Energy Employees Compensation
Many Claims Have Been Processed, but Action Is Needed to Expedite Processing of Claims Requiring Radiation Exposure Estimates Gao ID: GAO-04-958 September 10, 2004Subtitle B of the Energy Employees Occupational Illness Compensation Program Act, administered by the Department of Labor (Labor), provides eligible workers who developed illnesses from their work, or their survivors, with a onetime total payment of $150,000, and coverage for medical expenses related to the illnesses. For some claims, Labor uses radiation exposure estimates (dose reconstructions) performed by the National Institute for Occupational Safety and Health (NIOSH), part of the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC), to determine if the illness claimed was "as least as likely as not" related to employment at a covered facility. GAO was asked to determine (1) how well Labor's procedures and practices ensure the timely and consistent processing of claims that are not referred to NIOSH for dose reconstruction but are being processed by Labor and (2) how well Labor's and NIOSH's procedures and practices ensure the timely and consistent processing of claims that are referred for dose reconstruction. GAO did not assess the quality of Labor's claims decisions.
In the first 2 and 1/2 years of the program--July 31, 2001, through January 31, 2004--Labor had fully processed 83 percent of the nearly 30,000 claims that had not been referred to NIOSH for dose reconstruction; these claims correspond to nearly 23,000 cases for individual workers. (Multiple claims can be associated with a case as eligible survivors may each file claims.) Labor took an average of 7 months to fully process these claims. About 42 percent of claims with final decisions were approved, resulting in $625 million in lump-sum compensation payments. The remaining 58 percent of claims with final decisions were denied--the majority because they did not meet medical or employment eligibility criteria. Labor generally met its timeliness goals for processing claims and is working to ensure that claims are processed consistently by conducting accountability reviews and creating a task force to update its procedure manual. In the first 2= years of the program, Labor and NIOSH had fully processed about 9 percent of the more than 21,000 claims (which correspond to about 15,000 cases) that were referred to NIOSH for dose reconstructions, taking an average of 17 months to fully process claims. Fifty-one percent of the processed claims were approved, and Labor has paid out about $65 million in lump-sum compensation. Forty-nine percent were denied because it was determined that the claimed illness was not at least as likely as not related to employment at a covered facility. A backlog of claims needing dose reconstruction developed because NIOSH needed time to get the necessary staff and procedures in place to complete the dose reconstructions and develop site profiles. Efforts are under way to develop site profiles that contain facility-specific information that is useful in completing dose reconstructions. However, processing claims associated with facilities that do not have site profiles, in some instances, has essentially stopped, and NIOSH has not established a time frame for completing these remaining site profiles because of limited expert resources and site complexities. As a result, some claimants could wait a considerable period of time to have their claims fully processed. To help ensure the consistency of claim decisions, HHS's Advisory Board is conducting an independent external evaluation of dose reconstruction decisions and site profiles.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-04-958, Energy Employees Compensation: Many Claims Have Been Processed, but Action Is Needed to Expedite Processing of Claims Requiring Radiation Exposure Estimates
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Requiring Radiation Exposure Estimates' which was released on September
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Report to the Chairman, Subcommittee on Immigration, Border Security,
and Claims, Committee on the Judiciary, House of Representatives:
United States Government Accountability Office:
GAO:
September 2004:
Energy Employees Compensation:
Many Claims Have Been Processed, but Action Is Needed to Expedite
Processing of Claims Requiring Radiation Exposure Estimates Many
Claims:
GAO-04-958:
GAO Highlights:
Highlights of GAO-04-958, a report to Chairman, Subcommittee on
Immigration, Border Security, and Claims, Committee on the Judiciary,
House of Representatives
Why GAO Did This Study:
Subtitle B of the Energy Employees Occupational Illness Compensation
Program Act, administered by the Department of Labor (Labor), provides
eligible workers who developed illnesses from their work, or their
survivors, with a onetime total payment of $150,000, and coverage for
medical expenses related to the illnesses. For some claims, Labor uses
radiation exposure estimates (dose reconstructions) performed by the
National Institute for Occupational Safety and Health (NIOSH), part of
the Department of Health and Human Services‘ (HHS) Centers for Disease
Control and Prevention (CDC), to determine if the illness claimed was
’as least as likely as not“ related to employment at a covered
facility.
GAO was asked to determine (1) how well Labor‘s procedures and
practices ensure the timely and consistent processing of claims that
are not referred to NIOSH for dose reconstruction but are being
processed by Labor and (2) how well Labor‘s and NIOSH‘s procedures and
practices ensure the timely and consistent processing of claims that
are referred for dose reconstruction. GAO did not assess the quality of
Labor‘s claims decisions.
What GAO Found:
In the first 2½ years of the program”July 31, 2001, through January 31,
2004”Labor had fully processed 83 percent of the nearly 30,000 claims
that had not been referred to NIOSH for dose reconstruction (see the
fig. below); these claims correspond to nearly 23,000 cases for
individual workers. (Multiple claims can be associated with a case as
eligible survivors may each file claims.) Labor took an average of 7
months to fully process these claims. About 42 percent of claims with
final decisions were approved, resulting in $625 million in lump-sum
compensation payments. The remaining 58 percent of claims with final
decisions were denied”the majority because they did not meet medical or
employment eligibility criteria. Labor generally met its timeliness
goals for processing claims and is working to ensure that claims are
processed consistently by conducting accountability reviews and
creating a task force to update its procedure manual.
In the first 2½ years of the program, Labor and NIOSH had fully
processed about 9 percent of the more than 21,000 claims (which
correspond to about 15,000 cases) that were referred to NIOSH for dose
reconstructions, taking an average of 17 months to fully process
claims. Fifty-one percent of the processed claims were approved, and
Labor has paid out about $65 million in lump-sum compensation. Forty-
nine percent were denied because it was determined that the claimed
illness was not at least as likely as not related to employment at a
covered facility. A backlog of claims needing dose reconstruction
developed because NIOSH needed time to get the necessary staff and
procedures in place to complete the dose reconstructions and develop
site profiles. Efforts are under way to develop site profiles that
contain facility-specific information that is useful in completing dose
reconstructions. However, processing claims associated with facilities
that do not have site profiles, in some instances, has essentially
stopped, and NIOSH has not established a time frame for completing
these remaining site profiles because of limited expert resources and
site complexities. As a result, some claimants could wait a
considerable period of time to have their claims fully processed. To
help ensure the consistency of claim decisions, HHS‘s Advisory Board
is conducting an independent external evaluation of dose
reconstruction decisions and site profiles.
Status of EEOICPA Subtitle B Claims as of January 31, 2004:
[See PDF for image]
[End of figure]
What GAO Recommends:
HHS agreed with GAO‘s recommendation that the agency direct CDC to
establish time frames for completing the remaining site profiles.
www.gao.gov/cgi-bin/getrpt?GAO-04-958.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Robert E. Robertson at
(202) 512-7215 or robertsonr@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Labor Processes Claims Not Referred to NIOSH for Dose Reconstructions
in a Timely Manner and Has Taken Steps to Ensure Consistency:
Claims Needing Dose Reconstructions Face Large Processing Backlog:
Conclusions:
Recommendation:
Agency Comments and Our Evaluation:
Appendix I: Scope and Methodology:
Appendix II: Labor's and NIOSH's Claim-Processing Steps:
Appendix III: Comparison of Claim-and Case-Level Information Regarding
Claims Referred to NIOSH for Dose Reconstructions as of January 31,
2004:
Appendix IV: Comments from the Department of Health and Human Services:
Appendix V: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Staff Acknowledgments:
Tables:
Table 1: Labor's Performance with Respect to Its GPRA Goals for
Subtitle B, Fiscal Years 2002 and 2003:
Table 2: Completed and Partially Completed Site Profiles as of June
2004:
Table 3: Information on the Status of Claims Referred to NIOSH for Dose
Reconstructions at the Claim and Case Levels as of January 31, 2004:
Figures:
Figure 1: Claims That Require Dose Reconstructions Are Processed
Differently than Claims That Do Not:
Figure 2: Status of Claims Not Referred to NIOSH for Dose
Reconstruction as of January 31, 2004:
Figure 3: Payments for Medical and Travel-Related Expenses Made for
Approved Claims Not Referred to NIOSH for Dose Reconstruction as of
January 31, 2004:
Figure 4: Status of Claims Referred to NIOSH for Dose Reconstruction as
of January 31, 2004:
Figure 5: Payments for Medical and Travel-Related Expenses Made for
Approved Claims Referred to NIOSH for Dose Reconstruction as of January
31, 2004:
Abbreviations:
CDC: Centers for Disease Control and Prevention:
ECMS: Energy Case Management System:
EMBPS: Energy Medical Bill Processing Subsystem:
EEOICPA: Energy Employees Occupational Illness Compensation Program
Act:
GPRA: Government Performance and Results Act of 1993:
HHS: Department of Health and Human Services:
INEEL: Idaho National Engineering and Environmental Laboratory:
NIOSH: National Institute for Occupational Safety and Health:
NOCTSNIOSH: Office of Compensation Analysis and Support Claims Tracking
System:
OCAS: Office of Compensation Analysis and Support:
RECA: Radiation Exposure Compensation Act:
United States Government Accountability Office:
Washington, DC 20548:
September 10, 2004:
The Honorable John N. Hostettler:
Chairman, Subcommittee on Immigration, Border Security, and Claims:
Committee on the Judiciary:
House of Representatives:
Dear Mr. Chairman:
For the last several decades, the Department of Energy (Energy) and its
predecessor agencies and contractors have employed thousands of
individuals in secret and dangerous work in the nuclear weapons
production complex. Over the years, employees were unknowingly exposed
to toxic substances, including radioactive and hazardous materials, and
studies have shown that many of these employees subsequently developed
serious illnesses.
The Energy Employees Occupational Illness Compensation Program Act of
2000 (EEOICPA), enacted as Title XXXVI of Public Law 106-398 of the
Floyd D. Spence National Defense Authorization Act for Fiscal Year
2001, was signed into law on October 30, 2000. EEOICPA established two
programs to help secure compensation for certain workers who developed
occupational illnesses or for their survivors. The first program,
established by Subtitle B, is administered by the Department of Labor
(Labor). Under this program, eligible workers who were exposed to
radiation or toxic substances and who subsequently developed specific
kinds of cancers and other named conditions, or their survivors,
receive a onetime total payment of $150,000. Living and eligible Energy
employees also receive coverage for future medical expenses related to
the illness. Compensation of $50,000 and payment of medical expenses
from the date a claim is filed is also available for employees exposed
to uranium previously awarded benefits by the Department of Justice
under Section 5 of the Radiation Exposure Compensation Act (RECA). The
second program, established by Subtitle D, is administered by Energy.
This program allows Energy to help its employees file state workers'
compensation claims for illnesses determined by a panel of physicians
to be caused by exposure during employment at an Energy facility.
Several different federal agencies are involved with the implementation
of the Subtitle B program, including Labor, the Centers for Disease
Control and Prevention's (CDC) National Institute for Occupational
Safety and Health (NIOSH), and Energy[Footnote 1]. Labor has primary
responsibility for administering the program; Labor receives the claims
and determines whether the claimant meets the eligibility requirements.
Labor may receive multiple claims associated with a single worker, as
multiple survivors may each file a claim. When considering the
compensability of certain claims, Labor relies on estimations of the
levels of radiation particular workers were likely exposed to when
working for Energy; these estimations are known as "dose
reconstructions" and are developed by NIOSH. To avoid gathering similar
information for each claim associated with a particular facility, NIOSH
compiles facility-specific information in "site profiles." These site
profiles assist NIOSH in completing the dose reconstructions. Dose
reconstructions are not needed for certain workers from four designated
locations, who constitute the "special exposure cohort.[Footnote 2]"
Certain workers from these sites were designated as members of the
special exposure cohort in legislation because it was believed that
exposure records were insufficient and the reasonable likelihood was
that the workers' radiation exposure caused their cance[Footnote 3]rs.
Finally, Energy provides employment and radiation records, where
available, to Labor and NIOSH as appropriate.
While most of the concerns about EEOICPA have focused on Energy's
implementation of Subtitle D,[Footnote 4] concerns have also been
raised about Subtitle B claims, such as the length of time involved in
completing dose reconstructions. Now that the program has been in place
for a few years, you asked that we assess how well the program is
working. We focused our work on two key areas: (1) how well Labor's
procedures and practices ensure the timely and consistent processing of
claims that are not referred to NIOSH for dose reconstruction but are
being processed by Labor and (2) how well Labor's and NIOSH's
procedures and practices ensure the timely and consistent processing of
claims that are referred for dose reconstructions.
To perform our review, we analyzed both Labor's and NIOSH's procedures
and practices used to process claims. Specifically, we obtained and
analyzed information on the goals used to assess timeliness and the
quality assurance procedures. Also, we obtained information on NIOSH's
efforts to complete site profiles needed to assist with the dose
reconstruction process and on a recently introduced regulation for
considering special exposure cohort petitions. We also interviewed
officials from Labor's Office of Workers' Compensation Programs and its
four district offices as well as NIOSH's Office of Compensation
Analysis and Support. In addition, we interviewed several NIOSH
contracted staff, claimants, and EEOICPA experts regarding their
knowledge of, or experiences with, Subtitle B claims processing.
Further, we analyzed data extracted from Labor's and NIOSH's case
management systems for claims filed from the beginning of the program-
-July 31, 2001--through January 31, 2004. We determined that the data
we used were sufficiently reliable for our purposes by performing
electronic testing for obvious errors in accuracy and completeness,
reviewing available documentation, and interviewing agency officials
and contractors knowledgeable about the data. Using these data, we
determined the number of claims received, the status of the claims, the
average time taken to process the claims, and the approval rates of the
claims. We did not assess the quality of Labor's decisions. In
addition, we interviewed Labor and NIOSH officials to obtain updated
information on the approval rates for cases that required dose
reconstructions as of July 2004. We also interviewed NIOSH officials to
obtain information on the average time taken to draft dose
reconstructions as of July 2004 and the number of dose reconstructions
completed in the first 9 months of fiscal year 2004.
We conducted our review from October 2003 to September 2004 in
accordance with generally accepted government auditing standards. For a
more complete explanation of our methodology, see appendix I.
Results in Brief:
In the first 2½ years of the program--July 31, 2001, through January
31, 2004--Labor had fully processed 83 percent of the nearly 30,000
claims that had not been referred to NIOSH for dose reconstruction. It
took Labor an average of 7 months to fully process claims.[Footnote 5]
About 42 percent of claims with final decisions were approved,
resulting in $625 million in lump-sum compensation payments. The
remaining 58 percent of the fully processed claims with final decisions
were denied, in most instances because they did not meet medical or
employment eligibility criteria. Labor has generally met its
performance goals for timely claims processing. Moreover, Labor has
taken steps to help ensure that claims are processed consistently. For
example, Labor has conducted accountability reviews and worked with its
district offices to address problems identified through these reviews,
such as errors in how information was entered into the case management
system. In addition, Labor has established a task force to update its
procedure manual to provide a single source for claims-processing
guidance.
Labor and NIOSH face a large backlog of claims that had been referred
to NIOSH for dose reconstruction. In the first 2½ years of the program,
the agencies had fully processed about 9 percent of the more than
21,000 claims that require dose reconstructions, taking an average of
17 months to fully process claims.[Footnote 6] Fifty-one percent of the
fully processed claims with final decisions were approved, based on the
results of approximately 500 dose reconstructions, and Labor paid out
about $65 million in lump-sum compensation for these claims. Forty-nine
percent were denied because the results of the dose reconstruction were
used by Labor to determine that the claimed cancer did not meet the
threshold of being "at least as likely as not" to have been caused by
work-related exposure. However, more than 90 percent of claims referred
to NIOSH for dose reconstruction, which involved about 14,000
individual workers, remained in processing in the first 2½ years of the
program. NIOSH officials report that the backlog arose because of
several factors, including the time needed to get the necessary staff
and procedures in place for performing dose reconstructions and to
develop site profiles. As of June 2004, 11 site profiles were fully
completed, 9 were partially completed, and the remaining 10 that NIOSH
anticipates doing had not been started. NIOSH's progress in developing
site profiles has helped accelerate the completion of dose
reconstructions. Whereas the first 1,000 dose reconstructions took
about 2 years to complete, the second 1,000 were completed in about 4
months, and the third 1,000 were completed in 11 weeks. However, in
some instances, NIOSH has essentially stopped processing claims
associated with facilities for which it has not yet developed profiles
and has not established a time frame for completing these remaining
site profiles because of limited expert resources and site
complexities. As a result, some claimants could wait a considerable
period of time to have their claims fully processed. To help ensure the
consistency of claims decisions, HHS's Advisory Board is conducting an
independent external evaluation of dose reconstruction decisions and
site profiles.
To enhance program management and promote greater transparency with
regard to the timeliness of completing dose reconstructions, we
recommend that the Secretary of HHS direct CDC officials to establish
time frames for completing the remaining site profiles. In commenting
on a draft of this report, HHS agreed with the recommendation to
establish time frames for completing the remaining site profiles. HHS's
comments are provided in appendix IV.
Background:
Several different federal agencies are involved with the implementation
of EEOICPA's Subtitle B program, including Labor, CDC's NIOSH, and
Energy. Labor's Office of Workers' Compensation Programs is responsible
for adjudicating and administering claims filed by workers, former
workers, or certain eligible survivors under the act. NIOSH, as part of
the Centers for Disease Control and Prevention within the Department of
Health and Human Services, is responsible for performing several
technical and policy-making roles in support of Labor's program,
including:
* establishing by regulation methods for arriving at reasonable
estimates of radiation doses received by an individual at a covered
facility;
* establishing by regulation guidelines to be used by Labor to
determine whether an individual sustained a cancer in the performance
of duty for purposes of the compensation program if, and only if, the
cancer was "at least as likely as not" related to the radiation dose
received by the employee;[Footnote 7]
* establishing procedures for considering petitions to be added to the
special exposure cohort; and:
* providing the Advisory Board on Radiation and Worker Health with
administrative and other necessary support services.
EEOICPA specified that the President appoint an Advisory Board to
advise the Secretary, HHS, on its activities under the act. The
Advisory Board, which is composed of scientists, physicians, and
workers, advises the Secretary, HHS, on:
* the development of methods used to perform dose reconstructions and
guidelines to be used to assess the likelihood that an employee's
cancer is "at least as likely as not" related to work-related radiation
exposure,
* the scientific validity and quality of dose reconstruction efforts
performed, and:
* the addition of employees to the special exposure cohort.
Energy is responsible for providing Labor and NIOSH information to
assist with processing claims. This information includes such things as
employment verification, information specifying the estimated
radiation dose of that employee during each employment period claimed,
and facilitywide monitoring data.
Several requirements must be met for a claimant to be eligible for
compensation under Subtitle B.[Footnote 8] For a worker (or eligible
survivor) to qualify for benefits, the worker must have worked at a
covered Energy facility or at a beryllium vendor facility, or for an
atomic weapons employer during a covered time period, and developed one
of the specified illnesses associated with exposure to radiation,
beryllium, or silica. Covered medical conditions include all cancers
(except chronic lymphocytic leukemia), beryllium disease, and chronic
silicosis.[Footnote 9]
When a claim is filed, it is assigned to one of Labor's four district
offices--Jacksonville, Florida; Cleveland, Ohio; Denver, Colorado; or
Seattle, Washington--based on the geographical location of the covered
worker's last employment. Upon receipt of a claim, Labor determines
whether the Subtitle B claimant meets eligibility requirements for one
of three claim types: RECA Section 5 supplement claims; beryllium,
silicosis, and special exposure cohort cancer claims; and cancer claims
not covered by special exposure cohort provisions.[Footnote 10] For the
purposes of our report, we have grouped these three types of claims
into two categories, based on whether or not the claims are referred to
NIOSH for dose reconstruction during processing. As figure 1 shows,
claims that are not referred to NIOSH for dose reconstruction include
RECA Section 5 supplement claims and beryllium, silicosis, and special
exposure cohort cancer claims. Claims that are referred to NIOSH for
dose reconstruction include cancer claims not covered by special
exposure cohort provisions.
Figure 1: Claims That Require Dose Reconstructions Are Processed
Differently than Claims That Do Not:
[See PDF for image]
[End of figure]
Depending on the type of claim, Labor must complete certain claims-
processing tasks before a decision can be made as to whether the
claimant should receive compensation. Claims for the $50,000 RECA
Section 5 supplement are the least complex. For these, Labor verifies
with the Department of Justice that an award determination has
previously been made and documents the identity of the claimant. For
claims involving beryllium disease, silicosis, or a specified cancer
for workers at a special exposure cohort facility, the employment and
illness are verified.[Footnote 11] After the verification is completed
for a claim, Labor develops a recommended decision that is issued to
the claimant. The claimant may agree with the recommended decision or
may object and request either a review of the written record or an oral
hearing. In either case, the Final Adjudication Branch (a separate
entity within Labor's Office of Workers' Compensation Programs) will
review the entire record, including the recommended decision and any
evidence or testimony submitted by the claimant and will issue a final
decision. A claimant can appeal the decision in the U.S. District
Courts or have the case reopened if new evidence is provided to Labor.
Other claims are referred to NIOSH for dose reconstruction. Such claims
include those involving a claimed cancer not covered by the special
exposure cohort provisions.[Footnote 12] Before a determination of
compensability can be made, a dose reconstruction must be conducted for
the probability of causation to be established. In these instances,
once Labor determines a worker was a covered employee and that he or
she had a diagnosis of cancer, the case is referred to NIOSH. Using
scientific and other collected information, NIOSH performs a dose
reconstruction and provides the results to Labor. Labor uses these
results to assess whether the employee's cancer was "at least as likely
as not" related to the radiation dose received by the employee in order
to determine compensability.
The purpose of a dose reconstruction is to characterize the extent to
which workers were exposed to radiation present in the workplace and to
assist Labor in determining the probability that a person's cancer was
"at least as likely as not" caused by radiation. Dose reconstructions
rely on information that was periodically collected to monitor
radiation levels by Energy or other covered facilities and on
information collected during interviews with the claimant. For example,
when such information is available, NIOSH officials gather information
that was collected to monitor a worker's radiation exposure, such as
readings from a worker's monitoring badges, urinalysis results, and
radon monitoring results. They also obtain information from
workplacewide monitoring readings, such as general air-sampling
results, radon monitoring results, and work-required medical screening
x-rays. NIOSH officials also conduct interviews with claimants to
obtain information on their employment history, how they were monitored
for radiation exposure, whether they were aware of any particular
incidents during which they may have been exposed to radiation, and
whether medical screening had indicated they may have been exposed to
radiation. In cases where NIOSH officials cannot fully characterize the
likely level of radiation exposure, they estimate the level of exposure
using reasonable scientific assumptions that give the claimant all the
benefit of the doubt, according to NIOSH officials.
Compensation is limited to $150,000 per worker for all claims that are
not related to RECA Section 5 supplements. When multiple survivors of
the same worker file claims, the compensation amount is divided among
eligible survivors. Moreover, while multiple claims associated with a
single worker may be filed with Labor, only one dose reconstruction is
needed in such instances. See appendix II for detailed information
about the claim-processing steps used by Labor and NIOSH.
Labor Processes Claims Not Referred to NIOSH for Dose Reconstructions
in a Timely Manner and Has Taken Steps to Ensure Consistency:
In the first 2½ years of the program--July 31, 2001, through January
31, 2004--Labor had fully processed 83 percent of claims not referred
to NIOSH for dose reconstruction. During the first year of the program,
Labor was not able to meet one of its primary Government Performance
and Results Act of 1993 (GPRA) timeliness goals, but since then GPRA
goals have been met and Labor has set higher goals for the
future.[Footnote 13] Labor also established interim goals for
processing claims. In addition, Labor has instituted various procedures
to promote consistency, including conducting accountability reviews and
updating its procedures manual.
Labor Has Fully Processed Most Claims Not Referred to NIOSH for Dose
Reconstructions and Has Generally Met its Timeliness Goals for Claims
Processing:
As of January 31, 2004, Labor had fully processed 83 percent of the
nearly 30,000 claims for benefits under Subtitle B that had not been
referred to NIOSH for dose reconstruction.[Footnote 14] As shown in
figure 2, an additional 16 percent of claims were in processing, and
less than 1 percent had not yet begun processing.[Footnote 15] Of the
claims that were fully processed, 94 percent had final decisions, and
the remainder had been closed without a final determination for
administrative reasons.[Footnote 16] Forty-two percent of claims with
final decisions were approved, resulting in more than $625 million in
lump-sum compensation payments. The remaining 58 percent were denied,
in most instances because they did not meet medical or employment
eligibility criteria. On average, it took about 7 months to fully
process claims not needing dose reconstruction.
Figure 2: Status of Claims Not Referred to NIOSH for Dose
Reconstruction as of January 31, 2004:
[See PDF for image]
[End of figure]
As of January 31, 2004, the majority of approved claims that were not
referred to NIOSH for dose reconstructions reported cancer as a claimed
illness, and Labor had reimbursed claimants whose claims were approved
nearly $22 million in medical and travel-related expenses. About
55 percent of approved claims not referred for dose reconstruction
claimed cancer, 12 percent reported chronic beryllium disease, 10
percent reported beryllium sensitivity, and 4 percent reported chronic
silicosis.[Footnote 17] Approved claimants with ongoing medical and
travel-related expenses related to the occupational illness for which
they were compensated under Subtitle B are entitled to reimbursement
for these expenses.[Footnote 18] As shown in figure 3, more than half
of the nearly $22 million paid was reimbursement for claimants'
hospital expenses.
Figure 3: Payments for Medical and Travel-Related Expenses Made for
Approved Claims Not Referred to NIOSH for Dose Reconstruction as of
January 31, 2004:
[See PDF for image]
[End of figure]
Labor has generally met the two broad GPRA goals it established for
timeliness of processing Subtitle B claims, as shown in table 1. These
goals were (1) to complete the initial processing of claims within
specified time periods, depending upon the type of claim, 75 percent of
the time,[Footnote 19] and (2) to complete the final decision
processing of claims within specified time periods 75 percent of the
time.[Footnote 20] Labor did not establish different GPRA goals for
claims not referred to NIOSH for dose reconstruction versus those
needing dose reconstruction; rather, the GPRA goals are overall goals
that apply to Labor's processing of all Subtitle B claims. The initial
processing time frames and the final decision processing time frames
encompass all of the activities Labor must complete to fully process a
claim. In its fiscal year 2002 annual report, Labor stated that it set
these GPRA goals to provide a clear indication to claimants that their
claims would be processed efficiently. The report further stated that
the agency wanted to send a strong message to the new program's staff
that they should share this strong commitment in processing claims. In
its 2003 strategic plan, Labor indicated that it planned to set higher
processing goals through 2008 by increasing the goals by 2 percentage
points each year.
Labor officials cited several factors that contributed to not meeting
the GPRA goal for initial processing in fiscal year 2002. For example,
in the program's first year, the district offices received more than
34,000 claims and actually had a backlog of claims to process even
before they began operating the program on July 31, 2001. In addition,
several start-up problems, most notably unanticipated delays in
obtaining the employment information from Energy necessary to proceed
with initial claims processing, also prevented Labor from achieving
this goal during the first year, according to Labor officials. Labor
officials also stated that they have addressed many of these initial
problems and Energy has greatly improved its responsiveness rate. Labor
officials report that Energy is typically responding to a request
within 30 days, which exceeds Labor's goal of obtaining a response from
Energy within 60 days. Labor officials have also used other sources,
such as labor unions, to help provide necessary employment
verification.
Table 1: Labor's Performance with Respect to Its GPRA Goals for
Subtitle B, Fiscal Years 2002 and 2003:
Labor's GPRA goals: Complete the initial processing of claims within
various specified time periods;
Completion rate goals for both FY 2002 and FY2003: 75% of the time;
Actual completion rate for FY 2002: 48% of the time;
Actual completion rate for FY 2003: 79% of the time.
Labor's GPRA goals: Complete the final decision processing of claims
within various specified time periods;
Completion rate goals for both FY 2002 and FY2003: 75% of the time;
Actual completion rate for FY 2002: 76% of the time;
Actual completion rate for FY 2003: 76% of the time.
Source: GAO analysis of Labor documents.
Note: Shaded cells represent goals that were achieved.
[End of table]
To assist Labor officials in knowing how well claims are being
processed, and ultimately meeting its GPRA goals, Labor has also
established a number of interim processing goals. These interim
processing goals specify time frames for completing activities such as
initiating the employment and illness verification process and issuing
the lump-sum payments. Initially, the district offices had difficulty
meeting some of these interim goals. However, over time they have been
better able to meet these goals. For example, in fiscal year 2002,
Labor set an interim goal to initiate the employment and illness
verification process within 25 days 90 percent of the time. While the
district offices achieved only a 76 percent rate in fiscal year 2002,
they improved their rate to over 98 percent in fiscal year 2003.
Similarly, in fiscal year 2002, an interim goal was set to issue a
lump-sum payment to a claimant within 15 days of approving a claim 90
percent of the time. District offices achieved a 77 percent rate in
fiscal year 2002 but improved their performance to achieve a 93 percent
rate in fiscal year 2003.
Labor Has Taken Steps to Ensure Consistency, Including Accountability
Reviews and a Major Update of its Procedures Manual:
Labor has taken several steps to help ensure that Subtitle B claims are
processed consistently. For example, Labor requires that claim
decisions undergo several levels of review. After a claims examiner
develops a recommended decision, a senior claims examiner reviews that
recommended decision, and a claims manager, who reviews a sample of
such decisions, might review it as well. Labor's Final Adjudication
Branch then reviews the recommended decision before making a final
decision and awarding compensation, if appropriate. If during any of
these reviews the reviewer determines that there was not enough
information to make a decision, the case is sent back to the claims
examiner for further development.
To further promote consistency, Labor performs accountability reviews
each year on the EEOICPA program as it does with its other similar
compensation programs. In completing the reviews, Labor samples claims
in each of its four district offices as well as its Final Adjudication
Branch offices. The purpose of the reviews is to assess the quality of
work being performed in each office and to guide managers in developing
training and implementing any needed corrective actions. The reviews
focus on such tasks as processing claims in a timely manner, making
payments appropriately, assigning staff to appropriate roles, and
coding claims appropriately in the case management system. The
accountability reviews have proven very useful in identifying training
needs, according to Labor officials. For example, after an
accountability review showed that actions had been taken in some claims
but were not reflected through status codes in the case management
system, some district offices held training courses to help their
claims examining staff better understand how to use codes properly. In
addition to providing training, the district offices are required to
correct any problems identified during the reviews. Labor officials
told us they expect to continue to conduct accountability reviews each
year.
Labor has also taken steps to improve staff access to updates in
claims-processing procedures. Some district offices raised concerns
that the procedures manual, originally issued in January 2002, did not
always reflect Labor's most recent guidance and needed to be revised.
For example, a supervisor in one of the district offices said that the
bulletins announcing changes to the system are not available from a
central source and that he has struggled at times to determine the
proper procedure. According to Labor officials, because the program is
relatively new and the law was vague in some areas, Labor has issued
many different policies to define how staff should handle different
situations. In addition, guidance was not always centrally located
because, in issuing policy clarifications, Labor did not consistently
use one format; rather, it issued policies in bulletins, e-mails, and
documentation of telephone calls. To address the district offices'
concerns, Labor created a task force composed of 10 team members,
including staff from the four district offices and headquarters. The
task force is working to develop a comprehensive procedures manual that
would include all the bulletins, teleconference calls, and other
communications containing policy changes that have been issued since
the beginning of the program. Officials said that they are in the final
stages of completing the manual.
Claims Needing Dose Reconstructions Face Large Processing Backlog:
In the first 2½ years of the program--July 31, 2001, through January
31, 2004--Labor and NIOSH fully processed about 9 percent of the claims
referred to NIOSH for dose reconstruction, leaving a large backlog of
these claims. NIOSH officials report that the backlog resulted because
time was needed to develop the necessary regulations and get staff and
procedures in place for performing dose reconstructions. NIOSH now has
its staff and procedures in place and has an extensive effort under way
to complete site profiles that expedite the dose reconstruction
process. However, NIOSH's time frame for completing the remaining
profiles is uncertain, and as a result, some claims associated with
facilities that do not have site profiles may take a considerable
period of time to be fully processed. To ensure the consistency of
claim decisions, NIOSH's Advisory Board is overseeing an effort to
evaluate dose reconstruction decisions and site profiles. Finally, with
the recent issuance of special exposure cohort regulations, the backlog
of claims needing dose reconstructions may be reduced if additions are
made to the special exposure cohort, thereby eliminating the need for
performing dose reconstructions on these claims.
Relatively Few Claims Needing Dose Reconstructions Have Been Fully
Processed, and NIOSH Cites a Number of Factors Affecting Its Ability to
Complete Dose Reconstructions:
As of January 31, 2004, Labor, using dose reconstructions provided by
NIOSH, had fully processed relatively few of the claims referred to
NIOSH for dose reconstruction. Of the more than 21,000 claims requiring
dose reconstruction, 9 percent were fully processed, 91 percent were in
processing, and less than 1 percent had not yet begun processing, as
shown in figure 4.[Footnote 21] Of the 9 percent that had been fully
processed, 64 percent had final decisions, while the remaining claims
were closed for administrative reasons.[Footnote 22] Our analysis
showed that dose reconstructions had been started for about one-third
of the claims that were in processing. The remaining claims were either
waiting or undergoing development prior to the initiation of the dose
reconstruction.[Footnote 23] In some cases where a site profile has not
yet been developed, these claims are essentially on hold until the site
profile is developed.
Figure 4: Status of Claims Referred to NIOSH for Dose Reconstruction as
of January 31, 2004:
[See PDF for image]
[End of figure]
Fifty-one percent of claims with final decisions as of January 31,
2004, were approved, resulting in $65 million in lump-sum compensation
payments.[Footnote 24] Forty-nine percent were denied because the
results of the dose reconstruction were used by Labor to determine that
the claimed illness was not "at least as likely as not" to have been
caused by work-related radiation exposure.[Footnote 25] However,
approval rates for cases with final decisions have subsequently
decreased, and as of July 2004, Labor officials reported that the
approval rate for cases that required dose reconstruction was about 30
percent.
Claims referred to NIOSH for dose reconstruction have taken longer to
fully process than those that do not require dose reconstruction, and
some claims in processing at NIOSH may face a long wait for dose
reconstruction before returning to Labor for decisions. Of the Subtitle
B claims that were fully processed, as of January 31, 2004, those that
required dose reconstruction took an average of about 17 months to
fully process, compared with about 7 months for claims that did not
require dose reconstruction. However, the claims requiring dose
reconstruction that had not yet been fully processed had already been
pending for an average of 19 months. Approximately 15 of these months,
on average, had been spent in processing at NIOSH and 4 months had been
spent in processing at Labor.
All approved claims that had required dose reconstruction reported
cancer, and Labor reimbursed claimants for more than $3 million in
medical and travel-related expenses as of January 31, 2004. Almost all
of the reimbursements were for hospital and physician expenses, as
shown in figure 5.
Figure 5: Payments for Medical and Travel-Related Expenses Made for
Approved Claims Referred to NIOSH for Dose Reconstruction as of January
31, 2004:
[See PDF for image]
[End of figure]
Unlike Labor, which was able to immediately begin processing claims at
the start of the program on July 31, 2001, NIOSH needed time to develop
the necessary regulations and to get staff and procedures in place to
perform dose reconstructions. Two necessary regulations were finalized
in May 2002.[Footnote 26] In a May 2004 report to Congress,[Footnote
27] NIOSH reported that many of the key program pieces, such as
recruiting and training staff, were not completed until 2003,
contributing to the delays in its ability to complete dose
reconstructions. NIOSH also highlighted the difficulties it has
encountered in collecting information from Labor, Energy and other
employers, and claimants. For instance, NIOSH reported that information
such as employment history and cancer diagnosis provided by Labor is,
at times, inaccurate or incomplete. NIOSH also reported that obtaining
information from Energy or other employers has been difficult because
individual exposure records cannot always be located. Finally, while
the intent of conducting an interview with the claimant is to obtain
useful information, NIOSH officials report, however, that this will not
hinder a dose reconstruction.
NIOSH has been working to improve its ability to develop dose
reconstructions and address its backlog of claims needing dose
reconstruction. In March 2004, the Director of NIOSH testified that
NIOSH has steadily increased its capacity to complete dose
reconstructions and that much of the program's development is
complete.[Footnote 28] NIOSH officials stated that they continue to
work with Labor staff to establish a better understanding of what
information, such as ethnicity and smoking history, is needed by NIOSH
to perform a dose reconstruction, and officials stated that Labor is
now typically providing this information. In addition, NIOSH has worked
with Energy facilities to provide requested information in a more
timely fashion. Improvements have been made in this area, and officials
report that Energy generally provides the information within NIOSH's
time frame of 60 days. While NIOSH officials are working with claimants
to better educate them about the information NIOSH wants to collect
during the interview, NIOSH officials said that it was important to
realize that these interviews are voluntary and are not the sole source
of information. Information provided during the interviews is helpful,
but a dose reconstruction is not dependent upon an interview being
conducted, according to NIOSH officials.
While NIOSH reports that it has improved its ability to complete dose
reconstructions, it has not established any performance goal for the
overall timeliness of processing the claims referred to NIOSH for dose
reconstruction. Specifically, no GPRA goals were established in fiscal
year 2002 or 2003 for NIOSH's processing of Subtitle B cases, but a
GPRA goal, covering part of the dose reconstruction process, was
established for fiscal year 2004. Despite not having GPRA goals earlier
in the program, NIOSH did establish and track some interim processing
goals.[Footnote 29] NIOSH did not want to establish any overall
timeliness goal for completing dose reconstructions, but rather wanted
staff to complete them in as scientifically sound and efficient a
manner as possible. NIOSH's GPRA goal for fiscal year 2004 is to have
draft dose reconstructions sent to 80 percent of all claimants within
60 calendar days of the claim being assigned to staff to perform a dose
reconstruction. As of July 2004, NIOSH officials reported that
currently, an average of 70 days was required to conduct a dose
reconstruction after a case was assigned to a dose reconstructionist.
While NIOSH has developed innovative solutions to process claims from
more than 70 different sites regardless of whether a site profile
exists, the majority of these claims typically involve facilities that
do have a site profile either completed or partially completed.
However, since claims associated with facilities that do not have site
profiles are typically not assigned to staff for dose reconstruction,
it is possible that NIOSH could meet the GPRA goal and that some
claimants could still wait a considerable period of time to have their
cases fully processed.
NIOSH has accelerated the rate at which it is completing dose
reconstruction. For example, it took NIOSH a little more than 2 years
from when it received its first referral from Labor to complete the
first 1,000 dose reconstructions. In contrast, NIOSH completed the
second 1,000 dose reconstructions in less than 4 months and the third
1,000 dose reconstructions in 11 weeks. NIOSH established a target of
completing 8,000 dose reconstructions in fiscal year 2004. To assist in
meeting this goal, NIOSH is aiming to complete 200 dose reconstructions
per week. As of June 2004, NIOSH was averaging about 150 dose
reconstructions a week and had completed about 2,100 dose
reconstructions in the first 9 months of fiscal year 2004.
Completed Site Profiles Have Helped Accelerate Claims Processing, but
NIOSH Has Not Established Time Frames for Completing the Remaining
Profiles:
To facilitate the dose reconstruction process, NIOSH is developing site
profiles that compile information such as hazardous materials present
at the site, facilitywide monitoring information, and information on
workers at the site who may have been exposed to radiation. NIOSH
officials believe that these site profiles will enhance the efficiency
of performing dose reconstructions by eliminating the need to duplicate
efforts in gathering information. The site profiles for larger sites
consist of six documents, which are called Technical Basis Documents:
an introduction, a site description, an occupational medical dose
document, an occupational environmental dose document, an occupational
internal dose document, and an occupational external dose-monitoring
document. NIOSH officials are also compiling worker profiles, which
provide information on the worker' job, work location within the
facility, and time periods worked. NIOSH sometimes uses the worker
profiles to obtain proxy information when some information is not
available for a particular claimant.
NIOSH initially expected to conduct dose reconstructions while
developing site profiles for the facilities involved but encountered
difficulties in doing so. By pursuing both efforts at the same time,
NIOSH officials had hoped to avoid facing a backlog of claims by
completing a substantial number of dose reconstructions. However, NIOSH
determined that it was necessary to first complete the site profiles to
complete a high volume of dose reconstructions because it was too
inefficient to collect general site-related information on a case-by-
case basis. In addition, while Energy has supported NIOSH's efforts in
locating site-specific information, there have been some delays in
providing this information, particularly when the information requested
is from classified documents. When requests for classified documents
are made, delays have occurred because of the time needed for Energy to
comply with procedures for ensuring national security.
NIOSH currently has an extensive effort under way to develop site
profiles, and this effort has helped expedite the processing of claims.
NIOSH has established over a dozen teams, each composed of three to six
experts, and made each team responsible for developing a different site
profile. NIOSH prioritized its efforts by targeting those facilities
that have the largest number of claims needing dose reconstruction; 15
of the 30 sites NIOSH anticipates completing a site profile for
represent about 80 percent of the claims submitted for dose
reconstruction. As of June 2004, 11 site profiles were fully completed,
while 9 other site profiles were partially completed (see table 2).
Table 2: Completed and Partially Completed Site Profiles as of June
2004:
Completed site profiles:
* Bethlehem Steel, New York;
* Blockson Chemical Company, Illinois;
* Fernald Environmental Management Project, Ohio;
* Hanford, Washington;
* Huntington Pilot Plant, West Virginia;
* Iowa Army Ammunition Plant, Iowa;
* Mallinckrodt Chemical Company, Missouri;
* Rocky Flats Plant, Colorado;
* Savannah River Site, South Carolina;
* Tennessee Valley Authority Muscle Shoals Site, Alabama;
* Y-12 National Security Complex, Tennessee;
Partially completed site profiles:
* Idaho National Engineering and Environmental Laboratory, Idaho;
* Los Alamos National Laboratory, New Mexico;
* Mound Site, Ohio;
* Nevada Test Site, Nevada;
* Oak Ridge Gaseous Diffusion Plant (K-25), Tennessee;
* Oak Ridge National Laboratory (ORNL or X-10), Tennessee;
* Paducah Gaseous Diffusion Plant, Kentucky;
* Pantex Plant, Texas;
* Portsmouth Gaseous Diffusion Plant, Ohio.
Source: NIOSH.
[End of table]
In cases where a site profile has been completed, NIOSH has been able
to better process the claims needing dose reconstruction associated
with those facilities. For instance, since the first of six Technical
Basis Documents for the Savannah River site profile was approved, in
July 2003, NIOSH had completed about 500 dose reconstructions for that
site by January 31, 2004, whereas NIOSH had completed fewer than 10
dose reconstructions for that site prior to July 2003. While some site
profiles are only partially completed, NIOSH is still able to use the
completed Technical Basis documents, as applicable, to develop dose
reconstructions. For example, at the Idaho National Engineering and
Environmental Laboratory (INEEL), the occupational internal dose
document is still being finalized. However, if NIOSH has a claim that
only needs the use of other INEEL site profile documents that are
finalized, such as the occupational medical dose document or the
occupational external dosimetry documents, a dose reconstruction can be
developed for this claim. In addition, completed site profiles may be
modified as additional relevant information is identified and
incorporated. Claims originally denied based upon a prior version of a
site profile are re-examined to determine the effect that the new
information may have on the compensability of the claim. In turn, Labor
can make any appropriate modifications to its earlier claim decisions.
Despite efforts to complete the remaining site profiles, NIOSH
officials said that their time frame for completing these profiles is
uncertain. The site profiles that have been completed have taken on
average 4 to 6 months to complete. NIOSH reported that the pace at
which it can complete additional site profiles is constrained by the
limited expert resources available to conduct this specialized work and
by the complexity of the history and variety of operations at
particular sites. In addition, NIOSH officials said that it generally
takes longer to complete site profiles for atomic weapons employer
sites because many of these sites are no longer operating or are
privately owned, making it difficult to locate records. Because the
number of available staff needed to complete site profiles is very
limited, NIOSH officials stated that they have had to balance their use
of these resources. As site profiles are completed, resources are
reallocated to assist with the completion of additional site profiles.
HHS's Advisory Board Is Conducting an Evaluation to Ensure Claims
Decisions Are Consistent:
HHS's Advisory Board has a major effort under way to ensure claims
decisions are being made consistently. Specifically, HHS's Advisory
Board is responsible under the statute for (1) reviewing a reasonable
sample of individual dose reconstructions for scientific validity and
quality, (2) advising on the development of guidelines to determine
probability of causation and methods for dose reconstruction, and (3)
reviewing special exposure cohort petitions. To assist the Advisory
Board, HHS entered into a contract with an organization in October 2003
to carry out some of these tasks. The contractor is currently
developing its plans for completing these tasks and expects to conduct
the evaluation over the next 5 years and to provide interim status
reports each year.[Footnote 30]
Performing an independent review to examine the consistency of
individual dose reconstructions decisions is an important aspect of
effective program management for the Subtitle B program. In the past,
GAO reported concerns that a similar program that compensates veterans
with diseases caused by radiation exposure did not have an independent
review of its dose reconstructions.[Footnote 31] Such a review could
result in greater public confidence and mitigate concerns about dose
reconstructions. NIOSH officials have also stated that the evaluation
of the individual dose reconstructions and site profiles is an
important exercise to complete. The Chair of the Advisory Board said
that while the board is confident in what NIOSH's findings have been to
date, it is important to have an independent review completed in order
to validate these findings.
HHS Issued Regulations That Would Eliminate the Need for Dose
Reconstructions for Claims Granted Special Exposure Cohort Status:
After HHS had twice received public comments on proposed regulations
concerning how individuals or groups could apply for special exposure
cohort status, the agency issued final regulations on May 28,
2004.[Footnote 32] The Secretary of HHS is responsible for developing
procedures for considering petitions to be added to the special
exposure cohort. HHS originally published a proposal for these
procedures on June 25, 2002, and subsequently received a number of
public comments. Many of these comments pertained to the feasibility of
completing dose reconstructions and establishing time limits for
completing dose reconstructions. Because HHS needed to make substantial
changes to the procedures to address public comments, the agency issued
a second notice of proposed rule making on March 7, 2003, and solicited
public comments through May 6, 2003. Again many of the comments related
to completing dose reconstructions in a feasible and timely manner.
HHS's regulations establish procedures that describe how petitions can
be submitted and reviewed for special exposure cohort consideration.
These requirements are intended to ensure that petitions are submitted
by authorized parties, are justified, and receive uniform, fair, and
scientific consideration. The procedures are also designed to give
petitioners and interested parties opportunities for appropriate
involvement in the process. The procedures are not intended to provide
a second opportunity to qualify a claim for compensation, once NIOSH
has completed a dose reconstruction and Labor has determined that the
claimed cancer was not "at least as likely as not" to have been caused
by the estimated radiation doses.[Footnote 33]
With the implementation of the regulations, some of the claims in
NIOSH's backlog could be eligible for special exposure cohort status
and consequently reduce the backlog of claims requiring dose
reconstruction. If a petition to add a particular group to the special
exposure cohort is submitted and approved, NIOSH would not need to
develop an individual dose reconstruction for such a claim. Rather,
Labor would verify the claimant's employment and illness and follow the
review process currently used for existing special exposure cohort
groups. As of July 30, 2004, NIOSH had received eight special exposure
cohort petitions and was determining whether the petitions were
eligible for consideration.
Conclusions:
Labor's procedures and practices have helped the agency to fully
process most of the claims that had not been referred to NIOSH for dose
reconstruction. Because this program is relatively new, Labor has
issued many different policies to define how staff should handle
different situations and is working to develop a comprehensive
procedures manual that would contain these policies. In addition, the
accountability reviews performed each year have allowed Labor to
identify and correct problems as they occur and provide additional
training to staff as needed. To ensure consistency in the processing of
claims during this period of change, it will continue to be important
for Labor to maintain these ongoing efforts.
In contrast, relatively few claims requiring dose reconstructions have
been fully processed. NIOSH faces the challenge of balancing multiple
objectives--scientific soundness and timeliness--in completing dose
reconstructions. However, while NIOSH has placed considerable focus on
ensuring scientific soundness, it has not established a clear vision
for claimants or the Congress with regard to the time frames within
which they can expect dose reconstructions to be completed. NIOSH
established a GPRA goal for fiscal year 2004 that specifies a time
frame for completing draft dose reconstructions once a claim is
assigned to staff to perform a dose reconstruction. However, claims
associated with facilities that do not have site profiles are typically
not assigned to staff for dose reconstruction, and this waiting period
is not reflected in the GPRA goal. NIOSH learned from its initial
implementation experience that completing site profiles is a critical
element for efficiently processing claims requiring dose
reconstruction. While NIOSH had completed 11 site profiles and
partially completed 9 profiles as of June 2004, it had not established
any time frames for completing these 9 site profiles or the remaining
10 site profiles that it expects to develop. Without such time frames,
claimants do not have a good understanding of when their dose
reconstruction might be completed. While it is important to avoid the
extreme of establishing time frames that are unreasonable and would set
up NIOSH for failure, it is equally important to avoid the other
extreme of not setting any expectations for the timely completion of
dose reconstructions for which site profiles have not been completed.
Moreover, now that NIOSH has more experience in developing site
profiles, it is in a better position to identify and take account of
factors that can lead to differences in the amount of time required to
complete site profiles for different facilities.
Recommendation:
To enhance program management and promote greater transparency with
regard to the timeliness of completing dose reconstructions, we
recommend that the Secretary of HHS direct CDC officials to establish
time frames for completing the remaining site profiles.
Agency Comments and Our Evaluation:
We provided a draft of this report to both Labor and HHS for comment.
Labor did not have any comments on the report. HHS said that the report
was balanced, thorough, and constructive, and that it agreed with GAO's
recommendation to establish time frames for completing the remaining
site profiles. HHS also provided updated information on the number of
site profiles already completed and the total number of site profiles
that it anticipates compiling, and we revised the report to incorporate
this information. HHS added that it has used innovative solutions to
complete dose reconstructions in some instances in which site profiles
do not exist and we modified the report to incorporate this
information. Moreover, HHS provided additional information to explain
how completed site profiles function as "living documents" and are
modified as additional relevant information is identified. Finally, HHS
raised questions about the accuracy of certain statistics we cited
about cases that had been fully processed by Labor, while acknowledging
that Labor is a more authoritative source on this topic. We believe
that these statistics accurately describe what they were intended to
measure, and Labor did not raise any issue about their accuracy; hence,
we did not revise the figures. HHS's comments are provided in appendix
IV. HHS also provided technical comments, which we have incorporated as
appropriate.
Copies of this report are being sent to the Secretary of Labor and the
Secretary of Health and Human Services, appropriate congressional
committees, and other interested parties. The report will able be made
available at no charge on GAO's Web site at http://www.gao.gov. If you
have any questions about this report, please contact me at (202) 512-
7215. Other contacts and staff acknowledgments are listed in appendix
VI.
Sincerely yours,
Signed by:
Robert E. Robertson:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Scope and Methodology:
To determine how well the Department of Labor's (Labor) procedures and
practices ensure the timely and consistent processing of claims that
are not referred to the National Institute of Occupational Safety and
Health (NIOSH) for dose reconstruction but are being processed by
Labor, we reviewed Labor's regulations, procedures, and practices
related to processing claims. In addition, we interviewed officials
from Labor's Office of Workers' Compensation Programs and its four
district offices in Cleveland, Ohio; Denver, Colorado; Jacksonville,
Florida; and Seattle, Washington to discuss their procedures and
practices. In addition, we obtained and analyzed information on Labor's
Government Performance and Results Act (GPRA) goals and interim
processing goals for fiscal year 2002 through the second quarter of
fiscal year 2004. We also obtained and analyzed accountability review
documents for fiscal years 2002 and 2003. We interviewed Labor
officials to obtain information on the department's efforts to revise
its procedures manual used by staff in processing claims. Last, for
background purposes, we interviewed several claimants and Energy
Employees Occupational Illness Compensation Act (EEOICPA) experts
regarding their knowledge of or experiences with Subtitle B claims
processing.
To determine how well Labor's and the NIOSH procedures and practices
ensure the timely and consistent processing of claims that are referred
to NIOSH for dose reconstruction, we reviewed Labor's and NIOSH's
regulations, procedures, and practices related to processing claims.
Along with the work we performed at Labor as described earlier, we
interviewed officials from NIOSH's Office of Compensation Analysis and
Support (OCAS) to discuss their procedures and practices. In addition,
we obtained and analyzed information on NIOSH's GPRA goals and interim
processing goals for fiscal year 2002 through the second quarter of
fiscal year 2004. We also reviewed several of the completed site
profiles and obtained information on NIOSH's time frames for completing
additional site profiles needed to assist with the dose reconstruction
process. We reviewed recently introduced regulations for considering
petitions to be added to the special exposure cohort as well as
different pieces of legislation introduced that would establish
additional sites as special exposure cohort sites. We also interviewed
the Advisory Board chair and reviewed key documents pertaining to the
evaluation of dose reconstructions that the Advisory Board is
overseeing. Last, for background purposes, we interviewed several NIOSH
contract staff, claimants, and EEOICPA experts regarding their
knowledge of or experiences with Subtitle B claims processing.
To determine the number, status, and other characteristics of Subtitle
B claims filed through January 31, 2004, we analyzed administrative
data extracted from Labor's and NIOSH's case management systems for
applications filed from the beginning of the program--July 31, 2001--
through January 31, 2004. Neither agency publishes standardized data
extracts from their systems, so we requested that they provide
customized extracts for our analysis. Specifically, we received an
extract from the NIOSH Office of Compensation Analysis and Support
Claims Tracking System (NOCTS) and several files extracted from Labor's
Energy Cases Management System (ECMS) and Energy Medical Bill
Processing Subsystem (EMBPS).
Because multiple claims can be associated with a single worker, the
systems and the extracts received from both agencies contain data
collected at two levels--the case level and the claim level. For
example, if multiple children of a deceased worker file claims, all
claims will be associated with a single case, which is linked to the
worker. At the case level, the extracts contained information about the
worker, such as date of birth and date of death (if applicable), the
facilities at which the employee worked, the employee's dates of
employment, and the status of the case as it moves through the
development process. At the claim level, the extracts contained
information related to the individual claimants, such as the date the
claim was signed, the claimant's relationship to the worker, and the
status of the claim as it progressed through processing.
The Labor files were merged to produce claim-and case-level data files
and were subsequently merged with the NIOSH extract. Throughout this
report, we have reported our statistics at the claim level. Where case-
level statistics have been reported, they have been merged with the
claim-level data so that they could be reported at the claim level.
We interviewed key Labor and NIOSH officials and contractors and
reviewed available system documentation, such as design specifications
and system update documents. We tested the data sets to determine that
they were sufficiently reliable for our purposes. Specifically, we
performed electronic testing to identify missing data or logical
inconsistencies. We did not assess the quality of Labor's claims
decisions. We then computed descriptive statistics, including
frequencies and cross-tabulations, to determine the number and status
of claims received as of January 31, 2004.
In order to provide more current information, we interviewed Labor and
NIOSH officials to obtain updated information on the approval rates for
cases that required dose reconstructions as of July 2004. We also
interviewed NIOSH officials to obtain information on the average time
taken to draft dose reconstructions as of July 2004 and the number of
dose reconstructions completed in the first 9 months of fiscal year
2004.
[End of section]
Appendix II: Labor's and NIOSH's Claim-Processing Steps:
[See PDF for image]
[End of figure]
[End of section]
Appendix III: Comparison of Claim-and Case-Level Information Regarding
Claims Referred to NIOSH for Dose Reconstructions as of January 31,
2004:
While Labor makes and reports its decisions on the claim level, NIOSH
reports its dose reconstruction results on the case level because only
one dose reconstruction is completed for each worker regardless of the
number of claims filed by survivors. Table 3 presents information on
the status of claims referred to NIOSH for dose reconstructions at both
the claim and case levels as of January 31, 2004.
Table 3: Information on the Status of Claims Referred to NIOSH for Dose
Reconstructions at the Claim and Case Levels as of January 31, 2004:
Status: Fully processed;
Claims: 1,900;
Cases: 1,600.
Status: In processing;
Claims: 19,000;
Cases: 14,000.
Status: Not yet processed;
Claims: Fewer than 50;
Cases: Fewer than 50.
Total;
Claims: More than 21,000;
Cases: More than 15,000.
Source: GAO's analysis of Labor's data.
[End of table]
[End of section]
Appendix IV: Comments from the Department of Health and Human Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES:
Office of Inspector General:
Washington, D.C. 20201:
AUG 31 2004:
Mr. Robert E. Robertson:
Director, Education, Workforce, and Income Security Issues:
United States Government Accountability Office:
Washington, D.C. 20548:
Dear Mr. Robertson:
Enclosed are the Department's comments on your draft report entitled,
"Energy Employees Compensation-Many Claims Have Been Processed, But
Action Is Needed to Expedite Processing of Claims Requiring Radiation
Exposure Estimates" (GAO-04-958). The comments represent the tentative
position of the Department and are subject to reevaluation when the
final version of this report is received.
The Department provided several technical comments directly to your
staff.
The Department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Lewis Morris:
Chief Counsel to the Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the Department's
response to this draft report in our capacity as the Department's
designated focal point and coordinator for Government Accountability
Office reports. OIG has not conducted an independent assessment of
these comments and therefore expresses no opinion on them.
COMMENTS OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) ON THE
U.S. GOVERNMENT ACCOUNTABILITY OFFICE'S (GAG'S) DRAFT REPORT "ENERGY
EMPLOYEES COMPENSATION: MANY CLAIMS HAVE BEEN PROCESSED, BUT ACTION IS
NEEDED TO EXPEDITE PROCESSING OF CLAIMS REQUIRING RADIATION EXPOSURE
ESTIMATES" (GAO-04-958):
HHS appreciates the opportunity to review GAO's draft report on this
important program. HHS welcomes independent assessments as a way to
improve performance, and believes that the review is balanced,
thorough, and constructive. Following are HHS comments regarding the
draft report.
GAO Recommendation:
To enhance program management and promote greater transparency with
regard to the timeliness of completing dose reconstructions, we
recommend that the Secretary of HHS direct NIOSH to establish
timeframes for completing the remaining site profiles.
HHS Comments:
Throughout the document (including pages 4, 24, 25 [Table 2]), HHS's
Centers for Disease Control and Prevention (CDC), National Institute
for Occupational Safety and Health (NIOSH), is referred to as having
fully completed 7 site profiles and having partially completed 13 as of
June 2004. To be accurate, all such references and the information
contained in Table 2 on page 25 should identify 11 fully complete and 9
partially complete profiles. Four of the profiles labeled partially
complete in the draft report should be labeled as fully complete. These
are Bethlehem Steel, Huntington Pilot Plant, Blockson Chemical, and
Tennessee Valley Authority. These four Atomic Weapons Employer (AWE)
profiles may have been mislabeled, assuming that these profiles needed
six chapters (similar to Department of Energy [DOE] weapons complex
sites) to be complete. AWE sites do not necessarily require the six
Technical Basis Document (TBD) chapters that are found in the completed
DOE weapons complex Site Profiles (SP).
In addition, it is important to note that SP and TBD, which are deemed
"complete," are ready for use in dose reconstruction for claims where
the information contained in these documents allows for estimating
radiation doses with sufficient accuracy to yield a decision from the
Department of Labor (DOL) for a given claim. Furthermore, these SP and
TBD "living documents" which mean that they are modified as additional
relevant information is identified and incorporated. Any non-
compensable claim processed under a prior version of a SP is re-
examined against the new information to determine the effect that new
information may have on the compensability of the claim as required by
42 CFR 82.27(b).
In various passages, the draft report indicates that NIOSH is "planning
to complete the remaining 40 site profiles." NIOSH does not have plans
for, nor does it envision the need for, these site profiles. During an
interview with GAO staff, NIOSH officials indicated that they would
most likely develop site profiles only for sites where there are more
than 40 cases. NIOSH officials further indicated that this strategy was
designed to effectively utilize resources, and they explained that many
AWE sites with similar production process and exposure scenarios would
use an already completed TBD. If the cut point is 40 cases, NIOSH will
have a total of 30 site profiles. NIOSH understands and accepts the GAO
recommendation that a timetable needs to be established for the
unfinished site profiles. NIOSH will aggressively pursue the completion
of all SP and TBD necessary to provide scientifically sound dose
estimates that are fair to the claimant.
The draft report indicates that NIOSH has "essentially stopped
processing claims at sites where profiles do not exist" (Highlights,
paragraph 2, line 13; Page 5, paragraph l, line 4). In fact, NIOSH has
developed innovative solutions to process claims (i.e., complete dose
reconstructions) where site profiles are still under development. Using
complex wide technical information bulletins, NIOSH has been able to
process cases from more than 70 different DOE and AWE sites. While it
is true that many claims will need a full site profile in order to
achieve the scientific accuracy necessary to complete a dose
reconstruction, NIOSH has completed and continues to complete dose
reconstructions for claims in which sufficient scientific accuracy can
be achieved without the use of fully developed SP.
The statistics "9 percent fully processed" (Page 18, paragraph 1, line
6), "64 percent final decisions" and "36 percent closed for
administrative reasons" (Page 19, Figure 4) do not appear accurate to
NIOSH officials. This may be due to the metric being tracked (final
decisions from DOL). From a NIOSH perspective, it was indicated to GAO
that, as of the end of July 2004, 25 percent of the cases submitted had
been returned to DOL with completed dose reconstructions. However, DOL
should be consulted for accuracy of each of these statistics because
NIOSH does not have full access to these numbers and a lag time exists
between NIOSH completion of dose reconstruction cases and final
decisions by DOL.
[End of section]
Appendix V: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Andrew Sherrill (202) 512-7252 Mary F. Nugent (312) 220-7645:
Staff Acknowledgments:
In addition to the above contacts, Melinda L. Cordero and
Rosemary Torres Lerma made significant contributions to this report.
Luann Moy and William Bates assisted with methodology and data
analysis, Margaret Armen provided legal support, and Amy E. Buck
assisted with the message and report development.
FOOTNOTES
[1] NIOSH is part of the Centers for Disease Control and Prevention
within the Department of Health and Human Services (HHS).
[2] These four locations include three gaseous diffusion plants in Oak
Ridge, Tennessee, Paducah, Kentucky, Portsmouth, Ohio, and an
underground nuclear test site on Amchitka Island, Alaska.
[3] The statute created an Advisory Board on Radiation and Worker
Health, which is responsible for advising the President whether workers
at other locations should be added to the special exposure cohort.
NIOSH provides support to the Advisory Board on this and other matters.
[4] GAO. Energy Employees Compensation: Even with Needed Improvements
in Case Processing, Program Structure May Result in Inconsistent
Benefit Outcomes, GAO-04-516 (Washington, D.C.: May 28, 2004).
[5] These 30,000 claims correspond to nearly 23,000 cases involving
individual workers. Multiple claims can be associated with a single
case when multiple survivors file claims related to the same worker.
[6] The more than 21,000 claims referred to NIOSH for dose
reconstruction correspond to more than 15,000 cases involving
individual workers for whom dose reconstructions need to be completed.
[7] This is referred to as determining the "probability of causation."
[8] Claimants who submit Subtitle B claims to Labor may also submit
Subtitle D claims to Energy if they qualify for this program. There is
no offset provision that would preclude a claimant receiving
compensation under one of these programs from also receiving
compensation under the other program.
[9] 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 only covered for
individuals who worked in nuclear test tunnels in Nevada and Alaska.
[10] For RECA claims, Labor verifies with the Department of Justice
that the claimant had been previously awarded compensation under the
RECA program. For all other claims, Labor verifies that the claimant
meets the employment and illness criteria.
[11] These specified cancers include leukemia, multiple myeloma,
lymphomas, as well as lung, thyroid, breast, esophagus, stomach,
pharynx, small intestine, pancreas, bile duct, gall bladder, salivary
gland, bladder, brain, colon, ovary, liver, bone, and renal cancers.
Additional criteria, such as how soon the cancer developed after the
first exposure to radiation, must also be met for many of these
cancers.
[12] These claims involve such things as cancers incurred at a non-
special exposure cohort facility or workers who did not have sufficient
employment duration to qualify for the special exposure cohort.
[13] GPRA requires federal agencies to establish standards measuring
their performance and effectiveness.
[14] These 30,000 claims correspond to nearly 23,000 cases involving
individual workers. Multiple claims can be associated with a single
case when multiple survivors file claims related to the same worker.
[15] Some of the claims still in processing may be referred to NIOSH
for dose reconstruction as claim processing continues.
[16] Claims can be closed for various administrative reasons, including
claimants withdrawing the claim or dying prior to the final processing
of the claim. In the event that a claimant dies prior to final
processing, an eligible survivor may file a new claim.
[17] The illnesses reported here are not mutually exclusive; claimants
may report multiple illnesses and may have reported an illness that we
did not report here. Therefore the totals for the illnesses reported
here do not add to 100 percent.
[18] About one-third of the approved claims were filed by workers
rather than survivors; these workers would be eligible for medical and
travel-related expenses.
[19] Initial processing of claims includes such activities as
recommending that a claim be denied because it does not meet the
eligibility criteria or referring a claim to NIOSH for dose
reconstruction. Labor has specified various time periods for initial
processing, including processing claims for Energy employees or
contractors within 120 days 75 percent of the time and processing
claims for employees of atomic weapons employers or beryllium vendor
facilities within 180 days 75 percent of the time.
[20] Final decision processing of claims includes such activities as
issuing a recommended decision for approved claims and timely
responding to a request for a hearing. Labor has specified time periods
for these activities, including issuing final decisions for approved
claims within 75 days of the recommended decision 75 percent of the
time and issuing final decisions in formal hearings within 250 days of
the request for hearing 75 percent of the time.
[21] These 21,000 claims correspond with more than 15,000 cases
involving individual workers for whom dose reconstructions would need
to be completed. Multiple survivor claims can be associated with the
same worker, and hence there are more claims to be processed by Labor
than dose reconstructions to be completed by NIOSH. See appendix III
for additional comparative information on the status of claims and
cases. The approximately 19,000 claims that were in processing as of
January 31, 2004, corresponded to about 14,000 dose reconstructions
that needed to be completed.
[22] Claims can be closed for various administrative reasons, including
a claimant withdrawing the claim or dying prior to the final processing
of the claim. In the event that a claimant dies prior to final
processing, an eligible survivor may file a new claim.
[23] NIOSH develops a claim prior to completing a dose reconstruction
by completing such activities as interviewing claimants and obtaining
individuals' radiation exposure records from Energy or other sources as
appropriate.
[24] These claim approval decisions were based on the results of about
500 dose reconstructions.
[25] These claim denial decisions were based on the results of about
500 dose reconstructions.
[26] Guidelines for Determining the Probability of Causation, 42 CFR
Part 81, May 2, 2002, and Methods for Radiation Dose Reconstruction
under the Employees Occupational Illness Compensation Program Act of
2000, 42 CFR Part 82, May 2, 2002.
[27] As required by the National Defense Authorization Act for Fiscal
Year 2004 (Public Law 108-136), NIOSH issued a report to Congress,
titled Access to Information for Performance of Radiation Dose
Reconstruction.
[28] Testimony of Dr. John Howard, Director, NIOSH, before the Senate
Energy and Natural Resources Committee, March 30, 2004.
[29] For example, these processing goals established specified time
frames for activities such as receiving dose-monitoring data from
Energy and conducting claimant interviews. NIOSH officials stated that
program performance with respect to these goals has improved
substantially over time.
[30] GAO is doing follow-up work to examine issues related to the
contractor receiving timely access to information needed to conduct the
evaluation.
[31] GAO. Veterans' Benefits: Independent Review Could Improve
Credibility of Radiation Exposure Estimates, GAO/HEHS-00-32
(Washington, D.C.: Jan. 28, 2000).
[32] As the regulations were being developed, five different pieces of
legislation were introduced by members of Congress that would add
certain workers to the special exposure cohort. Specifically,
Representative Quinn introduced H.R. 3689 on December 8, 2003, to add
certain workers from a Bethlehem Steel plant in New York.
Representative Mark Udall introduced H.R. 3843 on February 25, 2004, to
add certain workers from the Rocky Flats site in Colorado.
Representative Tom Udall introduced H.R. 4388 on May 18, 2004, to add
certain workers from the Los Alamos National Laboratory in New Mexico.
Senator Bond introduced S. 2047 on February 2, 2004, to add certain
workers from the Mallinckrodt facilities (including the St. Louis
downtown facility, the Weldon Springs facility, and the Hematite
facility) in Missouri and Iowa Army Ammunition Plant in Iowa. As of
June 2004, none of the bills had been passed. On June 17, 2004,
however, Senator Bond offered an amendment to S. 2400 (the National
Defense Authorization Act for Fiscal Year 2005) that included the same
text as S. 2047. The Defense Authorization Act passed the Senate on
June 23, 2004, with the Bond amendment included.
[33] GAO is doing follow-up work to examine issues related to the
adequacy of the regulations on special exposure cohort status.
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