Implementation of EEOICPA

While the Division of Energy Employees Occupational Illness  Compensation (DEEOIC) within DOL’s Office of Workers’ Compensation  Programs has primary responsibility for administering the compensation  program, other federal agencies, including the Department of Health and  Human Services and Department of Energy, also have a role in  implementing the program. DOL Generally Followed Its Procedures, but Was Deficient in Performing Some Steps When Preparing Correspondence and Developing Claims

Based on our review of a stratified random probability sample of 200  EEOICPA Part E claims filed from 2010 through 2014 by employees or  their survivors, we found DOL claims examiners generally followed  established adjudication procedures. Deficiencies in Quality of Correspondence to Claimants

Our claim file review found that most of the inconsistency with the  Procedure Manual pertained to deficiencies in written correspondence to  claimants, such as in Recommended and Final Decision letters, and in  one instance, a letter requesting additional evidence. DOL officials  said there is no national policy on performing such reviews and that they  occur at the discretion of the district office. Reviews are one of DOL’s quality  controls, but their inconsistent application may increase the likelihood of  issues with the Recommended Decision, which in turn increases the  potential for claimant confusion and delays in adjudication. As a result, none of the deficiencies we identified during our claim  file review had led to the claim being remanded and corrected. For example, they estimated  that from 2006 to 2015, the number of links between toxins and illnesses  has increased from around 300 to over 3,000. Latest Linkages Must Be Applied during Adjudication but Lack of Documentation of This Step Hinders Monitoring

DOL provides limited notification to claims examiners and the public  regarding new links between toxic substances and illnesses due to the  large volume of information being continuously added to the SEM,  according to officials. Therefore, it is usually incumbent upon claims  examiners and the public to make themselves aware of new links. For that reason, DOL’s Procedure Manual instructs claims  examiners to check the SEM for any updates just prior to issuing a  Recommended Decision to deny a claim, however, documentation of that  step is not always required. Moreover, it was not possible to  determine whether any new causal links had been added because this  information was not contained in the notice. DOL’s Monitoring Has Identified Some Ongoing Concerns With Claims Adjudication

		DOL Continuously Monitors the Adjudication Process

In general, DOL’s monitoring from fiscal years 2010 through 2014 of how  well EEOICPA Part E claims are adjudicated concluded that the process  is working satisfactorily and meeting DOL’s established acceptability  standards. DOL has Taken Steps to Address Deficiencies but Some Persist

DOL took steps to address the significant deficiencies identified in the  Accountability Reviews from fiscal years 2010 through 2012, but  determined that deficiencies in 2013 and 2014 were not significant  enough to warrant corrective action. Nonetheless, according to DOL, the managers of  the district and FAB offices followed up on specific errors to ensure that  training or other actions were taken as appropriate. Conclusions

EEOICPA was enacted to compensate workers who carried out the  nation’s nuclear weapons production. This gap in required documentation hinders the ability to monitor,  consistent with federal internal control standards, whether claims  examiners are performing a final check of the SEM to ensure that their  decisions are based on the most up-to-date information. Recommendations for Executive Action

To enhance consistency with DOL policy and procedures in adjudicating  EEOICPA Part E claims, we recommend that the Secretary of Labor  strengthen internal controls by:
Requiring district offices to take steps to ensure that all claimant  correspondence for Recommended and Final Decisions receives  supervisory review;
Requiring district offices to document that the SEM was checked for  updates just prior to issuing a Recommended Decision to deny a  claim in cases in which the date of the last SEM update has not  changed since the claims examiner’s prior check. Across all 200 claims, the number of conditions being  claimed totaled 427. To determine how new links between toxic substances and diseases are  captured and applied in the adjudication process, we reviewed  adjudication guidance, including DOL’s EEOICPA Procedure Manual,  Circulars, and Bulletins. In all, we reviewed 80 Circulars and 147 Bulletins  and determined their relevance to our objective using two criteria: 1)  those that pertained to the development and adjudication of Part E  claims, and 2) those that provided guidance related to new links between  toxic substances or radiological exposure, and diseases, or that provided  guidance on whether the facility was covered under EEOICPA Part E.
In addition, we interviewed DOL officials and SEM contractor staff to  obtain an understanding about how the SEM was created, what it  contains, and DOL’s process for incorporating newly identified links into  the SEM and making the information available to claims examiners and  the public. Finally, we reviewed applicable  federal laws and regulations. GAO-10-302.
Why GAO Did This Study

EEOICPA was enacted in 2000 to compensate employees and contractors of the Department of Energy whose illnesses are linked to their work in the nuclear weapons industry. Part E of the Act, enacted in 2004, compensates these contractor and subcontractor workers, or their eligible survivors, for medical expenses, impairments, and lost wages up to $250,000. GAO was asked to review DOL's management of this program.
GAO examined (1) the extent to which DOL follows its procedures to adjudicate Part E claims, (2) how DOL captures new links between toxic substances and diseases and applies them to adjudication, and (3) what DOL's monitoring indicates about the adjudication process and whether any corrective actions have been taken to address identified problems. GAO reviewed a generalizable stratified random sample of 200 Part E claims filed from 2010 through 2014; reviewed applicable federal laws, regulations, guidance, internal audit reports, and other agency documentation associated with internal monitoring; and interviewed DOL officials.

What GAO Found

The Department of Labor's (DOL) adjudication process for compensating Department of Energy contract workers or their survivors for illnesses linked to work in the nuclear weapons industry generally follows guidance and procedures implementing Part E of the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA). Although GAO's analysis of a generalizable sample of 200 claims filed by workers from 2010 through 2014 found the adjudication process generally followed DOL's guidance and procedures, GAO identified some inconsistencies in an estimated 10 percent of the claims, including errors in correspondence to claimants and in development of claims. The procedure manual stipulates that written decisions should clearly convey information that led to the decision and that decisions are to be reviewed by the appropriate signatory. GAO found that decisions sometimes contained inaccurate, conflicting, or incomplete information, such as listing the wrong medical condition. DOL also did not always run accurate searches of its Site Exposure Matrices (SEM)—an online electronic database of facilities, toxic substances, and associated illnesses—when processing claims, or responding to requests for reopening claims. In addition, GAO found that supervisory review is at the discretion of each district office and, as a result, recommended decisions on claims were not always reviewed. This may increase the likelihood of poorly written decisions, which is inconsistent with procedures and which, in turn, increases the potential for claimant confusion and delays in adjudication.
DOL uses the SEM to, among other things, document newly identified causal links between toxins and diseases on the basis of medical research. According to DOL officials, since 2006 the number of such links listed in the SEM has increased from about 300 to over 3,000. They said that due to the large volume of information updates, DOL provides limited notification to claims examiners and the public when they occur. It has issued 10 notices specifically on new links since 2006. Therefore, it is usually incumbent on claims examiners and claimants to make themselves aware of new links by continuously checking the SEM for updates. As a result, new links are applied to claims largely to the extent these checks are performed. However, claims examiners are not always required to document that they checked whether the SEM had been updated prior to issuing a recommended decision to deny a claim. This gap in documentation hinders DOL's ability to monitor program performance, consistent with federal internal control standards.
According to DOL's monitoring, its process for adjudicating Part E claims is working satisfactorily, but persistent deficiencies remain. DOL conducted reviews from fiscal years 2010 through 2014 based on random sampling and found that the process for adjudicating claims met DOL's acceptability standards in any given year. Nonetheless, DOL consistently found deficiencies in certain adjudication steps across all years, including insufficient use of program resources to fully develop claims and improperly written decisions, as GAO also identified in its claim file review. DOL took corrective actions, such as training for claims examiners, to address deficiencies in 2010 through 2012, but determined that corrective actions were not warranted in 2013 and 2014.

What GAO Recommends

GAO recommends that DOL take steps to ensure all decision letters receive supervisory review, and require that claims examiners document that they checked whether the SEM had been updated just prior to issuing a decision to deny a claim. DOL agreed with the recommendations and indicated it would take steps to implement them.