(c) Any objection that is not presented
Recommended Decisions on Claims (b) For purposes of determining
to the FAB reviewer, including any
whether the written statement referred
objection to HHS’s reconstruction of the
§ 30.305 How does OWCP determine to in paragraph (a) of this section has
entitlement to EEOICPA compensation? radiation dose to which the employee
been timely filed with the FAB, the
was exposed (if any), whether or not the
(a) In reaching a recommended statement will be considered to be
pertinent issue was previously
decision with respect to EEOICPA ‘‘filed’’ on the date that the claimant
presented to the district office, is
compensation, OWCP considers the mails it to the FAB, as determined by
deemed waived for all purposes.
claim presented by the claimant, the postmark, or on the date that such
factual and medical evidence of record, written statement is actually received by § 30.314 How is a hearing conducted?
the dose reconstruction report the FAB, whichever is the earliest (a) The FAB reviewer retains
calculated by HHS (if any), any report determinable date. complete discretion to set the time and
submitted by DOE and the results of place of the hearing, including the
such investigation as OWCP may deem § 30.311 What happens if the claimant
does not object to the recommended amount of time allotted for the hearing,
necessary. decision or request a hearing within 60 considering the issues to be resolved. At
(b) The OWCP claims staff applies the days? the discretion of the reviewer, the
law, the regulations and its procedures hearing may be conducted by telephone
when it evaluates the medical evidence (a) If the claimant does not file a
written statement that objects to the or teleconference. As part of the hearing
and the facts as reported or obtained process, the FAB reviewer will consider
upon investigation. recommended decision and/or requests
a hearing within the period of time the written record forwarded by the
§ 30.306 What does the recommended allotted in § 30.310, the FAB may issue district office and any additional
decision contain? a final decision accepting the evidence and/or argument submitted by
The recommended decision shall recommendation of the district office as the claimant. The reviewer may also
contain findings of fact and conclusions provided in § 30.316. conduct whatever investigation is
of law. The recommended decision may (b) If the recommended decision deemed necessary.
accept or reject the claim in its entirety, accepts all or part of a claim for (1) The FAB reviewer will try to set
or it may accept or reject a portion of the compensation, the FAB may issue a the hearing at a place that is within
claim presented. It is accompanied by a final decision at any time after receiving commuting distance of the claimant’s
notice of the claimant’s right to file written notice from the claimant that he residence, but will not be able to do so
objections with, and request a hearing or she waives any objection to all or part in all cases. Therefore, for reasons of
before, the FAB. of the recommended decision. economy, the claimant may be required
to travel a roundtrip distance of up to
§ 30.307 To whom is the recommended § 30.312 What will the FAB do if the 200 miles to attend the hearing.
decision sent? claimant objects to the recommended (2) In unusual circumstances, the FAB
(a) A copy of the recommended decision but does not request a hearing? reviewer may set a place for the hearing
decision will be mailed to the claimant’s If the claimant files a written that is more than 200 miles roundtrip
last known address and to the statement that objects to the from the claimant’s residence. However,
claimant’s designated representative recommended decision within the in that situation, OWCP will reimburse
before OWCP, if any. Notification to period of time allotted in § 30.310 but the claimant for reasonable and
either the claimant or the representative does not request a hearing, the FAB will necessary travel expenses incurred to
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will be considered notification to both consider any objections by means of a attend the hearing if he or she submits
parties. review of the written record. If the a written reimbursement request that
(b) At the same time it issues a claimant only objects to part of the documents such expenses.
recommended decision on a claim, the recommended decision, the FAB may (b) Unless otherwise directed in
OWCP district office will forward the issue a final decision accepting the writing by the claimant, the FAB

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reviewer will mail a notice of the time reschedule the hearing on the same anniversary of such date. Any
and place of the hearing to the claimant docket (that is, during the same hearing recommended decision described in
and any representative at least 30 days trip). If a request to postpone a § 30.311 that is pending at the FAB for
before the scheduled hearing date. If the scheduled hearing does not meet one of more than one year from the date that
claimant only objects to part of the the tests of paragraph (b) of this section the period of time described in § 30.310
recommended decision, the FAB and cannot be accommodated on the expired shall be considered a final
reviewer may issue a final decision same docket, no further opportunity for decision of the FAB on the one-year
accepting the remaining part of the a hearing will be provided. Instead, the anniversary of such date.
recommendation of the district office FAB will consider the claimant’s (d) The decision of the FAB, whether
without first holding a hearing (see objections by means of a review of the issued pursuant to paragraph (a), (b) or
§ 30.316). Any objection that is not written record. In the alternative, a (c) of this section, shall be final upon
presented to the FAB reviewer, teleconference may be substituted for the date of issuance of such decision,
including any objection to HHS’s the hearing at the discretion of the unless a timely request for
reconstruction of the radiation dose to reviewer. reconsideration under § 30.319 has been
which the employee was exposed (if (b) Where the claimant or the filed.
any), whether or not the pertinent issue representative appointed by the (e) A copy of the final decision of the
was previously presented to the district claimant in accordance with § 30.600 of FAB will be mailed to the claimant’s
office, is deemed waived for all this part has a medical reason that last known address and to the
purposes. prevents attendance at the hearing, or claimant’s designated representative
(c) The hearing is an informal process, where the death or illness of the before OWCP, if any. Notification to
and the reviewer is not bound by claimant’s parent , spouse, or child either the claimant or the representative
common law or statutory rules of prevents the claimant from attending will be considered notification to both
evidence, or by technical or formal rules the hearing as scheduled, a parties.
of procedure. The reviewer may conduct postponement may be granted in the § 30.317 Can the FAB request a further
the hearing in such manner as to best discretion of the FAB if the claimant or response from the claimant or return a
ascertain the rights of the claimant. the representative provides at least 24 claim to the district office?
During the hearing process, the claimant hours notice and a reasonable At any time before the issuance of its
may state his or her arguments and explanation supporting his or her final decision, the FAB may request that
present new written evidence and/or inability to attend the scheduled the claimant submit additional evidence
testimony in support of the claim. hearing. or argument, or return the claim to the
(d) Testimony at hearings is recorded, (c) At any time after requesting a district office for further development
then transcribed and placed in the hearing, the claimant can request a and/or issuance of a newly
record. Oral testimony shall be made change to a review of the written record recommended decision without issuing
under oath. by making a written request to the FAB. a final decision, whether or not
(e) The FAB reviewer will furnish a Once such a change is made, no further requested to do so by the claimant.
transcript of the hearing to the claimant, opportunity for a hearing will be
who has 20 days from the date it is sent provided. § 30.318 Can the FAB consider objections
to submit any comments to the to HHS’s reconstruction of a radiation dose
§ 30.316 How does the FAB issue a final or to the guidelines OWCP uses to
reviewer.
decision on a claim? determine if a claimed cancer was at least
(f) The claimant will have 30 days
(a) If the claimant does not file a as likely as not related to employment?
after the hearing is held to submit
additional evidence or argument, unless written statement that objects to the (a) If the claimant objects to HHS’s
the reviewer, in his or her sole recommended decision and/or requests reconstruction of the radiation dose to
discretion, grants an extension. Only a hearing within the period of time which the employee was exposed, the
one such extension may be granted. allotted in § 30.310, or if the claimant FAB will evaluate the factual findings
(g) The reviewer determines the waives any objections to all or part of upon which HHS based its dose
conduct of the hearing and may the recommended decision, the FAB reconstruction. If these factual findings
terminate the hearing at any time he or may issue a final decision accepting the do not appear to be supported by
she determines that all relevant recommendation of the district office, substantial evidence, the claim will be
evidence has been obtained, or because either in whole or in part (see §§ 30.311, returned to the district office for referral
of misbehavior on the part of the 30.312 and 30.314(b)). to HHS for further consideration.
claimant and/or representative at or (b) If the claimant objects to all or part (b) The methodology used by HHS in
near the place of the oral presentation. of the recommended decision, the FAB arriving at reasonable estimates of the
reviewer will issue a final decision on radiation doses received by an
§ 30.315 May a claimant postpone a the claim after either the hearing or the employee, established by regulations
hearing? review of the written record, and after issued by HHS at 42 CFR part 82, is
(a) The FAB will entertain any completing such further development of binding on the FAB. The FAB reviewer
reasonable request for scheduling the the case as he or she may deem may determine, however, that objections
time and place of the hearing, but such necessary. concerning the application of that
requests should be made at the time that (c) Any recommended decision (or methodology should be considered by
the hearing is requested. Scheduling is part thereof) that is pending either a HHS and may return the case to the
at the discretion of the FAB, and is not hearing or a review of the written record district office for referral to HHS for
reviewable. In most instances, once the for more than one year from the date the such consideration.
hearing has been scheduled and FAB received the written statement (c) The methodology that OWCP uses
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appropriate written notice has been described in § 30.310(a), or the date the to determine if a claimed cancer was at
mailed, it cannot be postponed at the Director reopened the claim for issuance least as likely as not related to
claimant’s request for any reason except of a new final decision pursuant to employment at a DOE facility, an atomic
those stated in paragraph (b) of this § 30.320(a), shall be considered a final weapons employer facility, or a RECA
section, unless the FAB reviewer can decision of the FAB on the one-year section 5 facility, established by

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regulations issued by HHS at 42 CFR § 30.316, and without regard to whether services, appliances or supplies that a
part 81, is also binding on the FAB (see new evidence or information is qualified physician prescribes or
§ 30.213). However, since OWCP applies presented or obtained, the Director for recommends and that OWCP considers
this methodology when it makes these Energy Employees Occupational Illness necessary to treat his or her
determinations, the FAB reviewer may Compensation may reopen a claim and occupational illness or covered illness,
consider objections to the manner in return it to the FAB for issuance of a retroactive to the date the claim for
which OWCP applied HHS’s regulatory new final decision, or to the district benefits for that occupational illness or
guidelines. office for such further development as covered illness under Part B or Part E of
may be necessary, to be followed by a EEOICPA was filed. In situations where
§ 30.319 May a claimant request new recommended decision. The the occupational illness or covered
reconsideration of a final decision of the
Director may also vacate any other type illness is a secondary cancer, such
FAB?
of decision issued by the FAB. treatment may include treatment of the
(a) A claimant may request (b) At any time after the FAB has underlying primary cancer when it is
reconsideration of a final decision of the issued a final decision pursuant to medically necessary or related to
FAB by filing a written request with the § 30.316, a claimant may file a written treatment of the secondary cancer;
FAB within 30 days from the date of request that the Director for Energy however, payment for medical treatment
issuance of such decision. If a timely Employees Occupational Illness of the underlying primary cancer under
request for reconsideration is made, the Compensation reopen his or her claim, these circumstances does not constitute
decision in question will no longer be provided that the claimant also submits a determination by OWCP that the
considered ‘‘final’’ under § 30.316(d). new evidence of either covered primary cancer is a covered illness
(b) For purposes of determining employment or exposure to a toxic under Part E of EEOICPA. The employee
whether the written request referred to substance, or identifies either a change need not be disabled to receive such
in paragraph (a) of this section has been in the PoC guidelines, a change in the treatment. When a survivor receives
timely filed with the FAB, the request dose reconstruction methods or an payment, OWCP will pay for such
will be considered to be ‘‘filed’’ on the addition of a class of employees to the treatment if the employee died before
date that the claimant mails it to the Special Exposure Cohort. the claim was paid. If there is any doubt
FAB, as determined by postmark, or on (1) If the Director concludes that the as to whether a specific service,
the date that such written request is evidence submitted or matter identified appliance or supply is necessary to treat
actually received by the FAB, whichever in support of the claimant’s request is the occupational illness or covered
is the earliest determinable date. material to the claim, the Director will illness, the employee should consult
(c) A hearing is not available as part reopen the claim and return it to the OWCP prior to obtaining it.
of the reconsideration process. If the district office for such further (b) If a claimant disagrees with the
FAB grants the request for development as may be necessary, to be decision of OWCP that medical benefits
reconsideration, it will consider the followed by a new recommended provided under paragraph (a) of this
written record of the claim again and decision. section are not necessary to treat an
issue a new final decision on the claim. (2) New evidence of a medical occupational illness or covered illness,
A new final decision that is issued after condition described in subpart C of he or she may choose to utilize the
the FAB grants a request for these regulations is not sufficient to adjudicatory process described in
reconsideration will be ‘‘final’’ upon the support a written request to reopen a subpart D of this part.
date of issuance of such new decision. claim for such a condition under (c) Any qualified physician or
(1) Instead of issuing a new final paragraph (b) of this section. qualified hospital may provide medical
decision after granting a request for (c) The decision whether or not to services, appliances and supplies to the
reconsideration, the FAB may return the reopen a claim under this section is covered Part B employee or the covered
claim to the district office for further solely within the discretion of the Part E employee. A qualified provider of
development as provided in § 30.317. Director for Energy Employees medical support services may also
(2) If the FAB denies the request for Occupational Illness Compensation and furnish appropriate services, appliances,
reconsideration, the FAB decision that is not reviewable. If the Director reopens and supplies. OWCP may apply a test of
formed the basis for the request will be a claim pursuant to paragraphs (a) or (b) cost-effectiveness when it decides if
considered ‘‘final’’ upon the date the of this section and returns it to the appliances and supplies are necessary to
request is denied, and no further district office, the resulting new treat an occupational illness or covered
requests for reconsideration of that recommended decision will be subject illness. With respect to prescribed
particular final decision of the FAB will to the adjudicatory process described in medications, OWCP may require the use
be entertained. this subpart. However, neither the
(d) A claimant may not seek judicial of generic equivalents where they are
district office nor the FAB can consider available.
review of a decision on his or her claim any objection concerning the Director’s
under EEOICPA until OWCP’s decision decision to reopen a claim under this § 30.401 What are the special rules for the
on the claim is final pursuant to either section. services of chiropractors?
§ 30.316(d) (for claims in which no (a) The services of chiropractors that
request for reconsideration was filed Subpart E—Medical and Related may be reimbursed by OWCP are
with the FAB) or paragraph (c) of this Benefits limited to treatment to correct a spinal
section (for claims in which a request subluxation. The costs of physical and
Medical Treatment and Related Issues
for reconsideration was filed with the related laboratory tests performed by or
FAB). § 30.400 What are the basic rules for required by a chiropractor to diagnose
obtaining medical treatment? such a subluxation are also payable.
Reopening Claims
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(a) A covered Part B employee or a (b) A diagnosis of spinal subluxation


§ 30.320 Can a claim be reopened after the covered Part E employee who fits into as demonstrated by x-ray to exist must
FAB has issued a final decision? at least one of the compensable claim appear in the chiropractor’s report
(a) At any time after the FAB has categories described in subpart C of this before OWCP can consider payment of
issued a final decision pursuant to part is entitled to receive all medical a chiropractor’s bill.

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(c) A chiropractor may interpret his or determines that the travel expenses are Directed Medical Examinations
her x-rays to the same extent as any reasonable and necessary, and are
other physician. To be given any weight, § 30.410 Can OWCP require an employee
incident to obtaining authorized to be examined by another physician?
the medical report must state that x-rays medical services, appliances or
support the finding of spinal (a) OWCP sometimes needs a second
supplies. Requests for travel expenses
subluxation. OWCP will not necessarily opinion from a medical specialist. The
that are often approved include those
require submission of the x-ray, or a employee must submit to examination
resulting from referrals to a specialist for
report of the x-ray, but the report must by a qualified physician who conforms
further medical treatment, and those to the standards regarding conflicts of
be available for submission on request. involving air transportation of an
(d) A chiropractor may also provide interest adopted by OWCP as often and
employee who lives in a remote at such times and places as OWCP
services in the nature of physical
therapy under the direction of a geographical area with limited local considers reasonably necessary. Also,
qualified physician. medical services. OWCP may send a case file for second
(c) If a claimant disagrees with the opinion review to a qualified physician
§ 30.402 What are the special rules for the who conforms to the standards
decision of OWCP that requested travel
services of clinical psychologists?
expenses are either not reasonable or regarding conflicts of interest adopted
A clinical psychologist may serve as by OWCP where an actual examination
necessary, or are not incident to
a physician within the scope of his or is not needed, or where the employee is
obtaining authorized medical services,
her practice as defined by state law. deceased.
Therefore, a clinical psychologist may appliances or supplies, he or she may
utilize the adjudicatory process (b) If the initial examination is
not serve as a physician for conditions disrupted by someone accompanying
that include a physical component described in subpart D of this part.
the employee, OWCP will schedule
unless the applicable state law allows (d) The standard form designated for another examination with a different
clinical psychologists to treat physical medical travel refund requests is Form qualified physician who conforms to the
conditions. A clinical psychologist may OWCP–957 and must be used to seek standards regarding conflicts of interest
also perform testing, evaluation, and reimbursement under this section. This adopted by OWCP. The employee will
other services under the direction of a form can be obtained from OWCP. not be entitled to have anyone else
qualified physician. present at the subsequent examination
§ 30.405 After selecting a treating
§ 30.403 Will OWCP pay for the services of physician, may an employee choose to be
unless OWCP decides that exceptional
an attendant? treated by another physician instead? circumstances exist. For example, where
OWCP will authorize payment for a hearing-impaired employee needs an
personal care services under section (a) OWCP will provide the employee interpreter, the presence of an
7384t of the Act, whether or not such with an opportunity to designate a interpreter would be allowed.
care includes medical services, so long treating physician when it accepts the
claim. When the physician originally § 30.411 What happens if the opinion of
as the personal care services have been the physician selected by OWCP differs
determined to be medically necessary selected to provide treatment for an from the opinion of the physician selected
and are provided by a home health aide, occupational illness or a covered illness by the employee?
licensed practical nurse, or similarly refers the employee to a specialist for
(a) If one medical opinion holds more
trained individual. If a claimant further medical care, the employee need probative value than the other, OWCP
disagrees with the decision of OWCP not consult OWCP for approval. In all will base its determination of coverage
that personal care services are not other instances, however, the employee on the medical opinion with the greatest
medically necessary, he or she may must submit a written request to OWCP probative value. A difference in medical
utilize the adjudicatory process with his or her reasons for desiring a opinion sufficient to be considered a
described in subpart D of this part. change of physician. conflict only occurs when two reports of
§ 30.404 Will OWCP pay for transportation (b) OWCP will approve the request if virtually equal weight and rationale
to obtain medical treatment? it determines that the reasons submitted reach opposing conclusions.
(a) The employee is entitled to are sufficient. Requests that are often (b) If a conflict exists between the
reimbursement for reasonable and approved include those for transfer of medical opinion of the employee’s
necessary expenses, including care from a general practitioner to a physician and the medical opinion of a
transportation, incident to obtaining physician who specializes in treating second opinion physician, an OWCP
authorized medical services, appliances the occupational illnesses or covered medical adviser or consultant, or a
or supplies. To determine what is a illnesses covered by EEOICPA, or the physician submitting an impairment
reasonable distance to travel, OWCP need for a new physician when an evaluation that meets the criteria set out
will consider the availability of services, employee has moved. in § 30.905 of this part, OWCP shall
the employee’s condition, and the appoint a third physician who conforms
(c) If a claimant disagrees with the to the standards regarding conflicts of
means of transportation. Generally, a
roundtrip distance of up to 200 miles is decision of OWCP that insufficient interest adopted by OWCP to make an
considered a reasonable distance to reasons for a change of physician have examination or an impairment
travel. been submitted, he or she may utilize evaluation. This is called a referee
(b) If travel of more than 200 miles is the adjudicatory process described in examination or a referee impairment
contemplated, or air transportation or subpart D of this part. evaluation. OWCP will select a
overnight accommodations will be physician who is qualified in the
§ 30.406 Are there any exceptions to these
needed, the employee must submit a procedures for obtaining medical care? appropriate specialty and who has had
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written request to OWCP for prior no prior connection with the case. Also,
authorization with information In cases involving emergencies or a case file may be sent to a physician
describing the circumstances and unusual circumstances, OWCP may who conforms to the standards
necessity for such travel expenses. authorize treatment in a manner other regarding conflicts of interest adopted
OWCP will approve the request if it than as stated in this subpart. by OWCP for a referee medical review

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where there is no need for an actual (b) The report shall be submitted maximum allowable charge. The
examination, or where the employee is directly to OWCP as soon as possible provider that the employee paid, but not
deceased. after medical examination or treatment the employee, may request
(c) If the initial referee examination or is received, either by the employee or reconsideration of the fee determination
referee impairment evaluation is the physician. as set forth in § 30.712.
disrupted by someone accompanying
the employee, OWCP will schedule § 30.417 What additional medical (c) If the provider does not refund to
another examination or impairment information may OWCP require to support the employee or credit to his or her
continuing payment of benefits? account the amount of money paid in
evaluation with a different qualified
physician who conforms to the In all cases requiring hospital excess of the charge that OWCP allows,
standards regarding conflicts of interest treatment or prolonged care, OWCP will the employee should submit
adopted by OWCP. The employee will request detailed narrative reports from documentation of the attempt to obtain
not be entitled to have anyone else the attending physician at periodic such refund or credit to OWCP. OWCP
present at the subsequent referee intervals. The physician will be asked to may authorize reasonable
examination or referee impairment describe continuing medical treatment reimbursement to the employee after
evaluation unless OWCP decides that for the occupational illness or covered reviewing the facts and circumstances of
exceptional circumstances exist. For illness accepted by OWCP, a prognosis, the case.
example, where a hearing-impaired and the physician’s opinion as to the
employee needs an interpreter, the continuing causal relationship between Subpart F—Survivors; Payments and
presence of an interpreter would be the need for additional treatment and Offsets; Overpayments
allowed. the occupational illness or covered
illness. Survivors
§ 30.412 Who pays for second opinion and
referee examinations?
Medical Bills § 30.500 What special statutory definitions
OWCP will pay second opinion and apply to survivors under EEOICPA?
§ 30.420 How should medical bills and
referee medical specialists directly. reimbursement requests be submitted? (a) For the purposes of paying
OWCP will also reimburse the employee Usually, medical providers submit compensation to survivors under both
for all necessary and reasonable their bills directly for processing. The Parts B and E of EEOICPA, OWCP will
expenses incident to such an rules for submitting and processing use the following definitions:
examination, including transportation provider bills and reimbursement
costs and actual wages the employee (1) Surviving spouse means the wife
requests are stated in subpart H of this
lost for the time needed to submit to an or husband of a deceased covered Part
part. An employee requesting
examination required by OWCP. B employee or deceased covered Part E
reimbursement for out-of-pocket
medical expenses must submit a Form employee who was married to that
Medical Reports individual for the 365 consecutive days
OWCP–915 and meet the requirements
§ 30.415 What are the requirements for described in § 30.702. immediately prior to the death of that
medical reports? individual.
In general, medical reports from the § 30.421 What are the time frames for
(2) Child or children includes a
submitting bills and reimbursement
employee’s attending physician should requests? recognized natural child of a deceased
include the following: covered Part B employee or deceased
(a) Dates of examination and To be considered for payment, bills
and reimbursement requests must be covered Part E employee, a stepchild
treatment; who lived with that individual in a
(b) History given by the employee; submitted by the end of the calendar
year after the year when the expense regular parent-child relationship, and an
(c) Physical findings;
was incurred, or by the end of the adopted child of that individual.
(d) Results of diagnostic tests;
(e) Diagnosis; calendar year after the year when OWCP However, to be a ‘‘covered’’ child under
(f) Course of treatment; first accepted the claim as compensable Part E only, such child must have been,
(g) A description of any other under subpart D of this part, whichever as of the date of the deceased covered
conditions found due to the claimed is later. Part E employee’s death, either under
occupational illness or covered illness; the age of 18 years, or under the age of
(h) The treatment given or § 30.422 If an employee is only partially 23 years and a full-time student who
recommended for the claimed reimbursed for a medical expense, must the was continuously enrolled in one or
provider refund the balance of the amount
occupational illness or covered illness; more educational institutions since
paid to the employee?
and attaining the age of 18 years, or any age
(i) All other material findings. (a) The OWCP fee schedule sets
and incapable of self-support.
maximum limits on the amounts
§ 30.416 How and when should medical payable for many services. The (b) For the purposes of paying
reports be submitted? employee may be only partially compensation to survivors only under
(a) The initial medical report (and any reimbursed for out-of-pocket medical Part B of EEOICPA, OWCP will use the
subsequent reports) should be made in expenses because the amount he or she following additional definitions:
narrative form on the physician’s paid to the medical provider for a (1) Parent includes fathers and
letterhead stationery. The physician service exceeds the maximum allowable mothers of a deceased covered Part B
should use the Form EE–7 as a guide for charge set by the OWCP fee schedule. employee through adoption.
the preparation of his or her initial (b) If this happens, the employee will
medical report in support of a claim be advised of the maximum allowable (2) Grandchild means a child of a
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under Part B and/or Part E of EEOICPA. charge for the service in question and of child of a deceased covered Part B
The report should bear the physician’s his or her responsibility to ask the employee.
signature or signature stamp. OWCP provider to refund to the employee, or (3) Grandparent means a parent of a
may require an original signature on the credit to the employee’s account, the parent of a deceased covered Part B
report. amount he or she paid that exceeds the employee.

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§ 30.501 What order of precedence will surviving spouse and at least one employee or each eligible surviving
OWCP use to determine which survivors ‘‘covered’’ child of the deceased covered beneficiary filing a claim under this part
are entitled to receive compensation under Part E employee who is living at the to execute and provide an affidavit (or
EEOICPA? time of payment and who is not a declaration made under oath on Form
(a) Under Part B of the Act, if OWCP recognized natural child or adopted EE–1 or EE–2) reporting the amount of
determines that a survivor or survivors child of such surviving spouse, then any payment made pursuant to a final
are entitled to receive compensation half of such payment shall be made to judgment or settlement in litigation
under EEOICPA because a covered Part such surviving spouse, and the other seeking damages. Even if someone other
B employee who would otherwise have half of such payment shall be made in than the covered Part B employee or the
been entitled to benefits is deceased, equal shares to each ‘‘covered’’ child of covered Part E employee receives a
that compensation will be disbursed as the employee who is living at the time payment pursuant to a final judgment or
follows, subject to the qualifications set of payment. settlement in litigation seeking damages
forth in § 30.5(gg)(3) of these (e.g., the surviving spouse of a deceased
regulations: § 30.502 When is entitlement for survivors covered Part B employee or a deceased
(1) If there is a surviving spouse, the determined for purposes of EEOICPA?
covered Part E employee), the receipt of
compensation shall be paid to that Entitlement to any lump-sum any such payment must be reported.
individual. payment for survivors under EEOICPA, (1) For the purposes of this paragraph
(2) If there is no surviving spouse, the other than for ‘‘covered’’ children under (b) only, ‘‘litigation seeking damages’’
compensation shall be paid in equal Part E, will be determined as of the time refers to any request or demand for
shares to all children of the deceased OWCP makes such a payment. As noted money (other than for workers’
covered Part B employee. in § 30.500(a)(2) of these regulations, a compensation) by the covered Part B
(3) If there is no surviving spouse and child of a deceased Part E employee will employee or the covered Part E
no children, the compensation shall be only qualify as a ‘‘covered’’ child of that employee, or by another individual if
paid in equal shares to the parents of the individual if he or she satisfied one of the covered Part B employee or the
deceased covered Part B employee. the additional statutory criteria for a covered Part E employee is deceased,
(4) If there is no surviving spouse, no ‘‘covered’’ child as of the date of the made or sought in a civil action or in
children and no parents, the deceased Part E employee’s death. anticipation of the filing of a civil
compensation shall be paid in equal Payment of Claims and Offset for action, for injuries incurred on account
shares to all grandchildren of the Certain Payments of an exposure for which compensation
deceased covered Part B employee. is payable under EEOICPA. This term
(5) If there is no surviving spouse, no § 30.505 What procedures will OWCP does not also include any request or
children, no parents and no follow before it pays any compensation? demand for money made or sought
grandchildren, the compensation shall (a) In cases involving the approval of pursuant to a life insurance or health
be paid in equal shares to the a claim, whether in whole or in part, insurance contract, or any request or
grandparents of the deceased covered OWCP shall take all necessary steps to demand for money made or sought by
Part B employee. determine the amount of any offset or an individual other than the covered
(6) Notwithstanding paragraphs (a)(1) coordination of EEOICPA benefits Part B employee or the covered Part E
through (a)(5) of this section, if there is before paying any benefits, and to verify employee in that individual’s own right
a surviving spouse and at least one child the identity of the covered Part B (e.g., a spouse’s claim for loss of
of the deceased covered Part B employee, the covered Part E employee, consortium), or any request or demand
employee who is a minor at the time of or the eligible surviving beneficiary or for money made or sought by the
payment and who is not a recognized beneficiaries. To perform these tasks, covered Part B employee or the covered
natural child or adopted child of such OWCP may conduct any investigation, Part E employee (or the estate of a
surviving spouse, half of the require any claimant to provide or deceased covered Part B employee or
compensation shall be paid to the execute any affidavit, record or deceased covered Part E employee) not
surviving spouse, and the other half of document, or authorize the release of for injuries incurred on account of an
the compensation shall be paid in equal any information as OWCP deems exposure for which compensation is
shares to each child of the deceased necessary to ensure that the payable under the EEOICPA (e.g., a
covered Part B employee who is a minor compensation payment is made in the covered Part B employee’s or a covered
at the time of payment. correct amount and to the correct person Part E employee’s claim for damage to
(b) Under Part E of the Act, if OWCP or persons. OWCP shall also require real or personal property).
determines that a survivor or survivors every claimant under Part B of the Act (2) If a payment has been made
are entitled to receive compensation to execute and provide any necessary pursuant to a final judgment or
under EEOICPA because a covered Part affidavit described in § 30.620 of these settlement in litigation seeking damages,
E employee who would otherwise have regulations. Should a claimant fail or OWCP shall subtract a portion of the
been entitled to benefits is deceased, refuse to execute an affidavit or release dollar amount of such payment from the
that compensation will be disbursed as of information, or fail or refuse to benefit payments to be made under
follows, subject to the qualifications set provide a requested document or record EEOICPA. OWCP will calculate the
forth in § 30.5(gg)(3) of these or to provide access to information, amount to be subtracted from the benefit
regulations: such failure or refusal may be deemed payments in the following manner:
(1) If there is a surviving spouse, the to be a rejection of the payment, unless (i) OWCP will first determine the
compensation shall be paid to that the claimant does not have and cannot value of the payment made pursuant to
individual. obtain the legal authority to provide, either a final judgment or settlement in
(2) If there is no surviving spouse, the release, or authorize access to the litigation seeking damages by adding the
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compensation shall be paid in equal required information, records, or dollar amount of any monetary damages
shares to all ‘‘covered’’ children of the documents. (excluding contingent awards) and any
deceased covered Part E employee. (b) To determine the amount of any medical expenses for treatment
(3) Notwithstanding paragraphs (b)(1) offset, OWCP shall require the covered provided on or after the date the
and (b)(2) of this section, if there is a Part B employee, covered Part E covered Part B employee or the covered

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Part E employee filed a claim for of the payment made pursuant to a final 7384s(e), 7384u(e), and 7385s–3(c) and
EEOICPA benefits that were paid for judgment or settlement in litigation (d) of EEOICPA.
under the final judgment or settlement. seeking damages, OWCP will reduce (b) Under Part B of the Act,
In the event that these payments include currently payable EEOICPA benefits by compensation for any consequential
a ‘‘structured’’ settlement (where a party the amount of any surplus final injury, illness, impairment or disease is
makes an initial cash payment and also judgment or settlement payment that
limited to payment of medical benefits
arranges, usually through the purchase remains.
of an annuity, for payments in the for that injury, illness, impairment or
(c) Except as provided in § 30.506(b) disease. Under Part E of the Act,
future), OWCP will usually accept the of these regulations, when OWCP has
cost of the annuity to the purchaser as compensation for any consequential
verified the identity of every claimant
the dollar amount of the right to receive injury, illness, impairment or disease
who is entitled to the compensation
the future payments. consists of medical benefits for that
payment, or to a share of the
(ii) OWCP will then make certain injury, illness, impairment or disease, as
compensation payment, and has
deductions from the above dollar determined the correct amount of the well as any additional monetary benefits
amount to arrive at the dollar amount to payment or the share of the payment, that are consistent with the terms of
be subtracted from any unpaid OWCP shall notify every claimant, every § 30.505(d).
EEOICPA benefits. Allowable duly appointed guardian or conservator (c) Rejected compensation payments,
deductions consist of attorney’s fees of a claimant, or every person with or shares of compensation payments,
OWCP deems reasonable, and itemized power of attorney for a claimant, and shall not be distributed to other eligible
costs of suit (out-of-pocket expenditures require such person or persons to surviving beneficiaries, but shall be
not part of the normal overhead of a law complete a Form EN–20 providing
firm’s operation like filing fees, travel returned to the Fund.
payment information. Such form shall
expenses, witness fees, and court (d) No covered Part B employee may
be signed and returned to OWCP within
reporter costs for transcripts) provided receive more than one lump-sum
sixty days of the date of the form or
that adequate supporting documentation payment under Part B of EEOICPA for
within such greater period as may be
is submitted to OWCP. any occupational illnesses he or she
(iii) The EEOICPA benefits that will allowed by OWCP. Failure to sign and
return the form within the required time contracted. However, any individual,
be reduced will consist of any unpaid including a covered Part B employee
lump-sum payments payable in the may be deemed to be a rejection of the
payment. If the claimant dies before the who has received a lump-sum payment
future and medical benefits payable in for his or her own occupational illness
the future. In those cases where it has payment is received, the person who
receives the payment shall return it to or illnesses, may receive one lump-sum
not yet paid EEOICPA benefits, OWCP payment for each deceased covered Part
will reduce such benefits on a dollar- OWCP for redetermination of the correct
disbursement of the payment. No B employee for whom he or she
for-dollar basis, beginning with the
lump-sum payments first. If the amount payment shall be made until OWCP has qualifies as an eligible surviving
to be subtracted exceeds the lump-sum made a determination concerning the beneficiary under Part B of the Act.
payments, OWCP will reduce ongoing survivors related to a respective claim
for benefits. § 30.507 What compensation will be
EEOICPA medical benefits payable in provided to covered Part B employees who
the future by the amount of any (d) The total amount of compensation only establish beryllium sensitivity under
remaining surplus. This means that (other than medical benefits) under Part Part B of EEOICPA?
OWCP will apply the amount it would E that can be paid to all claimants as a
otherwise pay to reimburse the covered result of the exposure of a covered Part The establishment of beryllium
Part B employee or the covered Part E E employee shall not be more than sensitivity does not entitle a covered
employee for any ongoing EEOICPA $250,000 in any circumstances. Part B employee, or the eligible
medical treatment to the remaining surviving beneficiary or beneficiaries of
§ 30.506 To whom and in what manner will a deceased covered Part B employee, to
surplus until it is absorbed. In addition OWCP pay compensation?
to this reduction of ongoing EEOICPA any lump-sum payment provided for
medical benefits, OWCP will not be the (a) Except with respect to claims under Part B. Instead, a covered Part B
first payer for any medical expenses that under Part B of the Act for beryllium employee whose sole accepted
are the responsibility of another party sensitivity, payment shall be made to occupational illness is beryllium
(who will instead be the first payer) as the covered Part B employee or the sensitivity shall receive beryllium
part of a final judgment or settlement in covered Part E employee, to the duly sensitivity monitoring, as well as
litigation seeking damages. appointed guardian or conservator of medical benefits for the treatment of this
(3) The above reduction of EEOICPA that individual, or to the person with occupational illness in accordance with
benefits will not occur if an EEOICPA power of attorney for that individual,
§ 30.400 of these regulations.
claimant had his or her award under unless the covered Part B employee or
section 5 of RECA reduced by the full covered Part E employee is deceased at § 30.508 What is beryllium sensitivity
amount of the payment made pursuant the time of the payment. In all cases monitoring?
to a final judgment or settlement in involving a deceased covered Part B
litigation seeking damages. It will also employee or deceased covered Part E Beryllium sensitivity monitoring shall
not occur if an EEOICPA claimant’s employee, payment shall be made to the consist of medical examinations to
prior payment of EEOICPA benefits, or eligible surviving beneficiary or confirm and monitor the extent and
his or her workers’ compensation beneficiaries, to the duly appointed nature of a covered Part B employee’s
benefits, were offset to reflect the full guardian or conservator of the eligible beryllium sensitivity. Monitoring shall
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amount of the payment made pursuant surviving beneficiary or beneficiaries, or also include regular medical
to a final judgment or settlement in to every person with power of attorney examinations, with diagnostic testing, to
litigation seeking damages. However, if for an eligible surviving beneficiary, in determine if the covered Part B
the prior reduction or offset of the above accordance with the terms and employee has established chronic
benefits did not reflect the full amount conditions specified in sections beryllium disease.

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§ 30.509 Under what circumstances may a presumed to have received the notice of (3) Accepted a payment which he or
survivor claiming under Part E of the Act payment, whether mailed or transmitted she knew or should have known to be
choose to receive the benefits that would electronically. incorrect. (This provision applies only
otherwise be payable to a covered Part E
to the overpaid individual.)
employee who is deceased? § 30.511 What is an ‘‘overpayment’’ for
(a) If a covered Part E employee dies purposes of EEOICPA? (b) Whether or not OWCP determines
after filing a claim but before monetary that a recipient was at fault with respect
An ‘‘overpayment’’ is any amount of
benefits are paid under Part E of the Act, to the creation of an overpayment
compensation paid under sections
and his or her death is from a cause depends on the circumstances
7384s, 7384t, 7384u, 7385s–2 or 7385s–
other than a covered illness, his or her surrounding the overpayment. The
3 of the EEOICPA to a recipient that
survivor can choose to receive either the degree of care expected may vary with
constitutes, as of the time OWCP makes
survivor benefits payable on account of the complexity of those circumstances
such payment:
the death of that covered Part E (a) Payment where no amount is and the recipient’s capacity to realize
employee, or the monetary benefits that payable under this part; or that he or she is being overpaid.
would otherwise have been payable to (b) Payment in excess of the correct § 30.514 If OWCP finds that the recipient of
the covered Part E employee. amount determined by OWCP. an overpayment was not at fault, what
(b) For the purposes of this section criteria are used to decide whether to waive
only, a death ‘‘from a cause other than § 30.512 What does OWCP do when an recovery of it?
overpayment is identified?
a covered illness’’ refers only to a death If OWCP finds that the recipient of an
that was solely caused by a non-covered Before seeking to recover an
overpayment or adjust benefits, OWCP overpayment was not at fault,
illness or illnesses. Therefore, the repayment will still be required unless:
choice referred to in paragraph (a) of will advise the recipient of the
this section will not be available if a overpayment in writing that: (a) Adjustment or recovery of the
covered illness contributed to the death (a) The overpayment exists, and the overpayment would defeat the purpose
of the covered Part E employee in any amount of overpayment; of the Act (see § 30.516); or
manner. In those instances, survivor (b) A preliminary finding shows (b) Adjustment or recovery of the
benefits will still be payable to the either that the recipient was or was not overpayment would be against equity
claimant, but he or she cannot choose to at fault in the creation of the and good conscience (see § 30.517).
receive the monetary benefits that overpayment;
(c) He or she has the right to inspect § 30.515 Is a recipient responsible for an
would have otherwise been payable to overpayment that resulted from an error
and copy OWCP records relating to the
the deceased covered Part E employee made by OWCP?
overpayment; and
in lieu of survivor benefits.
(d) He or she has the right to present (a) The fact that OWCP may have
(c) OWCP only makes impairment
written evidence which challenges the erred in making the overpayment does
determinations based on rationalized
fact or amount of the overpayment, and/ not by itself relieve the recipient of the
medical evidence in the case file that is
or challenges the preliminary finding overpayment from liability for
sufficiently detailed and meets the
that he or she was at fault in the creation repayment if the recipient also was at
various requirements for the many
of the overpayment. He or she may also fault in accepting the overpayment.
different types of impairment
request that recovery of the (b) However, OWCP may find that the
determinations possible under the
overpayment be waived. Any recipient was not at fault if failure to
AMA’s Guides. Therefore, OWCP will
submission of evidence or request that report an event affecting compensation
only make an impairment determination
recovery of the overpayment be waived benefits, or acceptance of an incorrect
for a deceased covered Part E employee
must be presented to OWCP within 30 payment, occurred because:
pursuant to this section if the medical
days of the date of the written notice of (1) The recipient relied on
evidence of record is sufficient to satisfy
overpayment. misinformation given in writing by
the pertinent requirements in the
AMA’s Guides and subpart J of this part. § 30.513 Under what circumstances may OWCP regarding the interpretation of a
OWCP waive recovery of an overpayment? pertinent provision or EEOICPA of this
Overpayments part; or
(a) OWCP may consider waiving
§ 30.510 How does OWCP notify an recovery of an overpayment only if the (2) OWCP erred in calculating either
individual of a payment made on a claim? recipient was not at fault in accepting or the percentage of impairment or wage-
(a) In addition to providing narrative creating the overpayment. Recipients of loss under Part E of EEOICPA.
descriptions to recipients of benefits benefits paid under EEOICPA are
§ 30.516 Under what circumstances would
paid or payable, OWCP includes on responsible for taking all reasonable recovery of an overpayment defeat the
each check a clear indication of the measures to ensure that payments purpose of the Act?
reason the payment is being made. For received from OWCP are proper. The
payments sent by electronic funds recipient must show good faith and Recovery of an overpayment will
transfer, a notification of the date and exercise a high degree of care in defeat the purpose of the Act if such
amount of payment appears on the reporting events which may affect recovery would cause hardship to the
statement from the recipient’s financial entitlement to or the amount of benefits. recipient because:
institution. A recipient who has done any of the (a) The recipient from whom OWCP
(b) By these means, OWCP puts the following will be found to be at fault seeks recovery needs substantially all of
recipient on notice that a payment was with respect to creating an his or her current income to meet
made and the amount of the payment. overpayment: current ordinary and necessary living
If the amount received differs from the (1) Made an incorrect statement as to expenses; and
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amount indicated on the written notice a material fact which he or she knew or (b) The recipient’s assets do not
or bank statement, the recipient is should have known to be incorrect; or exceed two months’ expenditures as
responsible for notifying OWCP of the (2) Failed to provide information determined by OWCP using the Bureau
difference. Absent affirmative evidence which he or she knew or should have of Labor Statistics Consumer
to the contrary, the recipient will be known to be material; or Expenditure Survey tables.

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§ 30.517 Under what circumstances would (b) The provisions of subpart D of this authorization of the first individual. In
recovery of an overpayment be against part do not apply to any decision addition, OWCP will recognize only
equity and good conscience? regarding the recovery of an certain types of individuals (see
(a) Recovery of an overpayment is overpayment. § 30.601). For the purposes of paragraph
considered to be against equity and (b) of this section, a ‘‘representative’’
good conscience when the recipient § 30.520 How are overpayments collected?
does not include a person who only has
would experience severe financial (a) When an overpayment has been a power of attorney to act on behalf of
hardship in attempting to repay the made to a recipient who is entitled to a claimant.
debt. further payments, the recipient shall (c) A properly appointed
(b) Recovery of an overpayment is refund to OWCP the amount of the representative who is recognized by
also considered to be against equity and overpayment as soon as the error is OWCP may make a request or give
good conscience when the recipient, in discovered or his or her attention is direction to OWCP regarding the claims
reliance on such payments or on notice called to same. If no refund is made, process, including a hearing. This
that such payments would be made, OWCP shall recover the overpayment by authority includes presenting or
gives up a valuable right or changes his reducing any further lump-sum eliciting evidence, making arguments on
or her position for the worse. In making payments due currently or in the future, facts or the law, and obtaining
such a decision, OWCP does not taking into account the financial
information from the case file, to the
consider the recipient’s current ability circumstances of the recipient, and any
same extent as the claimant.
to repay the overpayment. other relevant factors, so as to minimize
(1) Any notice requirement contained
(1) To establish that a valuable right any hardship. Should the recipient die
in this part or EEOICPA is fully satisfied
has been relinquished, it must be shown before collection has been completed,
if served on the representative, and has
that the right was in fact valuable, that further collection shall be made by
the same force and effect as if sent to the
it cannot be regained, and that the decreasing later payments, if any,
payable under EEOICPA with respect to claimant.
action was based chiefly or solely in (2) A representative does not have
the underlying occupational illness or
reliance on the payments or on the authority to sign the Form EN–20,
covered illness.
notice of payment. Gratuitous transfers (b) When an overpayment has been described in § 30.505(c) of these
of funds to other individuals are not made to a recipient and OWCP is unable regulations, which collects information
considered relinquishments of valuable to recover the overpayment by reducing necessary for issuance of a
rights. compensation due currently, the compensation payment.
(2) To establish that a recipient’s recipient shall refund to OWCP the
position has changed for the worse, it § 30.601 Who may serve as a
amount of the overpayment as soon as representative?
must be shown that the decision made the error is discovered or his or her
would not otherwise have been made A claimant may authorize any
attention is called to same. The
but for the receipt of benefits, and that individual to represent him or her in
overpayment is subject to the provisions
this decision resulted in a loss. regard to a claim under EEOICPA,
of the Federal Claims Collection Act of
unless that individual’s service as a
§ 30.518 Can OWCP require the recipient 1966, as amended (31 U.S.C. 3701 et
representative would violate any
of the overpayment to submit additional seq.), and may be reported to the
applicable provision of law (such as 18
financial information? Internal Revenue Service as income. If
U.S.C. 205 and 208). A federal employee
(a) The recipient of the overpayment the recipient fails to make such refund,
may act as a representative only:
is responsible for providing information OWCP may recover the overpayment
(a) On behalf of immediate family
about income, expenses and assets as through any available means, including
members, defined as a spouse, children,
specified by OWCP. This information is offset of salary, annuity benefits, or
parents, and siblings of the
needed to determine whether or not other Federal payments, including tax
representative, provided no fee or
recovery of an overpayment would refunds as authorized by the Tax Refund
gratuity is charged; or
defeat the purpose of the Act, or would Offset Program, or referral of the debt to
(b) While acting as a union
be against equity and good conscience. a collection agency or to the Department
representative, defined as any officially
This information will also be used to of Justice.
sanctioned union official, and no fee or
determine the repayment schedule, if gratuity is charged.
Subpart G—Special Provisions
necessary.
(b) Failure to submit this requested Representation § 30.602 Who is responsible for paying the
information within 30 days of the representative’s fee?
request shall result in denial of waiver, § 30.600 May a claimant designate a A representative may charge the
representative?
and no further request for waiver shall claimant a fee for services and for costs
be considered until the requested (a) The claims process under this part associated with the representation
information is furnished. is informal, and OWCP acts as an before OWCP. The claimant is solely
impartial evaluator of the evidence. A responsible for paying the fee and other
§ 30.519 How does OWCP communicate claimant need not be represented to file costs. OWCP will not reimburse the
its final decision concerning recovery of an a claim or receive a payment.
overpayment?
claimant, nor is it in any way liable for
Nevertheless, a claimant may appoint the amount of the fee and costs.
(a) After considering any written one individual to represent his or her
documentation or argument submitted interests, but the appointment must be § 30.603 Are there any limitations on what
to OWCP within the 30-day period set in writing. the representative may charge the claimant
out in § 30.512(d), OWCP will issue a (b) There can be only one for his or her services?
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final decision on the overpayment. representative at any one time, so after (a) Notwithstanding any contract, the
OWCP will send a copy of the final one representative has been properly representative may not receive, for
decision to the individual from whom appointed, OWCP will not recognize services rendered in connection with a
recovery is sought and his or her another individual as a representative claim pending before OWCP, more than
representative, if any. until the claimant withdraws the the percentages of the lump-sum

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payment made to the claimant set out in § 30.607 How is a structured settlement § 30.611 If a settlement or judgment is
paragraph (b) of this section. (that is, a settlement providing for receipt of received for more than one medical
funds over a specified period of time) condition, can the amount paid on a single
(b) The percentages referred to in treated for purposes of reporting the EEOICPA claim be attributed to different
paragraph (a) of this section are: recovery? conditions for purposes of calculating the
(1) 2 percent for the filing of an initial amount to which the United States is
claim with OWCP, provided that the In this situation, the recovery to be subrogated?
representative was retained prior to the reported is the present value of the right (a) All medical conditions accepted
filing of the initial claim; plus to receive all of the payments included by OWCP in connection with a single
in the structured settlement, allocated in claim are treated as the same illness for
(2) 10 percent of the difference the case of multiple recipients in the
between the lump-sum payment made the purpose of computing the amount
same manner as single payment which the United States is entitled to
to the claimant and the amount recoveries.
proposed in the recommended decision offset in connection with the receipt of
with respect to objections to a § 30.608 How does the United States a recovery from a third party, except
recommended decision. calculate the amount to which it is that an injury caused by medical
(c)(1) Any representative who violates subrogated? malpractice in treating an illness
this section shall be fined not more than covered under EEOICPA will be treated
The subrogated amount of a specific
$5,000. as a separate injury.
claim consists of the total money paid (b) If an illness covered under
(2) The authority to prosecute by OWCP from the Energy Employees EEOICPA is caused under
violations of this limitation lies with the Occupational Illness Compensation circumstances creating a legal liability
Department of Justice. Fund with respect to that claim to or on in more than one person, other than the
(d) The fee limitations described in behalf of a covered Part B employee, a United States, a DOE contractor or
this section shall not apply with respect covered Part E employee or an eligible subcontractor, a beryllium vendor or an
to representative services that are surviving beneficiary, less charges for atomic weapons employer, to pay
rendered in connection with a petition any medical file review (i.e., the damages, OWCP will determine whether
filed with a U.S. District Court seeking physician did not examine the recoveries received from one or more
review of an OWCP decision that is final employee) done at the request of OWCP. third parties should be attributed to
pursuant to § 30.316(d), or with respect Charges for medical examinations also separate conditions for which
to any subsequent appeal in such a may be subtracted if the covered Part B compensation is payable in connection
proceeding. employee, covered Part E employee or with a single EEOICPA claim. If such an
an eligible surviving beneficiary attribution is both practicable and
Third Party Liability establishes that the examinations were equitable, as determined by OWCP, in
§ 30.605 What rights does the United
required to be made available to the its discretion, the conditions will be
States have upon payment of compensation covered Part B employee or covered Part treated as separate injuries for purposes
under EEOICPA? E employee under a statute other than of calculating the amount to which the
EEOICPA. United States is subrogated.
If an occupational illness or covered
illness for which compensation is § 30.609 Is a settlement or judgment Effect of Tort Suits Against Beryllium
payable under EEOICPA is caused, received as a result of allegations of
Vendors and Atomic Weapons
wholly or partially, by someone other medical malpractice in treating an illness
covered by EEOICPA a recovery that must Employers
than a federal employee acting within
be reported to OWCP?
the scope of his or her employment, a § 30.615 What type of tort suits filed
DOE contractor or subcontractor, a Since an injury caused by medical against beryllium vendors or atomic
beryllium vendor, an atomic weapons malpractice in treating an occupational weapons employers may disqualify certain
employer or a RECA section 5 mine or claimants from receiving benefits under
illness or covered illness compensable Part B of EEOICPA?
mill, the United States is subrogated for under EEOICPA is also covered under
the full amount of any payment of EEOICPA, any recovery in a suit (a) A tort suit (other than an
compensation under EEOICPA to any alleging such an injury is treated as a administrative or judicial proceeding for
right or claim that the individual to recovery that must be reported to workers’ compensation) that includes a
whom the payment was made may have OWCP. claim arising out of a covered Part B
against any person or entity on account employee’s employment-related
of such occupational illness or covered § 30.610 Are payments to a covered Part B exposure to beryllium or radiation, filed
illness. employee, a covered Part E employee or an against a beryllium vendor or an atomic
eligible surviving beneficiary as a result of weapons employer, by a covered Part B
§ 30.606 Under what circumstances must a an insurance policy which the employee or employee or an eligible surviving
recovery of money or other property in eligible surviving beneficiary has beneficiary or beneficiaries of a
connection with an illness for which purchased a recovery that must be reported
to OWCP?
deceased covered Part B employee, will
benefits are payable under EEOICPA be disqualify that otherwise eligible
reported to OWCP?
Since payments received by a covered individual or individuals from receiving
Any person who has filed an Part B employee, a covered Part E benefits under Part B of EEOICPA
EEOICPA claim that has been accepted employee or an eligible surviving unless such claim is terminated in
by OWCP (whether or not compensation beneficiary pursuant to an insurance accordance with the requirements of
has been paid), or who has received policy purchased by someone other than §§ 30.616 through 30.619 of these
EEOICPA benefits in connection with a a liable third party are not payments in regulations.
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claim filed by another, is required to satisfaction of liability for causing an (b) The term ‘‘claim arising out of a
notify OWCP of the receipt of money or occupational illness or covered illness covered Part B employee’s employment-
other property as a result of a settlement compensable under the Act, they are not related exposure to beryllium or
or judgment in connection with the considered a recovery that must be radiation’’ used in paragraph (a) of this
circumstances of that claim. reported to OWCP. section includes a claim that is

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derivative of a covered Part B became aware’’ will be deemed to be the this case, the spouse would be the only
employee’s employment-related date they received either a reconstructed eligible surviving beneficiary of the
exposure to beryllium or radiation, such dose from HHS, or a diagnosis of a deceased covered Part B employee
as a claim for loss of consortium raised covered beryllium illness, as applicable. under Part B of the EEOICPA because
by a covered Part B employee’s spouse. the other family members could not be
(c) If all claims arising out of a § 30.618 What happens if this type of tort eligible for benefits while he or she was
suit was filed after December 28, 2001?
covered Part B employee’s employment- alive. As a result, the spouse would be
related exposure to beryllium or (a) If a tort suit described in § 30.615 the only party to the tort suit who
radiation are terminated in accordance was filed after December 28, 2001, the would have to comply with the
with the requirements of §§ 30.616 claimant or claimants will be termination requirements of §§ 30.616
through 30.619 of these regulations, disqualified from receiving any benefits through 30.618.
proceeding with the remaining portion under Part B of EEOICPA if a judgment
is entered against them. § 30.620 How will OWCP ascertain whether
of the tort suit filed against a beryllium a claimant filed this type of tort suit and if
vendor or an atomic weapons employer (b) If a tort suit described in § 30.615
was filed after December 28, 2001 and he or she has been disqualified from
will not disqualify an otherwise eligible receiving any benefits under Part B of
individual or individuals from receiving a judgment has not yet been entered EEOICPA?
benefits under Part B of EEOICPA. against the claimant or claimants, they
Prior to authorizing payment on a
will also be disqualified from receiving
claim under Part B of EEOICPA, OWCP
§ 30.616 What happens if this type of tort any benefits under Part B of EEOICPA
suit was filed prior to October 30, 2000? will require each claimant to execute
unless, prior to entry of any judgment,
and provide an affidavit stating if he or
(a) If a tort suit described in § 30.615 they dismiss all claims arising out of a
she filed a tort suit (other than an
was filed prior to October 30, 2000, the covered Part B employee’s employment-
administrative or judicial proceeding for
claimant or claimants will not be related exposure to beryllium or
workers’ compensation) against either a
disqualified from receiving any radiation that are included in the tort
beryllium vendor or an atomic weapons
EEOICPA benefits to which they may be suit on or before the last permissible
employer that included a claim arising
found entitled if the tort suit was date described in paragraph (c) of this
out of a covered Part B employee’s
terminated in any manner prior to section. employment-related exposure to
December 28, 2001. (c) The last permissible date is the
beryllium or radiation, and if so, the
(b) If a tort suit described in § 30.615 later of:
current status of such tort suit. OWCP
was filed prior to October 30, 2000 and (1) April 30, 2003; or
may also require the submission of any
was pending as of December 28, 2001, (2) The date that is 30 months after
supporting evidence necessary to
the claimant or claimants will be the date the claimant or claimants first
confirm the particulars of any affidavit
disqualified from receiving any benefits became aware that an illness of the
provided under this section.
under Part B of EEOICPA unless they covered Part B employee may be
dismissed all claims arising out of a connected to his or her exposure to Coordination of Part E Benefits With
covered Part B employee’s employment- beryllium or radiation covered by State Workers’ Compensation Benefits
related exposure to beryllium or EEOICPA. For purposes of determining
§ 30.625 What does ‘‘coordination of
radiation that were included in the tort when this 30-month period begins, ‘‘the benefits’’ mean under Part E of EEOICPA?
suit prior to December 31, 2003. date the claimant or claimants first
In general, ‘‘coordination of benefits’’
became aware’’ will be deemed to be the
§ 30.617 What happens if this type of tort under Part E of the Act occurs when
date they received either a reconstructed
suit was filed during the period from compensation to be received under Part
dose from HHS, or a diagnosis of a
October 30, 2000 through December 28, E is reduced by OWCP, pursuant to
covered beryllium illness, as applicable.
2001? section 7385s–11 of EEOICPA, to reflect
(a) If a tort suit described in § 30.615 § 30.619 Do all the parties to this type of certain benefits the beneficiary receives
was filed during the period from tort suit have to take these actions? under a state workers’ compensation
October 30, 2000 through December 28, The type of tort suits described in program for the same covered illness.
2001, the claimant or claimants will be § 30.615 may be filed by more than one § 30.626 How will OWCP coordinate
disqualified from receiving any benefits individual, each with a different cause compensation payable under Part E of
under Part B of EEOICPA unless they of action. For example, a tort suit may EEOICPA with benefits from state workers’
dismiss all claims arising out of a be filed against a beryllium vendor by compensation programs?
covered Part B employee’s employment- both a covered Part B employee and his (a) OWCP will reduce the
related exposure to beryllium or or her spouse, with the covered Part B compensation payable under Part E by
radiation that are included in the tort employee claiming for chronic the amount of benefits the claimant
suit on or before the last permissible beryllium disease and the spouse receives from a state workers’
date described in paragraph (b) of this claiming for loss of consortium due to compensation program by reason of the
section. the covered Part B employee’s exposure same covered illness, after deducting
(b) The last permissible date is the to beryllium. However, since the spouse the reasonable costs to the claimant of
later of: of a living covered Part B employee obtaining those benefits.
(1) April 30, 2003; or could not be an eligible surviving (b) To determine the amount of any
(2) The date that is 30 months after beneficiary under Part B of EEOICPA, reduction of EEOICPA compensation,
the date the claimant or claimants first the spouse would not have to comply OWCP shall require the covered Part E
became aware that an illness of the with the termination requirements of employee or each eligible surviving
covered Part B employee may be §§ 30.616 through 30.618. A similar beneficiary filing a claim under Part E
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connected to his or her exposure to result would occur if a tort suit were to execute and provide affidavits
beryllium or radiation covered by filed by both the spouse of a deceased reporting the amount of any benefit
EEOICPA. For purposes of determining covered Part B employee and other received pursuant to a claim filed in a
when this 30-month period begins, ‘‘the family members (such as children of the state workers’ compensation program
date the claimant or claimants first deceased covered part B employee). In for the same covered illness.

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(c) If a covered Part E employee or a receives state workers’ compensation description of services performed
survivor of such employee receives benefits for both a covered and a non- should be provided.
benefits through a state workers’ covered illness arising out of and in the (c) For professional charges billed on
compensation program pursuant to a course of the same work-related Form OWCP–1500 or CMS–1500, the
claim for the same covered illness, incident. provider shall also state each diagnosed
OWCP shall reduce a portion of the condition and furnish the corresponding
dollar amount of such state workers’ § 30.627 Under what circumstances will diagnostic code using the ‘‘International
OWCP waive the statutory requirement to Classification of Disease, 9th Edition,
benefit from the compensation payable
coordinate these benefits?
under Part E. OWCP will calculate the Clinical Modification’’ (ICD–9–CM), or
net amount of the state workers’ A waiver to the requirement to as revised. A separate bill shall be
compensation benefit amount to be coordinate Part E benefits with benefits submitted when the employee is
subtracted from the compensation paid under a state workers’ discharged from treatment or monthly,
payment under Part E in the following compensation program may be granted if treatment for the occupational illness
manner: if OWCP determines that the is necessary for more than 30 days.
(1) OWCP will first determine the administrative costs and burdens of (1)(i) Hospitals shall submit charges
dollar value of the benefits received by coordinating benefits in a particular for medical and surgical treatment or
that individual from a state workers’ case or class of cases justifies the supplies promptly on Form OWCP–04
compensation program by including all waiver. This decision is exclusively or UB–04. The provider shall identify
benefits, other than medical and within the discretion of OWCP. each outpatient radiology service,
vocational rehabilitation benefits, outpatient pathology service and
received for the same covered illness or Subpart H—Information for Medical physical therapy service performed,
injury sustained as a consequence of a Providers using HCPCS/CPT codes with a brief
covered illness. Medical Records and Bills narrative description. The charge for
(2) OWCP will then make certain each individual service, or the total
deductions from the above dollar benefit § 30.700 What kinds of medical records charge for all identical services, should
received under a state workers’ must providers keep? also appear on the form.
compensation program to arrive at the Federal Government medical officers, (ii) Other outpatient hospital services
dollar amount that will be subtracted private physicians and hospitals are for which HCPCS/CPT codes exist shall
from any compensation payable under required to keep records of all cases also be coded individually using the
Part E of EEOICPA. treated by them under EEOICPA so they coding scheme noted in this section.
(i) Allowable deductions consist of can supply OWCP with a history of the Services for which there are no HCPCS/
reasonable costs in obtaining state claimed occupational illness or covered CPT codes available can be presented
workers’ compensation benefits illness, a description of the nature and using the RCCs described in the
incurred by that individual, including extent of the claimed occupational ‘‘National Uniform Billing Data
but not limited to attorney’s fees OWCP illness or covered illness, the results of Elements Specifications,’’ current
deems reasonable and itemized costs of any diagnostic studies performed, and edition. The provider shall also furnish
suit (out-of-pocket expenditures not part the nature of the treatment rendered. the diagnostic code using the ICD–9–
of the normal overhead of a law firm’s This requirement terminates after a CM. If the outpatient hospital services
operation like filing, travel expenses, provider has supplied OWCP with the include surgical and/or invasive
witness fees, and court reporter costs for above-noted information, and otherwise procedures, the provider shall code each
transcripts), provided that adequate terminates ten years after the record was procedure using the proper HCPCS/CPT
supporting documentation is submitted created. codes and furnishing the corresponding
to OWCP for its consideration. diagnostic codes using the ICD–9–CM.
(ii) The EEOICPA benefits that will be § 30.701 How are medical bills to be (2) Pharmacies shall itemize charges
reduced will consist of any unpaid submitted? for prescription medications,
monetary payments payable in the (a) All charges for medical and appliances, or supplies on electronic or
future and medical benefits payable in surgical treatment, appliances or paper-based bills and submit them
the future. In those cases where it has supplies furnished to employees, except promptly for processing. Bills for
not yet paid EEOICPA benefits under for treatment and supplies provided by prescription medications must include
Part E, OWCP will reduce such benefits nursing homes, shall be supported by all required data elements, including the
on a dollar-for-dollar basis, beginning medical evidence as provided in NDC number assigned to the product,
with the current monetary payments § 30.700. The physician or provider the generic or trade name of the drug
first. If the amount to be subtracted shall itemize the charges on Form provided, the prescription number, the
exceeds the monetary payments OWCP–1500 or CMS–1500 (for quantity provided, and the date the
currently payable, OWCP will reduce professional charges), Form OWCP–04 prescription was filled.
ongoing EEOICPA medical benefits or UB–04 (for hospitals), an electronic (3) Nursing homes shall itemize
payable in the future by the amount of or paper-based bill that includes charges for appliances, supplies or
any remaining surplus. This means that required data elements (for pharmacies), services on the provider’s billhead
OWCP will apply the amount it would or other form as warranted, and submit stationery and submit them promptly
otherwise pay to reimburse the covered the form or bill promptly for processing. for processing.
Part E employee for any ongoing (b) The provider shall identify each (d) By submitting a bill and/or
EEOICPA medical treatment to the service performed using the Physician’s accepting payment, the provider
remaining surplus until it is absorbed Current Procedural Terminology (CPT) signifies that the service for which
(or until further monetary benefits code, the Healthcare Common payment is sought was performed as
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become payable that are sufficient to Procedure Coding System (HCPCS) described and was necessary. In
absorb the surplus). code, the National Drug Code (NDC) addition, the provider thereby agrees to
(3) The above coordination of benefits number, or the Revenue Center Code comply with all regulations set forth in
will not occur if the beneficiary under (RCC), with a brief narrative description. this subpart concerning the rendering of
a state workers’ compensation program Where no code is applicable, a detailed treatment and/or the process for seeking

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payment for medical services, including service from the employee and a bill is submitted more than one year
the limitation imposed on the amount to statement of the amount paid. beyond the end of the calendar year in
be paid for such services. (c) The requirements of paragraphs (a) which the expense was incurred or the
(e) In summary, bills submitted by and (b) of this section may be waived if service or supply was provided, or more
providers must: Be itemized on Form extensive delays in the filing or the than one year beyond the end of the
OWCP–1500 or CMS–1500 (for adjudication of a claim make it calendar year in which the claim was
physicians), Form OWCP–04 or UB–04 unusually difficult for the employee to first accepted as compensable by OWCP,
(for hospitals), or an electronic or paper- obtain the required information. whichever is later.
based bill that includes required data (d) Copies of bills submitted for
elements (for pharmacies); contain the reimbursement will not be accepted Medical Fee Schedule
signature or signature stamp of the unless they bear the original signature of § 30.705 What services are covered by the
provider; and identify the procedures the provider and evidence of payment. OWCP fee schedule?
using HCPCS/CPT codes, RCCs, or NDC Payment for medical and surgical (a) Payment for medical and other
numbers. Otherwise, the bill may be treatment, appliances or supplies shall health services furnished by physicians,
returned to the provider for correction in general be no greater than the hospitals and other providers for
and resubmission. The decision of maximum allowable charge for such occupational illnesses or covered
OWCP whether to pay a provider’s bill service determined by OWCP, as set illnesses shall not exceed a maximum
is final when issued and is not subject forth in § 30.705. The decision of OWCP allowable charge for such service as
to the adjudicatory process described in whether to reimburse an employee for determined by OWCP, except as
subpart D of this part. out-of-pocket medical expenses, and the provided in this section.
amount of any reimbursement, is final (b) The schedule of maximum
§ 30.702 How should an employee prepare when issued and is not subject to the
and submit requests for reimbursement for allowable charges does not apply to
adjudicatory process described in charges for services provided in nursing
medical expenses, transportation costs,
loss of wages, and incidental expenses?
subpart D of this part. homes, but it does apply to charges for
(e) An employee will be only partially treatment furnished in a nursing home
(a) If an employee has paid bills for reimbursed for a medical expense if the
medical, surgical or other services, by a physician or other medical
amount he or she paid to a provider for professional.
supplies or appliances provided by a the service exceeds the maximum
professional due to an occupational (c) The schedule of maximum
allowable charge set by OWCP’s allowable charges also does not apply to
illness or a covered illness, he or she schedule. If this happens, the employee
must submit a request for charges for appliances, supplies,
will be advised of the maximum services or treatment furnished by
reimbursement on Form OWCP–915, allowable charge for the service in
together with an itemized bill on Form medical facilities of the U.S. Public
question and of his or her responsibility Health Service or the Departments of the
OWCP–1500 or CMS–1500 prepared by to ask the provider to refund to the
the provider and a medical report as Army, Navy, Air Force and Veterans
employee, or credit to the employee’s Affairs.
provided in § 30.700, for consideration. account, the amount he or she paid
(1) The provider of such service shall which exceeds the maximum allowable § 30.706 How are the maximum fees
state each diagnosed condition and charge. The provider that the employee defined?
furnish the applicable ICD–9–CM code paid, but not the employee, may request For professional medical services,
and identify each service performed reconsideration of the fee determination OWCP shall maintain a schedule of
using the applicable HCPCS/CPT code, as set forth in § 30.712. maximum allowable fees for procedures
with a brief narrative description of the (f) If the provider fails to make performed in a given locality. The
service performed, or, where no code is appropriate refund to the employee, or schedule shall consist of: An assignment
applicable, a detailed description of that to credit the employee’s account, within of a value to procedures identified by
service. 60 days after the employee requests a HCPCS/CPT code which represents the
(2) The reimbursement request must refund of any excess amount, or the date relative skill, effort, risk and time
be accompanied by evidence that the of a subsequent reconsideration required to perform the procedure, as
provider received payment for the decision which continues to disallow all compared to other procedures of the
service from the employee and a or a portion of the disputed amount, same general class; an index based on a
statement of the amount paid. OWCP will initiate exclusion relative value scale that considers skill,
Acceptable evidence that payment was procedures as provided by § 30.715. labor, overhead, malpractice insurance
received includes, but is not limited to, (g) If the provider does not refund to and other related costs; and a monetary
a signed statement by the provider, a the employee or credit to his or her value assignment (conversion factor) for
mechanical stamp or other device account the amount of money paid in one unit of value in each of the
showing receipt of payment, a copy of excess of the allowed charge, the categories of service.
the employee’s canceled check (both employee should submit documentation
front and back) or a copy of the of the attempt to obtain such refund or § 30.707 How are payments for particular
employee’s credit card receipt. services calculated?
credit to OWCP. OWCP may authorize
(b) If a hospital, pharmacy or nursing reasonable reimbursement to the Payment for a procedure identified by
home provided services for which the employee after reviewing the facts and a HCPCS/CPT code shall not exceed the
employee paid, the employee must also circumstances of the case. amount derived by multiplying the
use Form OWCP–915 to request relative values for that procedure by the
reimbursement and should submit the § 30.703 What are the time limitations on geographic indices for services in that
request in accordance with the OWCP’s payment of bills? area and by the dollar amount assigned
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provisions of § 30.701(a). Any such OWCP will pay providers and to one unit in that category of service.
request for reimbursement must be reimburse employees promptly for all (a) The ‘‘locality’’ which serves as a
accompanied by evidence, as described bills received on an approved form and basis for the determination of average
in paragraph (a)(2) of this section, that in a timely manner. However, no bill cost is defined by the Bureau of Census
the provider received payment for the will be paid for expenses incurred if the Metropolitan Statistical Areas. OWCP

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shall base the determination of the of the medication by the quantity or billed procedure or service if the code
relative per capita cost of medical care amount provided, plus a dispensing fee. is consistent with medical reports and
in a locality using information about (a) All prescription medications other evidence. Where no code is
enrollment and medical cost per county, identified by NDC number will be supplied, OWCP may determine the
provided by the Centers for Medicare assigned an average wholesale price code based on the narrative description
and Medicaid Services (CMS). representing the product’s nationally of the procedure on the billing form and
(b) OWCP shall assign the relative recognized wholesale price as in associated medical reports. OWCP
value units (RVUs) published by CMS to determined by surveys of manufacturers will pay no more than the maximum
all services for which CMS has made and wholesalers. OWCP will establish allowable fee for that procedure.
assignments, using the most recent the dispensing fee. (b) If the charge submitted for a
revision. Where there are no RVUs (b) The NDC numbers, the average service supplied to an employee
assigned to a procedure, OWCP may wholesale prices, and the dispensing fee exceeds the maximum amount
develop and assign any RVUs shall be reviewed from time to time and determined to be reasonable according
considered appropriate. The geographic updated as necessary. to the schedule, OWCP shall pay the
adjustment factor shall be that amount allowed by the schedule for that
§ 30.710 How are payments for inpatient
designated by Geographic Practice Cost service and shall notify the provider in
medical services determined?
Indices for Metropolitan Statistical writing that payment was reduced for
Areas as devised for CMS and as (a) OWCP will pay for inpatient
medical services according to pre- that service in accordance with the
updated or revised by CMS from time to schedule. OWCP shall also notify the
time. OWCP will devise conversion determined, condition-specific rates
based on the Prospective Payment provider of the method for requesting
factors for each category of service, and reconsideration of the balance of the
in doing so may adapt CMS conversion System (PPS) devised by CMS (42 CFR
parts 412, 413, 424, 485, and 489). Using charge. The decision of OWCP to pay
factors as appropriate using OWCP’s less than the charged amount is final
processing experience and internal data. this system, payment is derived by
multiplying the diagnosis-related group when issued and is not subject to the
(c) For example, if the unit values for adjudicatory process described in
a particular surgical procedure are 2.48 (DRG) weight assigned to the hospital
discharge by the provider-specific subpart D of this part.
for physician’s work (W), 3.63 for
practice expense (PE), and 0.48 for factors. § 30.712 If OWCP reduces a fee, may a
malpractice insurance (M), and the (1) All hospital discharges will be provider request reconsideration of the
dollar value assigned to one unit in that classified according to the DRGs reduction?
category of service (surgery) is $61.20, prescribed by CMS in the form of the (a) A physician or other provider
then the maximum allowable charge for DRG Grouper software program. On this whose charge for service is only
one performance of that procedure is the list, each DRG represents the average partially paid because it exceeds a
product of the three RVUs times the resources necessary to provide care in a maximum allowable amount set by
corresponding geographical indices for case in that DRG relative to the national OWCP may, within 30 days, request
the locality times the conversion factor. average of resources consumed per case. reconsideration of the fee
If the geographic indices for the locality (2) The provider-specific factors will determination.
are 0.988(W), 0.948 (PE), and 1.174 (M), be provided by CMS in the form of their
(1) Any such request will be
then the maximum payment calculation PPS Pricer software program. The
considered by the district office with
is: software takes into consideration the
jurisdiction over the employee’s claim.
type of facility, census division, actual
[(2.48)(0.988) + (3.63)(0.948) + (0.48)(1.174)] The request must be accompanied by
geographic location of the hospital, case
× $61.20 documentary evidence that the
mix cost per discharge, number of
[2.45 + 3.44 + .56] × $61.20 procedure performed was either
6.45 × $61.20 = $394.74 hospital beds, intern/beds ratio,
incorrectly identified by the original
operating cost to charge ratio, and other
code, that the presence of a severe or
§ 30.708 Does the fee schedule apply to factors used by CMS to determine the
every kind of procedure? concomitant medical condition made
specific rate for a hospital discharge
treatment especially difficult, or that the
Where the time, effort and skill under their PPS. OWCP may devise
provider possessed unusual
required to perform a particular price adjustment factors as appropriate
qualifications. In itself, board
procedure vary widely from one using OWCP’s processing experience
certification in a specialty is not
occasion to the next, OWCP may choose and internal data.
(3) OWCP will base payments to sufficient evidence of unusual
not to assign a relative value to that
facilities excluded from CMS’s PPS on qualifications to justify a charge in
procedure. In this case the allowable
consideration of detailed medical excess of the maximum allowable
charge for the procedure will be set
reports and other evidence. amount set by OWCP. These are the
individually based on consideration of a
(4) OWCP shall review the pre- only three circumstances that will
detailed medical report and other
determined hospital rates at least once justify reevaluation of the paid amount.
evidence. At its discretion, OWCP may
set fees without regard to schedule a year, and may adjust any or all (2) A list of district offices and their
limits for specially authorized components when OWCP deems it respective areas of jurisdiction is
consultant examinations, for directed necessary or appropriate. available upon request from the U.S.
medical examinations, and for other (b) OWCP shall review the schedule Department of Labor, Office of Workers’
specially authorized services. of fees at least once a year, and may Compensation Programs, Washington,
adjust the schedule or any of its DC 20210, or on the Internet at http://
§ 30.709 How are payments for medicinal components when OWCP deems it www.dol.gov/esa/regs/compliance/
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drugs determined? necessary or appropriate. owcp/eeoicp/main.htm. Within 30 days


Payment for medicinal drugs of receiving the request for
prescribed by physicians shall not § 30.711 When and how are fees reduced? reconsideration, the district office shall
exceed the amount derived by (a) OWCP shall accept a provider’s respond in writing stating whether or
multiplying the average wholesale price designation of the code to identify a not an additional amount will be

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allowed as reasonable, considering the surgical or hospital services, appliances entry of the judgment of conviction or
evidence submitted. or supplies; order of exclusion, suspension or
(b) If the district office issues a (b) Been excluded or suspended, or resignation, as the case may be, by the
decision that continues to disallow a has resigned in lieu of exclusion or court or agency concerned. Proof of the
contested amount, the provider may suspension, from participation in any conviction, exclusion, suspension or
apply to the Regional Director of the federal or state program referred to in resignation may consist of a copy
region with jurisdiction over the district paragraph (a) of this section; thereof authenticated by the seal of the
office. The application must be filed (c) Knowingly made, or caused to be court or agency concerned.
within 30 days of the date of such made, any false statement or
misrepresentation of a material fact in § 30.717 When are OWCP’s exclusion
decision, and it may be accompanied by procedures initiated?
additional evidence. Within 60 days of connection with a determination of the
receipt of such application, the Regional right to reimbursement under this part, Upon receipt of information
Director shall issue a decision in writing or in connection with a request for indicating that a physician, hospital or
stating whether or not an additional payment; provider of medical services or supplies
amount will be allowed as reasonable, (d) Submitted, or caused to be (hereinafter the provider) has engaged in
considering the evidence submitted. submitted, three or more bills or activities enumerated in paragraphs (c)
requests for payment within a 12-month through (h) of § 30.715, the Regional
§ 30.713 If OWCP reduces a fee, may a period under this subpart containing Director, after completion of inquiries
provider bill the employee for the balance? charges which OWCP finds to be he or she deems appropriate, may
A provider whose fee for service is substantially in excess of such initiate procedures to exclude the
partially paid by OWCP as a result of provider’s customary charges, unless provider from participation in the
the application of its fee schedule or OWCP finds there is good cause for the EEOICPA program. For the purposes of
other tests for reasonableness in bills or requests containing such these procedures, ‘‘Regional Director’’
accordance with this part shall not charges; may include any officer designated to
request payment from the employee for (e) Knowingly failed to timely act on his or her behalf.
the unpaid amount of the provider’s reimburse employees for treatment,
bill. services or supplies furnished under § 30.718 How is a provider notified of
OWCP’s intent to exclude him or her?
(a) Where a provider’s fee for a this subpart and paid for by OWCP;
particular service or procedure is lower (f) Failed, neglected or refused on The Regional Director shall initiate
to the general public than as provided three or more occasions during a 12- the exclusion process by sending the
by the schedule of maximum allowable month period to submit full and provider a letter, by certified mail and
charges, the provider shall bill at the accurate medical reports, or to respond with return receipt requested, which
lower rate. A fee for a particular service to requests by OWCP for additional shall contain the following:
or procedure which is higher than the reports or information, as required by (a) A concise statement of the grounds
provider’s fee to the general public for § 30.700 of this part; upon which exclusion shall be based;
that same service or procedure will be (g) Knowingly furnished treatment, (b) A summary of the information,
considered a charge ‘‘substantially in services or supplies which are with supporting documentation, upon
excess of such provider’s customary substantially in excess of the employee’s which the Regional Director has relied
charges’’ for the purposes of § 30.715(d). needs, or of a quality which fails to meet in reaching an initial decision that
(b) A provider whose fee for service professionally recognized standards; or exclusion proceedings should begin;
is partially paid by OWCP as the result (h) Collected or attempted to collect
from the employee, either directly or (c) An invitation to the provider to:
of the application of the schedule of
through a collection agent, an amount in (1) Resign voluntarily from
maximum allowable charges and who
excess of the charge allowed by OWCP participation in the EEOICPA program
collects or attempts to collect from the
for the procedure performed, and has without admitting or denying the
employee, either directly or through a
failed or refused to make appropriate allegations presented in the letter; or
collection agent, any amount in excess
of the charge allowed by OWCP, and refund to the employee, or to cease such (2) Request that the decision on
who does not cease such action or make collection attempts, within 60 days of exclusion be based upon the existing
appropriate refund to the employee the date of the decision of OWCP. record and any additional documentary
within 60 days of the date of the information the provider may wish to
§ 30.716 What will cause OWCP to furnish;
decision of OWCP, shall be subject to automatically exclude a physician or other
the exclusion procedures provided by provider of medical services and supplies? (d) A notice of the provider’s right, in
§ 30.715(h). the event of an adverse ruling by the
(a) OWCP shall automatically exclude
Regional Director, to request a formal
Exclusion of Providers a physician, hospital, or provider of
hearing before an administrative law
medical services or supplies who:
§ 30.715 What are the grounds for (1) Has been convicted of a crime judge;
excluding a provider from payment under described in § 30.715(a); or (e) A notice that should the provider
this part? (2) Has been excluded or suspended, fail to answer (as described in § 30.719)
A physician, hospital, or provider of or has resigned in lieu of exclusion or the letter of intent within 30 calendar
medical services or supplies shall be suspension, from participation in any days of receipt, the Regional Director
excluded from payment under this part federal or state program for which may deem the allegations made therein
if such physician, hospital or provider payments are made to providers for to be true and may order exclusion of
has: similar medical, surgical or hospital the provider without conducting any
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(a) Been convicted under any criminal services, appliances or supplies. further proceedings; and
statute of fraudulent activities in (b) The exclusion applies to (f) The name and address of the
connection with any federal or state participating in the program and to OWCP representative who shall be
program for which payments are made seeking payment under this part for responsible for receiving the answer
to providers for similar medical, services performed after the date of the from the provider.

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§ 30.719 What requirements must the issue a Notice of Hearing and Hearing § 30.723 How will the administrative law
provider’s reply and OWCP’s decision Schedule for the conduct of the hearing. judge conduct the hearing and issue the
meet? A copy of the hearing notice shall be recommended decision?
(a) The provider’s answer shall be in served on the provider by certified mail, (a) To the extent appropriate,
writing and shall include an answer to return receipt requested. The Notice of proceedings before the administrative
OWCP’s invitation to resign voluntarily. Hearing and Hearing Schedule shall law judge shall be governed by 29 CFR
If the provider does not offer to resign, include: part 18.
he or she shall request that a (b) The administrative law judge shall
(1) A ruling on each item raised in the receive such relevant evidence as may
determination be made upon the
existing record and any additional request for hearing; be adduced at the hearing. Evidence
information provided. (2) A schedule for the prompt shall be presented under oath, orally or
(b) Should the provider fail to answer disposition of all preliminary matters, in the form of written statements. The
the letter of intent within 30 calendar including requests for more definite administrative law judge shall consider
days of receipt, the Regional Director statements and for the certification of the Notice and Response, including all
may deem the allegations made therein questions to advisory bodies; and pertinent documents accompanying
to be true and may order exclusion of them, and may also consider any
(3) A scheduled hearing date not less evidence which refers to the provider or
the provider. than 30 days after the date the schedule
(c) By arrangement with the OWCP to any claim with respect to which the
is issued, and not less than 15 days after provider has provided medical services,
representative, the provider may inspect the scheduled conclusion of preliminary
or request copies of information in the hospital services, or medical services
matters, provided that the specific time and supplies, and such other evidence
record at any time prior to the Regional and place of the hearing may be set on
Director’s decision. as the administrative law judge may
10 days’ notice. determine to be necessary or useful in
(d) The Regional Director shall issue
his or her decision in writing, and shall (b) The purpose of the designation of evaluating the matter.
send a copy of the decision to the issues is to provide for an effective (c) All hearings shall be recorded and
provider by certified mail, return receipt hearing process. The provider is entitled the original of the complete transcript
requested. The decision shall advise the to be heard on any matter placed in shall become a permanent part of the
provider of his or her right to request, issue by his or her response to the official record of the proceedings.
within 30 days of the date of the adverse Notice of Intent to Exclude, and may (d) In conjunction with the hearing,
decision, a formal hearing before an designate ‘‘all issues’’ for purposes of the administrative law judge may:
hearing. However, a specific designation (1) Administer oaths; and
administrative law judge under the (2) Examine witnesses.
procedures set forth in § 30.720. The of issues is required if the provider (e) At the conclusion of the hearing,
filing of a request for a hearing within wishes to interpose affirmative defenses the administrative law judge shall issue
the time specified shall stay the or request the certification of questions a written decision and cause it to be
effectiveness of the decision to exclude. for an advisory opinion. served on all parties to the proceeding,
§ 30.720 How can an excluded provider § 30.722 How are subpoenas or advisory their representatives and OWCP.
request a hearing? opinions obtained? § 30.724 How can a party request review
A request for a hearing shall be sent (a) In exclusion proceedings involving by OWCP of the administrative law judge’s
to the OWCP representative named medical services provided under Part B recommended decision?
pursuant to § 30.718(f) and shall of the Act only, the provider may apply (a) Any party adversely affected or
contain: aggrieved by the decision of the
to the administrative law judge for the
(a) A concise notice of the issues on administrative law judge may file a
issuance of subpoenas upon a showing
which the provider desires to give petition for discretionary review with
of good cause therefore.
evidence at the hearing; the Director for Energy Employees
(b) Any request for a more definite (b) A certification of a request for an Occupational Illness Compensation
statement by OWCP; advisory opinion concerning within 30 days after issuance of such
(c) Any request for the presentation of professional medical standards, medical decision. The administrative law judge’s
oral argument or evidence; and ethics or medical regulation to a decision, however, shall be effective on
(d) Any request for a certification of competent recognized or professional the date issued and shall not be stayed
questions concerning professional organization or federal, state or local except upon order of the Director.
medical standards, medical ethics or regulatory agency may be made: (b) Review by the Director for Energy
medical regulation for an advisory (1) As to an issue properly designated Employees Occupational Illness
opinion from a competent recognized by the provider, in the sound discretion Compensation shall not be a matter of
professional organization or federal, of the administrative law judge, right but of the sound discretion of the
state or local regulatory body. provided that the request will not Director.
unduly delay the proceedings; (c) Petitions for discretionary review
§ 30.721 How are hearings assigned and
shall be filed only upon one or more of
scheduled? (2) By OWCP on its own motion either the following grounds:
(a) If the designated OWCP before or after the institution of (1) A finding or conclusion of material
representative receives a timely request proceedings, and the results thereof fact is not supported by substantial
for hearing, the OWCP representative shall be made available to the provider evidence;
shall refer the matter to the Chief at the time that proceedings are (2) A necessary legal conclusion is
Administrative Law Judge of the instituted or, if after the proceedings are erroneous;
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Department of Labor, who shall assign instituted, within a reasonable time after (3) The decision is contrary to law or
it for an expedited hearing. The receipt. The opinion, if rendered by the to the duly promulgated rules or
administrative law judge assigned to the organization or agency, is advisory only decisions of OWCP;
matter shall consider the request for and not binding on the administrative (4) A substantial question of law,
hearing, act on all requests therein, and law judge. policy, or discretion is involved; or

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(5) A prejudicial error of procedure from instituting exclusion proceedings § 30.801 What special definitions does
was committed. based upon the underlying facts of the OWCP use in connection with Part E wage-
(d) Each issue shall be separately matter. loss determinations?
numbered and plainly and concisely For the purposes of paying
(b) A physician, hospital, or provider compensation based on wage-loss under
stated, and shall be supported by
of medical services or supplies excluded Part E of the Act, OWCP will apply the
detailed citations to the record when
from participation as a result of an order following definitions:
assignments of error are based on the
issued pursuant to this subpart may (a) Average annual wage means four
record, and by statutes, regulations or
principal authorities relied upon. apply for reinstatement one year after times the average quarterly wages of a
Except for good cause shown, no the entry of the order of exclusion, covered Part E employee for the 12
assignment of error by any party shall unless the order expressly provides for quarters preceding the quarter during
rely on any question of fact or law upon a shorter period. An application for which he or she first experienced wage-
which the administrative law judge had reinstatement shall be addressed to the loss due to exposure to a toxic substance
not been afforded an opportunity to Director for Energy Employees at a DOE facility or RECA section 5
pass. Occupational Illness Compensation, and facility, excluding any quarters during
(e) A statement in opposition to the shall contain a concise statement of the which the employee was unemployed.
petition for discretionary review may be basis for the application. The Because being ‘‘retired’’ is not
filed, but such filing shall in no way application should be accompanied by equivalent to being ‘‘unemployed,’’
delay action on the petition. supporting documents and affidavits. quarters during which an employee had
(f) If a petition is granted, review shall no wages because he or she was retired
(c) A request for reinstatement may be
be limited to the questions raised by the will not be excluded from this
accompanied by a request for oral
petition. calculation.
argument. Oral argument will be (b) Normal retirement age means the
(g) A petition not granted within 20 allowed only in unusual circumstances
days after receipt of the petition is age at which a covered Part E employee
where it will materially aid the decision first became eligible for unreduced
deemed denied. process. retirement benefits under the Old-Age,
§ 30.725 What are the effects of non- (d) The Director for Energy Employees Survivors and Disability Insurance
automatic exclusion? Occupational Illness Compensation (OASDI) provisions of the Social
(a) OWCP shall give notice of the shall order reinstatement only in Security Act. In general, persons born
exclusion of a physician, hospital or instances where such reinstatement is during or before 1937 are eligible for
provider of medical services or supplies clearly consistent with the goal of this unreduced OASDI retirement benefits at
to: subpart to protect the EEOICPA program age 65, and that age increases in
(1) All OWCP district offices; against fraud and abuse. To satisfy this monthly increments until it reaches 67,
(2) CMS; and requirement the provider must provide which is the age at which persons born
(3) All employees who are known to reasonable assurances that the basis for during or after 1960 become eligible for
have had treatment, services or supplies the exclusion will not be repeated. unreduced OASDI retirement benefits.
from the excluded provider within the (c) Quarter means the three-month
six-month period immediately Subpart I—Wage-Loss Determinations period January through March, April
preceding the order of exclusion. Under Part E of EEOICPA through June, July through September,
(b) Notwithstanding any exclusion of or October through December.
a physician, hospital, or provider of General Provisions (d) Quarter during which the
medical services or supplies under this employee was unemployed means any
subpart, OWCP shall not refuse an § 30.800 What types of wage-loss are quarter during which the covered Part E
employee reimbursement for any compensable under Part E of EEOICPA? employee had $700 (in constant 2005
otherwise reimbursable medical Years of wage-loss occurring prior to dollars) or less in wages unless the
treatment, service or supply if: normal retirement age that are the result quarter is one during which the
(1) Such treatment, service or supply of a covered illness contracted by a employee was retired.
was rendered in an emergency by an covered Part E employee through work- (e) Year of wage-loss means a calendar
excluded physician; or related exposure to a toxic substance at year during which the covered Part E
(2) The employee could not a Department of Energy facility or a employee’s earnings were less than his
reasonably have been expected to know RECA section 5 facility, as appropriate, or her average annual wage, after such
of such exclusion. earnings have been adjusted using the
may be compensable under Part E of the
(c) An employee who is notified that Consumer Price Index for All Urban
Act. Whether years of wage-loss are
his or her attending physician has been Consumers (CPI–U), as produced by the
compensable depends on
excluded shall have a new right to select Bureau of Labor Statistics, to reflect
determinations with respect to: their value in the year during which the
a qualified physician.
(a) The average annual wage of the employee first experienced wage-loss
§ 30.726 How can an excluded provider be employee as determined by OWCP in due to exposure to a toxic substance at
reinstated? accordance with § 30.810; a DOE facility or RECA section 5
(a) If a physician, hospital, or provider facility.
(b) The percentage of his or her
of medical services or supplies has been
average annual wage that the employee Evidence of Wage-Loss
automatically excluded pursuant to
was able to earn during the calendar
§ 30.716, the provider excluded will § 30.805 What evidence does OWCP use to
automatically be reinstated upon notice year(s) in question as determined by
determine a covered Part E employee’s
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to OWCP that the conviction or OWCP in accordance with § 30.811; and


average annual wage and whether he or she
exclusion which formed the basis of the (c) Whether the employee’s inability experienced compensable wage-loss under
automatic exclusion has been reversed to earn at least as much as his or her Part E of EEOICPA?
or withdrawn. However, an automatic average annual wage was due to a (a) OWCP may rely on quarterly
reinstatement shall not preclude OWCP covered illness as defined in § 30.5(r). wages information reported to the Social

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Security Administration to establish a (c) Divide the sum of paragraphs (a) to a period for which a wage-loss claim
covered Part E employee’s presumed and (b) of this section by 12 less the for the employee has already been
average annual wage (see § 30.810) and number of quarters during which the adjudicated by OWCP. However, no
the duration and extent of any years of employee was unemployed; and compensation for wage-loss shall be
wage-loss that are compensable under (d) Multiply this figure by four to awarded for any period following the
Part E of the Act (see § 30.811). OWCP calculate the covered Part E employee’s year during which the covered Part E
may also rely on other probative average annual wage. employee attained normal retirement
evidence of a covered Part E employee’s age for purposes of the Social Security
§ 30.811 How will OWCP calculate the
wages, and may ask the claimant for duration and extent of a covered Part E
Act as described in § 30.801(b).
additional evidence necessary to make employee’s initial period of compensable Special Rules for Certain Survivor
this determination, if necessary. For the wage-loss? Claims Under Part E of EEOICPA
purposes of making these two types of (a) To determine the initial calendar
determinations, OWCP will consider all years of wage-loss, OWCP will use the § 30.815 Are there special rules that OWCP
monetary payments that the covered evidence it receives under §§ 30.805 and will use to determine the extent of a
Part E employee received in a quarter deceased covered Part E employee’s
30.806 to determine the quarter in compensable wage-loss?
from employment or services, except for which a covered Part E employee first
monetary payments that were not sustained wage-loss due to exposure to (a) For purposes of adjudicating a
taxable as income during that quarter a toxic substance while engaged in claim of a survivor of a deceased
under the Internal Revenue Code, to be employment at a DOE facility or a RECA covered Part E employee only, OWCP
‘‘wages.’’ section 5 facility, as appropriate. will presume that such employee
(b) OWCP also requires the (b) OWCP will then compare the experienced wage-loss for each calendar
submission of rationalized medical calendar-year wages for that employee, year subsequent to the calendar year of
evidence of sufficient probative value to as adjusted, with the average annual his or her death through and including
establish that the period of wage-loss at wage determined under § 30.810 for the calendar year in which the
issue is causally related to the covered each calendar year beginning with the employee would have reached normal
Part E employee’s covered illness. calendar year that includes the quarter retirement age under the Social Security
in which the wage-loss commenced, and Act. During these particular calendar
§ 30.806 May a claimant submit factual concluding with the last calendar year years, OWCP will also presume that the
evidence in support of a different of wage-loss prior to the submission of deceased covered Part E employee’s
determination of average annual wage and/ subsequent calendar-year wages did not
or wage-loss than that found by OWCP?
the claim or the calendar year in which
the employee reached normal retirement exceed 50 percent of his or her average
A claimant who disagrees with the age (as defined in § 30.801(b)), annual wage as determined under
evidence OWCP has obtained under whichever occurred first. § 30.810.
§ 30.805(a) and alleges a different (c) OWCP will then aggregate (b) Except as provided in paragraph
average annual wage for the covered separately the number of calendar years (a) of this section, OWCP will calculate
Part E employee, or that there was a of wage-loss in which the employee’s the wage-loss of a deceased covered Part
greater duration or extent of wage-loss, wages, as adjusted, did not exceed 50 E employee in conformance with the
may submit records that were produced percent of the average annual wage provisions of §§ 30.800 through 30.811.
in the ordinary course of business due determined under § 30.810, and the (c) If OWCP determines that a
to the employee’s employment to rebut number of calendar years of wage-loss deceased covered Part E employee had
that evidence, to the extent that such in which the employee’s wages, as an aggregate of not less than ten
records are determined to be authentic adjusted, exceeded 50 percent of such calendar years of adjusted earnings that
by OWCP by a preponderance of the average annual wage, but did not exceed did not exceed 50 percent of his or her
evidence. The average annual wage and/ 75 percent of such average annual wage. average annual earnings, it will pay the
or wage-loss of the covered Part E (d) For each calendar year of wage- eligible surviving beneficiary(s)
employee will then be determined by loss determined under paragraph (c) of additional compensation (the basic
OWCP in the exercise of its discretion. this section during which the survivor award payable under section
employee’s wages did not exceed 50 7385s–3(a)(1) is $125,000) in the
Determinations of Average Annual amount of $25,000 pursuant to section
percent of his or her average annual
Wage and Percentages of Loss 7385s–3(a)(2) of the Act. In the
wage, OWCP will pay the employee
$15,000 as compensation for wage-loss. alternative, if OWCP determines that the
§ 30.810 How will OWCP calculate the
average annual wage of a covered Part E For each calendar year of wage-loss aggregate number of such years is not
employee? determined under paragraph (c) of this less than 20 years, it will pay the
section during which the employee’s eligible surviving beneficiary(s)
To calculate the average annual wage additional compensation in the amount
of a covered Part E employee as defined calendar-year wages exceeded 50
percent of his or her average annual of $50,000 pursuant to section 7385s–
in § 30.801(a), OWCP will: 3(a)(3).
(a) Aggregate the wages for the twelve wage but did not exceed 75 percent of
quarters that preceded the quarter such average annual wage, OWCP will Subpart J—Impairment Benefits Under
during which the covered Part E pay the employee $10,000 as Part E of EEOICPA
employee first experienced wage-loss compensation for wage-loss.
due to exposure to a toxic substance at General Provisions
§ 30.812 May a covered Part E employee
a DOE facility or a RECA section 5 claim for subsequent periods of § 30.900 Who can receive impairment
facility, excluding any quarter during compensable wage-loss? benefits under Part E?
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which the employee was unemployed; A covered Part E employee previously In order to receive impairment
(b) Add any additional wages earned awarded compensation for wage-loss benefits under Part E, the employee
by the employee during those same under § 30.811 may file for additional must show that:
quarters as evidenced by records compensation for wage-loss suffered by (a) He or she is a covered Part E
described in §§ 30.805(a) and 30.806; the employee during periods subsequent employee who has been determined to

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Federal Register / Vol. 71, No. 250 / Friday, December 29, 2006 / Rules and Regulations 78567

have contracted a covered illness Medical Evidence of Impairment evaluation, and/or additional medical
through exposure to a toxic substance at evidence of impairment, before the
§ 30.905 How may an impairment
a DOE facility or a RECA section 5 district office issues a recommended
evaluation be obtained?
facility, as appropriate, pursuant to decision on his or her claim. However,
either §§ 30.210 through 30.215 or (a) Except as provided in paragraph the district office will not consider an
§§ 30.230 through 30.232 of these (b) of this section, OWCP may request additional impairment evaluation, even
regulations; and that an employee undergo an evaluation if it differs from the impairment
of his or her permanent impairment that evaluation obtained under §§ 30.905 or
(b) He or she has been determined to specifies the percentage points that are
have an impairment, pursuant to the 30.906, if it does not meet the criteria
the result of the employee’s covered
regulations set out in this subpart, that listed in § 30.905(b)(1), (2) and (3).
illness or illnesses. To be of any
is the result of the covered illness probative value, such evaluation must (b) If the district office obtains an
referred to in paragraph (a) of this be performed by a physician who meets additional impairment evaluation that
section. the criteria OWCP has identified for differs from the impairment evaluation
physicians performing impairment obtained under §§ 30.905 or 30.906, the
§ 30.901 How does OWCP determine the district office will base its
extent of an employee’s impairment that is evaluations for the pertinent covered
illness or illnesses in accordance with recommended determinations regarding
due to a covered illness contracted through
exposure to a toxic substance at a DOE the AMA’s Guides. impairment upon the evidence it
facility or a RECA section 5 facility, as (b) In lieu of submitting an evaluation considers to have the greatest probative
appropriate? requested by OWCP under paragraph (a) value, after evaluating all relevant
of this section, an employee may obtain evidence of impairment in the record,
(a) OWCP will determine the amount including evidence from directed
of impairment benefits to which an an impairment evaluation at his own
initiative and submit it to OWCP for impairment evaluations and referee
employee is entitled based on one or impairment evaluations, if any, that it
more impairment evaluations submitted consideration. Such an evaluation will
be deemed to have sufficient probative deems necessary pursuant to §§ 30.410
by physicians. An impairment and 30.411 of this part.
evaluation shall contain the physician’s value to be considered in the
opinion on the extent of whole person adjudication of impairment benefits by § 30.908 How will the FAB evaluate new
impairment of all organs and body OWCP only if: medical evidence submitted to challenge
(1) The evaluation was performed by the impairment determination in the
functions of the employee that are
a physician who meets the criteria recommended decision?
compromised or otherwise affected by
identified by OWCP for the covered (a) If an employee submits an
the employee’s covered illness or
illness or illnesses in question; additional impairment evaluation that
illnesses, which shall be referred to as (2) The evaluation was performed no
a ‘‘minimum impairment rating.’’ differs from the impairment evaluation
more than one year before the date that
(b) The minimum impairment rating relied upon by the district office, the
it was received by OWCP; and
shall be determined in accordance with (3) The evaluation conforms to all FAB will not consider the additional
the current edition of the American applicable requirements set out in this impairment evaluation if it does not
Medical Association’s Guides to the part. meet the criteria listed in § 30.905(b)(1),
Evaluation of Permanent Impairment (2) and (3).
(AMA’s Guides). In making impairment § 30.906 Who will pay for an impairment (b) The employee shall bear the
evaluation? burden of proving that the additional
benefit determinations, OWCP will only
consider medical reports from (a) OWCP will pay for one impairment evaluation submitted is
physicians who are certified by the impairment evaluation obtained by an more probative than the evaluation
relevant medical board and who satisfy employee if it meets the criteria set out relied upon by the district office to
any additional criteria determined by in § 30.905(b), unless it was performed determine the employee’s recommended
OWCP to be necessary to qualify to by a physician prior to the date that the minimum impairment rating.
perform impairment evaluations under claim for Part E benefits is filed, or (c) If an employee submits an
Part E, including any specific training in obtained for a claim in which OWCP additional impairment evaluation that
use of the AMA’s Guides, specific finds that the employee did not contract differs from the impairment evaluation
training and experience related to a covered illness. At its discretion, relied upon by the district office, the
particular conditions and other OWCP may direct that the employee FAB will review all relevant evidence of
objective factors. undergo additional evaluations. OWCP impairment in the record, and will base
will pay for any such additional its determinations regarding impairment
(c) OWCP will establish criteria based evaluations and will reimburse the
upon objective factors such as training upon the evidence it considers to be
employee for any reasonable and most probative. The FAB will determine
and certification that must be met by necessary costs incident to the
physicians preparing impairment the minimum impairment rating after it
evaluations, as described in §§ 30.404 has evaluated all relevant evidence and
evaluations in order for an impairment and 30.412 of this part.
evaluation to be considered in argument in the record.
(b) Except for one impairment
determining an impairment award. Such evaluation obtained pursuant to Ratable Impairments
criteria shall be made available to § 30.905(b) and meeting the criteria set
claimants and the public by OWCP. § 30.910 Will an impairment that cannot be
out in § 30.905(b)(1), (2) and (3), the assigned a numerical percentage using the
§ 30.902 How will OWCP calculate the employee must pay for any impairment AMA’s Guides be included in the
amount of the award of impairment benefits evaluations not directed by OWCP. impairment rating?
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that is payable under Part E?


§ 30.907 Can an impairment evaluation (a) An impairment of an organ or body
OWCP will multiply the percentage obtained by OWCP be challenged prior to function that cannot be assigned a
points of the minimum impairment issuance of the recommended decision? numerical impairment percentage using
rating by $2,500 to calculate the amount (a) An employee may submit the AMA’s Guides will not be included
of the award. arguments challenging an impairment in the employee’s impairment rating.

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78568 Federal Register / Vol. 71, No. 250 / Friday, December 29, 2006 / Rules and Regulations

(b) A mental impairment that does not that it is well-stabilized and unlikely to for the last award of such benefits by
originate from a documented physical improve substantially with or without OWCP. OWCP will only adjudicate
dysfunction of the nervous system, and medical treatment. claims for such an increased rating that
cannot be assigned a numerical (b) Notwithstanding paragraph (a) of are filed at least two years from the date
percentage using the AMA’s Guides, this section, if OWCP finds that an of the last award of impairment benefits.
will not be included in the impairment employee’s covered illness is in the However, OWCP will not wait two years
rating for the employee. Mental terminal stages, based upon probative before it will adjudicate a claim for
impairments that are due to medical evidence, an impairment that additional impairment that is based on
documented physical dysfunctions of results from such covered illness will be an allegation that the employee
the nervous system can be assigned included in the impairment rating for sustained a new covered illness.
numerical percentages using the AMA’s the employee even if it has not reached
Signed at Washington, DC, this 15th day of
Guides and will be included in the maximum medical improvement.
December, 2006.
rating.
§ 30.912 Can a covered Part E employee Victoria A. Lipnic,
§ 30.911 Does maximum medical receive benefits for additional impairment
Assistant Secretary of Labor for Employment
improvement always have to be reached for following an award of such benefits by
Standards.
an impairment to be included in the OWCP?
Signed at Washington, DC, this 15th day of
impairment rating? A covered Part E employee previously
December, 2006.
(a) An impairment that is the result of awarded impairment benefits by OWCP
a covered illness will be included in the may file a claim for additional Shelby Hallmark,
employee’s impairment rating impairment benefits. Such claim must Director, Office of Workers’ Compensation
determined by OWCP under § 30.901 be based on an increase in the Programs, Employment Standards
only if OWCP concludes that the impairment rating that is the result of Administration.
impairment has reached maximum the covered illness or illnesses from the [FR Doc. E6–21839 Filed 12–28–06; 8:45 am]
medical improvement, which means impairment rating that formed the basis BILLING CODE 4510–CR–P
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