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Report to Congressional Requesters: 

United States Government Accountability Office: 
GAO: 

March 2010: 

Energy Employees Compensation: 

Additional Independent Oversight and Transparency Would Improve 
Program's Credibility: 

GAO-10-302: 

GAO Highlights: 

Highlights of GAO-10-302, a report to congressional requesters. 

Why GAO Did This Study: 

Congress passed the Energy Employees Occupational Illness Compensation 
Program Act (EEOICPA) in 2000 to compensate Department of Energy 
(Energy) workers for illnesses stemming from exposure to hazardous 
substances while working in the atomic weapons industry. Part B of the 
act provides a lump-sum payment and medical coverage for certain 
illnesses, while Part E compensates for impairments and lost wages 
resulting from exposure to toxins. The Department of Labor (Labor) 
adjudicates all claims and is assisted by the National Institute for 
Occupational Safety and Health (NIOSH) and Energy. GAO examined (1) 
claim-processing time, (2) costs of administering the program, (3) 
extent to which there are quality controls to ensure that claim 
determinations are supported with objective and scientific 
information, and (4) actions taken by agencies to promote program 
transparency for claimants. GAO obtained data on cost and claims 
processing from Labor and NIOSH, and interviewed agency officials, 
experts, and claimant advocates. 

What GAO Found: 

Cases that do not require dose reconstruction can take about a year to 
adjudicate, but those that do can take a total of 3 or more years. 
Such cases require an extensive scientific process to "reconstruct" 
the historical evidence on exposure, and this has made dose 
reconstruction the primary reason for lengthier processing times. The 
availability of claimant data and the need to rework some cases in 
view of new claimant information or changes to scientific 
methodologies involved in determining exposures can also affect 
processing times. Meanwhile, Labor and NIOSH have each developed ways 
to expedite case processing. 

The administrative cost of EEOICPA reflects the requirements of a 
complex, science-based adjudication process. In 2008 this cost 
amounted to $106 million for the Part B program and almost $57 million 
for Part E. Administrative costs have averaged about 20 percent of the 
total program cost for Part B and 14 percent for Part E. A substantial 
factor underlying the greater administrative cost of the Part B 
program is dose reconstruction, which was required for about a third 
of all Part B cases. 

Quality controls in the form of multiple internal reviews are in place 
for both Part B and E programs. However, only the Part B program 
employs external expert reviews, required by statute, which provide 
independent verification of the work. EEOICPA does not specifically 
require external review of the Part E program. As a result, Labor’s 
processes related to the adjudication of Part E cases, in particular, 
are not informed by any independent expertise outside the agency’ s 
purview. For example, though Labor employs a contractor and a small 
team of internal experts to update its Part E database of work sites, 
toxins, and their associated diseases, the composition of this 
database lacks external review to ensure that it is as comprehensive 
and scientifically sound as possible. In addition, there is no 
oversight or independent review to ensure the quality of consultant 
physicians’ work for Part E. 

The agencies have taken various steps to assist claimants and make 
more program information public; however, program transparency remains 
somewhat limited, in part because of national security considerations. 
NIOSH has worked with Energy to clear information for publication in 
the site profiles developed for use in reconstructing doses for Part B 
cancer claims. However, Labor has not taken similar steps with Energy 
to release data in the site exposure matrix used to adjudicate Part E 
claims. Meanwhile, NIOSH has established an ombudsman to help Part B 
claimants with their claims. While the act established an ombudsman 
within the Department of Labor, GAO found that Labor does not respond 
publicly to his annual reports on claimant concerns. As a result, 
claimants have little knowledge that their concerns are heard or that 
they are being addressed. 

What GAO Recommends: 

To strengthen quality controls and improve program transparency, GAO 
recommends that Labor provide for more external review, respond 
publicly to reports by its Ombudsman, and increase public access to 
site exposure data it uses to adjudicate Part E claims. Meanwhile, 
Congress may wish to consider amending EEOICPA to create an 
independent review board for the Part E program. 

View [hyperlink, http://www.gao.gov/products/GAO-10-302] or key 
components. For more information, contact Andrew Sherrill at (202) 512-
7215 or sherrilla@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

Cases Can Require a Year to Adjudicate, but Dose Reconstruction Can 
Add 2 or More Years to the Process: 

Administrative Costs Reflect Requirements of Science-Based 
Adjudication: 

Part B Quality Controls Generally Include Internal and Independent 
Reviews, while Part E Processes Lack Independent and Expert Review: 

Despite Agencies' Actions, EEOICPA Program Transparency Remains 
Somewhat Limited: 

Conclusions: 

Recommendations for Executive Action: 

Matter for Congressional Consideration: 

Agency Comments and our Evaluation: 

Appendix I: Objective, Scope, and Methodology: 

Appendix II: Labor and NIOSH's Claim-Processing Steps: 

Appendix III: NIOSH and Labor's Performance Measures: 

Appendix IV: Comments from the Department of Energy: 

Appendix V: Comments from the Department of Labor: 

Appendix VI: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Comparison of EEOICPA Parts B and E Eligibility and Benefits: 

Table 2: Approval Rates for EEOICPA Cases as of January 28, 2010: 

Table 3: Average Days Added to Processing Times for Cases Labor 
Returned to NIOSH for Rework: 

Table 4: Part B Benefits Paid and Direct Administrative Costs: 

Table 5: Part E Benefits Paid and Direct Administrative Costs: 

Table 6: NIOSH Performance Measures for Fiscal Year 2009: 

Table 7: Department of Labor Performance Measures in 2008: 

Figures: 

Figure 1: Claims That Require Dose Reconstructions Are Processed 
Differently than Claims That Do Not: 

Figure 2: Processing Times for Cases Decided in Fiscal Year 2008: 

Figure 3: Average Processing Times for Part B and Part E Cases by Year 
Decided, Fiscal Years 2002-2008: 

Figure 4: NIOSH Efficiency Process Using Rough Estimates for Dose 
Reconstructions: 

Abbreviations: 

AFL-CIO: American Federation of Labor-Congress of Industrial 
Organizations: 

ANWAG: Alliance of Nuclear Worker Advocacy Groups: 

EEOICPA: Energy Employees Occupational Illness Compensation Program 
Act: 

FAB: Final Adjudication Branch: 

GPRA: Government Performance and Results Act: 

IG: inspector general: 

NIOSH: National Institute for Occupational Safety and Health: 

OMB: Office of Management and Budget: 

PART: Program Assessment Rating Tool: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

March 22, 2010: 

Congressional Requesters: 

For the last several decades, the Department of Energy (Energy) and 
its predecessor agencies[Footnote 1] and contractors employed hundreds 
of thousands of individuals in secret and dangerous work in nuclear 
weapons production in over 350 facilities in almost every state in the 
United States, such as the Rocky Flats Plant in Colorado and the Los 
Alamos National Laboratory in New Mexico. Over the years, especially 
early on, many workers were unknowingly exposed to toxic substances, 
including radioactive and other hazardous materials, and subsequently 
developed serious illnesses, including cancer and lung disease. To 
provide compensation to these workers, Congress enacted the Energy 
Employees Occupational Illness Compensation Program Act of 2000 
(EEOICPA). The Department of Labor (Labor) has the primary 
responsibility for administering this program, which provides for 
medical benefits, lost wage replacement, and/or onetime financial 
compensation. In addition, the Department of Health and Human 
Services, through its National Institute for Occupational Safety and 
Health (NIOSH), and Energy each have assigned duties under the act. 
[Footnote 2] As of January 2010, Labor had awarded compensation for 
work-related illnesses for over 56,000 claims to workers or their 
survivors totaling over $5 billion. 

Within a few years of EEOICPA's enactment, claimants and Members of 
Congress began raising questions about implementation of the program. 
Instead of receiving timely compensation for their work-related 
illnesses, claimants have reported difficulty navigating the program, 
years of delay, and perceived inconsistencies in the adjudication 
process. Meanwhile, several articles critical of the program have 
appeared in the press. Following a highly critical series of articles 
in the Denver, Colorado, Rocky Mountain News in 2008, 17 Members of 
Congress asked GAO to review how EEOICPA is being implemented. We 
reviewed the (1) average claim-processing times and factors that 
affect these, (2) costs of administering the program, (3) extent to 
which quality controls are in place to help ensure that claims 
determinations are supported with objective and scientific 
information, and (4) actions agencies have taken to make the program 
more transparent for claimants. 

To determine the time it takes to process claims and associated costs, 
we obtained reports on processing times for different types of claims, 
administrative costs, and performance measurement from Labor, NIOSH, 
and Energy. To determine which factors affected processing times, we 
obtained claim-processing times by type of claim to ascertain whether 
there were significant and consistent differences between the 
processing times based on the type of claim. We interviewed relevant 
officials regarding the reliability of the data, checked for outliers 
and inconsistencies, and determined that their claims management data 
were sufficiently reliable for the purposes of this report. We did not 
independently verify the accuracy of the data from any agency. To 
assess the quality controls and transparency of the claims 
adjudication process for our third and fourth objectives, we reviewed 
EEOICPA, relevant regulations, and agency technical and procedural 
guidance for EEOICPA; interviewed officials from Labor, Energy, and 
NIOSH; and interviewed members of the Advisory Board on Radiation and 
Worker Health, the presidentially appointed board that oversees the 
scientific validity of NIOSH's work, and its contractor. We obtained 
additional expert opinion on technical issues and further insight on 
topics of concern by interviewing representatives of the occupational 
and environmental health and other medical professions; claimant 
ombudsmen with Labor, NIOSH, and the state of New Mexico; and claimant 
representatives from a nationwide coalition of grassroots advocacy 
groups.[Footnote 3] 

We conducted this performance audit from November 2008 to March 2010 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. For more 
information on our scope and methodology, see appendix I. 

Background: 

EEOICPA, as amended, provides compensation and wage replacement for 
Energy workers employed over the last several decades in the 
production of U.S. nuclear weapons who developed illnesses related to 
their exposure to radiation and many other toxins.[Footnote 4] During 
and shortly after World War II, U.S.-sponsored nuclear weapons 
development and production included a small network of scattered, 
privately owned facilities. During the Cold War, this network expanded 
into a complex of as many as 365 industrial sites and research 
laboratories throughout the country that employed more than 600,000 
workers in the production and testing of nuclear weapons. 

Some of the production sites were owned by Energy and its predecessor 
agencies and operated by contractors; others were privately owned but 
operated under contract with Energy; still others provided Energy and 
its contractors with needed services and supplies. Workers in these 
facilities used manufacturing processes that involved handling very 
dangerous materials, and they often were provided inadequate 
protection from exposure to radioactive elements, although protective 
measures have increased over time. Because of national security 
concerns, they also worked under great secrecy, often facing severe 
criminal penalties for breaches of secrecy. Workers were also often 
given minimal information about the materials with which they worked 
and the potential health consequences of their exposure to the 
materials. Active production of nuclear weapons was halted at the end 
of the Cold War, and federally sponsored cleanup of some of these 
sites has been under way since that time. Other sites remain active 
for research, storage, uranium production, and weapons assembly and 
disassembly. As noted by Congress in EEOICPA, it had been Energy's 
long-standing policy to help its contractors litigate claims filed by 
their employees for state workers' compensation when they became ill. 
[Footnote 5] As a result of the many years of secrecy, the lack of 
information, and the years of denial that their conditions were 
related to exposure, many claimants find it difficult today to trust 
that the federal government is fairly evaluating their claims under 
the program established by EEOICPA. 

Structure of the Compensation Programs: 

EEOICPA established two compensation programs: Part B and Part E. 
[Footnote 6] While both pay for future medical expenses, there are 
significant distinctions. Part B of the act provides for a onetime 
payment of $150,000 to Energy employees or their survivors as well as 
certain contractor employees or their survivors, while Part E of the 
act covers Energy contractor employees or their spouses and dependent 
children and replaces lost wages and compensates for impairment up to 
$250,000.[Footnote 7] Each program also covers different types of 
exposure: The Part B program covers those who have developed cancer as 
the result of exposure to radiation and lung diseases resulting from 
exposure to beryllium and silica. The Part E program compensates for 
illnesses, including cancer, that result from exposure to toxic 
substances. Table 1 summarizes covered workers and illnesses, and the 
benefits paid under each program. 

Table 1: Comparison of EEOICPA Parts B and E Eligibility and Benefits: 

Part B: 
Covered employees: 
* Energy employees; 
* Energy contractor or subcontractor employees; 
* Employees of atomic weapons employers; 
* Employees of beryllium vendors; 
* Uranium miners, millers, and ore transporters awarded under Section 
5 of the Radiation Exposure Compensation Act; 
Covered survivors: 
* Next of kin (in order of precedence); 
- Spouse; 
- Children; 
- Parents; 
- Grandchildren; 
- Grandparents; 
Covered illnesses: 
* Cancer related to radiation; 
* Chronic beryllium disease[A]; 
* Chronic silicosis[A]; 
* Beryllium sensitivity[B]; 
Compensation: 
* $150,000 lump sum ($50,000 if awarded payment under Section 5 of the 
Radiation Exposure Compensation Act); 
* Plus medical coverage for future medical expenses related to the 
illness. 

Part E: 
Covered employees: 
* Energy contractor employees; 
* Uranium miners, millers, and ore transporters covered under Section 
5 of the Radiation Exposure Compensation Act; 
Covered survivors: 
* Spouse; 
* Children; 
- Under 18 at time of death,; 
- Under 23 and enrolled full-time in school, or; 
- Incapable of self-support; 
Covered illnesses: 
* Illnesses related to exposure to toxic substances at Energy weapons 
facilities; 
Compensation: 
* Wage loss and impairment up to $250,000; 
* Plus medical coverage for covered illnesses. 

Source: GAO analysis of the EEOICPA statute. 

[A] Chronic beryllium disease primarily affects the lungs and is 
caused by people inhaling beryllium dust or fumes. Chronic silicosis 
is a lung disease caused by overexposure to crystalline silica, a 
major component of sand, rock, and mineral ores. Chronic silicosis is 
covered only for individuals who worked in nuclear test tunnels in 
Nevada and Alaska. 

[B] There is no monetary compensation for beryllium sensitivity. Only 
medical monitoring is provided. 

[End of table] 

Agency Roles in Implementing EEOICPA: 

Labor adjudicates claims for compensation under the Part B and Part E 
programs. NIOSH conducts the technical and scientific research to 
support the adjudication of radiation-related cancer claims under Part 
B. Energy provides administering agencies and claimants with 
information relevant to worker exposures. EEOICPA required the 
President to establish the Advisory Board on Radiation and Worker 
Health and appoint members who reflect a balance of scientific, 
medical, and worker perspectives.[Footnote 8] The board advises the 
Department of Health and Human Services on the scientific quality and 
validity of NIOSH's work and has retained a contractor to provide 
technical expertise and support. In a prior report, we found that 
issues pertaining to the Part B Advisory Board's funding structure, 
appointment process, and staff support presented challenges to 
independence, leaving the board vulnerable to potential outside 
influence. We identified various options to enhance the board's 
independence in each area for congressional consideration.[Footnote 9] 

Labor's adjudication of claims entails first determining whether a 
claimant meets the eligibility requirements of the act, such as 
whether the claimant worked in a facility covered by the act or meets 
the definition of a covered survivor. Then Labor reviews evidence of 
the worker's employment history, exposure to radiation or other toxic 
substances, and medical records. To determine whether the claimed 
illness is compensable, Labor must find that the illness is related to 
radiation or toxic exposure during employment at a covered facility. 

For radiation-related cancer claims, Labor relies on NIOSH's estimates 
of the type and level of radiation exposure received by the worker and 
the associated radiation dose to each organ affected by cancer. This 
extensive process of estimating the radiation dose to each affected 
organ is referred to as dose reconstruction. The radiation dose 
associated with cancer risk depends on many variables: the type of 
radiation, dose pathway (for example, inhalation of particles, contact 
with skin, or ingestion of contaminated food or water), and the way 
radiation interacts with each organ or body system. Research to 
determine the radiation levels to which an individual worker was 
exposed requires gathering information such as the site's radiation 
level readings over time, readings from a worker's monitoring badge 
(if available), records of claimant interviews about working 
conditions, and work-required medical screenings. For cases in which 
NIOSH cannot fully characterize the likely level of radiation 
exposure, it estimates the level of exposure using reasonable 
scientific assumptions that give the claimant the benefit of the doubt. 

Since nuclear weapons research and production occurred over several 
decades and at sites throughout the country, many of which are now 
defunct, Labor, with assistance from NIOSH and Energy, must research 
and inventory these sites for the evidence needed to review workers' 
claims. Much of this evidence is maintained at the individual 
facilities where the work took place. Energy maintains and catalogs 
records from these facilities and provides experts to assist Labor and 
NIOSH in collecting this information. NIOSH has prepared detailed 
facility-specific information in site profiles, which describe the 
buildings, manufacturing, and other processes used, and the types of 
radioactive elements at each major covered facility. 

Despite these research efforts, there are groups of workers for whom 
it is not feasible to estimate the radiation doses with sufficient 
accuracy. In such cases, the act provides that workers may be 
designated as part of the Special Exposure Cohort, qualifying them for 
compensation without dose reconstruction if they have 1 of 22 
specified types of cancer and meet certain other requirements. 
[Footnote 10] NIOSH may recommend additions to the Special Exposure 
Cohort when, in its research, it determines that site records are 
inadequate to support dose reconstruction with sufficient accuracy. 
Claimants or their representatives may petition to add classes of 
workers to the Special Exposure Cohort if they identify a class of 
workers for whom dose reconstruction is not feasible. If a petition 
includes all required information, NIOSH will evaluate the petition, 
assessing the sufficiency and quality of available information and 
either proposing methods of reconstructing the dose or agreeing that 
the workers should be treated as part of the Special Exposure Cohort. 
The Advisory Board reviews the petition and NIOSH's evaluation and 
advises the Secretary of Health and Human Services on whether another 
class of workers should be added. 

To determine eligibility for Part E compensation for illnesses 
resulting from exposure to toxic substances, Labor relies heavily on a 
complex database of information that, with the help of a contractor, 
has been drawn from the facility records and toxicology research. 
Known as the site exposure matrix, it specifies a myriad of site-
specific information, such as what toxins were present at each 
facility, job descriptions, and production processes.[Footnote 11] 
Moreover, it cross-references the toxins known to be at each site with 
diseases for which there is an established link. This portion of the 
site exposure matrix was drawn from the National Library of Medicine's 
database of hazardous toxins and associated diseases--known as the Haz-
Map. When records are unavailable or insufficient to determine whether 
workers were exposed to toxins (other than radiation), there is no 
process similar to the Special Exposure Cohort petition process for 
radiation-related cancer claims. 

Part B Claim Processing: 

Upon receipt of a claim, Labor first determines whether the Part B 
claimant meets the eligibility requirements for any one of the 
following types of claims: Radiation Exposure Compensation Act Section 
5 supplement, chronic beryllium disease, chronic silicosis, or Special 
Exposure Cohort cancer claims. If so, these claims are adjudicated 
exclusively by Labor (see figure 1). All radiation-related cancer 
claims not covered by the Special Exposure Cohort are referred to 
NIOSH for dose reconstruction. 

Figure 1: Claims That Require Dose Reconstructions Are Processed 
Differently than Claims That Do Not: 

[Refer to PDF for image: illustration] 

Labor receives claims and determines whether the claimant meets the 
eligibility requirements; 

Claims examiner sorts claims by type; 

1) Radiation Exposure Compensation Act: Section 5; Beryllium; 
Silicosis; Special Exposure Cohort claims; 
- Labor develops a recommended decision; 

2) Claims involving cancers not covered by Special Exposure Cohort 
provisions; 

Dose Reconstruction: 

Labor refers this type of claim to NIOSH for dose reconstruction; 

NIOSH estimates the employee’s level of exposure to radiation; 

NIOSH submits dose reconstruction to Labor; 

Labor develops a recommended decision. 

Source: GAO analysis of Labor and NIOSH claim processes. 

[End of figure] 

Using scientific and other collected information, NIOSH performs a 
dose reconstruction and provides the results to Labor. NIOSH's dose 
reconstruction estimates the amount (dose) of radiation to the organ 
affected by the worker's cancer, erring on the side of higher exposure 
and greater cancer risk whenever specific exposure data are limited. 
Labor uses the dose reconstruction results to determine whether it is 
at least as likely as not that the worker's cancer is related to his 
or her employment at a covered Energy or contractor facility.[Footnote 
12] As required by EEOICPA, Labor uses regulatory guidelines developed 
by the Department of Health and Human Services to make that 
determination.[Footnote 13] Those guidelines provide that a cancer was 
at least as likely as not related to radiation exposure incurred by 
the worker in the performance of duty if the probability of causation 
is estimated to be 50 percent or more.[Footnote 14] See appendix II 
for detailed information about the claim-processing steps used by 
Labor and NIOSH. 

Part E Claim-Processing: 

Part E claims are adjudicated by Labor using information it collects 
in the site exposure matrix on the types of toxic substances at Energy 
facilities.[Footnote 15] This information is analyzed by claims 
examiners, and sometimes with the assistance of medical consultants, 
to determine if it is at least as likely as not that exposure to a 
toxic substance at a covered Energy facility is considered a 
significant factor in the development of the illness.[Footnote 16] 
Labor's claims examiners refer to the site exposure matrix for a 
historical description of the types of industrial toxins present and 
the processes in which they were utilized, as well as information on 
known links between these toxins and occupational illness documented 
in peer-reviewed professional journals. When considering 
compensability under Part E for radiation-related cancers, Labor 
generally uses the dose reconstruction process and the NIOSH 
probability of causation regulatory guidelines it uses for Part B 
claims. 

Cases versus Claims: 

Since the inception of the EEOICPA programs, over 188,000 claims have 
been filed by either workers or their survivors. These claims 
represent about 129,000 actual worker cases--because there is more 
than one survivor involved in some cases. Labor estimates that the 
claims it has handled to date represent closer to 75,000 individual 
workers. Therefore, we provide data for the numbers of cases 
processed, which refers to the individual workers represented by one 
or more claims. 

As shown in table 2, Labor had adjudicated approximately 89 percent of 
EEOICPA cases filed as of January 2010, of which just over 39 percent 
were approved. Approval rates excluding cases that did not meet 
initial eligibility requirements are over 56 percent. 

Table 2: Approval Rates for EEOICPA Cases as of January 28, 2010: 

Part B: 
Cases filed: 69,039; 
Cases processed (percent): 62,526 (91%); Includes 48,036 final 
decisions plus 14,490 noncovered[A](21% of cases filed); 
Cases approved (percent): 27,298 (40%). 

Part E: 
Cases filed: 60,364; 
Cases processed (percent): 52,553 (87%); Includes 41,605 final 
decisions plus 10,948 noncovered[A](18% of cases filed); 
Cases approved (percent): 22,646 (38%). 

Source: GAO analysis of Labor data. 

[A] Noncovered cases are those for which the medical condition claimed 
is not one of the covered occupational illnesses (applies only to Part 
B cases), the employee's covered employment has not been established 
(Parts B and E), or a survivor did not meet eligibility requirements 
(Part E). Ineligible survivors constitute the majority of the 
noncovered cases under Part E. Claims that do not have a covered 
occupational illness constitute the majority of the noncovered cases 
under Part B. 

[End of table] 

As part of a November 2008 report, Labor's Office of Inspector General 
reviewed a sample of 140 claims that had received final decisions or 
were administratively closed from October 2005 through June 2007 and 
determined that Labor issued claim decisions that complied with 
applicable federal laws and regulations and were based appropriately 
on the evidence supplied by or obtained on behalf of claimants. 
[Footnote 17] 

Cases Can Require a Year to Adjudicate, but Dose Reconstruction Can 
Add 2 or More Years to the Process: 

Cases that do not require dose reconstruction can take about a year to 
adjudicate, but those that do can take a total of 3 or more years, and 
other factors can delay processing even further. Dose reconstruction 
is the primary factor affecting processing time, and changes to the 
information provided or the scientific methods used to determine 
compensability can lengthen the processing time for any case requiring 
dose reconstruction. The availability of claimant information and 
agency workload also affect the processing times. Labor and NIOSH have 
developed strategies to expedite case processing and performance 
measures to monitor timeliness. These efforts have helped reduce the 
case backlog and shorten processing times of certain steps in the 
claims cycle. 

Dose Reconstruction Is a Key Determinant of Processing Time--Adding, 
on Average, 2 or More Years: 

Cases requiring dose reconstruction, which constitute a third of all 
Part B cases, have taken an average of 3 or more years to process. 
[Footnote 18] Since determining the causation of cancer requires 
extensive data collection and scientific estimates, dose 
reconstruction is a lengthy and meticulous scientific process. Dose 
reconstruction is not needed for Part B beryllium or silicosis cases 
or Part E cases that do not involve radiation-related cancers; 
therefore, the processing times for these cases are much shorter. 
According to data from Labor, Part B cases requiring dose 
reconstruction for which final decisions were issued in fiscal year 
2008 took 1,132 days, on average--just over 3 years--to process, 
compared with 377 days for non-dose reconstruction Part B cases for 
which final decisions were issued in fiscal year 2008.[Footnote 19] By 
contrast, Part E cases for which final decisions were issued in 2008 
averaged 351 days to process. Similarly, minimum and maximum 
processing times were also greater for those cases that underwent dose 
reconstruction compared with those that did not (see figure 2). 

Figure 2: Processing Times for Cases Decided in Fiscal Year 2008: 

[Refer to PDF for image: horizontal bar graph] 

Part B (With dose reconstruction): 
Low: 161 days; 
High: 2,591 days; 
Average 1,132 days; 
Median 932 days. 

Part B (Without dose reconstruction): 
Low: 7 days; 
High: 2,512 days; 
Average 377 days; 
Median 232 days. 

Part E[A]: 
Low: 9 days; 
High: 1,184 days; 
Average 351 days; 
Median 252 days. 

Source: GAO analysis of data from the Department of Labor’s Energy 
Case Management System for claims receiving final decisions in fiscal 
year 2008. 

[A] While some Part E cases require dose reconstruction, those cases 
are not included in the figure. Labor does not report on Part E cases 
requiring dose reconstruction because there is no consistent 
calculation available. 

[End of figure] 

Processing times were shorter earlier in the program and subsequently 
became longer. This was due, in part, to the fact that NIOSH chose to 
process simpler cases first in order to expedite them, which 
effectively postponed the handling of cases that were likely to be 
more difficult. As a result, the processing time for all Part B cases 
was greatest in 2006 and has only slightly decreased since then (see 
figure 3). On the other hand, processing time for cases under Part E 
has gradually increased since the program was implemented in 2005. 

Figure 3: Average Processing Times for Part B and Part E Cases by Year 
Decided, Fiscal Years 2002-2008: 

[Refer to PDF for image: vertical bar graph] 

Year: 2002; 
Average days to process: Part B cases without dose reconstruction: 177; 
Average days to process: Part B cases with dose reconstruction: 254. 

Year: 2003; 
Average days to process: Part B cases without dose reconstruction: 271; 
Average days to process: Part B cases with dose reconstruction: 412. 

Year: 2004; 
Average days to process: Part B cases without dose reconstruction: 228; 
Average days to process: Part B cases with dose reconstruction: 753. 

Year: 2005; 
Average days to process: Part B cases without dose reconstruction: 298; 
Average days to process: Part B cases with dose reconstruction: 977; 
Average days to process: Part E cases: 42. 

Year: 2006; 
Average days to process: Part B cases without dose reconstruction: 422; 
Average days to process: Part B cases with dose reconstruction: 1,223; 
Average days to process: Part E cases: 165. 

Year: 2007; 
Average days to process: Part B cases without dose reconstruction: 410; 
Average days to process: Part B cases with dose reconstruction: 1,105; 
Average days to process: Part E cases: 324. 

Year: 2008; 
Average days to process: Part B cases without dose reconstruction: 377; 
Average days to process: Part B cases with dose reconstruction: 1,132; 
Average days to process: Part E cases: 351. 

Source: Department of Labor’s Energy Case Management System for Part B 
claims receiving final decisions from fiscal years 2002 through 2008, 
and Part E claims receiving final decisions from fiscal years 2005 
through 2008. 

Note: Labor calculated the average processing times from the date the 
case was filed to the date Labor issued its final decision for the 
case. If there was more than one filing date for a given worker, Labor 
used the first final decision. These times were calculated based on 
the year in which a final decision was reached, rather than the year 
the case was filed. While some Part E cases require dose 
reconstruction, those cases are not included in the table. Labor does 
not report on Part E cases requiring dose reconstruction because there 
is no consistent calculation available. 

[End of figure] 

Though Special Exposure Cohort cases are not subject to dose 
reconstruction, cases processed in fiscal year 2008 nonetheless took 
almost 2½ years to process, on average. Moreover, total processing 
times for cases identified for inclusion in the Special Exposure 
Cohort in 2008 varied widely, from a minimum of 3 days to as much as 
2,584 days--just over 7 years. One reason that cases were in process 
for several years may have been that they were filed before the case 
became a part of the Special Exposure Cohort. As such, the case would 
have been sent to NIOSH to undergo dose reconstruction before it could 
be determined that site or other data needed to complete a dose 
reconstruction were insufficient. This determination could have taken 
years before the case was designated to the Special Exposure Cohort 
and then fast-tracked for adjudication. 

Dose Reconstruction Can Be Delayed by the Receipt of New Information 
or the Availability of Site Profiles: 

Within the scientific process underlying dose reconstruction, there 
are several factors that can delay dose reconstruction. For any one 
dose reconstruction, NIOSH may complete many steps to gather 
information before issuing a final dose reconstruction.[Footnote 20] 
While NIOSH tracks time spent on major steps of its process, the 
agency does not track time spent on every specific step of the 
process. However, NIOSH does track the additional time it takes to 
rework dose reconstructions to take into account new information added 
to the case in the form of an amendment. Processing amendments adds, 
on average, 25 percent more time to the dose reconstruction process, 
according to NIOSH.[Footnote 21] Amendments are filed most often when 
Labor or claimants identify new information, for example, about 
additional cancers, personal data such as a correction in date of 
birth or death, or employment information that may affect the 
estimated dose. Amendments are filed for about one-third of all cases 
requiring dose reconstruction, and about one-fourth of all amended 
cases have been amended multiple times, according to NIOSH. Each 
subsequent amendment adds more time to the process. For example, 
according to data provided by Labor, sending a case to NIOSH a second 
time adds, on average, 235 days to the dose reconstruction process, as 
shown in table 3. 

Table 3: Average Days Added to Processing Times for Cases Labor 
Returned to NIOSH for Rework: 

Number of times Labor sends case to NIOSH: 1; 
Number of cases: 19,112; 
Average cumulative days at NIOSH: 701; 
Average days added to processing time: Not applicable. 

Number of times Labor sends case to NIOSH: 2; 
Number of cases: 4,634; 
Average cumulative days at NIOSH: 936; 
Average days added to processing time: 235. 

Number of times Labor sends case to NIOSH: 3; 
Number of cases: 615; 
Average cumulative days at NIOSH: 1,109; 
Average days added to processing time: 408. 

Number of times Labor sends case to NIOSH: 4; 
Number of cases: 60; 
Average cumulative days at NIOSH: 1,253; 
Average days added to processing time: 552. 

Number of times Labor sends case to NIOSH: 5; 
Number of cases: 6; 
Average cumulative days at NIOSH: 1,317; 
Average days added to processing time: 616. 

Source: Data from the Department of Labor's Energy Case Management 
System for cases returned to NIOSH for rework for fiscal years 2002 
through 2008. 

[End of table] 

Even after a case is determined to be noncompensable, new information--
from the claimant, NIOSH, or Labor--may prompt Labor to send the case 
back to NIOSH to perform a new dose reconstruction. These reworks 
incorporate new information specific to a single worker, such as an 
additional cancer diagnosis or a newly discovered record of 
employment, or reflect revisions to either the site profile or the 
dose reconstruction method that was used.[Footnote 22] NIOSH was not 
able to report on the additional time needed for reworks resulting 
from revisions to its technical documents.[Footnote 23] However, these 
revisions often result in the reconsideration of cases that were 
previously denied. When NIOSH revises dose reconstruction methods, it 
publishes program evaluation reports describing the change so that 
completed cases that may be affected by the changes may be identified. 
According to NIOSH, it selects cases for rework based on technical 
revisions only if those cases had been previously denied. Thus, while 
performing new dose reconstructions on such cases may lengthen overall 
processing time, it might also result in a favorable outcome for the 
claimant if his or her previously denied claim is reconsidered for 
compensation. 

Another factor that affects the timeliness of completing dose 
reconstructions is the time it initially took NIOSH to research and 
develop the site profiles and dose reconstruction guidance for the 
more than 300 covered facilities.[Footnote 24] From the program's 
outset, NIOSH has given the highest priority to developing site 
profiles and dose reconstruction guidance for sites with the largest 
numbers of prospective claimants. For example, according to NIOSH, 
there are nine sites where 0 percent of dose reconstructions have been 
completed by NIOSH, affecting only nine claimants. NIOSH officials 
stated that the number of these sites with 0 percent of completed dose 
reconstructions is expected to decrease. 

Availability of Claimant Data and Fluctuating Agency Workloads Can 
Also Delay Processing Time: 

Irrespective of dose reconstruction, processing time for EEOICPA cases 
can be affected by the availability of claimant data, such as personal 
exposure and employment data, as well as by the agencies' workloads. 
Since many facilities employed workers several decades ago--before the 
advent of electronic data--some records are difficult for Energy to 
locate and obtain. Some older sites do not have well-organized or 
computerized methods of locating documents, so locating records 
requires a more time-consuming search. For example, at the Hanford 
site, older records must be searched by hand. According to Energy, the 
search is especially difficult when records are needed for claimants 
who worked for subcontractors many years ago because in most cases, 
employee records remained with the subcontractors who worked on Energy 
facilities and oftentimes, these companies no longer exist or have 
been bought and sold multiple times.[Footnote 25] Also, Labor may ask 
claimants to provide additional employment, exposure, or causation 
evidence that is not always readily available or no longer exists from 
their work site. Labor has contracted with the Center for Construction 
Research and Training to help research and document the information 
needed by workers in the construction trades to file claims, but it is 
often difficult to obtain the needed data.[Footnote 26] 

In addition, Labor reported that claims examiners' workloads--which 
range from 25 to 45 cases--may surge when new Special Exposure Cohort 
classes are designated and Labor must identify affected cases to 
review. In 2009, for example, when a class created for the Hanford 
Site was added to the Special Exposure Cohort, Labor's district office 
in Seattle reported that it expected to be required to review an 
additional 1,600 cases for this new class without receiving additional 
staff to handle the work. 

Staff turnover may also delay claim-processing time, although Labor 
reported that it has processes in place to limit the additional time 
that staff turnover adds to adjudication. Labor stated that turnover 
rates vary among district offices, depending on local job markets. 
According to Labor officials, some turnover occurs because of term- 
limited positions--some claims examiners are appointed to 4-year terms 
and seek more permanent employment elsewhere when the term is 
complete.[Footnote 27] These positions constitute 31 percent of 
Labor's claims examiners. Labor officials reported that these term-
limited positions were instituted in 2002, when the program was new 
and the number of claims that would be filed was not known. A 2008 
report by Labor's Ombudsman noted claimants' concerns that changing 
the claims examiner while claims were still being processed had 
resulted in processing delays.[Footnote 28] The Deputy Director of 
Labor's Division of Energy Employees Occupational Illness Compensation 
program acknowledged that delay can occur when claims examiners leave 
and claims are transferred to others, but explained that district 
office managers mitigate delays by effectively monitoring the transfer 
of claims after one examiner leaves and ensuring that the new claims 
examiner is quickly brought up to speed. 

Delays may also occur when new claims examiners are hired by Labor, 
because training and educating new claims examiners can be time- 
consuming given the complexity of the program. According to the Deputy 
Director, it usually takes, on average, 1 year for new claims 
examiners to confidently handle and adjudicate claims. 

NIOSH and Labor Have Procedures to Expedite Certain Cases: 

To help shorten processing times, both NIOSH and Labor have developed 
strategies to use in expediting certain cases. Because dose 
reconstruction is a complex process that requires considerable time, 
NIOSH has developed strategies to more efficiently complete dose 
reconstructions. First, NIOSH regularly reviews cases that were filed 
at the beginning of the program that have not yet been processed 
because of case complexity to determine the source of the delay. As a 
result, of the first 5,000 Part B cases sent to NIOSH for dose 
reconstruction, by 2008, NIOSH had completed dose reconstructions on 
all but 9.[Footnote 29] NIOSH is currently targeting the next 10,000 
cases filed to determine which of these are still awaiting final dose 
reconstructions from NIOSH and will subsequently complete these cases. 
[Footnote 30] This strategy of targeting older cases, including legacy 
cases--those that have been at NIOSH for 2 or more years--has 
contributed to NIOSH reducing its backlog from a high of 6,546 cases 
in fiscal year 2004 to 826 cases in fiscal year 2008.[Footnote 31] 

Another strategy to reduce processing times is NIOSH's use of rough 
dose estimations to expedite cases that would be clearly above or 
below the 50 percent threshold of probability of causation.[Footnote 
32] Figure 4 provides an overview of this process. NIOSH stated that 
this efficiency measure has minimized time spent reconstructing doses 
while maintaining the reliability of the outcome. In 2005, NIOSH 
invested in new software technology that allows for faster 
calculations for some dose reconstructions. According to the agency, 
this technology has reduced the time it takes to calculate certain 
types of dose estimates from months to hours. In fact, the average 
processing times for dose reconstructions began to decrease in 2006. 
Finally, NIOSH created several staff positions to assist claimants 
through the Special Exposure Cohort and dose reconstruction processes, 
because the completeness of the information submitted by claimants can 
directly affect the time it takes to process their claims. Two of 
these positions, NIOSH's Special Exposure Cohort Petition Counselor 
and the Ombudsman, help ensure that petitioners include all of the 
required and appropriate information when filing petitions. Similarly, 
NIOSH designated its Ombudsman to inform claimants of the information 
required for dose reconstructions. 

Figure 4: NIOSH Efficiency Process Using Rough Estimates for Dose 
Reconstructions: 

[Refer to PDF for image: illustration] 

NIOSH considers the organ(s) affected, the type of radioactive 
elements, and how the exposure occurred: 

1) Cancer unlikely to be caused by radiation exposure: 

Rough estimate: 
Exposure calculated using overestimating dose; 

Threshold not met: 
Low probability of causation that cancer is related to exposure; 

Threshold met or exceeded: 

Precise Estimate: 
Exposure calculated with complete dose reconstruction; 

Threshold not met: 
Low probability of causation that cancer is related to exposure; 

Threshold met or exceeded: 
High probability of causation that cancer is related to exposure. 

2) Cancer likely to be caused by radiation exposure: 

Rough estimate: 
Exposure calculated using underestimating dose; 

Threshold met or exceeded: 
High probability of causation that cancer is related to exposure; 

Threshold not met: 

Precise Estimate: 
Exposure calculated with complete dose reconstruction; 

Threshold not met: 
Low probability of causation that cancer is related to exposure; 

Threshold met or exceeded: 
High probability of causation that cancer is related to exposure. 

Source: GAO analysis of The NIOSH Radiation Dose Reconstruction 
Program. 

[End of figure] 

Labor prioritizes claims for terminally ill claimants in an effort to 
issue final decisions as quickly as possible for these claimants. 
Under Part E, about 98 percent of workers who filed claims survived 
long enough to receive Labor's final decision. Part B had similar 
results, where 97 percent of Part B eligible workers who filed claims 
survived to receive a final decision from Labor. 

NIOSH and Labor Have Established Performance Measures and Goals to 
Monitor Timeliness: 

In 2007, NIOSH established performance targets for fiscal year 2008 
for its processes in response to the results of the Office of 
Management and Budget's (OMB) Program Assessment Reporting Tool (PART) 
evaluation. The agency now has five measures it uses to track its 
performance in completing dose reconstructions and evaluating Special 
Exposure Cohort petitions. NIOSH uses these to track its progress 
toward completing a percentage of certain types of cases and petitions 
within specified time frames. See appendix III for a list of the 
performance measures and results. In 2008, NIOSH set baselines for two 
of the five measures. Program officials reported that NIOSH has not 
established timeliness measures for specific steps of the dose 
reconstruction process because its data system does not track specific 
job activities. 

Labor's annual operational plan for the program includes program 
workload and timeliness targets. Labor has established separate 
performance measures that correspond to 18 discrete steps of its 
adjudication process (excluding the activities of NIOSH). At the end 
of fiscal year 2008, Labor met 14 of the goals but did not meet the 
other 4 (see appendix III for more detailed information). Labor's 
performance in 2008 surpassed that in 2007, during which the agency 
met just over half of its goals. Moreover, Labor has adjusted its 
measures over time to target higher levels of performance. In 2008, 
the agency adjusted targets for one-third of its measures. 

In addition, Labor received a rating of "adequate" for its 
administration of the program in OMB's 2007 PART evaluation. This 
rating calls for more ambitious goals for monitoring agency 
performance.[Footnote 33] Nevertheless, the program has improved 
efficiency over time by increasing the average number of decisions per 
full-time claims examiner from about 117 decisions per full-time 
employee in fiscal year 2005 to 161 decisions in fiscal year 2008. 

In its 2008 report that, in part, reviewed the timeliness of Labor's 
claim processing, Labor's Inspector General (IG) noted that while the 
agency had many performance measures that target specific steps in the 
process, it did not report the overall processing time for claims from 
start to finish.[Footnote 34] The IG therefore recommended that Labor 
track and report overall claim-processing time, including time spent 
at NIOSH for dose reconstruction. Labor responded that it does not 
track overall timeliness because it does not have control over the 
activities of the other agencies involved.[Footnote 35] Labor added 
that such a measure would not be an accurate representation of its 
adjudication process and would render its performance measures 
useless. Nevertheless, Labor has begun posting information on overall 
claim-processing time on its Web site. The IG also recommended that 
Labor create interim milestones for the initial claim-processing phase 
since Labor did not meet its timeliness goals for this part of the 
process. Labor did not concur with this recommendation.[Footnote 36] 

Administrative Costs Reflect Requirements of Science-Based 
Adjudication: 

In 2008, EEOICPA's administrative costs were over $106 million for 
Part B and almost $57 million for Part E claims. That same year, over 
$484 million dollars in benefits was paid for Part B, and $456 million 
was paid for Part E claims.[Footnote 37] (See tables 4 and 5 for 
direct administrative costs and benefits paid over the life of the 
programs.) The administrative costs in any given year are not 
necessarily related to the benefits paid because paid claims do not 
reflect the number of claims processed in that same year. Payments 
represent only claims paid out in that year. The administrative costs 
reflect the costs of processing all claims, including those that were 
denied and those that have not yet been decided. 

Over the life of the program, direct administrative costs have 
averaged about 20 percent of the total program cost for Part B and 14 
percent for Part E. Yearly ratios, however, are affected by factors 
unrelated to efficiency, namely the approval rate and the amounts 
paid. A higher approval rate or higher benefit or both would result in 
a lower ratio of administrative costs to benefits paid. 

Table 4: Part B Benefits Paid and Direct Administrative Costs: 

(Actual obligations in thousands of dollars). 

Benefits paid[A]: 
2001: $3,450; 
2002: $350,970; 
2003: $305,236; 
2004: $251,051; 
2005: $325,792; 
2006: $461,385; 
2007: $463,889; 
2008: $484,380; 
Total: $2,646,153. 

Administrative costs: 
2001: $18,429; 
2002: $68,299; 
2003: $66,058; 
2004: $81,195; 
2005: $115,703; 
2006: $107,629; 
2007: $108,362; 
2008: $106,046; 
Total: $671,721. 

Administrative costs: NIOSH[B]: 
2001: $2,403; 
2002: $33,161; 
2003: $26,006; 
2004: $44,857; 
2005: $55,235; 
2006: $63,606; 
2007: $55,270; 
2008: $55,519. 

Administrative costs: LABOR:
2001: $16,026; 
2002: $35,138; 
2003: $40,052; 
2004: $36,338; 
2005: $60,468; 
2006: $44,023; 
2007: $53,092; 
2008: $50,527. 

Total program cost: $3,317,874. 

Percentage of cost that is administrative: 20%. 

Source: GAO presentation of unaudited NIOSH and Labor data. 

Note: Energy's costs average about $6 million per year. Energy did not 
report cost data prior to 2006. Additionally, Energy does not separate 
costs by Part B and Part E. 

[A] Benefits paid do not include medical benefits paid. Medical 
benefits for illnesses covered under Part B averaged $62 million per 
year for 2005-2008. 

[B] NIOSH's costs reflect both direct and indirect administrative 
costs. 

[End of table] 

Table 5: Part E Benefits Paid and Direct Administrative Costs: 

(Actual obligations in thousands of dollars). 

Benefits paid[A]: 
2005: $194,522; 
2006: $280,130; 
2007: $360,867; 
2008: $456,734; 
Total: $1,292,254. 

Administrative costs: 
2005: $34,939; 
2006: $52,361; 
2007: $63,268; 
2008: $56,878; 
Total: $207,446. 

Total program cost: $1,499,700. 

Percentage of cost that is administrative: 14%. 

Source: GAO presentation of unaudited NIOSH and Labor data. 

Note: Energy's costs average about $6 million per year. Energy did not 
report cost data prior to 2006. Additionally, Energy does not separate 
costs by Part B and Part E. 

[A] Benefits paid do not include medical benefits paid. Medical 
benefits for illnesses that were covered only under Part E averaged $1 
million per year for 2005-2008. Medical benefits for illnesses covered 
under both Parts B and E are recognized under Part B, not Part E. 

[End of table] 

The cost of administering EEOICPA reflects its science-based 
adjudication process and the highly technical nature of the claims. 
About 60 percent of Labor's direct costs for Part B are for personnel 
and benefits. Eighty-seven percent of NIOSH's direct costs are for 
contracts, primarily for dose reconstruction and the development of 
site profiles. Unlike other workers' compensation programs, EEOICPA 
compensates for diseases caused by exposure to radiation and toxic 
substances that are not generally found in most workplaces. 
Confirmation that these conditions are the result of exposure to 
radiation or toxic substances requires the skills of many specialists, 
including health physicists, industrial hygienists, occupational 
medicine physicians, and claims examiners. Dose reconstructions for 
cancer claims conducted by NIOSH health physicists are often the most 
technically complex part of the adjudication process. They require 
gathering and analyzing extensive data about working conditions and 
exposures for the entire facility before individual exposures can be 
estimated. Labor's adjudication process for claims of beryllium 
disease, silicosis, and illnesses related to exposure to toxic 
substances is also labor intensive because it requires expert review 
at several levels. 

While some claims require more time to adjudicate than other claims 
and can therefore be more costly to process, Labor does not collect 
and analyze data on administrative costs by individual claim or claim 
type. Therefore, we could not determine how much Labor spends on 
adjudicating approved claims compared with adjudicating claims that 
were denied. We also could not determine how costly each phase of the 
process is--other than dose reconstruction--because Labor does not 
break out costs in detail. 

On the basis of the number of total Part B dose reconstruction cases 
that NIOSH processed and its costs over the lifetime of the program, 
NIOSH estimates its direct administrative costs for each case to be 
about $12,000.[Footnote 38] Using the same method, we calculated 
Labor's direct cost per case to be about $8,000 for all Part B cases 
(about one-third of which require dose reconstruction) and about 
$6,000 for Part E cases. We were not able to calculate the 
administrative costs for each case by year and compare trends over 
time because NIOSH had significant start-up costs, which were 
relatively recent, and because Labor and NIOSH may spend more than a 
year processing each case.[Footnote 39] 

Part B Quality Controls Generally Include Internal and Independent 
Reviews, while Part E Processes Lack Independent and Expert Review: 

Both Parts B and E of the Energy Employees Occupational Illness 
Compensation Program have quality controls in place in the form of 
multiple reviews within the agencies; there is also an extensive 
independent review process for NIOSH's work on radiation-related 
cancer claims under Part B, provided for by the act. While there is no 
statutory requirement for an independent review of Labor's policies 
regarding occupational lung disease claims under Part B or claims 
regarding illnesses resulting from exposure to toxic substances under 
Part E, those policies have not undergone outside review, and the 
policy development process is mostly done internally. For example, 
Labor employs a contractor and a small team of internal experts to 
continuously update its site exposure matrix. However, this effort is 
not supported by public, expert outside review to provide assurance 
that the matrix is comprehensive and scientifically sound. Independent 
expert review can help provide assurance of scientific or technical 
quality and can provide decision makers with independent perspectives 
and judgments of experts who are knowledgeable in the subject area 
being reviewed. Experts we interviewed expressed concerns about the 
scientific soundness, completeness, and consistency of Labor's 
guidance used for Part E adjudications. 

NIOSH's Work for Part B Cancer Adjudication Undergoes Independent 
Expert Review: 

NIOSH's work to support Labor's adjudication of Part B cancer claims 
is independently reviewed by the Advisory Board required by EEOICPA. 
The board reviews the scientific validity and quality of NIOSH's dose 
reconstruction efforts, and it recommends whether to add new classes 
of workers to the Special Exposure Cohort--those for whom dose 
reconstruction is not feasible because of inadequate site data. Aided 
by its contractor, Sanford Cohen & Associates, the Advisory Board 
reviews NIOSH's technical documents including its site profiles, 
sample dose reconstructions, and NIOSH evaluations of petitions to add 
classes to the Special Exposure Cohort. When the board's contractor 
reports concerns or questions about any of these documents to NIOSH 
through the Advisory Board, NIOSH responds through an established 
resolution process, revising its documents and methods as needed. If 
warranted, NIOSH identifies and reconsiders all denied claims 
potentially affected by the revision, documenting the process in 
reports posted on its Web site. NIOSH issues these reports more often 
in response to changes in site profiles than to dose reconstruction 
audits, and does so on its own initiative as well as in response to a 
finding by the board. 

Technical documents and site profiles. The board, in conjunction with 
its contractor, audits NIOSH's technical documents and site profiles 
for adequacy and completeness of data sources, scientific validity, 
accuracy of data, and consistency among site profiles. Because the 
site profiles are used to support dose reconstructions, the audits 
also assess whether the site profile instructions are clear, accurate, 
complete, and auditable and whether NIOSH's methods and assumptions 
are scientifically valid and favorable to the claimant. Like NIOSH, 
the board's contractor traveled to many of the sites for its own 
independent research, including meeting with site experts and former 
workers to hear testimony about facility conditions and practices. 
NIOSH characterizes its technical documents and site profiles as 
living documents, subject to revision as new information and methods 
become available. For example, in 2006, NIOSH revised its site profile 
and dose reconstruction methods for Bethlehem Steel in response to 
findings from the Advisory Board contractor's audit that assessed the 
dose reconstruction data, assumptions, and methods. 

Dose reconstruction reports. To carry out its responsibility to review 
the scientific validity and quality of NIOSH's dose reconstructions, 
the Advisory Board, in conjunction with its contractor, periodically 
audits sampled dose reconstructions. These audits address whether 
sampled dose reconstructions (1) are consistent with records provided 
by Energy and the claimant interview; (2) comply with applicable 
procedures, both general and specific to the relevant facility; and 
(3) are supported by scientifically defensible and/or claimant-
favorable assumptions. For a portion of sampled dose reconstructions, 
the board's contractor performs its own dose reconstructions to 
determine if it can validate the results and evaluates the information 
and methods NIOSH applied. Using a detailed checklist, the contractor 
identifies areas of concern and their potential significance to the 
estimated dose. The contractor also notes whether it found similar 
problems in more than one dose reconstruction audit and identifies 
opportunities for NIOSH to revise ambiguous instructions or overly 
complex procedures. Following each audit, the Advisory Board and NIOSH 
engage in a resolution process to address the audit findings. In cases 
where comment resolution requires changes to the method used for the 
reconstruction, NIOSH publishes a Program Evaluation Report describing 
the change and identifying all claims that may have been denied under 
the earlier method to assess whether they should be reconsidered. 
NIOSH reported that, as of March 2009, the board's contractor had 
completed audits of its first sample of 100 NIOSH dose 
reconstructions, and as a result, one claim that had previously been 
denied was approved. 

Special Exposure Cohort petition evaluations. Under EEOICPA, the 
Advisory Board advises the Secretary of Health and Human Services on 
the addition of new classes of workers to the Special Exposure Cohort. 
The Advisory Board's deliberations address whether it is feasible to 
estimate workers' radiation dose with sufficient accuracy and whether 
there is a reasonable likelihood that the radiation dose endangered 
the workers' health.[Footnote 40] When a claimant or other authorized 
party petitions to add a new class to the cohort and the petition 
contains all required information, NIOSH prepares an evaluation 
report, which may agree that a new class is warranted or, 
alternatively, describe the basis for its position that dose 
reconstruction is feasible for those workers.[Footnote 41] To support 
the Advisory Board's deliberations, the board's contractor reviews and 
reports on all such NIOSH petition evaluations. When the contractor 
identifies shortcomings in NIOSH's proposed dose reconstruction 
methods, or when new information about a site is discovered, the 
Advisory Board considers the implications on the feasibility of dose 
reconstruction. In some cases, NIOSH responds to the board's concern 
with revised dose reconstruction methods, which the contractor reviews 
in turn. This ongoing revision and review process can be protracted: 
NIOSH's initial evaluation is subject to statutory time limits but its 
revisions are not because they take place during the Advisory Board's 
deliberation process.[Footnote 42] 

As of April 2009, NIOSH reported that 42 new classes of workers had 
been added to the Special Exposure Cohort on the basis of the Advisory 
Board's recommendation. The Advisory Board had not recommended adding 
3 new classes for which petitions had been filed, and 12 petitions 
were still under consideration. Twenty of the 42 new classes had been 
proposed by NIOSH and 22 by petition from claimants or their 
representatives. In 4 of the 22 claimant-initiated petitions for which 
the Advisory Board recommended adding a class, NIOSH's evaluation 
concluded that dose reconstruction was feasible, but the Advisory 
Board did not concur and recommended the addition of the class. Since 
April 2009, 9 additional classes have been added, bringing the total 
up to 51 classes as of March 2010. 

Use of surrogate data. NIOSH uses surrogate data--basically, 
information from facilities other than the site where the worker was 
employed--to perform dose reconstruction when records on the worker's 
own exposure or work site are insufficient for estimating the worker's 
radiation dose.[Footnote 43] This practice has been criticized by 
claimant advocates as inappropriate, given that EEOICPA provides for 
expansion of the Special Exposure Cohort when it is not feasible to 
estimate with sufficient accuracy the radiation dose received. Amidst 
this criticism, NIOSH has developed protocols that specify the 
criteria for when such information might be employed, and the Advisory 
Board is in the process of reviewing these protocols. NIOSH's 
protocols supplement its regulations by addressing in detail the 
information sources and methods used in dose reconstruction and the 
types of information and research needed to use surrogate data. On 
behalf of the board, its contractor reviewed the NIOSH protocols on 
surrogate data use and compared them with existing draft protocols 
developed to guide the Advisory Board's review of NIOSH's dose 
reconstructions that use surrogate data. The Advisory Board's draft 
protocols specify that surrogate data may be appropriate under certain 
conditions, subject to a case-by-case determination of scientific 
soundness, stipulating that the more central the surrogate data are to 
the dose reconstruction method, the more carefully they should be 
justified and validated. While the draft protocols are the 
contractor's current standards for reviewing NIOSH's dose 
reconstruction methods that rely on surrogate data and are currently 
under consideration by the board, they have not as yet been formally 
adopted. The board's work group on surrogate data, which developed the 
current draft protocols with the contractor, is planning to submit 
them to the full board for its consideration. In addition, NIOSH plans 
to review its approach to surrogate data as part of a planned internal 
evaluation of its EEOICPA-related work. 

Although the Advisory Board and its contractor have taken steps to 
weigh in on when the use of surrogate data is scientifically sound, 
some advocates question whether it is possible to adequately adjust 
for differences among facilities, accounting for both physical 
features such as size, layout, and ventilation, and human factors such 
as compliance with safety and reporting requirements. NIOSH maintains 
that dose reconstruction with surrogate data is reasonable when enough 
is known about the type and quantity of radioactive elements on site 
and the fabrication processes used, and it can identify monitoring or 
production records from other facilities, covering the same time 
frame, that are sufficiently comparable to estimate radiation exposure 
risks to workers. Further, NIOSH officials note that when using 
surrogate data or in any case where actual exposure records are 
incomplete, their practice is to overestimate radiation exposure, 
which generally results in higher estimates of exposure than workers 
were likely to have had.[Footnote 44] 

Throughout the dose reconstruction process, NIOSH incorporates 
claimant-favorable exposure assumptions that maximize estimated 
radiation dose and cancer risk. In addition, EEOICPA specifies that 
the probability that the worker's cancer was related to covered 
radiation exposure be calculated at the 99 percent confidence 
interval.[Footnote 45] These approaches, along with the Special 
Exposure Cohort provisions for situations in which dose reconstruction 
is not feasible, were intended to help ensure that claimants are not 
disadvantaged by their employers' lack of records. 

Labor's Requirements for Part B Occupational Lung Disease Claims Have 
Not Undergone External Expert Review: 

Unlike claims for radiation-related cancer, EEOICPA does not require 
independent review of Labor's requirements for occupational lung 
disease claims under Part B, despite the fact that these diagnoses can 
be challenging, and the disease may not manifest until years after 
exposure. Currently, these requirements do not undergo a review 
process by independent experts to ensure that they reflect current 
medical consensus, are clear, and result in consistent adjudication 
decisions. This can create unnecessary rework for the agency as well 
as frustration for claimants. 

For example, although occupational exposure is the recognized cause of 
lung diseases such as chronic beryllium disease, some of the 
diagnostic tests for this condition have been found to be unreliable 
when performed on patients taking certain medications. Labor has 
changed its approach to beryllium claims more than once, without the 
benefit of expert medical or scientific review. First, in 2007, Labor 
tightened its requirements for diagnostic evidence for Part B 
beryllium illness claims, requiring that living workers substantiate 
their claims with results from these tests or undergo more invasive 
testing. Then, in 2009, Labor once again relaxed its requirements and 
instructed claims examiners to consider a broader array of diagnostic 
evidence for living workers. As a result, Labor now plans to review 
beryllium claims that were denied when the more restrictive 2007 
policy was in effect. 

Labor's Processes for Certain Part E Claims Provide for Internal 
Review but Not Independent Outside Expert Review: 

Labor's decisions on Part E claims for diseases related to 
nonradioactive toxic exposure undergo multiple internal reviews. 
First, the adjudication process itself provides multiple opportunities 
for claimants to supplement the evidentiary record and object to 
Labor's adjudication decisions, both recommended and final, and 
request a hearing. All recommended decisions also undergo supervisory 
review within the district office and final adjudication branch before 
they are issued as final decisions. In addition to the levels of 
review built into the adjudication process, Labor's quality control 
process includes random audits. These audits include annual 
accountability reviews performed by staff from other district offices 
or final adjudication branches. The accountability reviews include 
audits of sampled claims and address, among other things, regulatory 
and procedural compliance, the sufficiency of claim development, and 
the appropriateness of the recommended decision. 

However, unlike Part B's provisions for oversight of NIOSH's work on 
radiation-related cancer claims, Part E of EEOICPA does not provide 
for independent review of Labor's scientific or technical guidance on 
nonradioactive toxic exposure claims. As a result, there is no 
systematic independent expert review of Labor's Part E technical 
documents and guidance. This includes development and use of its site 
exposure matrix, its guidance for claims examiners, and the advice 
examiners receive from consulting physicians. 

Site exposure matrix. While Labor has, with the assistance of a 
contractor, developed an extensive and growing exposure and work site 
database for use by its claims examiners--the site exposure matrix-- 
there is no independent expert review process in place to validate or 
augment this work. According to Labor, the site exposure matrix was 
created specifically because Labor recognized that it would be 
difficult for employees or their survivors to provide information 
concerning the toxic substances that may have been present at the 
facilities where the employees worked and the medical conditions that 
may relate to exposure to such substances. The site exposure matrix 
includes site-specific information, such as what toxins were present 
at each facility;[Footnote 46] building characteristics; job 
descriptions and activities; production processes; and incidents drawn 
from research, interviews, information from Energy, and submissions 
from the public.[Footnote 47] It also includes information about 
established links between specific toxins and diseases. Developing a 
comprehensive site exposure matrix is challenging for various reasons. 
Historically, employers tended to place less emphasis on documenting 
and monitoring exposure to toxic substances that were not radioactive. 
Consequently, the records are not as complete, especially for the 
earlier years of nuclear weapons production. In addition, research on 
the health effects of toxic exposure is evolving, and research into 
the health effects of some of the toxins used in the nuclear weapons 
industry is limited. 

Labor acknowledges that it would be impossible to compile a completely 
comprehensive database, but notes that it is constantly updating the 
matrix. In addition, Labor officials told us that the agency does not 
rely solely on this database for its determinations and added that 
their procedures and training both emphasize that the site exposure 
matrix is not a stand-alone decision-making tool. Labor stated that 
while it places strong weight on claims supported by information in 
the site exposure matrix, the absence of information is not by itself 
sufficient reason for denying a claim. For conditions without an 
established link in the matrix, Labor officials said they consider 
other evidence of causation, including information submitted by 
claimants, district medical consultants, industrial hygienists, health 
physicists, and toxicologists. Labor's guidance to its claims 
examiners specifies that this evidence must be compelling and 
probative--a well-rationalized medical opinion--in order to support 
compensation. 

Labor officials maintain that because the site exposure matrix's 
inventory of illnesses and associated toxins is drawn from the 
National Library of Medicine's Haz-Map, a database of peer-reviewed 
scientific articles, a formal review is not necessary and would create 
unnecessary delays for Part E claims. They also said that in addition 
to tracking changes in this database, the National Library of Medicine 
researcher who developed the database is working under contract with 
Labor to continually update the site exposure matrix to reflect 
ongoing research into the relationship between toxins and disease. The 
researcher works with Labor's ad hoc internal site exposure matrix 
review committee.[Footnote 48] 

Occupational health physicians we interviewed criticized the 
scientific soundness of the site exposure matrix, noting that the 
absence of published research linking certain chemicals to diseases 
does not constitute evidence that such links do not exist. Labor 
officials countered that the lack of a causal link in the matrix does 
not in itself constitute the basis for denying claims. They cited an 
example of an approved claim for a condition that was not linked to 
occupational exposure in the matrix but resulted from unique 
sensitivities to substances not toxic to the general population. 

Occupational health physicians and claimant advocates we interviewed 
also expressed concern that the site-specific information in the 
matrix, such as the location of toxins, building characteristics, and 
job descriptions, does not account for the exposure of roving workers 
such as maintenance mechanics, security guards, firemen, and 
electricians, who were likely to spend time in multiple buildings. The 
physicians also noted that even jobs not considered hazardous could be 
risky, depending on where the offices were located. Labor explained 
that the site exposure matrix is set up to allow claims examiners to 
review potential exposure risks. Search capabilities are not limited 
by superficial job titles but allow claims examiners to review 
potential exposures in work areas where workers were located.[Footnote 
49] Claims examiners are also encouraged to discuss potential exposure 
with claimants. Claims examiners use the matrix as one component of 
their review--and may consult its data on buildings, work areas, 
location of toxic substances, production processes, and incidents 
along with information from claimant interviews, affidavits, and other 
evidence. Nevertheless, Labor officials noted that ultimately, 
claimants must submit evidence that is sufficient to support a well-
reasoned compensation decision. 

Medical guidance and consultation for claims examiners. Labor offers 
detailed guidance to its claims examiners on how to weigh a claimant's 
medical evidence and provides a cadre of physician consultants for 
examiners to consult. However, this guidance is not reviewed by 
outside experts to ensure it is scientifically sound and reflects 
current research. 

Labor's claims examiners are not required to have medical expertise or 
training, but they are required to reach decisions about causation of 
diseases on the basis of medical evidence. Labor has developed a 
claims examiners' manual that specifies how to request, review, 
supplement, and clarify employment and medical records. Interpreting 
evidence of the health effects of toxic exposure for Part E claims 
adjudication is a complex, sophisticated task, yet this guidance is 
not reviewed by outside experts. Several occupational health experts 
we interviewed, as well as both former Labor medical directors for 
Part E, expressed concerns about this guidance. For example, some 
physicians we interviewed objected to Labor's instructions that 
exposure to each toxic substance be evaluated independently. They 
disagreed with Labor's position that current science does not support 
the assertion that exposure to multiple toxins has a combined effect 
on health.[Footnote 50] Because nuclear weapons facilities typically 
exposed workers to multiple hazardous substances, these physicians 
assert that it is not realistic to consider the health effects of each 
toxin in isolation. Because the matrix includes only single causal 
linkages and does not address combinations of toxins, these physicians 
are concerned that the site exposure matrix is not sufficiently 
sophisticated to include the nuances of toxic exposure research, and 
that some claims examiners will deny claims automatically if they 
don't find a causal link in the matrix even if Labor discourages this 
practice. 

Oversight of consulting physicians. Although adjudication decisions 
are subject to multiple levels of internal review, Labor does not have 
an oversight process in place to ensure quality, objectivity, and 
consistency of its consultant physicians' work.[Footnote 51] Of the 78 
physicians retained by Labor to help claims examiners interpret 
medical evidence on diagnosis, causation, and impairment, 61 reported 
specializing in occupational medicine. These physician consultants 
review medical records and provide advice about causation on an as- 
needed basis at the request of claims examiners. Occupational 
physicians and the former medical directors for EEOICPA programs 
expressed concerns to us about the consistency of the consultant 
physicians' reports and suggested the need for quality control 
measures such as peer review of sampled reports and trend analyses of 
multiple reports. Labor officials acknowledged the program does not 
have a system for quality review of its contractor physicians' reports. 

Probability of causation for Part E cancer claims. Although the 
statutory language regarding eligibility for compensation is different 
in Part B and Part E, Labor has decided to use the same procedures it 
uses to adjudicate Part B radiation-related cancer claims when it 
adjudicates radiation-related cancer claims under Part E.[Footnote 52] 
As a result, Labor applies the same 50 percent probability of 
causation standard to determine the compensability of radiation-
related cancer claims under Part B and Part E, which has raised 
concerns for claimant advocates about the agency's implementation of 
Part E. The disagreement centers on the appropriate interpretation of 
the differing language in Part B and Part E. Part B requires a 
determination that the cancer is "at least as likely as not related to 
employment at the [Department of Energy or Atomic Weapons Employer] 
facility."[Footnote 53] In contrast, Part E specifies that for a claim 
to be compensable, Labor must find that "it is at least as likely as 
not that exposure to a toxic substance at a Department of Energy 
facility was a significant factor in aggravating, contributing to, or 
causing the illness."[Footnote 54] 

Claimant advocates maintain that a 50 percent probability of causation 
is inappropriately high and not consistent with Part E. This position 
is grounded in the concept that the Part E language regarding 
compensation for illnesses that were caused, contributed to, or 
aggravated by exposure to toxic substances merits a lower threshold of 
probability than Part B. While Labor acknowledges that the statutory 
language is different for the two programs, the agency asserts that it 
is clear from the scientific literature that it is not possible to 
definitively attribute any individual's cancer to any particular cause 
and that scientific analysis does not distinguish between cancers that 
are caused or contributed to by radiation. Labor further asserts that 
its approach provides the only reasonable factual basis to support a 
determination under Part E.[Footnote 55] Labor officials also told us 
that the agency relies on the probability of causation based on 
NIOSH's dose reconstruction for Part E cancer claims only when it is 
unable to support compensation based on exposure to a nonradioactive 
toxic substance. 

NIOSH scientists noted that NIOSH was only informally involved in 
developing Labor's regulation on how to interpret dose reconstruction 
results under Part E despite that document's discussion of 
sophisticated legal, scientific, and statistical concepts. Although 
Labor adopted its regulation through the public notice and comment 
rulemaking process, Labor did not fully engage NIOSH experts on the 
more technical aspects of the issues during this process. Meanwhile, 
Labor maintains that the claimant-favorable nature of dose 
reconstruction more than compensates for differences between causal or 
contributory effects of radiation exposure (even if the probability 
models could make such distinctions, which Labor maintains they 
cannot). In particular, as noted above, use of the 99 percent 
confidence interval to estimate the probability of an exposure-cancer 
link attributes cancer risk, and compensates claimants, for cancers 
when radiation doses were very low. 

Despite Agencies' Actions, EEOICPA Program Transparency Remains 
Somewhat Limited: 

The implementing agencies have taken various steps to make information 
public, but national security considerations and the complex, science- 
based methods underlying EEOICPA claims adjudication pose challenges 
to information sharing. While NIOSH has worked with Energy to clear 
some sensitive and classified information for publication in the site 
profiles developed for Part B cancer claims, Labor has not as yet done 
so for the site exposure matrix used for Part E. Also, NIOSH has 
established an ombudsman to help claimants whose cases are undergoing 
dose reconstruction, but Labor has not publicly responded to its 
Ombudsman's annual reports on claimant concerns. 

Agencies Have Taken Steps to Help Claimants and Make Complex 
Information about Claims and Methods Accessible: 

The sheer complexity of the information NIOSH generates to assist 
Labor with its adjudication of cancer claims has led to concerns that 
the process is incomprehensible to claimants. According to agency 
officials and the Ombudsman, both the dose reconstruction process and 
the results of individual decisions are often difficult for claimants 
to grasp. NIOSH has taken a number of steps to assist claimants and 
communicate with them and the public about its work. Both Labor and 
NIOSH have also posted a great deal of information about program 
implementation and data on their respective Web sites. Agency measures 
to enhance public and claimant knowledge of the adjudication process 
include the following: 

Establishment of two claimant liaison positions at NIOSH. To help 
claimants and petitioners understand the dose reconstruction process 
and navigate the requirements for seeking Special Exposure Cohort 
status, NIOSH established a Special Exposure Cohort Petition Counselor 
position and a consultant/ombudsman position. These officials are 
available to provide specialized one-on-one consultations about 
NIOSH's programs, documents, and the results of dose reconstruction. 
The Special Exposure Cohort Petition Counselor is responsible for 
ensuring that petitioners are fully informed about the requirements 
for a successful petition, helping them prepare their petitions, and 
keeping them informed throughout the petition review process. The 
NIOSH Ombudsman is also available to help petitioners compile the 
information they need to support their petitions and to help resolve 
claimants' questions about the dose reconstruction process. 

The officials in both of these positions told us how confusing it is 
for claimants to navigate the program and keep track of all the 
various agencies and processes involved. In addition to clarifying 
complex program and regulatory requirements, both liaisons told us 
they take an active role to resolve concerns. For example, the Special 
Exposure Cohort Petition Counselor described her response to a 
petitioner's concern that NIOSH had not reviewed a classified document 
important to the petition's success. She first arranged for Energy to 
review the document and respond to specific questions to determine 
whether it might affect the petition, then arranged for NIOSH 
scientists with the appropriate clearance to see the document. 
Finally, she arranged a conference call between the petitioner and 
NIOSH health physicists to discuss NIOSH's interpretation of the 
classified information and its decision that its contents would not 
change the petition's outcome. The petitioner in question disagrees 
with that decision, but the NIOSH petition counselor ensured that the 
decision was reached only after NIOSH could demonstrate that it had 
not overlooked pertinent information. The Ombudsman told us she is 
able to facilitate access to information for claimants and arrange 
conference calls with the health physicists who prepare dose 
reconstructions to discuss individual dose reconstruction results. 

Revision of standards for written and oral communication with 
claimants by NIOSH. NIOSH officials have described the challenge of 
creating reports and letters that provide the degree of specificity 
needed for legal and technical accuracy without being so complex they 
are not understandable to a layperson. According to agency officials, 
the agency is working with its contractor and public health 
communications specialists to revise the descriptions of the results 
of dose reconstructions it sends to claimants. The new format will 
include a section with legal information, another section with enough 
technical specificity to describe the dose reconstruction process and 
results, and a third interpretive section that will convey the 
findings in terms designed to be accessible to readers with an eighth 
grade education. 

The Advisory Board has also recommended that NIOSH revise the 
information it provides to claimants when they receive the results of 
a dose reconstruction for claims in which the agency has employed an 
overestimation measure. The information provided to claimants would 
need to explain that the probability of causation could decrease later 
if NIOSH has to provide a more precise estimate because more detailed 
information has become available or the claimant develops a new 
cancer. This recommendation was made in response to complaints that 
claimants whose original dose reconstruction was overestimated were 
confused and dismayed when they developed additional cancers, and 
subsequent, more precise estimates resulted in lower doses. 

Publication of a variety of informational resources. NIOSH's publicly 
available information includes an overview of EEOICPA, a detailed 
frequently asked questions section on its Web site about its 
activities, a video describing dose reconstruction, and a number of 
pamphlets that explain NIOSH's activities in various levels of detail. 
These materials are designed for a variety of claimants with diverse 
educational backgrounds, ages, and health status. Labor has also 
developed a variety of brochures about the application and 
adjudication process and publishes its internal bulletins and claims 
examiners' manuals on its Web site. 

Open Advisory Board meetings. Since the Advisory Board is subject to 
the Federal Advisory Committee Act, most of its meetings must be open 
to the public and announced in advance in the Federal Register. The 
board also announces its meetings on NIOSH's Web site. Members of the 
public can attend in person or by calling a toll-free telephone 
number. In addition, transcripts of all meetings are published on the 
Web site, although according to the board's designated federal 
official, the complex subject matter makes proofreading and rapid 
publication a challenge. To address this problem, the board Chairman 
decided in late 2009 to expedite the public availability of meeting 
transcripts by posting a preliminary version, reviewed only for 
Privacy Act compliance and subject to correction. 

Labor's information and assistance to claimants. For its part, Labor 
manages contractor-run resource centers around the country to provide 
information about EEOICPA and to assist the public in filing claims. 
Staff at the Richland, Washington (Hanford), resource center told us 
they travel to regional events to do outreach for potential claimants. 
Labor has also established a "traveling" resource center that visits 
various communities to provide one-on-one assistance. In addition, the 
program director at Labor has participated in conference calls with 
claimant advocates. 

Public Access to Site Exposure Matrix for Part E Is Limited, but Labor 
and Energy Are Planning to Release More Information: 

Public access to facility information about other types of toxins 
compiled in Labor's site exposure matrix for Part E adjudication is 
far more limited than it is for the documents NIOSH has published 
about radiation exposure. This means that one of Labor's key resources 
for Part E claims adjudication has not had the benefit of being 
reviewed by claimants and others who worked in those facilities. While 
there are detailed search capabilities for claims examiners, the 
publicly available information in the matrix for each site consists of 
a list of substances confirmed to have been present. Searches by 
disease yield either a list of toxic substances with established links 
or a statement that no toxic substances in the site exposure matrix 
database show an established link to the occupational disease at this 
time. As noted above, the matrix is a key resource for Part E 
adjudication, used to inform claims examiners' research on the link 
between exposure to toxins and illness. However, because claimants do 
not have access to the full informational resources in the site 
exposure matrix, they cannot review the totality of the evidence that 
Labor considered when adjudicating their claims and thus may not be 
able to understand the basis for, or potentially challenge, a denial. 
In addition, to the extent that the information in the database is not 
available to be reviewed, there are few opportunities for claimants 
and scientists to discover and remedy any areas where information is 
missing or inaccurate. 

Because the information about toxic chemicals and site characteristics 
is sensitive, agency officials told us that Labor's access to site 
data from Energy for its site exposure matrix has been based on an 
interagency agreement that the information would be used internally by 
Labor and kept secure. Labor lacks the authority to publish more of 
the site exposure matrix content before it has been cleared by Energy. 
The agencies have only recently begun to formally discuss a process 
for making these data public, and they do not yet have a schedule in 
place for this clearance process. Labor's practice has been to release 
only limited excerpts in response to claimant requests for a copy of 
their claim file under the Privacy Act.[Footnote 56] Whereas NIOSH 
worked with Energy at the outset of the Part B program to, as much as 
possible, make the information it has acquired for its site profiles 
public, Labor only recently approached Energy about undertaking a 
similar process for Part E.[Footnote 57] Although Energy officials 
maintain that full public access could pose a national security risk, 
they are willing to work with Labor on a clearance process to 
determine what additional information may be safely made available. 

Lack of Response by Labor to Ombudsman's Reports Hampers Effective 
Resolution of Claimant Concerns: 

The Labor Ombudsman responds to claimant queries and reports annually 
to Congress on their concerns, but his role is relatively limited. 
Although the act provides that the Secretary of Labor may assign 
additional responsibilities, the Ombudsman's activities have been 
limited to date to those specified in the act--to provide information 
to claimants regarding the available benefits and the relevant 
requirements and procedures involved in a claim, and to submit an 
annual report to Congress regarding the number and types of claimant 
requests for assistance and an assessment of the most common 
difficulties faced by claimants.[Footnote 58] For example, according 
to the Ombudsman, the Ombudsman's office does not have access to 
Labor's claims files or databases, so it cannot respond to questions 
about a claim without seeking information or access to documents from 
other Labor officials. Until late 2009, Labor required the Ombudsman's 
office to request official decision letters from claimants rather than 
providing the Ombudsman with direct access. This is changing 
gradually: The Ombudsman reported in January 2010 that program 
officials have gradually and informally granted the Ombudsman more 
access to information and been more supportive of his activities. For 
example, the agency has begun providing more direct lines of 
communication with program staff. The activities and access are still 
not comparable to those of the NIOSH Ombudsman, who is authorized to 
review claimant files and facilitate discussions with the scientists 
who performed dose reconstructions to help address questions related 
to individual claims. Also, while the Labor Ombudsman's reports to 
Congress can offer insights on aspects of the program that have 
presented problems for claimants, Labor is not required to respond 
formally to those reports, or take remedial actions. Labor officials 
reported that they do confer with the Ombudsman regarding his 
findings, and the Ombudsman related to us that the agency has recently 
become more receptive to his suggestions. 

By comparison, some federal statutes provide a more robust role for 
various ombudsmen within their respective agencies. For example, the 
National Taxpayer Advocate of the Internal Revenue Service and the 
Ombudsman for Citizenship and Immigration Services are authorized by 
statute to make recommendations to their respective agencies, which 
must then report on actions they have taken in response. In contrast, 
Labor is not statutorily required to respond to its Ombudsman's 
reports. For example, the Ombudsman has reported since 2005 that 
complaints about customer service consistently rank high among 
claimant concerns, but Labor has not publicly responded to these 
concerns or developed formal plans for addressing the issues.[Footnote 
59] After years of raising this as a general issue, the Ombudsman's 
office has begun sending every complaint to the director of the 
district office involved. Although the Ombudsman's office receives a 
copy of the director's response, the Ombudsman told us that no 
noticeable improvements have yet resulted. 

Although EEOICPA requires only one ombudsman--the Ombudsman at Labor-- 
other claimant liaison positions have been separately created. 
[Footnote 60] As noted above, NIOSH established two claimant liaison 
positions to help individuals interpret complex program requirements 
and documents.[Footnote 61] The NIOSH Ombudsman's role extends to 
helping petitioners complete forms and prepare an effective, complete 
Special Exposure Cohort petition. In 2007, New Mexico established an 
office of Nuclear Workers' Advocacy for EEOICPA claimants. The New 
Mexico Advocate works on behalf of individual claimants, and in July 
2008, the state of New Mexico reported that the office had assisted 
220 workers and survivors to obtain EEOICPA compensation of more than 
$4.9 million. The Advocate acts as a liaison among claimants who have 
filed EEOICPA claims, their former employers, Energy, and Labor--and 
assists claimants throughout the process, including appeals. The 
Advocate explained that because lack of employment records is one of 
the biggest barriers to obtaining benefits, her office has been 
especially effective at helping claimants obtain documentation from 
Energy contractors, even after Energy was not able to obtain the 
records. She attributed her office's success at finding these records 
to a thorough interview process, in-depth research on behalf of 
claimants, and the relationships the office has established with local 
Energy officials. The Advocate and another New Mexico official noted 
that state funds for this work are limited and that they might not be 
able to keep up with the growing demand for these services. 

Conclusions: 

EEOICPA was established to provide compensation to nuclear weapons 
production workers performing work vital to the nation's interests, 
often under extremely hazardous conditions, who developed cancer or 
other diseases related to on-the-job exposure. As Congress stated in 
the act, government agencies and contractors had a history of placing 
workers at risk without informing them about the hazards and deterring 
compensation claims. In light of this history, it is critical that 
policies and procedures are in place to promote program credibility 
and transparency. This is especially important in cases where Energy 
or its predecessor agencies failed to maintain records of employment, 
accidents, and exposure to radiation and other hazards. 

Meanwhile, it is inevitable that there will be differences of opinion 
about the program, particularly since issues of national security are 
still a concern when it comes to full public disclosure of all nuclear 
site data. It may be, as well, that no amount of information about 
dose reconstruction will be enough to satisfy those who question its 
validity. Nonetheless, independent review is an important method of 
validating findings and enhancing the credibility of the scientific 
basis of claims decisions, and the Advisory Board serves this purpose 
for the aspects of the Part B program that it oversees. In contrast, 
there is no outside independent review of the scientific soundness of 
important aspects of Labor's implementation of the Part E program. 
Moreover, while Labor has various quality control measures in place 
for the Part E program, there are some gaps, such as no oversight 
process to ensure the quality, objectivity, and consistency of its 
consultant physicians' work and no independent expert review of the 
scientific soundness of the detailed information in the site exposure 
matrix. 

Labor and Energy have expressed a willingness to work together to 
determine what additional information from the Part E site exposure 
matrix may be cleared for public release. This could facilitate 
opportunities for claimants to better understand the basis for 
decisions on their claims and for claimants and others to help improve 
the accuracy and comprehensiveness of the matrix. However, a formal 
agreement and action plan for this clearance process would provide 
greater assurance that it will be carried out in an efficient and 
effective manner. 

Labor, NIOSH, and Energy have taken steps to assist claimants in 
navigating a program that is scientifically complex and requires an 
extensive investment of resources. In addition, the Labor Ombudsman 
has issued annual reports to Congress highlighting the most common 
difficulties claimants have faced, including persistent complaints 
about customer service. However, Labor does not respond publicly to 
the Ombudsman's reports. As a result, claimants have little knowledge 
that their concerns are heard or that they are being addressed. 

Recommendations for Executive Action: 

To enhance oversight and transparency of EEOICP, we recommend that the 
Secretary of Labor take the following three actions: 

1. Strengthen the quality control measures in place for Part B lung 
disease claims and Part E processes with independent reviews. Such 
measures should include, for example, instituting periodic peer 
reviews of sampled reports by Part E consulting physicians, arranging 
for technical review of detailed information in the site exposure 
matrix, and obtaining periodic expert review of medical evidentiary 
requirements for the Part B claims related to lung diseases. 

2. Establish a formal agreement and action plan with the Secretary of 
Energy to release more information, where appropriate, in the site 
exposure matrix database in order to allow greater public access and 
input. In doing so, Labor should actively seek additional information 
from worker representatives and site experts about job descriptions, 
processes, and potential exposure. 

3. Develop formal action plans, within Labor's scope of authority, in 
response to the Labor Ombudsman's reports regarding major claimant 
concerns and make the plans and updates on their subsequent status 
publicly available. One such plan should offer Labor's response to the 
Ombudsman's reports about consistent problems with customer service. 

Matter for Congressional Consideration: 

To enhance oversight of claims adjudication under Part E of EEOICPA, 
Congress may wish to consider amending the act to establish an 
independent review board for Part E, similar to the Advisory Board on 
Radiation and Worker Health established under Part B of the program. 
Such an independent board could review and report on the scientific 
soundness of Labor's implementation of Part E, including the site 
exposure matrix, guidance provided to claims examiners on medical 
evidence, and Part E probability of causation standards for radiation- 
related cancers. In creating such an independent board, it would be 
critical to develop appropriate provisions regarding its funding 
structure, appointment of members, and staff support. Our 2007 report 
on the Part B Advisory Board highlighted challenges that these three 
areas had presented to the board's independence and identified various 
options to enhance board independence in each area. 

Agency Comments and our Evaluation: 

We provided a draft of this report to the Secretaries of Labor, 
Energy, and Health and Human Services for review. Health and Human 
Services provided technical comments, which we have incorporated in 
the report where appropriate. 

In its comments, Energy said that with regard to our second 
recommendation, it has requested from Labor a static copy of the site 
exposure matrix database, and will screen the database and redact 
information that would pose a national security risk if released, so 
the database can be made available to the public. Comments from Energy 
are reproduced in full in appendix IV. 

In its comments on the draft, Labor said that it is always looking to 
improve the program and will be planning ways to implement changes in 
light of our recommendations. In addition, Labor provided 
clarification of the nature and uses of the site exposure matrix. With 
regard to making more of the site exposure matrix publicly available, 
Labor stated that the site exposure matrix is available on its Web 
site but is not in the format that is used by claims staff during the 
claims process. As we noted in our report, the information available 
to the public is much more limited than that available to the claims 
examiners. It added that Energy owns and controls dissemination of the 
information regarding toxic substances, locations, and processes in 
the nuclear complex, and that making a detailed version of the site 
exposure matrix available to the public could pose a threat to 
national security. Labor said, however, that it recognizes that this 
creates a transparency issue and stated that it has been working with 
Energy on this issue and will continue to do so. 

With regard to the use of the site exposure matrix, Labor clarified 
that the database was created specifically to assist claimants in 
making their case by providing information on toxic substances that 
may have been present at the facilities and any medical conditions 
resulting from exposure. Labor noted that the site exposure matrix is 
not used to deny claims and that its procedures and training reiterate 
that the database is not a stand-alone decision-making tool, and that 
all avenues must be pursued when developing a claim, even if the 
database does not contain a link between exposure and illness. We 
clarified our characterization of the site exposure matrix and how 
Labor uses it to adjudicate claims. Comments from Labor are reproduced 
in full in appendix V. 

In addition, this report will be available at no charge on the GAO Web 
site at [hyperlink, http://www.gao.gov/]. 

If you or your staff have any questions about this report, please 
contact Andrew Sherrill at (202) 512-7215 or sherrilla@gao.gov. 
Contact points for our Offices of Congressional Relations and Public 
Affairs may be found on the last page of this report. Key contributors 
to this report are listed in appendix VI. 

Signed by: 

Andrew Sherrill: 
Director, Education, Workforce, and Income Security Issues: 

List of Requesters: 

The Honorable Jeff Bingaman:
Chairman: 
Committee on Energy and Natural Resources: 
United States Senate: 

The Honorable Tom Harkin: 
Chairman: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Patty Murray: 
Chairman: 
Subcommittee on Employment and Workplace Safety: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable George Miller: 
Chairman: 
Committee on Education and Labor: 
House of Representatives: 

The Honorable Lamar Alexander: 
United States Senate: 

The Honorable Michael F. Bennet: 
United States Senate: 

The Honorable Sherrod Brown: 
United States Senate: 

The Honorable Jim Bunning: 
United States Senate: 

The Honorable Maria Cantwell: 
United States Senate: 

The Honorable Mitch McConnell: 
United States Senate: 

The Honorable Bill Nelson: 
United States Senate: 

The Honorable Harry Reid: 
United States Senate: 

The Honorable Charles E. Schumer: 
United States Senate: 

The Honorable Mark Udall: 
United States Senate: 

The Honorable George V. Voinovich: 
United States Senate: 

The Honorable Ed Perlmutter: 
House of Representatives: 

The Honorable Jared Polis: 
House of Representatives: 

[End of section] 

Appendix I: Objective, Scope, and Methodology: 

To determine the length of time Labor, the National Institute for 
Occupational Safety and Health (NIOSH), and Energy each spent 
processing claims, and the factors affecting processing times, we 
obtained data from Labor and NIOSH from their case management systems 
for claims filed from fiscal year 2002 for Part B and fiscal year 2005 
for Part E through September 2008. We assessed the data's reliability 
and found the data reliable for the purposes of this study by checking 
for outliers and inconsistencies and by interviewing Labor officials. 
We analyzed trends in minimum, maximum, median, and average processing 
times from fiscal year 2002 for Part B and fiscal year 2005 for Part E 
through September 2008. To determine which steps in the process are 
most time-consuming, we examined time spent by each agency and time 
spent between the milestones tracked by the agencies. To determine 
which factors affected processing times, we examined claim-processing 
times by type of claim (e.g., Parts B and E or with and without dose 
reconstruction cases), and by district offices to determine if there 
were significant and consistent differences among the processing times 
based on these characteristics. We also reviewed NIOSH's analysis of 
how frequently claims move back and forth between NIOSH and Labor, 
[Footnote 62] reasons for and effects of major NIOSH revisions to dose 
reconstruction methods and site profiles,[Footnote 63] and how long it 
took Energy to respond to Labor and NIOSH requests for information. We 
also interviewed agency officials to obtain their views on what 
aspects of the program they believe affect processing times. We 
interviewed officials and reviewed relevant documentation to identify 
efforts to expedite claim processing. To evaluate agencies' 
performance in the area of timeliness, we examined timeliness measures 
established by Labor and NIOSH and whether they had met their 
established goals. For additional context, we reviewed external 
evaluations of Labor's implementation of the program such as the 
Program Assessment Rating Tool review and a report on the program by 
Labor's Office of Inspector General. 

To determine the direct cost of claim processing, we obtained 
administrative cost data from program inception (fiscal year 2001 for 
Part B and fiscal year 2005 for Part E) through fiscal year 2008 from 
Labor and NIOSH and from fiscal year 2006 through fiscal year 2008 
from Energy. These data have not been audited. We assessed the data's 
reliability by checking for outliers and inconsistencies and found the 
data reliable for the purposes of this study. We also interviewed 
agency officials and reviewed relevant documentation to identify 
possible reasons behind the trends in costs (e.g., number of claims 
processed, complexity of claims processed, whether greater 
efficiencies have been introduced, and so forth). Because the same 
administrative resources were used for various parts of the process, 
we were not able to disaggregate costs for discrete steps in the 
claims process. Consequently, we could not determine the costliest 
parts of the process within an individual agency. 

To assess the quality controls and transparency of the claims 
adjudication process, we reviewed relevant statutes, regulations, and 
agency technical and procedural guidance for the Energy Employees 
Occupational Illness Compensation Program Act of 2000 (EEOICPA); 
interviewed officials from Labor, Energy, and NIOSH; and interviewed 
members of the Advisory Board on Radiation and Worker Health and its 
technical contractor. To obtain additional expert opinion on the 
technical and medical aspects of EEOICPA claims adjudication, we 
identified occupational and environmental health organizations and 
specialty societies, such as the American College of Occupational and 
Environmental Medicine. We contacted all such organizations we could 
identify through referrals, Internet searches, and review of Advisory 
Board meeting minutes and interviewed those physicians and scientists 
that made themselves available. We also interviewed the two former 
Medical Directors of Labor's Division of Energy Employees Occupational 
Illness Compensation and occupational medicine specialists who are 
actively involved in assisting claimants. 

To obtain claimant perspectives on the quality controls and 
transparency of the claims adjudication process, we interviewed 
claimant ombudsmen with Labor, NIOSH, and the state of New Mexico, and 
claimant representatives from a nationwide coalition of grassroots 
advocacy groups, known as the Alliance of Nuclear Worker Advocacy 
Groups (ANWAG). Largely through the assistance of ANWAG, we were in 
touch with individual claimants as well as physicians and 
representatives of labor unions with experience at sites including 
Hanford, Santa Susana, Oak Ridge, Rocky Flats, Linde Ceramics, and the 
Portsmouth Gaseous Diffusion Plant. 

Regarding quality control, we also reviewed EEOICPA, the agencies' 
regulations, and policies and procedures to determine whether there 
was adequate oversight of claim processing and oversight to ensure 
that decisions were reached using complete and accurate information. 
In addition to speaking with officials in Labor's national office, we 
visited the Seattle District Office to interview officials about 
quality control processes in place at the regional level. We did not 
assess the scientific validity of technical methodologies (for 
example, NIOSH dose reconstruction) or the accuracy of individual 
claims determinations or site profiles. In addition, we did not 
attempt to resolve disputes regarding individual claims or Special 
Exposure Cohort petitions. 

To examine agencies' efforts to promote program transparency for 
claimants, we also reviewed the agencies' policies and procedures for 
providing pertinent information to claimants, including agency 
ombudsman reports. We reviewed Freedom of Information Act and security 
review procedures, including Energy's security plan for providing 
classified and controlled information to NIOSH and Labor, and 
interviewed agency officials about their practices. We interviewed 
claimant advocacy groups and obtained documentation about their 
experiences with requesting and obtaining documents. We interviewed 
Labor and NIOSH officials about whether the agencies were able to 
obtain the information that they need to adjudicate claims. To 
determine the kind of assistance the agencies provide to claimants, we 
interviewed agency officials about the various types of assistance 
available (e.g., Former Worker Medical Screening Program, resource 
centers, and ombudsman's offices) and visited Labor's Hanford Resource 
Center and the Hanford Nuclear Reservation. We also reviewed relevant 
agency policies and procedures and interviewed Labor's Ombudsman and 
NIOSH's Ombudsman and Special Exposure Cohort Petition Counselor about 
their claimant assistance activities. We discussed claimant concerns 
about information and assistance with agency officials. We reviewed 
the Labor Ombudsman's reports and followed up with Labor to determine 
its response to the documented claimant concerns. We also reviewed 
statutes creating ombudsman positions in connection with other federal 
programs. 

Because Labor's Office of Inspector General recently reviewed and made 
recommendations on the role of the resource centers, we designed our 
study to avoid duplicating its efforts. 

We conducted this performance audit from November 2008 to March 2010 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

[End of section] 

Appendix II: Labor and NIOSH's Claim-Processing Steps: 

1) Claimant: Submits claim to Labor. 

Department Of Labor: 

2) Does claim meet eligibility requirements? 
If yes, go to step 3; 
In no, go to step 10. 

3) What type of claim is it? 
Radiation Exposure Compensation Act; Section 5, Beryllium Silicosis, 
Special Exposure Cohort claims; Go to step 12. 

Claims involving cancers not covered by Special Exposure Cohort 
provisions; go to step 4. 

4) Claim referred to NIOSH for dose reconstruction. 

NIOSH: 

5) NIOSH obtains worker’s and workplace monitoring information from 
Energy and any other sources as needed. 

6) NIOSH interviews claimant on employment history, radiation 
monitoring, radiation incidents, medical screening, and other relevant 
information. A report based on the collected data is submitted to the 
claimant for review and approval. 

7) (Dose reconstruction) NIOSH assigns a health physicist to conduct 
the dose reconstruction using data from the claimant, the site 
profile, and other sources. 

8) Claimant is given a draft dose reconstruction report and a chance 
to provide additional information in a close-out interview. 

9) After changes are made, claimant is required to submit a form to 
NIOSH certifying record can be closed. Upon receipt of the form, NIOSH 
forwards final report to claimant and to Labor. 

10) Labor’s Office of Workers’ Compensation Programs issues a 
recommended decision to the claimant. 

11) Does claimant object to the recommended decision? 
If yes, go to step 18; 
If no, go to step 12. 

12) FAB reviews entire record, including the draft recommended 
decision and any additional evidence or testimony submitted by the 
claimant. 

13) FAB reviews the written record, holds an overall hearing, and 
reviews any additional information submitted by the claimant. 

14) Is the information adequate for FAB to make a decision? 
If yes, go to step 15; 
If no, go to step 17. 

15) FAB issues final decision. 

16) Claimant can seek reconsideration of FAB decision within 30 days, 
request claim be reopened with submission of new information, or 
appeal decision to U.S. courts. 

17) Claim returned to Labor’s Office of Workers’ Compensation Programs 
for development. Return to step 10. 

18) Claimant can request either a written record review or an oral 
hearing from Labor’s Final Adjudication Branch (FAB). 

Go to step 13. 

Source: GAO analysis of Labor and NIOSH claim processes. 

[End of section] 

Appendix III: NIOSH and Labor's Performance Measures: 

Table 6: NIOSH Performance Measures for Fiscal Year 2009: 

Goal 1: Provide a dose reconstruction to all claimants in a timely 
manner: 

Measure: Complete a percentage of initial cases within 6 months of 
receipt[B]; 
Target: 35%; 
Baseline performance[A]: 31%; 
Target achieved: N/A. 

Measure: Complete a percentage of legacy cases during fiscal year 
2009[C]; 
Target: 50%; 
Baseline performance[A]: 54%; 
Target achieved: N/A. 

Measure: Complete a percentage of returns from Labor within 6 months 
of being sent back to NIOSH[D]; 
Target: 40%; 
Baseline performance[A]: Baseline not set; 
Target achieved: N/A. 

Goal 2: Deliver an evaluation report within 180 days for §83.13 
petitions[E]: 

Measure: Complete a percentage of evaluation reports within 180 days; 
Target: 60%; 
Baseline performance[A]: Baseline not set; 
Target achieved: N/A. 

Measure: Provide to the board and petitioners a schedule to complete 
those evaluation reports that were not completed within 180 days; 
Target: No target; 
Baseline performance[A]: Baseline not set; 
Target achieved: N/A. 

Source: NIOSH. 

[A] A baseline is a starting point for measuring performance, while a 
target is the level of performance an agency wishes to achieve. Actual 
performance for fiscal year 2009 was not available (N/A). 

[B] NIOSH defines "initial cases" as cases that have been sent to 
NIOSH for a dose reconstruction for the first time. 

[C] NIOSH defines "legacy cases" as cases that have been at NIOSH for 
2 years or more without a completed dose reconstruction. 

[D] NIOSH defines a "rework" as a case that has been returned to NIOSH 
by Labor to perform a dose reconstruction again using all currently 
approved methodologies applicable to that case. 

[E] These are Special Exposure Cohort petitions submitted to NIOSH 
from petitioners. NIOSH then develops an evaluation report that 
describes NIOSH's determination of the petition. 

[End of table] 

Table 7: Department of Labor Performance Measures in 2008: 

Measure: 1. Create claims within 5 calendar days of receipt; 
Target: 95%; 
Actual, Part B: 96.8%; 
Actual, Part E: 97.0%; 
Target achieved: Yes. 

Measure: 2. Take initial action within 14 calendar days of creating 
claim; 
Target: 90%; 
Actual, Part B: 96.0%; 
Actual, Part E: 95.7%; 
Target achieved: Yes. 

Measure: 2. Take initial action within 25 calendar days of creating 
claim; 
Target: 3: 95%; 
Actual, Part B: 3: 97.7%; 
Actual, Part E: 3: 97.5%; 
Target achieved: 3: Yes. 

Measure: 3. Complete initial processing on claims within 180 days of 
receipt; 
Target: 65%; 
Actual, Part B: 77.6%; 
Actual, Part E: 54.9%; 
Target achieved: No. 

Measure: 3: Complete initial processing on claims within 300 days of 
receipt; 
Target: 4: 85%; 
Actual, Part B: 4: 89.1%; 
Actual, Part E: 4: 69.1%; 
Target achieved: 4: No. 

Measure: 4. Average number of days to complete initial processing 
(Government Performance and Results Act [GPRA] goal); 
Target: Part B: 226 Part E: 290; 
Actual, Part B: 164.6; 
Actual, Part E: 283.7; 
Target achieved: Yes. 

Measure: 5. Complete probability of causation calculations and issue 
recommended decisions after claims are returned from NIOSH within 45 
days receipt; 
Target: 90%; 
Actual, Part B: 89.8%; 
Actual, Part E: N/A[A]; 
Target achieved: No. 

Measure: 6. Actions taken on claims affected by Special Exposure 
Cohorts and Program Evaluation Plans and Program Evaluation Reports 
within 45 days; 
Target: 50%; 
Actual, Part B: 45.0%; 
Actual, Part E: N/A[A]; 
Target achieved: No. 

Measure: 6. Actions taken on claims affected by Special Exposure 
Cohorts and Program Evaluation Plans and Program Evaluation Reports 
within 90 days; 
Target: 7: 95%; 
Actual, Part B: 7: 77.8%; 
Actual, Part E: 7: N/A[A]; 
Target achieved: 7: No. 

Measure: 7. Issue final decisions within 30 days of receipt of 
claimant's waiver of the right to a hearing or a review of record; 
Target: 87%; 
Actual, Part B: 91.0%; 
Actual, Part E: 91.0%; 
Target achieved: Yes. 

Measure: 7: Issue final decisions within 75 days of receipt of 
claimant's waiver of the right to a hearing or a review of record; 
Target: 87%; 
Actual, Part B: 8: 96.2%; 
Actual, Part E: 8: 95.3%; 
Target achieved: 8: Yes. 

Measure: 8. Issue final decisions on all other approved or no-contest 
claims within 75 days of the recommended decision (GPRA goal); 
Target: 87%; 
Actual, Part B: 92.1%; 
Actual, Part E: 89.7%; 
Target achieved: Yes. 

Measure: 9. Issue final decisions for review of the written record 
within 75 days of receipt of the request for review of the written 
record (GPRA goal); 
Target: 87%; 
Actual, Part B: 89.7%; 
Actual, Part E: 89.2%; 
Target achieved: Yes. 

Measure: 10. Issue final hearing decisions within 180 days of the 
receipt of the request for hearing (GPRA goal); 
Target: 87%; 
Actual, Part B: 90.2%; 
Actual, Part E: 87.5%; 
Target achieved: Yes. 

Measure: 11. Take initial action on remands or the director's order 
within 30 days of receipt of the case; 
Target: 90%; 
Actual, Part B: 95.5%; 
Actual, Part E: 91.0%; 
Target achieved: Yes. 

Measure: 12. Make recommended decision after remand or director's 
order within 120 days; 
Target: 75%; 
Actual, Part B: 92.9%; 
Actual, Part E: 80.8%; 
Target achieved: Yes. 

Measure: 13. Process lump-sum payments within 15 days of receiving 
claimant's EN-20 form; 
Target: 90%; 
Actual, Part B: 99.0%; 
Actual, Part E: 99.4%; 
Target achieved: Yes. 

Measure: 14. Complete reopening requests in district office within 90 
days; 
Target: 75%; 
Actual, Part B: 88.9%; 
Actual, Part E: 86.6%; 
Target achieved: Yes. 

Measure: 15. District office responds to phone inquiries for both 
Parts B and E within 2 work days; 
Target: 90%; 
Actual, Part B: 94.8%; 
Actual, Part E: 94.8%; 
Target achieved: Yes. 

Measure: 16. Final Adjudication Branch responds to phone inquiries for 
both Parts B and E within 2 work days; 
Target: 90%; 
Actual, Part B: 94.8%; 
Actual, Part E: 94.8%; 
Target achieved: Yes. 

Measure: 17. Respond to requests for medical authorization within 5 
calendar days of thread opening; 
Target: 75%; 
Actual, Part B: 86%; 
Actual, Part E: 86%; 
Target achieved: Yes. 

Measure: 18. Complete wage loss recommended decisions within 240 days; 
Target: 75%; 
Actual, Part B: N/A[B]; 
Actual, Part E: 32.3%; 
Target achieved: No. 

Measure: 18. Complete impairment recommended decisions within 180 days; 
Target: Target: 75%; 
Actual, Part B: N/A[B]; 
Actual, Part E: 40.2%; 
Target achieved: No. 

Source: Department of Labor data. 

Note: Two of these measures were not met because of performance on 
Part B claims and two were not met because of performance on Part E 
claims. However, one missed target for Part E was established in 2007. 

[A] This is not applicable to all Part E cases, because only Part B 
cases are considered for special exposure cohorts. 

[B] This is not applicable to Part B, because only Part E cases 
qualify for compensation for wage loss and impairment. 

[End of table] 

[End of section] 

Appendix IV: Comments from the Department of Energy: 

Department of Energy: 
Washington, DC 20585: 

March 9, 2010: 

Mr. Andrew Sherrill: 
Director: 
Education, Workforce and Income Security Issues: 
U.S. Government Accountability Office: 
Room 5928: 
441 G Street, NW: 
Washington, DC 20548: 

Dear Mr. Sherrill: 

In response to your February 2, 2010, request for comments from the 
Department of Energy (DOE) on Energy Employees Compensation: 
Additional Independent Oversight and Transparency Would Improve 
Program's Credibility (GAO-I 0-302), the Office of Health, Safety and 
Security provides the following comment: 

With regard to page 45 of the report, Recommendation 2 states: 
"Establish a formal agreement and action plan with the Secretary of 
Energy to release more information, where appropriate, in the site 
exposure matrix database in order to allow greater public access and 
input. In doing so, actively seek additional information from worker 
representatives and site experts about job descriptions, processes, 
and potential exposure." 

DOE has requested from the Department of Labor a static copy of the 
site exposure matrix database, and will screen the database and redact 
information that would pose a national security risk if released so 
the database can be made available to the public. 

If you have any questions, please contact me at (202) 287-6071, or 
your staff my contact Dr. Andrew Weston-Dawkes at (301) 903-3526. 

Sincerely, 

Signed by: 

Glenn S. Podonsky: 
Chief Health, Safety and Security Officer: 
Office of Health, Safety and Security: 

[End of section] 

Appendix V: Comments from the Department of Labor: 

U.S. Department of Labor: 
Employment Standards Administration: 
Office of Workers' Compensation Programs: 
Washington, D.C. 20210: 

February 26, 2010: 

Andrew Sherrill: 
Director: 
Education, Workforce, and Income Security Issues: 
United States Government Accountability Office: 
441 G Street, NW: 
Washington, DC 20548: 

Dear Mr. Sherrill: 

I am writing in response to the draft of your report on the Energy 
Employees Occupational Illness Compensation Program Act (EEOICPA) 
Thank you for allowing us the opportunity to comment on the report 
prior to its publication. 

First, we appreciate the report's findings that DOL has developed 
strategies to expedite case processing and performance measures to 
monitor timeliness, as well as the acknowledgment that these efforts 
have helped reduce the case backlog and shorten processing times. In 
addition, we are pleased with the finding that administrative costs 
appropriately reflect EEOICPA' s science-based adjudication process 
and the highly technical nature of the claims. 

There is one area (concerning our Site Exposure Matrices — SEM) for 
which we would like to provide some clarification. First, one 
recommendation in the report is that the Department of Labor (DOL) 
should increase transparency by making the SEM available to the 
public. Currently, the SEM is on DOL's web site, however it is not in 
the format that is used by the claims staff during the claims process. 
The SEM was developed in close coordination with the Department of 
Energy (DOE), and they own and control dissemination of the 
information regarding toxic substances, locations, and processes in 
the nuclear complex. They have indicated that the detailed version of 
SEM that the claims staff use could potentially pose a threat to 
national security if it were made public. We recognize that this 
creates a transparency issue and have been working with DOE for some 
time to determine whether and how we could place more of the detailed 
version of the SEM on our web site. DOE has indicated they are 
developing a plan for consideration of inclusion of more information 
on the SEM webpage, and we will continue to work closely with them on 
this issue. 

In addition, the report does not clearly describe how the SEM is used 
during the claims process. On the one hand, it underestimates SEM as a 
tool in the development of a claim by leaving the impression that it 
is used to hinder, rather than help, the claimants. SEM was created 
specifically because DOL recognized that it would be difficult for 
employees or their survivors to provide us with information concerning 
the toxic substances that may have been present at the facilities 
where the employees worked and the medical conditions that may relate 
to exposure to such substances. The database was created to assist the 
claimants with this information in order to make a case towards 
acceptance. 

At the same time, the report tends to overestimate the importance of 
SEM in the adjudication process by leaving the impression that DOL 
relies on SEM to render compensation decisions. The SEM is not used to 
deny a claim, and DOL procedures and training reiterate that SEM is 
not a stand alone decision tool and that all development avenues must 
be pursued. DEEOIC places strong weight on claims that are supported 
by the information contained in SEM; however, the inverse is not true. 
Claims staff continues to develop claims even if no link or exposure 
is contained in SEM (through the use of district medical consultants, 
industrial hygienists, health physicists, and toxicologists, as 
appropriate). 

We appreciate your team's thorough analysis of the program and their 
work with our policy and claims staff throughout this last year. We 
are always looking to improve the 'program and will be planning ways 
to implement changes in light of your recommendations. 

Sincerely, 

Signed by: 

Shelby Hallmark: 
Director: 

[End of section] 

Appendix VI: GAO Contact and Staff Acknowledgments: 

Contact: 

Andrew Sherrill, Director, Education, Workforce, and Income Security 
(202) 512-7215, sherrilla@gao.gov: 

Acknowledgments: 

Meeta Engle, Assistant Director, managed this assignment. Other staff 
who made key contributions to this assignment were Emily Gunn, Lara 
Laufer, and Suzanne Rubins. In addition, Jessica Botsford provided 
legal assistance; Luann Moy assisted with the methodology; Susan 
Bernstein provided writing assistance; and James Bennett produced the 
graphics. 

[End of section] 

Related GAO Products: 

Energy Employees Compensation: Actions to Promote Contract Oversight, 
Transparency of Labor's Involvement, and Independence of Advisory 
Board Could Strengthen Program. [hyperlink, 
http://www.gao.gov/products/GAO-08-4]. Washington, D.C.: October 26, 
2007. 

Energy Employees Compensation: Adjustments Made to Contracted Review 
Process, but Additional Oversight and Planning Would Aid the Advisory 
Board in Meeting Its Statutory Responsibilities. [hyperlink, 
http://www.gao.gov/products/GAO-06-177]. Washington, D.C.: February 
10, 2006. 

Federal Compensation Programs: Perspectives on Four Programs. 
[hyperlink, http://www.gao.gov/products/GAO-06-230]. Washington, D.C.: 
November 18, 2005. 

Energy Employees Compensation: Many Claims Have Been Processed, but 
Action Is Needed to Expedite Processing of Claims Requiring Radiation 
Exposure Estimates. [hyperlink, 
http://www.gao.gov/products/GAO-04-958]. Washington, D.C.: September 
10, 2004. 

Energy Employees Compensation: Even with Needed Improvements in Case 
Processing, Program Structure May Result in Inconsistent Benefit 
Outcomes. [hyperlink, http://www.gao.gov/products/GAO-04-515]. 
Washington, D.C.: May 28, 2004. 

Veterans' Benefits: Independent Review Could Improve Credibility of 
Radiation Exposure. [hyperlink, 
http://www.gao.gov/products/GAO/HEHS-00-32]. Washington, D.C.: January 
8, 2000. 

[End of section] 

Footnotes: 

[1] The Energy Research and Development Administration and the Atomic 
Energy Commission. 

[2] NIOSH is part of the Centers for Disease Control and Prevention, 
which is an agency in the Department of Health and Human Services. 

[3] Physicians we contacted included members of specialty societies 
such as the American College of Occupational and Environmental 
Medicine, two former Medical Directors for Part E, and occupational 
specialists who are actively involved in assisting claimants. 

[4] 42 U.S.C. §§ 7384-7385s-15. 

[5] 42 U.S.C. § 7384(a)(4). See also Executive Order 13179, December 
7, 2000. 

[6] Part E replaced Part D, which had authorized Energy to enter into 
agreements with states to assist Energy contractor employees in filing 
state workers' compensation claims. In our prior work, we had found 
that the structure of the Part D program could result in inconsistent 
benefit outcomes for claimants. See GAO, Energy Employees 
Compensation: Even with Needed Improvements in Case Processing, 
Program Structure May Result in Inconsistent Benefit Outcomes, 
[hyperlink, http://www.gao.gov/products/GAO-04-516] (Washington, D.C.: 
May 28, 2004). Part E was created in 2004 with the goal of creating a 
fair and equitable alternative to state workers' compensation programs 
under which workers had encountered chronic delays and inefficiencies. 

[7] Under Part B, compensation of $50,000 and payment of medical 
expenses is also available for employees exposed to uranium who have 
previously been awarded benefits by the Department of Justice under 
Section 5 of the Radiation Exposure Compensation Act. 

[8] 42 U.S.C. § 7384o. 

[9] GAO, Energy Employees Compensation: Actions to Promote Contract 
Oversight, Transparency of Labor's Involvement, and Independence of 
Advisory Board Could Strengthen Program, [hyperlink, 
http://www.gao.gov/products/GAO-08-4] (Washington, D.C.: Oct. 26, 
2007). 

[10] 42 U.S.C. § 7384q. The act initially designated workers from four 
specific sites as members of the Special Exposure Cohort. As of March 
2010, 51 additional classes of workers had been added to the Special 
Exposure Cohort since that time. On March 5, 2010, the Advisory Board 
on Radiation and Worker Health recommended to the Secretary of HHS the 
addition of five additional classes of employees to the Special 
Exposure Cohort. These five classes are awaiting approval by the 
Secretary. According to NIOSH, if approved, the additional classes of 
employees will also become part of the Special Exposure Cohort in 
early May 2010. 

[11] According to Labor officials, the site exposure matrix database 
does not include radioactive substances except those whose properties 
may have toxic effects independent of radiation. For example, 
inhalation of soluble forms of uranium may cause kidney disease. 

[12] 42 U.S.C. § 7384n(b) and (c). 

[13] 42 U.S.C. § 7384n(b). 

[14] The Department of Health and Human Services' NIOSH has issued the 
required guidelines at 42 C.F.R. Part 81 which state in § 81.2 that, 
as required by EEOICPA, the guidelines "produce a determination as to 
whether it is at least as likely as not (a 50 percent or greater 
probability) that the cancer of the covered employee was related to 
radiation doses incurred by the employee in the performance of duty." 

[15] Also at Radiation Exposure Compensation Act Section 5 facilities. 

[16] 42 U.S.C. § 7385s-4(c). 

[17] Department of Labor's Office of Inspector General, Energy 
Employees Occupational Illness Compensation Program-DOL Could Do More 
to Assist Claimants and Further Improve Timeliness, (Washington, D.C.: 
Nov. 12, 2008), 04-09-002-04-437. 

[18] This and the following calculations are based on individual 
cases, which for some include more than one claim or claimant. 

[19] Processing times are calculated from the date of filing to the 
date of the final decision. This time includes the average days spent 
preparing the case, performing dose reconstructions, preparing 
recommended decisions, and issuing final decisions. 

[20] NIOSH requests records, compiles data, evaluates exposure 
records, interviews the claimant, develops detailed information, 
identifies coworkers, reports to the claimant summarizing information 
from the interview, incorporates additional claimant information, 
requests additional records from Energy, reviews the adequacy of 
monitoring data and completeness of the records, characterizes 
internal and external exposure environments, and conducts a final dose 
reconstruction calculation. 

[21] This is the average time added to the process and includes cases 
with single and multiple amendments. 

[22] The vast majority (97 percent) of cases returned to NIOSH for 
rework because of new information about the individual worker were 
cases that had been previously denied or recommended for denial based 
on NIOSH's initial dose reconstruction. That is, they did not 
initially meet the 50 percent probability of causation threshold. Of 
the 3 percent of cases returned for rework that initially met the 50 
percent probability of causation threshold, 15 percent were later 
found not to meet the threshold. Of the 97 percent of cases returned 
for rework that did not initially meet the causation threshold, only 
10 percent were later found to have met the threshold. Almost half of 
the 97 percent of cases that did not initially meet the threshold that 
were sent to NIOSH for rework have not been returned from NIOSH to 
Labor. Another 10 percent had been returned, but Labor had not yet 
issued a final decision. Fifteen percent of cases that had initially 
met the threshold for approval and were sent to NIOSH for rework had 
not been returned from NIOSH to Labor, while another 7 percent that 
were returned were still awaiting a final decision from Labor. 

[23] NIOSH does not track how much more time is added to the process 
as a result of these revisions to site profiles or dose reconstruction 
methods, because claims are returned to NIOSH for many different 
reasons--including amendments. 

[24] Site profiles contain information about the work site necessary 
to establish exposure parameters--namely historical information on 
radioactive materials at sites, activities at sites, worker monitoring 
programs, and detection limits. 

[25] Even after information is found, Energy must review the 
information to determine if it is classified, which can delay the 
information gathering process. Energy has procedures in place that 
allow NIOSH scientists access to the classified documents. 

[26] The Center for Construction Research and Training (formerly known 
as the Center to Protect Workers' Rights) is a nonprofit organization 
created by the Building and Construction Trades Department of the 
American Federation of Labor-Congress of Industrial Organizations (AFL-
CIO). Since 1990, it has conducted applied research and provided 
training and service to the construction industry. When Labor is 
unable to find a claimant's employment information from Energy or his 
or her employer, the center researches and provides information for 
construction and trade worker claims. 

[27] Labor reported that several claims examiners left for other 
government compensation programs. 

[28] Department of Labor, Office of the Ombudsman for Part E, 2008 
Annual Report of the Ombudsman for Part E to Congress, (Washington, 
D.C.: Feb. 13, 2009). The Ombudsman's office and the annual report to 
Congress are required under EEOICPA. 42 U.S.C. § 7385s-15. Although 
the Ombudsman's authority was initially limited to Part E, in October 
2009, the EEOICPA was amended to expand the Ombudsman's authority to 
Part B. Pub. L. No. 111-84, Div. C, Title XXXI, Subtitle D, § 3142(a). 

[29] These 5,000 cases are the oldest Part B cases sent to NIOSH in 
the beginning of the program; 4,991 have received final dose 
reconstructions or were withdrawn by Labor, administratively closed, 
qualified for a Special Exposure Cohort, sent with draft dose 
reconstruction reports to the claimant for review, or returned to 
NIOSH by Labor for rework. 

[30] NIOSH has identified approaches to moving forward on the 
remaining 9 cases. 

[31] In addition, NIOSH's start-up process of developing most site 
profiles, establishing procedures, and hiring staff is now complete 
and does not affect processing time for cases reviewed by NIOSH, as we 
previously reported in September 2004: GAO, Energy Employees 
Compensation: Many Claims Have Been Processed, but Action Is Needed to 
Expedite Processing of Claims Requiring Radiation Exposure Estimates, 
[hyperlink, http://www.gao.gov/products/GAO-04-958] (Washington, D.C.: 
Sept. 10, 2004). 

[32] The practice of rough estimation, described in NIOSH's 
regulations at 42 CFR 82.10(k), allows NIOSH to more quickly complete 
dose reconstructions for certain kinds of claims. According to NIOSH, 
this process of rough estimation prioritizes cases based on their 
likelihood of compensation. It allows for the reconstruction of doses 
only so far as to provide an unambiguous compensation decision to 
Labor. NIOSH may substantially overestimate the potential dose 
received by an employee when compensation seems unlikely based on the 
type of cancer and length of employment. In this instance, if the 
probability of causation still does not reach or exceed 50 percent, 
despite the overestimation of the exposure dose, NIOSH can easily 
determine that the case will not be compensated. 

[33] Office of Management and Budget, Detailed Information on the 
Energy Employees Occupational Illness Compensation Program Assessment, 
Assessment Year 2007. 

[34] Department of Labor's Office of Inspector General, Energy 
Employees Occupational Illness Compensation Program-DOL Could Do More 
to Assist Claimants and Further Improve Timeliness (Washington, D.C.: 
Nov. 12, 2008), 04-09-002-04-437. 

[35] While Labor is the designated agency responsible for 
administering the program, the Department of Health and Human Services 
is responsible for administering the dose reconstruction process, as 
established in Executive Order 13179. 

[36] In addition to these recommendations to improve timeliness 
measures, the IG also recommended that Labor expand the responsibility 
of Resource Centers to include assisting claimants by providing them 
more information about the claims process, improve the methods through 
which Labor obtains claimant information, improve interagency 
agreements to more clearly outline data-gathering methods, institute a 
comprehensive workload tracking system to monitor the status of claims 
at other agencies and to monitor the caseload of claims examiners, and 
increase communication with claimants. Labor agreed with these 
recommendations in part. 

[37] These amounts do not include medical benefits paid. 

[38] NIOSH counts initial dose reconstructions and reworks as separate 
cases. Counting them as one case would result in a cost per case of 
about $15,000 rather than $12,000. 

[39] We could not calculate the administrative costs for each case for 
Energy because Energy does not have data going back to the inception 
of the program and because Energy tracks requests for its services but 
does not track them by case, so one case may generate multiple 
requests, such as a request from Labor and a request from NIOSH. 

[40] 42 U.S.C. § 7384q(b). 

[41] New Special Exposure Cohort classes are initiated either by NIOSH 
or by petition from claimants or their representatives. NIOSH prepares 
evaluation reports for all petitions that qualify for evaluation. 
NIOSH may agree with the petitioners that facility data are too 
limited for dose reconstruction to be feasible, propose revisions to 
the time period or workers covered by the proposed petition, or 
propose methods of remedying the effect of limited data on dose 
reconstructions. Such dose reconstruction methods may rely on general 
knowledge about production processes and radioactive elements and/or 
incorporate radiation-monitoring data from facilities NIOSH considers 
comparable. 

[42] The act requires that NIOSH complete its evaluation within 180 
days. 42 U.S.C. § 7384q(c)(1). This requirement was added in 2004 by 
Pub. L. No. 108-375, Div. C, Title XXXI, Subtitle E, § 3166(b)(1)(B). 

[43] NIOSH's dose reconstruction methods give the highest priority to 
individual worker radiation-monitoring records, but recognize that 
such records are not available for all workers. Its dose 
reconstruction regulation provides that when complete, accurate 
individual workplace monitoring records are not available, NIOSH may 
use a combination of other information sources to estimate radiation 
exposure (and dose to the affected organ). These other sources include 
radiation-monitoring records of coworkers with comparable exposure 
risks, facility monitoring records, and supplemental information about 
radioactive elements and production processes. See 42 C.F.R. § 82.2. 

[44] NIOSH officials described this overestimation process as follows: 
When faced with equally plausible radiation exposure scenarios during 
dose reconstruction, the agency will always incorporate the scenario 
that results in the highest exposure to the worker. It may do this, 
for example, when a worker's cancer is not in an organ for which 
NIOSH, in collaboration with the National Cancer Institute, has 
developed risk models: NIOSH will select among comparable "substitute" 
organs the one that is most susceptible to cancer risk from the type 
of radiation exposure the worker was likely to have had. Such organ 
substitution models are reviewed both internally and externally. 

[45] 42 U.S.C. § 7384n(c)(3)(A). The technical documents use the term 
"credibility limit" to indicate the maximum acceptable level of risk 
of estimating an exposure that is too low. If a "best estimate" of the 
dose were to be made, a 50 percent credibility limit, which means that 
in 50 cases out of 100, the actual probability of causation would be 
lower than the estimated probability of causation. Instead, the 99 
percent credibility limit is a more generous estimate, assigning 
increased cancer risk at far lower actual levels of radiation exposure 
than the best estimate. In addition, it means that in 1 case out of 
100, the actual probability of causation would be higher than the 
estimated probability. Conversely, in 99 cases out of 100, the actual 
probability of causation received would be lower than the estimated 
probability. 

[46] According to Labor officials, the site exposure matrix does not 
include radioactive substances except those whose properties may have 
toxic effects independent of radiation. For example, inhalation of 
soluble forms of uranium particles may cause kidney disease. 

[47] The site exposure matrix has many features to help claims 
examiners perform their research: For example, information about 
chemicals may be found through searches of the official scientific 
name, trade or commercial names, or informal terms, and the matrix 
contains links to documentation about uses, properties, and acute and 
chronic health effects. 

[48] The committee reviews the results of the contractor's research 
and determines both the research priorities and the additions and 
modifications to the site exposure matrix. The contractor reports 
weekly to the committee on changes to the matrix. 

[49] At our request, Labor arranged for GAO staff to view the site 
exposure matrix's search capabilities for one site. While our 
observations are consistent with Labor's description of the site 
exposure matrix's search capabilities, we remain aware that limited 
public availability contributes to doubts about the site exposure 
matrix. 

[50] The terms used are "additive" or "synergistic," referring to the 
concept that toxic substances may act in combination in ways that 
magnify their adverse effects on health, doubling or even multiplying 
the degree of potential harm. 

[51] The physicians' role is limited to helping interpret medical 
evidence and responding to questions from the claims examiners, who 
are responsible for making all legal determinations. 

[52] 20 C.F.R. § 30.213. For Part B claims, Labor is required to use 
the guidelines issued by the Department of Health and Human Services' 
NIOSH at 42 C.F.R. Part 81, which state at § 81.2 that, as required by 
EEOICPA, the guidelines "produce a determination as to whether it is 
at least as likely as not (a 50 percent or greater probability) that 
the cancer of the covered employee was related to the radiation doses 
incurred by the employee in the performance of duty." 

[53] 42 U.S.C. § 7384n(b). 

[54] 42 U.S.C. § 7385s-4(c). Labor must also find that it is at least 
as likely as not that the exposure to the toxic substance was related 
to employment at a Department of Energy facility. 

[55] See preamble to Department of Labor's Final Rule "Performance of 
Functions; Claims for Compensation under Energy Employees Occupational 
Illness Compensation Program Act of 2000, as amended," 71 Fed. Reg. 
78520, December 29, 2006. 

[56] According to Labor officials, the contents of the site exposure 
matrix are not classified and excerpts may be safely disclosed to 
individual claimants, but all of the data together could be considered 
sensitive. If a printout of the matrix search result is in the file, 
Labor sends it along with the rest of the claim file in response to a 
claimant's Privacy Act request for his or her own records. However, 
claims examiners are not consistent about printing out their matrix 
search results. 

[57] NIOSH's work preparing site profiles and dose reconstruction 
methods involves research into radioactive materials, production, 
building conditions, incidents, and worker monitoring and safety 
practices at Energy and Atomic Weapons Employer sites throughout the 
country from World War II through the present. To facilitate this 
research while protecting national security, Energy has entered into 
agreements with NIOSH regarding access to documents cleared for review 
and granted security clearances to allow NIOSH direct access to 
classified documents. 

[58] The Ombudsman is also authorized to recommend that Labor 
establish additional claimant resource center sites. 42 U.S.C. § 7385s-
15(c). 

[59] Labor requires claims examiners to take customer service training 
annually and instituted a program in 2007 to monitor calls between 
claimants and customer service representatives--agency representatives 
who can answer basic questions about the status of the claim. This 
program, however, does not monitor calls between claimants and claims 
examiners, and agency officials could not tell us whether the 
monitoring program had any effect on customer complaints. 

[60] The amendment to EEOICPA expanding the Labor Ombudsman's 
authority to Part B also directed the Labor Ombudsman to work with the 
NIOSH Ombudsman. Pub.L.No. 111-84, Div. C, Title XXXI, Subtitle D, § 
3142(a), (42 U.S.C. §7385s-15(g)). 

[61] For convenience we refer to these two positions as claimant 
liaisons, although each has a unique title. 

[62] Cases may move back and forth between NIOSH and Labor because 
NIOSH, Labor, or claimants may identify new information, such as new 
types of cancer or a change in employment information. 

[63] Dose reconstruction methods and site profiles are revised on an 
as-needed basis, frequently triggered by new information or modified 
scientific approaches. 

[End of section] 

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