DTRA / NTPR - Standard Operating Procedures Manual

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

Page 1 of 39

DEFENSE THREAT REDUCTION AGENCY

NUCLEAR TEST PERSONNEL REVIEW PROGRAM

RADIATION DOSE ASSESSMENT

Standard Operating Procedure

RA07 – Expedited Processing of Radiation Dose Assignments

for Enewetak Cleanup Project Veterans

Revision 2.0

Cleared for Release

Key to SOP Name ID Codes

RA (Radiation Assessment – Standard Operating Procedures)

ED (External Dose – Standard Methods)

ID (Internal Dose – Standard Methods)

UA (Uncertainty Analysis – Standard Methods)
DTRA / NTPR - Standard Operating Procedures Manual

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

Page 2 of 39

Revision Control

Revision Revision Description Revision Date Authorization 

Official

1.0 Original version 12/31/2021 James D. Franks

1.1 - Revised Figure 1 to include EPG assignment and DSS 

completion

- Revised Sections 5.3 and 5.4 to clarify assigning and 

verifying EPG assignments, and identifying exclusions

- Added EPG selection flowchart as new Figure 2

- Updated References

- Added diabetes to Table A1-1

- Revised Section A2 to update the description of exclusions

- Updated Tables A2-4 and A2-5 based on revised skin 

doses in Table A4-2

- Revised Attachment 3 to clarify and provide additional 

details of the EPG descriptions

- Corrected skin doses for “Back of neck” in Table A4-2

- Minor editorial changes.

06/15/2022 James D. Franks

2.0 - Revised Attachment 2 to update list of applicable general 

exclusions and deletion of EPG-specific scenario exclusion

- Revised Section A3-1 to exclude transporting soil-cement 

slurry reformed into concrete blocks, moved in dump 

trucks

- Revised Section A3-2 to add transporting soil-cement 

slurry reformed into concrete blocks and moved in dump 

trucks

- Corrected testes dose in Table A4-1

- Corrected shoulder and Torso (back, sides) doses in 

Table A4-2

- Minor editorial changes

04/30/2023 Lee A. Alleman
DTRA / NTPR - Standard Operating Procedures Manual

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Table of Contents

1. Purpose and Summary ........................................................................................................ 6

2. Scope................................................................................................................................... 6

3. Responsibilities................................................................................................................... 7

3.1 NTPR Research Analyst ......................................................................................... 7

3.2 DTRA NTPR Case Manager/DTRA Analyst......................................................... 7

3.3 Radiation Dose Assessment Analyst (RDA Analyst)............................................. 8

3.4 Quality Assurance Auditor ..................................................................................... 8

4. Definitions........................................................................................................................... 8

5. Procedure: Detailed Activity/Task Description................................................................ 10

5.1 Initial Case Review by NTPR Research Analyst.................................................. 10

5.2 Identification of Standard or Surrogate Organ/Skin Site...................................... 12

5.3 Assignment of EPG and Documentation in the Dose Summary Sheet by NTPR 

Research Analyst .................................................................................................. 12

5.4 DTRA Analyst Case Review ................................................................................ 14

5.5 Further Evaluation of a Case................................................................................. 15

5.6 RDA Analyst Technical Review........................................................................... 16

5.7 Assigning Doses.................................................................................................... 16

5.8 Quality Assurance Auditor Review ...................................................................... 17

6. Data and Records Management ........................................................................................ 17

7. Quality Assurance and Quality Control............................................................................ 18

8. Referenced SOPs from the NTPR/RDA SOP Manual ..................................................... 18

9. References......................................................................................................................... 19

Attachment 1. Organ and Disease/Standard Organ Cross-References......................................... 20

Attachment 2. ECUP Veteran Cases Excluded from Expedited Processing ................................ 24

A2-1 General Exclusions ............................................................................................... 24

A2-2 EPG-specific Exclusions....................................................................................... 24

A2.2.1 EPG Exposure Scenario Exclusions......................................................... 25

A2.2.2 EPG-specific Exclusions when EPG TOD is Higher than LD ................. 25
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Attachment 3. Description of Expedited Processing Groups for Enewetak Cleanup Project 

Radiation Dose Assessments ................................................................................ 30

A3-1 Soil Removal Workers (EPG-1) ........................................................................... 30

A3-2 Northern Island Workers (EPG-2)........................................................................ 31

A3-3 Lojwa Support Workers (EPG-3) ......................................................................... 32

A3-4 Southern Island Workers (EPG-4)........................................................................ 33

Attachment 4. Estimated Organ Doses, Eye Lens and Skin Doses for ECUP EPGs................... 37
DTRA / NTPR - Standard Operating Procedures Manual

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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List of Figures

Figure 1. Expedited Processing of ECUP Dose Assessment – Process Overview...................... 11

Figure 2. EPG selection flowchart............................................................................................... 13

Figure A3-1. Islands of Enewetak Atoll (DTRA, 2023).............................................................. 35

List of Tables

Table A1-1. Cross-Reference of diseased organs, ECUP standard organs, and NIOSH-IREP 

cancer models*......................................................................................................... 20

Table A2-1. Limiting doses for cancers based on all alpha......................................................... 26

Table A2-2. EPG and standard organ combinations excluded from expedited processing......... 27

Table A2-3. Limiting doses for skin cancers assuming all alpha ................................................ 27

Table A2-4. Excluded skin cancer cases for “American Indian or Alaska Native”, “Asian, 

Native Hawaiian, or other Pacific Islander”, and “Black” participants .................. 28

Table A2-5. Excluded skin cancer cases for “White (Hispanic)” and “White (Non-Hispanic)” 

participants.............................................................................................................. 29

Table A3-1. Enewetak Atoll islands (DTRA, 2023).................................................................... 36

Table A4-1. Estimated organ doses for ECUP EPGs (rem) ........................................................ 38

Table A4-2. Upper-bound external lens of the eye and skin doses for ECUP EPGs .................. 39
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Standard Operating Procedure

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak 

Cleanup Project Veterans

1. Purpose and Summary

This standard operating procedure (SOP) describes the roles, responsibilities, and 

methodology for processing Department of Defense (DoD) Defense Threat Reduction 

Agency (DTRA) Nuclear Test Personnel Review (NTPR) radiation dose assessments 

(RDAs). These assessments are performed in response to requests from the Department 

of Veterans Affairs (VA) on behalf of Enewetak Cleanup Project (ECUP) veterans. In 

particular, the SOP provides specific criteria and detailed actions to accomplish expedited 

processing of the majority of ECUP cases received by DTRA. Expedited processing 

involves assignment of upper-bound group-based estimated radiation doses to ECUP 

veterans without the need for individualized RDAs. Expedited processing of ECUP 

RDAs supports more timely response to VA requests and more timely decision-making 

for veterans’ claims than if individual-specific, full RDAs are performed for every case. 

For ECUP cases not qualified for expedited processing under the criteria in this SOP, 

technical reviews and/or full RDAs for those cases will be conducted based on 

appropriate DTRA NTPR SOPs. Finally, requirements and procedures for data and 

records management, and associated quality assurance (QA) activities are provided for 

completing the processing of the case.

This SOP is written for qualified NTPR Research Analysts, DTRA Analysts, RDA 

Analysts, and QA Auditors who process and evaluate ECUP veteran cases received from 

the VA, and for managers who oversee the entire dose assessment process. The SOP 

conforms to procedures, methods, quality standards, and established NTPR policies and 

guidelines.

2. Scope

This SOP applies to all ECUP participants, defined as veterans participating in the 

cleanup of Enewetak Atoll from 1977 to 1980. All ECUP participant cases are initially 

evaluated for eligibility for expedited processing and processed according to the detailed 

methodology described herein. The doses to be assigned under expedited processing 

described in this SOP are likely to be below the doses that could result in service 

connection for a claimant. Cases that do not pass the evaluation for expedited processing 

under the criteria in this SOP require technical reviews and/or individualized dose 

assessments as discussed in SOP RA06. This SOP is applicable to cases involving 

cancers of internal organs and skin and is also applicable to non-cancerous conditions 

when requested by the VA and documented in the NTPR veteran case file.
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

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Date: April 30, 2023

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3. Responsibilities

3.1 NTPR Research Analyst

The NTPR Research Analyst is responsible for conducting the initial case review. The 

tasks include the following activities:

• Completing the input fields of the DTRA Dose Summary Sheet (DSS) that provide 

historical and dose-related information from the Nuclear Test Research Information 

System (NuTRIS) database

• Summarizing veteran’s comments and notating them with differences between 

historical and dose-related information from records and the veteran’s comments 

• Documenting any special considerations or potential exclusions from expedited 

processing in the DSS

• Identifying the applicable expedited processing group (EPG) and corresponding doses 

based on the veteran’s scenario of participation and affected organ(s), tissue(s), 

disease(s), or skin sites; Attachment 1 provides a cross-reference of an extensive list 

of organs and diseases along with the corresponding surrogate ECUP standard organs 

or diseases for which EPG doses have been estimated. 

3.2 DTRA NTPR Case Manager/DTRA Analyst

The DTRA NTPR Case Manager or the Manager’s designee performs most tasks 

required to assign the expedited processing doses estimated in DTRA (2023), to include

the following:

• Reviewing veteran-provided, historical, NTPR-developed, and other information 

pertinent to the veteran’s potential exposure

• Determining the need for additional, veteran-specific information

• Determining the applicability of the expedited processing dose assignments for an 

individual veteran’s case

• Requesting further technical evaluation by an RDA Analyst and reviewing the

findings of the evaluation

• Documenting the radiation dose assignment evaluation and basis of the decisionmaking process in the DTRA DSS

• Assigning, if applicable, and documenting the assignment of expedited processing 

doses from this SOP in the DTRA DSS and the VA response letter

• Evaluating the results of QA Auditor reviews and taking any corrective actions.
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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3.3 Radiation Dose Assessment Analyst (RDA Analyst)

An RDA Analyst performs dose assessment tasks, when required, for a veteran who has 

filed a claim with the VA for service-connected diseases and a dose request is received 

from DTRA. At the request of the DTRA Analyst, the RDA Analyst provides 

consultative discussions during any further evaluation of a case by the DTRA Analyst, to 

assist in determining the applicability of the expedited processing dose assignment. When 

the case does not qualify for expedited processing under the criteria in this SOP, the RDA 

Analyst is requested to perform a technical review and/or full RDA in accordance with 

SOP RA06. The analyst’s tasks include simplification, modification, or development of 

dose calculation tools and preparation of a report that is specific to the veteran.

3.4 Quality Assurance Auditor

The quality assurance auditor (QA Auditor), with the assistance of a QA reviewer as 

needed, performs and documents independent quality assurance/quality control (QA/QC) 

reviews of the decision-making process and the resulting dose assignment and/or RDA 

documentation. The audit is performed to ensure that the documentation is clear, 

complete, and prepared in accordance with NTPR policies and procedures. The QA 

Auditor documents the results of the review on a QA/QC Review Report. (DTRA, 2022)

4. Definitions

DoD Department of Defense

Dose component Potential contributors to total organ or skin dose, including:

 External gamma dose from residual radiation

 External dose from other sources (e.g., radiological samples, 

diagnostic x-ray machine)

 Internal alpha organ dose

 Internal beta plus gamma organ dose

 Dermal contamination skin dose.

DSS Dose Summary Sheet

DTRA Defense Threat Reduction Agency

ECUP Enewetak Cleanup Project

EPG Expedited processing group as described in DTRA (2023)

EPG Doses Expedited processing group doses, the estimated upper-bound 

dose values for external gamma, internal alpha, and internal beta 

plus gamma radiation (for internal organs); external beta and 

gamma, and dermal contamination doses (for skin)

Full RDA An RDA developed by an RDA Analyst that uses veteran-specific 

dose parameter values to estimate doses and upper-bound doses in 
DTRA / NTPR - Standard Operating Procedures Manual

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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accordance with SOP RA06. A full RDA is performed for cases 

that are excluded from expedited processing

Further evaluation Case file evaluation beyond the initial review by the DTRA 

Analyst. Further evaluation of an ECUP case may include one or 

both of the following actions:

 An additional documented DTRA Analyst review, 

supplemented with an RDA Analyst consultation as needed

 A technical review by an RDA Analyst, or recommendation 

to prepare a full RDA in accordance with SOP RA06.

LD Limiting dose, radiation dose value that corresponds to a 

40 percent probability of causation for cancers

LDα Limiting dose based entirely on alpha radiation, listed in 

DTRA (2023) and Attachment 2 of this document

NIOSH-IREP National Institute of Occupational Safety and Health-Interactive 

RadioEpidemiological Program, an online software application

used to calculate the probability that a cancer was caused by a 

radiation dose (NIOSH, 2020)

NTPR Nuclear Test Personnel Review

NuTRIS Nuclear Test Research Information System: a computerized 

database containing veteran information and dosimetry data

PM Program manager 

QA Quality assurance

QC Quality control

RDA Radiation dose assessment (see “Full RDA” above)

SOP Standard Operating Procedure

Surrogate organ or 

skin site

An ECUP standard organ/skin site used for dose calculations as a 

substitute organ/skin site when no published dose coefficients 

are available for the requested disease or medical condition for 

the organ/skin site

Target organ/skin site The biological organ, tissue, or skin site that is associated with 

the specific medical condition specified by the VA for which a 

radiation dose determination has been requested

TOD Total organ dose, the total of all external and internal dose 

components for a target organ

VA Department of Veterans Affairs
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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5. Procedure: Detailed Activity/Task Description 

The methodology for expedited processing of NTPR ECUP cases described in this SOP 

utilizes the supporting technical information and the maximized EPG doses documented 

in DTRA (2023). The maximized EPG doses were developed for four broadly defined 

groups of exposed individuals: Soil Removal Workers, Northern Island Workers, Lojwa 

Support Workers, and Southern Island Workers. The EPG doses are not intended to be 

representations of doses actually received by an ECUP veteran. However, the EPG doses 

bound the actual doses received by any individual included in an EPG.

The major SOP actions are shown in the process overview diagram (Figure 1). The 

responsible NTPR personnel and more detailed activities are described in the text 

following Figure 1.

5.1 Initial Case Review by NTPR Research Analyst

The decision to expedite or otherwise respond to a VA claim inquiry starts with review 

by the NTPR Research Analyst of the program participant’s identified diseases and the 

request and receipt of required records and other information in accordance with the 

NTPR Program Support and Management SOP (DTRA, 2021). The NTPR Research 

Analyst identifies any exclusions deemed necessary and appropriate based on the review. 

The NTPR Research Analyst reviews case file information that may include, but is not 

limited to, the following:

• Veteran-provided information, including comments, identification of unusual 

exposure conditions, and answers to questionnaires regarding the potential exposures

• VA-furnished information, particularly the disease(s), target organ(s), or target skin 

site(s) for which the doses are requested

• Historical veteran- and assignment-specific information

• Additional medical opinion(s) available regarding the disease(s), target organ(s), or 

target skin site(s).
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Figure 1. Expedited Processing of ECUP Dose Assessment – Process Overview

No

Yes

Is further 

evaluation

of the case 

needed?

DTRA Analyst

• Conduct further evaluation of the case, including consultative 

discussions with RDA analyst as necessary

• If necessary, forward case file and request Technical Review or full 

RDA from RDA Analyst

• Document results of the further evaluation of the case, to include a 

summary of any consultation with RDA Analyst

RDA Analyst (if requested)

• Review case file

• Consult with DTRA Analyst, if necessary, and transmit record of 

discussion to DTRA Analyst

• Perform Technical Review or full RDA and document as 

applicable with associated dose calculations

DTRA Analyst

• Review Technical Review or full RDA report, if applicable

• Assign EPG doses as applicable

• Complete documentation for all work and/or draft VA response 

letter

QA Auditor

• Review case file with completed documentation of all work, draft 

or finalize VA response letter, and any RDA Analyst information 

from further evaluation of the case

• Document QA review on QA/QC Review Report for transmittal to

the NTPR and DTRA Analysts

DTRA Analyst

• Review case file and documents 

forwarded from NTPR Research Analyst

• Confirm EPG assignment

• Determine need for additional, veteranspecific information and if there is a need 

for further evaluation of the case

• Complete applicable sections of DSS

• Provide external and internal organ or 

external skin dose assignments for case 

evaluation, decision-making process and

any analyst’s additional comments, 

including reason(s) for further evaluation 

of the case, if applicable

NTPR Research Analyst

• Review case file

• Identify target/surrogate organ(s) or skin 

sites

• Identify any applicable general 

exclusions

• If no general exclusions, make initial 

EPG assignment

• Identify any EPG-specific exclusions

• Summarize veteran comments, clarify or 

respond to issues raised by veteran

• Complete applicable sections of the DSS 

and forward case file with draft response 

letter to the VA and the documentation 

for all work performed to DTRA Analyst
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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5.2 Identification of Standard or Surrogate Organ/Skin Site

The NTPR Research Analyst uses the VA dose request, which specifies the target organ, 

tissue, skin site, or disease, to identify the corresponding ECUP standard organ, tissue, or 

skin site. The ECUP standard organs and tissues are listed in Table A4-1 with the 

estimated organ doses, and are cross-referenced to target organs, tissues, and diseases in 

Table A1-1. The ECUP standard skin sites are listed in Table A4-2 along with the 

estimated skin doses. The identified standard organ/skin site is either the same as the 

target organ/skin site, or in the case where the target organ/skin site or disease is not a 

standard organ/skin site, it is a surrogate organ/skin site for the specified target organ, 

tissue, skin site, or disease. The NTPR Research Analyst documents the identified organ, 

tissue, or skin site in the DSS.

5.3 Assignment of EPG and Documentation in the Dose Summary Sheet by NTPR 

Research Analyst

Following the initial case review, the NTPR Research Analyst completes the “Research 

Analyst’s Comments” section of the DTRA DSS. The following tasks need to be 

performed to complete the section: 

• Summarize veteran comments, particularly those that might pertain to, or that the 

veteran might expect to pertain to, potential radiation exposure

• Clarify or respond to issues raised by the veteran when available pertinent historical 

information differs from the veteran’s comments 

• Identify any applicable general exclusions per Figure 2 and Attachment 2

• Make an initial EPG assignment using the EPG selection flowchart shown in Figure 2

and the EPG definitions contained in Attachment 3. If multiple EPGs are applicable 

to a veteran, assign the EPG with the highest doses regardless of the duration of time 

spent under each EPG. (See note below)

• Identify any applicable EPG-specific exclusions

• If no EPG-specific exclusions, assign the applicable EPG doses corresponding to the 

ECUP standard organs or skin sites as reported in Table A4-1 and Table A4-2

• Prepare a draft response letter for reporting NTPR assigned doses to the VA; for VA 

dose requests that are for a specific disease instead of a physical location or organ, 

such as chronic lymphocytic leukemia (CLL), the requested disease should be 

indicated in the draft VA response letter.
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Figure 2. EPG selection flowchart

1. Soil-removal work activities are discussed in Section A3-1.

2. The 5 soil-removal islands are Boken (Irene), Enjebi (Janet), Lujor (Pearl), Aomon (Sally), and Runit (Yvonne).

3. The northern islands of Enewetak Atoll are defined in Section A3-2.

Did the veteran 

work on or visit 

any Northern 

islands3 other than 

Lojwa for any 

duration?

Did the veteran 

work, visit, or 

reside on Lojwa 

Island at any time 

and for any 

duration?

Assign Doses for EPG-1

Soil Removal Workers

Assign Doses for EPG-2

Northern Island Workers

Assign Doses for EPG-3

Lojwa Support Workers

Assign Doses for EPG-4

Southern Island Workers

Are there any 

EPG-1 

exclusions?

Technical Review Technical Review

YES

Technical Review Technical Review

Did the veteran 

work on or visit one 

or more southern 

islands, or was 

aboard a ship in the 

lagoon, for any 

duration?

Are there any 

general exclusions 

or unusual 

exposure 

scenarios?

[EPG cannot be 

readily assigned]

Case Review Technical Review

Are there any 

EPG-2 

exclusions?

Are there any 

EPG-3 

exclusions?

Are there any 

EPG-4 

exclusions?

Did the veteran 

perform any soilremoval work 

activities on any of 

the 5 soil-removal 

islands1, 2 for any duration?

Technical Review

YES YES YES

YES

YES

YES YES YES

NO NO NO NO

NO NO NO NO

NO

Initial EPG-1 Assignment Initial EPG-2 Assignment Initial EPG-3 Assignment Initial EPG-4 Assignment
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Note: For assigning doses when multiple EPGs are applicable to a veteran, the order 

of EPGs from highest to lowest doses is as follows:

1) Soil Removal Workers (EPG-1)

2) Northern Island Workers (EPG-2)

3) Lojwa Support Workers (EPG-3)

4) Southern Island Workers (EPG-4)

Although evidentiary documents may be missing to confirm a veteran’s presence at a 

specific worksite given in statements or answers by the veteran, the veteran’s information 

must be accepted unless other relevant documents or records are produced as proof the 

veteran was at a different location.

The NTPR Research Analyst then forwards the case, including the DTRA DSS and the 

draft response letter to the VA, to the DTRA Analyst for review and decision on dose 

assignment.

5.4 DTRA Analyst Case Review

The DTRA Analyst reviews available case information, including completed portions of 

the DTRA DSS, and conducts the following actions:

• Review the case file, including, as applicable, the information summarized by the 

NTPR Research Analyst, veteran comments, and clarifications and responses to the 

veteran’s comments documented in the DSS

• Verify that the ECUP standard organ or tissue or skin site is correctly identified and, 

if necessary, request an expert medical opinion from a professional who is qualified 

and knowledgeable about radiogenic illnesses regarding the applicable standard 

organ/skin site or the radiogenicity of a medical condition 

• Verify that the selected EPG is the applicable EPG based on the selection flowchart

shown in Figure 2 and the EPG definitions contained in Attachment 3

• Check that any identified exclusions are necessary and appropriate

• Request additional veteran-specific information, if needed.

Following review and any subsequent actions as identified below, the DTRA Analyst

provides the analyst comments, documents external and internal organ dose assignments

in the DSS, and justification in the response letter to the VA. For cases in which the RDA 

Analyst completes a technical review or a full RDA, the total rounded external and 

internal doses are reported in the final VA response letter.
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5.5 Further Evaluation of a Case

During review of the case file, the DTRA Analyst determines whether the applicable 

EPG Total Organ Dose (TOD) or total skin dose can be assigned, or if the case requires 

further evaluation to assign the appropriate dose components. The case requires further 

evaluation if it involves any of the following conditions:

• The applicable EPG TOD as shown in Table A4-1 is greater than the corresponding 

Limiting Dose (LDα) listed in Table A2-1. These exclusions are identified in

Table A2-2.

• The applicable EPG Total Skin Dose(s) as shown in Table A4-2 is greater than the 

applicable LDα listed in Table A2-3. These exclusions are identified in Table A2-4

and Table A2-5.

• There is no applicable EPG for the veteran’s exposure scenario.

• There are unusual aspects, or a poorly defined veteran exposure scenario identified by 

the DTRA Analyst; this type of exclusion would be driven by the veteran’s exposure 

scenario that includes possible sources/pathways not fully accounted for by any of the 

EPG scenarios. General exclusions are identified in Section A2-1. 

When further evaluation of a veteran’s case is required to determine the appropriate dose 

components, a more detailed review by the DTRA Analyst should be performed. If 

deemed necessary, an RDA Analyst should be requested to perform a technical review 

and/or a full RDA. 

A more detailed DTRA Analyst review is used to determine if the veteran’s specific 

exposure scenario clearly indicates that the EPG TOD or EPG total skin dose is bounding 

to the veteran’s actual TOD or total skin dose. If this cannot be determined, the DTRA 

Analyst requests a technical review or a full RDA due to indications of potential exposure 

beyond the criteria that define the applicable EPG.

The DTRA Analyst may request informal consultation with an RDA Analyst during this 

additional review. This consultation will normally consist of discussions and possibly 

minimal calculations or data evaluation so that the DTRA Analyst is able to determine if 

the EPG doses are adequate to assign or if a technical review or full RDA is required. If 

the RDA Analyst is consulted during the review, the RDA Analyst transmits a record of 

the communication to the DTRA Analyst to document the consultation.

If, after additional review, the DTRA Analyst determines that EPG doses are adequate to 

assign, i.e., the veteran’s estimated TOD or total skin dose is less than both the EPG dose 

and the applicable LDα, the DTRA Analyst prepares a summary that documents the 

review and all pertinent results. If the EPG doses cannot be assigned, the case is excluded 

from expedited processing and the case is referred to an RDA Analyst for a technical 

review and/or full RDA as described in the following section.
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Date: April 30, 2023

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5.6 RDA Analyst Technical Review

If the DTRA Analyst determines that the case is excluded from expedited processing, a

technical review and/or full RDA is conducted by an RDA Analyst. The tasks involved in 

the technical review by an RDA Analyst include the following:

• Reviewing the case file, and if additional veteran-specific information is necessary to 

evaluate a case, requesting assistance from the DTRA NTPR Case Manager

• Performing technical review dose assessment by following the general methodology 

used for full ECUP RDA dose estimates (SOP RA06) with additional simplifications, 

minimal detailed calculations, and the use of maximum plausible parameter values to

expedite the determination of bounding doses for the veteran’s specific scenario

• Comparing the estimated bounding TOD or total skin dose to the applicable EPG 

TOD or total skin dose, and for cancers verifying that it is less than the applicable 

LDα

• Documenting the technical review in the form of a memorandum with or without 

supporting dose calculations 

• Recommending a full RDA to the DTRA Analyst if the estimate of the veteran’s 

bounding TOD or total skin dose is greater than the applicable LDα. 

If a full RDA is recommended, it should address all radiation dose components using 

detailed assumptions and calculations and should be performed and documented in 

accordance with SOP RA06. This requirement will be limited to cases excluded from 

expedited processing based on an EPG dose or bounding TOD that is greater than the 

applicable LDα, or to cases where the veteran claims an unusual radiation exposure 

scenario that includes pathways not fully accounted for by any of the EPG scenarios and

the selected ECUP default assumptions described in DTRA (2023).

If a full RDA is required, the DTRA Analyst documents the reason(s) for the full RDA 

requirement. The RDA Analyst completes and transmits the RDA report and 

accompanying calculations to the DTRA Analyst for review and inclusion in the case file.

5.7 Assigning Doses

Dose assignments are completed by the DTRA Analyst and transmitted to the DTRA 

NTPR Case Manager for inclusion in the veteran case file using the following guidance:

• If the participant is not excluded from expedited processing per Section 5.5, the 

DTRA Analyst assigns the applicable EPG dose components for the requested 

organ(s), disease, and/or skin site(s). All ECUP EPG doses are reported in

Attachment 4. 

• When a technical review is performed because the EPG TOD or total skin dose is 

greater than the applicable LDα, all estimated bounding dose components are 
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assigned. In the case of cancers, the bounding TOD or total skin dose must be lower 

than the respective LDα. 

• When a technical review is performed for reasons other than the EPG TOD is greater 

than the applicable LDα (e.g., unusual aspects to a veteran’s exposure scenario), the 

dose components (bounding or EPG) that result in the larger TOD or total skin dose 

are assigned. In the case of cancers, the assigned TOD or total skin dose must be 

lower than the respective LDα.

• If a full RDA is performed, the DTRA Analyst assigns all dose components from the 

RDA report to the affected organs/diseases and/or skin sites.

5.8 Quality Assurance Auditor Review

The QA Auditor reviews the case file and records the performance of the quality review 

of the decision-making process, the DSS, the draft VA response letter, RDA Analyst

documentation (if applicable), and the resulting dose assignment for clarity, 

completeness, and conformance to the NTPR Quality Assurance SOP (DTRA, 2022).

The QA Auditor may be assisted by a QA reviewer in this review. A QA reviewer is a 

peer analyst from the team described in Sections 3.1, 3.2, and 3.3. If corrections or 

changes are recommended by the QA Auditor, actions described above in this section 

should be repeated as appropriate for the completion and documentation of the dose 

assignment and results to the VA.

6. Data and Records Management 

Documentation resulting from implementation of this SOP is added to the case file and 

may include any of the following:

• Relevant documentation obtained or developed in accordance with DTRA (2021)

• NTPR Research Analyst’s additions to the required documentation per Sections 5.1, 

5.2, and 5.3

• DTRA Analyst’s additions to the required documentation per Section 5.4 to 5.7

• Results of consultation with an RDA Analyst, consisting of a brief summary of any 

communications

• A technical review memorandum or an RDA Report and supporting radiation dose 

calculations, in accordance with SOP RA06 if a full RDA is performed

• Report of the QA Auditor QA/QC review

• Draft and/or final VA response letter.
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7. Quality Assurance and Quality Control

The NTPR Quality Assurance SOP (DTRA, 2022) describes the quality procedures for 

controlling the NTPR processes and products to ensure that defensible, consistent, and 

objective case processing is accomplished. In addition, NTPR Program Support and 

Management SOPs (DTRA, 2021) and RDA SOPs have been written to ensure that QA 

requirements will be met, by documenting the procedures for all aspects of the program, 

including records research, case processing, dose assessments, and standard report 

template. Finally, when technical reviews are requested or full RDAs are recommended, 

the NTPR ECUP radiation dose assessment procedure, SOP RA06, and references therein 

provide conservative default assumptions and parameter values that further ensure 

consistency and defensibility of all dose assessments. 

If a technical review is required because of identified exclusions or when a full RDA is 

recommended, internal quality control checks are performed throughout the dose 

estimation and reporting process. The RDA Analyst discusses with members of the RDA 

team proposed assumptions to perform the required dose estimations until a consensus on 

best approach to proceed is reached. Technical reviews of the draft Technical Review 

Memorandum are conducted by peer radiation analysts from the RDA team. When a full 

RDA is recommended, all aspects of the dose assessment including quality management 

are performed in accordance with SOP RA06. Consistency and conformance with 

policies and guidelines are further assured through the RDA team management review. 

Further quality control actions are conducted by independent external reviewers 

according to the NTPR Quality Assurance SOP (DTRA, 2022). For this procedure, 

external reviews are defined as reviews conducted by qualified analysts who are not part 

of the RDA team. For full RDAs, the RDA Report is revised in response to significant 

comments from such external reviews in accordance with SOP RA06. 

Independent review of the records, process, and results related to radiation dose 

assignment, including expedited processing, with or without a technical review, and full 

RDAs, is performed and documented by the QA Auditor. Results of case processing and 

quality reviews are reported to DTRA NTPR program management during semi-annual 

NTPR Program Management Reviews and the Reported Quality Issues spreadsheet. 

8. Referenced SOPs from the NTPR/RDA SOP Manual

(1) SOP RA02 Expedited Processing of Radiation Dose Assessments for Atmospheric 

Nuclear Weapons Testing Veterans

(2) SOP RA06 Radiation Dose Assessment for Participants in the Enewetak Cleanup 

Project
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9. References

DTRA (Defense Threat Reduction Agency), 2021. DTRA NTPR Program Support and 

Management SOP (Rev. 7). Defense Threat Reduction Agency, Fort Belvoir, VA. 

October 29.

DTRA (Defense Threat Reduction Agency), 2022. DTRA NTPR Program Quality Assurance 

SOP, Revision 6, Fort Belvoir, VA. February 28.

DTRA (Defense Threat Reduction Agency), 2023. Expedited Processing of Radiation Dose 

Assessments for Military Personnel of the Enewetak Atoll Cleanup Project (1977–1980)

Revision 1. DTRA-TR-21-050(R1), Defense Threat Reduction Agency, Fort Belvoir, VA. 

In review, to be published in May 2023.

ICRP (International Commission on Radiological Protection), 2011. ICRP Database of Dose 

Coefficients: Workers and Members of the Public, Version 3.0. The International 

Commission on Radiological Protection, Ottawa, Ontario. 

NIOSH (National Institute for Occupational Safety and Health), 2020. Interactive 

RadioEpidemiological Program, NIOSH-IREP ver. 5.9. National Institute for 

Occupational Safety and Health, Washington, DC. December. Available at: 

https://irep.oraucoc.org/, accessed August 25, 2021.
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Attachment 1.

Organ and Disease/Standard Organ Cross-References

Table A1-1. Cross-Reference of diseased organs, ECUP standard organs, and NIOSH-IREP cancer models*

Organ, Tissue, or Disease ECUP Standard Organ ECUP Standard 

Organ Type† NIOSH-IREP Cancer Model

Acute lymphocytic leukemia (ALL) Red Marrow Surrogate Acute Lymphocytic Leukemia

Acute myeloid leukemia (AML) Red Marrow Surrogate Acute Myeloid Leukemia 

Adrenal glands Adrenals ICRP Other endocrine glands

Arthritic tissue Bone Surface Surrogate Not applicable (not a malignant 

neoplasm)

Bladder Bladder Wall ICRP Bladder 

Blood, bone marrow, red marrow, 

yellow marrow Red Marrow ICRP, Surrogate Leukemia, excluding CLL 

Bone, bone surface, endosteum, joints, 

and all other bones (e.g., ankle, elbow, 

femur, hand, jaw, pelvis, shoulder, spine, 

vertebrae)

Bone Surface ICRP, Surrogate Bone 

Brain, anterior commissure, brain stem, 

cranial nerve Brain ICRP, Surrogate Nervous system 

Breast Breast ICRP Breast 

Cervix Uterus Surrogate Female Genitalia, excluding

ovary 

Chronic lymphocytic leukemia (CLL) Spleen Surrogate Chronic Lymphocytic Leukemia 
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Organ, Tissue, or Disease ECUP Standard Organ ECUP Standard 

Organ Type† NIOSH-IREP Cancer Model

Chronic myeloid leukemia (CML) Red Marrow Surrogate Chronic Myeloid Leukemia 

Colon Colon ICRP Colon 

Connective tissue Muscle Surrogate Connective tissue

Diabetes (type 1, type 2) Pancreas Surrogate Not applicable (not a malignant 

neoplasm)

Endocrine glands (endocrine glands not 

included elsewhere)

Specific diseased organ 

must be known. Surrogate Other endocrine glands

Esophagus Esophagus ICRP Esophagus

Eye, choroid, retina Brain Surrogate Eye 

Gallbladder, bile duct Liver Surrogate Gallbladder 

Heart, aorta, atrial sarcoma Muscle Surrogate Other respiratory 

Kidney Kidneys ICRP Urinary organs, excluding 

bladder 

Larynx, including glottis, vocal cords ET Airways‡ Surrogate Other respiratory

Leukemia (excluding ALL, AML, CLL, 

and CML) Red Marrow Surrogate Leukemia, excluding CLL 

Lipoma Muscle Surrogate Not applicable (not a malignant 

neoplasm)

Liver Liver ICRP Liver 

Lower large intestine, large intestine LLI Wall‡ ICRP Colon 

Lung, trachea, bronchus Lungs ICRP, Surrogate Lung 

Lymph system, including lymph glands, 

lymph nodes, lymphatic tissue, 

lymphoma

Thymus (If this is 

primary disease) Surrogate Lymphoma and multiple myeloma 
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Organ, Tissue, or Disease ECUP Standard Organ ECUP Standard 

Organ Type† NIOSH-IREP Cancer Model

Middle ear Brain Surrogate Other respiratory 

Multiple myeloma Red Marrow Surrogate Lymphoma and multiple 

myeloma 

Muscle, including, thigh muscle, eye 

muscle, eyelid muscle, neuro-muscular Muscle ICRP, Surrogate Other and ill-defined sites 

Nasal cavities, including sinus 

(maxillary), sinus (nasal), nasal tip ET Airways‡ Surrogate Other respiratory

Nervous system, spinal cord, spine nerves Brain Surrogate Nervous system 

Neuroendocrine system, including 

hypothalamus, pituitary gland, pineal 

gland

Brain Surrogate Other endocrine glands 

Oral cavity and pharynx, including 

epiglottis, gum, hypopharynx, lip, mouth, 

nasopharynx, oropharynx, palate, parotid 

gland, salivary gland, throat, tongue, 

tonsil, uvula, and nasolabial fold (specific 

disease needed if not skin cancer) 

ET Airways‡ Surrogate Oral Cavity and Pharynx 

Ovary Ovaries ICRP Ovary 

Pancreas Pancreas ICRP Pancreas 

Parathyroid Thyroid Surrogate Other endocrine glands 

Peritoneum, peritoneal cavity muscle Muscle Surrogate All digestive 

Pleura Lungs Surrogate Other respiratory 

Prostate Testes Surrogate All Male Genitalia 

Rectum, anus, anal canal LLI Wall‡ Surrogate Rectum 

Respiratory other than Lung ET Airways‡ Surrogate Other respiratory
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Organ, Tissue, or Disease ECUP Standard Organ ECUP Standard 

Organ Type† NIOSH-IREP Cancer Model

Small intestine, duodenum SI Wall‡ ICRP, Surrogate All digestive 

Soft tissue, e.g., hip, shoulder, thigh, 

upper arm

Muscle Surrogate Other and ill-defined sites 

Spleen

Spleen (Use only if solid 

cancer of spleen is the 

primary disease)

ICRP All digestive

Stomach Stomach Wall ICRP Stomach 

Testes and other male genitalia, including 

penis and scrotum Testes ICRP, Surrogate All Male Genitalia 

Thymus Thymus ICRP Other respiratory 

Thyroid Thyroid ICRP Thyroid 

Upper large intestine, including 

appendix, cecum ULI Wall‡ ICRP, Surrogate Colon 

Urinary tract, urethra, ureter Bladder Wall Surrogate Urinary organs, excluding 

bladder 

Uterus Uterus ICRP Female Genitalia, excluding 

ovary 

* Modified from Table A2-1 of SOP RA02. Several modifications were made due to use of ICRP organs for ECUP instead of FIIDOS organs used for

SOP RA02. 

† ICRP (in bold) means that there are ICRP 68 dose coefficients for the organ(s) in bold. “Surrogate” means that dose coefficients for the ECUP Standard 

Organ are used for the non-bolded diseased organ(s).

‡ ET=extra-thoracic, LLI=lower large intestine, SI=small intestine, ULI = upper large intestine
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Attachment 2.

ECUP Veteran Cases Excluded from Expedited Processing

ECUP participants may be excluded from automatic expedited processing for several reasons. 

Although unlikely to be frequent, there may be cases in which there is insufficient information 

regarding a veteran’s activities to justify expedited processing of the case. Another reason for 

exclusion from automatic expedited processing is for cases where information provided from the 

veteran indicates activities that represent the potential for doses higher than the applicable EPG 

doses. Finally, a case is excluded from automatic expedited processing if the applicable EPG 

TOD or total skin dose is greater than the LD value that is applicable to the target organ or skin 

site. Cases involving any of these situations are subjected to further review as described in 

Section 5.5. Several scenarios previously identified as exclusions or potential exclusions have 

been reevaluated and eliminated (DTRA, 2023). General and EPG-specific exclusions that 

should trigger a further evaluation by an RDA Analyst are discussed below. 

A2-1 General Exclusions

Certain activities may have resulted in exposure scenarios that do not fit within any of the EPG 

definitions provided in Attachment 3. Possible activities that could initiate further review of a 

case are listed below and should be considered on a case-by-case basis as potential exclusions 

from expedited processing:

• Removing plutonium fragments from burial crypts on Aomon

• Disposing soil bags with plutonium fragments from Fig-Quince ground zero area on Runit

• Removing concentrated contaminated material from outside of the bunkers on Boken

• Participating in duties at the Decontamination Laundry Facility on Lojwa

• Being involved in or near accidents or abnormal events involving contaminated soil or debris

• Having an ECUP assignment at Enewetak Atoll for greater than one year

• Having unusual exposure aspects or a poorly defined veteran exposure scenario.

A2-2 EPG-specific Exclusions

EPG-specific exclusions are based on veteran exposure scenarios or on comparisons of EPG 

TODs or total skin doses to applicable Limiting Doses (LD). 
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A2.2.1 EPG Exposure Scenario Exclusions

There are no realistic ECUP veteran exposure scenarios that are applicable only to a specific 

EPG that would potentially result in organ or skin doses that could equal or exceed applicable 

EPG doses. EPG-specific exclusions based on comparison to applicable LD values are discussed 

in the following sections.

A2.2.2 EPG-specific Exclusions when EPG TOD is Higher than LD

Values of LD based on alpha radiation (LDα) have been estimated using the NIOSH-IREP 

software application (NIOSH, 2020). Cases with EPG TODs that are greater than the 

corresponding LDα value are initially excluded from expedited processing and are subject to

further review.

Values of LDα for cancers associated with internal organs and diseases are shown in Table A2-1.

EPG TODs that exceed the applicable LDα values are excluded from expedited processing and

are shown in Table A2-2. 

A2.2.3 EPG-specific Exclusions when EPG Total Skin Dose is Higher than LD

Values of LDα for three types of skin cancers and five NIOSH-IREP race categories are shown 

in Table A2-3. EPG total skin doses that exceed the applicable LDα values are excluded from 

automatic expedited processing. These occurrences are shown in Table A2-4 and Table A2-5. 
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Table A2-1. Limiting doses for cancers based on all alpha 

Cancer of Organ/Disease LDα* (rem)

Acute Lymphocytic Leukemia (ALL) 20†

Acute Myeloid Leukemia (AML) 15†

All digestive, other than excluding esophagus, stomach, colon, 

rectum/anus 17

Bone 15

Breast (male) 10

Breast (female) 15

Chronic Lymphocytic Leukemia (CLL) 34†

Chronic Myeloid Leukemia (CML) 89†

Colon 11

Connective tissue 17

Endocrine glands, other than thyroid 12

Esophagus 11

Eye 16

Female genitalia 1400

Gallbladder 6.5

Leukemia, other than ALL, AML, CML, and CLL 27†

Liver 3.6

Lung (never smokers) 13

Lymphoma and multiple myeloma 28

Male genitalia 30

Nervous system 37

Oral cavity and Pharynx 36

Other and ill-defined sites 17

Ovary 14

Pancreas 34

Rectum 43

Respiratory tract, other than lung 48

Stomach 10

Thyroid 3.2‡

Urinary Bladder 16

Urinary organs, other than bladder) 13

* LDα = Limiting dose (PC of 40 percent) assuming the total organ dose is due entirely to alpha radiation. LDα 

values were estimated with the NIOSH-IREP online software. Assumptions include acute exposure at age 

18 years and attained age of 50 years (elapsed time of 32 years) unless noted otherwise. Values are for males 

except values for three female-specific organs listed.

† LDα values for leukemia are calculated for an elapsed time of 30 years.

‡ LDα values for thyroid cancer are calculated for an elapsed time of >10 years.
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Table A2-2. EPG and standard organ combinations excluded from expedited processing

ECUP EPG ECUP Standard Organ NIOSH-IREP Cancer Model

Soil Removal Workers Bone Surface Bone

Liver Liver, Gallbladder

Northern Island Workers – None – n/a

Lojwa Support Workers – None – n/a

Southern Island Workers – None – n/a

Table A2-3. Limiting doses for skin cancers assuming all alpha

LDα* (rem)

NIOSH-IREP Race Category MM† BCC† SCC†

American Indian or Alaska Native 1.0 0.85 63

Asian, Native Hawaiian, or other Pacific 

Islander

1.8 0.85 63

Black 1.7 0.85 63

White - Hispanic 2.1 2.4 165

White - Non-Hispanic 2.4 2.5 175

* LD values correspond to a PC of 40 percent. LD values are estimated with the on-line NIOSH-IREP software

(NIOSH, 2020), using an acute exposure at age 18 and cancer diagnosis at age 50. LDα is estimated by assuming 

the total skin dose is due entirely to alpha radiation.

† MM = malignant melanoma; BCC = basal cell carcinoma; SCC = squamous cell carcinoma.
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Table A2-4. Excluded skin cancer cases for “American Indian or Alaska Native”,

“Asian, Native Hawaiian, or other Pacific Islander”, and “Black” participants

Skin Site

EPG/Cancer/Skin Site Combinations that are Excluded (red) for ECUP Expedited Processing *,†,‡

Soil Removal Northern Islands Lojwa Support Southern Islands

MM BCC SCC MM BCC SCC MM BCC SCC MM BCC SCC

Scalp

Face

Forehead

Behind ear

Neck

Back of neck

Shoulder

Chest

Torso (backside)

Under belt

Forearm

Upper leg

Palm

Back of hand

Lower leg

Sole of foot

Under boot edge

* MM = malignant melanoma. LDα values for MM are 1.0–1.8 rem for the participants represented in this table; an LDα of 1.0 rem is used for 

expedited processing.

BCC = basal cell carcinoma. The BCC LDα value for all participants represented in this table is 0.85 rem.

SCC = squamous cell carcinoma cases. The SCC LDα value for all participants represented in this table is 63 rem.

† Red-shaded table cells indicate EPG/Skin cancer/Skin site combinations that are excluded from expedited processing for the participants 

represented in this table (see Table caption).

‡ Green-shaded table cells shaded green indicate EPG/Skin cancer/Skin site combinations that are recommended for expedited processing for the 

participants represented in this table (see Table caption), with assignment of the applicable doses from Table A4-2.
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Table A2-5. Excluded skin cancer cases for “White (Hispanic)” and “White (Non-Hispanic)” participants

Skin Site

EPG/Cancer/Skin Site Combinations that are Excluded (red) for ECUP Expedited Processing*,†,‡

Soil Removal Northern Islands Lojwa Support Southern Islands

MM BCC SCC MM BCC SCC MM BCC SCC MM BCC SCC

Scalp

Face

Forehead

Behind ear

Neck

Back of neck

Shoulder

Chest

Torso (backside)

Under belt

Forearm

Upper leg

Palm

Back of hand

Lower leg

Sole of foot

Under boot edge

* MM = malignant melanoma. LDα values for MM are 2.1–2.4 rem for the participants represented in this table; an LDα of 2.1 rem is used for 

determining cases excluded from expedited processing.

BCC = basal cell carcinoma. LDα values for BCC are 2.4–2.5 rem for the participants represented in this table; an LDα of 2.4 rem is used for 

expedited processing recommendations.

SCC = squamous cell carcinoma cases. LDα values for SCC are 165–175 rem for the participants represented in this table; an LDα of 165 rem is 

used for expedited processing recommendations.

† Red-shaded table cells indicate EPG/Skin cancer/Skin site combinations that are excluded from expedited processing for the participants 

represented in this table (see Table caption).

‡ Green-shaded table cells indicate EPG/Skin cancer/Skin site combinations that are recommended for expedited processing for the participants 

represented in this table (see Table caption), with assignment of the applicable dose from Table A4-2.
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Attachment 3.

Description of Expedited Processing Groups

for Enewetak Cleanup Project Radiation Dose Assessments

Four Expedited Processing Groups (EPGs) were defined to represent most of the ECUP 

participant population. Each EPG was expected to represent a large number of ECUP 

participants that were engaged in common activities and experienced similar radiation exposure 

environments at well-defined worksite locations. The EPG descriptions included below will aid 

in identifying an appropriate EPG to assign to a veteran based on the information available in the 

veteran’s case file especially personal statements and answers in the ECUP Questionnaire. 

A3-1 Soil Removal Workers (EPG-1) 

This EPG consists of ECUP participants whose documented or stated duties included performing 

soil-removal activities that involved disrupting and/or handling contaminated soil that required 

removal from one or more of the five soil-removal islands. The soil-removal islands are the 

northern islands of Boken (Irene), Enjebi (Janet), Lujor (Pearl), Aomon (Sally), and Runit 

(Yvonne). These islands are located in the north rim and in the northeast quadrant of the atoll as 

shown in Figure A3-1.

Soil removal activities involved excising, windrowing, stockpiling, loading/unloading, 

transporting, and mixing contaminated soil for containment in the Cactus crater and dome. 

Sample activities that could have been performed by individuals under this EPG on any of the 

five soil-removal islands include, but are not limited to, the following:

• Digging, excavating, moving, stockpiling soil

• Loading soil into dump trucks, boats, and vehicles of any kind using heavy machinery

• Transporting soil to Runit

• Unloading soil on Runit

• Gathering and reforming the soil into other media for disposal, such as rejected soil-cement 

slurry from the tremie system reformed into concrete blocks

• Transporting soil to the disposal site for containment in Cactus crater.

Typical individuals who performed activities relevant to this EPG may include, but are not 

limited to, U.S. Army Engineer heavy equipment operators, soil transport truck drivers, crew of 

boats that transported contaminated soil, tremie workers and soil-cement mix teams that operated 

at worksites on Runit. Personnel that can be assigned this EPG are likely to have resided on 
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Lojwa Island while performing soil cleanup work on any of the five soil-removal islands

identified above. 

A3-2 Northern Island Workers (EPG-2)

This EPG includes ECUP participants whose documented or stated duties involved performing 

any activities such as those listed below on one or more of 21 northern islands of the atoll. The 

northern islands of this EPG include the five soil-removal islands. The 21 northern islands are 

listed in Table A3-1 and are shown in Figure A3-1. The 21 northern islands included in this EPG 

consist of the line of islands starting with Bokoluo (Alice) in the northwest going clockwise 

along the northern and northeast rim of the atoll to Runit (Yvonne), excluding Lojwa (Ursula). 

The residence island (Lojwa) where members of this EPG were typically billeted is not 

considered a work island for this EPG. However, participants who had work duties on Lojwa are 

considered under the Lojwa Support Workers (EPG-3). 

Activities of members of this EPG involved removing, handling, and transporting debris, 

performing regular or periodic radiological safety monitoring or sampling, and removing brush 

from any of the 21 northern islands including the five soil-removal islands. Oversight, 

inspection, and other short-term activities conducted on any of the 21 northern islands are also 

included. Sample work activities that would have been performed by members of this EPG 

include, but are not limited to, the following: 

• Handling contaminated and uncontaminated debris

• Preparing debris for transport

• Accompanying debris during transport

• Unloading, moving, and disposing of yellow debris at lagoon disposal sites and red debris in 

the Cactus crater

• Performing radiological monitoring, sampling, and inspections 

• Removing brush

• Performing activities that are not specifically listed above on any of the northern islands, 

such as loading or unloading supplies, equipment, or personnel

• Transporting rejected soil-cement slurry reformed into concrete blocks, transferred in dump 

trucks to the Cactus crater

• Performing supervisory, oversight, assessment, or inspection duties, including RSAIT 

inspections

• Participating in short-term visits such as VIP and morale-boosting visits, and other visitor 

tours.

Typical individuals who performed activities relevant to this EPG may include, but are not 

limited to, members of U.S. Army Engineer Units, U.S. Navy Harbor Clearance Units, Water-
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Beach Cleanup Teams, and U.S. Air Force Field Radiation Support Teams. Personnel that can be 

assigned this EPG are likely to have resided on Lojwa Island while performing cleanup work on 

the northern islands identified above.

A3-3 Lojwa Support Workers (EPG-3)

This EPG includes ECUP participants whose documented or stated duties involved working on 

Lojwa Island shown in Figure A3-1. It does not include individuals who resided on Lojwa and 

worked on other northern islands. Such participants should be considered as part of the Soil 

Removal Workers EPG (EPG-1) or the Northern Island Workers EPG (EPG-2).

Activities of members of this EPG generally involved maintaining the island’s infrastructure and 

providing services that supported the cleanup operations. Oversight, inspection, and other shortterm activities conducted on Lojwa Island are also included. Sample work activities associated 

with this EPG include, but are not limited to, the following:

• Maintaining instrumentation and analyzing samples at on-site laboratory facilities

• Maintaining the facilities and structures, such as residence buildings, power production units, 

and repair shops 

• Installing and maintaining telecommunication systems

• Supporting petroleum, oil, and lubrication stores to supply other northern islands

• Operating postal, food, and recreation services

• Transporting workers to and from cleanup sites

• Producing potable and drinking water and operating desalination systems

• Running general laundry services

• Providing medical and dental care

• Performing activities on Lojwa that are not specifically listed above, such as loading or 

unloading supplies, equipment, or personnel

• Performing supervisory, oversight, assessment, or inspection duties, including RSAIT 

inspections

• Participating in short-term visits such as VIP and morale-boosting visits, and other visitor 

tours.

Typical members of this EPG may include, but are not limited to, personnel of U.S. Army 

Engineer Units, U.S. Army, U.S. Navy, and U.S. Air Force, who provided support services such 

as laundry, finance, laboratory, medical, postal, and communication services. Personnel that can 

be assigned to this EPG are likely to have resided on Lojwa Island or Enewetak Island while 

performing infrastructure and support work on Lojwa.
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A3-4 Southern Island Workers (EPG-4) 

This EPG includes ECUP participants whose documented or stated work duties involved 

working on one or more of the 18 southern islands. The 18 southern islands included in this EPG 

are listed in Table A3-1 and are shown in Figure A3-1. They comprise the line of islands starting 

with Boko (Sam) southeast of Runit and continuing clockwise along the southern rim of the atoll 

and ending with the island of Biken (Leroy). 

Activities of members of this EPG included removal, transport, and disposal of uncontaminated 

debris; building and maintaining facilities and structures; and providing support services. 

Individuals performing oversight, inspection, and other short-term activities on the southern 

islands are also included. Also included are crews of aircraft and transient ships that spent time 

on any of the southern islands and nearby lagoon areas. In addition, personnel who participated 

in the removal of a small volume of soil from Medren that was contaminated with Co-60 should 

be included. Sample activities associated with work performed on the southern islands by 

members of this EPG include, but are not limited to, the following: 

• Performing command, control, and communication functions

• Providing central logistical support to the cleanup operations

• Performing project management and administration

• Constructing and maintaining buildings and structures

• Preserving petroleum, oil, and lubrication stores

• Providing medical and dental care

• Installing and maintaining telecommunication systems

• Operating the postal, food, and recreation services

• Transporting personnel and materials, e.g., during MEDEVAC and SAR missions

• Performing radiological surveys

• Removing Co-60 contaminated soil from Medren

• Removing uncontaminated debris

• Removing unexploded ordnance

• Conducting mobilization and demobilization activities

• Crews of transport aircraft and transient ships transporting personnel, delivering materials

and supplies, picking up cargo, or performing on-board support services. Transient ships

generally anchored in the lagoon in the proximity of Enewetak Island.

• Performing supervisory, oversight, assessment, or inspection duties, including RSAIT

inspections

• Participating in short-term visits such as VIP and morale-boosting visits, and other visitor

tours. 
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

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Date: April 30, 2023

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Typical members of this EPG may include, but are not limited to, personnel from all of the 

service elements and FCDNA that provided construction or support services such as laundry, 

finance, medical, postal, communication, security, airfield, harbor, and administrative services 

on Enewetak, Medren, or Japtan islands, as well as cleanup activities in the identified southern 

islands. Personnel that can be assigned to this EPG are likely to have resided on Enewetak 

Island. 
DTRA / NTPR - Standard Operating Procedures Manual

RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Figure A3-1. Islands of Enewetak Atoll (DTRA, 2023)
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RA07 – Expedited Processing of Radiation Dose Assignments for Enewetak Cleanup Project Veterans

Revision No.: 2.0

Date: April 30, 2023

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Table A3-1. Enewetak Atoll islands (DTRA, 2023)

Island Code Site Name Island Name

Northern Islands

FA Alice Bokoluo

FB Belle Bokombako

FC Clara Kirunu

FD Daisy Louj

FE Edna Bocinwotme

FH Helen Bokaidrik

FI Irene Boken

FJ Janet Enjebi

FK Kate Mijikadrek

FL Lucy Kidrinen

MP Percy Taiwel

FM Mary Bokenelab

FN Nancy Elle

FO Olive Aej

FP Pearl Lujor

FR Ruby Eleleron

FS Sally Aomon

FT Tilda Bijile

FU Ursula Lojwa

FV Vera Alembel

FW Wilma Billae

FY Yvonne Runit

Southern Islands

MS Sam Boko

MT Tom Munjor

MU Uriah Inedral

MV Van “No local name”

MA Alvin Jinedrol

MB Bruce Ananij

MC Clyde Jinimi

MC David Japtan

MR Rex Jedrol

ME Elmer Medren (aka Parry)

MW Walt Bokandretok

MF Fred Enewetak

MG Glenn Ikuren

MH Henry Mut

MI Irwin Boken

MJ James Ribewon

MK Keith Kidrenen

ML Leroy Biken

MO Oscar (coral head) Drekatimon

MM Mack (coral head) Unibor
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Date: April 30, 2023

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Attachment 4.

Estimated Organ Doses, Eye Lens and Skin Doses for ECUP EPGs

The upper-bound external, UB α, and UB β+γ organ doses for all EPGs are listed in Table A4-1. 

These doses are recommended for assignment in expediting ECUP cases except as noted in 

Attachment 2 regarding exclusions. For each standard organ, the doses are recommended for all 

organs, diseases, and tissues for which the standard organ is applicable. The ECUP standard 

organs are the organs for which internal dose coefficients are available in ICRP 68 (ICRP, 2011).

The upper-bound total external doses for the lens of the eye and all skin sites for the four ECUP 

EPGs are shown in Table A4-2. These doses should be assigned except for those EPG/race/skin 

cancer/skin site combinations identified in Attachment 2 regarding exclusions.
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Date: April 30, 2023

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Table A4-1. Estimated organ doses for ECUP EPGs (rem)

EPG Name

Internal 

Radiation

Type

and 

EPG TOD*

ECUP Standard Organs

AdrenalsBladder WallBone SurfaceBrainBreastEsophagusStomach WallSI Wall*ULI Wall*LLI Wall*ColonKidneysLiverMuscleOvariesPancreasRed MarrowET Airways*LungsSpleenTestesThymusThyroidUterus

Soil Removal 

Workers (EPG-1) UB α 0.08 0.08 47 0.08 0.08 0.08 0.08 0.08 0.09 0.09 0.09 0.2 10 0.08 0.6 0.08 3 0.3 1 0.08 0.6 0.08 0.08 0.08

External 

Dose

Upper 

Bound UB β+γ 0.02 0.02 0.07 0.02 0.02 0.02 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.04 0.02 0.02 0.02 0.02 0.02 0.02 0.02

0.1 0.3 EPG TOD 0.4 0.4 48 0.4 0.4 0.4 0.4 0.4 0.4 0.5 0.4 0.5 10 0.4 1 0.4 3 0.7 2 0.4 1 0.4 0.4 0.4

Northern Island 

Workers (EPG-2) UB α 0.009 0.009 4 0.009 0.009 0.009 0.009 0.009 0.01 0.02 0.01 0.02 0.7 0.009 0.06 0.009 0.2 0.03 0.07 0.009 0.06 0.009 0.009 0.009

External 

Dose

Upper 

Bound UB β+γ 0.02 0.02 0.07 0.02 0.02 0.02 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.04 0.02 0.02 0.02 0.02 0.02 0.02 0.02

0.1 0.3 EPG TOD 0.4 0.4 5 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 1 0.4 0.4 0.4 0.5 0.4 0.4 0.4 0.4 0.4 0.4 0.4

Lojwa Support 

Workers (EPG-3) UB α 0.004 0.004 1 0.004 0.004 0.004 0.004 0.004 0.005 0.008 0.006 0.006 0.2 0.004 0.02 0.004 0.05 0.006 0.01 0.004 0.02 0.004 0.004 0.004

External 

Dose

Upper 

Bound UB β+γ 0.02 0.02 0.07 0.02 0.02 0.02 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.04 0.02 0.02 0.02 0.02 0.02 0.02 0.02

0.03 0.09 EPG TOD 0.1 0.1 1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.1 0.3 0.1 0.2 0.1 0.2 0.1 0.1 0.1 0.2 0.1 0.1 0.1

Southern Island 

Workers (EPG-4) UB α 0.003 0.003 0.6 0.003 0.003 0.003 0.003 0.004 0.005 0.007 0.006 0.005 0.1 0.003 0.01 0.003 0.03 0.004 0.004 0.003 0.01 0.003 0.003 0.003

External 

Dose

Upper 

Bound UB β+γ 0.02 0.02 0.07 0.02 0.02 0.02 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.04 0.02 0.02 0.02 0.02 0.02 0.02 0.02

0.002 0.005 EPG TOD 0.03 0.03 0.7 0.02 0.02 0.03 0.03 0.03 0.03 0.04 0.04 0.03 0.2 0.02 0.04 0.03 0.07 0.03 0.03 0.03 0.03 0.03 0.03 0.03

* TOD = Total Organ Dose; SI = small intestine; ULI = upper large intestine; LLI = lower large intestine; ET Airways = extra-thoracic airways.
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Revision No.: 2.0

Date: April 30, 2023

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Table A4-2. Upper-bound external lens of the eye and skin doses for ECUP EPGs

Dose location

Total Upper-Bound External (beta+gamma) Lens of the Eye Dose (rem)*

Soil Removal Northern Islands Lojwa Support Southern Islands

Lens of the eye 0.4 0.4 0.4 0.4

Skin Site

Upper-Bound External Skin Doses (rem)

Soil Removal Northern Islands Lojwa Support Southern Islands

UB α UB β+γ UB Tot† UB α UB β+γ UB Tot UB α UB β+γ UB Tot UB α UB β+γ UB Tot

Scalp 45 0.4 45 3 0.4 4 0.3 0.1 0.4 0.02 0.006 0.02

Face 3 0.4 4 0.2 0.4 0.6 0.02 0.1 0.1 0.001 0.006 0.007

Forehead 3 0.4 4 0.2 0.4 0.6 0.02 0.1 0.1 0.001 0.006 0.007

Behind ear 60. 0.5 60. 9 0.4 9 2 0.2 2 0.1 0.007 0.1

Neck 3 0.4 4 0.2 0.4 0.6 0.02 0.1 0.1 0.001 0.006 0.007

Back of neck 60 0.5 60 9 0.4 9 2 0.1 2 0.1 0.006 0.1

Shoulder 3 0.4 4 0.2 0.4 0.6 0.02 0.1 0.2 0.001 0.006 0.007

Chest 6 0.4 7 0.5 0.4 0.8 0.04 0.1 0.2 0.002 0.006 0.008

Torso (back, sides) 3 0.4 4 0.2 0.4 0.6 0.02 0.1 0.2 0.001 0.006 0.007

Under belt 63 0.5 63 9 0.4 9 2 0.2 2 0.1 0.007 0.1

Forearm 2 0.4 2 0.1 0.4 0.5 0.009 0.1 0.1 <0.001 0.006 0.007

Upper leg 2 0.5 2 0.1 0.4 0.5 0.009 0.1 0.2 <0.001 0.006 0.007

Palm 0 0.4 0.4 0 0.4 0.4 0 0.1 0.1 0 0.006 0.006

Back of hand 0 0.5 0.5 0 0.4 0.4 0 0.1 0.1 0 0.006 0.006

Lower leg 2 0.5 2 0.1 0.5 0.6 0.009 0.2 0.2 <0.001 0.007 0.008

Sole of foot 0 0.7 0.7 0 0.7 0.7 0 0.2 0.2 0 0.009 0.009

Under boot edge 7 0.8 8 1 0.7 2 0.2 0.2 0.4 0.02 0.01 0.03

* A maximized upper-bound lens of the eye dose was estimated for the Soil Removal Workers EPG and is recommended as a bounding dose for all EPGs.

† “UB Tot” is the total upper-bound skin site dose. This dose may not equal the sum of UB α and UB β+γ because the doses shown are rounded up.