Energy Employees Compensation: Adjustments Made to Contracted	 
Review Process, But Additional Oversight and Planning Would Aid  
the Advisory Board in Meeting Its Statutory Responsibilities	 
(10-FEB-06, GAO-06-177).					 
                                                                 
For the last several decades, the Department of Energy and its	 
predecessor agencies and contractors have employed thousands of  
individuals in secret and dangerous work in the atomic weapons	 
industry. In 2000, Congress enacted the Energy Employees	 
Occupational Illness Compensation Program Act to compensate those
individuals who have developed cancer or other specified diseases
related to on-the-job exposure to radiation and other hazards at 
these work sites. Under Subtitle B, determining the eligibility  
of claimants for compensation is a complex process, involving	 
several federal agencies and a reconstruction of the historical  
evidence available. The Department of Labor must consider a	 
claimant's case based on records of his or her employment and	 
work activities, which are provided by the Department of Energy. 
Labor considers the compensability of certain claims by relying  
on estimates of the likely radiation levels to which particular  
workers were exposed. These "dose reconstructions" are developed 
by the National Institute for Occupational Safety and Health	 
(NIOSH) under the Department of Health and Human Services (HHS). 
NIOSH also compiles information in "site profiles" about the	 
radiation protection practices and hazardous materials used at	 
various plants and facilities, which helps complete the dose	 
reconstructions. Because certain facilities are known to have	 
exposed employees to radiation while keeping few records of	 
individuals' exposure, their employees have been designated under
the law as members of a "special exposure cohort," and their	 
claims may be paid without individual dose reconstructions. The  
law also allows the Secretary of HHS to add additional groups of 
employees to the special exposure cohort. For quality control and
to raise public confidence in the fairness of the claims process,
the compensation act also created a citizen's advisory board of  
scientists, physicians, and employee representatives--the	 
President's Advisory Board on Radiation and Worker Health.	 
Members of the board serve part-time and the board has limited	 
staff support. The advisory board is tasked to review the	 
scientific validity and quality of NIOSH's dose reconstructions  
and advise the Secretary of HHS. The board has the flexibility to
determine the scope and methodology for this review. We assessed 
how well the advisory board's review and the contracted work with
SC&A are proceeding. We focused on three questions: (1) Are the  
roles of key federal officials involved in the review of NIOSH's 
dose reconstructions sufficiently independent to assure the	 
objectivity of the review? (2) Have the agency's management	 
controls and the advisory board's oversight been sufficient to	 
ensure that the contract to review site profiles and dose	 
reconstructions is adequately carried out? and (3) Is the	 
advisory board using the contractor's expertise in reviewing	 
special exposure cohort petitions?				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-177 					        
    ACCNO:   A46677						        
  TITLE:     Energy Employees Compensation: Adjustments Made to       
Contracted Review Process, But Additional Oversight and Planning 
Would Aid the Advisory Board in Meeting Its Statutory		 
Responsibilities						 
     DATE:   02/10/2006 
  SUBJECT:   Claims processing					 
	     Employees						 
	     Independent contractors				 
	     Internal controls					 
	     Occupational safety				 
	     Performance appraisal				 
	     Program evaluation 				 
	     Program management 				 
	     Radiation exposure hazards 			 
	     Workers compensation				 
	     Eligibility criteria				 
	     Eligibility determinations 			 
	     Energy Employees Occupational Illness		 
	     Compensation Program				 
                                                                 

******************************************************************
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GAO-06-177

     

     * Summary of Findings
     * Conclusions
     * Recommendations for Executive Action
     * Agency and Other Comments and Our Evaluation
     * GAO Contact:
     * Staff Acknowledgements:
     * GAO's Mission
     * Obtaining Copies of GAO Reports and Testimony
          * Order by Mail or Phone
     * To Report Fraud, Waste, and Abuse in Federal Programs
     * Congressional Relations
     * Public Affairs

                 United States Government Accountability Office

GAO

                    the Judiciary, House of Representatives

February 2006

ENERGY EMPLOYEES COMPENSATION

  Adjustments Made to Contracted Review Process, But Additional Oversight and
Planning Would Aid the Advisory Board in Meeting Its Statutory Responsibilities

GAO-06-177

Contents

Letter 1
Summary of Findings 3
Conclusions 5
Recommendations for Executive Action 6
Agency and Other Comments and Our Evaluation 6

Appendix I Briefing Slides

Appendix II Comments from the Department of Health & Human Services

Appendix III Comments from S. Cohen & Associates

Appendix IV GAO Contact and Staff Acknowledgments

Related GAO Products

Abbreviations

    CDC             Centers for Disease Control and Prevention               
    EEOICPA         Energy Employees Occupational Illness Compensation       
                    Program Act                                              
    FACA            Federal Advisory Committee Act                           
    HHS             Department of Health and Human Services                  
    NIOSH           National Institute for Occupational Safety and Health    
    OCAS            Office of Compensation Analysis and Support              
    ORAU            Oak Ridge Associated Universities                        
    PGO             Procurement and Grants Office                            
    SC&A            Sanford Cohen & Associates                               

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
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separately.

United States Government Accountability Office Washington, DC 20548

February 10, 2006

The Honorable F. James Sensenbrenner, Jr. Chairman Committee on the
Judiciary House of Representatives

Dear Mr. Chairman:

For the last several decades, the Department of Energy and its predecessor
agencies and contractors have employed thousands of individuals in secret
and dangerous work in the atomic weapons industry. In 2000, Congress
enacted the Energy Employees Occupational Illness Compensation Program Act
to compensate those individuals who have developed cancer or other
specified diseases related to on-the-job exposure to radiation and other
hazards at these work sites. Under Subtitle B, determining the eligibility
of claimants for compensation is a complex process, involving several
federal agencies and a reconstruction of the historical evidence
available. The Department of Labor must consider a claimant's case based
on records of his or her employment and work activities, which are
provided by the Department of Energy. Labor considers the compensability
of certain claims by relying on estimates of the likely radiation levels
to which particular workers were exposed. These "dose reconstructions" are
developed by the National Institute for Occupational Safety and Health
(NIOSH) under the Department of Health and Human Services (HHS). NIOSH
also compiles information in "site profiles" about the radiation
protection practices and hazardous materials used at various plants and
facilities, which helps complete the dose reconstructions. Because certain
facilities are known to have exposed employees to radiation while keeping
few records of individuals' exposure, their employees have been designated
under the law as members of a "special exposure cohort," and their claims
may be paid without individual dose reconstructions. The law also allows
the Secretary of HHS to add additional groups of employees to the special
exposure cohort.

For quality control and to raise public confidence in the fairness of the
claims process, the compensation act also created a citizen's advisory
board of scientists, physicians, and employee representatives-the
President's Advisory Board on Radiation and Worker Health. Members of the
board serve part-time and the board has limited staff support. The
advisory board is tasked to review the scientific validity and quality of
NIOSH's dose reconstructions and advise the Secretary of HHS. The board
has the flexibility to determine the scope and methodology for this
review. In addition, the advisory board is tasked with reviewing NIOSH's
evaluation of petitions for special exposure cohort status and
recommending whether such status should be granted. To facilitate the
advisory board's review, HHS awarded a 5-year $3 million contract to
Sanford Cohen & Associates (SC&A) in October 2003 to perform a variety of
tasks, such as examining selected site profiles and a sample of dose
reconstructions. The contract awarded was an indefinite-delivery,
indefinite-quantity type of contract, which establishes the basic terms of
the contract but then allows the advisory board to develop specific task
orders requiring the contractor to complete certain tasks within specified
time frames and budgets. SC&A is to be reimbursed for its costs and
receive an additional fixed fee. However, this effort has been marked by
delays and higher than originally anticipated costs and some concerns over
the roles of the federal officials assigned by the Secretary of HHS to
oversee this work. Because citizen advisory bodies do not have direct
authority to spend federal monies, the government is responsible for
awarding and managing support contracts. Insofar as the charge of the
advisory board has been not merely to advise but to review the scientific
validity and quality of NIOSH's work, there could potentially be a
conflict of roles for agency officials responsible for the program under
review if they also oversee the contract work or assist the advisory
board. In addition, there are congressional concerns about whether the
advisory board is using the contractor's expertise as the board evaluates
special exposure cohort petitions.

There is another contractor-Oak Ridge Associated Universities (ORAU)-that
also plays an important role in the Energy Employees Occupational Illness
Compensation Program. In September 2002, NIOSH awarded a 5-year contract
to ORAU to support NIOSH in performing its responsibilities related to the
program, such as developing site profiles and performing dose
reconstructions. About $70 million was originally allocated to this
contract, but this figure had increased to over $200 million by 2004.

We assessed how well the advisory board's review and the contracted work
with SC&A are proceeding. We focused on three questions: (1) Are the roles
of key federal officials involved in the review of NIOSH's dose
reconstructions sufficiently independent to assure the objectivity of the
review? (2) Have the agency's management controls and the advisory board's
oversight been sufficient to ensure that the contract to review site

                              Summary of Findings

profiles and dose reconstructions is adequately carried out? and (3) Is
the advisory board using the contractor's expertise in reviewing special
exposure cohort petitions?

To perform our review, we analyzed pertinent contract-related materials,
including the contract; monthly progress reports submitted by the
contractor; minutes of advisory board meetings; special exposure cohort
regulations; and correspondence between the contractor, agency, and
advisory board. In addition, we interviewed agency officials, contractor
officials, and advisory board members, and also attended meetings of the
advisory board. The scope of our work did not include examining NIOSH's
contract with ORAU. We conducted our review from March 2005 to November
2005 in accordance with generally accepted government auditing standards.
On December 13, 2005, we briefed your office on the results of our work
(see app. I). This report conveys the information provided at that
briefing, as updated to reflect changes we made in response to comments
received on a draft of this report.

The roles of certain key federal officials initially involved in the
advisory board's review of the dose reconstructions may not have been
sufficiently independent and actions were taken to replace these
officials. Nonetheless, continued diligence by HHS is required to prevent
such problems from recurring as new candidates are considered for these
roles. Initially, the project officer assigned responsibility for
reviewing the monthly progress reports and monitoring the technical
performance of the contractor was also a manager of the NIOSH dose
reconstruction program being reviewed. In addition, the designated federal
officer for the advisory board, who is responsible for scheduling and
attending board meetings, was the director of the dose reconstruction
program being reviewed. In response to concerns about the appearance of
conflicting roles, the director of NIOSH replaced both of these officials
in December 2004 with a senior NIOSH official not involved in the NIOSH
program under review. The contractor and members of the board told us that
implementation of the contract improved after these replacements were
made. With regard to structural independence, we found it appropriate that
the contracting officers, who are responsible for managing the contract on
behalf of the advisory board, have been federal officials with the Centers
for Disease Control and Prevention (CDC), NIOSH's parent agency. The
contracting officers do not have responsibilities for the NIOSH program
under review and are not accountable to its managers. Members of the
advisory board helped facilitate the independence of the contractor's work
by playing the leading role in developing and approving the initial
statement of work for the contractor and the independent cost estimate for
the contract.

The progress of the contracted review of NIOSH's site profiles and dose
reconstructions has been hindered by the complexity of the work.
Specifically, in the first 2 years, the contractor spent almost 90 percent
of the $3 million that had been allocated to the contract for a 5-year
undertaking. Various adjustments have been made in the review approach in
light of the identified complexities, which were not initially understood.
However, further improvements could be made in the oversight and planning
of the review process. First, the contractor's expenditure levels were not
adequately monitored by the agency in the initial months and the
contractor's monthly progress reports did not provide sufficient details
on the level of work completed compared to funds expended. The monthly
report for each individual task order was subsequently revised to provide
more details but developing more integrated data across the various tasks
could further improve the board's ability to track the progress of the
overall review. Second, while the advisory board has made mid-course
adjustments to the contractor's task orders and review procedures, the
board has not comprehensively reexamined its long-term plan for the
overall project. The board revised the task orders for the contractor
several times, in part to reflect adjustments made as the board gained a
deeper understanding of the needs of the project. Nonetheless, the board
has not reexamined its original plan for the total number of site profile
and dose reconstruction reviews needed, and the time frames and funding
levels for completing them. Third, there is still a gap with regard to
management controls for the resolution of the findings and recommendations
that emerge from SC&A's review. The advisory board developed a six-step
resolution process to help resolve technical issues between the contractor
and NIOSH, and this process uses matrices to track the findings and
recommendations of the contractor and advisory board. However, NIOSH
currently lacks a system for documenting that changes it agrees to make as
part of this resolution process are implemented.

With regard to reviewing special exposure cohort petitions, the advisory
board has asked for and received the contractor's assistance, expanded its
charge, and acknowledged the need for the board to review the petitions in
a timely manner. The board has reviewed eight petitions as of October
2005, and the contractor assisted with six of these by reviewing the site
profiles associated with the facilities. The contractor will play an
expanded role by reviewing some of the other submitted petitions and
NIOSH's evaluation of those petitions and recommending to the advisory

                                  Conclusions

board whether the petitioning group should be added to the special
exposure cohort. The contractor will also develop procedures for the
advisory board to use when reviewing petitions. While NIOSH is generally
required by law to complete its review of a petition within 180 days of
determining that the petition has met certain initial qualification
requirements, the advisory board has no specified deadline for its review
of petitions. However, the board has discussed the fact that special
exposure cohort petition reviews have required more time and effort than
originally estimated and that the advisory board needs to manage its
workload in order to reach timely decisions.

Credibility is essential to the work of the advisory board and the
contractor, and actions were taken in response to initial concerns about
the independence of federal officials in certain key roles. Nonetheless,
it is important for HHS to continue to be diligent in avoiding actual or
perceived conflicts of roles as new candidates are considered for these
roles over the life of the advisory board.

The advisory board's review of site profiles and dose reconstructions has
presented a steep learning curve for the various parties involved. These
experiences have prompted the board to make various adjustments to the
contractor's work that are intended to better meet the needs of the
review, such as the establishment of a formal six-step resolution process
that increases transparency. Nonetheless, further improvements could be
made to the oversight and planning of the contracted review. Even though
the advisory board has made numerous midcourse adjustments to the work of
the contractor, the board has not comprehensively reexamined its long-term
plan for the project to determine whether the plan needs to be modified in
light of the knowledge gained over the past few years. In addition, while
the contractor's monthly reports were modified to provide more detailed
expenditure data, the lack of integrated and comprehensive data across the
various tasks makes it more difficult for the advisory board to track the
progress of the overall review or make adjustments to funding or
deliverables across tasks. Finally, without a system to track the actions
taken by NIOSH in response to the findings and recommendations of the
advisory board and contractor, there is no assurance that any needed
improvements are being made.

Recommendations for Executive Action

We are making three recommendations to the Secretary of HHS.

To assist the advisory board meet its statutory responsibilities, we
recommend that the Secretary of HHS

(1)
           direct the contracting and project officers to develop and share
           with the advisory board more integrated and comprehensive data on
           contractor spending levels compared to work completed and

(2)
           consider the need for providing HHS staff to collect and analyze
           pertinent information that would help the advisory board
           comprehensively reexamine its long-term plan for assessing the
           NIOSH site profiles and dose reconstructions.

To ensure that the findings and recommendations of the advisory board and
the contractor are promptly resolved, we recommend that the Secretary of
HHS direct the Director of NIOSH to establish a system to track the
actions taken by the agency in response to these findings and
recommendations and update the advisory board periodically on the status
of such actions.

Agency and Other Comments and Our Evaluation

We provided a draft of this report to HHS, the contractor, and all the
members of the advisory board for comment. We received comments from HHS,
the contractor, and four individual members of the advisory board. The
comments from the four members of the board represent the views of these
individuals and not an official position of the advisory board. HHS agreed
with GAO's recommendations to provide more integrated and comprehensive
data to the advisory board and said that it will consider the need to
provide staff to help the advisory board reexamine its overall plan for
assessing NIOSH site profiles and dose reconstructions. With regard to the
third recommendation, HHS stated that a system is already in place to
track actions taken by the agency in response to advisory board
recommendations in letters from the board to the Secretary of HHS. HHS
added that matrices used in conjunction with the six-step resolution
process outline the contractor's concerns, NIOSH's response, and the
actions to be taken. However, we believe that these matrices do not
provide sufficient closure with regard to tracking the actions NIOSH has
actually implemented in response to advisory board and contractor findings
and recommendations. For example, in some of the matrices, the advisory
board has made numerous recommendations that NIOSH perform certain actions
to resolve various issues, but there is no system in place to provide
assurance that these actions have in fact been taken. Thus, we continue to
see a need for this recommendation.

Some individual advisory board members who provided comments expressed
concerns about our recommendations, although differing in their reasons.
One individual board member expressed concern about the recommendations to
provide more integrated and comprehensive data to the advisory board or to
provide staff to help in reexamining the overall review plan, suggesting
that these changes might not be very helpful. We still believe that these
recommendations are necessary to ensure that the advisory board has more
complete information to better oversee the review as well as a long-term
plan for completing the review; hence we did not revise the
recommendation. Another individual board member suggested that a system be
established to track the advisory board's recommendations rather than the
contractor's recommendations since it is these that should be of greater
concern. While GAO believes it is important to track the resolution of the
board's recommendations, it also important to track the resolution of the
contractor's recommendations, and we therefore revised the wording of our
recommendation to reflect this position.

HHS, the contractor, and individual advisory board members took issue with
statements in the report about the contractor being over budget and behind
schedule. While they agreed with GAO's assessment that the review process
got off to a slow start, they thought that the report did not provide
sufficient information about the various factors that complicated or led
to an expansion of work for the contractor, the revisions to the
contractor's task orders, and the performance of the contractor with
respect to the revised task orders. For example, commenters pointed out
that in some instances, the contractor had to review a site profile more
than once after NIOSH had revised the site profile to include additional
information. Commenters added that the contractor's work also had to shift
to accommodate changing priorities. For instance, NIOSH's increased
reliance on using the site profiles to complete dose reconstructions
prompted a shift in contractor priorities to devote more time and
resources to site profile reviews than originally anticipated. The
commenters added that since the task orders were revised, the contractor
has been meeting the time frames and budgets specified in the task orders.
We therefore revised the report to incorporate additional information on
factors that complicated or led to an expansion in the work of the
contractor, the revisions that were made to the task orders, and the
contractor's progress in meeting the terms of the revised task orders.

HHS, the contractor, and some of the individual members of the advisory
board maintained that the advisory board has taken actions to reexamine
and adjust its strategy for reviewing site profiles and dose
reconstruction cases. For instance, HHS stated that during the advisory
board's meetings in 2005, the board regularly discussed the future of
contract activities and altered the review schedule and scope of work
several times. For example, the contractor was asked to perform site
profile reviews for sites not originally anticipated in order to
facilitate the advisory board's review of related special exposure cohort
petitions. Other commenters pointed out the board's development of a
six-step resolution process for use by NIOSH and the contractor to resolve
differences on technical issues. We revised the report to more fully
reflect actions taken by the advisory board to reexamine and adjust its
strategy for the review. We also changed the report title to reflect
changes made in the report in this regard. However, we continue to see a
need for the advisory board to build on its actions by comprehensively
reexamining whether its original long-term plan for the overall project is
still appropriate.

Several individual advisory board members commented that they remain
concerned about the independence of the board and its contractor. Although
acknowledging that replacement of the original officials appointed as the
designated federal officer and project officer has helped reduce possible
challenges to independence, the members pointed out that NIOSH officials
remain involved in managing the contract and could still potentially
influence the work of the contractor. These individual board members also
emphasized that the board has no independent budgetary authority and that
it relies on NIOSH to obtain funding. Our review suggests that the
contractor has been able to demonstrate its independence during the
review. For instance, our report notes that the contractor's reports have
criticized numerous aspects of NIOSH site profiles and dose
reconstructions. Further, contractor officials told us that they believe
relations with NIOSH are thoroughly professional and board members told us
that they are satisfied with the information provided by the contractor.
We acknowledge that the potential for impairment of the contractor's
efforts remains. In fact, our draft report concluded that there is a need
for continued diligence in avoiding actual or perceived conflicts of roles
as new candidates are considered for certain positions over the life of
the advisory board. We have further highlighted this point in the final
report.

HHS's comments are provided in appendix II, and the contractor's comments
are provided in appendix III. HHS, the contractor, and individual board
members also provided technical comments, which we have incorporated as
appropriate.

As arranged with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days from
the issue date. At that time, we will send copies of this report to the
Secretary of Health and Human Services, interested congressional
committees, and other interested parties. We are also sending copies to
the Chair and members of the advisory board. We will make copies available
to others upon request. In addition, the report will be available at no
charge on GAO's Web site at http://www.gao.gov.

If you have any questions about this report, please contact me at (202)
5127215. Contact points for our Offices of Congressional Relations and
Public Affairs may be found on the last page of this report. GAO staff
that made major contributions to this report are listed in appendix III.

Sincerely yours,

Director, Education, Workforce, and Income Security Issues

Appendix II: Comments from the Department of Health & Human Services

Appendix III: Comments from S. Cohen & Associates

Appendix IV: GAO Contact and Staff Acknowledgments

Robert E. Robertson, (202) 512-7215 or [email protected]

GAO Contact:

Andy Sherrill, Assistant Director; Margaret Armen, Richard Burkard,

Staff

Susan Bernstein, Sandra Chefitz, Mary Nugent, and Robert Sampson made
Acknowledgements: significant contributions to this report.

Related GAO Products

Energy Employees Compensation: Many Claims Have Been Processed, but Action
Is Needed to Expedite Processing of Claims Requiring Radiation Exposure
Estimates. GAO-04-958. Washington, D.C.: Sept. 10, 2004.

Energy Employees Compensation: Even with Needed Improvements in Case
Processing, Program Structure May Result in Inconsistent Benefit Outcomes.
GAO-04-516. Washington, D.C.: May 28, 2004.

(130448)

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