Energy Employees Compensation:
Additional Independent Oversight and Transparency Would Improve Program's Credibility
GAO-10-302, Mar 22, 2010
Congress passed the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) in 2000 to compensate Department of Energy (Energy) workers for illnesses stemming from exposure to hazardous substances while working in the atomic weapons industry. Part B of the act provides a lump-sum payment and medical coverage for certain illnesses, while Part E compensates for impairments and lost wages resulting from exposure to toxins. The Department of Labor (Labor) adjudicates all claims and is assisted by the National Institute for Occupational Safety and Health (NIOSH) and Energy. GAO examined (1) claim-processing time, (2) costs of administering the program, (3) extent to which there are quality controls to ensure that claim determinations are supported with objective and scientific information, and (4) actions taken by agencies to promote program transparency for claimants. GAO obtained data on cost and claims processing from Labor and NIOSH, and interviewed agency officials, experts, and claimant advocates.
Cases that do not require dose reconstruction can take about a year to adjudicate, but those that do can take a total of 3 or more years. Such cases require an extensive scientific process to "reconstruct'" the historical evidence on exposure, and this has made dose reconstruction the primary reason for lengthier processing times. The availability of claimant data and the need to rework some cases in view of new claimant information or changes to scientific methodologies involved in determining exposures can also affect processing times. Meanwhile, Labor and NIOSH have each developed ways to expedite case processing. The administrative cost of EEOICPA reflects the requirements of a complex, science-based adjudication process. In 2008 this cost amounted to $106 million for the Part B program and almost $57 million for Part E. Administrative costs have averaged about 20 percent of the total program cost for Part B and 14 percent for Part E. A substantial factor underlying the greater administrative cost of the Part B program is dose reconstruction, which was required for about a third of all Part B cases. Quality controls in the form of multiple internal reviews are in place for both Part B and E programs. However, only the Part B program employs external expert reviews, required by statute, which provide independent verification of the work. EEOICPA does not specifically require external review of the Part E program. As a result, Labor's processes related to the adjudication of Part E cases, in particular, are not informed by any independent expertise outside the agency' s purview. For example, though Labor employs a contractor and a small team of internal experts to update its Part E database of work sites, toxins, and their associated diseases, the composition of this database lacks external review to ensure that it is as comprehensive and scientifically sound as possible. In addition, there is no oversight or independent review to ensure the quality of consultant physicians' work for Part E. The agencies have taken various steps to assist claimants and make more program information public; however, program transparency remains somewhat limited, in part because of national security considerations. NIOSH has worked with Energy to clear information for publication in the site profiles developed for use in reconstructing doses for Part B cancer claims. However, Labor has not taken similar steps with Energy to release data in the site exposure matrix used to adjudicate Part E claims. Meanwhile, NIOSH has established an ombudsman to help Part B claimants with their claims. While the act established an ombudsman within the Department of Labor, GAO found that Labor does not respond publicly to his annual reports on claimant concerns. As a result, claimants have little knowledge that their concerns are heard or that they are being addressed.
- Review Pending
- Closed - implemented
- Closed - not implemented
Recommendations for Executive Action
Recommendation: To enhance oversight and transparency of EEOICP, the Secretary of Labor should develop formal action plans, within Labor's scope of authority, in response to the Labor Ombudsman's reports regarding major claimant concerns and make the plans and updates on their subsequent status publicly available. One such plan should offer Labor's response to the Ombudsman's reports about consistent problems with customer service.
Agency Affected: Department of Labor
Status: Closed - Implemented
Comments: The Department of Labor's Division of Energy Employees Occupational Illness Compensation (DEEOIC) issued a formal response to the March 4, 2010 Ombudsman's report, though the response was not made publicly available. In some instances, DEEOIC articulated an action plan to address the Ombudsman's comments. For example, in response to the Ombudsman's comment about problems with customer service, DEEOIC outlined efforts to conduct a survey to assess claimant satisfaction with the claims process. This survey was mailed to 5,000 claimants on March 17, 2010 and DEEOIC plans to make survey results publicly available. In other instances, the agency's responses to the Ombudsman's comments generally reiterated existing policies and practices or sought specific recommendations for improvement from the Ombudsman. In FY12, OWCP reported that it has begun providing a formal response to the Ombudsman's Annual Report to Congress, with the hope that issues involving customer service complaints can be resolved expediently.
Recommendation: To enhance oversight and transparency of EEOICP, the Secretary of Labor should establish a formal agreement and action plan with the Secretary of Energy to release more information, where appropriate, in the site exposure matrix database in order to allow greater public access and input. In doing so, Labor should actively seek additional information from worker representatives and site experts about job descriptions, processes, and potential exposure.
Agency Affected: Department of Labor
Status: Closed - Implemented
Comments: The Departments of Labor and Energy have taken concrete steps toward implementing this recommendation. As of September 18, 2010 the Department of Energy (DOE) had authorized release of more detailed information, including buildings, processes, labor categories, and related occupational illness associations, for 68 DOE sites and all uranium mining and milling facilities in the Department of Labor's Site Exposure Matrices (SEM). The detailed information for 29 DOE sites is still undergoing DOE review. Both agencies are currently working to establish a schedule for additional SEM data publication. Although DOL has made substantial progress, not all of the information related to each site has been reviewed. In FY12, the agency reported that the SEM, now available to the public in its entirety, was last updated in June 2011. The information listed in the public SEM database lags the DOL SEM database by six months so DOE can review all new information for security purposes before it is made public. OWCP will be updating the public SEM database every six months.
Recommendation: To enhance oversight and transparency of EEOICP, the Secretary of Labor should strengthen the quality control measures in place for Part B lung disease claims and Part E processes with independent reviews. Such measures should include, for example, instituting periodic peer reviews of sampled reports by Part E consulting physicians, arranging for technical review of detailed information in the site exposure matrix, and obtaining periodic expert review of medical evidentiary requirements for the Part B claims related to lung diseases.
Agency Affected: Department of Labor
Comments: The Department of Labor's Division of Energy Employees Occupational Illness Compensation (DEEOIC) plans to engage an external scientific entity to conduct a study of its Site Exposure Matrices (SEM) to ensure SEM data integrity and strengthen the scientific rigor of the data compilation methodology. DEEOIC also plans to hire a new Medical Director responsible for assembling a network of nationally recognized specialists to help review complex cases and streamline medical evidentiary requirements for lung diseases. As of May 2010, however, DEEOIC had not outlined any plans for providing peer review of medical consultants' work nor expert review of medical evidentiary requirements for lung disease. In FY12, OWCP reported that it is restructuring its contract with District Medical Consultants (DMCs) to provide DEEOIC with medical consultants through one vendor. This contract will require the company to conduct audits on medical reports for consistency, provide a mechanism for obtaining in-person second opinion medical examinations, and enhance the quality of reports overall. In addition, OWCP is contracting with the National Institute of Medicine to review the SEM database to ensure that the information reflects the most current and accurate scientific evidence. At the end of the contract period, they will provide OWCP with a report including recommendations for any changes that result from their study. Labor needs to complete these efforts and ensure quality control of reports prepared by consulting physicians and expert review of the requirements.
Matter for Congressional Consideration
Matter: To enhance oversight of claims adjudication under Part E of EEOICPA, Congress may wish to consider amending the act to establish an independent review board for Part E, similar to the Advisory Board on Radiation and Worker Health established under Part B of the program. Such an independent board could review and report on the scientific soundness of Labor's implementation of Part E, including the site exposure matrix, guidance provided to claims examiners on medical evidence, and Part E probability of causation standards for radiation-related cancers. In creating such an independent board, it would be critical to develop appropriate provisions regarding its funding structure, appointment of members, and staff support. Our 2007 report on the Part B Advisory Board highlighted challenges that these three areas had presented to the board's independence and identified various options to enhance board independence in each area.
Comments: Congress has not passed any amendments to the Energy Employees Occupational Illness Compensation Program Act.