Presumptive Causation Part 1: SEC Cancer Claims

I frequently receive questions requesting additional background on how claims for various cancers are adjudicated, and “why and where” Special Exposure Cohort rules apply.

Fundamentally, EEOICPA law applies to over 650,000 current or former nuclear workers (who worked under AEC/DOE), and considers any medical condition for which there was the potential that exposure to radiation or chemicals in the workplace caused or contributed to the development of the claimed condition.

The method(s) for adjudication can be found in the 700+ page EEOICPA Procedure Manual. Breaking it down to the basics, the process considers all cancer claims for possible cause by radiation exposure or possible cause by chemical exposure. The primary inputs into the adjudication process are what work site the worker was at, how long present, the medical condition claimed, and worker radiation monitoring or any chemicals with known causal links to the claimed condition. 

Cancers of all types are adjudicated under Part B (radiation exposure as cause) and/or Part E (chemical exposure as cause). By law under Part B, all cancers are evaluated through a mathematical process called “Dose Reconstruction”, whereby an estimate of radiation exposure for a worker drives an analysis to determine if a Probability of Causation (POC) is equivalent to 50% or greater likelihood.

The burden of having appropriate monitoring programs in place was the responsibility of Prime Contractors. For certain work sites, worker monitoring was well executed, or at least within the bounds of what was expected. For certain work sites, the scope of radiation monitoring (for employees of specific contractors, or for specific classifications of workers) was deemed to have been inadequate or there were workers who should have been monitored for radiation who were not. 

This latter scenario gives rise to designations of Special Exposure Cohort(s) under Part B, and claims bypass the default “Dose Reconstruction” analysis. As examples, for Los Alamos National Lab, the current SEC extends from 1942 through to the end of 1995. For Sandia National Labs the SEC extends through the end of 1996. Most SEC designated work sites have a date range that applies to all workers for all contractors and subcontractors on site. Notable exceptions are found in the Hanford and Fernald SEC designations in which specific contractors and their employees are excluded from an SEC designation based on CDC/NIOSH determining those contractors performed appropriate radiation monitoring.

In making these SEC designations, CDC/NIOSH determined that based on lack of appropriate worker monitoring there is an accepted presumption that workplace exposure was at “least as likely as any other cause” to have led to any of 22 designated SEC cancers. These “22” are mostly major body organs and forms of blood cancers (leukemias/lymphomas, etc.). 

In context, for either radiation or chemical causation, “causation” means was likely to have a) directly caused, or b) contributed to (increased risk), or c) aggravated (in the instance of preexisting condition being exacerbated). The EEOICPA standard is “at least as likely as any other source” to have caused, contributed to, or aggravated. It’s not a 50% or greater chance threshold. It is interpreted as “given known potential causes, was such exposure at least as likely (probability) as any other known cause”? So, there could be 50% unknowns, and 50% known causes, and for known causes, each of them has roughly the same probability. The law does not require absolute certainty that exposure caused an instance of cancer; it does allow that if there is a reasonable likelihood of cause and/or contribution, or increased risk for development of a condition, the standard for approval of a claim can be met.

There may be skepticism (by the medical community) as to root cause of any one person’s cancer. And, there is certainly skepticism as to the quality and appropriateness of worker radiation monitoring. The fact is that a worker who meets the criteria as established for either a Special Exposure Cohort claim, or where Dose Reconstruction yields a POC of 50% or greater, meets the causation threshold. In these claims, the Decision on causation was made by the Federal Department of Labor, EEOICPA program. 

Look for Presumptive Causation Part 2: Chemically Caused Conditions in the next few weeks on our blog.

If you have questions about your eligibility for EEOICPA financial and/or medical benefits, please reach out to us. We Can Help.

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