42 CFR § 81.25 - Guidelines for claims including two or more primary cancers.

---
identifier: "/us/cfr/t42/s81.25"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 81.25 - Guidelines for claims including two or more primary cancers."
title_number: 42
title_name: "Public Health"
section_number: "81.25"
section_name: "Guidelines for claims including two or more primary cancers."
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: "2026-03-24"
last_updated: "2026-03-24"
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"
---


# 81.25 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<sub>1</sub>} × {1−PC<sub>2</sub>} × . . . × {1−PC<sub>n</sub>}] = PC<sub>total</sub>,

where PC<sub>1</sub> is the probability of causation for one of the primary cancers identified in the claim, PC<sub>2</sub> is the probability of causation for a second primary cancer identified in the claim, and PC<sub>n</sub> is the probability of causation for the nth primary cancer identified in the claim. PC<sub>total</sub> 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<sub>1</sub>, . . ., PC<sub>n</sub>.
<sup>3</sup> DOL will use the probability of causation value calculated for PC<sub>total</sub> to adjudicate the claim.
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<sup>3</sup> Evaluating Equation 1 based on the individual upper 99th percentiles of PC<sub>1</sub>, . . ., PC<sub>n</sub> approximates the upper 99th percentile of PC<sub>total</sub> whenever PC<sub>1</sub>, . . ., PC<sub>n</sub> are highly related, e.g., when a common dose-reconstruction is the only non-negligible source of uncertainty in the individual PC<sub>i</sub>'s. However, this approximation can overestimate it if other sources of uncertainty contribute independently to the PC<sub>1</sub>, . . ., PC<sub>n</sub>, whereas treating the joint distribution as fully independent could substantially underestimate the upper 99th percentile of PC<sub>total</sub> whenever the individual PC<sub>i</sub>'s are positively correlated.

[67 FR 22309, May 2, 2002; 67 FR 62096, Oct. 3, 2002; 84 FR 37591, Aug. 1, 2019]