Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

Summary Minutes 

Seventeenth Meeting of the 

Advisory Board on Radiation and Worker Health 

August 18-19, 2003 

Meeting Held at the Westin Cincinnati 

Cincinnati, Ohio 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

 Executive Summary 

The Seventeenth Meeting of the Advisory Board on Radiation and 

Worker Health (ABRWH or the Board) was held at the Westin 

Cincinnati Hotel in Cincinnati, Ohio on August 18-19, 2003. All 

members, but one were in attendance. Others in attendance 

included staff of various Federal agencies, as well as members of 

the public. A list of those in attendance is included in the 

Summary Minutes of this Seventeenth Meeting. The Summary Minutes 

of Meetings 14, 15, and 16 were approved with no changes. 

Monday, August 18, 2003

 _________________________________________________________________ OCAS Program Status Report 

Mr. David Sundin presented the Office of Compensation Analysis and 

Support (OCAS) Program report to date, providing current 

statistics on cases transferred from the Department of Labor 

(DOL), requests to the Department of Energy (DOE) for personal 

radiation exposure information and response. Additional 

statistics were provided on claimant interviews, completed dose 

reconstructions sent to DOL for final adjudication, cases assigned 

for dose reconstruction, and draft dose reconstruction reports 

sent to claimants. Recent accomplishments and developments were 

noted, including progress on site profiles and the OCAS office 

relocation. 

Mr. Sundin indicated that a list of 44 additional physicians had 

been submitted to DOE recently, bringing the current total 

appointed to 123. 

_________________________________________________________________ DOL Program Status Report
 

Mr. Peter Turcic reported that payments have been made in all 

facets of the Program. Initial decisions have been issued on 

approximately 90 percent of the 45,000 claims received, with 

15,000 to 20,000 more anticipated by the end of the year. Mr. 

Turcic indicated the majority of claims continue to be for cancer, 

with nearly 57 percent being filed by survivors. Claims for 

payment of medical expenses are beginning to increase. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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Mr. Turcic reported the goal of eliminating backlog had been 

accomplished and there was currently a working inventory. Average 

turnaround time for reaching a recommended decision or forwarding 

the case to NIOSH has been reduced to 142 days for claimants from 

Atomic Weapon Employers (AWEs) and 64 days for DOE facilities. 

_________________________________________________________________ Status of Procurement
 

Dr. Jim Neton reported that more than one proposal had been 

received on the task order contract, which allowed movement 

forward to evaluation. A technical evaluation panel had been 

assembled for evaluation and scoring of the proposals. The 

procurement process is now at the past-performance evaluation 

stage. The process could be concluded fairly soon, provided 

negotiations with vendors is not required. 

_________________________________________________________________ 

Board Discussion to Develop Task Order
 

Mr. Mark Griffon, Chair of the Workgroup, reported the development 

of draft documents to be considered: "Dose Reconstruction 

Procedure and Methods Review" and "Individual Dose Reconstruction 

Review." A third document, "Procedure for Processing Individual 

Dose Reconstruction Reviews," was provided to the Board for 

overnight review and discussion. Other items for future 

consideration were enumerated, including a tracking process, 

additional workgroups, lines of responsibility, and Board and 

contractor access to data. 

_________________________________________________________________ Public Comment Period
 

Public comment was solicited on both days of the meeting. Public 

input on the first day included the following: 

#	 Issues related to claimants taping their telephone 

interviews. 

#	 Claimants' lack of knowledge about their exposures due to 

code names and secrecy issues. 

#	 Questions were posed relative to finalization of the rule on 

adding classes to the Special Exposure Cohort (SEC). 

#	 Completion of the site profile for Mallinckrodt Chemical 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Works. 

#	 Availability of DOE mobile screening units for former 

Mallinckrodt workers. 

#	 A Request was made for access to Integrated Modules for Bio 

Assay Analysis (IMBA)software through the National Institute 

for Occupational Safety and Helath (NIOSH) web site. 

#	 Suggestion was made relative to auditing site profiles. 

#	 Concerns were raised relative to the Subtitle D claimants 

being sent by DOE to physicians panels. With abolition of 

the DOE advisory committee, this Board's intervention was 

suggested. 

Tuesday, August 19, 2003

 _________________________________________________________________ ORAU Contract Support Status
 

Dr. Richard Toohey reminded the Board that the Oak Ridge 

Associtaed University’s (ORAU) effort is organized into six tasks. 

He described each one and the personnel types and numbers involved 

in each. He noted that the task previously called Computer 

Assisted Telephone Interview (CATI), had been changed to Claimant 

Contact, moving some responsibilities from dose reconstruction 

into an area of more people-oriented personnel. No activities 

have been added or deleted. A separate telephone interview 

facility has been set up near the Operations Center. 

A 300-user nationwide computer network has been established, with 

security measures of prime importance. Telecommunications and 

data transfer has been established, with a high-speed link to 

NIOSH, as well as a link to the Dade-Moeller office in Richland, 

Washington. Other items discussed included the dose 

reconstruction production plan, clearing backlog, completion of 

Technical Basis Documents (TBDs)for both AWEs and DOE facilities, 

and development of efficiency protocols. 

_________________________________________________________________ National Academy of Sciences Review of 

the Dose Reconstruction Program of
 The Defense Threat Reduction Agency
 

Dr. John E. Till, Chair of the Academy's committee which reviewed 

the DTRA program, discussed the committee's findings. The 

official charge to the review committee was described, as well as 

background on its efforts in conducting the review. Dr. Till 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

offered challenges to the Board in the furtherance of its 

oversight responsibilities. He particularly specified advancing 

the science, communication with claimants, documentation, and 

consistency in handling claims. 

_________________________________________________________________ Status of Technical Basis Document/Site Profile Development
 

Dr. Jim Neton presented a companion piece to Dr. Richard Toohey's 

earlier report from ORAU. Dr. Neton explained the purpose of the 

site profiles was to support dose reconstructions. They were 

defined as compilations of TBDs covering specific sections. Each 

section is a stand-alone document. 

A decision was made to develop the TBDs in parallel in an effort 

to move claims along. Currently 12 or 13 teams are working on 

their completion. Dr. Neton explained the process of creating, 

evaluating, and approving the TBDs prior to their release for use. 

He further emphasized the changing nature of the documents as more 

information is gathered. He described the procedure for tracking 

the documents to assure the most current version is in use by the 

dose reconstructors. 

Dr. Neton announced the completion of the AWE site profile for 

Bethlehem Steel, with the Savannah River Site as the first 

completed DOE site profile. 

_________________________________________________________________ Administrative/Housekeeping
 

Dr. Paul Ziemer noted that the members of the Board had been 

provided with copies of its current charter dated August 1, 2003. 

He directed the members to the paragraph relating to membership 

term, which had not been included in the original charter. 

Mr. Larry Elliott advised the members that they would be contacted 

individually about their term of membership, which is a policy of 

both the Department of Health and Human Services (DHHS) and the 

Federal Advisory Committee Act (FACA). Mr. Elliott also reminded 

the Board members of the need to receive their voucher information 

in a timely manner as the fiscal year closeout is approaching. 

_________________________________________________________________ Board Discussion/Working Session
 

Development of Task Order
 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Mr. Mark Griffon presented the Board with two documents for their 

review. The first document was a statement of work entitled "Dose 

Reconstruction Procedure and Methods Review," was discussed. After 

modification a Board motion to adopt was carried. The second 

document, a statement of work entitled "Individual Dose 

Reconstruction Review," was discussed. After modification a Board 

motion to adopt was carried. 

The Board discussed at length a document entitled "Procedure for 

Processing Individual Dose Reconstruction Review." During 

discussion the Chair appointed an additional workgroup to address 

issues identified. The formal charge to the workgroup was 

expressed. A motion for provisional approval of the document was 

made, seconded, and carried. 

Review and Approval of Draft Minutes, Meetings 14, 15, and 16
 

A motion to approve the executive summary and the minutes of the 

fourteenth meeting was seconded and unanimously passed. 

A motion to approve the executive summary and the minutes of the 

fifteenth meeting was seconded and unanimously passed. 

A motion to approve the executive summary and the minutes of the 

sixteenth meeting was seconded and unanimously passed.
 

ABRWH Schedule
 

The Board made a decision to meet next in St. Louis, Missouri on 

October 28th and 29th, with Richland, Washington designated as the 

alternate site if accommodations could not be secured in St. Louis 

on that date. 

It was further decided to set the succeeding meeting in Amarillo, 

Texas on December 9th and 10th, with Las Vegas, Nevada as the 

alternate location. 

_________________________________________________________________ Public Comment Period
 

Public comment was solicited on both days of the meeting. Public 

input on the second day included the following: 

#	 A desire to have union health and safety representatives on 

the teams developing site profiles. 

#	 A concern that site information gathered by the TBD teams may 

not be completely unbiased without worker input. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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#	 The need for documentation, including identifying the source, 

of all information gathered for site profiles. 

#	 Issues regarding a perceived resistance to transparency in 

identifying subcontractors working on site profiles. 

With no further business posed, the meeting was officially 

recessed at 4:30 p.m.
 

End of Executive Summary
 

Ë Ë Ë 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

The Advisory Board on Radiation and Worker Health 

National Institute for Occupational Safety and Health
 

Centers for Disease Control and Prevention
 

Summary Minutes of the Seventeenth Meeting 

August 18-19, 2003 

The Seventeenth Meeting of the Advisory Board on Radiation and 

Worker Health (ABRWH or the Board) was held at the Westin 

Cincinnati Hotel in Cincinnati, Ohio on August 18-19, 2003. The 

meeting was called by the Centers for Disease Control and 

Prevention's (CDC's) National Institute for Occupational Safety 

and Health (NIOSH), the agency charged with administering the 

ABRWH. These summary minutes, as well as a verbatim transcript 

certified by a court reporter, are available on the internet on 

the NIOSH/Office of Compensation Analysis and Support (OCAS) web 

site located at www.cdc.gov/niosh/ocas. Those present included 

the following: 

ABRWH Members: Dr. Paul Ziemer, Chair; Dr. Henry Anderson; Dr. 

Antonio Andrade; Dr. Roy DeHart; Mr. Richard Espinosa; Mr. Michael 

Gibson; Mr. Mark Griffon; Dr. James Melius; Ms. Wanda Munn, Mr. 

Robert Presley; and Dr. Genevieve Roessler. 

Designated Federal Official: Mr. Larry Elliott, Executive 

Secretary 

Federal Agency Attendees:
 

Department of Health and Human Services: 

Mr. David Sundin, Dr. David Utterback, Mr. Brant Ulsh, Dr. Mary 

Schubauer-Berigan, R. DeLon Hull, Mr. Steve Ahrenholz, Mr. Russ 

Henshaw, Ms. Paula McCreary, Ms. Helen Buelow, Ms. Cori Homer, Mr. 

David Naimon, and Dr. Jim Neton. 

Department of Labor: 

Mr. Peter Turcic and Mr. Jeffrey Kotsch. 

Department of Defense: 

Mr. D. M. Schaeffer and Mr. Steve Powell. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Guests and Members of the Public:
 

John Alexander (ICWUC, Cincinnati, OH); Eula Bingham (University 

of Cincinnati, Cincinnati, OH); Denise Brock (U.N.W.W. of St. 

Louis Region, Moscow Mills, MO); Julia DeHart (Nashville, TN); 

John Dement (Duke University, Durham, NC); Lou Doll (Building 

Trades Site Rep, Cincinnati, OH); James East (PrSM, Knoxville, 

TN); Judson Kenoyer (Dade Moeller Associates, Cincinnati, OH); 

David Kocher (SENES Oak Ridge, Oak Ridge, TN); Michele R. Landis 

(PrSM, Knoxville, TN); Paula McCreary; Jay Maisler (IEM, Dayton, 

OH); Richard Miller (GAP, Washington, DC); John S. Morawetz 

(ICWUC, Cincinnati, OH); Louise S. Presley (Clinton, TN); Harry 

Richardson (LIUWA 265, Cincinnati, OH); Bob Tabor (FAT&LC, 

Harrison, OH). 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Monday, August 18, 2003

 Opening Remarks
 

Call to Order/Welcome
 

Dr. Paul Ziemer called the meeting to order at 1:00 p.m., 

welcoming the attendees. He reminded everyone to register their 

attendance each day at the registration table located in the back 

of the room, and instructed members of the public to sign up if 

they wished to address the Board during the public comment 

periods. 

Announcements
 

Dr. Ziemer inquired of the Board if they chose to defer approval 

of the three sets of minutes until tomorrow's meeting. He noted 

that perhaps not everyone had yet had an opportunity to fully 

review them. The Board expressed a preference to do so, and 

action on the approval of minutes was deferred to the session the 

following day. 

Ocas Program Status Report 

Mr. David Sundin 

Deputy Director, NIOSH/OCAS
 

Mr. David Sundin reported on the current status of NIOSH's Office 

of Compensation Analysis and Support (OCAS) Program. More than 

13,000 cases have been transferred from the Department of Labor 

(DOL). In addition to the initial contact letter, the claimants 

have now been sent an update letter with the new telephone number. 

The case is logged into the computer system, with every document 

received scanned, as well as maintaining a paper filing system. 

More than 13,000 requests for personal radiation exposure 

information have been sent to the Department of Energy (DOE) 

points of contact. This represents approximately 11,700 cases. 

Roughly 17,000 responses have been received as a result of some 

requests being responded to separately. Responses received 

represent approximately 9,600 cases. Some of those responses are 

not yet complete. About 12 percent of requests are more than 60 

days outstanding. These cases continue to be highlighted in a 

periodic e-mail status report sent to each DOE point of contact 

and the DOE Office of Worker Advocacy. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Oak Ridge Associated Universities (ORAU) has made significant 

progress in completing telephone interviews. At least one 

interview has been conducted for more than 6,000 dose 

reconstruction cases in NIOSH’s possession. Several secure 

interviews have been conducted to address concerns raised by the 

claimants regarding the disclosure of sensitive information. The 

number of completed dose reconstructions sent back to DOL for 

final adjudication continues to increase steadily. Nearly 1,200 

cases have been assigned for dose reconstruction. As of this 

morning 350 draft dose reconstruction reports have been approved 

by the claimants and returned as final dose reconstructions to 

DOL. 

The number of phone calls received increased substantially each 

quarter, but has leveled out this past quarter. OCAS currently 

receives approximately 80 per day. ORAU is now receiving and 

initiating calls, many related to the interview process. The web 

site continues to be an active source of information. Over 1,900 

claim-related e-mails have been received. 

A list of 44 physicians was recently sent to DOE in response to 

their request for additional physicians for their panel to 

evaluate claims under Subtitle D. That brings the number to 123. 

Last week another call was initiated for nominations of 

interested and qualified physicians. 

Discussion Points:
 

#Dr. Paul Ziemer asked if an upper limit had been identified by 

NIOSH or DOE for the number of physicians for the panels. 

#Mr. David Sundin replied that DOE had requested up to 500. It's 

doubtful that number could be identified who possess the 

necessary qualifications. It's also early in the process to 

work out capacity calculations, but that number was expressed 

at one point. 

#Dr. James Melius asked for an update on receipt of exposure 

records from DOE for Iowa and Idaho. 

#Mr. Sundin reported that the Department of Defense was in a 

position to provide records relative to Iowa, although he 

didn't know if they'd begun to flow. A large volume of 

records in Idaho needed basic indexing to allow retrieval of 

records. Once completed, responses should start flowing 

smoothly. 

#Dr. Melius inquired when the backlog was anticipated to begin 

decreasing. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

#Mr. Sundin responded that Dr. Toohey's later presentation would 

address that issue. 

#Dr. Melius asked how the backlog was to be triaged, by site based 

on site profiles or on a first come/first served basis, or 

perhaps a mix. 

#Mr. Sundin replied that it was a mix, but specifics would be 

presented in tomorrow's session. 

#Ms. Wanda Munn wondered where the Board could see the specific 

requirements DOE had identified for the physicians being 

sought. 

#Mr. Sundin indicated it was the role of NIOSH to determine what 

qualifications would equip a physician to serve on a 

physicians panel. Styled as an announcement, it had been 

sent to the two major occupational medicine societies. A 

copy would be provided to the Board. 

#Dr. Roy DeHart asked whether the number of physicians named to 

the panel included those who had since withdrawn. 

#Mr. Sundin replied that it did. DOE had mentioned a handful 

having withdrawn, but the exact number was not given. A 

current roster has been requested from DOE. 

#Dr. DeHart inquired into the significance of claimant refusals 

regarding the telephone interviews. 

#Mr. Sundin responded he had learned from the interviewers that 

there had been a few, but not a significant number. 

#Mr. Mark Griffon asked if any aggregate analysis of the 

interviews was being done for use in building the worker 

profiles. 

#Mr. Sundin replied that it was not. 

#Dr. DeHart asked whether the goal of 6,000 reconstructions by 

year end remained an optimistic goal. 

#Mr. Sundin indicated he felt it to be overly-optimistic. 

#Dr. Melius asked if the update letter to claimants on the office 

move included an update on the status of their claim. 

#Mr. Sundin replied that it had not. There are ongoing internal 

discussions with health communication specialists about what 

the message should be and how to craft it in a way that will 

be useful to the claimant. 

#Dr. Melius asked about the status of staffing. 

#Mr. Sundin responded that OCAS staff numbered 40 to 45, with four 

vacancies left. 

_________________________________________________________________ _____
 DOL Program Status Report
 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Mr. Peter Turcic 

Department of Labor
 

Mr. Peter Turcic announced that payments have been made in all 

facets of the program. This included both Special Exposure Cohort 

(SEC) and non-SEC cancers, as well as beryllium and silicosis. 

The majority of claims continue to be for cancer. More than $628 

million has been paid in compensation benefits. Payment for 

medical benefits has increased to $14 million as people are 

starting to submit their bills for payment. Initial decisions have 

been issued in slightly more than 90 percent of the more than 

45,000 claims received. Approximately 300 full-time equivalents 

are working on the program, not including contractor staff working 

in the outreach areas. 

At present 13,700 cases have been referred for dose 

reconstruction, with more than 1,800 pending a final decision. Of 

the final decisions issued, nearly 9,500 have been approved and 

12,500 denied. The most common reason for denial is for a noncovered condition. Claims for non-covered conditions are on a 

slight rise from facilities where closing or contractor change is 

anticipated. Outreach is planned to address the fact that there 

is no statute of limitations. 

Performance goals were established setting a time within which 75 

percent of cases would reach initial decision. AWEs were set at 

180 days and DOE facilities at 120 days. Early in this fiscal 

year the focus was on elimination of the backlog, which has been 

accomplished. There is now a working inventory of approximately 

4,000 cases. For the first quarter of this year, the average time 

for AWE cases was 242 days. Current time is about 142 days. DOE 

facilities dropped from 176 days to an average of 64 days. 

District offices have been given a target time period of 21 days 

to reach a recommended decision once a dose reconstruction is 

received from NIOSH. The time to final adjudication from that 

point is dependent on the claimant's acceptance, request for 

review or hearing, which could change the time significantly. 

Claims are anticipated to be returned from NIOSH in batches as a 

result of the site profiles. District offices have been paired. 

If one office gets an overload, it can be shared to the point of 

recommended decision. The case would then go back to the original 

District office for administration. The process will be seamless 

to the claimant. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Discussion Points:
 

#Dr. Roy DeHart asked if he was correct in his understanding that 

beryllium sensitivity only implied ongoing medical 

evaluations. 

#Mr. Turcic confirmed Dr. DeHart's understanding. 

#Dr. James Melius requested an update on the outreach to address 

the small number of claims for medical payments. 

#Mr. Turcic explained that one problem area was Alaska, where they 

found pharmacies didn't want to accept their card. A meeting 

is planned at the end of the month to meet with medical 

providers to get more signed up. A mailing has been done for 

everyone entitled to medical benefits with a packet of 

information to provide handy access for bill-paying, phone 

numbers and assistance. 

#Dr. DeHart inquired as to the fee structure used to reimburse 

providers and pharmacies. 

#Mr. Turcic pointed out the current fee structure is a national 

cap set on California, so it is significantly higher than 

Medicare charges. 

#Dr. DeHart asked if there was movement towards reimbursement 

based on usual and customary. 

#Mr. Turcic replied that it is usual and customary based on the 

California fee schedule. 

_________________________________________________________________ Status of Procurement 

Dr. Jim Neton 

NIOSH
 

Dr. Jim Neton announced that he could discuss the status of 

procurement of the contractor to assist the Board in its review 

process only to the extent allowed by the procurement regulations. 

He was able to report more than one proposal for the task order 

contract had been received. That allowed forward movement to an 

evaluation. An evaluation panel has been assembled and has met 

twice by teleconference for technical evaluation and scoring of 

the proposals. A competitive range was established. Those 

proposals within the range went forward to a request for pastperformance evaluation. The past-performance evaluations have 

been received and are being FedExed to the technical evaluation 

panel members this afternoon. 

Once that has been reviewed, the competitive range will be re14 
__________________________________________________________________ 

 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

evaluated or re-established. Cost proposals will be sent out and 

reviewed when returned. Recommendation to procurement will then 

be made based on technical merit. 

This process could be wrapped up fairly quickly, provided it is 

not necessary to enter negotiations with vendors. 

Dose Reconstruction Workgroup and Board 

Discussion to Develop Task Order
 

Mr. Mark Griffon 

Dose Reconstruction Review Process Workgroup
 

As an update on the working group's progress, Mr. Mark Griffon 

announced that two documents had been prepared for the Board's 

consideration. The first was entitled "Dose Reconstruction 

Procedure and Methods Review" and the other "Individual Dose 

Reconstruction Review." It was hoped the Board could take action 

on those documents tomorrow. A third document, entitled 

"Procedure for Processing Individual Dose Reconstruction Reviews," 

was provided for the Board to review overnight and discuss in 

tomorrow's session. 

Mr. Griffon identified a number of issues the workgroup had 

discussed and was continuing to discuss. He outlined the items he 

hoped to discuss tomorrow. 

# Board and contractor access to data, both NIOSH and DOE. 

There were questions related to Privacy Act issues and 

whether the data could be available to the Board members on 

CD. 

# Board and contractor access to site personnel and/or NIOSH 

staff. The interest was in DOE site personnel and NIOSH 

staff who had worked on individual dose reconstructions so 

that assumptions, et cetera could be discussed. 

# Board and contractor access to claimants for follow-up. 

Discussion is suggested on whether the Board feels it is 

necessary to follow up with the claimants regarding phone 

interviews and surrounding issues. If so, what would it take 

to allow the Board to do that. 

# Board recommendations derived from individual case review 

reports and summary reports. The issue is how to communicate 

to NIOSH and HHS, more particularly where case findings would 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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have made a difference between a favorable and unfavorable 

claim. 

#	 Establish a process for the Board to review the contractor's 

response to individual tasks. The question is one of the 

lines of responsibility for refining the scope the contractor 

agrees to do under a specific task. 

Discussion Points:
 

#	 Dr. Roy DeHart asked if Mr. Griffon had a feel for when this 

could be forwarded to the contractor and begin the review 

process. 

#	 Mr. Griffon deferred to Dr. Jim Neton, who indicated that 

selection of a vendor could happen in a matter of a week or 

two, if all goes well and doesn't end up going through 

negotiations. A task order could be issued upon award of the 

contract, possibly early October. 

# Mr. Larry Elliott agreed that October was a good target date. 

He suggested that consideration should be given to adding a 

task for the Board's contractor to do the monitoring 

assignment. 

#	 Mr. Elliott asked for clarification of Mr. Griffon's remark 

regarding defining the scope, pointing out that the scope of 

work is defined in the award. He asked if Mr. Griffon meant 

scope within a task. Mr. Griffon did. 

#	 Mr. Elliott explained the process. Once the contract is 

awarded, a meeting is held with the contractor to present the 

tasks. The contractor then has usually two weeks to prepare 

a proposal against the task. The proposal is evaluated and 

if any negotiating is required, it's done and usually the 

proposal is refined against the task. 

#	 Mr. Elliott further noted that a number of things had to be 

considered just in preparing to issue the tasks in final 

form, such as timing, whether action by the full Board is 

required, whether some things need to be done in closed 

session. He offered NIOSH's assistance wherever possible. 

#	 Dr. Paul Ziemer suggested an opinion of counsel may be 

necessary regarding the extent to which the Board may 

delegate activities to a workgroup. 

#	 Mr. Griffon asked for discussion on the issue of Board or 

contractor access to claimants for re-interview. 

#	 Dr. Ziemer suggested the necessity may become more or less 

apparent as the Board moved through the review process. 

#	 Dr. Melius noted that in his training session he spent some 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

time considering to what extent the interview summary was an 

adequate document for a dose review. He expressed reluctance 

to a wait and see approach, preferring to deal with issues as 

completely as possible early. If modification is needed 

later, it can be done. 

# Dr. Melius also reminded the Board that should the reinterview process be added, it would have to receive OMB 

approval. That alone could take some months, once what 

should be done and how to do it has been agreed upon by the 

Board. 

# Mr. Griffon agreed, pointing out that the interview summary 

has been a recurrent theme during public comment periods. 

# Ms. Wanda Munn expressed continued concern that the concept 

of re-interview would be viewed as an appeal process, which 

all are in agreement it is not. She urged the Board to keep 

that very clearly in mind because how things are perceived by 

the claimants is key. 

# Dr. Ziemer noted that a procedure spelling out how the Board 

will evaluate the quality of the interviews might lead to a 

determination of whether follow-up is needed. He urged 

caution in that the Board is auditing, not doing the job for 

NIOSH or ORAU. If there is reason to believe the interviews 

are inadequate, which may emerge from audit, it is NIOSH's 

duty to correct that issue. 

# Mr. Griffon explained not everything an interviewee brought 

up was going to be apparent from the summary. And the 

question had been raised about relevant information being 

missed if the interviewer didn't have site-specific 

knowledge. The suggestion is to re-interview a small 

percentage to determine if the form captured all the relevant 

information. The audit contractor would be asked to do a 

sampling to say it didn't capture every word, but it captured 

all the relevant information on 95 percent of them, for 

example. 

# Dr. Antonio Andrade asked for clarification on two points. 

If the Board deals only with settled cases, by definition 

there would be no re-interview. If interviews are found to 

be generally inadequate, that should be stated up front and 

it becomes a quality improvement issue for NIOSH to deal 

with. If the Board looks at closed cases adjudicated either 

way, the results can be anticipated. Positive adjudications 

will give high marks to staff and there may be contentious 

issues with those for whom compensation was denied. Those 

human issues will have to be dealt with. 

# Mr. Elliott offered clarification on the first point. The 

Board and its contractor will review only adjudicated claims. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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 No appeal cases will be looked at. 

# Dr. Genevieve Roessler opined that while the motivation for 

wanting to evaluate interviews is understandable, it cannot 

be an unbiased process and has only down sides. 

# Dr. Melius pointed out the Board was not conducting a 

consumer satisfaction survey. The issue is whether there was 

different information relevant to the claim that would have 

changed the way the dose reconstruction was done, in either 

direction. 

# Dr. Andrade indicated his belief that the information that 

was tracked and actually written down is a good indicator to 

the claimant as to whether important information was 

captured, and those mechanisms are in place now. 

# Dr. Ziemer suggested the workgroup ponder two issues: 

developing the criteria by which the interviews will be 

evaluated, and how to decide which ones to interview if 

granted that power. 

# Dr. Melius remarked that the only quality control is the fact 

that the interview summary is sent to the interviewee for 

review and comment. The summary comes from one person. 

That's the process the Board is being asked to look at. 

# Dr. Ziemer acknowledged the point, but noted that something 

to look for might be at what point the claimant agrees with 

the interview summary. Is there evidence that agreement was 

reached out of the claimant's frustration rather than because 

the interview captured the information. Then it becomes a 

matter of was there other information the claimant didn't 

know about, and that's not a deficiency in the interview 

process. 

# Dr. Melius disagreed, noting many claimants were of limited 

education, had been sworn to secrecy about their work 

activities, and were given little information about their 

exposures. Asking them to recreate what happened decades 

later is the challenging issue the Board is trying to assess. 

The issue is what kind of information is being derived from 

the interview and the Board should take a serious look at how 

it's being done. 

# Dr. Ziemer indicated that had been his point, how to 

determine the adequacy of the interview, given the limited 

knowledge of those being interviewed. What are the measures 

to be? 

# Dr. DeHart opined that the point of the audit was to assure 

the interview had captured corrections made by the 

interviewee. If the summary is returned with three or four 

additional things, has that information been incorporated 

18 
__________________________________________________________________ 

 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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into the record. That is appropriate to do with the record. 

# Mr. Griffon reminded the Board they were to review the 

document entitled "Procedure for Processing Individual Dose 

Reconstruction Reviews" overnight for discussion tomorrow. 

Public Comment Period 

Ms. Denise Brock
 

United Nuclear Weapons Workers of St. Louis, Missouri
 

Ms. Denise Brock informed the Board that she had used a speaker 

phone and a tape recorder during her mother's interview, which 

they later used to review the interview summary. She noted that 

their comments had been resolved. An inquiry was made into 

whether that would not be more easily accomplished by the 

government. 

Ms. Brock agreed with Dr. Melius' assessment that many workers had 

little information about their exposures. She read a portion of a 

letter from one of the workers she represents which commented on 

that issue, noting that her activities had received considerable 

publicity in Missouri from both reporters and legislators. Their 

questions had revived memories of living with her father's illness 

as a child and she reflected on some of her personal issues. It 

was pointed out that the workers had protected their government, 

many dying in the process. Those still living or their survivors 

were being asked to come up with details of events, documentation 

of which has been destroyed. 

Ms. Brock inquired into the time frame for finalization of the 

rule for adding classes to the SEC and completion of Mallinckrodt 

dose reconstructions. She inquired into the inclusion of 

epidemiologic studies and if there were enough information 

available about claimant dose if individual data were not 

available. 

Ms. Brock asked if DOE had mobile units available to come in and 

screen workers, and wondered why DOE never attended meetings of 

the Board. 

Mr. Richard Miller 

Government Accountability Project
 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Mr. Richard Miller commented that his review of the site profiles 

indicated a NIOSH version of the Integrated Modules for Bio Assay 

Analysis (IMBA) and inquired if it might be made available to the 

public on the NIOSH web site. He noted that whatever program was 

needed to convert dose would be valuable. If not, the program 

would lose transparency. 

Mr. Miller observed that it appeared more site profiles would be 

done than had been discussed. Noting this was an effort to gain 

efficiency, he wondered if it would make sense for the Board to 

consider auditing all site profiles, perhaps lessening the number 

of dose reconstructions reviewed. 

Mr. Miller asked if the increase in ORAU staffing could be 

addressed, indicating who the people were and where they came 

from. 

Mr. Miller noted that DOE had abolished its advisory committee and 

was now sending cancer claims dually filed under Subtitles B and D 

to the physicians panel without benefit of the NIOSH probability 

of causation findings. He wondered if it would be appropriate for 

the Board to intervene. 

With no further comments, the Board officially recessed until the 

following morning.
 

Tuesday, August 19, 2003
 

Dr. Paul Ziemer called the meeting to order at 8:30 a.m. 

__________________________________________________________________ ORAU Contract Support Status 

Dr. Richard Toohey, 

SENES Oak Ridge, Inc.
 

Dr. Richard Toohey reported that ORAU was approaching a year on 

their team contract with NIOSH for dose reconstruction support. 

He reminded the Board of the organization of their effort into six 

separate tasks. Task one, database management, is the computer 

operations, utilizing 17 full-time equivalents (FTEs). 

Task two is data collection for claims and petitions. This group 

of 29 FTEs scans in monitoring data from DOE, data collected from 

field trips to records repositories. It includes some health 

20 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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physicists who review claimant files looking for gaps in 

monitoring data to determine if the case is ready for dose 

reconstruction. QA personnel look at DOL-supplied information to 

check for problems that might cause delays. 

Task three is dose reconstruction research, headed by Mr. Judson 

Kenoyer of Dade Moeller & Associates. The primary effort of these 

102 FTEs is currently development of technical basis documents or 

site profiles. 

Task four was originally called the Computer-Assisted Telephone 

Interviews (CATIs) of claimants. The name has been changed to 

Claimant Contact. Activities including dose reconstruction 

assignment letters, closeout interviews with the claimants, dose 

reconstruction and OCAS-1 mailings, and the 800 number operation 

have been consolidated into that task. At present 21 FTEs are 

assigned to handle these activities. 

Nothing has been added or deleted, but those items were reassigned 

from task five, dose reconstruction reports. ORAU felt it would 

be more logical and would allow them to be handled by personnel 

with better people skills. Task five is manned by 98 FTEs, 

primarily health physicists, actually doing the dose 

reconstructions. 

Task six is technical and program management support with a staff 

of 18 FTEs. 

This totals 285 FTEs. The number of actual people is more, 

approximately 320 including part-time personnel. 

The big number is on task three. A decision was made that 

generating the technical basis documents needed to be done first. 

It was going to take a long time to do using only ORAU resources, 

so some work was contracted out and there are now 13 technical 

basis document teams. ORAU personnel oversee the task and work 

with them. OCAS staff was involved early on to help expedite the 

eventual review process. A year from now that number of 102 is 

expected to be down to around 30. 

The Cincinnati Operations Center has been set up about 15 minutes 

away from NIOSH. A separate telephone interview facility is a 

block away. A 300-user nationwide computer network has been set 

up. Security protection was very important, so great care has 

been taken with anti-viral software, firewalls and the like. 

Telecommunications and data transfer has been established. There 

is a high-speed link to NIOSH, as well as a link to the Dade 

Moeller office in Richland. This expedites the physical 

21 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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production of the dose reconstruction report. 

ORAU was originally hoping to do 6,000 dose reconstructions by 

year end. Current best estimate is about 4,000. As of last week, 

850 dose reconstruction reports had been completed and turned in 

to NIOSH. The majority of those were from Bethlehem Steel and the 

Savannah River Site. Weekly average for the last month has been 

about 75. That's being increased to 100 to 125. The plan is to 

be doing 150 a week in September and 200 a week by October, 

holding steady at that rate. 

Dr. Toohey then addressed the question of clearing the backlog of 

cases. The operational definition of clearing the backlog, the 

goal of NIOSH, is to have no claims in the hopper over one year 

old. On the assumption that 200 cases are completed a week, but 

100 new ones are arriving weekly, the point of no claims over a 

year old will be reached in April of 2005. By fall of 2005 it is 

anticipated the average age of a claim will be about 90 days. If 

new claims continue to arrive at a rate of 100 per week, there 

will always be a 90-day supply on hand, or about 1,200 to 1,500 

claims in the hopper. 

A decision was made to use an approach which would do the most 

good for the most people in the least amount of time. That is 

batch processing. Once a site profile or technical basis document 

(TBD) is done, as many claims as is possible to do will be done 

from the site. The order in which the site is decided upon is 

based upon number of claims from the site. Savannah River Site 

and Y-12 claims are pretty equal, but only about half the Y-12 

claimants worked only at Y-12. Half also worked at X-10 or K-25. 

Y-12 is being addressed, along with Oak Ridge National Lab 

(ORNL)and the Oak Ridge gaseous diffusion plant. It is hoped all 

three will be completed at the same time. 

Hanford and Iowa ordnance plant or Iowa Army ammunition plant are 

nearing completion. Rocky Flats and Los Alamos will be finished 

up later in the fall. The TBDs for Idaho and a few other sites 

will be completed this year, but those claims won't actually be 

processed this year. There is about a one-month lag time after 

the document is approved before claims can be done from a site, 

due to a number of factors. 

Some delay is built into the process. The dose reconstructor 

assignment letter gives a claimant two weeks to object to the 

assigned dose reconstructor. To date only two claimants have 

raised that issue out of more than 1,200 assignments. The 

telephone interview has to be scheduled, and then the claimant 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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gets two weeks to review the interview summary. 

It takes about a month to put data from the site profile into 

spreadsheets which serve as templates for dose reconstruction. 

Those spreadsheets are gone over with NIOSH and a verification and 

validation procedure is followed. 

With the spreadsheet and the monitoring data having been entered 

up front, the dose reconstructor enters some specific personal 

information. Much of this is downloaded from NIOSH's NOCTS 

database. Still done by hand is the entry of some of the bioassay 

data into the IMBA program to do the internal dose calculation. 

The process has been streamlined as much as possible, but there is 

still about a month of work in generating spreadsheets, getting 

them debugged and distributed. 

Bethlehem Steel was the first AWE site completed. Currently being 

developed are its clones, or other plants which performed the same 

operations. The Blockson Chemical document is in its second round 

of comment and review. Blockson clones or other phosphate 

processing plants will follow from that. A draft of the 

Huntington Pilot plant, which recovered nickel that had been 

contaminated with uranium, is being reviewed by NIOSH. Still an 

issue is the efficiency of the recovery process. A draft of 

Mallinckrodt Chemical Works is undergoing internal ORAU review and 

should be forwarded to NIOSH for their review in a week or two. 

Once site profiles are done and approved, claims from the site are 

processed in the order received. Total processing time for a 

given site is anticipated to be only a few months. 

One supplemental dose reconstruction team has been assembled thus 

far. It consists of four senior health physicists, two external 

dosimetrists, and two internal dosimetrists. Their assignment is 

to start a claim and work it through. This is done to keep people 

who have been in the queue for some time from being neglected 

until their site profile is completed. 

Some claims from other sites are being done under efficiency 

protocols. Potentially compensable cases would be workers at 

primarily DOE facilities whose records show positive bioassay 

results for inhalation exposure to actinides or transuranics, and 

who have either lung cancer or a cancer of an organ which tends to 

concentrate that radionuclide. An internal dose assessment of 

their bioassay data will be done using the IMBA program. If the 

probability of causation is equal to or greater than 50 percent at 

the 99 percent confidence interval, the case is like;y compensable 

and the dose reconstruction is finished. There are about 100 of 

23 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

those cases from Y-12 to date, as well as some from Hanford, Rocky 

Flats, Idaho, and some other sites. 

The other end of the spectrum is the potentially non-compensable 

cases. The criteria for those cases are low exposure potential, 

exposure records show either zero or small internal and external 

dose, and the cancer is in an organ which does not concentrate the 

radionuclides to which the claimant was exposed. This was tried 

at the Savannah River Site and written up in ORAU technical 

information bulletin number one, posted on the OCAS web page. 

The next step is to extend the efficiency procedure complex-wide 

and develop a maximum intake scenario complex-wide. It would be 

submitted to NIOSH for review and approval, but would open up a 

lot of claims that could be processed without the full technical 

basis document being completed for a site. ORAU would want to 

extend the procedure to AWE site where exposures are primarily to 

uranium. 

Discussion Points:
 

#	 Dr. James Melius inquired as to the number of supplemental 

dose reconstruction teams, when they were established and 

what their productivity would be. 

#	 Dr. Toohey replied there was currently one team, but ORAU 

hoped to establish two more. The program had started within 

the past few months. Because they're working without a TBD, 

they have to do all the records research independently, so 

their productivity is about one or two a week. 

#	 Dr. Melius asked the status of the posting of conflict of 

interest statements and bio sketches and what was being done 

about the new subcontractors. 

#	 Dr. Toohey responded that it was his belief that bio sketches 

and conflict of interest statements for everyone involved in 

performing, reviewing, or supervising dose reconstructions 

are posted on the ORAU web page. It was not contemplated for 

the subcontractors because they are not directly involved in 

dose reconstruction, which was the essence of the conflict of 

interest requirement. 

#	 Mr. Michael Gibson asked if people doing the site profile 

could have a past history at the site, but not give their 

background and potential conflict of interest. 

#	 Dr. Toohey explained ORAU had proposed using personnel with 

experience at a site because they knew what was going on 

there, but they had not proposed giving background or 

potential conflict of interest 

24 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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# Mr. Robert Presley asked if a procedure existed for 

expediting the claim of a terminally ill claimant from one of 

the other sites. 

# Dr. Toohey replied that the NIOSH compassionate processing 

procedure would push them to the head of the queue to capture 

their interview. Actual dose reconstruction may not be 

accelerated, depending on quality of the data and if it can 

be done without the site profile. However, the supplemental 

dose reconstruction team would also have the task of doing 

special processing. 

# Mr. Mark Griffon asked what data was used for the Savannah 

River internal dose determinations and if it had been 

verified. 

# Dr. Toohey replied it was Savannah River's monitoring records 

and incident reports. Existence of a high intake comes off 

an incident report, but quantification of the intake comes 

from bioassay data. 

# Dr. Paul Ziemer requested clarification on the types of 

personnel from a site who may now be involved in site 

profiles. He specifically wondered if someone who had been 

responsible for generating some of the data now used would be 

in the position of defending it. 

# Dr. Toohey responded with the example of a key subcontractor 

looking at external dosimetry data who probably knows more 

about external dosimetry across the DOE complex than anyone. 

He had been responsible for generating some of the data, 

yes. Whether he's defending it is unknown. He's providing 

it, and then it's subject to scientific review and analysis 

by people who did not generate it. 

# Dr. Ziemer asked for the composition of a typical team. 

# Dr. Toohey replied a typical team is approximately six people 

who in general probably did not themselves work at the site. 

People who did or still do work at a site are used as 

resources for the team. His previous example was an 

exception. 

# Dr. Jim Neton noted that each team has a NIOSH health 

physicist assigned as a monitor of the TBD or site profile. 

The document is both reviewed by ORAU and reviewed and signed 

by NIOSH, issued as a controlled document. Ultimate approval 

of the document comes from NIOSH, not the person who may have 

worked at the site. 

# Mr. Gibson inquired how many teams had field workers on them 

to guide them to events. And if an event was later 

discovered to have happened and the report were generated 

when bioassay data weren't adequate, how is the dose 

25 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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determined. 

#	 Dr. Toohey responded the teams consisted of health 

physicists. In the other situation, available data would 

have to be used. In dose reconstructions the effort is to 

determine what the maximum could have been, and claimantfavorable assumptions are made to maximize that. 

#	 Dr. Melius asked if the conflict of interest rules had been 

relaxed for those doing dose reconstructions as requested at 

the last meeting. 

#	 Dr. Toohey replied the consensus of the Board had been that 

it was not a good idea and it had not been pursued. 

__________________________________________________________________ National Academy of Sciences Review of 

the Dose Reconstruction Program of
 

The Defense Threat Reduction Agency
 

Dr. John E. Till, 

Risk Assessment Corporation
 

Dr. John E. Till, President of Risk Assessment Corporation and 

Chairman of the review committee of the National Academy of 

Sciences which reviewed the Defense Threat Reduction Agency (DTRA) 

dose reconstruction program, presented insight into the 

committee's findings. Dr. Till prefaced his remarks by noting 

that he was speaking as an individual and not for the National 

Academy of Sciences. The Academy report would be published on 

Friday, August 22. 

Dr. Till suggested that it is often forgotten how science evolves, 

and the message should be conveyed to the claimants that this 

science is in its infancy. Understanding of it is improving all 

the time. 

Dr. Till noted that he knew it would be a difficult task when he 

accepted the job as chairman of his committee, having been 

involved in dose reconstruction work for some time. He knew it to 

be tedious, complex, and how much information is always missing. 

He challenged the Board, the scientists working on the program and 

NIOSH to advance the science, not simply fulfill the law. While 

he had some insight into what he was getting into, he had no idea 

how ultimately complicated it would be. He indicated the Academy 

report did not deal with the issue of compensation, but was to 

determine if the science was being done and the law being 

fulfilled. He cautioned against allowing personal feelings to be 

involved in what was being done. 

26 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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While the Academy is normally a closed organization, Dr. Till's 

committee approached its charge in a manner unlike the strict 

rules for how they work. The committee felt it was important to 

meet the veterans and talk to them, and so they did. 

They were obligated by their charge to develop a statistically 

significant sample from which to work. They determined to sample 

99 of the 3,700 dose reconstructions that had been performed. 

They wanted two-thirds to be in a higher dose category of above 

one rem. Concerned that this approach would result in neglecting 

the veterans from Hiroshima/Nagasaki, a separate sample of about 

ten was taken from that group. They also encouraged those 

veterans who wanted to do so to send the committee their files. 

About two dozen were received. For a year and a half every 

committee member reviewed every file. 

The committee wanted the report to be understandable to everyone 

who read it, Congress, scientists, and the veterans. Some of the 

report probably didn't reach that goal, but parts are deliberately 

written in language that it was hoped the veterans would 

understand what the committee was saying. The committee wanted to 

be detailed, and Dr. Till challenged its members to be specific, 

including case numbers, so that anyone who wanted to could go back 

and see what they were talking about. 

Dr. Till explained the report included an outline, a chapter on 

the process of the committee, which was what he had just 

described. It went into chapters on the dose reconstruction 

process, findings, and other findings not strictly dose 

reconstruction. Their charge was interpreted broadly to give 

DTRA, Congress, and the veterans more than what had been asked 

for. Finally there was a chapter on conclusions and 

recommendations. 

Although the veterans program had been reviewed before, the right 

questions had not been asked. Issues that had been described in a 

1985 report still existed. Dr. Till noted the importance of 

challenging those who verify what's being done and being sure the 

right questions are asked or the answers sought will not be found. 

Dr. Till observed that few areas of science had changed as much as 

the ability to grasp information and the ability to manage huge 

amounts of data, even within the last five years. He suggested 

that should be kept in mind when criticizing what happened in the 

DOE complex 20 to 50 years ago. He cautioned that what is being 

seen now may be changes in science and changes in the expectations 

of scientists and data management rather than people not doing 

27 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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their job. He noted that it was difficult to make that charge, 

not living in that era, because by the time this Board completes 

its job, what is being done will be much different from what's 

being done today. 

Dr. Till advised that if there were not a policy on changing 

science, there should be one. One of the findings in the Academy 

report was that in a lot of the methods the most current 

information was not being used to calculate dose. 

The charge to the Academy committee was outlined as: Whether the 

dose reconstruction of the sampled doses is accurate; whether the 

reconstructed doses are accurately reported to the VA; whether the 

assumptions made about radiation exposure are credible; and 

whether the data from nuclear tests used by DTRA as part of the 

reconstruction of sampled doses are accurate. The committee was 

also asked to recommend whether there should be a permanent system 

of review for the dose reconstruction program. 

Answering the recommendation first, Dr. Till said the report found 

it to be absolutely recommended. He noted that, in his opinion, 

the DTRA program had suffered from lack of a group to advise them 

on science and challenging them on issues such as conflict of 

interest, communication, and quality assurance. 

In answer to its charge, the Academy committee found the average 

dose calculated was pretty good, but was concerned about the upper 

bound. Credible upper bound doses from external gamma, neutron 

and beta exposure were often underestimated, sometimes 

considerably. As with this Program, the upper bound is what was 

used for compensation. 

As to whether the reconstructed doses are accurately reported, the 

committee determined that the numbers calculated were accurately 

reported to the Veterans Administration (VA) and the veterans, 

although the numbers calculated may not be the correct upper 

bound. 

Regarding whether assumptions made about radiation exposure are 

credible, the Academy report indicates many key assumptions and 

methods used are not appropriate, often leading to underestimation 

of the upper bounds of doses. 

Whether the data used by DTRA to reconstruct the sample doses are 

accurate, the Academy interpreted as meaning is there enough 

information to reconstruct the doses. The committee was amazed at 

how much information was collected at the tests. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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Quality control was found to be a problem. There was difficulty 

following the logic of the calculations, the documentation. Dr. 

Till cautioned that documentation was absolutely crucial. He 

advised making sure anybody who knew anything about the science 

could take the records and follow every assumption made and how 

the numbers were calculated. And if something is not being used, 

make it clear why. He noted that it was important to mention that 

if the thousands of reconstructions were redone, there would be 

little difference in the number of awards made. 

Dr. Till made particular note of the fact that the DTRA program, 

like EEOICPA, was very favorable to the claimants. But there was 

a lack of understanding of the level of dose required for 

compensation. He opined it was a huge communication problem and 

urged this Board to resolve that issue as it moved forward. The 

Academy committee found the veterans had a lot to say about what 

they went through, and suggested listening to the claimants was 

also of importance. 

There were three factors Dr. Till described he felt were important 

to the success of the program. Regarding benefit of the doubt, if 

you don't have something and there's a chance it could have 

happened, assume in favor of the claimant or in favor of the 

assumption that makes the dose higher. As to consistency, deal 

with all claimants in the same way with the same fairness, using 

the same assumptions where there is a choice. 

The third factor was uncertainty. Dr. Till expressed his concern 

that people are being misled when it is suggested that uncertainty 

accounts for all the lack of knowledge; it is a part of the lack 

of knowledge. He noted caution should be used in what scientists 

can and cannot defend. 

Dr. Till described some of the cases reviewed by the committee 

which illustrated his points made to the Board. He commended the 

Board for its work. He noted the Board's earlier questioning and 

challenging of ORAU on credibility, conflict of interest, and 

details of what was being done, and urged its continuance. 

Discussion Points:
 

# Dr. Roy DeHart noted the issue of inconsistency related to 

the SEC being raised repeatedly in public comment and asked 

Dr. Till how he would deal with it. 

# Dr. Till advised sticking with the plan. He noted there 

would be cases for inconsistency and that may be one of them. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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He urged consistency in the science. If lawmakers want to 

change the law, let them do it. 

#	 Dr. Genevieve Roessler inquired what this Board could do 

better in the way of communication. 

#	 Dr. Till suggested being aggressive, establishing a track 

record of what you've done, whether it's successful or not. 

A newsletter to explain probability of causation, what it's 

going to take, what is known about it could be helpful. 

#	 Mr. Larry Elliott noted that brochures speaking to 

probability of causation and dose reconstruction are sent 

with claimant letters. Topic pages on both are also on the 

web site. 

#	 Dr. Till expressed a belief that most claimants don't and 

won't look at the web because they don't know how. He also 

suggested including in a newsletter statistical information 

regarding numbers or percentages of awarded claims so that 

people would understand. 

#	 Mr. Mark Griffon asked if the Academy committee had developed 

a procedure for evaluating against criteria; and if so, if it 

were available to the Board. 

#	 Dr. Till responded that the list of some ten specific 

criteria his panel had when it received its first set of 

cases was abandoned because the cases were so different it 

couldn't be applied. It evolved into several key issues, as 

usually happens. 

#	 Ms. Wanda Munn inquired into when do you decide to revisit if 

science changes; and made the observation that this program 

may be seeing more claims by survivors, resulting in less 

first-hand information. 

#	 Dr. Till replied the report had made no recommendation how it 

be done, simply that changing science be recognized. It is a 

policy decision for the Board to make. Perhaps it will 

choose to fix the science in time so that everyone is treated 

the same. As to the survivor issue, the buddy system, people 

who knew the individual and had similar work style, is a 

legitimate, defensible manner of coming up with a dose 

estimate. 

__________________________________________________________________ Status of Technical Basis Document/ 

Site Profile Development 

Dr. James Neton, 

NIOSH 

30 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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Dr. James Neton indicated his presentation was a companion piece 

to Dr. Toohey's earlier update. He would provide more detail of 

how TBDs are put together. Because they serve as a road map for 

how a dose reconstruction is done for a particular site, there was 

a need for one for at least the major DOE sites. They are limited 

in scope, a summary to provide the dose reconstructor sitespecific information. They are dynamic documents. If further 

information is obtained through site searches or from claimants, 

they will be amended. 

Dr. Neton defined a site profile as a compilation of technical 

basis documents set out as a series of chapters on areas needed to 

do a dose reconstruction. The areas of facility/processes, 

environmental dose, external dose, internal dose and diagnostic Xray dose are described in detail. Each section is a stand-alone 

document, allowing progress to be made in claims processing 

without waiting for completed site profiles. 

The site profiles try to be true to the concept of the hierarchy 

of data used for dose reconstruction. From personal dosimetry 

down to source term and radiation control limits, they follow what 

was intended when the rule was written. 

Because it takes some three to four months to complete a site 

profile, it was decided to do them in parallel. There is a 

formalized process and they are issued as controlled documents. A 

NIOSH health physicist is assigned to the TBD or site profile 

team, informally reviewing the process as it goes along. NIOSH is 

involved in resolving comments before the document is sent for 

official review. At that point they are officially commented on 

in writing. ORAU is required to respond. There are both critical 

review and non-critical review comments. Critical review comments 

must be addressed. Comments are considered, reviewed, and a 

consensus opinion is reached as to how to proceed. 

From that point it goes into the ORAU document control process, 

after being signed by both Dr. Toohey and Dr. Neton as authorizer 

for the document to be released for use. It is assigned a 

revision date and revision number, and tracked for which 

reconstructions were done with which revision of the TBDs. 

Any reliable source of information is used in assembling the 

documents. Among the best have been site TBDs that the DOE sites 

put together themselves. As DOE radiation control programs 

matured, TBDs were required for the external/internal programs. 

They tend to not only document what's currently being done, but 

usually have a historical discussion at the beginning, which is a 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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good starting point for obtaining additional information. 

Also useful are safety analysis reports completed for certain 

projects. These talk about process descriptions and potential 

radiation exposure environments. Workplace environmental reports 

are used when they can be found. Facility data, which would be 

area monitoring results from air samples, surface smears, survey 

swipes, if they can be obtained; internal memos and correspondence 

are sometimes useful. Any available publication, particularly 

peer reviewed publications, are obtained. Previous dose 

reconstruction reports would be used as a starting point. They 

are evaluated to determine whether they may be applicable to this 

effort. 

Information submitted to NIOSH by claimants has been beneficial. 

In the case of the Bethlehem Steel TBD, a claimant had rich sets 

of data which led to other sets of data and helped in the 

development of the document. Anywhere information can be 

obtained, it is. 

Parameters of interest are the areas the site profile attempts to 

address. Medical X-ray dose is addressed by year due to dramatic 

changes in X-ray monitoring technology since the early '50s. 

Occupational internal dose for unmonitored workers is addressed by 

looking at inhalation based on air monitoring data that are 

readily available. If the information is not readily available, 

the approach defaults to source term analysis using claimantfavorable assumptions. If the person is not inside the facility 

where equipment generating airborne radioactivity is used, 

knowledge about site ambient radionuclide activities is needed. 

If the probability for occupational external dose is low, a 

maximum background dose can be determined based on the area or 

coworker data. Data from coworkers probably exposed to higher 

levels would be used. If exposure probability is high, coworker 

data or claimant-favorable assumptions would be used. Also 

addressed is the release of any noble gases. An attempt is made 

in the TBD to address uncertainties in the external dose 

calculation, as in all other forms of exposure. 

Occupational internal dose for monitored workers is difficult to 

reconstruct. Bioassay cards 50 years old have cryptic notations. 

Results don't have units of measurement, just a letter or a 

number. Sometimes special notations were used for radioactive 

materials, probably for security reasons. A lot of research is 

needed to deciphering the coded information. Method of analysis 

needs to be taken into account. Wherever there's a question, the 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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TBD will err on the side of being favorable to the claimant. 

While the Internnational Commission on Radiological Protection 

(ICRP) has never come out with a concrete statement as to what the 

uncertainties are associated with internal dose, it has been the 

subject of discussion among the health physicists. Dr. Neton 

indicated he felt they were close to putting brackets on it. 

Regarding occupational external dose for monitored workers, there 

are badges, but the badges have to be interpreted. The site 

profile will have the type of radiation energy, the range of 

energies for photons and neutrons. The energy interval to which 

the worker was exposed has a direct effect on the probability of 

causation calculation. If the labor category is known, it will be 

described in the document. Exposure geometry is important, dose 

correction factors, handling of missed dose, detection limits, 

badge exchange frequencies, dosimeter correction factors, where 

possible, are included in the document so that the professional 

judgments exercised by the health physicists in doing the dose 

reconstruction are consistent. To the extent possible, putting 

the uncertainty with the dose is included in the documents. 

Dr. Neton noted that if site profiles are developed for the top 11 

claims-producing DOE sites, theoretically dose reconstructions 

could be initiated for over 10,000 claimants. The first DOE site 

profile was completed as of July 15 for Savannah River Site. It 

covers operations from 1952 to the present at 29 separate 

facilities on-site. At 188 pages it is a comprehensive, 

technically detailed document. It was not written from a layman's 

perspective, though there is a readable executive summary. It has 

some gaps where information was missing. They are identified and 

what areas are not covered will be added as they can be. The 

decision was made to get the document in place rather than waiting 

for every piece of information to be complete. 

As a controlled document, once they're issued, they're maintained. 

The dose reconstructor should only be working with the latest 

revision. Revision one is currently being worked on for the 

Savannah River Site which will add another 50 pages of data to 

help interpret internal doses. When ORAU distributes it, they 

make sure that that document is in effect in the field. All dose 

reconstructors will be made aware that as of the distribution 

date, that is the document that should be used to perform dose 

reconstructions. 

The Atomic Weapon Employer (AWE) sites represent a smaller 

percentage of claims, 12 to 14 percent. The number of claims from 

the top ten AWE sites totals about 1,200. Bethlehem Steel TBD is 

33 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

done and the majority of those claims have been moved through the 

process. Blockson Chemical and Huntington Pilot Plant are under 

review. 

Most of the AWEs were uranium facilities and did limited scope 

work. While not exactly the same, they tend to fall into similar 

categories. There can be a skeleton approach, with details of 

other factors contributing to claimant dose being worked out. The 

efficiency process Dr. Toohey discussed will add more claimants 

who can be moved through without having a TBD or site profile. 

And while these documents and strategies cover the vast majority 

of claims, there will always be a few that will be problematic. 

Discussion Points:
 

#	 Dr. James Melius asked if this was a change from the original 

plan of sequential site profiles built from individual dose 

reconstructions. 

#	 Dr. Neton indicated that was partially correct. Doing them 

sequentially was the plan, but a few at a time. Doing them 

all in parallel is a change, but it was needed to get the 

claims out the door. Basing the site profiles on dose 

reconstructions and worker profiles was not the idea. The 

idea was to have site profiles to move claims and process 

claims, and as experience was gained from exposures with 

those workers being processed using the site profile, the 

worker profile databases could start to be populated. Worker 

profile databases can't be established until dose 

reconstructions are done. 

#	 Dr. Melius inquired if the site profiles were technical 

resource documents for people doing individual dose 

reconstructions that will allow them to complete those 

individual dose reconstructions. 

#	 Dr. Neton replied the site profile covered standard 

operations at a facility and standard work practices. If a 

person was involved in some very unusual incident or unusual 

circumstance, it might not be in the document. Then it would 

take a little longer and a little more investigation to 

complete a claim. 

#	 Dr. Melius noted the Savannah River Site document appeared to 

be primarily a paper review and asked how the information was 

being gathered, and if labor representatives were included. 

#	 Dr. Neton responded that it was not merely a paper study, but 

was primarily based on paper data capture. Site contacts or 

site conference calls with current personnel at the facility 

did not include labor representatives, to his knowledge. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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# Dr. Melius observed it appeared to be a closed process 

between NIOSH, ORAU, and the contractors ORAU had hired, and 

wondered if there were plans to include those people in the 

other documents underway. 

# Dr. Neton replied that there were no formal plans, but if 

labor representatives had useful information, it would be 

considered. And while he wouldn't characterize it as a 

closed process, it typically involves health physicists who 

are knowledgeable about a facility's exposure conditions. 

Labor's input had not been solicited. 

# Dr. Melius queried whether that might not be valuable, as 

well as that from retirees and other people around a site. 

# Dr. Neton noted there was a balancing act in getting the 

documents completed and into use. But since they are dynamic 

documents, including worker data is a reasonable idea when 

time permits. 

# Mr. Larry Elliott added that the Bethlehem Steel document did 

use information contributed by a worker, a claimant, noting 

that it was unfair to say NIOSH didn't accept and use that 

input. He pointed out that Savannah River Site does not have 

an organized labor group. Advantage was not taken of the 

opportunity to seek or solicit information from anyone other 

than those people previously mentioned by Dr. Neton. Once 

the documents are on the web site or available to the public, 

any comment or input would be welcome. 

# Dr. Melius contended that he had seen nothing to indicate 

interest in or solicitation of input. It was on the web site 

as a completed document and looked like an official, final 

document with no hint that input was being sought, and he 

felt that should be corrected. Noting that he had not read 

the document, he asked if there was anything in it indicating 

sources of information, particularly the individuals spoken 

with. 

# Dr. Neton deferred to Mr. Judson Kenoyer, who indicated that 

the original draft referenced specific conversations with 

people on site, but wasn't sure about the document as 

printed. He added that some of the most valuable information 

retrieved is from direct interaction with people who worked 

on-site in the early years. He noted they had gone to more 

and more face-to-face interviews with retirees. 

# Dr. Melius expressed concern that the documents were being 

rushed into because the program needed to get going and 

wondered what valuable information might be left out that 

would have affected someone's dose reconstruction. 

# Dr. Neton acknowledged that was a good point and it would be 

35 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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#

#

#

#

#

#

#

considered, but emphasized the document would not be released 

if it were not felt to capture the essence of the exposure 

profile of the site. He noted that if information came to 

light, there was a commitment to re-evaluating processed 

claims, using that information, to ensure a claimant was not 

inappropriately characterized. 

Dr. Melius suggested external peer review might be considered 

as a way of soliciting both technical input as well as 

soliciting more information from people. 

Dr. Neton pointed out the line had to be drawn at some point. 

A contractor was being hired in about three months to do 

nothing but review the TBDs. Layering review upon review 

impedes the process. 

Dr. Melius expressed concern that the credibility of the 

program was going to be dependent on the documents. He felt 

having them done without knowing who was involved was a 

serious mistake which could jeopardize the process if the 

wrong people were involved or misinformation got out about 

who was involved and why it was kept secret. He suggested 

giving serious consideration to opening up the whole process 

of gathering information, reviewing and soliciting input, as 

well as transparency for people involved in the process. 

Dr. Genevieve Roessler asked how information was being 

obtained to calculate radon dose and how what non-workplace 

radon might have been was being taken into account. 

Dr. Neton replied that there are radon monitoring data for a 

number of facilities. To the extent it's available, it will 

be used to model exposures. If it isn't available, but how 

much radium was there is known, it could be back-calculated 

based on emanation rate and equilibrium situation, what could 

have been there at the upper limit. It's included in the TBD 

if it's occupationally-derived. The second part, what 

portion of radon exposures at these facilities is 

occupationally-derived, is tricky. That concept is being 

wrestled with and a policy is currently being formulated on 

that position. 

Mr. Mark Griffon asked for a definition of "readily 

available." 

Dr. Neton responded that the documents had to be produced in 

a reasonable time frame. Information consolidated and 

available, either electronically or in one room as paper 

records, would be considered for use in the TBDs. If 

information is distributed around a site in multiple 

facilities, contaminated facilities, it isn't beneficial to 

hold up the TBDs to retrieve those records. There seems to 

either be an electronic database or not and the records are 

36 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

not retrievable, so what the cut point is hasn't had to be 

defined. 

#	 Mr. Griffon inquired if DOE had a role in the collection 

process if a set of records were identified that may not be 

easily retrievable. 

#	 Dr. Neton replied that DOE had a role in making records 

available for capture, so they would consolidate them to a 

certain point. NIOSH or ORAU would do a data capture effort, 

scanning all the records, if possible, and obtaining images 

of them. 

#	 Mr. Griffon noted that concerns have been expressed that past 

reports and past DOE databases may be suspect. He suggested 

it would be a valuable exercise to verify the bioassay 

records. 

#	 Dr. Neton reiterated that as information becomes available it 

will be reviewed against the TBDs. He reminded the Board 

that where information is lacking, the TBDs are claimantfavorable. He noted that in two instances as additional 

information became available, it would tend to reduce the 

doses or estimated exposures rather than increase them. 

#	 Dr. Melius offered a hypothetical scenario of a completed 

site profile, but a group of claims came in and dose 

reconstructions are attempted, but the site profile is not 

sufficient to determine compensability, what would be done 

with those claims. 

#	 Dr. Neton replied they would not be moved through just for 

the sake of getting them out. They would be held up until 

there was sufficient information for Labor to make a 

decision. 

#	 Dr. Henry Anderson observed that as he scanned the Savannah 

River Site document he had difficulty identifying the 

specific data gaps and suggested it might be helpful to 

initiate a data call-in asking for additional information. 

He further suggested that since a number of sites had been 

involved in lawsuits, a search of documents produced through 

discovery might be a useful source of information. 

Administrative Housekeeping and Board Work Schedule
 

#	 Mr. Larry Elliott drew the attention of the Board to the 

August 1, 2003, copy of their Charter. He asked them to take 

note of a new provision regarding term of membership on the 

Board which had not been in the original charter. Membership 

term is the Department of Health and Human Service (HHS) and 

Federal Advisory Committee Act (FACA) policy. He informed 

the Board members they would each be contacted directly 

37 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

regarding membership and term of membership. 

#	 Dr. Henry Anderson asked if "term" meant everyone would serve 

only four years. 

#	 Mr. Elliott reminded the Board members they were 

Presidentially appointed and that the White House had 

designated staggered terms, so that each year there would 

perhaps be moderate turnover. FACA provides a specified 

number of terms or number of years. The charter indicates 

terms of more than two years are contingent upon renewal of 

the charter. 

#	 Dr. Paul Ziemer inquired as to whether the White House had 

already made that determination. 

#	 Mr. Elliott replied that such determination had been made. 

The Board had been alphabetically grouped into three 

categories. The first category would leave the Board in one 

year, the second in two years, the third in three. The 

possibility of reappointment would be up to the President. 

#	 Mr. Elliott reminded the Board members of the process of 

submitting preparation time by e-mail, and requested all 

travel vouchers be submitted as soon as possible as fiscal 

year closeout was approaching. 

#	 Dr. Ziemer reminded the members that Ms. Homer also needed 

their calendars for the remainder of the year. 

__________________________________________________________________
 Board Discussion/Working Session 

Development of Task Order 

Procedure for Processing Individual Dose Reconstruction Reviews
 

Mr. Mark Griffon distributed copies of the document reflecting 

edits resulting from the previous day's discussions. 

Dr. Paul Ziemer indicated he was presuming the document's form and 

content met the requirements of its purpose, and inquired if the 

contractor would use it to develop the cost document for final 

approval. 

Mr. Larry Elliott replied that the task order would be delivered 

to the contractor, who would be allowed two weeks to prepare a 

proposal. The proposal would include how the specified work would 

be conducted, describe the skill categories required, and provide 

a cost estimate. The proposal would be returned to the person or 

group specified by the Board's process for evaluation and, if 

necessary, negotiation. 

38 
 

 

 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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Dr. Ziemer asked Mr. Griffon if he were seeking Board input and 

reaction or approval of the document. 

Motion
 

On behalf of the Dose Reconstruction Workgroup, Mr. Mark 

Griffon moved adoption of the Statement of Work. 

Needing no second, the motion was on the floor for 

discussion. 

# Mr. Robert Presley inquired whether periods of time should be 

changed into numbers of days. 

# Mr. Mark Griffon replied that, as in the original contract 

language, NIOSH could be allowed to make technical edits. 

# Mr. Larry Elliott advised the Board that once the task has 

been developed, it will be sent to the procurement office, 

which determines those types of edits to ensure proper 

procurement procedure. 

# Mr. Elliott noted that he felt the second sentence under 

"Purpose and Description of Work," beginning "This task may 

be extended to be a periodic annual review..." could be a bit 

of a problem. Future work cannot be promised. The task can 

be resurrected or a new task issued. He felt the procurement 

office would require removal of the sentence because it could 

build expectation. Procurement will require each task to 

stand alone. 

# Dr. Paul Ziemer indicated the succeeding sentence would, as 

well. He proposed, without objection, deleting the second 

and third sentences, reading "This task may be extended to be 

a periodic annual review of procedures since it is likely 

that procedures will be modified as the program evolves. The 

focus of the periodic reviews will be to assure overall 

consistency of the program from the earliest cases that were 

completed." 

The Chairman called for a vote and the motion received 

unanimous approval.
 

Individual Dose Reconstruction Review
 

Mr. Mark Griffon noted that, as a result of the previous 

discussion, two sentences should be deleted from this document, as 

well. He called the Board's attention to the last two sentences 

of the third paragraph, reading "The Board anticipates that the 

next four years will also involve a review of 2.5% of the total 

39 
 

 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

cases. For purposes of this proposal the contractor should only 

consider the first year workload." 

Mr. Larry Elliott agreed that would be advisable. 

Mr. Griffon informed the Board that two new paragraphs had been 

added on the last page. Those paragraphs were entitled "Period of 

Performance" and "Reporting/Deliverable Requirements." The 

intention had been to assign procedure numbers, but on reflection 

suggested deleting that reference to "Board #XX." 

On behalf of the Dose Reconstruction Workgroup, Mr. Mark 

Griffon moved adoption of the Statement of Work. 

Needing no second, the motion was on the floor for 

discussion. 

#	 Dr. Paul Ziemer called the Board's attention to Paragraph 

1.B.1 on page 2 of the document, the sentence beginning 

"Evaluate whether NIOSH appropriately addressed all of the 

reported work history..." He asked if this simply called for 

review of the interview in terms of documentation on hand. 

# Mr. Mark Griffon confirmed the interpretation was correct. 

# Dr. Roy DeHart inquired if the Advanced Review, outlined in 

Paragraph 2 on page 3 of the document, was the first 

inclusion of site profile. 

# Mr. Griffon confirmed it was, noting the Basic Review did not 

go into that depth. 

# Dr. Antonio Andrade called the Board's attention to Paragraph 

2.B.1 on page 3. He suggested the words "Evaluate the 

effectiveness of the phone interview..." might be too openended, causing the contractor to call for clarification. His 

concern was raising the issues discussed yesterday on re- evaluation. 

#	 Mr. Griffon replied they may have some question on what 

"effectiveness" means, but re-interview is not an option. 

#	 Dr. Andrade suggested one way of evaluating effectiveness 

might be responses from interviewees with numerous additional 

comments. If it happens repeatedly it could suggest 

something faulty with the interview process. 

#	 Dr. James Melius queried whether site profiles shouldn't be 

included in the basic review now, given that they will be 

basic procedural documents used in nearly all dose 

reconstructions. 

#	 Mr. Griffon noted that had been new information, but that 

site profiles probably would be referenced in all dose 

40 
 

 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

reconstructions. He noted that there will be a separate task 

for a more extensive site profile review. 

#	 Dr. Ziemer added that Paragraph A.2 of the Basic Review 

requiring the reviewer to evaluate the data used by NIOSH 

opens the door if site profile was part of that data. 

#	 Mr. Larry Elliott called the Board's attention to Paragraph 3 

on page 4, "Blind Dose Reconstruction." He suggested it 

would be beneficial to specify who would select those cases. 

#	 Dr. Ziemer asked if they could just agree an appropriate 

explicit sentence would be added. 

#	 Ms. Wanda Munn suggested it might be cleaner to do on page 1, 

third paragraph, to say "10 Blind Review cases specifically 

chosen by the Board." 

#	 Mr. Griffon asked why not simply add a sentence at the end of 

that paragraph stating the Board shall select all cases for 

review. 

#	 Dr. Ziemer announced, without objection, that the third 

paragraph on page 1 would be modified by adding at the end a 

sentence to read "The Board shall select all cases for 

review." 

#	 Ms. Munn returned to a concern about the meaning of 

"effectiveness" as used in Paragraph 2.B.1 on page 3. She 

suggested changing the sentence to read "Evaluate the 

completeness of the phone interview in ascertaining that all 

relevant work history information has been addressed." 

#	 Dr. Ziemer speculated it would come down to the meaning of 

"completeness." 

#	 Ms. Munn countered that the interview form had been 

identified as being as complete as could be gotten in terms 

of material that needed to be covered. Is the material on 

the form adequately represented in the NIOSH report of the 

interview. 

#	 Dr. Ziemer suggested deleting the words "the effectiveness 

of" from the sentence. 

#	 Dr. Melius noted it would be easier to limit what the 

contractor was directed toward rather than trying to describe 

the evaluation. 

#	 Dr. Ziemer announced, without objection, that Paragraph 2.B.1 

on page 3 would be modified by deleting the words "the 

effectiveness of." 

The Chairman called for a vote and the motion received 

unanimous approval.
 

41 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Board Discussion
 

Mr. Mark Griffon informed the Board that there were several 

matters the workgroup had discussed earlier in the morning. He 

noted some had been answered in discussing the previous two 

documents. One that was remaining was the steps involved in 

moving forward, and whether the entire Board would have to act on 

any meetings with the contractor, if executive session would be 

required, et cetera. 

Mr. Larry Elliott indicated that while he did not have the 

answers, the questions had been captured and the answers would be 

pursued expeditiously. 

Mr. Griffon advised the Board, the workgroup had discussed meeting 

in Cincinnati for a day to work through remaining questions and 

report back to the full Board at the next meeting. 

Mr. Elliott responded NIOSH would support the workgroup and assist 

with scheduling. Mr. Elliott added that it would be beneficial to 

come forward with the task which spoke to tracking of the Board's 

cases. Since the discussion had indicated the Board wanted to 

review and approve the tools used by the contractor, that might be 

included in the tracking task, as well. In any event, the Board 

would have to specify what those tools are to be and that it wants 

to see and approve them. 

Mr. Griffon indicated the workgroup had not had an opportunity to 

discuss the tracking task due to time constraints. However, he 

had envisioned looking at it along with case selection. He 

suggested a reasonable task for the contractor was to work with 

NIOSH in establishing a baseline matrix of all the cases and 

laying out parameters of interest for the Board. That would 

provide something to select from. 

Mr. Elliott asked if the review process itself had been discussed, 

noting NIOSH needed a sense of how it was anticipated to operate. 

He specifically mentioned language in the approved task orders 

relating to selected Board members working with the contractor in 

the review. 

Mr. Griffon replied that it had been discussed involving reports 

back to the full Board and caution needed regarding Privacy Act 

issues. He suggested that could be the next item of discussion. 

Dr. Paul Ziemer raised the issue of reviewing 25 cases every two 

months, as mentioned in the section on deliverables in the second 

42 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

document just approved. Noting that it was not a trivial task, he 

wondered what the workgroup had considered in terms of Board 

panels. He suggested if the work were spread out to smaller 

panels it would lighten the workload. 

Mr. Griffon responded that the document suggested two members. 

Dr. Ziemer asked if the workgroup were then intending members have 

personal responsibility for two cases per month. 

Dr. Antonio Andrade reminded the Board they were about to discuss 

the process for case selection, focusing on the idea of developing 

a matrix listing the types of cases the contractor would review. 

He suggested that a rough matrix had already been developed. 

Given the dose reconstructions to date, it was not going to be 

possible to fill out that matrix in a way that starts to populate 

all the areas. He opined this might be a task better developed 

over time, possibly to a point it could be released to the 

contractor, by the end of the year when it is expected there will 

be several site profiles developed and different types of dose 

reconstructions done. He suggested giving this consideration, 

defer discussion and develop the task for issuance at a later 

date. 

Mr. Griffon explained he was anticipating two parts to the 

process. The first would be to develop the matrix on the existing 

cases in the system, all the ones in the hopper. The tracking 

would be the second part. He noted the tracking task was not 

ready for Board approval anyway. 

Dr. James Melius agreed with Dr. Andrade that there wouldn't be 

enough cases to select from until year end. He noted the 

assumption had been there would be a random group of cases from 

which to select. Doing them in batches will complicate the 

process. He suggested consideration of alternative measures. One 

would be an early task for the contractor to examine the database, 

work with NIOSH, see how information is available, what would be 

feasible and easy to select on, what would be a potential 

procedure. This would stop development of a selection procedure 

that would be burdensome or impossible to accomplish. 

Alternatively, the workgroup could do it when they're meeting. 

Either would be helpful if done before the end of the year. At 

the end of the year a selection process can be more fully 

developed. 

Dr. Roy DeHart reminded the Board that they could only review 

finalized cases. 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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Dr. Ziemer inquired whether there was an appeal period after 

adjudication. 

Mr. Elliott responded claimants can object to a recommended 

decision within 60 days. 

Dr. DeHart asked if NIOSH anticipated having cases ready for Board 

review by end of the year. 

Mr. Elliott replied that the issue was being looked into. If 

they're in an appeal stage, they're still tied up. There are 

statute of limitation issues. Six years is too long for the Board 

to wait. There is still some coordination with DOL as to when a 

case has achieved a point of adjudication that can be audited. It 

is not anticipated compensable cases would be contested. 

Currently those are in the range of 45 to 47 percent. While some 

of those are still in recommended decision, there should be a 

goodly number from which to select by the end of the year. 

Mr. Elliott returned to Mr. Griffon's comment about the 13,500 

cases in the hopper to put a matrix together. He informed the 

Board that it was not its contractor's responsibility to do that. 

That was a NIOSH job and NIOSH had a robust tracking system. 

While it may not do everything the Board wanted, he proposed the 

Board decide what it wanted the matrix to contain and the 

parameters it wanted populated, and the IT staff would work to put 

it into place. 

Dr. Melius remarked he thought it would work better if it were 

more of an interactive process. It may be possible to select 

cases based on things already in the database without making extra 

work for the staff. If it were done jointly, it may help both. 

He suggested a joint effort. 

Dr. Henry Anderson suggested a pilot phase and a production phase. 

Rather than spend a lot of time finalizing something that may 

ultimately be unworkable, perhaps begin with 25 or so and have a 

month or two delay to process those. 

Mr. Griffon noted the workgroup had some draft parameters and 

suggested that was an issue that could be addressed when they met 

and were in front of the database. 

Procedure for Processing Individual Dose Reconstruction Reviews
 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Mr. Mark Griffon suggested the Board turn to the "Procedure for 

Processing Individual Dose Reconstruction Reviews" draft which had 

been provided for their review. He indicated the language in the 

fourth bullet on page one regarding interface with individual 

claimants still needed to be discussed. He suggested it might be 

deleted from this process and handled separately. That is the 

question of re-interview and is not currently a part of the dose 

review process, which this document is addressing. 

He noted that Section B addresses the 25 cases every two months, 

and suggested adding some verbiage based on discussing within the 

workgroup that morning. One matter was that the Board needed a 

conflict of interest plan related to its review work. Another was 

the question of Privacy Act issues and the idea that the rotating 

Board members could work with the contractor and have in-depth 

conversations relative to individual cases. The workgroup had 

also discussed the possibility of going into executive session for 

the full Board to discuss individual cases where there may be 

identifiable information. 

Mr. Larry Elliott agreed it could happen that way. He noted any 

Board member who wanted to see an individual claimant's 

administrative record could be accommodated separately. However, 

in order to go into executive session it would have to be 

announced in advance by Federal Register notice. 

Dr. James Melius inquired into the possibility of announcing a 

provisional executive session, that a period of time at each 

meeting would be set aside for review of confidential information. 

Mr. Elliott responded that it was being researched. It was both 

FACA-related and legal-related, so some questions had to be 

answered. 

Mr. Griffon directed the Board to section D.3 on page 2, 

suggesting its deletion as it was directly related to reinterview. 

Dr. Paul Ziemer asked for clarification of the word "experts" in 

section D.1 and wondered whether the fact that it was enclosed in 

quotation marks indicated it would workers. 

Mr. Griffon indicated it did include workers, people with years of 

experience. Moving forward, Mr. Griffon suggested adding a 

sentence related to the Board's consideration of a standing 

executive session for in-depth discussion of individual cases. 

45 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Dr. Ziemer asked to return to section D-1, inquiring if the Board 

could legally go back to any expert, whether they are workers or 

worker representatives, and discuss particular cases. 

Mr. Elliott observed that the generalities of the claim could be 

discussed, such as job title, years employed, et cetera. Privacy 

information such as name or Social Security number cannot be 

revealed. He noted that when coworker interviews were sought, it 

had to be done with a claimant waiver. 

Mr. Griffon indicated clarification might be needed, as the intent 

had been background information potentially related to a case. 

Mr. Griffon suggested editing sections E.6, F.3, and G.3 by 

changing the word "periodic" to "semi-annual" in order to make it 

consistent with the task order previously approved. He also 

suggested editing section F.3 further by adding the words "along 

with the contractor" after the words "The full Board." 

Mr. Elliott offered an edit to section G.3 that would allow 

recommendations to NIOSH be made at whatever time information 

becomes available. 

Dr. Ziemer raised an idea for the Board and NIOSH to consider 

related to the interview issue. He wondered if it might be 

possible for NIOSH to consider taping two to three percent of the 

interviews on a random basis. That would serve their quality 

control purposes and the Board's purposes of having a record 

against which interview summaries could be compared. That would 

eliminate re-interview, which was only for the purpose of 

evaluating the interview process, anyway. Additionally, that 

sample could be used to audit the interviews aside from the case 

audits. 

Dr. Melius opined alternatives should be considered. He expressed 

concern that a process is needed to make sure the interviews 

collect the appropriate necessary information. He also expressed 

a belief that NIOSH needed an internal process for continuing 

improvement of interviews and information-gathering, as well as 

the Board's ability to review it. 

Dr. Melius suggested perhaps another workgroup could be formed to 

address that issue, explore the alternatives, report back to the 

Board and have a more complete discussion. 

Ms. Wanda Munn observed such a record might also be helpful in 

determining trends with respect to the reaction of people being 

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NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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interviewed. 

Dr. Ziemer noted it could only be done with the interviewee's 

knowledge. Both the interviewer and interviewee would have to be 

told the interview may be taped, but it would be important for the 

interviewer not to know a specific interview was being recorded. 

The interviewee would also have to have the option of refusing to 

allow recording. 

Mr. Elliott reminded the Board the audit was of the process, of 

the quality control, and quality assurance measures in place. He 

offered a further option of a Board member or the contractor 

observing the interview process. 

Mr. Elliott indicated he was very much interested in seeing the 

best job possible done with the interviews. He encouraged counsel 

and staff to speak their minds, noting they could identify issues 

they were aware of. Mr. Elliott also encouraged the Board to 

think of ways to perform its audit and identify ways NIOSH can 

improve the process without going back to the claimants after the 

fact. 

Mr. Michael Gibson expressed concern that having a Board member 

sit in on an interview might be intimidating to interviewees. 

Dr. Ziemer asked if presence of a Board member observing would 

have to be made known to the interviewee. 

Mr. Elliott replied he hadn't thought it through, but felt it 

would perhaps take some legal review to determine those issues. 

Mr. Robert Presley disagreed with Mr. Gibson, observing that some 

might be glad to have a Board member listening. They would know 

the Board was taking an interest in what they were doing or 

saying. 

Dr. Henry Anderson noted NIOSH was already sitting in on some 

interviews for quality control. He asked if notes were taken or 

if the interview form was filled in by both the interviewer and 

the NIOSH observer. If that were being done and the notes were 

available, those could be used to make a comparison. He expressed 

a concern for potential loss of information because what is not 

important to the interviewer may be important to someone else 

because of special knowledge. 

Mr. Elliott responded that those issues would be examined in the 

Board's audit and would be evaluated appropriately. He noted that 

47 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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the claimant controlled the process. The claimant can come back 

and object to things not being included in the report. The Board 

will see how many times those edits have been made to make 

corrections. Mr. Elliott suggested the Board should go through 

the process of the audit, figure out what areas can be improved 

upon, where deficiencies are, and that information would be very 

welcome. 

Dr. Andrade agreed and noted that type analysis was easily done 

and should be done and be a part of the review process. He liked 

the idea of observing or sitting in on interviews, and felt Mr. 

Gibson and Mr. Presley were both correct. If there were two sets 

of note-takers, with those notes compared at the end, that would 

give a level of information that could indicate whether a person 

might be biased in taking certain types of information. 

Dr. Ziemer observed there was no desire to have either the 

interviewee or the interviewer know a specific conversation was 

being audited. An audit would have to be blind to that. And two 

people asking questions might perturb the system. 

Dr. Andrade clarified his suggestion was to present the 

interviewee with the possibility that information would be taken 

by two people, one being a Board member. The interview would be 

conducted as usual, but a second person would be taking down their 

own set of responses. 

Dr. Melius observed that the Board was to audit completed cases. 

Interviews would not be being conducted on completed cases, so 

that would involve a change in the directive parameter of the 

audit process. He again suggested setting up a workgroup to look 

at current practices, alternatives, what could be done legally, et 

cetera. He noted it would be helpful to get this issue moved 

along due to its difficult and contentious nature. 

Mr. David Naimon advised the Board that counsel had looked into 

the matter of taping in great detail, and felt the option of 

listening in may have some of the same issues. There would be a 

significant legal question in some states as to whether it's 

possible to have someone listening in without the interviewer or 

interviewee knowing. If tapes were made for even a sample of the 

interviews, they would potentially have to be added to the 

administrative record for that claim. That would raise the 

possibility of the claimant asking for copies, so there would be 

an issue of providing them. 

Mr. Naimon further noted that one state required every party to a 

48 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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phone call give his consent on tape. That would require every 

person who was going to participate saying it was okay, then the 

tape would be turned on and they'd have to say it again to verify 

that each person had said it. He agreed with Dr. Melius that it 

is a very complicated question. 

Dr. Ziemer observed that it had not been his intent to resolve the 

issue, but rather to get some ideas out to get people started 

thinking about options. 

Dr. Melius asked if he could formally propose a workgroup. 

Dr. Ziemer recognized him for that purpose, noting the Chair was 

empowered to appoint workgroups, and asked for volunteers, noting 

five would be an upper limit. Mr. Richard Espinosa, Dr. Andrade, 

Dr. Melius, Ms. Munn, and Mr. Gibson indicated interest. Dr. 

Ziemer asked for staff support. 

Dr. Melius volunteered to chair the workgroup. 

Dr. Ziemer announced the formal charge to the workgroup would be 

to explore potential options the Board may consider for the 

purpose of auditing the interview process. He asked for a report 

at the next meeting of the Board, and further requested the 

workgroup keep the Chair of the Board informed on its 

deliberations, expressing his personal interest in the question. 

Mr. Elliott indicated a staff person would be made available, 

though he could not say yet who it would be. He also noted that 

the general counsel's office was at the ready to assist. 

Dr. Ziemer expressed the importance of creativity, while being 

sensitive to the issues. The Board had requirements, NIOSH had 

needs, and the desire is to find a way that will be helpful to all 

groups involved. 

Dr. Anderson asked if the claimants who recorded their interviews 

told anyone they were doing so, and how many interviewees had 

other people sitting with them in their interviews. 

Mr. Elliott responded that he couldn't answer either question. He 

had just learned of that being done and he had asked staff to find 

out whether or not it is recorded on the interview that it was 

taped. He indicated that they were aware that a number of people, 

particularly survivors, had people sit with them. Or people who 

were hard of hearing, couldn't sit for long periods of time or had 

difficulty understanding have had people sit with them, and the 

49 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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names of those people have been taken. 

Mr. Richard Espinosa recommended labor unions and advocacy groups 

be solicited for comments on the phone interview. 

Dr. Ziemer asked how he was suggesting that be done. 

Mr. Espinosa surmised it could be done by the workgroup, noting 

that the Los Alamos Project on Worker Safety and other labor 

unions such as the Paper, Allied-Industrial, Chemical & Energy 

Workers International Union (PACE), sheet metal workers, and iron 

workers would have input on what they'd like to see done. 

Dr. Ziemer replied that it would have to be an all or nothing sort 

of thing, so that Los Alamos couldn't be singled out for input. 

Dr. Melius suggested that might be something the workgroup could 

bring up in the appropriate context after some options had been 

developed. 

Dr. Ziemer cautioned that at this point the idea that the Board 

was proposing recording interviews should not be floated because 

that was not what had been discussed. 

Motion

 Dr. James Melius moved to provisionally 

approve the draft document entitled "Procedure 

for Processing Individual Dose Reconstruction 

Reviews." Dr. Roy DeHart seconded. The 

motion received unanimous approval. 

__________________________________________________________________ Review/Approval of Minutes
 

Motions

 Mr. Robert Presley moved to approve the 

executive summary and minutes of the 

Fourteenth meeting. Ms. Wanda Munn seconded. 

The motion received unanimous approval. 

 Mr. Robert Presley moved to approve the 

minutes of the Fifteenth meeting, held by 

teleconference. Ms. Wanda Munn seconded. The 

motion received unanimous approval. 

50 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

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 Ms. Wanda Munn moved to approve the executive 

summary and minutes of the Sixteenth meeting. 

Mr. Robert Presley seconded. The motion 

received unanimous approval. 

ABRWH Schedule
 

The Board determined the schedule for the next two meetings should 

be set now to avoid conflicts at the end of the year. It was 

suggested and agreed that the Board should convene on October 28 

and 29 in St. Louis, Missouri, with Richland, Washington as the 

alternate city should accommodations not be available in St. Louis 

for those dates. 

It was suggested and agreed that the subsequent meeting of the 

Board would be held on December 9 and 10 in Amarillo, Texas, with 

Las Vegas, Nevada as the alternate city should accommodations not 

be available in Amarillo for those dates. 

__________________________________________________________________ Public Comment Period 

Mr. John Alexander 

Center for Worker Safety and Health Education 

Cincinnati, Ohio
 

Mr. John Alexander informed the Board that the earlier discussions 

related to composition of the site profile teams had piqued his 

curiosity, so over the lunch hour he had approached a retired 

colleague to get his opinion of who he would want on such a team. 

Without hesitation he had replied he would want his union 

representative. In response to who he would not want, his answer 

was the company's safety representative, adding he would want an 

outside source doing the work. 

Mr. Alexander went on to say he felt this example reinforced Dr. 

Till's belief that the program should be managed in a way that 

would withstand scrutiny. He noted the Board's task orders are to 

review any information to reconstruct exposure. He asserted that 

from his personal experience that would include union health and 

safety reps. He urged the Board to ensure the site profiles 

discovered what actually happened on the sites. 

Dr. Eula Bingham 

University of Cincinnati Medical Center 

Cincinnati, Ohio
 

51 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

Dr. Eula Bingham related to the Board some of her experiences as a 

member of a team conducting a study at the Savannah River Site. 

She noted that, as Dr. Till had done earlier, she would encourage 

the importance of documentation. She emphasized it was at the 

heart of good science, which was what the program was going to be 

judged on. She urged NIOSH and ORAU to document the source of 

information received from a site, noting that some sources will 

say whatever is convenient. 

Mr. Richard Miller, 

Government Accountability Project 

Washington, D.C.
 

Mr. Richard Miller commented that EEOICPA was a program priding 

itself on transparency and having an open process. He made the 

observation that this meeting was the first time he'd heard 

resistance to that transparency. 

Mr. Miller noted that some of the names listed in Dr. Neton's 

earlier presentation would probably be disqualified under the ORAU 

conflict of interest criteria because they are experts in 

litigation defense. Mr. Miller suggested that if there was a 

sensitivity to there being something that doesn't reflect well, 

the answer is not to follow the DOE example of non-disclosure. 

Mr. Miller raised additional questions as to what will happen if 

something really objectionable is found. He further noted that 

the manager of the site profile teams should be aware of whatever 

unconscious filtering biases team members might be operating 

under. 

Board Discussion
 

Dr. Paul Ziemer noted the site profile teams consisted entirely of 

technical people and wondered whether it wouldn't be of benefit to 

include the union health and safety person from a site, as had 

been suggested. He felt it would be sensible for NIOSH to 

consider how to address that issue. 

Dr. Ziemer further observed that he had assumed the editors or 

authors of the site profiles would be identified in the reports 

themselves, not only for the sake of transparency, but because the 

Board members would like to know. 

Mr. Larry Elliott indicated that was perhaps an oversight and that 

issue will be looked at. He commented further that the issue of a 

balanced perspective would be addressed. Mr. Elliott addressed 

52 
 

 

NIOSH/CDC Advisory Board on Radiation and Worker Health Executive 

Summary/Minutes August 18-19, 2003

the perception of the term "controlled document." He noted that 

while those with a government base understood the term, he was 

hearing it interpreted from a civilian perspective as meaning a 

closed system. He commented that was a benefit of the meetings 

and reiterated, on behalf of NIOSH and ORAU, appreciation for the 

input from the public. 

Mr. Richard Espinosa suggested having a union or worker rep set up 

a forum for the site profile teams so that former workers could 

provide a history and current workers could connect the history to 

current conditions. 

Mr. Mark Griffon offered his experience from group interviews 

conducted in risk mapping sessions. He disclosed the most 

productive sessions included former workers, management or 

supervisory personnel, and perhaps a former health physicist. He 

noted the workers knew where things were and what they worked 

with, often knew code names. Technical people helped put 

radioisotopes with the code names. Supervisory personnel 

presented how it looked on paper. The ensuing dialogue of what 

was versus what should have been yielded the best results. 

Dr. Ziemer suggested many sites may have retired health physicists 

and/or retired union health and safety people with valuable 

institutional memory. 

Mr. Robert Presley informed the Board of a group at Y-12 they 

called the retiree corps which included hourly people on the floor 

to health physicists. He noted that the plant manager for many 

years at Y-12 had started as a chemical operator and advanced to 

vice president of the corporation. 

Dr. Roy DeHart observed that the issue was not whether the source 

was union or management, it was the contribution to be made. 

Dr. Ziemer noted Mr. Elliott had acknowledged the expressions of 

concern and interest, and appropriate action could be taken. 

53 
With no further business posed, the meeting was officially

adjourned at 4:30 p.m.

.

EDd of .C:'f7mrn.8ry M~n'f~~A'...j",

~

I hereby confirm that these Summary Minutes

are accurate to the best of my knowledge.

54