For claims including two or more primary cancers, DOL will use NIOSH-IREP to calculate the estimated probability of causation for each cancer individually. Then DOL will perform the following calculation using the probability of causation estimates produced by NIOSH-IREP:
Equation 1 Calculate: 1-[{1-PC1{time} x {1-PC2{time} x . . . x {1-PCn{time} ] = PCtotal, where PC1 is the probability of causation for one of the primary cancers identified in the claim, PC2 is the probability of causation for a second primary cancer identified in the claim, and PCn is the probability of causation for the nth primary cancer identified in the claim. PCtotal is the probability that at least one of the primary cancers (cancers 1 through ``n'') was caused by the radiation dose estimated for the claim when Equation 1 is evaluated based on the joint distribution of PC1, . . ., PCn.\4\ DOL will use the probability of causation value calculated for PCtotal to adjudicate the claim.---------------------------------------------------------------------------
\4\ Evaluating Equation 1 based on the individual upper 99th percentiles of PC1, . . ., PCn approximates the upper 99th percentile of PCtotal whenever PC1, . . ., PCn are highly related, e.g., when a common dose-reconstruction is the only non-negligible source of uncertainty in the individual PCi's. However, this approximation can overestimate it if other sources of uncertainty contribute independently to the PC1, . . ., PCn, whereas treating the joint distribution as fully independent could substantially underestimate the upper 99th percentile of PCtotal whenever the individual PCi's are positively correlated. [67 FR 22309, May 2, 2002; 67 FR 62096, Oct. 3, 2002]
Sec. Appendix A to Part 81--Glossary of ICD-9 Codes and Their Cancer
Descriptions \1\ ------------------------------------------------------------------------
ICD-9 code Cancer description------------------------------------------------------------------------140....................................... Malignant neoplasm of lip.141....................................... Malignant neoplasm of
tongue.142....................................... Malignant neoplasm of major
salivary glands.143....................................... Malignant neoplasm of gum.144....................................... Malignant neoplasm of floor
of mouth.145....................................... Malignant neoplasm of other
and unspecified parts of
mouth.146....................................... Malignant neoplasm of
oropharynx.147....................................... Malignant neoplasm of
nasopharynx.148....................................... Malignant neoplasm of
hypopharynx.149....................................... Malignant neoplasm of other
and ill-defined sites
within the lip, oral
cavity, and pharynx.150....................................... Malignant neoplasm of
esophagus.
151....................................... Malignant neoplasm of
stomach.152....................................... Malignant neoplasm of small
intestine, including
duodenum.153....................................... Malignant neoplasm of colon.154....................................... Malignant neoplasm of
rectum, rectosigmoid
junction, and anus.155....................................... Malignant neoplasm of liver
and intrahepatic bile
ducts.156....................................... Malignant neoplasm of gall
bladder and extrahepatic
bile ducts.157....................................... Malignant neoplasm of
pancreas.158....................................... Malignant neoplasm of
retroperitoneum and
peritoneum.159....................................... Malignant neoplasm of other
and ill-defined sites
within the digestive organs
and peritoneum.160....................................... Malignant neoplasm of nasal
cavities, middle ear, and
accessory sinuses.161....................................... Malignant neoplasm of
larynx.162....................................... Malignant neoplasm of
trachea, bronchus and lung.163....................................... Malignant neoplasm of
pleura.164....................................... Malignant neoplasm of
thymus, heart, and
mediastinum.165....................................... Malignant neoplasm of other
and ill-defined sites
within the respiratory
system and intrathoracic
organs.170....................................... Malignant neoplasm of bone
and articular cartilage.171....................................... Malignant neoplasm of
connective and other soft
tissue.172....................................... Malignant melanoma of skin.173....................................... Other malignant neoplasms of
skin.174....................................... Malignant neoplasm of female
breast.175....................................... Malignant neoplasm of male
breast.179....................................... Malignant neoplasm of
uterus, part unspecified.180....................................... Malignant neoplasm of cervix
uteri.181....................................... Malignant neoplasm of
placenta.182....................................... Malignant neoplasm of body
of uterus.183....................................... Malignant neoplasm of ovary
and other uterine adnexa.184....................................... Malignant neoplasm of other
and unspecified female
genital organs.185....................................... Malignant neoplasm of
prostate.186....................................... Malignant neoplasm of
testis.187....................................... Malignant neoplasm of penis
and other male genital
organs.188....................................... Malignant neoplasm of
urinary bladder.189....................................... Malignant neoplasm of kidney
and other unspecified
urinary organs.190....................................... Malignant neoplasm of eye.191....................................... Malignant neoplasm of brain.192....................................... Malignant neoplasm of other
and unspecified parts of
nervous system.193....................................... Malignant neoplasm of
thyroid gland.194....................................... Malignant neoplasm of other
endocrine glands and
related structures.195....................................... Malignant neoplasm of other
and ill-defined sites.196....................................... Secondary and unspecified
malignant neoplasm of the
lymph nodes.197....................................... Secondary malignant neoplasm
of the respiratory and
digestive organs.198....................................... Secondary malignant neoplasm
of other tissue and organs.199....................................... Malignant neoplasm without
specification of site.200....................................... Lymphosarcoma and
reticulosarcoma.201....................................... Hodgkin's disease.202....................................... Other malignant neoplasms of
lymphoid and histiocytic
tissue.203....................................... Multiple myeloma and other
immunoproliferative
neoplasms.204....................................... Lymphoid leukemia205....................................... Myeloid leukemia.206....................................... Monocytic leukemia.207....................................... Other specified leukemia.208....................................... Leukemia of unspecified cell
type.------------------------------------------------------------------------\1\ The International Classification of Diseases Clinical Modification
(9th Revision) Volume I&II.; [1991] Department of Health and Human
Services Publication No. (PHS) 91-1260, U.S. Government Printing
Office, Washington, D.C.