Notice2026-06728
World Trade Center Health Program; Petitions 029, 034, 035, and 062-Hepatic Steatosis; Finding of Insufficient Evidence
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
April 7, 2026
Issuing agencies
Health and Human Services DepartmentCenters for Disease Control and Prevention
Abstract
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.
Full Text
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<title>Federal Register, Volume 91 Issue 66 (Tuesday, April 7, 2026)</title>
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[Federal Register Volume 91, Number 66 (Tuesday, April 7, 2026)]
[Notices]
[Pages 17650-17654]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-06728]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[NIOSH Docket 094]
World Trade Center Health Program; Petitions 029, 034, 035, and
062--Hepatic Steatosis; Finding of Insufficient Evidence
AGENCY: Centers for Disease Control and Prevention, Department of
Health and Human Services.
ACTION: Denial of petition for addition of a health condition.
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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 <a href="https://www.cdc.gov/wtc/received.html">https://www.cdc.gov/wtc/received.html</a> 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 <a href="/cdn-cgi/l/email-protection#307e797f637842555743705354531e575f46"><span class="__cf_email__" data-cfemail="216f686e726953444652614245420f464e57">[email protected]</span></a>.
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
[[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\ (survivors).
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\1\ Title XXXIII of the PHS Act is codified at 42 U.S.C. 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 do not pertain to the WTC Health Program and are codified
elsewhere.
\2\ The List of WTC-Related Health Conditions is established in
42 U.S.C. 300mm-22(a)(3)-(4) and 300mm-32(b); additional conditions
may be added through rulemaking, and the complete list is provided
in WTC Health Program regulations at 42 CFR 88.15.
\3\ See 42 U.S.C. 300mm-5(8); 42 CFR 88.1.
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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 Sec. 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 <a href="http://www.cdc.gov/wtc/">www.cdc.gov/wtc/</a>.
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\
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\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, <a href="https://www.cdc.gov/wtc/pdfs/policies/PNP_SubmissionsPetitions%20_20260122-508.pdf">https://www.cdc.gov/wtc/pdfs/policies/PNP_SubmissionsPetitions%20_20260122-508.pdf</a>.
\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, <a href="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</a>.
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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.
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\6\ Supra note 4.
\7\ Id. at 7.
\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, 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, <a href="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</a>.
\9\ Supra note 4 at 7.
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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:
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\10\ Supra note 5 at 7-8.
\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.
[[Page 17652]]
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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.
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\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.
\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.
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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:
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\14\ See Petition 029, WTC Health Program: Petitions Received,
<a href="http://www.cdc.gov/wtc/received.html">http://www.cdc.gov/wtc/received.html</a>.
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<bullet> 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.
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\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.
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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:
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\16\ See Petition 034, WTC Health Program: Petitions Received,
<a href="http://www.cdc.gov/wtc/received.html">http://www.cdc.gov/wtc/received.html</a>.
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<bullet> 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.
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\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.
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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.
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\18\ See Petition 035, WTC Health Program: Petitions Received,
<a href="http://www.cdc.gov/wtc/received.html">http://www.cdc.gov/wtc/received.html</a>.
\19\ See supra note 17.
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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.
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\20\ See Petition 062, WTC Health Program: Petitions Received,
<a href="http://www.cdc.gov/wtc/received.html">http://www.cdc.gov/wtc/received.html</a>.
\21\ See supra note 17.
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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\
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\22\ <a href="https://www.cdc.gov/niosh/docket/archive/docket094.html">https://www.cdc.gov/niosh/docket/archive/docket094.html</a>.
\23\ <a href="https://www.cdc.gov/wtc/received.html">https://www.cdc.gov/wtc/received.html</a>.
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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
[[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.
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\24\ See supra note 5 at 7-8.
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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:
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\25\ Supra note 5 at 9-10.
\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.
\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.
\28\ Consistent findings are demonstrated when they have been
repeatedly reported by multiple studies.
\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.
\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.
\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.
\32\ Coherence implies that the interpretation of a causal
association agrees with known disease etiology.
\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.
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Aspect of associative causal
inference Evaluation findings
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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 An association between 9/11 agents
Analogy. 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
[[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\
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\34\ See Policy and Procedures supra note 5 at Sec. V.E.--
Evidence is Inadequate to Determine a Causal Association.
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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.
[FR Doc. 2026-06728 Filed 4-6-26; 8:45 am]
BILLING CODE 4163-18-P
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