A board-certified pathologist must make the diagnosis of all malignant disease levels.
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Non-Malignant Disorders
Medical criteria normally need a diagnosis of bilateral pleural plaques or thickening, bilateral pleural calcification, diffuse pleural thickening, bilateral pleural illness of grade B2, or asbestosis based on X-ray readings or pathology for non-malignant disorders (Levels I to V). Level II claims include those with mixed obstructive and restrictive disease based on pulmonary function testing and supporting medical documentation, such as a written opinion by the examining or diagnosing physician establishing that asbestos exposure was a contributing factor to the disease in accordance with diagnostic guidelines. Mild, moderate, and severe impairment are required for Levels III, IV, and V, respectively, based on pulmonary function test results and supporting medical documentation, such as a written opinion by the examining or diagnosing physician following diagnostic guidelines establishing that the claimant’s asbestos exposure is a significant contributing factor in causing the pulmonary condition in question. Level I requires five years of cumulative occupational exposure, while Levels II through V necessitate five years of considerable occupational exposure weighted by time and industry (“weighted years”).
Cancerous Conditions
The medical criteria for malignant illnesses (Levels VI to IX) necessitate a diagnosis of mesothelioma, primary lung cancer, or another malignancy.
Level VI (other cancers) claims include the following:
A primary colorectal, laryngeal, esophageal, pharyngeal, or stomach cancer diagnosis.
Evidence of a nonmalignant asbestos-related illness on both sides.
Asbestos exposure for fifteen years, weighted.
Supporting medical proof, such as a written judgement by the examining or diagnosing physician based on diagnostic criteria proving that the claimant’s asbestos exposure was a significant contributing cause in the claimant’s other malignancy.
Level VII claims must contain the following:
A primary lung cancer diagnosis.
Evidence of bilateral pleural plaques, thickness, or calcification as determined by a chest x-ray or any other diagnostic approach supported by the Institute of Medicine’s results.
Evidence of 12 or more weighted years of significant occupational exposure.
Medical evidence, such as a written judgement by the examining or diagnosing physician based on diagnostic protocols, proving asbestos exposure as a significant contributing cause in the cancer’s development.
Level VIII claims must contain the following:
A primary lung cancer condition has been diagnosed.
Asbestosis evidence based on a chest x-ray with irregular opacities and the relevant weighted years of exposure.
Supporting medical proof, such as a written judgement by the examining or diagnosing physician based on diagnostic criteria, indicating that the claimant’s exposure to asbestos for 10 or more weighted years was a significant contributing cause in the claimant’s cancer.
Level IX claims must contain the following:
A malignant mesothelioma diagnosis.
Credible evidence derived from occupational, take-home, or other identified asbestos exposure.
A board-certified pathologist must make the diagnosis of all malignant disease levels.
Outstanding Medical Claims
This permits a claimant to have a claim labelled as an extraordinary medical claim if the claim does not fulfil the medical criteria requirements of the bill or if the claim has been declared ineligible for compensation solely on the basis of failing to meet the medical criteria. The claimant must present a report from a physician that meets the standards of this section, which contains the following information:
A thorough examination of the claimant’s medical history and present condition.
Additional information as requested by the Administrator.
A thorough description of why the claim fulfils the criteria for extraordinary medical claims.
All petitions for classification as an extraordinary medical claim must be reviewed by a Physicians Panel. A Physicians Panel must find that the claimant cannot meet the requirements for reasons beyond the individual’s control, but can establish a condition similar to one that would satisfy the requirements through comparably reliable evidence in order for the claim to be treated as an exceptional medical claim. A Physicians Panel may seek extra reasonable tests in making its decision. In addition to an x-ray, the claimant may provide CT scans.
If a Physicians Panel certifies a claim as an extraordinary medical claim, it must specify the illness category for which the claimant may seek compensation and forward the claim to the Administrator for eligibility decision based on the remaining diagnostic, latency, and exposure criteria. The Administrator must take the Physicians Panel’s suggestion into account while making this decision. If a Physicians Panel declines a claimant’s application for classification as an extraordinary medical claim, the claimant may resubmit the application with additional evidence, indicating the new evidence on which the resubmission is based.
Asbestos that occurs naturally
Claimants who have been exposed to naturally occurring asbestos may make a claim and request that it be designated as an extraordinary medical claim.