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 Code of Federal Regulations (Last Updated: July 5, 2024)
 Title 42 - Public Health
 Chapter I - Public Health Service, Department of Health and Human Services
 SubChapter G - Occupational Safety and Health Research and Related Activities
 Part 81 - Guidelines for Determining Probability of Causation Under the Energy Employees Occupational Illness Compensation Program Act of 2000
 Subpart E - Guidelines To Estimate Probability of Causation

  § 81.23 - Guidelines for cancers for which primary site is unknown.  

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  • § 81.23 Guidelines for cancers for which primary site is unknown.

    (a) In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL will calculate probability of causation estimates for various likely primary sites. Table 1 , below, of this paragraph (a) indicates the primary cancer site(s) DOL will use in NIOSH-IREP when the primary cancer site is unknown.

    Table 1 to Paragraph (a)

    Primary cancers (ICD-

    9 codes[3]

    10-CM codes) for which probability of causation is to be calculated, if only a secondary cancer site is known. “M” indicates cancer site should be used for males only, and “F” indicates the cancer site should be used for females only.

    A glossary of cancer descriptions for each ICD-9 code is provided in appendix A to this part.
    Secondary cancer
    (ICD-9 10-CM code)     		ICD-9 10-CM code of likely primary cancers
    Lymph nodes of head, face and neck (196C77.0)141C01, 142 C02, C07(M), 146 C08(M), 149 (C09(M), C10(M), C14(F), 161 C32(M), 162C33, 172C34, 173C43, 174 C44, C50(F), 193 C73(F), D03.
    Intrathoracic lymph nodes (196C77.1)150 C15(M), 162C33, 174 C34, C50(F).
    Intra-abdominal lymph nodes (196C77.2)150 C15(M), 151 C16(M), 153C18, 157 C25(F), 162C33, 174 C34, C50(F), 180 C53(F), 185 C61(M), 189, 202 C64, C65, C66, C68, C82(F), C84(F) (excluding C84.6, C84.7), C85(F), C86(F) (excluding C86.5, C86.6), C91.4(F), C96(F).
    Lymph nodes of axilla and upper limb (196C77.3)162C33, 172C34, 174 C43, C50(F) , D03.
    Inguinal and lower limb lymph nodes (196C77.54)154 C19(M), 162, 172, 173 C20(M), C21(M), C33, C34, C43, C44(F), 187 C60(M), C63(M), D03.
    Intrapelvic lymph nodes (196C77.65)153 C18(M), 154 C19(F), 162 (C20(F), C21(F), C33(M), 180 C34(M), C53(F), 182 C54(F), 185 C61(M), 188C67.
    Lymph nodes of multiple sites (196C77.8)150 C15(M), 151 C16(M), 153 C18(M), 162C33, 174 C34, C50(F).
    Lymph nodes, site unspecified (196C77.9)150 C15(M), 151C16, 153C18, 162C33, 172C34, 174 C43, C50(F), 185 C61(M), D03.
    Lung (197C78.0)153C18, 162C33, 172 C34, C43(M), 174 C50(F), 185 C61(M), 188 C67(M), 189C64, C65, C66, C68, D03(M).
    Mediastinum (197C78.1)150 C15(M), 162C33, 174 C34, C50(F).
    Pleura (197C78.2)150 C15(M), 153 C18(M), 162C33, 174 C34, C50(F), 183 C56(F), 185 C57(F), C61(M), 189 C64(M), C65(M), C66(M), C68(M).
    Other respiratory organs (197C78.3)150C15, 153 C18(M), 161C32, 162C33, 173 C34, C44(M), 174 C50(F), 185 C61(M), 193 C73(F).
    Small intestine, including duodenum (197C78.4)152C17, 153C18, 157C25, 162C33, 171C34, 172 C49, C43(M), 174 C50(F), 183 C56(F), 189 C57(F), C64(M), C65(M), C66(M), C68(M), D03(M).
    Large intestine and rectum (197C78.5)153C18, 154C19, 162, 174 C20, C21, C33, C34, C50(F), 183 C56(F), 185 C57(F), C61(M).
    Retroperitoneum and peritoneum (197C78.6)151C16, 153C18, 154 C19(M), 157, 162 C20(M), C21(M), 171C25, 174 (C33(M), C34(M), C49, C50(F), 182 C54(F), 183 C56(F), C57(F).
    Liver, specified as secondary (197C78.7)151 C16(M), 153C18, 154 C19(M), 157, 162, 174 C20(M), C21(M), C25, C33, C34, C50(F).
    Other digestive organs (197C78.8)150 C15(M), 151C16, 153C18, 157C25, 162C33, 174 C34, C50(F), 185 C61(M).
    Kidney (198C79.0)153C18, 162C33, 174 C34, C50(F), 180 C53(F), 185 C61(M), 188C67, 189, 202 C64, C65, C66, C68, C82(F), C84(F) (excluding C84.6, C84.7), C85(F), C86(F) (excluding C86.5, C86.6), C91.4(F), C96(F).
    Other urinary organs (198C79.1)153C18, 174 C50(F), 180 C53(F), 183 C56(F), 185 C57(F), C61(M), 188C67, 189 C64(F), C65(F), C66(F), C68(F).
    Skin (198C79.2)153C18, 162C33, 171 C34, C49(M), 172C43, 173 C44(M), 174 C50(F), 189 C64(M), C65(M), C66(M), C68(M), D03.
    Brain and spinal cord (198C79.3)162C33, 172 C34, C43(M), 174 C50(F), D03(M).
    Other parts of nervous system (198C79.4)162C33, 172 C34, C43(M), 174 C50(F), 185 C61(M), 202. C82, C84 (excluding C84.6, C84.7), C85, C86 (excluding C86.5, C86.6), C91.4, C96, D03(M).
    Bone and bone marrow (198C79.5)162C33, 174 C34, C50(F), 185 C61(M).
    Ovary (198C79.6)153 C18(F), 174 C50(F), 183 C56(F), C57(F).
    Suprarenal Adrenal gland (198C79.7)153 C18(F), 162C33, 174 C34, C50(F).
    Other specified sites (198C79.8)153C18, 162C33, 172 C34, C43(M), 174 C50(F), 183 C56(F), 185 C57(F), C61(M), 188 C67(M), D03(M).
    Unspecified sites (C79.9)C18, C33, C34, C43(M), C50(F), C56(F), C57(F), C61(M), C67(M), D03(M).
    Carcinoid tumor of distant lymph nodes (C7B.01)C15(M), C16, C18, C33, C34, C43, C50(F),C61(M), D03.
    Carcinoid tumor of liver (C7B.02)C16(M), C18, C19(M), C20(M), C21(M), C25, C33, C34, C50(F).
    Carcinoid tumor of bone (C7B.03)C33, C34, C50(F), C61(M).
    Carcinoid tumor of peritoneum (C7B.04)C16, C18, C19(M), C20(M), C21(M), C25, C33(M), C34(M), C49, C50(F), C54(F), C56(F), C57(F).
    Merkel cell carcinoma (C7B.1)C18, C33, C34, C49(M), C43, C44(M), C50(F), C64(M), C65(M), C66(M), C68(M), D03.

    (b) DOL will select the site producing the highest estimate for probability of causation to adjudicate the claim.

    Footnotes - 81.23

    [3] The International Classification of Diseases Clinical Modification (9th Revision) Volume I&II. [1991] Department of Health and Human Services Publication No. (PHS) 91-1260, U.S. Government Printing Office, Washington D.C.

    [67 FR 22309, May 2, 2002, as amended at 84 FR 37590, Aug. 1, 2019]