42 CFR § 81.21 - Cancers requiring the use of NIOSH-IREP.

---
identifier: "/us/cfr/t42/s81.21"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 81.21 - Cancers requiring the use of NIOSH-IREP."
title_number: 42
title_name: "Public Health"
section_number: "81.21"
section_name: "Cancers requiring the use of NIOSH-IREP."
chapter_name: "PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "G"
subchapter_name: "OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES"
part_number: "81"
part_name: "GUIDELINES FOR DETERMINING PROBABILITY OF CAUSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 7384n(c); E.O. 13179, 65 FR 77487, 3 CFR, 2000 Comp., p. 321."
regulatory_source: "67 FR 22309, May 2, 2002, unless otherwise noted."
cfr_part: "81"
---


# 81.21 Cancers requiring the use of NIOSH-IREP.

(a) DOL will calculate probability of causation for all cancers using NIOSH-IREP.

(b) Carcinoma in situ (ICD-10-CM codes D00-D09), neoplasms of uncertain behavior (ICD-10-CM codes D37-D44 and D48), and neoplasms of unspecified nature (ICD-10-CM code D49) are assumed to be malignant, for purposes of estimating probability of causation.

(c) All secondary and unspecified cancers of the lymph node (ICD-10-CM codes C77 and C7B.01) shall be considered secondary cancers (cancers resulting from metastasis of cancer from a primary site). For claims identifying cancers of the lymph node, Table 1 in § 81.23(a) provides guidance for assigning a primary site and calculating probability of causation using NIOSH-IREP.

[84 FR 37590, Aug. 1, 2019]