Regulations
Title 42, Part 88 of the Code of Federal Regulations (42 C.F.R. Part 88)
Congress passed the James Zadroga 9/11 Health and Compensation Act of 2010 (Zadroga Act) (PDF, 45 pages) , which was signed by President Barack Obama on January 2, 2011, as Public Law 111-347. The Zadroga Act amends the Public Health Service Act and establishes the WTC Health Program within the Department of Health and Human Services. The Zadroga Act directed the Administrator of the WTC Health Program to establish by regulation certain Program procedures, including enrollment and appeals processes. WTC Health Program regulations are found in Title 42, Part 88 of the Code of Federal Regulations and are reprinted below:
§ 88.1 Definitions.
§ 88.2 General provisions.
§ 88.3 Eligibility — currently identified responders.
§ 88.4 Eligibility criteria — WTC responders.
§ 88.5 Application process — WTC responders.
§ 88.6 Enrollment decision — WTC responders.
§ 88.7 Eligibility — currently identified survivors.
§ 88.8 Eligibility criteria — WTC survivors.
§ 88.9 Application process — WTC survivors.
§ 88.10 Enrollment decision — screening-eligible survivors.
§ 88.11 Initial health evaluation for screening-eligible survivors.
§ 88.12 Enrollment decision — certified-eligible survivors.
§ 88.13 Disenrollment.
§ 88.14 Appeal of enrollment or disenrollment decision.
§ 88.15 List of WTC-Related Health Conditions.
WTC-related health conditions include the following disorders and conditions:
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Aerodigestive disorders:
- Interstitial lung diseases.
- Chronic respiratory disorder--fumes/vapors.
- Asthma.
- Reactive airways dysfunction syndrome (RADS).
- WTC-exacerbated and new-onset chronic obstructive pulmonary disease (COPD).
- Chronic cough syndrome.
- Upper airway hyperreactivity.
- Chronic rhinosinusitis.
- Chronic nasopharyngitis.
- Chronic laryngitis.
- Gastroesophageal reflux disorder (GERD).
- Sleep apnea exacerbated by or related to a condition described in preceding paragraphs (a)(1) through (11) of this section.
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Mental health conditions:
- Posttraumatic stress disorder (PTSD).
- Major depressive disorder.
- Panic disorder.
- Generalized anxiety disorder.
- Anxiety disorder (not otherwise specified).
- Depression (not otherwise specified).
- Acute stress disorder.
- Dysthymic disorder.
- Adjustment disorder.
- Substance abuse.
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Musculoskeletal disorders:
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WTC-related musculoskeletal disorder is a chronic or recurrent disorder of the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring during rescue or recovery efforts in the New York City disaster area in the aftermath of the September 11, 2001, terrorist attacks. For a WTC responder who received any treatment for a WTC-related musculoskeletal disorder on or before September 11, 2003, such a health condition includes:
- Low back pain.
- Carpal tunnel syndrome (CTS).
- Other musculoskeletal disorders.
- [Reserved].
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WTC-related musculoskeletal disorder is a chronic or recurrent disorder of the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring during rescue or recovery efforts in the New York City disaster area in the aftermath of the September 11, 2001, terrorist attacks. For a WTC responder who received any treatment for a WTC-related musculoskeletal disorder on or before September 11, 2003, such a health condition includes:
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Cancers:
- Malignant neoplasms of the lip; tongue; salivary gland; floor of mouth; gum and other mouth; tonsil; oropharynx; hypopharynx; and other oral cavity and pharynx.
- Malignant neoplasm of the nasopharynx.
- Malignant neoplasms of the nose; nasal cavity; middle ear; and accessory sinuses.
- Malignant neoplasm of the larynx.
- Malignant neoplasm of the esophagus.
- Malignant neoplasm of the stomach.
- Malignant neoplasms of the colon and rectum.
- Malignant neoplasms of the liver and intrahepatic bile duct.
- Malignant neoplasms of the retroperitoneum and peritoneum; omentum; and mesentery.
- Malignant neoplasms of the trachea; bronchus and lung; heart, mediastinum and pleura; and other ill-defined sites in the respiratory system and intrathoracic organs.
- Mesothelioma.
- Malignant neoplasms of the peripheral nerves and autonomic nervous system; and other connective and soft tissue.
- Malignant neoplasms of the skin (melanoma and non-melanoma), including scrotal cancer.
- Malignant neoplasm of the female breast.
- Malignant neoplasms of corpus uteri and uterus, part unspecified.
- Malignant neoplasm of the prostate.
- Malignant neoplasm of the urinary bladder.
- Malignant neoplasm of the kidney.
- Malignant neoplasms of the renal pelvis; ureter; and other urinary organs.
- Malignant neoplasms of the eye and orbit.
- Malignant neoplasm of the thyroid.
- Malignant neoplasms of the blood and lymphoid tissues (including, but not limited to, lymphoma, leukemia, and myeloma).
- Childhood cancers: any type of cancer diagnosed in a person less than 20 years of age.
- Rare cancers: any type of cancer* that occurs in less than 15 cases per 100,000 persons per year in the United States.
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Acute traumatic injuries:
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WTC-related acute traumatic injury is physical damage to the body caused by and occurring immediately after a one-time exposure to energy, such as heat, electricity, or impact from a crash or fall, resulting from a specific event or incident. For a WTC responder or screening-eligible or certified-eligible survivors who received any medical treatment for a WTC-related acute traumatic injury on or before September 11, 2003, such a health condition includes:
- Eye injury.
- Burn.
- Head trauma.
- Fracture.
- Tendon tear.
- Complex sprain.
- Other similar acute traumatic injuries.
- [Reserved]
* Based on 2005-2009 average annual data age-adjusted to the 2000 U.S. population. See Glenn Copeland, Andrew Lake, Rick Firth, et al. (eds), Cancer in North America: 2005-2009. Volume One: Combined Cancer Incidence for the United States, Canada and North America, Springfield, IL: North American Association of Central Cancer Registries, Inc., June 2012.
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WTC-related acute traumatic injury is physical damage to the body caused by and occurring immediately after a one-time exposure to energy, such as heat, electricity, or impact from a crash or fall, resulting from a specific event or incident. For a WTC responder or screening-eligible or certified-eligible survivors who received any medical treatment for a WTC-related acute traumatic injury on or before September 11, 2003, such a health condition includes:
§ 88.16 Addition of health conditions to the List of WTC-Related Health Conditions.
§ 88.17 Physician’s determination of WTC-related health conditions.
§ 88.18 Certification.
§ 88.19 Decertification.
§ 88.20 Authorization of treatment.
§ 88.21 Appeal of certification, decertification, or treatment authorization decision.
§ 88.22 Reimbursement for medical treatment and services.
§ 88.23 Appeal of reimbursement denial.
§ 88.24 Coordination of benefits and recoupment.
§ 88.25 Reopening of WTC Health Program final decisions.
Federal Register Notices
The WTC Health Program makes changes to the regulations above by first publishing a notice in the Federal Register that contains both an explanation of the changes and the new regulatory text (this is a notice of proposed rulemaking or an interim final rule*). When a Federal Register notice is published, the public is given an opportunity to offer comments.
After the Program considers those comments, another Federal Register notice is published, finalizing the changes and responding to the public comments (this is a final rule). Once a final rule or an interim final rule* is published, the regulations above are changed to reflect the changes.
*If the Program decides it is in the best interest of the public to issue a rule quickly, an interim final rule will be published. In this case, the Program does not have to wait to receive and respond to public comment for the rule to be effective–an interim final rule is effective once it is published. The public is still given the opportunity to comment but the opportunity occurs at the same time the interim final rule is effective. After the Program considers the comments, it publishes a response to the comments and adjusts the rule accordingly, making it a final rule. In some cases, the publication of a final rule might occur months or years after the interim final rule is published. In those cases, the interim rule is considered final.
Listed below are the Federal Register notices that contain discussions of each of the Part 88 provisions and answer comments submitted by the public:
Note: Notices are listed in the order they were published with the most recent notices at the top of the list.
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Addition of Uterine Cancer to the List of WTC-Related Health Conditions (RIN 0920–AA82)
Final Rule
https://www.govinfo.gov/content/pkg/FR-2023-01-18/pdf/2023-00645.pdf (PDF, 14 pages, 386 KB)
Notice of Proposed Rulemaking
Federal Register, Vol. 88, No. 11
Page: 2845-2858
Published: January 18, 2023
https://www.govinfo.gov/content/pkg/FR-2022-05-10/pdf/2022-09708.pdf (PDF, 11 Pages, 352 KB)
Federal Register, Vol. 87, No. 90
Pages: 027961 - 27971
Published: May 10, 2022
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Amendments to Definitions, Appeals, and Other Requirements
Final Rule
https://www.gpo.gov/fdsys/pkg/FR-2016-12-15/pdf/2016-29957.pdf (PDF, 22 Pages, 299 KB)
Federal Register, Vol. 81, No. 241
Pages: 90926-90947
Published: December 15, 2016
Effective Date: January 17, 2017
Notice of Proposed Rulemaking
https://www.gpo.gov/fdsys/pkg/FR-2016-08-17/pdf/2016-18679.pdf (PDF, 19 Pages, 290 MB)
Federal Register, Vol. 81, No. 159
Pages: 55086-11204
Published: August 17, 2016
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Addition of New-Onset Chronic Obstructive Pulmonary Disease and Acute Traumatic Injury to the List of WTC-Related Health Conditions
Final Rule
https://www.gpo.gov/fdsys/pkg/FR-2016-07-05/pdf/2016-15799.pdf (PDF, 1 Pages, 316 KB)
Federal Register, Vol. 81, No. 128
Pages: 43510-43523
Published: July 5, 2016
Effective date: August 4, 2016
Additional information:
Peer Review Comments on New-Onset Chronic Obstructive Pulmonary Disease
https://www.regulations.gov/document?D=CDC-2015-0063-0020
Peer Reviewers:-
Philip Harber, M.D., M.P.H.
University of Arizona
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David M. Mannino, M.D.
University of Kentucky
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Carrie A. Redlich, M.D., M.P.H.
Yale School of Medicine
Peer Review Comments on Acute Traumatic Injury
https://www.regulations.gov/document?D=CDC-2015-0063-0021
Peer Reviewers:-
David Bonauto, M.D., M.P.H.
Washington State Department of Labor and Industries
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Sue Mallonee
Independent Consultant
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David L. Parker, M.D.
Park Nicollet Health Research
Notice of Proposed Rulemaking
http://www.gpo.gov/fdsys/pkg/FR-2015-09-11/pdf/2015-22599.pdf (PDF, 15 Pages, 321 KB)
Federal Register, Vo. 80, No. 176
Pages: 54746-54760
Published: September 11, 2015
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Philip Harber, M.D., M.P.H.
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Amendments to List of WTC-Related Health Conditions; Cancer; Revision (RIN 0920–AA50)
Interim Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2014-02-18/pdf/2014-03370.pdf (PDF, 18 Pages, 309 KB)
Federal Register, Vol. 79, No. 32
Pages: 9100-9117
Published: February 18, 2014
Effective date: February 18, 2014
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Addition of Prostate Cancer to the List of WTC-Related Health Conditions (RIN 0920–AA54)
Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2013-09-19/pdf/2013-22800.pdf (PDF, 19 Pages, 1.9 MB)
Federal Register, Vol. 78, No. 182
Pages: 57505-57523
Published: September 19, 2013
Effective date: October 21, 2013
Notice of Proposed Rulemaking
http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15816.pdf (PDF, 22 Pages, 1 MB)
Federal Register, Vo. 78, No. 127
Pages: 39670-39691
Published: July 2, 2013
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Eligibility Requirements for Shanksville, Pennsylvania and Pentagon Responders (RIN 0920-AA48)
Interim Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2013-03-28/pdf/2013-07146.pdf (PDF, 11 Pages, 262 KB)
Federal Register, Vol. 78, No. 60
Pages: 18855-18865
Published: March 28, 2013
Effective date: May 1, 2013
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Addition of Certain Types of Cancer to the List of WTC-Related Health Conditions (RIN 0920-AA49)
Final Rule Correction
http://www.gpo.gov/fdsys/pkg/FR-2012-10-12/pdf/2012-25142.pdf (PDF, 10 Pages, 1.5 MB)
Federal Register, Vol. 77, No. 198
Pages: 62167-62176
Published: October 12, 2012
Effective date: October 12, 2012
Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2012-09-12/pdf/2012-22304.pdf (PDF, 34 Pages, 9.9 MB)
Federal Register, Vol. 77, No. 177
Pages: 56138-56168
Published: September 12, 2012
Effective date: October 12, 2012
Proposed Rule
http://www.gpo.gov/fdsys/pkg/FR-2012-06-13/pdf/2012-14203.pdf (PDF, 42 Pages, 3.9 MB)
Federal Register, Vol. 77, No. 114,
Pages: 35574-35615
Published: June 13, 2012
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Requirements for the Addition of New WTC-Related Health Conditions (RIN 0920-AA45)
Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2012-04-25/pdf/2012-9425.pdf (PDF, 5 Pages, 211 KB)
Federal Register, Vol. 77, No. 80
Pages: 24628-24632
Published: April 25, 2012
Effective date: May 25, 2012
Proposed Rule
http://www.gpo.gov/fdsys/pkg/FR-2011-07-01/pdf/2011-16511.pdf (PDF, 5 Pages, 144 KB)
Federal Register, Vol. 76, No. 127
Pages: 38938-38942
Published: July 1, 2011
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Requirements for Enrollment, Appeals, Certification of Health Conditions, and Reimbursement (RIN 0920-AA44)
Interim Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2011-07-01/pdf/2011-16488.pdf (PDF,23 Pages, 223 KB
Federal Register, Vol. 76, No. 127
Pages: 38914-38936
Published: July 1, 2011
Effective date: July 1, 2011