Changeflow GovPing Healthcare WTC Health Program Denies Petitions on Hepatic ...

Routine Notice Denied Final

WTC Health Program Denies Petitions on Hepatic Steatosis

FR: Centers for Disease Control and Prevention

Published April 7th, 2026

Detected April 7th, 2026

Summary

The CDC's World Trade Center Health Program Administrator has denied Petitions 029, 034, 035, and 062, which requested the addition of hepatic steatosis (fatty liver disease) as a covered health condition under the program. The finding of insufficient evidence was published in the Federal Register (91 FR 17650). This decision affects WTC responders and survivors seeking coverage for this condition.

View original document View source feed page

What changed

The WTC Health Program Administrator issued a final determination denying four petitions (029, 034, 035, and 062) that sought to add hepatic steatosis (non-alcoholic fatty liver disease) to the list of covered health conditions under the program. The Administrator found insufficient scientific evidence to establish a causal relationship between 9/11 exposures and hepatic steatosis. The petition denial is specific to the WTC Health Program and does not affect coverage determinations for other conditions already recognized under the program.

Petitioners and WTC Health Program participants should note that this denial is final and does not create a new covered condition. Individuals currently experiencing hepatic steatosis should continue working with their WTC Health Program-certified physicians for covered conditions. Healthcare providers administering care under the program should be aware that hepatic steatosis remains outside the scope of covered conditions as of this date. The denial does not preclude future petitions if new scientific evidence becomes available.

Source document (simplified)

Legal Status This site displays a prototype of a “Web 2.0” version of the daily
Federal Register. It is not an official legal edition of the Federal
Register, and does not replace the official print version or the official
electronic version on GPO’s govinfo.gov.

The documents posted on this site are XML renditions of published Federal
Register documents. Each document posted on the site includes a link to the
corresponding official PDF file on govinfo.gov. This prototype edition of the
daily Federal Register on FederalRegister.gov will remain an unofficial
informational resource until the Administrative Committee of the Federal
Register (ACFR) issues a regulation granting it official legal status.
For complete information about, and access to, our official publications
and services, go to About the Federal Register on NARA's archives.gov.

The OFR/GPO partnership is committed to presenting accurate and reliable
regulatory information on FederalRegister.gov with the objective of
establishing the XML-based Federal Register as an ACFR-sanctioned
publication in the future. While every effort has been made to ensure that
the material on FederalRegister.gov is accurately displayed, consistent with
the official SGML-based PDF version on govinfo.gov, those relying on it for
legal research should verify their results against an official edition of
the Federal Register. Until the ACFR grants it official status, the XML
rendition of the daily Federal Register on FederalRegister.gov does not
provide legal notice to the public or judicial notice to the courts.

Legal Status

Notice

World Trade Center Health Program; Petitions 029, 034, 035, and 062-Hepatic Steatosis; Finding of Insufficient Evidence

A Notice by the Centers for Disease Control and Prevention on 04/07/2026

Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Disease Control and Prevention Agency/Docket Number NIOSH Docket 094 Document Citation 91 FR 17650 Document Number 2026-06728 Document Type Notice Pages 17650-17654
(5 pages) Publication Date 04/07/2026 Published Content - Document Details
PDF Official Content
- View printed version (PDF) Official Content
Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Disease Control and Prevention Agency/Docket Number NIOSH Docket 094 Document Citation 91 FR 17650 Document Number 2026-06728 Document Type Notice Pages 17650-17654
(5 pages) Publication Date 04/07/2026 Published Content - Document Details
Document Dates Published Content - Document Dates Dates Text The Administrator of the WTC Health Program is denying these petitions for the addition of a health condition as of April 7, 2026. Published Content - Document Dates
Table of Contents Enhanced Content - Table of Contents This table of contents is a navigational tool, processed from the
headings within the legal text of Federal Register documents.
This repetition of headings to form internal navigation links
has no substantive legal effect.
Related Documents Enhanced Content - Related Documents FederalRegister.gov uses the agency dockets published with the document to display related documents.

Enhanced Content - Related Documents

Public Comments Enhanced Content - Public Comments This feature is not available for this document.

Enhanced Content - Public Comments
- Regulations.gov Data Enhanced Content - Regulations.gov Data Additional information is not currently available for this document.

Enhanced Content - Regulations.gov Data

- Sharing Enhanced Content - Sharing Shorter Document URL https://www.federalregister.gov/d/2026-06728 Email Email this document to a friend Enhanced Content - Sharing

Print Enhanced Content - Print
- Print this document Enhanced Content - Print
Other Formats Enhanced Content - Other Formats This document is also available in the following formats:

JSON Normalized attributes and metadata XML Original full text XML MODS Government Publishing Office metadata More information and documentation can be found in our developer tools pages.

Enhanced Content - Other Formats
- Public Inspection Public Inspection This PDF is FR Doc. 2026-06728 as it appeared on Public Inspection on
04/06/2026 at 8:45 am.

It was viewed
26
times while on Public Inspection.

If you are using public inspection listings for legal research, you
should verify the contents of the documents against a final, official
edition of the Federal Register. Only official editions of the
Federal Register provide legal notice of publication to the public and judicial notice
to the courts under 44 U.S.C. 1503 & 1507. Learn more here.

Public Inspection
Published Document: 2026-06728 (91 FR 17650) This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Document Headings Document headings vary by document type but may contain
the following:

the agency or agencies that issued and signed a document
the number of the CFR title and the number of each part the document amends, proposes to amend, or is directly related to
the agency docket number / agency internal file number
the RIN which identifies each regulatory action listed in the Unified Agenda of Federal Regulatory and Deregulatory Actions See the Document Drafting Handbook for more details.

Department of Health and Human Services

Centers for Disease Control and Prevention

[NIOSH Docket 094]

AGENCY:

Centers for Disease Control and Prevention, Department of Health and Human Services.

ACTION:

Denial of petition for addition of a health condition.

SUMMARY:

The Administrator of the World Trade Center (WTC) Health Program has received several petitions (Petitions 029, 034, 035, and 062) to add “hepatic steatosis” or “fatty liver disease” to the List of WTC-Related Health Conditions. Upon reviewing the scientific and medical literature, including information provided by the petitioners, the Administrator has determined that there is insufficient evidence available to support taking further action at this time regarding hepatic steatosis. The Administrator also finds that insufficient evidence exists to request a recommendation of the WTC Health Program Scientific/Technical Advisory Committee, publish a proposed rule, or publish a determination not to publish a proposed rule.

DATES:

The Administrator of the WTC Health Program is denying these petitions for the addition of a health condition as of April 7, 2026.

ADDRESSES:

Visit the WTC Health Program website at https://www.cdc.gov/wtc/received.html to review Petitions 029, 034, 035, and 062.

FOR FURTHER INFORMATION CONTACT:

Rachel Weiss, Program Analyst, 1090 Tusculum Avenue, MS: C-48, Cincinnati, OH 45226; telephone (404) 498-2500 (this is not a toll-free number); email NIOSHregs@cdc.gov.

SUPPLEMENTARY INFORMATION:

A. WTC Health Program Statutory Authority

B. Procedures for Evaluating a Petition

C. Petitions 029, 034, 035, and 062

D. Evaluation of Scientific Evidence: Findings and Conclusion ( printed page 17651)

E. Administrator's Final Decision on Whether To Propose the Addition of Hepatic Steatosis to the List

F. Approval To Submit Document to the Office of the Federal Register

A. WTC Health Program Statutory Authority

Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 (Pub. L. 111-347, as amended by Pub. L. 114-113, Pub. L. 116-59, Pub. L. 117-328, Pub. L. 118-31, and Pub. L. 119-75), added Title XXXIII to the Public Health Service (PHS) Act, [1 ] establishing the WTC Health Program within the Department of Health and Human Services (HHS). The WTC Health Program provides medical monitoring and treatment benefits for health conditions on the List of WTC-Related Health Conditions (List) [2 ] to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery, and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, at the Pentagon, and in Shanksville, Pennsylvania (responders). The Program also provides benefits to eligible persons who were present in the dust or dust cloud on September 11, 2001, or who worked, resided, or attended school, childcare, or adult daycare in the New York City disaster area 3 .

All references to the Administrator of the WTC Health Program (Administrator) in this document mean the Director of the National Institute for Occupational Safety and Health (NIOSH) or his designee.

In accordance with section 3312(a)(6)(B) of the PHS Act, interested parties may petition the Administrator to add a health condition to the List in 42 CFR 88.15. Within 90 days after receipt of a valid petition to add a condition to the List, the Administrator must take one of the following four actions described in section 3312(a)(6)(B) of the PHS Act and § 88.16(a)(2) of the WTC Health Program regulations: (1) Request a recommendation of the WTC Health Program Scientific/Technical Advisory Committee (STAC); (2) publish a proposed rule in the Federal Register to add such health condition; (3) publish in the Federal Register the Administrator's determination not to publish such a proposed rule and the basis for such determination; or (4) publish in the Federal Register a determination that insufficient evidence exists to take action under (1) through (3) above.

More information about the WTC Health Program, including the List and the petition process, is available at www.cdc.gov/wtc/.

B. Procedures for Evaluating a Petition

In addition to the regulatory provisions, the WTC Health Program has developed policies to guide the review of submissions and petitions, [4 ] as well as the analysis of evidence supporting the potential addition of a non-cancer health condition to the List. [5 ]

A valid petition must include sufficient medical basis for the association between the September 11, 2001, terrorist attacks and the health condition to be added. In accordance with WTC Health Program Policy and Procedures for Handling Submissions and Petitions to Add a Health Condition to the List of WTC-Related Health Conditions, [6 ] reference to a peer-reviewed, published, epidemiologic study about the health condition among 9/11-exposed populations or clinical case reports of health conditions in WTC responders or survivors may demonstrate the required medical basis. [7 ] Studies linking 9/11 agents or hazards [8 ] to the petitioned health condition may also provide sufficient medical basis for a valid petition. [9 ] In accordance with 42 CFR 88.16(a)(5), the Administrator is required to consider a new petition for a previously evaluated health condition determined not to qualify for addition to the List only if the new petition presents a new medical basis for the association between 9/11 exposures and the condition to be added. A new medical basis is evidence not previously reviewed by the Administrator.

After the Program has determined that a petition is valid, and in accordance with the Policy and Procedures for Adding Non-Cancer Conditions to the List of WTC-Related Health Conditions (Policy and Procedures), the Administrator directs the WTC Health Program Science Team (Science Team) to conduct a review of the scientific literature. The literature review includes a keyword search of relevant scientific databases intended to identify peer-reviewed, published, epidemiologic studies about the health condition among 9/11-exposed populations.

The Science Team evaluates the scientific quality of each peer-reviewed, published, epidemiologic study of the health condition identified in the literature search using validity indicators described in the Policy and Procedures. [10 ] Studies exhibiting sufficient validity indicators have the potential to provide a basis for deciding whether to propose adding the health condition to the List and are considered “high-quality” studies. The Science Team then evaluates the identified high-quality studies, individually and together, to characterize the evidence of a causal association between 9/11 exposures and the health condition. As part of this evaluation, the Science Team considers the Bradford Hill weight of evidence criteria, [11 ] study limitations, and whether the studies are representative of the 9/11-exposed population of responders and survivors. After evaluating the totality of the evidence, the Science Team assesses the degree to which the evidence supports a causal association between 9/11 exposures and the health condition and assigns the evidence to one of the following five categories:

( printed page 17652) Category I Evidence supports substantial likelihood of causal association

Category II Evidence supports high likelihood of causal association

Category III Evidence supports limited likelihood of causal association

Category IV Evidence does not support causal association

Category V Evidence is inadequate to determine the likelihood of causal association.

The Science Team provides the outcome of its evaluation to the Administrator. A health condition may be added to the List if peer-reviewed, published, epidemiologic studies provide support that there is a substantial likelihood of a causal association between the health condition and 9/11 exposures (Category I). [12 ] If the evaluation of evidence provided in peer-reviewed, published, epidemiologic studies of the health condition in 9/11 populations shows a high, but not substantial, likelihood of a causal association between the 9/11 exposures and the health condition (Category II), [13 ] then the Administrator may consider additional highly relevant scientific evidence regarding exposures to 9/11 agents in non-9/11 exposure scenarios. If that additional assessment establishes that there is now sufficient evidence to support the conclusion that a causal association between the 9/11 exposures and the health condition is substantially likely among 9/11-exposed populations (Category I), then the Administrator may propose the addition of the health condition to the List.

C. Petitions 029, 034, 035, and 062

On November 12, 2020, the Administrator received a petition (Petition 029) requesting the addition of several conditions, including “hepatotoxic injury—fatty liver disease” to the List. [14 ] The petition's validity was established by references to one peer-reviewed, published, epidemiologic study that provided a medical basis for the association between 9/11 exposures and hepatotoxic injury—fatty liver disease. The referenced study establishing a medical basis is:

Elevated Prevalence of Moderate-to-Severe Hepatic Steatosis in World Trade Center General Responder Cohort in a Program of CT Lung Screening, by Chen et al. [2020], [15 ] a peer-reviewed, published cross-sectional study of WTC responders designed to compare hepatic steatosis in 9/11-exposed WTC responders compared with non-9/11-exposed lung cancer screening participants. This study suggests a potential association between exposure to 9/11 agents and hepatotoxic injury—fatty liver disease, and thus provided a sufficient medical basis to consider the submission a valid petition.

On August 4, 2021, the Administrator received a petition (Petition 034) requesting the addition of “Hepatic Steatosis (also known as Fatty Liver Disease or Non-Alcoholic Liver Disease)” to the List. [16 ] The petition's validity was established by reference to two peer-reviewed, published, epidemiologic studies that provided a medical basis for the association between 9/11 exposures and hepatic steatosis. The referenced studies each individually establishing a medical basis were the study by Chen et al. [2020], described above, and:

Dose-Response Relationship between World Trade Center Dust Exposure and Hepatic Steatosis, by Jirapatnakul et al. [2021], [17 ] peer-reviewed, published cross-sectional study to evaluate the existence of a dose-response relationship between the intensity of 9/11 exposures and hepatic steatosis prevalence in WTC responders. These two studies suggest a potential association between exposure to 9/11 agents and hepatic steatosis, and thus provided sufficient medical basis to consider the submission a valid petition.

On November 15, 2021, the Administrator received a petition (Petition 035) requesting the addition of “Hepatic Steatosis/Cirrhosis” to the List. [18 ] The petition's validity was established by reference to one peer-reviewed, published, epidemiologic study that demonstrates a positive association between 9/11 exposures and hepatic steatosis. The referenced study establishing a medical basis is the study by Jirapatnakul et al. [2021], [19 ] described above. This study suggests a potential association between exposure to 9/11 agents (specifically WTC dust) and hepatic steatosis, and thus provided a sufficient medical basis to consider the submission a valid petition.

Finally, on May 14, 2025, the Administrator received a petition (Petition 062) requesting the addition of “Hepatic Steatosis (Fatty Liver Disease)” to the List. [20 ] The petition's validity was also established by reference to Jirapatnakul et al. [2021], [21 ] described above.

D. Evaluation of Scientific Evidence: Findings and Conclusion

In response to Petitions 029, 034, 035, and 062 and pursuant to the Policy and Procedures, the Administrator of the WTC Health Program directed the Science Team to conduct a systematic search of the scientific literature to identify all peer-reviewed, published, epidemiologic studies of hepatic steatosis among 9/11-exposed populations. Identified studies were assessed for quality; those studies determined to be high-quality were then evaluated to determine if they provide evidence to support a likelihood of a causal association between 9/11 exposure and the health condition under consideration. The Science Team provided the Administrator with a paper describing its findings, Evaluation of Scientific Evidence Supporting the Addition of Hepatic Steatosis to the List of WTC-Related Health Conditions. This paper is available in the docket for this activity [22 ] and on the Program's website. [23 ]

The literature search conducted by the WTC Health Program identified two peer-reviewed, published, epidemiologic studies of hepatic steatosis in 9/11-exposed populations: Chen et al. [2020] and Jirapatnakul et al. [2021], discussed above. These two studies were determined to have ( printed page 17653) sufficient validity indicators to be considered high-quality studies eligible for further evaluation in accordance with the Program's Policy and Procedures. [24 ] The Science Team conducted an evaluation, separately and together, of the two studies to determine the likelihood of a causal association between 9/11 exposures and the petitioned health condition. The systematic literature search, the Science Team's evaluation and synthesis of the available literature, and the Science Team's conclusions regarding the association between 9/11 exposure and hepatic steatosis are described in full in the Science Team's Evaluation of Scientific Evidence Supporting the Addition of Hepatic Steatosis to the List of WTC-Related Health Conditions.

In accordance with the Policy and Procedures, [25 ] the WTC Health Program uses the following Bradford Hill criteria to evaluate studies of 9/11-exposed populations: strength of association, [26 ] precision of the risk estimate, [27 ] consistency of associations, [28 ] temporality, [29 ] biological gradient, [30 ] biological plausibility, [31 ] coherence, [32 ] and analogy. [33 ] As discussed in full in the Evaluation of Scientific Evidence Supporting the Addition of Hepatic Steatosis to the List of WTC-Related Health Conditions, the Science Team assessed each criterion as follows:

| Aspect of associative causal
inference | Evaluation findings |
| --- | --- |
| Strength of Association | Two high-quality studies were available for evaluation [Chen et al. 2020; Jirapatnakul et al. 2021]. Both studies reported statistically significant estimates of increased prevalence of hepatic steatosis in the 9/11 responder population. Chen et al. [2020] found that the prevalence of moderate-to-severe hepatic steatosis was more than 3-fold higher in the WTC-participant group compared with non-WTC participants, while the linear regression estimates reported by Jirapatnakul et al. [2021] for liver attenuation were lower among those with earlier arrival dates, suggesting an exposure-response of more hepatic steatosis among those with higher 9/11 exposures (liver attenuation is inversely related to hepatic steatosis, meaning that lower liver attenuation demonstrates higher amounts of hepatic steatosis). |
| Precision of the Risk Estimate | The confidence interval for the risk estimate in the Chen et al. [2020] study is wide but does not include the null value. Likewise, the multivariable regression estimates in the Jirapatnakul et al. [2021] study were above the statistical significance level of 0.05, except for the exposure category of those arriving on or after September 14, 2001. |
| Consistency of Associations | The findings are consistent among both studies, but the study by Chen et al. [2020] includes only a small sample of heavy smokers. Further studies, particularly among other 9/11 populations (e.g., survivors, responders from the Fire Department of the City of New York [FDNY]), are needed to confirm the findings reported by Jirapatnakul et al. [2021]. |
| Temporality | Both studies were cross-sectional; therefore, information on temporality was limited. It is unclear in either study whether occupational and environmental exposures occurring prior to 9/11 or unmeasured exposures after 9/11 may have contributed to the observed health conditions. |
| Biological Gradient | The study by Jirapatnakul et al. [2021] suggests a trend of increasing hepatic steatosis prevalence with earlier arrival dates. However, no such gradient was found among those who arrived on 9/11 and had extensive dust cloud exposure versus those who arrived on 9/11 but did not have extensive dust cloud exposure [Jirapatnakul et al. 2021]. The study by Chen et al. [2020] did not report biological gradient findings. |
| Plausibility, Coherence, and Analogy | An association between 9/11 agents such as trichloroethylene, tetrachloroethylene, trichloroethane, carbon tetrachloride, polychlorinated biphenyls, arsenic, thallium, phosphorus, dioxin, lead, and chloroform, and hepatic steatosis satisfies these criteria and agrees with the available evidence. |
| Representativeness | The two studies examined persons in the General Responder Cohort. There were no studies of hepatic steatosis in the survivor population nor from the FDNY, Pentagon, or Shanksville responder cohorts. The findings of the evaluated studies might not be generalizable to other 9/11-exposed groups. |
As summarized above, the Science Team evaluated the studies by Chen et al. [2020] and Jirapatnakul et al. [2021] using the Bradford Hill criteria to determine whether a causal association between 9/11 exposures and hepatic steatosis is supported. The Science Team concluded that the information available in these studies is insufficient to support a claim for causation using these criteria.

Only the study by Jirapatnakul et al. [2021] reported an exposure-response gradient with hepatic steatosis prevalence. However, Jirapatnakul et al. [2021] found no such gradient among those who arrived on 9/11 and had extensive dust cloud exposure versus those who arrived on 9/11 but did not have extensive dust cloud exposure. Even though both studies showed positive associations, the risk estimate in the study by Chen et al. [2020] lacked precision and is subject to potential selection bias. Both studies controlled for some, but not all, important confounders, and misclassification of ( printed page 17654) exposure and outcome is possible. Consequently, chance, bias, and confounding could not be ruled out with reasonable confidence for either study. The known information on mechanisms of action supports an association between certain 9/11 agents and hepatic steatosis. However, given the significant limitations discussed above, the Science Team concluded that the available evidence is inadequate to determine the likelihood of a causal association between 9/11 exposures and hepatic steatosis.

Upon review of the evidence available in high-quality studies regarding hepatic steatosis among 9/11-exposed populations, the Science Team concluded that there is inadequate evidence to determine the likelihood of a causal association between 9/11 exposures and hepatic steatosis (Category V). [34 ]

E. Administrator's Final Decision on Whether To Propose the Addition of Hepatic Steatosis to the List

Pursuant to the PHS Act, sec. 3312(a)(6)(B)(iv) and 42 CFR 88.16(a)(2)(iv), and in accordance with Sec. VIII.B. of the Policy and Procedures, the Administrator has determined that insufficient evidence is available to take further action at this time, including proposing the addition of hepatic steatosis to the List (pursuant to the PHS Act, sec. 3312(a)(6)(B)(ii) and 42 CFR 88.16(a)(2)(ii)) or publishing a determination not to publish a proposed rule in the Federal Register (pursuant to the PHS Act, sec. 3312(a)(6)(B)(iii) and 42 CFR 88.16(a)(2)(iii)). The Administrator has also determined that requesting a recommendation from the STAC (pursuant to the PHS Act, sec. 3312(a)(6)(B)(i) and 42 CFR 88.16(a)(2)(i)) is unwarranted.

For the reasons discussed above, the request in Petitions 029, 034, 035, and 062 to add hepatic steatosis to the List of WTC-Related Health Conditions is denied.

F. Approval To Submit Document to the Office of the Federal Register

The Secretary, HHS, or his designee, the Director, Centers for Disease Control and Prevention (CDC) and Administrator, Agency for Toxic Substances and Disease Registry (ATSDR), authorized the undersigned, the Administrator of the WTC Health Program, to sign and submit the document to the Office of the Federal Register for publication as an official document of the WTC Health Program. Jay Bhattacharya, MD, Ph.D., Senior Official Carrying out the Delegable Duties of the CDC Director, approved this document for publication on April 2, 2026.

John J. Howard,

Administrator, World Trade Center Health Program and Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Department of Health and Human Services.

Footnotes

                     Title XXXIII of the PHS Act is codified at [42 U.S.C. 300mm](https://www.govinfo.gov/link/uscode/42/300mm) to 300mm-64. Those portions of the James Zadroga 9/11 Health and Compensation Act of 2010 found in Titles II and III of [Public Law 111-347](https://www.govinfo.gov/link/plaw/111/public/347) do not pertain to the WTC Health Program and are codified elsewhere.

Back to Citation 2.

                     The List of WTC-Related Health Conditions is established in [42 U.S.C. 300mm-22(a)(3)-(4)](https://www.govinfo.gov/link/uscode/42/300mm-22) and [300mm-32(b)](https://www.govinfo.gov/link/uscode/42/300mm-32); additional conditions may be added through rulemaking, and the complete list is provided in WTC Health Program regulations at [42 CFR 88.15](https://www.ecfr.gov/current/title-42/section-88.15).

Back to Citation 3.

                     
                    See [42 U.S.C. 300mm-5(8)](https://www.govinfo.gov/link/uscode/42/300mm-5); [42 CFR 88.1](https://www.ecfr.gov/current/title-42/section-88.1).

Back to Citation 4.

                     
                    See 
                     WTC Health Program [2026], *Policy and Procedures for Handling Submissions and Petitions to Add a Health Condition to the List of WTC-Related Health Conditions,* January 22, 2026, *[https://www.cdc.gov/wtc/pdfs/policies/PNP_SubmissionsPetitions%20_20260122-508.pdf](https://www.cdc.gov/wtc/pdfs/policies/PNP_SubmissionsPetitions%2520_20260122-508.pdf).*

Back to Citation 5.

                     
                    See 
                     WTC Health Program [2024], *Policy and Procedures for Adding Non-Cancer Conditions to the List of WTC-Related Health Conditions,* October 18, 2024, *[https://www.cdc.gov/wtc/pdfs/policies/WTCHP_PP_Adding_NonCancer_Health_Conditions_20241018.pdf](https://www.cdc.gov/wtc/pdfs/policies/WTCHP_PP_Adding_NonCancer_Health_Conditions_20241018.pdf).*

Back to Citation 6. Supra note 4.

Back to Citation 7. Id. at 7.

Back to Citation 8.

                     9/11 agents are chemical, physical, biological, or other hazards reported in a published, peer-reviewed exposure assessment study of responders, recovery workers, or survivors who were present in the New York City disaster area, or at the Pentagon site, or the Shanksville, Pennsylvania site, as those locations are defined in [42 CFR 88.1](https://www.ecfr.gov/current/title-42/section-88.1), as well as those hazards not identified in a published, peer-reviewed exposure assessment study, but which are reasonably assumed to have been present at any of the three sites. 
                    See 
                     WTC Health Program [2018], *Development of the Inventory of 9/11 Agents,* July 17, 2018, *[https://www.cdc.gov/wtc/pdfs/policies/Development_of_the_Inventory_of_9-11_Agents_20180717.pdf](https://www.cdc.gov/wtc/pdfs/policies/Development_of_the_Inventory_of_9-11_Agents_20180717.pdf).*

Back to Citation 9. Supra note 4 at 7.

Back to Citation 10. Supra note 5 at 7-8.

Back to Citation 11.

                     Hill AB [1965], *The Environment and Disease: Association or Causation?* Proc R Soc Med 58(5):295-300.

According to the Policy and Procedures for Adding Non-Cancer Conditions to the List of WTC-Related Health Conditions, the Bradford Hill criteria are a leading weight of evidence framework “which comprises nine aspects of association. These aspects comprise strength of association, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy.” See id. at 9-10 and footnotes 21-30, discussion of Bradford Hill analysis.

Back to Citation 12. Substantial likelihood of causal association means that the association is strongly supported by evidence from high-quality, peer-reviewed, published epidemiologic studies of the health condition in 9/11-exposed populations and there is high confidence that the association cannot be explained by chance, bias, confounding, or any other alternative explanation. See supra note 5 at 12.

Back to Citation 13. High likelihood of causal association means that the scientific evidence, taken as a whole, demonstrates that the likelihood of a causal association is less than substantial, but definitively more than limited. Therefore, there is some meaningful likelihood that the association can be explained by chance, bias, confounding, or another alternative explanation. See supra note 5 at 12.

Back to Citation 14.

                     
                    See 
                     Petition 029, *WTC Health Program: Petitions Received, [http://www.cdc.gov/wtc/received.html](http://www.cdc.gov/wtc/received.html).*

Back to Citation 15.

                     Chen X, Ma T, Yip R, Perumalswami PV, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI [2020], *Elevated Prevalence of Moderate-to-Severe Hepatic Steatosis in World Trade Center General Responder Cohort in a Program of CT Lung Screening,* Clin Imaging 60(2):237-243.

Back to Citation 16.

                     
                    See 
                     Petition 034, *WTC Health Program: Petitions Received, [http://www.cdc.gov/wtc/received.html](http://www.cdc.gov/wtc/received.html).*

Back to Citation 17.

                     Jirapatnakul A, Yip R, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI [2021], *Dose-Response Relationship between World Trade Center Dust Exposure and Hepatic Steatosis,* Am J Ind Med 64(10):837-844.

Back to Citation 18.

                     
                    See 
                     Petition 035, *WTC Health Program: Petitions Received, [http://www.cdc.gov/wtc/received.html](http://www.cdc.gov/wtc/received.html).*

Back to Citation 19. See supra note 17.

Back to Citation 20.

                     
                    See 
                     Petition 062, *WTC Health Program: Petitions Received, [http://www.cdc.gov/wtc/received.html](http://www.cdc.gov/wtc/received.html).*

Back to Citation 21. See supra note 17.

Back to Citation 22. https://www.cdc.gov/niosh/docket/archive/docket094.html.

Back to Citation 23. https://www.cdc.gov/wtc/received.html.

Back to Citation 24. See supra note 5 at 7-8.

Back to Citation 25. Supra note 5 at 9-10.

Back to Citation 26.

                     It is generally thought that strong associations are more likely to be causal than weak associations; however, a weak association does not rule out a causal relationship.

Back to Citation 27.

                     Precision of the risk estimate describes the uncertainty inherent in estimating the strength of association (the effect size) between exposure and health effect from observational data. It is expressed as a confidence interval illustrating a range of values that contains the true effect size. A narrow confidence interval indicates a more precise measure of the effect size, and a wider interval indicates greater uncertainty. While precision is not a Bradford Hill criterion, the Science Team takes it into consideration to evaluate the existence of random error in a study.

Back to Citation 28.

                     Consistent findings are demonstrated when they have been repeatedly reported by multiple studies.

Back to Citation 29.

                     Temporality is the condition that the 9/11 exposure must precede the health condition of interest and is typically assessed when considering aspects of exposure in the study design.

Back to Citation 30.

                     Studies establish an exposure-response relationship by demonstrating that increases in exposure (*i.e.,* exposures of greater intensity and/or longer duration) are associated with a greater incidence of disease. A thorough evaluation of exposure-response requires analysis of multiple levels of exposure such that the investigator can demonstrate that the risk increases with increasing levels of exposure.

Back to Citation 31.

                     Study findings demonstrate a basis in scientific theory that supports the relationship between the exposure and the health effect and do not conflict with known facts about the biology of the health condition.

Back to Citation 32.

                     Coherence implies that the interpretation of a causal association agrees with known disease etiology.

Back to Citation 33.

                     Analogy is used to inform on biological plausibility and coherence by contrasting the evidence on the suspected causal association with that from an established association between similar (analogous) causes or effects.

Back to Citation 34. See Policy and Procedures supra note 5 at Sec. V.E.—Evidence is Inadequate to Determine a Causal Association.

Back to Citation [FR Doc. 2026-06728 Filed 4-6-26; 8:45 am]

BILLING CODE 4163-18-P

Published Document: 2026-06728 (91 FR 17650)

Named provisions

Petitions 029, 034, 035, and 062 - Hepatic Steatosis

Related changes

Proposed Data Collection Under Paperwork Reduction Act

Routine Apr 07, 2026 • FR: Centers for Disease Control and Prevention • Healthcare

Proposed Data Collection Submitted for Public Comment

Routine Apr 07, 2026 • FR: Centers for Disease Control and Prevention • Healthcare

Agency Forms Undergoing Paperwork Reduction Act Review

Routine Apr 07, 2026 • FR: Centers for Disease Control and Prevention • Healthcare

Oregon Beach Bacteria Monitoring List 2026-2027

Routine Apr 07, 2026 • Oregon OHA News • Healthcare

Measles Exposure Locations Confirmed in Keizer Oregon

Routine Apr 07, 2026 • Oregon OHA News • Healthcare

Requires Tennessee Department of Health Annual Report

Routine Apr 07, 2026 • Tennessee Legislative Events • Government General

Source

FR: Centers for Disease Control and Prevention federalregister.gov/documents/search?conditions%5Bagencies%5D%5B%5D=centers-for-disease-control-and-prevention&order=newest

Healthcare

Analysis generated by AI. Source diff and links are from the original.

Classification

Agency

Health and Human Services Department

Published

April 7th, 2026

Instrument

Notice

Legal weight

Non-binding

Stage

Final

Change scope

Minor

Document ID

91 FR 17650 / NIOSH Docket 094

Docket

NIOSH Docket 094

Who this affects

Applies to

Healthcare providers Government agencies Patients

Industry sector

6211 Healthcare Providers 9211 Government & Public Administration

Activity scope

Health Condition Coverage Federal Benefits Administration

Threshold

Enrolled WTC Health Program responders and survivors

Geographic scope

United States US

Taxonomy

Primary area

Public Health

Operational domain

Compliance

Topics

Healthcare Government Benefits

Get Healthcare alerts

Weekly digest. AI-summarized, no noise.

Free. Unsubscribe anytime.

WTC Health Program Denies Petitions on Hepatic Steatosis

Summary

What changed

Source document (simplified)

Notice

World Trade Center Health Program; Petitions 029, 034, 035, and 062-Hepatic Steatosis; Finding of Insufficient Evidence

Enhanced Content - Related Documents

- Sharing Enhanced Content - Sharing Shorter Document URL https://www.federalregister.gov/d/2026-06728 Email Email this document to a friend Enhanced Content - Sharing

Department of Health and Human Services

Centers for Disease Control and Prevention

AGENCY:

ACTION:

SUMMARY:

DATES:

ADDRESSES:

FOR FURTHER INFORMATION CONTACT:

SUPPLEMENTARY INFORMATION:

Table of Contents

A. WTC Health Program Statutory Authority

B. Procedures for Evaluating a Petition

C. Petitions 029, 034, 035, and 062

D. Evaluation of Scientific Evidence: Findings and Conclusion

E. Administrator's Final Decision on Whether To Propose the Addition of Hepatic Steatosis to the List

F. Approval To Submit Document to the Office of the Federal Register

Footnotes

Named provisions

Related changes

Source

Classification

Who this affects

Taxonomy

Browse Categories

Get alerts for this source