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Probability of Causation (PC)

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Once a case is filed under the Energy Employees Occupational Illness Compensation Program Act of 2000 (the Act or EEOICPA; 42 U.S.C. 7384 et seq.) [208 KB (35 pages)], the Department of Labor (DOL) determines whether the employee worked at a covered facility during a covered time period and has a qualifying health condition.

If the qualifying health condition is cancer, DOL sends the case to NIOSH for dose reconstruction. NIOSH returns the case to DOL once it completes the dose reconstruction.

DOL will use the energy employee’s personal characteristics, employment information, medical information, and dose reconstruction results to determine the Probability of Causation (PC)—that is, the likelihood that the worker’s cancer was caused by exposure to radiation during employment.

If the PC is 50% or greater (if the cancer was at least as likely as not caused by their exposure during covered employment), the energy worker (or his or her survivors) is eligible for compensation from DOL: $150,000, plus medical benefits for surviving energy workers for their cancer treatment.

See our page on Calculating the Probability of Causation for more information.

Probability of Causation Final Rule

On May 2, 2002, the Department of Health and Human Services published its final rule on the guidelines the DOL uses to determine the PC. The guidelines rely on well-established science for determining radiation-related cancer risks. The guidelines describe how DOL will use the NIOSH Interactive RadioEpidemiological Program (NIOSH-IREP) to calculate a worker’s PC.

Revision of Guidelines on Non-Radiogenic Cancers

On March 21, 2011, the Department of Health and Human Services (HHS) proposed to treat chronic lymphocytic leukemia (CLL) as a radiogenic cancer under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA or the Act) (76 FR 15268).

CLL is now treated as being potentially caused by radiation and as potentially compensable under the Act. This reverses the earlier decision by HHS to exclude this cancer from consideration. The final rule was published on February 6, 2012. This change became effective on March 7, 2012.

Technical Amendments to the Guidelines for Determining the Probability of Causation

On August 1, 2019, the Department of Health and Human Services (HHS) revised its regulations to update references to the International Classification of Disease (ICD) codes from ICD–9–CM to ICD–10– CM. Outdated references to chronic lymphocytic leukemia were also removed. The regulation became final on January 30, 2020.

These technical amendments have no effect on the cancer eligibility requirement under the Program because all cancer types are eligible to receive a dose reconstruction from NIOSH. Thus, no eligible claimant will be adversely impacted by this rulemaking.

The Rule covers these elements
  1. Data required to estimate PC
    • use of personal and medical information
    • use of radiation dose information
  2. Requirements for risk models used to estimate PC
    • use of cancer risk assessment models in NIOSH-IREP (a program used by DOL to calculate the PC)
    • procedures for updating NIOSH-IREP
  3. Guidelines to estimate PC
    • required use of NIOSH-IREP
    • cancers requiring the use of NIOSH-IREP
    • general guidelines for use of NIOSH-IREP
    • guidelines for cancers for which primary site is unknown
    • guidelines for leukemia
    • guidelines for claims involving two or more primary cancers
    • non-radiogenic cancers

Public Comments on the Probability of Causation Rule

The final Rule on PC went into effect after the public the Advisory Board had the opportunity to comment. Comments can be found on the Public Docket for 42 CFR 81 (Probability of Causation) page of our website.

Frequently Asked Questions (FAQs)

More information on probability of causation can be found on the FAQs: Probability of Causation page of our website.