Guidelines for claims including two or more primary cancers.

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−PC 1 } × {1−PC 2 } × . . . × {1−PC n }] = PC total , where PC 1 is the probability of causation for one of the primary cancers identified in the claim, PC 2 is the probability of causation for a second primary cancer identified in the claim, and PC n is the probability of causation for the nth primary cancer identified in the claim. PC total 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 PC 1 , . . ., PC n . 3 DOL will use the probability of causation value calculated for PC total to adjudicate the claim. 3 Evaluating Equation 1 based on the individual upper 99th percentiles of PC 1 , . . ., PC n approximates the upper 99th percentile of PC total whenever PC 1 , . . ., PC n are highly related, e.g., when a common dose-reconstruction is the only non-negligible source of uncertainty in the individual PC i 's. However, this approximation can overestimate it if other sources of uncertainty contribute independently to the PC 1 , . . ., PC n , whereas treating the joint distribution as fully independent could substantially underestimate the upper 99th percentile of PC total whenever the individual PC i 's are positively correlated. [67 FR 22309, May 2, 2002; 67 FR 62096, Oct. 3, 2002; 84 FR 37591, Aug. 1, 2019]