1 

Presidential Advisory Committee
 

Department of Health and Human Services
 

Centers for Disease Control and Prevention (CDC)
 

National Institute for Occupational Safety and Health 

(NIOSH)
 

Advisory Board on Radiation and Worker Health
 

VOLUME I
 

The verbatim transcript of the Meeting of
 

the Advisory Board on Radiation and Worker Health
 

held at the Hyatt Regency Cincinnati, 151 West Fifth
 

Street, Cincinnati, Ohio, on August 14 and 15, 2002.
 

NANCY LEE & ASSOCIATES
 

Certified Verbatim Reporters
 

P.O. Box 451196
 

Atlanta, Georgia 31145-9196
 

(404) 315-8305
 
 

2 

C O N T E N T S
 

August 14, 2002
 

Registration and Welcome, Dr. Paul Ziemer, Chair. 8
 

Review and Approval of Draft Minutes, Dr. Paul 

Ziemer, Chair ............. 10 
 

Review of Action Items, Mr. Larry Elliott, Executive
 

Secretary . . . . . . . . . . . . . . . . 17 

Dose Recononstruction Workgroup Report, Mr. Mark 

Griffon, Workgroup Chair . . . . . . . . .25
 

Dose Reconstruction - Atomic Veterans, Mr. Michael
 

Schaeffer, Defense Threat Reduction Agency
 

. . . . . . . . . . . . . . . . . . . . . 57
 

Adjudication of Claims - Atomic Veterans, Mr. Jerry
 

Steele, Department of Veterans Affairs . 114
 

Probability of Causation - Determination for Atomic
 

Veterans, Dr. Neil Otchin, Department of 

Veterans Affairs . . . . . . . . . . . . 129
 

Public Comment Period . . . . . . . . . . . . . .148
 

Adjourn . . . . . . . . . . . . . . . . . . . . .181
 

Court Reporter's Certification . . . . . . . . . 182
 
 

 

3 

P A R T I C I P A N T S
 

CHAIR
 

ZIEMER, Paul L., Ph.D.
 

Professor Emeritus
 

School of Health Sciences
 

Purdue University 

Lafayette, Indiana 

EXECUTIVE SECRETARY
 

ELLIOTT, Larry J.
 

Director, Office of Compensation Analysis and Support
 

National Institute for Occupational Safety and Health
 

Centers for Disease Control and Prevention
 

Cincinnati, Ohio
 

MEMBERSHIP
 

ANDERSON, Henry A., M.D.
 

Chief Medical Officer
 

Occupational and Environmental Health
 Wisconsin Division of Public Health
 Madison, Wisconsin 

ANDRADE, Antonio, Ph.D.
 Group Leader 

Radiation Protection Services Group
 Los Alamos National Laboratory
 Los Alamos, New Mexico
 

DeHART, Roy Lynch, M.D., M.P.H. 

Director
 The Vanderbilt Center for Occupational and Environmental
 Medicine
 Professor of Medicine
 Nashville, Tennessee
 

ESPINOSA, Richard Lee 

Sheet Metal Workers Union Local #49
 

Johnson Controls
 

Los Alamos National Laboratory
 

Espanola, New Mexico
 
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GADOLA, Sally L., M.S., R.N., COHN-S
 

Occupational Health Nurse Specialist
 

Oak Ridge Associated Universities
 

Occupational Health
 

Oak Ridge, Tennessee
 

GRIFFON, Mark A.
 

President
 

Creative Pollution Solutions, Inc. 

Salem, New Hampshire
 

MELIUS, James Malcom, M.D., Ph.D.
 

Director
 

New York State Laborers' Health and Safety Trust Fund
 

Albany, New York
 

MUNN, Wanda I. 

Senior Nuclear Engineer (Retired)
 

Richland, Washington
 

PRESLEY, Robert W. 

Special Projects Engineer
 

BWXT Y12 National Security Complex
 

Clinton, Tennessee
 

ROESSLER, Genevieve S., Ph.D.
 Professor Emeritus
 University of Florida 

Elysian, Minnesota
 
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INVITED SPEAKERS
 

Mr. Jerry Steele, Department of Veterans Affairs
 

Mr. Michael Schaeffer, Defense Threat Reduction Agency
 

Dr. Neil Otchin, Department of Veterans Affairs
 
6 

STAFF/VENDORS
 

CORI HOMER, Committee Management Specialist, NIOSH
 

MARIE MURRAY, Writer/Editor
 

STEVEN RAY GREEN, Certified Court Reporter
 

AUDIENCE PARTICIPANTS
 

Everett "Ray" Beatty, Sr.
 

Gary F. Benjamin
 

Eula Bingham
 

Joe Carson
 

Liz Homoki-Titus
 

Eric H. Kearney
 

Jeffrey L. Kotsch
 

Bruce D. Lawson
 

Mark Lewis
 

Bill McGowan
 

Richard Miller
 

Leon Owens
 

Susan Pinney
 

Herman Potter
 

Marybeth Potter
 Louise S. Presley
 Sam Ray
 Robert G. Tabor
 Rose Toufexis
 Jerry Tudor
 
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TRANSCRIPT LEGEND
 

The following transcript contains quoted material. 

Such material is reproduced as read or spoken.
 

In the following transcript a dash (--) indicates an
 

unintentional or purposeful interruption of a sentence. 

An ellipsis (. . .) indicates halting speech or an
 

unfinished sentence in dialogue or omission(s) of word(s)
 

when reading written material.
 

In the following transcript (sic) denotes an
 

incorrect usage or pronunciation of a word which is
 

transcribed in its original form as reported.
 

In the following transcript (phonetically) indicates
 

a phonetic spelling of the word if no confirmation of the
 

correct spelling is available.
 

In the following transcript "uh-huh" represents an
 

affirmative response, and "uh-uh" represents a negative
 

response.
 

In the following transcript "*" denotes a spelling
 

based on phonetics, without reference available.
 

In the following transcript (inaudible) signifies
 

mechanical failure or speaker failure.
 
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P R O C E E D I N G S
 

(12:30 p.m.)
 

DR. ZIEMER: Good afternoon, everyone. I'd
 

like to call the meeting to order. I'm Paul Ziemer,
 

Chairman of the Advisory Board on Radiation and
 

Worker Health. This is the sixth meeting of the
 

Board. It actually was -- we had a sort of prelude. 

Our working group on dose reconstruction actually
 

met yesterday and this morning, and now the full
 

Board meets here this afternoon and all day
 

tomorrow.
 

The Board members are all present. If you
 

are an observer and wonder who the various people
 

are who, their placards are by their seats so you
 

can identify them. I'm not going to go around and
 

introduce all the Board members at this time, but I
 

would like to introduce two new Board members who
 

are not yet seated at the table. They were approved
 

just within the last couple of days by the White
 

House, but the government bureaucracy is such that
 

the White House approval is not enough to get them
 

at the table here for some reason. There actually
 

are some red tape issues that have to be taken care
 

of before they're formally seated, but they are here
 

today both as observers and they're certainly
 
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welcome to speak at any time.
 

Let me introduce first Mike Gibson. Mike,
 

stand up so we can see you.
 

MR. GIBSON: (Stands)
 

DR. ZIEMER: Mike is president of the PACE
 

local union at the Mound facility. Mike's from
 

Franklin, Ohio. Welcome, Mike. We're glad to have
 

you here.
 

And then Leon Owens, who is in a similar
 

position with the PACE local, president of the PACE
 

local at the Paducah facility. And again, Leon, we
 

welcome you, and both of you are certainly welcome
 

to participate in the ongoing deliberations here
 

today and we look forward to having your full
 

participation once all that bureaucracy is taken
 

care of.
 

I wanted to remind everyone here, Board
 

members and observers, members of the public and
 

other staff to be sure to register your attendance. 

There's a registration book at the table in the
 

rear. Please do that, if you haven't already,
 

sometime during the day.
 

And then also, members of the public who
 

wish to address the Board during the public comment
 

session, there is a notebook page for you to sign up
 
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on so that we can have some idea of how many will be
 

planning to speak and we can adjust the timing
 

accordingly.
 

The agenda has been distributed. It's been
 

on the web site, but I believe there are also copies
 

of the agenda, as well as other handout materials,
 

on the table in the back so members of the public
 

and others who have not already done so, if you need
 

copies of those, please help yourself to those, as
 

well.
 

We're going to proceed with the agenda
 

items, the first of which is the approval of the
 

minutes of our last meeting, and I'm now going to
 

move back to my seat for this. Let me comment first
 

that the draft minutes are rather lengthy. They are
 

40-some pages in length. Some -- although they were
 

on the web site, some of the Board members were in
 

travel status and may not have gotten them before
 

they arrived. Some Board members just arrived this
 

morning and may not have had a chance to even look
 

at those, so I'm going to give the Board two
 

options. One would be a motion to approve, the
 

other option is a motion to defer action until
 

tomorrow, which means if you make such a motion,
 

you're committed to reading these tonight before we
 
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return tomorrow, so no goofing off tonight. But I
 

do want to allow that option if you want to defer
 

action on these until tomorrow, if -- I don't know
 

how many have had a chance to read these or not.
 

Does anyone wish to defer action?
 

(No responses.)
 

DR. ZIEMER: No motion to defer action. If
 

not, I'm going to ask for corrections or additions. 

Now let me preface that by saying I'm not going to
 

ask you for typographicals because -- and there are
 

some. We will simply feed those back to the staff
 

and they can make those. I'm looking for changes of
 

substance, either incorrect statements or comments
 

or things of that sort. So -- and -- okay, Mark
 

Griffon, you can start.
 

MR. GRIFFON: It's just a -- on page three,
 

kind of a technical point.
 

DR. ZIEMER: Is this three of the -­

MR. GRIFFON: Three of the body -­

DR. ZIEMER: Three of eight?
 

MR. GRIFFON: Three of eight -­

DR. ZIEMER: Which is the executive summary.
 

MR. GRIFFON: Yeah. It's the third to last
 

paragraph, starts with any suggestions. The line
 

(reading) This could be the reasonable uncertainty. 
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Was actually -- it should be: This could be the
 

uncertainty combined with the central estimate that
 

is then cancer specific. That was my proposal
 

there. And that appears again on page 16 of the
 

main body of the report.
 

DR. ZIEMER: So your suggestion is that the
 

word "reasonable" be deleted and that it simply say: 

This could be the uncertainty, combined with the -­

MR. GRIFFON: And replace "mean" with
 

"central estimate". And that appears again in the
 

main body on page 16.
 

DR. ZIEMER: Also on page 16. Are there any
 

objections to this change? Let me move on and ask
 

for others, I'm not going to vote on these one by
 

one. Let's get them all before us and then we'll
 

take action.
 

Other comments or corrections? Wanda,
 

you're next.
 

MS. MUNN: A minor point, perhaps, on page
 

ten of the main body, the next to the last paragraph
 

when we're talking about the Board advising the
 

Department before it decides not to evaluate the
 

petition. I don't recall how much conversation we
 

had, but I think there were a couple of comments
 

about whether we needed to specify the basis for our
 
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decision. And I don't know that we captured that. 

I don't know whether it's of major importance,
 

but -­

DR. ZIEMER: I believe the context here is
 

that this is Mr. Katz's explanation to us of how he
 

understood the wording or what he understood the
 

wording to mean.
 

MS. MUNN: Yes, and -­

DR. ZIEMER: And in fact, some of that
 

includes things that -- where we had some
 

differences and I think would be taken care of by
 

our comments later, perhaps.
 

MS. MUNN: Okay, I didn't -­

DR. ZIEMER: I believe this is Mr. Katz's
 

explanation.
 

MS. MUNN: It was, yes, but I didn't see
 

that we caught it elsewhere. That's -- as I said,
 

no major issue for me. I just felt when I read it
 

that it didn't quite -­

DR. ZIEMER: This isn't necessarily what the
 

final rule will say -­

MS. MUNN: Right.
 

DR. ZIEMER: -- is what I'm saying. This is
 

-- yes.
 

MS. MUNN: Yeah.
 
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DR. ZIEMER: Okay. Thank you. Other
 

comments? I'd like to ask a question on the
 

footnote on page 4/8, that's the executive summary,
 

and I think this appears elsewhere, too. (Reading)
 

Two dose levels produced a 5.25 threshold.
 

And maybe I can ask one of the staff, is
 

that 5.25 -- is that intended to be rem? Do we -­

what is that number, the threshold? Is that a dose
 

threshold?
 

UNIDENTIFIED: Yes, I believe it is.
 

DR. ZIEMER: Is it rem? Is that -- okay, if
 

we could add the word "rem" there then.
 

There was -- I have a question on page 5/8,
 

and this is part of a public comment. I think the
 

commenter's here, and perhaps the statement is
 

correct. It talks about a wish to reinstate DOE's
 

retention of historical records. I guess my
 

question was, have they -- is there an official
 

policy that they not retain historical records? I
 

guess perhaps I shouldn't ask for this to be
 

corrected. I think that probably was the statement. 

I think it was your statement.
 

UNIDENTIFIED: What was it again? I was -­

DR. ZIEMER: That -- the commenter wished to
 

reinstate the DOE's retention of historical records.
 
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UNIDENTIFIED: Yes, I made that statement.
 

DR. ZIEMER: Okay, then that's fine. Okay. 

On the top of page 7/8, the first paragraph -­

again, I can ask -- maybe address this to staff. 

The third line from the end of that paragraph says
 

(Reading) These assumed, except for breast and
 

thyroid cancer, a quadratic dose response.
 

Could that be a linear-quadratic?
 

UNIDENTIFIED: It should be linear -­

DR. ZIEMER: So it would be linear-quadratic
 

dose response.
 

UNIDENTIFIED: What page was that?
 

DR. ZIEMER: It's the first paragraph on
 

7/8. It would be line -- line five. It should be
 

then linear-quadratic.
 

On page six, item two -- and this has to do,
 

Mark, with I think your report. And in the bullet
 

under item two, it talks about the need to do a
 

strategic sample. I'm wondering if that perhaps is
 

supposed to be a stratified sample.
 

MR. GRIFFON: A stratified sample, yes.
 

DR. ZIEMER: A stratified sample?
 

MR. GRIFFON: Yes.
 

DR. ZIEMER: Okay. Thank you. I think the
 

others that I have are mainly editorial and I'll
 
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feed those back to the recorder.
 

Let me ask this question -- it's on page 32,
 

the very last line, we have the 5.25 threshold again
 

and so we'll insert the word "rem" there. And then
 

in that sentence it says (reading) The average of
 

1.5 and 9 produces a 5.25 threshold -- rem threshold
 

for health endangerment.
 

I'm wondering if -- I think this is Mr.
 

Katz's material. I don't want to necessarily put
 

words in his mouth. I think I'd be more comfortable
 

if we said health effects. I'm not sure we endanger
 

health.
 

MR. ELLIOTT: That comes from the language
 

of the statute.
 

DR. ZIEMER: Okay, so we'll have to leave 

it. Okay. 

DR. MELIUS: What about putting quotes 

around health endangerment. That way we know it's a
 

term and it's not a statement of -­

DR. ZIEMER: That would -- thanks, that
 

would help, right.
 

Are there any other additions, corrections,
 

modifications? If not, I'll ask for a motion to
 

accept the minutes with the changes that have been 

noted.
 
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DR. MELIUS: I so move.
 

MS. MUNN: Second.
 

DR. ZIEMER: Moved and seconded. All in
 

favor, aye?
 

(Affirmative responses)
 

DR. ZIEMER: Any opposed, no?
 

(No responses.)
 

DR. ZIEMER: The motion carries, the minutes
 

are adopted. Thank you very much.
 

Now we have an opportunity to review past
 

action items and Larry Elliott's going to take us
 

through that. There also is a -- in your booklet
 

there is a section called action items.
 

MR. ELLIOTT: Well, it's good to be here
 

with you all again on a very short turnaround. 

Seems like just yesterday and only about 40,000 air
 

miles ago we were together, and hope that your visit
 

and stay here in Cincinnati is going to be very
 

enjoyable for you. And if it's not, let me know and
 

I'll get this right 'cause I'm trying to move us
 

along.
 

Certainly a lot of work the Board has
 

accomplished again in a short amount of time, and a
 

lot of work ahead of you. If you recall, I think it
 

was the third meeting in Washington where you all
 
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suggested and we thought a good idea, and this has
 

also been practiced in other boards, as well, to
 

carry on a list of action items and show the status
 

of those items. As you can see, these -- we kind of
 

started providing lists of these efforts back in
 

February, so we wanted to touch base at this meeting
 

on where we're at with some of these things, show
 

what we consider to be the status among the staff
 

and make sure that you're in agreement with that
 

status or if there's remaining work to do or some
 

other spin-off that you feel needs to be added to
 

this list, we get that accounted for.
 

So as you see here -- I'm not going to go
 

through each one of these, but just to highlight -­

you wanted to hear about the history of this
 

legislation so we brought Dr. Michaels in in May and
 

provided that to you.
 

We -- I think this first one here should say
 

clarified at 5/02 meeting commitment to provide
 

consultation to this body as you deem it necessary
 

and appropriate. We'll have to add some kind of
 

language to that 'cause I think that's an ongoing
 

effort. When you identify a expert that you want to
 

hear from, we'll bring them to you, as we did with
 

Dr. Lamb to discuss IREP issues.
 
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We're going down through what list we
 

acquired in May and you're going to see a lot of
 

spaces there. You see the status as we see it, and
 

I would ask for your comment on that. But I'd also
 

ask you to help identify what the priority should be
 

for this Board, what priority of action you want to
 

take, recognizing that some of these items are not
 

timely to act upon, that there needs to be certain
 

things put in place before we can take some action
 

on them.
 

For example, let's go down to identifying
 

research gaps. I think that's something that we do
 

need to engage on and work on, but I'm not so sure
 

we're at a juncture right now where it makes a lot
 

of sense for us to pick that up ahead of let's say
 

explaining the records request process. So that's
 

the kind of thing I'm asking you to take a look at
 

and help identify for us what you want to hear
 

about.
 

We're going to talk briefly tomorrow about
 

our experience with the Town Hall meetings on the
 

SEC, but we lay claim here that we completed those
 

as of last week. We certainly don't have the last
 

two transcripts up on the web site. And Mr. Ray
 

Green, who went on the west coast trip, is somewhat
 
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in a complicated situation trying to finish those up
 

and pull this one together, as well. Right, Ray? 

So he's assured me we're going to get those soon and
 

I've given him a little bit of breathing time to do
 

so. We will give you the summary of what happened
 

in those meetings, however, tomorrow, so -- let me
 

see if I'm on the right track here.
 

You have this also in your books, the dose
 

reconstruction working group meeting, so you need to
 

take that into account. And I'll leave you with
 

this last one on the action items that we think are
 

the Board's action items specifically. So it's up
 

to you to -­

DR. ZIEMER: Maybe there is some question -­

one of the items up there is -- it says (Reading) If
 

no MOU -- this is a DOE MOU -- by next meeting -­

Is that this meeting? -- then update
 

status. If now's the time, I can direct to that or
 

MR. ELLIOTT: I can't remember.
 

DR. ZIEMER: We didn't have that as a
 

separate item, did we, on the -­

MR. ELLIOTT: It's not an agenda item on
 

this. There's no program status report on this
 

agenda for this meeting.
 
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DR. ZIEMER: But maybe if you might comment
 

on the MOU.
 

MR. ELLIOTT: Surely. The MOU has now been
 

interchanged several times between -- at staff level
 

and is now at the Deputy Secretary's level being
 

negotiated.
 

DR. MELIUS: One other update, the dose
 

reconstruction status not detailed.
 

MR. ELLIOTT: Sure. That -- the award for
 

that dose reconstruction contract is at the best and
 

final stage of negotiation. We expect an award to
 

be made very shortly.
 

DR. MELIUS: Could you just -­

MR. ELLIOTT: Follow up.
 

DR. MELIUS: -- government jargonese, but
 

best and final's changed since the last meeting and
 

hopefully -­

MR. ELLIOTT: In the competitive process of
 

awarding a contract, there's been one proposer that
 

has been deemed ready to negotiate for a final award
 

out of all those proposers that competed.
 

DR. MELIUS: Thanks.
 

MR. ELLIOTT: So we're just going back and
 

forth on -­

DR. ZIEMER: Sounds like a name has gone
 
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forward up the channels, perhaps.
 

Other questions for Larry or comments on the
 

list right now?
 

(No responses.)
 

DR. ZIEMER: Thank you very much. Larry,
 

you're going to report on the visits to the public
 

meetings later. Right?
 

MR. ELLIOTT: Yes, we -- Ted Katz will be
 

giving you a summary presentation on that at the
 

start of your agenda item tomorrow morning,
 

discussion on the SEC NPRM.
 

DR. ZIEMER: Thank you. 

DR. MELIUS: Can I just -­

DR. ZIEMER: Jim? 

DR. MELIUS: One procedural question. The 

agenda that was on the web site I think listed Owen
 

Hoffman as being on the agenda for tomorrow. Is
 

that just a misprint or -­

DR. ZIEMER: I don't think Owen -- Owen -­

MR. GRIFFON: Yeah, I noticed that, too.
 

DR. ZIEMER: -- was on the August agenda?
 

DR. MELIUS: Yeah, on the one that was
 

posted on the web site.
 

DR. ZIEMER: I wonder if that's something
 

that didn't clear from the previous agenda or
 
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something.
 

MR. ELLIOTT: Well, Owen was on last month's
 

-- or last meeting's agenda.
 

DR. MELIUS: It was a misprint.
 

MR. ELLIOTT: He's not on this agenda. He
 

had no plans to be here. I hadn't even -- I'm
 

sorry. I'll check that out.
 

DR. ZIEMER: Unless you were looking at last
 

month's.
 

DR. MELIUS: Mark and I -- Mark was on the
 

phone -­

DR. ZIEMER: Oh.
 

DR. MELIUS: -- trying to figure out which
 

agenda we were looking at.
 

DR. ZIEMER: At the last meeting we approved
 

-- in fact, take a look at the very last page of
 

your minutes, which is addendum two or attachment
 

two, dose reconstruction review work group
 

recommendations. You recall at the last meeting we
 

actually approved these recommendations. They were,
 

in a sense, sort of the first step or first cut from
 

the working group as to what they felt should be our
 

direction, and basically we've adopted these. They
 

are broad and somewhat general. That working group
 

was tasked with visiting -- in fact, the reason
 
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we're here in Cincinnati was to couple with the work
 

group's visit to the facilities to look at how the
 

paperwork is being handled, how the dose
 

reconstructions are being done and to get a kind of
 

a better first-hand knowledge of what it might
 

entail for us to oversee, in a sense, the dose
 

reconstruction processes. So Mark's working group
 

met all day yesterday and this morning, and Mark's
 

going to report to us.
 

Mark, if you would include in your report a
 

bit of a description on what all your folks did
 

while you were here and then you can give us at
 

least a preview of what your thinking is as we move
 

forward.
 

MR. GRIFFON: Yeah, I will do -- I can do
 

that and one thing I was going to ask, though, on
 

the schedule -- I don't see any time today for
 

Special Exposure Cohort and I was wondering if -­

because this report back probably for me right now
 

probably is going to take 15 minutes, at most. I
 

was wondering if we might want to have -- or if we
 

can make room for a preliminary discussion and maybe
 

continue tomorrow for the SEC.
 

DR. ZIEMER: Without objection, we can
 

introduce the preliminary report of the exposure
 
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cohort group, as well.
 

MR. GRIFFON: My name is Mark Griffon. We
 

-- yeah, the dose reconstruction review working
 

group met yesterday and today. We had agreed at the
 

last meeting that to get a better handle on the task
 

that the Board is responsible for in reviewing a
 

percentage of the dose reconstructions that are done
 

by NIOSH, we felt that we really needed to get a
 

handle on what was involved in doing a case. And
 

since NIOSH has initiated the process or actually
 

gone quite far with the data collection phase of it
 

and actually has completed a number of dose
 

reconstructions, we thought it was beneficial to
 

come out to Cincinnati a little early and get the
 

tour.
 

And we did that yesterday. We had a -- Jim
 

Neton and his staff took us through the whole
 

process from when a claim comes in -- or from when
 

they get a package from the Department of Labor,
 

walked us through the whole system, including the
 

database, and did some pretty extensive reviews on
 

some of the cases that they've completed. And it
 

was very instructive, and I should also note that
 

the few staff that Jim has have done a lion's share
 

of work in terms of getting all this data and
 
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getting the system up and running. It's pretty
 

impressive to see how far they've gone in this short
 

time.
 

This morning -- that was mainly yesterday. 

This morning we spent a couple of hours trying to
 

fine-tune, as Paul pointed out, the recommendation
 

from the last meeting where we had sort of begun to
 

construct what is this review going to involve. And
 

we had a review panel, how were we going to do case
 

selection and then sort of the scope of work are the
 

three areas. And this morning we continued that
 

discussion, mainly on those three items.
 

I'll review a little bit of what we
 

discussed. I'm also going to offer that I'm going
 

to try to construct some sort of a -- more of a
 

draft that we can circulate tomorrow so it'll have
 

more of the details in and would ask my working
 

group colleagues to maybe help me out on that one,
 

but we'll work on that tonight.
 

We discussed the panel makeup. We discussed
 

questions on the procurement process and how the
 

Board can be involved in -- in the selection
 

process, and we went over the ways that the Board
 

can construct criteria for the contract and to
 

assure that the expertise of these independent
 
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reviewers is appropriate. And we're going to try to
 

draft some of that language tonight in terms of how
 

can this -- how can we construct the language for
 

the criteria for these experts that will do the
 

independent review.
 

We're also going to turn to NIOSH's RFP for
 

the dose reconstruction. We could probably look at
 

some of that language there for the RFP to do the
 

dose reconstruction to help us out in that language.
 

For case selection, we talked about how are
 

we going to select which cases the Board's going to
 

review. And we talked about possibly stratifying
 

along NIOSH's efficiency process, and this is the
 

process they're using when cases come in where they
 

can sort of -- they group them by sort of complexity
 

of cases. It's not quite that simply defined, but
 

when I type this all out you'll see it more
 

specifically. And that would create certain groups
 

of -- or categories that we'd be interested in. And
 

then we could do a selection within those
 

categories, keeping in mind certain strata that
 

we're interested in, such as geographic strata,
 

chronological strata and one was raised today,
 

gender. Certainly we should pay attention to that.
 

And then we also agreed that we have to,
 
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sooner rather than later, get a pretty good handle
 

on the number of cases and the expectation on how
 

long it would take to review an individual case so
 

we can get a sense, not only for the independent
 

reviewers, but also each independent review panel
 

that's set up is going to be comprised of one
 

independent reviewer and two Board members, so
 

there's a burden on the Board members, as well. So
 

we wanted to get a handle on just how many we expect
 

to select and how long we expect the review process
 

to take.
 

We threw around some numbers. We may or may
 

not include that in -- you know, I don't know if
 

we're that far along, but we have a better sense
 

from yesterday in terms of just what the workload
 

will be for the review.
 

And then we spent a large majority of the
 

time this morning talking about the scope, and some
 

issues we discussed -- and I'm going to frame that
 

way right now and hopefully I can better flesh them
 

out for tomorrow -- included the depth of review. 

One thing we are certainly -- we believe the Board
 

should certainly pay strong attention to is that the
 

claimants -- from the claimants' standpoint, we want
 

to make sure that we do the best job possible to
 
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make sure that NIOSH had adequate data to do the
 

dose reconstruction and that they made every effort
 

to make sure that data they used in the dose
 

reconstruction was adequate to make a determination
 

for causation. And that's different from refining
 

the dose perfectly, as we know.
 

We talked about how we can review the
 

completeness of the data. That's a phrase that was
 

I think in our original scope, that we wanted to
 

make sure there was a completeness of data. And you
 

can see where that could put -- you know, there's
 

scenarios where that could be a never-ending -- you
 

know, data always pops up, so we had to sort of -­

we're trying to grapple with how can we define an
 

end to this, but also make sure that we meet that
 

criteria of it's a complete record.
 

We discussed also looking at the
 

consistency. We thought consistency on many
 

different levels was something that this review
 

panel can have value added into the process. And by
 

that I mean that there's going to -- the
 

subcontractor's likely to do many of the dose
 

reconstructions. NIOSH is reviewing all those dose
 

reconstructions, from what I understand. By the
 

time it gets to this independent review panel,
 
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errors in mathematics or errors in calculations are
 

unlike -- you know, less likely. Where we thought
 

more value will be added is to make sure that the
 

data used to calculate the dose is consistent across
 

many different levels. And when I say that, I mean
 

it's consistent with the interview -- interviews
 

conducted or the allegations made by the potential
 

claimant. It's also consistent with the site
 

profile which NIOSH is building for that site. For
 

example, if certain exposures occurred in certain
 

buildings according to the site profile, then
 

they're in some way reflected in the data that's
 

used in that case.
 

And also that there's some consistency or
 

fairness across co-workers. The way this was raised
 

I think was that certain individuals -- and we saw
 

this, looking through some of the records. Certain
 

individuals have done a heck of a lot of homework
 

and they've sent NIOSH a lot of very interesting
 

documents, which has helped NIOSH to track certain
 

things down. But that shouldn't work against those
 

that didn't have that information, so we want to
 

make sure that there's some fairness to co-workers,
 

is kind of how we framed it.
 

And I think that was the main focus of our
 
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discussion. We're going to try to better draft
 

language around the scope of work -- and certainly
 

anybody from the working group can add if I'm
 

missing a big thing that we discussed. But I think
 

we're going to try to refine some of that language
 

around the scope of work particularly for tomorrow,
 

and I think -- all in all, I think the trip to
 

NIOSH's facilities was helpful for us to get a sense
 

of -- you know, from the time the Fed Ex package is
 

received with the data to the time they can put it
 

-- you know, what's happening in there, how much
 

data do they have, how long might we envision these
 

reviews to take and what -- you know, drawing some
 

end points to this review. And I guess that's it.
 

DR. ZIEMER: Thank you, Mark. And your
 

group actually looked at the dose reconstructions
 

for what, five cases that have been completed?
 

DR. NETON: Six cases.
 

DR. ZIEMER: Six cases?
 

MR. GRIFFON: Right.
 

DR. ZIEMER: That ran the gamut of sort of
 

doses and kinds of events and exposures?
 

MR. GRIFFON: Right, six cases, and actually
 

this efficiency process that NIOSH has is -- the
 

cases sort of went along the efficiency process that
 
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they're using wherein they showed us some -- they
 

categorize them by low potential for external
 

exposure, low potential for internal exposure. And
 

at the other extreme, high potential and high
 

potential, and I guess generally those six cases
 

they tried to give us to show us some of the
 

different categories that way so that we'd have a
 

sense of what was involved on either side of the -­

and actually one thing that they impressed upon us,
 

which I think surprised some of them even, was that
 

the low/low were some of the harder cases because
 

they wanted to make sure they looked at every
 

possible exposure. The high -- highly exposed, once
 

they had enough data to say that they tripped the
 

threshold, there was no reason to go -- you know, to
 

proceed with much more detail, so -­

DR. ZIEMER: The low/lows are often cases
 

where people worked in areas where perhaps
 

monitoring wouldn't be required normally because
 

they are presumably not restricted areas, so it
 

makes it more difficult than -- 'cause there's
 

typically not monitoring data. Is that correct?
 

MR. GRIFFON: Yeah, that's the notion I -­

generally, yes.
 

DR. ZIEMER: Now your review of these six
 
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cases was more along the lines of an acquaintance
 

with the process. You didn't formally evaluate
 

these six reviews -­

MR. GRIFFON: That's right.
 

DR. ZIEMER: -- so you're not saying yea or
 

nay on those, but was there a gut feeling amongst
 

the working group that the -- what you saw made
 

sense to you in terms of how the assumptions were
 

made and so on?
 

MR. GRIFFON: Well -­

DR. ZIEMER: Maybe I'm putting you on the
 

spot. I'm just sort of -­

MR. GRIFFON: Yeah, I mean -­

DR. ZIEMER: -- getting an early reaction to
 

sort of the process, what they had available in
 

terms of data and so on.
 

MR. GRIFFON: Right. My personal reaction
 

was that they -- you know, it was the easier cases
 

and so there weren't many surprises.
 

DR. ZIEMER: It was pretty straightforward,
 

uh-huh.
 

MR. GRIFFON: I guess I'll leave it -- there
 

weren't many surprises. I think at least one of
 

them was a fairly well-publicized accident with very
 

high exposures and, to no one's surprise, that was a
 
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compensable -­

DR. ZIEMER: Right.
 

MR. GRIFFON: So I think what's going to be
 

the challenge will be those mid-level cases where
 

the data is incomplete and those high-level cases
 

where the personal monitoring record tripped the
 

threshold, then I think everything was fine. But I
 

did -- I guess I still have this question about
 

consistency, and I don't think that they had to do
 

much of this, but comparing the -- right now what
 

they're getting from DOE and what they're requesting
 

from DOE is personnel monitoring records. They're
 

also, on the other parallel track, they're building
 

these site profiles. But from the personnel
 

standpoint they're just requesting the personnel
 

records, and in these cases I think for the most
 

part they were good enough to make a decision. But
 

that may not be true in the future so I think that
 

might be one question.
 

DR. ZIEMER: I wonder if any of the other
 

working group members have any additional comments
 

or observations. Gen Roessler?
 

DR. ROESSLER: I was impressed with the case
 

where it was a low/low, because I think what the
 

group is finding out is that these, as Mark said,
 
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might not be all that easy, that when there's a real
 

lack of data, then one has to try and come up with
 

what could be the upper limit. And that impressed
 

me with some of the -- I don't know if creative is
 

the right word, but the ways that they developed for
 

coming up with this upper limit. And I think
 

overall, those cases that we saw show how this
 

efficiency process can really be beneficial and I
 

think that's one of the developments they've made in
 

this whole process that I'm sure will be picked up
 

by other groups when they do this sort of thing.
 

MR. PRESLEY: Larry, I have one comment -­

Bob Presley. I'd like to thank Jim and his group
 

again. They did an excellent job of hosting us. 

But the thoroughness -- you know, a lot of us had a
 

question, what it took to do a dose reconstruction. 

And the six cases that we went through, the
 

thoroughness of the case, what you all did to make
 

sure that you took the data that you were given and
 

left no stone unturned, and then also the fact that
 

we've heard a lot of comments in some of the town
 

meetings about people not caring about the people
 

and things like this. And this morning we had a
 

opportunity to hear one of the interviews, and the
 

gentleman that did that I want to say did an
 
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excellent job. I was very much pleased with the way
 

he conducted hisself (sic) and the way he conducted
 

the interview. Your staff is to be commended.
 

DR. DEHART: To give those who weren't there
 

some kind of insight into what the datasets are that
 

we're looking at, one case, for example, had over
 

700 pages of historical data information,
 

interviews, letters and dose records. That one case
 

consumed, obviously, a bit of time. And in doing
 

the calculations, one individual spent nearly a week
 

or more actually working that case and fine-tuning
 

the dose calculations that were necessary. And in
 

fact in one case the final determinate does was
 

considerably higher than the dose of record because
 

of some of the factors related to the kind of
 

exposure that wasn't appropriately taken care of or
 

not well documented, perhaps, in the records that
 

were available. So a lot of work, a lot of time. 

And for the members of the Board, it indicates that
 

we're going to be very busy trying to review these
 

cases, even with an external expert going through
 

because we're being -- we're proposing that there
 

would be two of us with each one of these experts,
 

going through literally hundreds of records as we
 

proceed through the perhaps 8,000 records that would
 
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be reviewed the first year of the contract.
 

DR. ZIEMER: Jim?
 

DR. MELIUS: In your review did you have a
 

chance to get a feeling for how this process would
 

work as you would gear up to deal with hundreds of
 

cases and thousands of cases that are sort of
 

pending out there and how this would -- sort of what
 

would be the -- not necessarily the time frame
 

'cause that's hard to say, but how that process
 

would work. For example, I would think like with
 

the low/lows that you're going to -- it's going to
 

take a -- where there's not much information, it's
 

going to take a while to build up an inventory of
 

site profiles that would be specific enough to
 

different work areas and so forth to be able to deal
 

with those cases. And at the same time, you have
 

others that -- with the 700 pages of monitoring
 

records which are just going to take a while to wade
 

through. And is there a sense of how that part of
 

it would work? And I'm thinking in terms of how we,
 

in doing the reviews, take the sample from that. 

Maybe this will be clearer when you present
 

tomorrow, Mark, in terms of how we're going to
 

sample the cases, but -­

MR. GRIFFON: Maybe. We did talk about some
 
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possibilities for how to sample and maybe -- we
 

talked about quarterly, and then we talked about the
 

cases that we want to -- in that first quarter we
 

may have all high/highs, you know, I don't know. 

And we may have all from one site. But maybe we
 

just go -- proceed and sample those cases and then
 

continue to track to make sure -- and establish sort
 

of a matrix to make sure that we still complete our
 

sort of geographic and chronological requirements as
 

we proceed so that we cover all the sites and all
 

the time periods of interest. They may not come up,
 

like you said. We may have an even number of
 

low/lows and high/highs in the first quarter, so we
 

may have to adopt to that just to keep the process
 

moving. If anybody else can add to that, I -­

DR. ZIEMER: Let me add to that and then
 

we've got Henry and Gen. I did sit in and observe
 

the working group and learned a little bit of some
 

of their thinking. And it's pretty clear, since
 

they'll be looking at dose reconstructions that are,
 

in essence, already completed that -- and this
 

becomes a kind of audit -- that they need to develop
 

a standard operating procedure as to what the audit
 

is and perhaps say okay, are the assumptions that
 

the staff made reasonable and appropriate. You
 
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know, a list of issues that you -- every time you
 

look at a reconstruction, you ask certain questions
 

which have to do perhaps with completeness of
 

information, validity. And I think the group is
 

working toward developing this 'cause that will also
 

tell us a little about how much time will be needed
 

both by the Board members and outside consultants to
 

do a proper audit job. And part of this has to do
 

with what percent of the total reconstructions will
 

we look at.
 

DR. MELIUS: Just to follow up on that
 

point, seems to me that with a 700-page one, then
 

it's a question of calculations and different types
 

of exposures and so forth is going to be the focus
 

of any review. With a low/low, the real question's
 

not going to be how the calculations were done as
 

much as the completeness of the records and how do
 

you avoid a false negative and miss a significant
 

exposure, which may be a -- you know.
 

MR. GRIFFON: And I would just add to that
 

that I hope that with that -- while I'm impressed by
 

the amount of data that NIOSH has collected, I've
 

also got stacks of data, and I hope that we don't
 

fall into that trap where we just say there's a lot
 

of data so this will be the focus of our review and
 
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it must be just some calculations we have to look
 

at. We do want to look at consistency across those
 

other factors.
 

DR. ANDERSON: Yeah, I kibitzed this
 

morning, as well, but I -- and I looked through some
 

of the records and it's a numbing exercise to go
 

through some of the scanned documents which are
 

difficult to read. I think it was very helpful for
 

the group to look at that so you know what the dose
 

reconstructor's doing, not just on a one-afternoon
 

basis, but on a day-to-day and day out for a long
 

time. And you can kind of get a sense of well,
 

where's that system likely to break down. And I
 

think we talked about there being maybe different
 

levels of review, one which would be actually going
 

through and looking at all of the documents. What's
 

good in the system is up on the top of the report. 

They list which of the exposure information they
 

actually used out of the whole document. So one can
 

then, as a review, go through the documents, see if
 

they missed something or omitted something that
 

might be valuable.
 

I think the other issue we talked about is
 

having, despite the attempt to make it very
 

objective, there are subjective decisions and
 
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choices that are made and that would be one thing
 

that we want to keep track of, as well. So one of
 

the points we thought that would be a good -- at
 

least one level of activity would be there's some
 

detailed information in the interview and being sure
 

that in fact the issues raised by the interviewee in
 

fact is addressed or if they indicate well, I had
 

this kind of an exposure and then you look and
 

there's no data on that, well, how was that issue
 

resolved. Those I think are sort of qualitative
 

issues that I think'll be important because they're
 

going to be addressed systematically. And if
 

they're not applied in a uniform manner, we then
 

thought there may well be the same people working
 

next to each other that different assessors go
 

through their records and they could come out with a
 

different result, causing again consternation. So
 

those are the kind of issues that we thought may
 

well be a focus of some types of reviews, but not do
 

every one overly comprehensive. And so I think
 

there's work yet to be done, but I think the
 

framework, it sounded to me, was starting to flesh
 

out. We still have a little time left.
 

DR. ROESSLER: I just want to pick up on
 

Jim's comment about developing site profiles because
 
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I think that's something that I became aware of when
 

the low/low dose one was brought up. And I think
 

that's really going to work and will save time is
 

once you develop a site profile, at least in this
 

kind of a general case, then it's something that
 

they can go back on. And so I think it's important
 

for us -- and I'm sure they've realized it -- to
 

emphasize just what you said, the importance of
 

having those site profiles.
 

DR. ZIEMER: Further comments then?
 

(No responses.)
 

DR. ZIEMER: Mark, your group then is going
 

to do some refining this evening and perhaps have -­

well -­

MR. GRIFFON: Yeah. Yeah.
 

DR. ZIEMER: This is an ongoing thing. I
 

think nobody is feeling like we know everything we
 

need to know, now we can just draft up some kind of
 

a document saying what's going to be done. But at
 

least you're ready to take the next step and start
 

to flesh out a little bit and define perhaps what it
 

is we're looking for in the way of professional
 

consultants to work with the Board and so on. So we
 

have on our agenda tomorrow some time to get some
 

additional feedback then from the working group.
 
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43 

Then if it's agreeable, we'll very briefly
 

introduce the topic of Special Exposure Cohort. 

This is actually on the agenda for 8:30 in the
 

morning, but it would I think be useful if we at
 

least introduced to the group the straw man document
 

that was developed since our last meeting. I'm
 

wondering if copies of this were run. I know that
 

Cori was -­

(Pause)
 

DR. ZIEMER: What we're going to distribute
 

to you -- first of all, if you recall -- and you can
 

look in the minutes -- there was a lot of discussion
 

last time about the nature of the comments we would
 

make. And so I distilled those into the document
 

that I think is the first two pages of the handout
 

here. This is the straw man group of comments that
 

I distributed to the others in the working group. 

And then attached to that is some feedback from Tony
 

and from Wanda, I believe -- and I haven't even seen
 

Wanda's yet since I was in transit before that went
 

off. And we did not have a conference call, so this
 

is just feedback e-mailed back and forth.
 

But let me point out to you -- and we don't
 

-- I'm not proposing that we discuss it even now. I
 

think, Mark, your -- I assume your point was perhaps
 
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it would be useful to have this to look at overnight
 

before tomorrow morning's discussion. So the
 

primary comments were dealing with sections 83.1,
 

83.5, 10, 13 and 15. And then on the last two
 

pages, which are feedback from Tony, Tony's
 

suggesting I think I comment under 83.7, so that
 

would also need to be inserted and some other
 

massaging on mine and then Wanda, I haven't even
 

looked at yours, but we'll take it home tonight and
 

see how we can nail these all -­

Now the ultimate document that would go to
 

the Secretary of Health and Human Services would be
 

in the form of a letter that would point out the
 

activities of this Board since our last
 

communication. So we've had -- this would have been
 

our third meeting since we last communicated, so I
 

think the cover letter would point out how hard
 

we've been working since the last communication, and
 

then would point out that we are commenting on this
 

rule-making and then the actual detailed comments
 

would be in the attachment to the letter. That's
 

what I would propose.
 

DR. ANDERSON: I just wanted to -- since I'm
 

not going to be here tomorrow, unfortunately, I
 

think it's good to have these out, but I know a
 
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number of us have gotten calls subsequent to the
 

public meetings by individuals raising issues. And
 

I guess what would seem to me to be very helpful is
 

if those that got those or have some new thoughts
 

get them down in writing and maybe get them
 

exchanged today so people can think about it so that
 

we're not -- those of you here tomorrow are not kind
 

of thinking off the cuff on the comments it would be
 

helpful 'cause I think there's a number of people
 

that I've heard from that had some suggestions that
 

we need to get into this. And the sooner we get
 

some language so we're not crafting tomorrow, unless
 

there's going to be some possibility that NIOSH
 

would extend the comment period that would give us
 

more time. I know I just got some of the minutes
 

from the meetings and not all of them are on the
 

internet yet, so other than the people who called, I
 

don't really know what was actually said there. So
 

it could be a one-sided conversation. So I don't
 

know if -- is there a thought on the basis of the
 

turnouts, and I think some groups wanted to have a
 

meeting in their area and things like that, is what
 

I've heard, and it would be too late if you're
 

thinking of going to one of the other sites if -- is
 

there any possibility of getting an extension on the
 
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comment period, to keep it open a little longer?
 

MR. ELLIOTT: Well, at this time the comment
 

period closes August the 26th and that's -- as of
 

today, that's still the Secretary's desire, to see
 

this put in place as soon as possible. So -- but
 

that's certainly -- we've not had in our input in
 

the Town Hall meetings requests for extension of the
 

public comment period.
 

DR. ANDERSON: Okay.
 

MR. ELLIOTT: So -- and the last two
 

transcripts will be on the web site very soon.
 

DR. ANDERSON: Okay.
 

MR. ELLIOTT: We just couldn't get them
 

turned around, since we were there last Thursday.
 

DR. ANDERSON: I know.
 

MR. ELLIOTT: But tomorrow you -- you'll
 

miss it tomorrow if you're not here, Dr. Anderson. 

Ted Katz will give a short summary of what we
 

benefitted from in our experience.
 

DR. ZIEMER: And keep in mind, we don't
 

necessarily have to be able to incorporate those
 

things into our comments because they are comments
 

that they will have to respond to anyway. So -­

unless there's something that are so pertinent that
 

we think we need to include it or add to it.
 
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MR. ELLIOTT: Absolutely. Transcripts are
 

going to be added to the regulatory docket and each
 

of the Town Hall meetings -- everyone was encouraged
 

multiple times to provide their written comments to
 

the docket before the expiration of the public
 

comment period, so we hope to see them there.
 

DR. ZIEMER: Rich?
 

MR. ESPINOSA: Yes. Has there been input in
 

from other sites that didn't get a Town Hall
 

meeting, like Oak Ridge or anything like that
 

requesting for a Town Hall meeting?
 

MR. ELLIOTT: Yes. I have taken a couple of
 

phone calls and one of those phone calls was from
 

Oak Ridge requesting a Town Hall meeting. There was
 

just no way that we could work it into the tight
 

schedule that we had, and I'm sure that those sites
 

are -- and in fact, Denver was the other call that I
 

took and I explained that we had just been there
 

with the full Advisory Board and talked about this
 

and they had missed an opportunity. But I think it
 

also speaks to the Board's interests to go around
 

and hold these meetings at different sites and the
 

benefit to doing that.
 

MR. GRIFFON: I just -- I'm just scanning
 

the e-mails back and forth so maybe I'm not seeing
 
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everything, but -- and looking at this for the first
 

time, but I recall in the last meeting in our
 

discussions that we had sort of turned over some
 

issues that we wanted the working group to discuss. 

And I wonder if -- maybe it's not reflected in the
 

e-mail or it didn't make it to the comments or
 

whatever, but did you all have a chance -- I know
 

you didn't have a conference call or anything, but
 

did you have a chance to discuss -- some that come
 

to the top of my mind are some of those definitional
 

issue that I was focused on like sufficient accuracy
 

or how the endangered health was defined. Did the
 

working group discuss those or -­

DR. ZIEMER: No, and we -- we may not have
 

had -- "we", me, I guess, may not have had complete
 

enough notes so that if there are some of those that
 

simply fell through the cracks, I'd be very pleased
 

to have those. Maybe you can remind me. I'll get
 

my notes back out, but maybe you can remind me of
 

those sometime before evening and try to incorporate
 

that.
 

I knew when I sent this out I hadn't really
 

-- I know I hadn't captured all of Tony's ideas,
 

either, and probably missed some other folks's
 

ideas, so -­
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MR. GRIFFON: I mean I think there's even
 

some ones that just -- just glancing at the New York
 

minutes, I mean I think there's some that are sort
 

of potential gaps in the current regulation that
 

really need to be addressed. The particular one I'm
 

thinking of is that someone, if they're put in a
 

class and they are not eligible for non-SEC cancers
 

and they cannot apply, and it -- you know, I guess
 

my question along those lines would be if they had
 

exposure, say -- say a certain class is defined for
 

a certain building over a ten-year span and they
 

have reconstructible dose before and after, you
 

know, in that kind of situation it seems to me that
 

they would still be eligible to go forward and
 

submit for a non-SEC cancer. And I was trying to
 

understand the interpretation, but I didn't see it
 

that way and -- in the New York meeting.
 

MR. ELLIOTT: I may be confused by your
 

comment, Mark, but they wouldn't be excluded. They
 

would be certainly eligible to file and proceed
 

through dose reconstruction. I think the issue
 

would be if at the end of the completed dose
 

reconstruction the PC came out to -- in that upper
 

mid-range right below compensability, what do you do
 

then? How do you react to the particular situation
 
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in that case? You see where I'm -­

MR. GRIFFON: Uh-huh.
 

MR. ELLIOTT: -- leading this to? So maybe
 

what we need is to have some clarification in
 

language to assure that if you have monitoring or
 

records that would support dose reconstruction for
 

other periods of your employment and your work
 

history, that doesn't exclude you from filing a
 

claim and going through dose reconstruction.
 

MR. GRIFFON: And then I guess -­

MR. ELLIOTT: Nor should it exclude you as a
 

member of that class -­

MR. GRIFFON: Right. Right, and then the
 

question on either side of that is in making a
 

decision on defining the class, you know, this
 

hypothetical scenario comes to mind where you're
 

defining -- you're defining this potential class. 

It's not a certified class yet, and you come up with
 

your worst case dose estimates and you come up to 48
 

percent and therefore it's not an authorized class,
 

a certified class.
 

MR. ELLIOTT: That's a different -- yeah,
 

that's a different issue.
 

MR. GRIFFON: However, they've worked ten
 

years before that and had exposures, some of them -­
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maybe not all of them, you know -- they've worked
 

ten years after and then -­

MR. ELLIOTT: So what do you do with that -­

MR. GRIFFON: -- reverse -- reverse that and
 

say they've got exposure on either side, for ten
 

years in the middle they're in this class. They
 

don't have that type of cancer.
 

MR. ELLIOTT: Right.
 

MR. GRIFFON: If we only use the dose from
 

either side, they don't trigger the threshold, but
 

we can't assign the dose from the class 'cause
 

that's not an individual dose.
 

MR. ELLIOTT: Both points -­

MR. GRIFFON: So that's the -­

MR. ELLIOTT: Both points made lead us to
 

the same dilemma, and I think that dilemma would be
 

evaluated and the research and recommendation on how
 

to handle that would be accomplished within what we
 

would do in evaluating the petition. That's the
 

research that we would examine, part of the research
 

effort that would go into evaluating the petition.
 

MR. GRIFFON: Okay, well -­

DR. ZIEMER: Mark, I'm looking at my notes
 

here and then get to Jim. Let's see, one of the -­

last time when we had some general questions raised,
 
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one of them -- there was questions on definitions,
 

one of which I jotted down as ill effects. I guess
 

that's what you were referring to then, what the
 

definition of -­

MR. GRIFFON: And I have some of these
 

thoughts written out which I can provide to the
 

working -- but just the question of endangered
 

health, whether -- you know, just this whole notion
 

of trying to -- I mean we discussed this at the last
 

meeting, the question -- you can't do an individual
 

dose reconstruction, but somehow we're saying we
 

have enough information to do a worst case estimate
 

and then plug it into IREP and make an -- you know,
 

make a sort of quantitative judgment on endangerment
 

of health. And I just wonder if that's -- you know,
 

I just wondered if the group had discussed that and
 

whether there are other options that might be more
 

appropriate.
 

DR. ZIEMER: Okay. And I'm not sure how
 

we'll address that here, but if you have some ideas
 

on wording, that would be helpful. Jim.
 

DR. MELIUS: Yeah, thanks. One is to follow
 

up on that point. I do think it comes back to this
 

issue of the criteria for when you can't do a dose
 

reconstruction with sufficient accuracy, and we
 
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talked about that last time. Some of the points I
 

think Tony had made last time, also, and we've got
 

to act. We've got this endangerment issue and now
 

we've got sort of a third situation where this -­

we've run into this, if we have someone with a
 

cancer that doesn't qualify for SEC, has some
 

history outside of the Special Exposure Cohort
 

period, how do we deal with their dose. Is there a
 

situation where we would take -- somehow take some
 

of the information on their exposures during the SEC
 

period and apply it to their individual other
 

information. I mean it just -- I'm just
 

uncomfortable just doing it always on a case-by-case
 

basis 'cause I think we're going to end up with
 

arbitrary and basically unfair decisions.
 

I've written up some comments which I think
 

are being copied and will be circulated and I think
 

we can talk about them tomorrow. I also believe
 

that in the minutes for this meeting I captured
 

particularly some of Tony's comments that -- from
 

the last meeting that we can probably incorporate
 

some of that language, also.
 

MR. GRIFFON: And just to pick up on Henry's
 

point, you know, the transcripts did -- and I'd be
 

very interested in the Hanford and Los Alamos
 
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meeting 'cause you said that was -- both were very
 

telling, very instructive, and I think one place
 

this was picked up on was NIOSH staff response to
 

these questions, so I think that would help the
 

Board in wrestling with some of these issues.
 

DR. ZIEMER: Any other comments right now on
 

Special Exposure Cohort?
 

(No responses.)
 

DR. ZIEMER: Let me ask the members of that
 

group if they're available for a while this evening
 

to look at the input. Tony? Gen, you're involved.
 

DR. ROESSLER: Wanda is.
 

DR. ZIEMER: Wanda was. Sally, were you?
 

MS. GADOLA: The working group?
 

DR. ZIEMER: The working group.
 

MS. GADOLA: You're talking the working
 

group on the -­

DR. ZIEMER: The SEC working group -- Tony,
 

Wanda -- who else was involved? Sally. Robert,
 

were you in there?
 

MR. PRESLEY: No.
 

MS. MUNN: As long as I'm well-fed.
 

DR. ZIEMER: As long as you're well-fed. 

Perhaps we'll go ahead and take our break right now
 

so that the speakers will have their -­
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MR. GRIFFON: Paul -­

DR. ZIEMER: A question first?
 

MR. GRIFFON: Paul, can I ask -- is -- if
 

you -- I'm sorry.
 

DR. ZIEMER: Oh, I'm sorry, Mark.
 

MR. GRIFFON: If you can maybe let us know
 

when the working group might be meeting or where you
 

might be meeting 'cause if I have some written up
 

stuff I can drop it with you.
 

DR. ZIEMER: Sure.
 

MR. GRIFFON: Okay.
 

DR. ZIEMER: Okay, let's take a 15-minute
 

break and then we'll reconvene.
 

(Whereupon, a recess was taken.)
 

DR. ZIEMER: We're going back to order. 

We're going to switch the agenda slightly, simply
 

because we have some problems loading one of the
 

slide sets onto the projector, so we're going to
 

start the paper by Michael Schaeffer and then we'll
 

back up and pick up the presentation by Jerry
 

Steele.
 

Mike Schaeffer is a senior health physicist. 

He's had -- at the Department of the Navy -- well,
 

Department of Defense. He's had 22 years of
 

experience at the Department of Navy in designing
 
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56 

and deploying and maintaining dosimetry and
 

radiological instrument systems and programs. For
 

the last 11 years he's been at the Defense Threat
 

Reduction Agency. That was formerly the Defense
 

Nuclear -- well, Defense Nuclear Agency and Defense
 

Special Weapons Agency, I guess.
 

He's been involved in reviewing a lot of the
 

nuclear test personnel information in the registry
 

for atmospheric nuclear test veterans, also manager
 

of DoD reclamation and experiments command center. 

Is that the right title?
 

MR. SCHAEFFER: Radiation.
 

DR. ZIEMER: Yeah, I'm trying to read
 

somebody's handwritten notes and they're -- it's not
 

my writing. Is it radiation experiments command
 

center?
 

MR. SCHAEFFER: That's correct.
 

DR. ZIEMER: I guess I could read that as
 

radiation. It's -- but Michael is going to talk to
 

us about the dose reconstruction work that relates
 

to the atomic veterans program. We're all
 

interested in sort of how they're doing that insofar
 

as it might give us some ideas in terms of how we
 

review some of the records that we'll be facing
 

ourselves. So Michael, we're pleased to have you
 
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here and please, if you would, take the podium.
 

MR. SCHAEFFER: I appreciate the opportunity
 

to come here today and discuss the dose
 

reconstruction program of the atomic veterans. 

Atomic veterans is a term that applies to those
 

folks that were exposed during atmospheric nuclear
 

testing, mainly from the period of 1945 to 1962.
 

What I'd like to do for the short period
 

today is explore a unique opportunity to understand
 

dose reconstruction within the context of our
 

nuclear test personnel review program. Before dose
 

reconstruction, we need to of course set the stage
 

for some other things.
 

For whom was this program started and what
 

are the influencing factors of the program that have
 

affected the conduct of business over the last
 

number of years? And of course how does the program
 

operate? And I think that's of great interest to
 

this panel because there's a lot of comparison and a
 

lot of contrast between what you're engaged in
 

starting to do and what we've been doing for over 20
 

years. And of course, how does dose reconstruction
 

fit and what are the significant issues of dose
 

reconstruction that have risen over the particular
 

years? I think those items you're going to find
 
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quite fascinating in that you're probably going to
 

have to grapple, as a advisory committee and also
 

the other factors, the other agencies in the program
 

are going to have to grapple with some of these
 

very, very similar issues somewhere along the lines. 

And of course then there'll be a brief summary at
 

the end.
 

Program serves almost exclusively veterans,
 

maybe less than 1,000 civilians. The gender of the
 

population is almost exclusively make, perhaps a few
 

hundred females in this particular population. The
 

U.S. atmospheric testing from '45 to '62 encompasses
 

20 test series and in total approximately 235
 

individual nuclear tests. The particular
 

operational period for these tests extend through
 

somewhere between as short as three months over nine
 

months, and then of course it covers a period of
 

participation six months thereafter, because there
 

are activities engaged with the testing.
 

We also -- later on the population of postwar occupation troops at Hiroshima and Nagasaki were
 

covered. Basically these are people who were within
 

a ten-mile radius of Hiroshima and Nagasaki, and
 

also were there a six-month post period from the
 

actual occupation period. Also covers certain POW's
 
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that were around during the time when the
 

detonations occurred.
 

We also use the Department of Veterans
 

Affairs definitions to decide who the test
 

participants are and who they aren't, and Jerry
 

Steele and Neil Otchin will talk more about those
 

particular definitions in their presentation.
 

There's 13 public laws in all that govern
 

the program. The one important one is Public Law
 

98-542, enacted in October, 1984, important from two
 

aspects. As you'll see when Jerry Steele gives his
 

presentation, there are a number of things that came
 

about during that period of time establishing
 

specific compensation programs for veterans exposed
 

to radiation, not only nuclear tests, but other
 

radiation risk activities within the DoD. Also the
 

very important thing that it did for our program is
 

it established a requirement for our coming up with
 

standards for dose reconstructions for atomic
 

veterans. It will become clear to you in a short
 

while as to why dose reconstructions are important
 

for this group of veterans.
 

Other programs that are covered, Department
 

of Justice over on the right-hand side, that
 

reflects the Radiation Exposure Compensation Act,
 
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which I believe you are familiar with. And also
 

another mention of the dose reconstruction
 

standards. We went through extensive Federal
 

Register comments, much like you did with 42 CFR
 

part 82. We also, in addition to that, we vetted
 

those reviews with the National Academy of Sciences
 

before we actually published the final document for
 

dose reconstruction standards.
 

The program as we know it today started in
 

1978. Vice Admiral Monroe, who was the Director of
 

Defense Nuclear Agency at the time. There was a lot
 

of Congressional interest in radiation exposures to
 

people in general, namely the military and people in
 

DoD. It was right during the era that was just on
 

the heels of Three Mile Island, so there was a lot
 

of public focus on radiation issues. And basically
 

Vice Admiral Monroe promised Congress that he would
 

start a program that would establish a registry for
 

atomic veterans and try to establish the maximal
 

dose as to which this cohort of people was exposed
 

to. And basically our program has the Veterans
 

Outreach Program as a result of that where we have
 

people who could call in to us through an 800 hot
 

line number. The basic information we provide is -­

can be summarized in two questions. Was I there? 
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61 

And what was my radiation -- what radiation dose did
 

I receive by being there?
 

Of course as we've gone along the program we
 

have supported Congressionally-mandated scientific
 

studies conducted by the National Academy of
 

Sciences. Two that have been most important in the
 

program have been the study of crossroads
 

participants. That was the Navy participants,
 

Operation Crossroads, in 1946, a cohort of about
 

40,000 Navy participants. Also we did later on two
 

studies, a basic and a follow-on study of what we
 

call the Five Series Participants. Those were
 

participants that were at [Greenhouse Castle,
 

Upshot, Knothole, Plumb-bob and Redwing]*, so those
 

are the five series. That's why it has the name
 

Five Series.
 

Right now we don't have any work under way
 

with the National Academies looking at mortality
 

studies of atomic veterans.
 

There's four ways veterans can make contact
 

with the NTPR program. One is by filing a VA claim,
 

another by filing a claim with the Department of
 

Justice. They can also reach us through their
 

Congressman, and most of them of course reach us
 

individually since early on in the program we
 
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62 

publicized widely in many newspapers, veterans'
 

magazines, what-have-you, the 800 hot line number,
 

so they know where to get ahold of us. And I'd have
 

to say the traffic today, about 60 percent of the
 

traffic comes by way of veterans affairs claims. 

The bulk of the rest of the business is from
 

individuals who call in to the program or write in
 

to the program. We also receive Congressionals on
 

the order of two Congressional inquiries a month at
 

this particular point in time. Traffic into the
 

program is about 100 -- or 80 to 120 transactions
 

per month, to give you an idea of the traffic we
 

have.
 

As far as transitting through the process,
 

it takes anywhere from 90 to 120 days for a request
 

to transit the process. The metric that we use
 

that we know that we get the best customer
 

satisfaction is if we can turn around answers -- 75
 

percent of the transactions in 90 days, we generally
 

have a good customer satisfaction rate, and we're
 

running above that at this particular point in time.
 

The difficult cases take longer. I heard
 

some of you talk about difficult cases where you can
 

get stacks and stacks of information. We have
 

those. Some of those can take longer than the 90
 
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days, some of them can go up to six months,
 

depending upon the complexity. Most of that
 

complexity is driven by the fact that we can't put
 

the person there behind some kind of record, and we
 

just keep digging and digging and digging for the
 

eventual record. If we can't find it in their
 

personnel record, we know what military unit they
 

went to. The fortunate part about our cohort is we
 

can track people by military records, which are
 

very, very robust. You have the name of a military
 

unit a person says they were in. If we can't track
 

that personal record, we can get the report from the
 

military unit and track them through alternate
 

means. So we go through a rather exhaustive means
 

of trying to put the person at the -- connect the
 

person with the particular event.
 

The research that we do is answering the
 

basic question of who, what, when, where and why in
 

terms of trying to put together the information to
 

back up before we do the dose reconstruction.
 

That goes next to the dose reconstruction
 

process, and I'll point out to you that the archival
 

search and the dosary* search is actually done by
 

two separate contractors. We do have them united by
 

a teaming arrangement, but basically there's some
 
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objectivity and distance in bridging the process
 

between archival search and dosary search.
 

That all culminates together in a package of
 

the outgoing letter, which comes to me. I'm the
 

final review authority that checks off to see if
 

there's an adequate research done, adequate time
 

spent in drawing the conclusions. Did we draw on
 

all the references that we have in the program for
 

doing the dose reconstruction. Once that's done and
 

I sign off the package, then it's mailed to the
 

veteran or mailed to the Congressman or mailed to
 

the VA.
 

Then of course we database all the
 

information we gathered during the process. And
 

it's very, very important later on because when we
 

see a veteran that performed common activities to
 

the veteran we just processed, it's good to have
 

that history of the research that we're not reinventing the wheel again, and also from the
 

standpoint that the next veteran may give us
 

something that adds to the experience of the first.
 

This gives you an idea of the traffic coming
 

in to the program over the last ten years. 

Basically the demands on the program are driven by
 

events outside the program -- new laws, new
 
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Executive Department initiatives. There are also
 

some unpredictable trends, just what our veterans
 

feel about the program. For instance, in 1994 we
 

had the emergence of the President's Openness
 

Initiative on Human Radiation Experiments. And even
 

though atomic veterans didn't, by definition, fall
 

into the program, you can see it caused a lot of
 

awareness and a lot of writing in to our particular
 

program, even through the Radiation Experiments
 

program, so you see traffic was very high in that
 

one year. And you can see the peripheral years
 

around it, as well.
 

We go down further to 1998, that was driven
 

by our publishing the availability of a very limited
 

bioassay program, and this caused a lot of veterans
 

to write in to the program to queue in the line to
 

make themselves available for urine bioassay.
 

And now we go to 2002 and you can see that
 

that's almost twice the number that we received
 

during calendar year 2001. The driver for that is
 

the Department of Veterans Affairs Secretary
 

established a program and a tiger* team in
 

Cleveland, Ohio to process some of the older
 

veterans' claims more efficiently and kind of took
 

the one bite out of the elephant of looking at that
 
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factor of claims of veterans older, dying for some
 

reason whose claim has been laying in the queue for
 

a long period of time. So the folks of that team -­

we've gotten much more traffic from the tiger team.
 

Basically historical information document
 

collection is very crucial before you can do a dose
 

reconstruction. And basically when a veteran writes
 

in to us, we want to focus on what are the questions
 

that the veteran has, what are the issues the
 

veteran wants treated. Basically when we go back
 

and answer the veteran, we try to keep the
 

information brief, to the point, answer the
 

questions, only augment to understand. We find that
 

over the years if you get into a long and involved
 

discussion of the underlying science, you basically
 

confuse them and perhaps lose their confidence in
 

what you're trying to do in concentrating on the
 

basic questions.
 

The main records sources we use are the
 

Personnel Records Center in St. Louis and also the
 

Coordination and Information Center in Las Vegas,
 

Nevada, and that's the biggest collection -­

hundreds of thousands of pages of documents
 

chronicling what happened during the nuclear test
 

era, all stored in a repository in Las Vegas which
 
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DOE and Department of Defense jointly funds. 

Basically this culminates in all the document
 

research that was done early on in the program, for
 

the first ten years of the program, since 1978.
 

Now again, as I was saying before, we look
 

for special orders for people if we can't find
 

information, personal records. Again, we collect it
 

anyway. We want to collect as much as we can on the
 

person. We also conduct extensive interviews with
 

the person if the person's still alive, and in the
 

case of the person being deceased, we will talk to
 

the family member who wants to correspond with us. 

Of course that information is a bit sketchy, but
 

it's part of the information-gathering process. And
 

this all culminates again in establishing
 

participation, and once we know what the person did
 

-- basic who, where, when and why questions -- we
 

construct a dose if needed. In some cases, as Jerry
 

Steele will explain, there's presumptive
 

compensation, very closely akin to your special
 

cohort group, that can receive compensation
 

presumptively without needing a dose reconstruction.
 

So we pull all this together for the
 

veterans. We provide the fact sheet for the
 

program, any of the personnel records and other
 
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source records that actually zero in on the person's
 

participation. We make this available to the
 

veteran and to the VA if the VA wants it.
 

This kind of gives you an idea of the
 

technical data that we also collect during the
 

exhaustive search. I believe our job is a bit
 

easier than the job that you have before you in that
 

we're just worried about nuclear test participation. 

We're not looking at multiple sites. We're only
 

looking at tests done in the Pacific, tests done at
 

Nevada test site, so basically our job is easier. 

We only have two sites versus -- with a large
 

population versus the job that you've undertaken
 

with your smaller groups of people having done many
 

tasks at many sites.
 

But some of the basic information we want to
 

collect in establishing participation is where was
 

the person? You know, what did the person exactly
 

do when they were on the test site? Where did they
 

go when they went from point A to point B? What
 

were the -- what was the weather? Was it raining? 

Was it blistering hot? Did it rain later on? Were
 

there winds -- wind directions and so forth, so all
 

this information is very key, as you'll find out
 

later on when we get to the dose reconstruction
 
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process.
 

Also lots of information on fallout
 

intensity and duration, lots of survey information
 

that exists in historical records. One of the most
 

important pieces of information we have is shotspecific radiochemical data. We had cloud samplers
 

who went up and actually took samples of the
 

radioisotopes that were in the debris of the nuclear
 

tests that provide some very, very key health
 

physics information in determining the abundance of
 

the up to a few hundred isotopes that can be in the
 

debris, you know, both fission elements as well as
 

transuranics.
 

And again personal exposure data, there's an
 

abundance of film badge data -- not in the early
 

days of the program, but later on as time goes on,
 

we'll talk about that issue. And of course lots of
 

after-action reports that were written that
 

chronicled the various different things that
 

happened at the test site.
 

This block diagram summarizes everything
 

that's in our Federal Register description of the
 

procedures and methodology for dose reconstruction. 

We actually start with trying to gather film badge
 

data. And if we find the film badge data are not
 
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complete, we look at other people in the same
 

cohort. These are people doing the same common jobs
 

as the person under question, and we look at the
 

film badges and radiological data for the other
 

people. And again, we ask ourselves the question,
 

especially in the early days of the program, do the
 

film badge doses account for all of the potential
 

for radiation exposures. In a lot of cases we find
 

that it does. So again we have to go and gather the
 

radiological data for the environment in which these
 

people worked and relate it to the particular duties
 

that they did.
 

One of the particular features in putting
 

dose reconstruction together is how to validate
 

those dose reconstruction. Early days, what we did
 

is wherever we had robust film badge data on
 

personnel, we went ahead and reconstructed the doses
 

anyway, just from a priori radiological data, and
 

compared those two results and that allowed us some
 

means of calibrating film badges -- actual film
 

badge dosimetry that was known to be good in the
 

later periods of the program with actual
 

reconstructions from other radiological data. And
 

this gave us the means of calibrating the dose, and
 

of course in all this data that you're collecting
 
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during the time, there's scientific uncertainties
 

that were reported with these results, even by
 

contemporaneously, including the instruments used
 

and so forth and the military fare very good. We
 

can go back and actually dig up older technical
 

manuals and calibration procedures to know how
 

accurate instruments were or how inaccurate they
 

were back at that particular period of time. So
 

this is what allows us to actually put together the
 

external dose for people engaged in the testing when
 

film badge data is either robust or in some cases
 

completely lacking.
 

This is a very, very important slide in that
 

it tells you the one radiation environment that we
 

are concerned with for all of our nuclear test
 

participants. On the right-hand (sic) side is
 

immediate -- is at the time of detonation. If you
 

were at a test at the time of detonation, you can be
 

exposed to prompt gamma and neutrons. The time to
 

the right side of the chart is delayed. This is
 

some time after the detonation goes up or weeks,
 

months, hours -- actually hours, weeks and months
 

later. And these are people who, at least on the
 

other side, are exposed to activation products. 

This is where if you were close enough in, the
 
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neutrons could actually activate the soil. We also
 

have descending fallout. If the test of course were
 

close to the ground, ground shots brought up a lot
 

of dust and debris in the fallout cloud.
 

We also have tests that were done in close
 

proximity to one another and also close proximity in
 

time, so you could have troops exposed to fallout
 

that's on the ground from a previous test. And also
 

you can have fallout that is deposited on the ground
 

from all of these sources of course that get lofted
 

into the air and resuspended, so there's another
 

opportunity for exposure.
 

To give you an idea in the immediate range,
 

that's -- you're talking about being 5,000 feet or
 

closer at the time of detonation. And I can say, at
 

least from our population, is no one was closer than
 

2,000 feet. We have about 1,000 out of the few
 

hundred thousand that were between 2,000 and 10,000
 

feet. About one-quarter of the population, 50,000,
 

were up to six miles away, and then the rest of the
 

population were further away and exposed basically
 

to delayed sources of radiation.
 

We have two types of dose reconstructions in
 

the program, the generic dose reconstructions. 

These were done early in the program when we defined
 
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cohorts of people engaged in common military
 

activities. We performed dose reconstructions based
 

on a unit engaged in common activities, what was the
 

worst case dose that these people could have
 

received if they were engaged full-time in the
 

activity from start to finish of an operation. And
 

again, it provides a maximal upper-bound dose for
 

any military unit that was engaged in a particular
 

operation. And this was the goal of the program in
 

the early days as envisioned by Vice Admiral Monroe
 

was let's determine the worst case doses people were
 

exposed to, and I think that was a worthwhile goal
 

during that period. This is before any movement
 

came along to say that we were going to be engaged
 

in compensation programs. And as you can see, later
 

on that provides a little bit of a tension that's
 

been created in the program over the years.
 

As time went on, with the emergency of
 

Public Law 98-542, we shifted from group
 

reconstructions into individualized dose
 

reconstructions. These are uniquely constructed
 

based on the actual activities of the people. We
 

perform them only upon receipt of the inquiry on a
 

person. It's based on the actual activities and the
 

anecdotal information they give us in terms of
 
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trying to resolve the inconsistencies. You talked a
 

little bit about that in your process, and I can't
 

add any more to it except that we struggled in the
 

same way that you do in terms of trying to reconcile
 

the information. It's very difficult for these
 

folks 50 years hence to remember all of the details
 

they were involved in.
 

What we generally do, if they say they were
 

-- we say they were engaged in activity A and we
 

know they went to activity B and they say well,
 

along the way I did this, if it consistent with the
 

movement where they went in moving from one point to
 

another, we're going to give them the benefit of the
 

doubt and include that activity. Furthermore, if we
 

have any kind of military history that says well,
 

they did another event along the way that they
 

didn't remember, we're going to credit them with
 

this information, as well. And they may come back
 

to us and say well, I don't remember ever having
 

done that, I don't know why you're putting this in
 

the dose reconstruction. I guess comically
 

sometimes they fight about this, say why are you
 

adding this to me? Actually, we say, we're trying
 

to give you some more dose that is consistent with
 

the military records, so that happens in the
 
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process.
 

And sometimes we have to use the first type
 

of group dose reconstructions to fill in those
 

activities. If we don't have the specific details,
 

we'll give them the maximal dose for something that
 

they plausibly could have been involved in and they
 

didn't remember.
 

Building the participation scenario, very,
 

very important to dose reconstruction because it
 

establishes time and place in a radiological
 

environment. And very much like your process, we
 

construct the tentative scenario based on
 

information we have from the military records. And
 

again, there's some incompleteness there and what we
 

do is do a careful triage between the two
 

contractors in terms of what do we know from the
 

records versus what we don't know from the records. 

What are other plausible activities that could have
 

resulted in exposure to sources of radiation. 

Again, we work in the experience of the veteran, if
 

the veteran is alive. If the veteran is not alive,
 

this is where it really gets sketchy. And I haven't
 

heard that during some of the discussions of your
 

Board meetings here is what do you do for folks that
 

are not living? I'm presuming that they can still
 
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file a claim and you'll still have to do a dose
 

reconstruction, but how do you work around the fact
 

that you may not have a prime source of anecdotal
 

evidence?
 

Again, after this is all done, we construct
 

the final activity scenario. We identify the
 

sources on certainty from the historical records and
 

we provide this to the dose reconstruction team as a
 

result of the triage of activity and the compilation
 

of the records.
 

These are some crucial technical data that
 

we must gather for each -- device output spectrum is
 

very, very important. It tells you the
 

radioisotopes in the cloud and it tells you the
 

relative abundance of them. Very, very important
 

for constructing internal doses, and we'll have some
 

-- we'll talk more about that.
 

Also if we have the folks who were exposed
 

to prompt neutrons. Again, during the time, we
 

didn't have neutron dosimetry to measure this
 

important component of radiation exposure, and if
 

they were close enough, they're certainly there. 

And we use our conventional transport codes to come
 

up with neutron doses.
 

We have to normalize field measurement data
 
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because it's taken at different points in time. If
 

you read a lot of our text, you have terms like H
 

plus 1, D plus 1. That's hour plus one. Day plus
 

one, that's talking about time elapsed since the
 

actual shot. We want to normalize to something like
 

the first hour after the shot. We want to bring all
 

the data back to that normalized position.
 

Next we look at free-air exposures occupied
 

at shot time, the troops that were -- the few troops
 

that received neutron exposures that were in
 

trenches. So then of course we use time, distance
 

and shielding in terms of what would have been the
 

neutron dose if they were partially shielded, chesthigh out of the trench, so that's also added in
 

there.
 

Then again all of the associated
 

uncertainties with the scientific techniques we use
 

of course are overlaid onto the process.
 

So that's the initial environment. Now we
 

shift to the residual radiation environment, and
 

again there's a wealth of radiological data that's
 

been collected at the time. There've been contours
 

drawn and basically it's take all this data and
 

normalize it to one particular time component so we
 

have a standard frame of reference. And again,
 
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we're trying to overlay the participant walking
 

through these contours of radiation -- varying
 

radiation levels to integrate the external gamma
 

dose. And at this particular time we look at
 

environmental data to say what were the potentials
 

for internal exposure, either through ingestion,
 

inhalation or absorption through the skin, although
 

that becomes a very small component.
 

So again this particular point, once we
 

understand the external exposure for the residual
 

environment -- residual dose environment, then we
 

start to think about how we're going to do an
 

internal dose.
 

Now for each shot, in order to conduct this
 

calculation, we have to look at the decay rate, and
 

that's been empirically determined for many of our
 

particular tests. If you look at the -- again, the
 

radiochemical mix, there's been plots of how the
 

radiation measurements decay over time. Most of
 

them decay by T to the minus 1.2. In some
 

environments it's minus 1.3 and then some -- if the
 

-- you've got weathering involved, it could be minus
 

1.4, but all of these are well-established from
 

empirical measurements. So we have to apply that
 

factor to a particular situation.
 
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Again we have to normalize it back to a time
 

base, an hour after the shot, then we draw maps of
 

whatever the isopleths of radiation that were at
 

hour plus one. And then of course we identify the
 

uncertainties associated with applying these
 

factors.
 

Of course what we have is you had some
 

troops involved in a couple of days of the
 

operation. You have multiple surveys done in space
 

and time. You have troops marching in where the
 

radiation is not only varying by contour, but it's
 

varying by decay. We do linear regression on the
 

[level wealth of this data]* to decide what's
 

happening in terms of walking out from ground zero,
 

what type of radiation levels you could expect. 

Then we characterize that field in surface and time,
 

just what's going to happen with it, and we overlay
 

on that the actual marching of the troops, going
 

through some defined maneuver that you can find in
 

the military records across this varying radiation
 

field in space and time. And again, using computer
 

models and so forth, we can come up with an
 

integrated dose for a troop activity, marching
 

through a couple of days of varying radiation
 

fields.
 
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This is a very, very key chart for dose
 

reconstruction of internal doses. The block in the
 

middle, activity concentration, is the main quantity
 

that one must have in order to honestly do a
 

internal dose reconstruction. And if it weren't for
 

the radiochemistry and film badge data, it would
 

probably not be possible to do an internal dose
 

reconstruction. And what we do there in mating
 

those two pieces of data together to make this
 

possible is if you know the relative abundance of
 

the isotopes in the cloud, you know the gamma
 

emitters from all of those isotopes, you have a film
 

badge on a person who is being exposed to the gamma
 

component of these isotopes in space and time, you
 

can go back and actually calibrate what the
 

radiochemistry should give as far as some kind of
 

absolute output.
 

Once we do that particular calculation, then
 

we go back and we can derive an actual activity
 

concentration corresponding to that particular time,
 

like going back again to the relative abundance of
 

all the other elements of the alpha, the beta, the
 

gamma and all the radioactive constituents and
 

construct an activity concentration. After we've
 

done that, then we enter it into all of the internal
 
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dose models that we're accustomed to using. In our
 

particular program we originally started with ICRP30 and we still, for the most part, use ICRP-30, and
 

I'll explain why we're not using more modern models
 

today. I'll just give you a reference point. We
 

use organ dose factors that -- also from ICRP-30 to
 

move from the activity to the dose for the
 

particular model, and also we check this through
 

consistency with other radiological measurements to
 

make sure again that we have some reference
 

calibration to film badge data. And this is, in
 

short, how we do the internal dose estimate.
 

Again, before I showed you the radiochemical
 

analysis, very crucial to this. Also the
 

conditions, what kind of winds did you have ongoing? 

What kind of surface level measurements did you
 

have? What kind of resuspension did you have at the
 

particular time? This is where we get into the
 

realm of making some assumptions.
 

As you know, resuspension is a factor that
 

is very, very hard to tie down, even from all of the
 

literature data. The best you can tie resuspension
 

down is perhaps by order of magnitude by a factor of
 

ten. Most of the resuspension factors we use are
 

ten to the minus six, ten to the minus five, ten to
 
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the minus four. We do have some special situations
 

where it could be minus three or minus two. But for
 

the most part, if we're going to err on the side of
 

the veteran here, if we have a choice of picking say
 

ten to the minus five or ten to the minus four,
 

we're going to pick ten to the minus four, just for
 

making sure that we're not underestimating the
 

radiological condition.
 

Again, we have external doses to calibrate
 

everything back to. I think that's a very, very
 

crucial point here. If you have a situation where
 

you have good dosimetry at some point in your
 

program, that allows you to do that.
 

Urine bioassays, early on in the program
 

there were small cohorts of people had urine
 

bioassays. We haven't found them to be of too great
 

a help because they are gross measurements. They're
 

also -- did not have the accuracy in those days. We
 

find a very difficult time correlating bioassay
 

measurements back to doses. I guess the factor that
 

works best for us here is the bioassay data usually
 

complements the film badge data, so really they were
 

not of any necessity -- it doesn't help us very much
 

in doing a dose reconstruction. I think they were
 

taken at the time to provide, at the time, high
 
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exposure cohorts to see what kind of internal
 

exposures they might have had.
 

But we've also done some modern-day
 

bioassays, plutonium bioassays, and I can say from
 

the limited experience we had in doing a pilot study
 

is it's really not given us any kind of data that we
 

can rely on for a dose reconstruction. In fact,
 

most of the uncertainties in the process are such
 

that it just doesn't give us the degree of
 

sensitivity in looking at internal doses by some
 

alternative means, although we've tried very hardly
 

(sic) to try to get that to work.
 

But again we take a conservative selection
 

of some of our assumptions. We talked about
 

resuspension. Breathing rates, if the troops were
 

marching at a kind of fast rate, we're going to use
 

a breathing rate out of ICRP-26. Now I think it's
 

been updated to ICRP-123. That is conservative with
 

respect to the stress of the activities that they
 

were undertaking as a marching troop into a fallout
 

-- or a deposit fallout field.
 

Also the duration of the exposure, if we
 

can't tie down precisely how long the person or
 

troops were in a fallout field, we're going to
 

assume that they were there for the longer period of
 
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time.
 

Activity fraction of each isotope, we're
 

going to make the most conservative of the estimates
 

there if we don't know. Particle size kind of comes
 

into that equation. One is if we can't determine
 

what the particle size is, we're going to assume
 

that it's a ten micron particle size with the
 

following exception that if we know that there's a
 

larger particle size that would promote a larger
 

dose to a specific organ, we're going to use that. 

In case of lung, we're going to use a 20 micron
 

particle size because that maximizes the dose to the
 

lung for the particular veteran who needs a lung
 

dose. So again, we're always working on the maximal 

side. 

What we try to get out of the internal dose 

is a 50-year dose commitment to a specific organ. 

That will become clear to you why we picked that as
 

the dose.
 

Once we've done the dose reconstruction, now
 

it's the reporting requirement. Under 32 CFR 218 we
 

have to come up with an external dose that's based
 

on the alpha, beta, gamma. We also have to come up
 

with external neutron and we have to report the
 

range of uncertainties for the doses. And of course
 
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if you look at the standard, it's not very specific
 

on what type of internal dose that you're supposed
 

to report. It doesn't say whether you're supposed
 

to report a total effect dose equivalent, an
 

effective dose equivalent or dose equivalent just is
 

very, very open.
 

And what do we do in that case? Well, we go
 

to our customer, the VA, and say well, what is it
 

that we must provide to the VA in order to fulfill
 

the requirements of a claim submitted by a veteran? 

And in doing so we provide a total external dose
 

with a 95 percent upper bound in rems. We also
 

provide an internal dose to a specific organ and -­

that corresponds to the VA-claimed disease. The
 

internal dose we do not provide a range of
 

uncertainty on. It's inherently high-sided for some
 

of the reasons I mentioned before. If we're going
 

to pick resuspension factor, it's going to be on the
 

high side. If we're going to pick a breathing rate,
 

it's going to be on the high side. So every
 

internal dose that we provide because the
 

assumptions is inherently high-sided.
 

Of course if there's an eye and skin dose
 

needed for a particular VA claim, we provide that
 

when there's a related disease for the eye or the
 
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86 

skin, such as your basal cell carcinoma.
 

The veteran-provided doses we do something a
 

little bit different. We give them the total
 

external dose with the upper bound. Internal organ
 

doses, we don't provide it, and the reason we don't
 

provide is that particular time when a veteran
 

corresponds with us, it's unclear to us whether
 

there's a specific disease process involved yet at
 

that point, or the veteran may just want some
 

baseline information, trying to make up his mind as
 

to whether he wants to submit a claim to the VA or
 

Department of Justice. And if we provide of course
 

a total effective dose equivalent internal dose,
 

that's going to clash and be confusing with
 

transmitting the dose to the VA later on. As you'll
 

see, an organ dose is not going to correspond to a
 

total effective dose equivalent internal dose, so we
 

don't report that for the mere fact that we don't
 

want to promote some confusion in passing out
 

radiation information. Lord knows from the myriads
 

of letters we receive from veterans, it's very
 

confusing just to explain basic radiation units and
 

principles to them, so we try to keep this at a
 

simple level.
 

And of course we very, very much stress to
 
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87 

the veteran that even though we're providing them
 

some basic dose information, he doesn't need to have
 

this information in order to file a claim, and that
 

will become evident to you when Jerry Steele and
 

Neil Otchin talk about the VA regulations. One of
 

the common myths is the veteran believes that he has
 

to have a delineation of radiation dose in order to
 

file a VA claim. In fact in some cases I think they
 

have to have proven participation information. And
 

again, none of these of course would prevent a
 

veteran from filing a claim. If they don't have
 

participation and dose information, they can still
 

file a claim. VA, by their regulations, of course
 

are bound to come to us and get that same
 

information all over again, so again, you can see
 

this process is doubled up somewhat in the minds of
 

the veteran.
 

Next course of slides I'm going to get into
 

some of the special issues in the program that have
 

arisen over the years, and I think you want to pay
 

particular attention to these in terms of some of
 

the things that have caused us heartburn over the
 

years.
 

First is reporting film badge doses. We
 

believe that the film badge doses you report have to
 
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mirror what's in the record. And in our particular
 

program, film badges weren't widely worn by folks. 

When I say widely worn, in '56 there was a policy
 

that said we'll put a film badge on every person
 

that goes into the test area. Of course the reason
 

for that is through the 1940's and 1950's, film
 

badge dosimetry was still an emerging dosimetric
 

technology. Not all the bugs were ironed out in it. 

Of course there were manufacturing problems and
 

because you couldn't mass-produce film dosimetry at
 

that time, there were a lot of people who were
 

engaged in radiation risk activities that didn't
 

have badges, and those were kind of operational
 

decisions made at the time. But as we get later on
 

into '56, the technology was not much better. 

Again, the drawback is it only measures the external
 

gamma component. And also the benefit of film is
 

many of the films that atomic veterans wore, we can
 

actually go back to our repository at Los Vegas,
 

recover them and actually look at the image on the
 

badge.
 

We found for a few of our test series -- in
 

1956, for instance, Redwing; in 1962, Dominick* -­

that some of the badges suffered environmental
 

damage -- heat, humidity, light leakage. Again, we
 
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were just learning how to mass package dosimetry and
 

put it on people in a very, very damp and oceanic
 

environment in the Pacific, and so we had to learn
 

the hard way that film badge dosimetry en masse was
 

not that simple. And again, you can go back to the
 

records and pull these out.
 

In terms of doing uncertainty analysis on
 

film badges, because we -- Crossroads, perhaps only
 

ten percent of the total dose commitment was done by
 

film badges, the rest was done by dose
 

reconstructions, and we had various different
 

productions of film over the years, we engaged the
 

National Academy in a study to characterize film
 

badge uncertainties. And it's done specifically by
 

series in terms of bias, processing errors and what
 

have you. It doesn't depend on whether you were in
 

the Pacific or whether you were in Nevada test site. 

It depends on whether you were doing dosimetry for a
 

few months or for nine months.
 

And what we found out in the study -­

scientific study is it provided us a very, very good
 

basis for doing statistical uncertainty. In fact,
 

we use it quite extensively in our program, and if
 

you haven't seen this particular monograph, you
 

ought to get a copy of it because it's invaluable in
 
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90 

terms of the sources of error.
 

But one of the factors that came out in
 

this, it said if you want to get true deep dose
 

equivalents, we're going to have to divide our doses
 

by a factor of -- or multiply our doses on our film
 

badges by a factor of .7, and that was a little bit
 

troubling in the program, as even though that's a
 

good scientific answer, has a lot of good backup as
 

to why the recorded image should be lowered by .7 -­

again, when we dealt with the public in trying to
 

put that information out, we got lots of information
 

back that you're lowering my dose. It doesn't match
 

what I have in the record. How can you take good
 

science, I don't care if it is the National Academy,
 

you're lowering my dose. That's the dose that's
 

been in my record for the last 30 years. How dare
 

you come along and change the particular dose in the
 

record.
 

We also ran into a discussion of what do you
 

do with damaged film badges. As you know, when a
 

film badge is damaged by heat and humidity, you get
 

a darkening of the image, which relates to perhaps a
 

higher radiation exposure. That I could explain
 

away a little bit better in the program in that when
 

we employed dosimetry you had people side by side
 
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91 

who had good dosimetry next to people who had bad
 

dosimetry, so again you could establish some parity
 

in terms of knowing that a darkened image from
 

humidity actually did erase what your radiation dose
 

was.
 

So those are kind of the factors that we had
 

to deal with in communicating film badge information
 

to veterans, and we finally abandoned using the
 

factor of .7 and we used the actual dose of record
 

that's on the film badge, unless of course health
 

physicist in examining the badge says we have a
 

compromised image and a dose reconstruction would be
 

in order. So again the public perception in trying
 

to apply good science on film badges is we're
 

lowering their doses, and it's not a good position
 

to be in so I just want to pass it on to you as you
 

engage yourself in looking at lots of film badge
 

records and I'm sure you're going to run into in the
 

energy cohort.
 

As film badge dosimetry technology emerged
 

through its development, we also had changes over
 

time in terms of radiation limits. Back in
 

Crossroads the radiation limit in '46 was a tenth of
 

an R per day. As time went on, say to the era where
 

we had lots of film badges in the late fifties and
 
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92 

mid fifties, it was 3.9 R in 15 weeks, and some of
 

you who have been around the radiation trade can
 

relate to that if you take -- that's a quarterly
 

dose, which if you take times four gives you 15 rem
 

per year limit that we had as our national radiation
 

occupational exposure limit.
 

And of course during the times where we had
 

high accidental exposures, there were special
 

physical exams done on folks, bioassays taken. And
 

we also know from 1956 when we tried to put film out
 

there en masse that it's just -- you just can't put
 

it in a holder and hang it on somebody and go out in
 

a wet environment. It doesn't work that way. So
 

we've had to learn through other lessons learned. 

But we do have a supplement with a wealth of other
 

extensive monitoring data to back us up.
 

And of course a lot of the things you're
 

going to come across in a business that's done over
 

a number of years where the radiation standards get
 

stricter and your practices get better as you learn
 

more about lessons learned is the informationgathering process, the public's going to want you,
 

along the line somewhere, to admit that the
 

government did them wrong. And of course that puts
 

us in a very precarious position in the NTPR program
 
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93 

in that we're only the fact-gathering people in
 

terms of, again, was I there and what dose did I
 

get. And again, we do that by seeing what the
 

records chronicle, without any judgment as to
 

whether there were less strict practices, let's say,
 

in the forties versus the fifties versus the
 

sixties. Certainly you can see how things evolved
 

over the years, and it's quite amazing that despite
 

the changes and practice that, again, the wealth of
 

data helps us go back and chronicle what really
 

happened in terms of what exposures these people
 

received.
 

So again, we report doses based on the
 

facts. You know, the facts and nothing but the
 

facts. Again, we place no judgments over
 

radiological practices, but that's something that
 

you're going to be faced with in terms of people
 

submitting claims is they want the government to
 

admit fault to the radiation dose that they
 

received.
 

What you'll probably run into, does better
 

science always help us in terms of working
 

compensation claims? No, it hasn't helped us at
 

all. It's gotten us into some really heavy
 

quandaries.
 
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94 

If you go back to 1985 when we established
 

the program, we used the best ICRP NCRP standards at
 

the time and, again, we used ICRP-30, ICRP-26. Now
 

as dose conversion factors have changed over the
 

years and we looked at better biokinetic models,
 

have we put them into the programs? No, we haven't. 

We looked at them very carefully and said if it's
 

going to lower the dose to any degree, we're going
 

to leave the old science intact. By the same token,
 

if any of these case-by-case situations raise the
 

dose to the person by applying the modern science,
 

the newer, up-to-date science in dosimetry, we will
 

put it in on a case-by-case basis.
 

So basically our tightrope that we walk is
 

reviewing the new science. If it's going to lower
 

the dose, we make that acknowledgement and then
 

don't put it into effect. If it is going to
 

appreciably raise the dose, we will put it into
 

effect on a case-by-case basis.
 

Again this all kind of contributes to the
 

public perception that science is not helping them. 

In our cases, if you -- in putting science into
 

effect that lowers people's doses over time as the
 

program matures, people are going to become less and
 

less sanguine with the science, even though we know
 
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95 

it's best science, as some of us who are scientists
 

in the room know. And the public perception is
 

you're lowering my dose again and you're helping
 

produce an answer that is not going to help or get
 

me compensated. So you're going to be of course
 

paying attention to that time and time again as your
 

program matures over the years.
 

What I believe is what that's led to the
 

very last bullet on the chart is as the public
 

perceives less and less science helping them with
 

compensation, more and more there's socio-economic
 

solutions such as presumptive compensation that
 

Congress feels the need to come along and award
 

compensation benefits through other means. So you
 

can see how this evolved over the number of years.
 

Here's one that I think really threw the
 

credibility out the window on the NTPR program. 

We've been engaged since 1978 in coming up with the
 

maximal doses to cohorts of people. Again, Congress
 

came along and said we're going to do individualized
 

dose reconstructions, so when you move from maximal
 

doses to units to individuals doing specific things
 

over specific periods of time versus an entire
 

operation, doses are going to go down. Even though
 

we know an individualized dose is going to be a
 
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96 

better dose for that person, in the minds of the
 

person who say wrote in to the program in the era
 

between 1978 and 1984 now submits a claim because
 

there's a VA program, the dose is going to go down. 

And this happened -- this happens time and time
 

again in our program. We see people writing in
 

accusing us of lowering their doses.
 

Of course if you really look at all factors
 

considered, when we went to individualized doses we
 

also were required to account for periods of
 

exposure that weren't covered by film badges. So
 

actually doses kind of go in both directions as
 

doses not only go down from the generic dose, but if
 

there have been specific instances that are not
 

covered by any of the information we have, the dose
 

can climb back up. Again that leads the public to
 

believe when they write in as we have gained more
 

and more historical information over the years that
 

we really don't have a handle on what the dose is. 

And as time has gone on when we've gotten better and
 

better information both from historical records and
 

for other veterans engaged in the other activities
 

and their buddies write in, we get a better
 

definition of what they did. And when you get a
 

better definition of what you were engaged in, the
 
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97 

doses generally are going to go down. So it's one
 

of these perceptions that the veteran feels that
 

there's no net gain here at all in learning more
 

about the process as time has gone on.
 

And of course this has redoubled over the
 

years, despite the fact that we've had NAS look at
 

our dose reconstructions. Again, the public regards
 

dose reconstruction in our program with very, very
 

high suspicion, and this is the area of our program
 

that carries, still to this day, the highest
 

controversy with any group -- Congress, the general
 

public, veterans at large.
 

Another misconception is accuracy of doses. 

You have to really view accuracy in terms of what
 

the program's intended to do. We started these
 

programs with the idea in mind -- at least we knew
 

from the direction of Congress that we're going to
 

support compensation programs. The need for
 

accurate doses can be very, very highly
 

misunderstood. If you're supporting a compensation
 

program, are you really interested in taking a
 

yardstick that's 36 inches long and precisely trying
 

to come up with a limit around 36 inches. Or do you
 

find measuring 40 inches on the yardstick's good
 

enough and you move on. Again, in terms of working
 
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98 

with the VA programs, we're trying to give benefit
 

of the doubt to the veteran. We view accuracy not
 

in terms of how accurately can you measure 36 inches
 

in the yard, but if we, through the information, can
 

only get 40, 42 inches of the yard, that's good
 

enough for the veteran, provides some margin of
 

error and benefit of the doubt. 

In 1985 and 1995 the National Academy of
 

Sciences took a hard look at our dose reconstruction
 

program, '85 when we first started it, '95 when we
 

were doing the mortality studies, and they
 

recognizes (sic) that high-bounded doses are good
 

for compensation program, but any -- anything that
 

we're doing in terms of central tendency valued
 

doses, we really aren't a program that's doing that
 

to any degree of accuracy, so one can get the
 

misconcept here that NTPR doses are not accurate. 

Scientifically they're not accurate. Are they highended in terms of serving the compensation program? 

Surely they are, and that was the intent for our
 

performing dose reconstructions.
 

Independent oversight, that's a very, very
 

important issue. The Energy Workers Employee
 

Compensation Act started off with this advisory
 

panel. This is a very, very good thing. We didn't
 
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99 

have this in the NTPR program in the early days, or
 

we had it in some kind of fragmented fashion. In
 

1985 and '95 the NAS of course looked at our doses. 

They said they're not accurate enough for
 

epidemiologic study, and certainly I would not take
 

our doses and our database and submit them to any
 

review for epidemiologic purposes because they're
 

high-sided. And I think you all know high-sided
 

doses are going to produce low-sided risk estimates. 

For the fact that we have a gamut of doses that
 

could be accurate to high-bounded, you're going to
 

have risk estimates that are off to the same degree. 

But they are adequate for supporting compensation
 

programs, and I think one of the early-on comments
 

to your program is how do you wed the two together. 

Can you wed compensation with the goals of doing
 

scientific epidemiology later on.
 

I don't think you can. I think if you're
 

going to pick one goal versus the other, you're
 

going to get there from here. If you pick
 

epidemiology as your goal, you're probably going to
 

get very, very expensive dose reconstructions. 

They're going to be highly accurate. They're going
 

to serve the purposes, but again, are we going to
 

serve the public by sparing that expense. If you go
 
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100 

to supporting a compensation program, which some of
 

you I see in reading your Federal Register is you've
 

got some connection that if your dose in the worst
 

case is never going to get you to a good probability
 

of causation number, finish the work and walk away
 

from it. Or by the same token, if the dose is very,
 

very high and already gets you there to the answer,
 

are you going to go the extra yard to get the rest
 

of the radiation dose. If that's your main content
 

of your program, I don't think you would be able to
 

really look at doing epidemiology, so it's something
 

that you all need to consider, that you're probably
 

going to have to sacrifice one for the other.
 

GAO of course came in and looked at our
 

program in January, 2000. They confirmed the
 

previous NAS finding that we're doing high-sided
 

dose estimates. They also said there's no better
 

alternatives to dose reconstruction. This was even
 

taking a look at our preliminary results on our
 

plutonium bioassay. But they did note that we did
 

not have an independent review process, that
 

apparently the Academy, in looking at the program
 

twice in ten years and the GAO later on, five years
 

hence, is this is not considered an oversight
 

process, and said when the finding -- the big
 
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101 

finding -- the only finding they had in the GAO
 

report is that the NTPR program lacks an oversight
 

process. It lacks an independent review process for
 

dose reconstruction. And of course the action item
 

was, DoD establish such a thing. And of course that
 

got us into a Congressionally-directed NAS study
 

that's ongoing at present to look at this very, very
 

important question.
 

The major issues that we have, and some of
 

you have read the statement of work for the NAS
 

study we're talking about -- accuracy and so forth. 

To put this in the words of John Till*, the
 

Chairman, the major issues here are the doses right. 

Again, we're not using the word accuracy. Are they
 

right, are they serving the compensation program. 

And are they fair, and that's sort of the same
 

questions I'm hearing you ask here today. And we'll
 

see that report in the spring of next year.
 

Again, Congress asked them to recommend what
 

kind of permanent system of review should be put in
 

place, if any. So that's another public policy
 

question that's going to get answered during the
 

course of the study. And what they're doing in our
 

study -- and Mark, you'll find this of particular
 

interest -- they are basing their review on a sample
 
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102 

of 99 dose reconstructions that have been stratified
 

by series, by numbers of people involved in specific
 

series, also whether they had internal doses,
 

whether they had high doses and there's some other
 

discriminators there that figured into their
 

stratification of these 99 dose reconstructions. 

They also run the gamut of the program from the
 

early days before we were supporting compensation
 

programs and well into the era of today where we are
 

supporting heavily VA claims. And of course you'll
 

see this process or these results released in April,
 

2003.
 

Interfaces with the Department of Veterans
 

Affairs. We provide the participation in dose
 

information to the VA. We don't interact with the
 

process. Again, we provide in accordance with our
 

Federal Register requirements. We don't receive any
 

feedback as to what the VA does with the doses. We
 

don't get involved in benefits review decisions that
 

Jerry Steele will talk about or the medical review
 

that Neil Otchin will talk about, or the final
 

decision as to whether there are merits for grant of
 

an award. And also we don't receive any feedback on
 

the process on individual veterans as to whether
 

they successfully worked through the process or not. 
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103 

So this is a complete unknown to us.
 

What I can point out is, as far as oversight
 

is concerned, is the VA, by Public Law 98-542, has
 

an oversight process. We don't have it in our
 

program, but the VA has it through the VA Advisory
 

Committee on Environmental Hazards, and they oversee
 

the process of the VA review of radiogenic diseases,
 

probability of causation, all those particular
 

issues. But again, that doesn't factor back to
 

DTRA's program.
 

As far as our relationship's concerned,
 

we're very much engaged in managing the process. 

And what I mean by that is making sure that when we
 

get information from the VA that we have a proper
 

citation of a disease so that we can gather the
 

information and go forward. We have the veteran's
 

claim and specific statement of claim that we get
 

all of the information the veteran has provided to
 

the VA, so this helps us put together our package,
 

and making sure that all the boxes are checked up
 

front as to having all the information that one
 

could get from the VA in order to move forward in
 

our process. So we do most of the time managing to
 

make sure this happens. We're one place in DTRA. 

The VA of course has 57 regional offices across the
 
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104 

country and, again, we need to make sure that that
 

process is monitored, that we get the information
 

uniformly.
 

The one important thing that Jerry Steele is
 

going to concentrate on, the very last thing, is VA
 

can grant benefit of the doubt. One of the
 

questions you'd asked is once they get through our
 

process, the veteran gets the dose, he doesn't get
 

the grant of the award, is it the end of the line. 

No, the veteran can come back and contest the dose
 

to us. We go through a very extensive question and
 

answering process in trying to satisfy the veteran's
 

issues over the dose. And oftentimes we're not able
 

to and, you know, when does the process end. And I
 

think if you looked at your Federal Register
 

process, it's kind of open-ended and at some point,
 

you know, you have to say that the answer is the
 

answer. But through the VA, if we had issued a
 

decision to say that we could not put them at a
 

particular event, the VA can look at the
 

preponderance of evidence -- we look at the records
 

only -- and say as a result of other evidence, if
 

the person was at a particular test, they can
 

concede the person's presence at the test, come back
 

to us with a hypothetical scenario for
 
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105 

reconstructing the dose and we reconstruct the dose. 

So again, the veteran does have a benefit of the
 

doubt process.
 

Another means of benefit of the doubt
 

concerning the dose reconstruction is the veteran
 

can bring a second opinion dose into the process. 

And if that dose disagrees with our dose by more
 

than a factor of two, the VA by law must go out and
 

contract with a third party to provide some
 

reconciliation of the two dose estimates, and
 

whatever final result comes out of the independent
 

dose estimate is finally what results in the dose
 

assigned to the veteran.
 

In summary, our dose reconstruction supports
 

high-sided doses, thus we support compensation
 

programs. We try to support benefit of the doubt to
 

the veteran. Over the years we've had to compromise
 

the science in order to interface with
 

administrative and public policy issues and we
 

talked about some of those at length at the end of
 

the brief.
 

The PC process is totally independent of
 

ours. Basically it's an interface with the VA
 

without interaction. And again, independent
 

oversight has been sporadic with the program and
 
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some remedial action I'm sure will be recommended
 

with the issuance of the National Academy report in
 

April, 2003.
 

Questions and discussion.
 

DR. ZIEMER: Thank you very much, Michael. 

Yes, the floor is open for questions and discussion.
 

Mike -- or Mark.
 

MR. GRIFFON: I think -- I was just
 

wondering and I think I've seen this -- I either
 

talked to you or some of your staff at various times
 

and got some of this information off the web site,
 

but I was wondering if the scope of work for the NAS
 

review is available. I think what's on the web site
 

is probably the full scope. And then also if the
 

NAS panel has developed protocols or procedures for
 

review in the cases and if those are available.
 

MR. SCHAEFFER: The first question
 

concerning the statement of work, they actually
 

condensed it down to the two basic issues with the
 

concurrence of the Veterans Affairs staff who they
 

worked with in terms of are they right, are they
 

fair.
 

As far as the other question of the actual
 

protocol developed to review, again, due to the
 

nature of the National Academy of Sciences in doing
 
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an independent investigation, they have not shared
 

the development of this protocol with us or actual
 

procedure they're using to conduct the review. And
 

I would be quite certain -- I don't think I'm making
 

any presumptions here -- if you were to ask them
 

today, they probably would say that they can't make
 

them available to you or to anybody. But it might
 

be a question you want to ask after April, 2003 when
 

the ink is dry on their report.
 

DR. ZIEMER: Doesn't the Academy now have to
 

operate under a process that very much looks like
 

the FACA process where their deliberations of their
 

committees open and so on? Wouldn't that -­

MR. SCHAEFFER: It's certainly true they're
 

under FACA, just as you are here. However, the
 

actual work products that take place outside the
 

public forum, they can tell the public what the
 

bottom line is in terms of what they're doing as a
 

result of the development of the protocol, but they
 

can't tell you exactly what they're doing as far as
 

looking at the dose reconstructions. For instance,
 

we know they're looking at 99 doses, and why they're
 

looking at 99.
 

DR. ZIEMER: And I think that's the kind of
 

information we're talking about here. We're
 
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interested in the methodology, not the details of
 

the doses and so on. You know, is there some logic
 

-- is it -- yeah, the rationale for -- how many
 

total dose -- 99 -­

MR. SCHAEFFER: They looked at 99 doses.
 

DR. ZIEMER: Out of how many? What's -­

MR. SCHAEFFER: Individualized dose
 

reconstructions out of 4,000 or 5,000.
 

DR. ZIEMER: 'Cause we were thinking about a
 

two to three percent.
 

MR. GRIFFON: That's the same. 

DR. ZIEMER: Is that where the number came 

from? 

MR. GRIFFON: That's where that number came 

from. 

DR. ZIEMER: Yeah. 

MR. GRIFFON: Yeah. 

DR. ZIEMER: Okay. 

MR. SCHAEFFER: And what they're doing in 

terms of the internal review, they've not shared
 

that in public with anyone. We do know that from
 

time to time they come and gather records from us. 

We have to provide redacted records to them. What
 

they're actually going and what content they're
 

drawing from those records, I don't think anybody
 
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knows. But we know from the statement of work that
 

the -- whatever has been done in the process, such
 

as what you're talking about, Congress has asked
 

that they report exactly how they conducted this
 

process, so that will become a matter of the public
 

record when the report's issued.
 

DR. ZIEMER: Whose decision was it to use
 

old science when it benefitted the claimant and new
 

science when it benefitted the claimant? In other
 

words -­

MR. SCHAEFFER: It's been in the process -­

DR. ZIEMER: -- there's almost an issue of
 

fairness here. You could say well, I'll use
 

whatever, old and older and new and newer. I
 

mean -­

MR. SCHAEFFER: If newer results in a dose
 

that's -­

DR. ZIEMER: Yeah, I understand what you're
 

saying, but who -- is that a policy decision or -­

MR. SCHAEFFER: It's been a policy decision
 

throughout our program from the time even before I
 

joined the program, and I've not changed that policy
 

in any degree. It does work against the science, of
 

course. And you know, it begs the question again is
 

if you were to put that into place and what do you
 
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do about compensation to folks that perhaps would
 

not have been given compensation years ago. Also
 

begs the question on the other side is what do you
 

do if it -- there's often a more favorable award
 

today, how do you go back and back-check that in the
 

system. Again, since the VA process is not married
 

to our system, it's hard for me to conjecture on
 

that one.
 

DR. NETON: If I might -- this is Jim Neton. 

I'd like to ask a question, Mike, on that issue. 

Maybe some clarification on what you were saying. 

My understanding is that you based the program
 

initially on the current science, the best science
 

at the time.
 

MR. SCHAEFFER: That's correct.
 

DR. NETON: But then you were just reluctant
 

to change to a more current model if it would -­

MR. SCHAEFFER: Lowered -­

DR. NETON: -- be detrimental to the
 

claimant. So an instance, in 1985 ICRP-2 was the
 

standard in effect for regulatory purposes, but you
 

nonetheless chose to use the ICRP-30 models.
 

MR. SCHAEFFER: Uh-huh.
 

DR. NETON: So they were the best models
 

available at the time of the program inception.
 
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MR. SCHAEFFER: That's correct.
 

DR. NETON: Okay, so I think that's an
 

important point.
 

MR. SCHAEFFER: And that's going to loom
 

heavy on anyone who runs this -- you know, looking
 

back at the program 20, 30 years hence, what you do
 

about that issue. I don't know the answer to it. 

The fact that you all are starting a program afresh,
 

you might have a better idea on how to handle that
 

so we can learn from you.
 

MR. GRIFFON: Just one more thing. Are
 

there any provisions for this whole Special Exposure
 

Cohort -- I know you have presumed causation for
 

certain subclasses. Are there provisions when you
 

can't estimate a dose -- I'm going to use the words
 

from our regulations -- with reasonable certainty
 

where you would consider -- have you had that
 

situation, first of all, where you can't estimate
 

the dose -- a reasonable estimate of the dose. And
 

secondly, are there provisions for adding those
 

individuals or classes to the presumed causation
 

group.
 

MR. SCHAEFFER: The answer to that question
 

-- the first question is what do we do if we can't
 

perform a dose reconstruction. I don't think we've
 
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112 

ever faced a situation where we couldn't assign some
 

dose value. And basically gets us back to the chart
 

where it's fairly well-defined, the activities for
 

atmospheric nuclear testing and post-war occupation
 

of Hiroshima and Nagasaki. By the same token, we
 

are blessed with military records. The military
 

kept very, very robust records of what people did
 

and where they went, except in the cases of we do
 

run into some frustrations with Hiroshima and
 

Nagasaki where people went on excursion trips apart
 

from their regular duties and they never got
 

recorded. That's not to say if we can't get the
 

record and VA concedes that they were there, again,
 

we're still able to assign a dose to that particular
 

process. Whether they were at the ten-mile limit of
 

the two cities or whether they were inside the city
 

or even just traveling around 20, 30 miles away, we
 

can still assign some maximal dose value.
 

Now you had a second question, special
 

cohorts.
 

MR. GRIFFON: Right.
 

MR. SCHAEFFER: The special cohorts in our
 

program have been the Congressionally-mandated
 

decisions to grant individuals in the same
 

population -- atomic testing, Hiroshima, Nagasaki -­
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113 

presumptive compensation just for being present. 

And it's been done for certain classes of diseases,
 

other special categories which Jerry Steele will
 

talk about in terms of the complexities. But it is
 

possible in the course of the VA program where a
 

veteran can file under both programs. And are there
 

any advantages -- lots of pros and cons on that that
 

it's too complex to answer.
 

DR. ZIEMER: Okay. No further questions? 

Then I thank you again, Michael -­

MR. GRIFFON: I just want to add on that the
 

pros and cons that are difficult to answer might be
 

of interest for our Special Exposure Cohort working
 

group because I think that's a similar issue with
 

the pros and cons of petitioning to get in the
 

Special Exposure Cohort.
 

DR. ZIEMER: Thank you very much. Next
 

we'll have a presentation dealing with adjudication
 

of claims through the atomic veterans. The
 

presenter is Jerry Steele, who's with the Department
 

of Veterans Affairs. Jerry began his work with VA
 

regional office in Montgomery, Alabama several
 

decades ago and then transferred to the VA central
 

office in the mid-eighties. Jerry did his
 

undergraduate studies at the University of
 
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114 

Mississippi, his graduate work at Troy State
 

University in Montgomery, and currently Jerry is a
 

consultant and advisory -- I'm trying to read this
 

writing -- consultant for the advisory review staff,
 

compensation and pension services. Is that the
 

correct title?
 

MR. STEELE: Yes, sir.
 

DR. ZIEMER: Good, I want to get it
 

correctly in the record, even if I get it wrong
 

here. Thank you. Jerry, if you would, please.
 

MR. STEELE: I know the schedule had me on
 

before Mike today, but as it turns out, Mike pretty
 

well taught my presentation. Are there any
 

questions?
 

(Laughter)
 

MR. STEELE: No questions? We will address
 

exposure, the regulations under which the Department
 

of Veterans Affairs can compensate a veteran or a
 

survivor of a deceased veteran for a radiogenic
 

disease, a disease due to radiation exposure. As
 

one veteran pointed out in a claim, he says hey, I
 

was 19, I was -- nothing could harm me. He said
 

Hell, I could eat it and it would not hurt me. But
 

we're finding out ten and 20 and 30 years later that
 

that is not the case.
 
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115 

We'll look at Public Law 98-542 which was
 

enacted by Congress, the Veterans Dioxin and
 

Radiation Exposure Compensation Standards Act of
 

1984. Now I gather that is where you are at this
 

point, standards or evaluating standards. My job is
 

easy because the standards are set by Mike
 

Schaeffer's group at DTRA for the atomic veterans
 

and by Dr. Otchin for the other types of radiation
 

exposure cases. Anyway, my job's a no-brainer. I
 

process papers and get the radiation dose assessment
 

from DTRA, from Mike's group, and then I -- we
 

transfer -- we write it up and send that over to Dr.
 

Otchin for an opinion as to whether it is likely,
 

unlikely, or at least as likely as not that the
 

veteran's now diagnosed prostate cancer is due to
 

exposure to whatever dosage of radiation that DTRA
 

established.
 

This is landmark legislation, actually,
 

establishing standards. I hope I don't get in your
 

way here, I sort of move around. This established
 

not only radiation, which is kind of the focus of
 

your interest now, but also dioxin. What is dioxin? 

Dioxin is a part of certain herbicides used in the
 

Republic of Viet Nam.
 

So I was talking in the hallway on break. 
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116 

The issue was prostate cancer and how that would
 

impact the NIOSH realm. Well, with prostate cancer
 

and the veteran who is diagnosed with that having
 

served in-country in Viet Nam during the Viet Nam
 

era, it is presumed -- it's a no-brainer. You have
 

service in Viet Nam in-country, you're presumed to
 

have been exposed to herbicides containing dioxin. 

Prostate cancer is one of the presumptive
 

disabilities.
 

With Public Law 98-542 we're getting way
 

down the road, though. When it was initially
 

established, the only disability that was serviceconnectable was coracne*. I gather that's a skin
 

condition. I defer to the medical experts. But I
 

personally, in 30-something years of VA, have not
 

seen an allowed case of coracne. That's not to say
 

they don't exist.
 

So Public Law 98-542 -- and in your handout
 

I think I had that listed as 3.311(a). It's in the
 

definitive handout, not the slides -- 3.311(a). You
 

can kind of skip over the (a) part because that's
 

not the subject of my address today. But if you
 

would go to 3.311(b), which is the radiation issue,
 

radiation standard that was established September
 

25, 1985. The Standards Act of 1984 gave VA lead
 
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117 

time of what, 300 days to publish regulations
 

establishing standards for dioxin and radiation
 

cases. We almost made that deadline, because the
 

effective date of our regulations is September -­

well, we may have made it -- September 25, 1985. 

Maybe we missed it by about 30 days. But at any
 

rate, we probably had published in the Federal
 

Register proposed regulations. The final -- final
 

effective date or the effective date of the final
 

regulation was certainly under a year from the date
 

of enactment of Public Law 98-542.
 

Our other law under which we consider
 

radiation -- well, this is it, isn't it? This is
 

the (a) and (b). The (a), dioxin, for the (b) is
 

radiation. In 1994 Congress took the 311(a) and
 

codified that at 38 USC 116 -- 111 -- whatever,
 

1016, so they renumbered 311 -- it used to be weird. 

If you're familiar with the way statutes are listed,
 

we have a 311(a),(a) for subdivision (a) under
 

dioxin. Then we had a 311(b),(a), so it was
 

strange.
 

At any rate, in 1994 the Congress took the
 

herbicides and placed them under 38 USC 1116. 

That's -- we caught that in the regulations, 38 CFR
 

3.313, so anything under 3.311 now is radiation.
 
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118 

The Public Law 100-321 took -- well, what
 

did it do? It established a series of disabilities
 

for which all we needed to know was that the person
 

participated in a radiation-risk activity. 

Radiation-risk activity was defined as atmospheric
 

testing of nuclear weapons, or the occupation of
 

Hiroshima or Nagasaki before July 1, 1946. So if
 

the veteran served on the American Occupation Forces
 

in Hiroshima or Nagasaki prior to July 1, 1946, then
 

that veteran met the definition of having
 

participated in a radiation-risk activity. That
 

meant the veteran was a radiation-exposed veteran.
 

And for the -- how many was it, 13
 

disabilities, 13 diseases, if any of those diseases
 

were diagnosed, then we simply had to have from Mike
 

Schaeffer's group confirmation that the veteran
 

participated -- review of historical records confirm
 

the veteran's presence in VA-defined Nagasaki area. 

That was good enough.
 

You might ask what is a VA-defined Hiroshima
 

or Nagasaki area. By definition under statute, that
 

is within a ten-mile radius of ground zero, Nagasaki
 

or Hiroshima. Within ten miles. And that's
 

important. We get letters of -- letters from DTRA
 

that say the veteran is shown to have been assigned
 
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119 

to whatever unit at Kobe, Honshu, Japan, 125 miles
 

from Nagasaki. So that veteran is not radiation -­

does not meet the definition of a radiation-exposed
 

veteran. That veteran does not meet the definition
 

of participating in a radiation-risk activity,
 

meaning the veteran -- official military records do
 

not place the veteran within the VA-defined -- in
 

this case, Nagasaki -- area.
 

So we're faced with -- this is a particular
 

case I have on my desk now, someone writing to the
 

Undersecretary for Benefits, to Admiral Cooper,
 

asking for his personal attention and to the case. 

Since the veteran cannot be established by official
 

military records as being in a VA-defined Nagasaki
 

area, we will have to go back to DTRA, Defense
 

Threat Reduction Agency, and say that since official
 

military records do not establish the veteran's
 

presence at or absence from Nagasaki, a site at
 

which radiation exposure is claimed, then VA
 

concedes that the veteran was there. So Mike will
 

have his folks at DTRA come up with a radiation dose
 

assessment on this particular case, which we will
 

then -- doesn't fit under the presumed, does it,
 

under 100-321 because the veteran is not a
 

radiation-exposed veteran. Right? Did not
 
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120 

participate in a radiation-risk activity. So -- but
 

he does fit under the 3.311 criteria, so we'll have
 

to refer the case over to Dr. Otchin for an opinion
 

as to whether the veteran's exposure to whatever
 

dose -- it will probably be less than one rem -­

whether the veteran's exposure to that one rem is
 

likely, unlikely, or at least as likely as not to
 

have resulted in the now-diagnosed prostate cancer. 

Okay?
 

We've been talking about 3.309. That's the
 

regulatory -- the VA regulation for Public Law 100­

321. Okay? That's the presumed -- actually, 3.309
 

-- you know what that is? It's the chronic
 

diseases, chronic diseases for which service
 

connection will be presumed if diagnosed within a
 

certain period of time; 309(d) addresses the
 

radiation diseases -- the diseases for which service
 

connection is presumed if diagnosed at any time
 

after service in a radiation-exposed veteran. We
 

have a handout, probably is page 9 of the definitive
 

handout that compares the diseases listed under
 

3.311 and those listed under 3.309. We'll get to
 

that later.
 

How can a veteran be exposed to radiation? 

Could be exposed through participation in American
 
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121 

Occupation Forces in the VA-defined Hiroshima or
 

Nagasaki area. Right? Can be exposed from
 

participation in atmospheric nuclear testing,
 

nuclear weapons testing. Occupational exposure, on
 

the job exposure. What types of military
 

occupations would result in occupational exposure? 

X-ray technician, perhaps?
 

UNIDENTIFIED: Nuclear weapons.
 

MR. STEELE: Nuclear -- occupational
 

exposure? Right, nuclear weapon -­

UNIDENTIFIED: Technician.
 

MR. STEELE: -- technician, changing out
 

warheads and so forth, that would get it. What
 

would be another one?
 

UNIDENTIFIED: Nuclear subs.
 

MR. STEELE: Nuclear -- nuclear -- let's
 

call it nuclear propulsion, which would include subs
 

-- we have some surface vessels, don't we, that are
 

-- okay. These cases we -- the regional office
 

might accidentally send an inquiry to Mike, but
 

someone there screens them there pretty fast and
 

lets the regional office know that that's -- that's
 

not the proper agency to request radiation dose
 

assessment for occupational exposure.
 

For a nuclear propulsion -- for a Navy
 
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122 

nuclear propulsion person or a claim involving Navy
 

nuclear propulsion, the source would be the Naval
 

Dosimetry Center at Bethesda, Maryland. Captain
 

Paul Blake would look at his database. The Navy
 

Dosimetry Center maintains a database for Navy and
 

Marine personnel occupationally exposed to ionizing
 

radiation and then would send us or send the
 

regional office a statement showing periods of
 

exposure, perhaps ships to which assigned when
 

exposed, and then the -- they do it -- they show a
 

CDE -- they list neutron, gamma, gamma and X-ray
 

combined, and I think they show a beta. But at any
 

rate, those beta columns and neutron columns are
 

typically zeroes. Practically everything we get
 

would be under the X-ray and gamma.
 

We would take Captain Blake's statement of
 

exposure, and he would typically tell us that all
 

exposures are whole-body -- probably means something
 

to -- but so that's what we -- when we refer it over
 

to Dr. Otchin for an opinion, we say -- you know, we
 

just repeat what Captain Blake may have said, that
 

all exposures are whole-body, for example.
 

There's another -- our manual is -- I didn't
 

write this particular part, but it says on
 

occupational exposure if the service records contain
 
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123 

DD form 1141, record of occupational exposure to
 

ionizing radiation, if -- no, it -- how is it
 

worded? If it does not contain that, then go to the
 

Naval Dosimetry Center if it's Navy or to the
 

address -- the Redstone Arsenal if it's Army,
 

Bowling* Air Force Base if it's Air Force. Anyway,
 

the different service addresses are listed. If I
 

had written that I would say in addition to, you
 

know, any documentation of exposure on DD form 1141,
 

go to the Naval Dosimetry Center and ask for any
 

other records, so that we would have a complete -­

everything that any database might have as far as
 

radiation exposure, and then send that over to Dr.
 

Otchin for an opinion.
 

I think what our slides -- what this series
 

of slides is addressing is the 311 case, the one
 

that we're not going to presume, we're going to get
 

a dose estimate. The first factor to be done is to
 

determine that a specific disability is claimed. 

And this is weird, 3.303 just addresses service
 

connection, so if it's not a presumptive disability
 

under 3.309 and it's not listed under 3.311(b),
 

notwithstanding the regional office should consider
 

service connection -- well, that just means going
 

through all the service medical records and ensuring
 
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124 

that no early manifestation of the disease was
 

diagnosed in service because if it were, then that's
 

service-connected on a direct basis. That's
 

service-incurred. Okay? That's what 3.30... Okay.
 

Okay, here's what we're going to do if it's
 

not listed. Wait a minute, am I getting ahead of
 

myself?
 

UNIDENTIFIED: I think you skipped a bullet.
 

MR. STEELE: Did I skip one?
 

(Pause to reset)
 

MR. STEELE: If the disability is listed,
 

okay, all right, there we go. If it's actually a
 

listed disability, then we do the following. And
 

here's where we're -- we ask that the regional
 

office, before they go to DTRA -- because that's 90
 

days that we don't know that need to be expended. 

We need medical evidence establishing the claimed
 

condition in fact exists. Okay? If it is a
 

radiogenic disease or a presumptive disability that
 

can be service-connected based on radiation
 

exposure, then we go to the Defense Threat Reduction
 

Agency. Why do I have a (b) on that? I should have 

eliminated the (b). It's just 3.311. Okay? (b) is 

a part of that, but it's -- okay. 

Now what's the difference between the one
 
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that I did before -- what's the difference between
 

the 3.309 and the 3.311? 3.309 is the presumed
 

list. Right? The 3.311 is the one that we have to
 

get a radiation dose assessment from Mike
 

Schaeffer's group, Defense Threat Reduction Agency. 

Or if it's -- if it's other occupational exposure,
 

then we have to go to the appropriate service
 

department -- Naval Dosimetry Center for a nuclear
 

propulsion person, Army for a warhead -- nuclear
 

warhead technician, Air Force for whatever Air Force
 

is exposed to. X-ray technicians, dental
 

technicians would have to go to whichever branch of
 

service that person worked. Okay?
 

Once the regional office has done the three
 

items here, then they contact my section and -­

Compensation and Pension Service. I guess they do
 

that to ensure that everything's been done, all the
 

T's crossed -- crossed and -- I's dotted and T's
 

crossed. We then -- we continue to log the cases
 

and ask the questions to make sure that everything's
 

been done before they send the case in to us. Maybe
 

that lessens the cases we have to send back before
 

they -- you know, for them to -- the regional
 

offices to finish their development of the case. 

And if their development was correct up to the time
 
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126 

that it's called in, we ask them at that point to go
 

to DTRA. I don't know if that lessens the number of
 

requests that Mike gets or what, but...
 

Overall, for the -- these figures were
 

correct the first of the year, or as correct as
 

figures could -- you know. They were reported to
 

Congress as accurate, probably couched in this is
 

the best we can do right now -- 21,135 total
 

radiation compensation claims; 2,582 grants of
 

service connection. Of those -- of this number, 500
 

or 515 are grants under the presumptive -- the
 

presumed disabilities under Public Law 100-321 under
 

38 CFR 3.309, and of those 515 what, almost twothirds are based on atomic testing and then onethird on occupation of Japan.
 

UNIDENTIFIED: That's all you've got.
 

MR. STEELE: That's all I have.
 

DR. ZIEMER: Of all of those claims -- let's
 

see, the 2,582, do those require dose
 

reconstruction, the service connection -- those
 

must. Right?
 

MR. STEELE: No, 515 did not require a dose
 

reconstruction, but they required a letter from -­

DR. ZIEMER: No, the 515, I understand that
 
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MR. STEELE: The 515 -­

DR. ZIEMER: -- but what about the 2,582?
 

MR. STEELE: This number is included in
 

here, so we would be looking at -­

DR. ZIEMER: Oh, I see, okay.
 

MR. STEELE: -- 2,000 -- somebody that's
 

good with math -­

DR. ZIEMER: Okay, about 2,000. Now -­

MR. GRIFFON: But how -- I think -- my
 

question -- maybe Paul's going to ask the same
 

question, is I thought I heard a number of 4,000 to
 

5,000 dose reconstructions done, but there's 21,000. 

Is that 2,500 a subset of the 21,000 -­

MR. STEELE: Yes.
 

MR. GRIFFON: -- claims, and then there were
 

only 4,000 or 5,000 that had dose reconstructions
 

done, is that correct? I'm trying to connect the
 

numbers from the previous presentation.
 

MR. STEELE: My presumption would be that
 

the majority of the 21,000 would have had -- well -­

DR. ZIEMER: Seems like most of those would
 

have had dose -­

MR. STEELE: Most of those -­

DR. ZIEMER: -- reconstruction because you
 

pull out the -­
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MR. STEELE: Yeah, right.
 

DR. ZIEMER: -- presumptive ones right off
 

the top. It seems like everything else would have
 

to have a reconstruction then. Am I understanding
 

that correctly?
 

MR. STEELE: Yes.
 

MR. GRIFFON: But the -- previously we heard
 

4,000 or 5,000 dose -­

MR. STEELE: Right, right, but -­

MR. GRIFFON: -- reconstructions.
 

MR. ELLIOTT: Mike Schaeffer's not in the
 

room right now -- maybe we can get him back in -­

but I think you've got to remember that they do dose
 

reconstructions for veterans not with a claim. 

Sometimes a request for dose reconstruction comes to
 

them from the veteran without the veteran filing a
 

claim and they go ahead and do it to respond to the
 

veteran's need.
 

MR. STEELE: Also Mike's group is only going
 

to do the, quote, atomic veteran. Is that true? 

The atomic veteran. Now what -- how did Mike define
 

those? Occupation of Hiroshima and Nagasaki or
 

atmospheric nuclear tests. We have other exposure
 

claims, although I would not have thought 17,000
 

from that, so there's some disconnect there, yet.
 
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DR. DEHART: Are those numbers in total with
 

the law for the last what, ten years?
 

MR. STEELE: Yes, sir. They're cumulative
 

as of the spring of this year. Okay? Any
 

questions?
 

(No responses.)
 

MR. STEELE: Thank you.
 

DR. ZIEMER: Thank you very much. Then
 

we're ready to hear from Dr. Otchin, and he's going
 

to talk about probability of causation determination
 

for the atomic veterans. Dr. Otchin is an MD,
 

studied at Duke Medical School. He's Boardcertified in internal medicine. He's program chief
 

for clinical matters in the Office of Public Health
 

and Environmental Hazards in the VA's central office
 

in Washington, D.C. So Dr. Otchin, we're pleased to
 

have you here with us this afternoon. Thank you.
 

DR. OTCHIN: Certainly. I should also
 

mention I did my undergraduate work at the
 

University of Florida since we have a professor
 

emeritus from the University of Florida here.
 

(Laughter)
 

DR. OTCHIN: While we're getting ready, I
 

might mention that essentially the whole text of my
 

presentation is in your handout. The draft has been
 
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revised very slightly, but those that don't want to
 

listen certainly can read the presentation at your
 

leisure. Also the overhead transparencies are also
 

included in the handout, so if I can't get the
 

overhead transparency working properly, you'll have
 

a copy of that, also.
 

Can you hear me all right?
 

(Affirmative responses)
 

DR. ZIEMER: Are you going to move back and 

forth? 

DR. OTCHIN: No, I'm just going to stay 

here. 

As mentioned, I'm a physician with the
 

Veterans Health Administration, which is the part of
 

the Department of Veterans Affairs that provides
 

health care and operates the VA hospitals and
 

clinics. Our office, the Office of Public Health
 

and Environmental Hazards, is responsible for
 

providing medical opinions to assist in the
 

adjudication of some compensation claims to veterans
 

exposed to ionizing radiation when requested by the
 

Veterans Benefits Administration, VBA, the component
 

of the VA that is responsible for disability
 

compensation and various other benefits programs.
 

Basically I'm on the part of the VA on the
 
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left-hand side, which is primarily the hospital and
 

clinic system of the VA, and Jerry Steele is part of
 

the VA on the dotted side of the table of
 

organization, so basically then send the cases over
 

to our side and we send the medical opinions back.
 

I would like to stress that while our office
 

provides medical opinions, it does not make the
 

actual compensation decisions, which is the
 

responsibility of the VBA. Also there is an
 

extensive process through which a veteran may appeal
 

an unfavorable compensation decision.
 

And if there are any technical questions
 

regarding the adjudication process, I would defer
 

them to Jerry Steele because his office actually is
 

involved in the detailed adjudication process.
 

I'd like to now go into the issue of socalled radiation-risk activities. Participation in
 

radiation-risk activities for VA purposes includes
 

approximately 195,000 veterans who were involved in
 

the occupation of Hiroshima and Nagasaki, as was
 

mentioned; some former POW's with similar likelihood
 

of exposure to radiation in Japan; and approximately
 

210,000 veterans who participated in atmospheric
 

nuclear weapons tests. Also recently some veterans
 

stationed at nuclear weapons facilities now
 
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controlled by the Department of Energy and some
 

veterans who participated in underground tests in
 

Alaska were included in the definition of radiationrisk activities, effective March 26th, 2002, to
 

ensure equity for veterans in light of the DOE/DOL
 

compensation program.
 

Veterans who were exposed in a so-called
 

risk -- radiation-risk activity have enhanced
 

eligibility for VA health care -- including free VA
 

health care for any malignancy or other condition
 

that the VA recognizes as potentially due to
 

radiation, as well as compensation -- compared to
 

veterans who were exposed to radiation in other
 

circumstances. For instance, nuclear submariners or
 

dental techs in the military or X-ray techs or
 

whatever.
 

As was alluded to, there are really two
 

separate compensation programs available for
 

radiation-exposed veterans. The presumptive program
 

is limited to veterans who were in the -- in a
 

defined radiation-risk activity who develop one of
 

the diseases on the VA's presumptive list, which
 

includes 21 different forms of malignancy. And
 

hopefully the next transparency will point out this. 

This is the same as one of Jerry Steele's.
 
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So in order to be eligible for a presumptive
 

compensation, essentially a veteran would have to be
 

-- have been exposed in a, quote, radiation-risk
 

activity and have one of the diseases on the
 

presumptive list. And five of the conditions on the
 

presumptive list, those with asterisks, were just
 

added effective March 26, 2002 -- again to ensure
 

equity for veterans compared to civilians eligible
 

for compensation in civilian programs, both the RECA
 

amendments and the DOE/DOL program.
 

For presumptive cases, medical opinions are
 

not needed and so ideally or theoretically the cases
 

would never come to me.
 

The other program is the non-presumptive
 

program, and the types of cases that are included in
 

the non-presumptive program would be a veteran or
 

veterans who were exposed in a radiation-risk
 

activity who develops a disease on the nonpresumptive list; or veterans who were not in a
 

radiation-risk activity but were exposed to
 

radiation in some other circumstance like a nuclear
 

submariner or a dental tech or X-ray tech who are
 

not eligible for the presumptions; or veterans who
 

have another disease and for whom a expert opinion
 

is provided by their physician or somebody else
 
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supporting the fact that those diseases might be due
 

to radiation, even though they're not on the formal
 

list of diseases that the VA officially recognizes
 

as related to radiation. And these cases, all the
 

three cases I just described, are compensated under
 

the non-presumptive process and they do require a
 

medical opinion by our office.
 

And then the last of my transparencies -­

this is sort of a flow diagram that shows the
 

sequence of adjudicating a non-presumptive radiation
 

claim that would come to our office for a medical
 

opinion. Now this particular flow diagram is
 

specific for an atomic veteran, the type of case
 

that would go to Mike Schaeffer's group for a dose. 

If it's an occupational dose, rather than sending it
 

to DTRA, it would go to the service dosimetry office
 

or some other source of information for a dose, but
 

the general process of how the claim is managed and
 

how a medical opinion is requested by our office,
 

the Office of Public Health and Environmental
 

Hazards, is obtained and then the opinion goes back
 

to the Compensation and Pension Service and an
 

advisory opinion is then sent to the VA regional
 

office. And it's really the VA regional office that
 

makes the final compensation decision. And our
 
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office does get about 200 to 250 medical opinion
 

cases per year relating to radiation.
 

For a case adjudicated under the nonpresumptive program, the veteran's estimated dose is
 

considered in formulating a medical opinion on the
 

likelihood that the radiation was responsible for
 

the veteran's illness. VA regulations specify that
 

when a range of doses is reported, the highest level
 

of the dose range is to be utilized. And as Mike
 

Schaeffer said, for instance, they'd give us an
 

upper bound dose and so it would be the upper bound
 

dose, not any of the more detailed doses cited in
 

their letter, that is ultimately used by the VA.
 

For veterans involved in the occupation of
 

Hiroshima or Nagasaki or those who participated in
 

atmospheric nuclear weapons tests, the DTRA is
 

mandated to provide the radiation doses, and the VA
 

does not review or vet or analyze the DTRA doses
 

independently. Essentially DTRA is mandated by law
 

to provide the doses and the VA accepts them at face
 

value.
 

But as was said earlier, a veteran who
 

disagrees with an official military dose may submit
 

an alternate dose from a so-called credible source,
 

and this would include a person certified in the
 
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field of health physics, nuclear medicine or
 

radiology. And if one dose is at least twice the
 

other dose, then a independent expert can be -- or
 

is utilized to provide an independent dose estimate
 

to resolve the disagreement.
 

Now for an occupational dose, in lieu of
 

using the DTRA dose, we would get information from
 

the file, such as the DD 1141 form which is the form
 

that most veterans had that were an occupational
 

exposure, report essentially incremental exposure
 

throughout their military career. Also as was
 

alluded to, each service has a dosimetry office that
 

maintains a dosimetry database, and those are
 

ordinarily queried to see if they have additional
 

dose information available on the veterans. And in
 

some cases, if there seems to be a disagreement
 

between what the veteran says he did in the service
 

and in the absence of a recorded dose or the dose
 

seems inconsistent with what the veteran says he
 

did, sometimes our office actually contacts the
 

military dosimetry offices and asks them to research
 

the case further. In some cases, as most of you
 

probably already know, the VA does have probably the
 

country's largest health care system, and we do have
 

our own health physics program in the VA and
 
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sometimes we actually send cases to the VA's
 

national health physics program to try to come up
 

with a dose estimate in the absence of any recorded
 

doses or if there appears to be inconsistency
 

between what's recorded and what the veteran's
 

statement describes in terms of his activities.
 

Currently the VA compares the veteran's
 

doses to screening doses developed by the Committee
 

on Interagency Radiation Research and Policy
 

Coordination, or CIRRPC, to assist in formulating
 

medical opinions when applicable. These screening
 

doses are based on the 1985 NIH radioepidemiological
 

tables and were intended to satisfy VA criteria of
 

"no reasonable possibility" and "at least as likely
 

as not" and to be consistent with the VA's
 

"reasonable doubt" policy.
 

The screening doses were determined so that
 

they correspond to the upper-bound credibility or
 

confidence value for the probability of causation of
 

50 percent. The VA utilizes the most lenient of the
 

CIRRPC screening dose tables, which is based on the
 

upper 99 percent credibility or confidence limits.
 

For non-presumptive cases, VA regulations
 

also require that other factors besides dose be
 

considered. These include the sensitivity of the
 
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tissue and specific pathology to radiation, the
 

gender and family history, age at exposure, time
 

lapsed between exposure and onset of the disease,
 

and exposure to radiation and other carcinogens
 

outside of military service. Some of these factors
 

are incorporated into the CIRRPC screening doses. 

For instance, specific pathology of some conditions,
 

the age at exposure and the latency period.
 

In 1994 our office requested that CIRRPC
 

update and expand its screening doses to reflect
 

more current scientific information and to address
 

additional diseases that the VA recognizes as
 

potentially radiogenic. We were informed by CIRRPC
 

that new screening doses could not be provided until
 

the radioepidemiological tables themselves were
 

updated. A request therefor was submitted to the
 

Director of NIH referencing the requirement in the
 

Orphan Drug Act for updating of the tables.
 

In 1995 the presidential Advisory Committee
 

on Human Radiation Experiments recommended that
 

serious consideration be given to "reviewing and
 

updating radioepidemiological tables that are relied
 

upon to determine whether relief is appropriate for
 

veterans who participated in atomic testing..."
 

Subsequently the VA and HHS have co­
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sponsored a project to update and expand the
 

radioepidemiological tables and provide the results
 

in the form of a computer software designated as the
 

Interactive Radioepidemiological Program, or IREP. 

As with the CIRRPC screening doses the IREP software
 

incorporates some of the factors to be considered by
 

VA in addition to dose. A committee of the National
 

Research Council has provided oversight review for
 

this project.
 

At present our office is using the IREP in a
 

test and comparison mode since it has not yet been
 

formally approved and issued by HHS. the NIOSH
 

version of the IREP is used in the same way for
 

cases not addressed by the NIH IREP. Based on my
 

discussion with Dr. Charles Land at the National
 

Cancer Institute, it is my understanding that the
 

current NIH and NIOSH versions of the IREP are
 

identical except for bone cancer and malignant
 

melanoma.
 

The VA's Veterans Advisory Committee on
 

Environmental Hazards has advised us to defer use of
 

the new system for actual formulation of medical
 

opinions until it reviews the IREP further and
 

recommends its use. We also plan to ask their
 

advice regarding use of the NIOSH version of the
 
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IREP for cases not addressed by the NIH IREP.
 

I will be happy to try to answer your
 

questions. Thank you.
 

DR. ZIEMER: Thank you very much. 

Questions?
 

(No responses.)
 

DR. ZIEMER: I might ask -- I'm curious
 

about the possibility of outside consultants coming
 

in and challenging the established dose records. On
 

what basis do they do that? Are they given
 

information from the site that would allow them to
 

say well, the -­

DR. OTCHIN: Well, it's a difficult issue
 

and I'm not sure I can address it, but some of the
 

people that have done it have been experts that have
 

been familiar with the DTRA program by virtue of
 

having been on some of the NAS advisory committees
 

that have reviewed some of the work in the past. 

Part of the problem -- you know, maybe Mike can
 

comment on this further -- is the issue of
 

classified information. I'm not sure how much
 

access a person coming in totally unknown to the DoD
 

would have access to the information upon which to
 

generate an alternate dose. But basically this is
 

-- and the other issue of course is cost. The
 
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feeling is that the average veteran might not know
 

whom to turn to or might not have the money to pay
 

for an independent dose estimate, so there are some
 

uncertainty of whether this is a meaningful
 

alternative, but it is contained in the VA
 

regulations and recently I did discuss -- not with
 

Jerry Steele but with some other members of the
 

staff in his office -- about sending a letter to NIH
 

to seek additional names of people that could be
 

contacted about providing at least a tie-breaker
 

third dose, so there must be some -- you know, some
 

veterans that do take advantage of this option. 

That's as much as I can say.
 

DR. ZIEMER: I could understand if there
 

were some old records where there was a question
 

about say the quality factors or radiation weighting
 

factors for neutrons and something like that. Maybe
 

that's the basis of it. It just seemed a little
 

strange.
 

MR. ELLIOTT: Neil, I thank you for being
 

here, as well as Mike and Jerry. My question -- I
 

must have lost the point or didn't understand the
 

point you made about using the VA's health physics
 

staff. Could you go over that again for me, just so
 

I understand when you engage them and why you would
 
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and why you engage them versus sending it over to
 

DTRA.
 

DR. OTCHIN: Well, these are not DTRAmandated cases. To give you an example, we had a
 

case recently of a Navy veteran that was stationed
 

in the Puget Sound area where he claimed that he was
 

involved in -- he was stationed where he'd had -­

involved duties on a super-fund away site that
 

involved radioactivity, as well as various chemical
 

carcinogens. And there was no record, as I recall,
 

or a very low dose on his DD 1141. The military
 

service had no record of any doses in their
 

dosimetry systems. But because the person claimed
 

it, I sort of felt we should see whether the VA's
 

own health physics program could contribute
 

anything, and it turned out that the VA's health
 

physics program is based in Little Rock and sort of
 

the second in command of that is a former Navy -­

nuclear Navy veteran himself. And by virtue of sort
 

of knowing about this particular circumstances and
 

that particular site and so forth, using sort of
 

worst-case estimates, was able to actually come up
 

with a dose. And in lieu of any other dose, we then
 

used that dose. So this is an unusual -- this is
 

not routinely done.
 
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But another example, sometimes a veteran
 

will claim that -- these again are not Mike
 

Schaeffer's types of cases, but a veteran will claim
 

that he was in a chemical -- the NBC* corps and they
 

had to go out and do field tests to see if they
 

could detect radioactive sources and so there would
 

be radioactive sources hidden in the field and they
 

would have to try to spot them. And because the
 

military felt this was a low-risk activity, they
 

weren't badged and so there was no doses and so
 

forth, so -­

But again, based on assumptions of distance
 

and time and shielding and other health physics type
 

concepts, actually in some cases we have managed to
 

get a dose estimate. So the bottom line I think,
 

without wanting to be too -- to sound too much like
 

a Pollyanna, I think we do make a bona fide effort
 

to get doses. If we can't get recorded doses, we do
 

at least make an effort to try to get estimated
 

doses. But those are unusual cases. They're not
 

frequent.
 

Another problem at the moment, which I
 

mentioned to you over the telephone, is veterans who
 

were stationed at Hanford or Los Alamos or other
 

places where they weren't badged, and it's been very
 
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difficult to get dose estimates for those kind of
 

veterans. And so again our health physics people in
 

Little Rock have worked with me to try to -- using
 

things like CDC draft report on on-site exposure
 

information at Hanford, to try to use that as the
 

basis for estimating doses so we have something to
 

plug in so we can give a medical opinion. If we
 

don't have a dose, we can't give a medical opinion. 

So that's sort of in a -- more than a nutshell.
 

DR. ZIEMER: Thank you. And it also
 

appeared that outside doctors can sort of declare
 

cancers to be radiogenic if they're not on the list
 

DR. OTCHIN: Well, the way that came about
 

-- and Jerry Steele may want to correct me -- is
 

that for a long time the VA used these two lists,
 

which is not up there right now, as an exclusive
 

list. And then the court system declared that these
 

lists were an added mechanism for veterans to get
 

their cases compensated, but they didn't negate the
 

ordinary mechanism for veterans to have any claim
 

that they wanted adjudicated. And as I understand
 

it -- maybe Jerry can amplify it -- this led to
 

additional diseases being accepted, but only if some
 

credible medical source issues a statement that they
 
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145 

think that that condition was related to the
 

radiation. Jerry?
 

MR. STEELE: You're exactly right. You're
 

right, Dr. Otchin. Congress enacted the -- after
 

Combee v. Brown, which held that the 311 list wasn't
 

an exclusive list. The VA position prior to Combee
 

v. Brown was that the diseases listed under 3.311
 

were exclusive and therefore if one had a disease
 

not listed, then it was denied at the regional
 

office level as not being a radiogenic disease. 

3.311 was amended to say that -- or to read, provide
 

that VA will nevertheless consider a disease not on
 

the list if the veteran has submitted competent
 

medical authority -- competent medical evidence to
 

establish a relationship.
 

Now we have historically used liberality
 

there. We go with say a chief pulmonologist stating
 

that this pulmonary condition is as likely as not
 

due to radiation. So then we will accept that,
 

although it's not a cancer, and we'll send it over
 

to Dr. Otchin for an opinion as to whether the
 

exposure to radiation at whatever level was -- is
 

likely, unlikely or at least as likely as not to
 

have resulted in this intersticial whatever
 

fibrosis. Thank you.
 
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MR. GRIFFON: Yeah. I just wanted to ask a
 

question along the lines of the presentation from
 

DTRA on the notion of not moving to more current
 

models in cases where it wasn't going to benefit the
 

claim. And I wondered and I've talked to you before
 

about this on the phone. You said you were now
 

reviewing or considering the IREP model and it -- in
 

the recent report we got from NCI they did a
 

comparison of this CIRRPC 99 percentile causation
 

values versus the IREP model and it seems that that
 

-- it will lower the amount that will be
 

compensated, and I wonder if you're considering a
 

policy rule there and -­

DR. OTCHIN: Well, as I mentioned in my
 

presentation, Dr. Land has made several
 

presentations to the Veterans Advisory Committee on
 

Environmental Hazards which was alluded to several
 

times and I actually gave them at one point a table
 

showing cases without names on them but ones that
 

would pass muster with the CIRRPC versus pass muster
 

with the IREP versus pass muster with both. The
 

ones that weren't addressed by either I didn't put
 

on the table. And it does look like the CIRRPC is
 

an easier barrier to jump over or whatever you want
 

to call it. And actually I've discussed it with the
 
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General Accounting Office when they were doing a
 

review of some of the dose issues and they felt this
 

was not surprising given the fact that we -- the
 

science is more robust, if you will, now than it was
 

in 1985 and so the uncertainty intervals have shrunk
 

down. But the outgoing chairman of the Veterans
 

Advisory Committee on Environmental Hazards, Dr.
 

Yanders*, and Dr. Warren Sinclair*, who's one of the
 

eminent radiobiologists with -- who is on the
 

committee both advised me not to utilize the IREP
 

until the committee has had greater opportunity to
 

consider it. And unfortunately, the committee is
 

somewhat in an interregnum period because they're in
 

the process of appointing replacement members, but
 

my intention would be to present the official NIH
 

IREP package and radioepi tables package when it's
 

officially released by NIH as an official, endorsed
 

publication. And they already know the implications
 

in terms of how this is going to affect compensation
 

claims. And I think obviously I'll await with
 

interest what their recommendations will be. I
 

think one doesn't have to be a rocket scientist to
 

think of what various possibilities might come to
 

mind. But at this point the committee is not
 

meeting and the IREP is not released, so we've got
 
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these two things that have to happen before it will
 

be discussed.
 

DR. ZIEMER: Thank you again for sharing
 

with us today.
 

We have opportunity for public comment now
 

on our agenda. I have requests from two individuals
 

to speak. First, Richard Miller. Richard, if you
 

want, you can use the podium.
 

MR. MILLER: Good afternoon. My name is
 

Richard Miller, Government Accountability Project. 

I feel like we all meet each other in hotel lobbies
 

and hotel rooms like this regularly. It's our fifth
 

opportunity to meet in a hotel. We should stop
 

meeting like this.
 

I'd like to touch on at least today three
 

different topics, the first of which is I was very
 

encouraged to hear from Larry about -- in his
 

presentation today that soon we will have a
 

contract. Obviously some unfortunate circumstances
 

have led to this delay. But one of the issues that
 

we have raised in earlier advisory committee
 

meetings was this concern about the population set
 

of contractors that are going to be bidding on this
 

work and the potential for conflict of interest. 

And now that you're in the BAFO stage, or maybe
 
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you're in the give-us-your-real-BAFO stage, it seems
 

to me it would be very helpful for the advisory
 

committee to provide some guidance. Maybe, you
 

know, it's inappropriate, but I don't think it is. 

You know, you're not getting involved in
 

procurement-sensitive issues to make recommendations
 

any more than you were when you reviewed requests
 

for proposal and could have commented on it. I mean
 

the RFP does discuss the conflict of interest and
 

invites a plan from the bidders.
 

The degree and extent to which the potential
 

for conflict arises is so broad in terms of the
 

potential for companies, for example, who are
 

bidding or who get awarded the contract actually
 

would be reviewing their own company's work product
 

elsewhere, or professionals who work for one company
 

may be reviewing their former colleagues or even
 

their own work product at other locations. Or they
 

may have current contracts or expect future
 

contracts that they're bidding on involving sites
 

where they could be reviewing dose reconstruction. 

And so, you know, for claimants to have some sense
 

of transparency that knowing that the individual -­

not necessarily the company is 'cause you've got
 

this problem. I mean you're in a box. It's a
 
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shallow pool. There's a limited number of bidders,
 

you know. You can -- you know, people are going to
 

drink from the stream if they want to. But if
 

there's some possible way to try to have a dialogue
 

about what constitutes an appropriate level of
 

disclosure to the claimant so that they know at the
 

end of the day that the individual or group of
 

individuals working on their claims do not have a
 

potential for conflict of interest, given all of the
 

-- shall we say subjective and judgment-specific
 

calls that have to get made along the way by these
 

individuals. I think that would be very, very
 

helpful. And this is in no way a comment on the
 

integrity of people that NIOSH itself has on staff,
 

but I worry about who these contractors might be.
 

Which sort of brings me to the next point,
 

which I suspect is going to get raised again, but
 

just -- by others, but just we're pleased to see
 

that the Senate Appropriations Committee took it
 

upon themselves to put some nice language in
 

commending NIOSH for their fine work on this
 

program, particularly encouraging the Centers for
 

Disease Control to think about allocating some more
 

Federal staff so that Jim Neton has a little bit
 

more help over there over than four health
 
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physicists reviewing this sea of paper. I would not
 

sleep well at night if I had to think about how much
 

paper four people have to review, and I think it'll
 

create a huge logjam and maybe the committee can
 

address that in some way.
 

And then the last is really specific to a
 

policy question regarding the special cohort rule
 

and which I would really like to see the committee
 

take up. And I just want to read you a statement
 

that was made at one of the meetings -- field
 

meetings. It was made on the special cohort, you
 

know, four -- one of the four field meetings. And
 

one of the NIOSH officials stated -- and I'm just
 

going to quote from the transcript here, if that's
 

okay. (Reading) And the last point I just want to
 

make is that the decisions to add a class to the
 

cohort are really in a sense grave decisions, and we
 

view them as grave decisions. They are important
 

consequences because if you add a class to the
 

cohort, the members of that class can then only be
 

compensated for the 22 cancers that are specified
 

cancers, as allowed by the energy employees act -­

allowed by law. And if you have a different cancer,
 

you cannot be compensated under this program. For
 

example, if you have prostate cancer or skin cancer. 
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So when we make decisions to add a class to the
 

cohort, it's a grave decision. It's an important
 

decision that has real implications for some members
 

of that class, in all likelihood, because some
 

members of a class are likely to have skin cancer or
 

prostate cancer.
 

So the question is, what do you do about the
 

non-SEC cancers. Mark Griffon I guess and others
 

maybe raised this a little bit earlier, and I want
 

to just sort of walk through what I think are the
 

outlines of the problem or the contours of the
 

problem and whether to suggest perhaps this needs to
 

be addressed in the rule in some way, shape or form,
 

perhaps. And so let me just lay out what I think
 

the policy questions are and then perhaps a remedy.
 

The policy question, it seems to me -- and
 

again, this is not laid out in the rule -- blocks
 

anybody in a Special Exposure Cohort class from
 

seeking -- in effect, if that statement as it was
 

made is accurate -- for non-SEC cases, non-SEC
 

cancers in all circumstances.
 

Now classes, as -- in the rule are defined
 

by time and exposure. And you can imagine
 

circumstances where individuals -- by definition if
 

you can't reconstruct their dose and they have a
 
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non-SEC cancer, they're out of luck. And it's by
 

definition that's the case. The question is, what
 

happens to doses -- as Mark was mentioning perhaps
 

earlier -- that bookend. So say you worked in -­

and one of my favorite facilities recently has been
 

Numec* and Apollo*, Pennsylvania, in which, you
 

know, there were clearly periods of time where there
 

were very hazardous conditions and it looks like
 

pretty shoddy exposure assessment work. Might be a
 

candidate potentially for special cohort, say
 

between 1960 and 1980, but in 1980 to 1985 there
 

might be adequate dose records.
 

So then the two policy questions that arise
 

are this. One, will people who have non-SEC cancers
 

be able to apply for the '80 to '85 time period. 

And the second question is, and more difficult in
 

the rule, is can any of the dose that was received
 

between 1960 and 1980, which by admission you can't
 

estimate except that you come up with a potential
 

dose to go into your endangerment algorithm into
 

IREP. Can any portion of that dose be applied to
 

that non-SEC cancer, or even an SEC cancer -­

doesn't matter which cancer it is, really -- between
 

the periods 1980 and 1985. In other words, is -- is
 

by virtue of having declared that you can't estimate
 
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the dose between 1960 and 1980 in this example mean
 

that therefore none of that potential dose can be
 

added to the '80 to '85 period. That's one
 

question.
 

And if you can, then the second related
 

question is what would it be? Would it be that
 

potential dose that you use to plug into the IREP
 

models or do the worst-case or worst possible
 

potential case or -- I don't want to characterize it
 

'cause it's not what the rule says, but sort of the
 

potential dose estimate. Then you have a corollary
 

problem 'cause it's already sort of clear on that
 

one example, sort of -- kind of that puzzle that has
 

to -- and then the question is can the -- and can
 

the rule deal with that. And I think there may be
 

practical solutions to this.
 

This one's a little harder, but it's the
 

corollary to this if you turn this one upside down,
 

and that's if you accept the endangerment criteria
 

that's been established and proposed at least in
 

this rule, which is the -- come up with a potential
 

dose estimate and then you try to somehow fathom
 

what cancers might be caused by that. I mean I
 

don't know where all the biokinetic models are going
 

to come from that are going to assign particular
 
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isotopes to particular organs because they don't all
 

exist, but somehow that's going to happen. And then
 

you'll figure out whether the most radiosensitive
 

solid tumor is going to make you eligible or if it's
 

leukemia then you split the difference. I mean it's
 

this sort of algorithm you have there.
 

But let's think about this. What happens if
 

you go through that endangerment algorithm and you
 

only come up with a 40 percent probability of
 

causation for the class. You've concluded you can't
 

estimate the dose, but when you get to the
 

endangerment question and you've only got 40 percent
 

-- you don't get over that 50 percent or 51 percent
 

threshold in the IREP model -- can you account for
 

dose those individuals, say in the same case, might
 

have received between '80 and '85 to push them over
 

that 40 percent, or can you only consider the dose
 

within that cohort time frame.
 

Now this gets tricky because then you're
 

going to say well, wait a minute. Between that 1980
 

and '85 period, some people may have been working. 

Some people may have been new into the work force. 

Some people may have not been in hazardous working
 

environments. Some people may have been very wellprotected and some may not. And so the definition
 
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of the cohort between '60 and '80 may be different
 

than the difference between '80 and '85. But
 

nevertheless, what you've got is this puzzle. 

You've got this sort of interesting question about
 

can you include any dose received outside the time
 

and space of the Special Exposure Cohort, 1960 to
 

'80 in this case, that you could then supplement -­

it's sort of the inverse of the puzzle.
 

Now how to deal with this. Maybe there's an
 

easy answer to all of this and -- and I'm wasting my
 

breath, but I didn't see it in the rule. And the
 

more I thought about the comments that were made at
 

the public hearings, the more provocative this got
 

because it gets messy. And I think what would be
 

helpful is if NIOSH staff could come up with sort of
 

an options paper on how to deal with this. That's
 

one idea. And let the Board look at the options
 

paper and then make a recommendation on which one to
 

incorporate in the rule or as modified. Right? 

However y'all want to deliberate, it's your
 

challenge. But -- but that's one.
 

Another is that your working group, your SEC
 

working group come up with a solution to this, in
 

which case you all deserve a pay raise, and -- or
 

maybe it just ought to be debated out here. But I
 
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don't think this rule is ready for prime time until
 

you grapple with this because I think you'll deal
 

with this whenever you have an SEC that doesn't
 

cover the entire history of a facility. Or at least
 

a huge period of time.
 

And then the question becomes, if you have a
 

non-SEC cancer at a gas diffusion plant, how do you
 

deal and can you impute any of the time periods
 

between when the plants opened in 1992 when it's
 

presumed the dose can't be reconstructed or are you
 

just going to go ahead and reconstruct those. And
 

what I think I've heard from NIOSH on that is
 

they're just going to go try and reconstruct them.
 

But where you've actually made a physical
 

determination through examination of records and
 

your best analysis that you can't reconstruct that
 

dose, and you're going to then posit some potential
 

dose for inclusion in the IREP model, is that going
 

to be a useful estimation process for helping and
 

can any portion of that dose then be applied to
 

other claims that fall outside that time period. So
 

that's sort of the policy question that I see.
 

I think that sort of summarizes it 'cause I
 

think -­

DR. ZIEMER: Thank you, Richard. Let me ask
 
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if any of the Board members have questions for
 

Richard on the comments he just made.
 

DR. MELIUS: I just have a follow-up. I
 

believe we've talked about this conflict of interest
 

issue before and I think Larry deferred it because
 

of the contractual situation, but if the contract is
 

awarded by our next meeting, I really think we
 

should have a presentation, some discussion of the
 

-- of that issue. And I think Larry will be -- then
 

be free to talk to us about it. So I'd like that on
 

the agenda for the next meeting, or whenever the
 

meeting is following the awarding of the contract.
 

MR. MILLER: Does that -- let me just ask a
 

rhetorical question. Isn't that closing the door
 

after the horse has left the stable?
 

DR. ZIEMER: Since that's a rhetorical
 

question, it doesn't call for an answer, but we're
 

all pondering it heavily here. Henry?
 

MR. MILLER: Just may the record reflect a
 

pause.
 

DR. ANDERSON: A quick question, Larry. Do
 

you see the dose reconstructions kind of being
 

anonymous or will whoever did it have their name
 

attached to it so that the claimant could see that
 

this is the person that did it and here's their
 
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159 

credentials and have some sense that they know that
 

they could do the -- their concern about any
 

conflict of interest, or is it going to be
 

anonymous?
 

MR. ELLIOTT: As I've said before, completed
 

dose reconstructions are NIOSH work. They will come
 

across to the claimant as a NIOSH product, using
 

NIOSH letterhead and a NIOSH report to transmit that
 

information.
 

I didn't answer your question. I hear
 

somebody saying that. I did answer the question. 

No, you will not see the name of the individual dose
 

reconstructionist from the contractor on the
 

transmittal of the report. Whether we have it -- I
 

think we will have it on the individual draft dose
 

reconstruction report and on the final. Am I
 

correct, Jim? That's the way the current reports
 

are set up so we know who conducted -- who was the
 

dose reconstructionist. We know who was the
 

reviewer. We know who reviewed the reviewer's work.
 

DR. NETON: That's correct.
 

MR. ELLIOTT: But again, it's a NIOSH
 

product. We take -- we are the ones held
 

accountable for that.
 

MR. MILLER: So does that mean the claimant
 
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will never have access to that information?
 

MR. ELLIOTT: Again, the claimant will get a
 

NIOSH letterhead transmitting the dose
 

reconstruction report that will indicate who the
 

dose reconstructionist was.
 

MR. MILLER: Okay.
 

MR. ELLIOTT: Who the reviewer of the dose
 

reconstruction was and who reviewed that reviewer's
 

work.
 

MR. MILLER: Okay. So they will get -­

MR. ELLIOTT: They're going to see all
 

three, but they're not going to have access, per se,
 

to that individual dose reconstructionist, if that's
 

what you're seeking.
 

MR. MILLER: Well, I guess the question is
 

will the resumés of those individuals be available
 

to claimants.
 

MR. ELLIOTT: I'd have to defer and -- I
 

don't have an answer for that question at this time.
 

DR. NETON: I think we're getting into
 

issues that are related to our contract
 

negotiations, really.
 

MR. MILLER: Oh, so that's great, so you're
 

dealing with this. Okay. Thank you.
 

DR. ZIEMER: Thank you, Richard.
 
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161 

MR. ELLIOTT: I can't let that go. Yes, we
 

are dealing with this. We're very serious about
 

this conflict of interest and certainly your
 

comments are well-taken and they have from the very
 

start, Richard. And once the contract is awarded,
 

the conflict of interest plan that's been negotiated
 

and put in place will be available, and I think
 

that's a key document. That's more of a key
 

document to your understanding of how we're
 

addressing this than the individual dose
 

reconstructionist's name and resumé.
 

DR. ZIEMER: We have another public comment
 

from Joseph Carson. If I read this right, Joseph is
 

Department of Energy. Is that correct?
 

MR. CARSON: Correct.
 

DR. ZIEMER: Thank you.
 

MR. CARSON: Well, good day, Dr. Ziemer. I
 

think it's about ten years since we've last spoken.
 

Anybody know who I am? Joe Carson, DOE
 

whistle-blower, prevailed eight times? I don't want
 

to belabor points.
 

I'm a safety inspector in DOE nuclear worker
 

safety. My background, Navy scholarship to college,
 

six years an officer on submarines, worked at
 

commercial nuclear power plants in the eighties,
 
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162 

joined DOE in 1990, so I didn't grow up in DOE. I
 

was hired to be an OSHA NRC inspector.
 

Following the Chernobyl reactor accident the
 

National Academy of Sciences did a review -- I'm
 

from New York, as you can probably tell, and I want
 

to talk quick so you can get out. Okay? -- review
 

of safety of DOE reactors. One of the
 

recommendations was DOE should mimic the NRC, which
 

following Three Mile Island has placed resident
 

inspectors at all commercial nuclear power plants so
 

that the NRC and headquarters would have another way
 

of getting safety -- as opposed to getting it from
 

the utility, could also have their people providing
 

another insight into the safety conditions at the
 

plant.
 

So at that point in time, you know, DOE is
 

still self-regulating in both worker safety and
 

nuclear safety. I was hired to be a headquarters
 

safety inspector, primarily in Oak Ridge, but I
 

reported back to headquarters. Dr. Ziemer was the
 

Assistant Secretary. Not initially, I think he
 

became Assistant Secretary sometime in '90 through
 

the Bush administration, so he was my first
 

Assistant Secretary.
 

At the time DOE was very -- and still is
 
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very dependent upon support service contractors. 

You're talking about your contractors here. I was
 

working alongside primarily support service
 

contractors, and I found that it was kind of like a
 

Persian court where the viewing manager would be the
 

caliph, the support service contractors would make
 

about $200 an hour, would be kind of fawning down
 

because the manager had complete control of how much
 

work they would get, and the DOE employees were at
 

the back of the bus.
 

I voiced concerns about the use of support
 

service contractors and basically, to make an
 

example out of me, they started throwing my safety
 

findings away so they could fire me for cause. And
 

I said -- you know, not only -- this -- and this
 

happened about the time when Dr. Ziemer was still
 

there. I said not only -- you know, you're going to
 

go after me, but what about all the people you're
 

putting at risk? And this is DOE self-regulating
 

safety and you're the regulators willing to roll
 

dice with people's lives to go after me, so I dug in
 

my heels and here we are ten years later. DOE has
 

now paid over $400,000 in my legal bills.
 

The sickest thing about the whole entire
 

process is when you prevail as a whistle-blower,
 
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164 

nothing ties it back to where the safety concerns
 

get addressed. It's kind of like when you're a
 

victim in a crime, you know, the victim gets kind of
 

ignored sometimes. The safety issues that motivate
 

a whistle-blower, at least in DOE, they're often -­

I could win 100 times, they could pay millions of
 

dollars, but DOE will actually turn around and say
 

we were not ordered to address your safety issues,
 

so we won't.
 

Well, MSPB is there to fix -- you tried to
 

fire him, you can't fire him. You tried to reassign
 

him, you can't reassign him. What is MSPB going to
 

say about safety issues? All they have to do to
 

prevail as a whistle-blower is show they're
 

reasonable, so MSPB doesn't order DOE to address the
 

safety issues. DOE turns and says we weren't
 

ordered to, so we won't. So I'm -- it's like
 

Groundhog Day. I go back and say well, I'm a
 

licensed P.E. My options are resign, blow the
 

whistle or both. Well, here we go again, yeah, and
 

it's been going on for ten years.
 

So what does that mean to you? A couple of
 

things. One of my initial findings that was
 

suppressed by EH -- off course EH had a
 

responsibility for it -- by Peter Brush*, who was
 
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the principal deputy to Dr. Ziemer -- and this is
 

all in writing -- was that DOE's accident
 

investigation program was totally broken -- in Oak
 

Ridge, at least. I identified that approximately 80
 

accident investigations -- serious accident
 

investigation fatality, a serious injury, a serious
 

workplace exposure, a release to the environment. 

There'd been approximately 80 -- of course Oak Ridge
 

didn't exactly know how many, but in the eighties
 

and early nineties, not once for any accident
 

investigation was there any verification of any
 

corrective action. Not once. So what'd happen is,
 

people who knew this, when they would go out to do
 

an accident investigation, they would basically
 

phone it in. Nothing's going to get fixed anyway. 

And when I tried to document that because EH had a
 

responsibility for the follow-up or the tracking of
 

the accident investigations, because I was
 

embarrassing my own management, they suppressed it.
 

I said what about safety? As a licensed
 

P.E. I have a legal obligation to hold paramount the
 

health, safety and welfare of the public and the
 

workers in the performance of my professional duty. 

So I said to DOE you knew I was a P.E. when you
 

hired me. I'm just being a P.E. and I'm required
 
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legally to blow the whistle when necessary. I'm
 

just doing my lawful duty.
 

I'm named after a New York City fireman. 

I'm wearing my grandfather's ring. I guess came to
 

view the wrong set of values.
 

All right, so let's talk about the sick
 

workers. My contention is DOE treated these workers
 

as expendable, and what I handed out to you today is
 

DOE in a microcosm. In 1994 I was involved in
 

investigating a fire at a reactor at Brookhaven
 

National Lab. During the fire there was a
 

measurable release of radiation to the environment. 

A number of the first responders were contaminated. 

The interior of the reactor building was
 

contaminated. DOE later claimed that no safety
 

violations had occurred at the fire, which I knew to
 

be a complete lie, so I told my -- I did point --

Dr. Ziemer had moved on. I told my supervision. 

They tacitly agreed with me, but when the report
 

came out, no mention of the safety violations. When
 

you have a fire and you have people risking their
 

lives as first responders to put the fire out, and
 

there are safety violations that cause the fire and
 

there's a cover-up of the safety violations, you're
 

treating those first responders as if they were
 
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expendable, and that's what DOE did.
 

And that -- in this case, here we are eight
 

years later. I have gone all the way to the
 

President with this issue and DOE's representation
 

is it wasn't a nuclear facility because the uranium
 

that was used in this experiment, before it was
 

irradiated with neutrons or exposed to neutron
 

flux*, wasn't that hazardous.
 

Well, that's true, just like new nuclear
 

fuel is not that hazardous. If you have it in your
 

garage, you're not going to have a problem with it. 

But if you put a spent nuclear fuel rod in your
 

garage, you're going to be dead pretty quick. And
 

this experiment would take neutrons from the reactor
 

and irradiate a fissile target of uranium, creating
 

basically fissions in that uranium. So this
 

experiment was surrounded by heavy shielding walls. 

When the experiment was done, the target was treated
 

as high level nuclear waste, and now DOE has
 

represented to the President it wasn't a nuclear
 

facility because before the target was exposed to
 

the flux it wasn't that dangerous.
 

So but my issue is, DOE, why don't you just
 

tell the President we don't need Yucca Mountain
 

because the new nuclear fuel's not that dangerous,
 
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either. So that's the kind of rigmarole I've
 

experienced from DOE.
 

So what does this mean to you? I would have
 

to question -- okay, additionally, the sick workers. 

Here now you -- you're the advisory committee. I'm
 

going to make a contention, making this as a P.E. 

If you don't think it's accurate, please, file an
 

ethics complaint against me. Please, because DOE
 

will not address my issues. I want them addressed
 

somewhere in some form. These sick workers are a
 

workplace health and safety disaster of national
 

scale. Just like Enron, WorldCom, Global Crossing,
 

CPA and lawyer disasters, so to speak, which is
 

financial, who has said where were the safety
 

professionals when all these people were being
 

exposed? Where were the people who had legal duties
 

to hold paramount the health, safety and welfare,
 

risking their jobs, risking their careers if
 

necessary to do their duty by the health and safety
 

of the workers? That's what all these Codes of
 

Ethics say. That's what the law says. It didn't
 

happen and no one is saying it. We're tacitly part
 

of a cover-up and then we're turning around, saying
 

to the same safety professionals, tell us what
 

happened, without even saying you did wrong.
 
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If you think I'm wrong, where are all the
 

safety professionals now? I have won and won and
 

won. You think they would be insulted. Oh, no,
 

it's my personal problem. My personal problem. So
 

they can go home, get their fat paychecks, get their
 

pretty easy jobs and say well, it's just Joe's
 

personal problem, just like the DOE will say he's
 

emotionally unstable. He's a threat of workplace
 

violence. Because it's like the politics of
 

personal destruction at a retail level. If I could
 

be discredited personally, you don't have to deal
 

with the technical issues, do you?
 

Okay. I'm squeaky clean. I have a Q
 

clearance. DOE has dirt on me. Where is it? It's
 

going on for ten years. My life's an open book. My
 

wife is the president of PTA. I teach Sunday
 

School. Okay? I'm involved in leadership positions
 

in a number of leading professional societies. 

Where's the dirt, DOE? When are you going to deal
 

with the technical issues? I'm really right now at
 

the point that one or more Senators going to put a
 

hole in as DOE Deputy Secretary to persuade DOE it's
 

not going to get away with it anymore. Just last
 

week DOE said a settlement of my case is not,
 

quote/unquote, legally warranted. Well, when is a
 
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settlement ever legally warranted. Try to persuade
 

DOE that doing the right thing is going to be
 

politically warranted, or hopefully someone in the
 

Senate will.
 

I'm saying that you can't trust any of those
 

safety records. You can't trust the safety
 

professional providing it to you. You may say I'm
 

wrong. Well, let's address what -- are the sick
 

workers a health and safety -- workplace health and
 

safety disaster? If so, where was the breakdown in
 

the Code of Ethics? Where was the breakdown by the
 

professionals by their professionals, and let's try
 

to get to the bottom of that aspect of it 'cause I
 

think that will give some answers to how much
 

reliability can be placed on the safety records by
 

which you're going to be -- or you'll be advising
 

the people who'll be making the determinations about
 

claims for people.
 

So some suggestions. Acknowledge the
 

possibility that the DOE workers are a workplace
 

health and safety disaster and ask the appropriate
 

safety professions and professionals to evaluate was
 

there a breakdown in the Code of Ethics in their
 

professional duty, individually and collectively. 

What should be done about it?
 
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The handout I gave about this HFBR fire. I
 

would request this advisory committee request the
 

DOE do in fact a differing professional opinion as
 

to whether I was right or wrong about that facility
 

being a nuclear facility because if I'm right, it
 

has EH implicated, the Office of Science implicated,
 

the DOE IG implicated in a cover-up, right up to the
 

Secretary -- or I should say the Assistant
 

Secretary.
 

Discretionary function. One reason we're
 

here is because discretionary functions have been
 

used over the years by the courts to prevent workers
 

from getting claims. I'm not an attorney, but I
 

have to ask the question, does discretionary
 

function allow DOE to suppress, as in my case, a
 

licensed safety professional from doing their duty
 

and then to punish them for it? Does the government
 

have the discretion to do that, too? I don't think
 

so, but I think that's a question the court should
 

address.
 

Conflict of interest. I'm speaking about
 

what Richard Miller said. I think one way to
 

address conflict of interest is what things -- what
 

do your -- and the dose reconstruction people, if
 

they're certified as something or other, what are
 
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their professional ethics? How are they relevant to
 

conflicts of interest? What -- where's that
 

professional accountability that might -- you know,
 

if there's a conflict (inaudible) on one side, but
 

on the other side, you know, this is where we rely
 

upon professional ethics to try to bring things back
 

to an even keel. What is the applicability of that?
 

Okay. Those -- that's my comments. I'd
 

appreciate any questions you may have.
 

DR. ZIEMER: Okay. Are there any questions
 

for Joe? Joe, you particularly expressed concern
 

about the reliability of those records that we'll be
 

depending upon. Are you suggesting that they may be
 

altered or we're just not going to be able to get
 

what we need or -- can you give us -- what's -- from
 

where you sit, what does that look like? We've had
 

some concern, number one, about getting full
 

records. I don't think we've been so concerned that
 

there's folks sitting there trying to doctor them,
 

per se. But can you flesh out a little bit about
 

your concern about those records or -- flesh that
 

out a little bit 'cause I think we want to be sure
 

we get full records.
 

MR. CARSON: Well, I'm going to speak first
 

personally and I'll try to expand on it. As an EH
 
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safety we had databases that we would keep our
 

safety findings, and they were erased twice and we
 

basically start all over. So my first question
 

would be how complete they are.
 

My next question would be -­

DR. ZIEMER: Now when those things occurred,
 

was there a record made of the loss of information
 

to -­

MR. CARSON: No, that was one of the things
 

I blew the whistle about and suffered the punishment
 

for. No, there was not.
 

And these type A and B accident
 

investigations, there is still records that these
 

investigations occurred, but there's no record that
 

corrective action was ever completed and they
 

basically just kind of waved their hands over them I
 

guess in the late nineties.
 

I would also have -- suspect if you're a
 

industrial hygienist, a health physicist, and you
 

were told don't find positive readings, that you may
 

have readings there but they were not accurate
 

readings in some -- to what people were exposed to. 

And I guess the phrase that came up three years ago
 

at Paducah was midnight negatives, when they would
 

vent the cascades to the atmosphere at night so no
 
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one would see it and they would call it midnight
 

negatives, you know, 'cause they wouldn't be keeping
 

track of what was going up the stack.
 

It's some very stark realities in DOE. You
 

know, DOE had security clearance, and I would not be
 

here at this point had the Cold War not ended
 

because they tried to pull my clearance. There is
 

no due process for pulling a clearance. They can
 

just pull it for any reason, and if your job
 

requires you to have a clearance, that's grounds to
 

terminate you 'cause basically for DOE or a DOE
 

contractor, triple play. One, you know, you're
 

fired; two, you're personally discredited; three,
 

you're black-listed in the industry the rest of your
 

career -- 'cause if you ever lose a clearance at one
 

place, you can never work, at least in nuclear
 

power, again. So it's pretty -- you know, pretty
 

high odds, pretty -- you know, I'm -- be honest,
 

that's -- you know. I served on submarines for six
 

years. I was willing, if so ordered, to play an
 

active part in the deaths of millions of people. It
 

wasn't so I could just look the other way at what I
 

saw wrong in DOE. But to -­

So in trying to address your question, Dr.
 

Ziemer, I would question the completeness, I would
 
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question the accuracy, I would question -- you know,
 

the -- again -- and this is the -- and another
 

aspect of the bigger issue, how much -- you know,
 

who are you going to trust? How much could those
 

technicians -- you know, they -- were they in fact
 

to some degree subject to biases, they make -- write
 

them less than what they really are? And that's
 

what I'm asking because some of the things in my
 

case, it's talking by extract -- interpolation, but
 

that's -- that's my -- that's my point.
 

DR. ZIEMER: Yeah. Okay, thank you. 

Additional questions? Yes, Sally.
 

MS. GADOLA: I was wondering just which
 

facilities you were particularly talking about in
 

Oak Ridge, if you could make that clearer, please.
 

MR. CARSON: Well, at Oak Ridge I was a
 

headquarters resident so I went to all the sites at
 

Oak Ridge -- K-25, X-10, Y-12 -- and I saw some
 

similar issues in each. Like I would be looking at
 

hoisting and rigging -- well, the accident
 

investigation was cross-cutting. You know, there
 

would be -- Oak Ridge, that would even be looking at
 

reports from Paducah and Portsmouth, which at the
 

time were reporting back to Oak Ridge, the Oak Ridge
 

operations office. But in my field inspections, I
 
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would be at all three sites. Am I answering your
 

question? I'm not sure I fully understand your
 

question.
 

MS. GADOLA: Yeah, you are answering. That
 

was what my specific question was, and Dr. Ziemer
 

also asked the other question that I had and that
 

was changing safety records and reporting, which is
 

something that I've expressed concerns about that
 

I've seen happen in private industry and it's
 

something that I've been questioning that -- that
 

has this also happened in DOE facilities. So I
 

appreciate your addressing that.
 

MR. CARSON: You know, there are two ways of
 

-- you know, one lie is not write anything. 

Another lie is to say -- write something -- you
 

know, sample where you think you're going to -­

you're going to get what you want to find and not
 

what you don't want to find. You follow me? 

There's a scale of gray, so to speak, as the poets
 

would say. Someone actually went in and read A and
 

wrote B, well, that's one thing that may have
 

happened. But it's more -- I would think more
 

likely either someone decided not to go in and read
 

or someone didn't go there, they read somewhere else
 

and said I think I was close enough. You know,
 
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there's any number of ways to kind of nick it, you
 

know.
 

MS. GADOLA: Right, and sometimes people
 

have good intentions, but sometimes genuine mistakes
 

are made, too, especially if people are not as
 

careful as they should be.
 

MR. CARSON: Well, let me -- DOE, as you may
 

know, pays the highest salaries in the Federal
 

government. And when I say that, you're going to
 

say how can that be, isn't everything by grade and
 

whatever, whatever? Yes. And if you go to DOE,
 

you're a grade or two above what you would be just
 

about anywhere else. So you might think DOE gets
 

the best and the brightest. My perception is no,
 

you get people who put up with it because they get a
 

little more money, and that's why they don't want to
 

voice a concern because they can't get paid that
 

much anywhere else. And they're saying that there's
 

-- there's a greed and a fear that was at -- that
 

was -- still -- still is today very much present at
 

DOE. What you would think -- you would think, you
 

know, 20 -- DOE I mentioned is self-regulating. Why
 

are not all the engineers in DOE licensed
 

professional engineers, at least to give some
 

individual professional accountability. I would not
 
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have experienced what I've experienced in the last
 

ten years if these engineers were P.E.'s 'cause I
 

would go after them through the state boards. DOE
 

may reward them, but the state boards might take a
 

different view of things. So just to -- I'm just
 

trying to -- there's just up and down.
 

You know, and I'll point the finger at the
 

safety professionals. In that handout you have a
 

bunch of letters written in the last couple of
 

months, AAAS has written letters about my behalf,
 

NSPE -- and again, I don't want to be selfaggrandizing, but these are firsts because the
 

bullets are still flying, legally. And these -- and
 

the profession actually showing some cohesiveness -­

Code of Ethics? Unheard of. So you know, you're
 

seeing the pioneer at the frontier of engineering
 

ethics. But you see DOE, I think, as the wasteland
 

that happened with these sick workers because too
 

many other people just basically said I don't want
 

you to get sick. I'm not going to put it in
 

people's heads, but push to shove, my economic wellbeing takes precedence over your physical wellbeing.
 

MS. GADOLA: Well, I'm sure we appreciate
 

your comments and different people have different
 
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opinions about what actually happened, but I think
 

the more light that's shed on the whole picture, the
 

sooner we can get more actual truthful information.
 

MR. CARSON: Yeah, I don't want to -- and
 

it's not so black and white. It's a tapestry. It's
 

complex. That's why I'm saying let's look at it
 

from the perspective of was there -- was the Code of
 

Ethics inadequate? Was the implementation
 

inadequate? Was it both? Because if it was, what
 

has changed to make it better now? If it's not -­

you know, if you're going to trust the
 

prescriptions, you have to trust the diagnosis. I'm
 

saying that's part of the diagnosis that has not
 

been evaluated.
 

MS. GADOLA: Right. Sometimes you need to
 

re-evaluate the whole big picture again, and I think
 

that's what you're getting at. Thank you.
 

MR. CARSON: Okay.
 

DR. ZIEMER: Okay, additional comments or
 

questions for Joe? Okay, Joe, thank you very much
 

for being with us today.
 

MR. CARSON: Thank you.
 

DR. ZIEMER: Were there any other public
 

comments? I only have the two signed up, but -­

that's it? Thank you.
 
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There will be opportunity tomorrow again for
 

public comments, if additional individuals wish to
 

make such.
 

Tomorrow morning the schedule is as shown,
 

beginning at -- 8:00 to 8:30 is really your chance
 

to get here, grab a snack and chat a little bit. 

The actual gavel will hit the table at 8:30. The
 

main things on our agenda tomorrow are discussions
 

on Special Exposure Cohort and on the dose
 

reconstruction work group's recommendations.
 

Let me see if there's any administrative
 

things we have to take care of today. Any -- okay,
 

the room will be locked, so you can leave materials
 

here if you need to overnight. Anyone have any
 

other -- oh, those that -- the working groups -­

Mark, your working group is going to get together?
 

MR. GRIFFON: Yeah, I was just discussing -­

I mean I'll offer to -- I'll talk with them after
 

this, but I was going to offer to draft something
 

tonight and then maybe meet a half an hour before
 

the meeting. Is that okay?
 

DR. ZIEMER: Meet here?
 

MR. GRIFFON: Yeah, meet here, and I was
 

going to ask the same, Paul, for your -- is your
 

group going to get -- 'cause I was going to get some
 
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-- the reason I don't want to meet right now is I
 

have some written comments for the SEC that I'd like
 

to get to your group and -­

DR. ZIEMER: Right.
 

MR. GRIFFON: -- how can -- how can people
 

do that if they wish to get written stuff to you?
 

DR. ZIEMER: Well, I'm -- again, I can
 

compile it tonight if -- unless the group wants to
 

meet briefly. But would you want me to compile it
 

and then meet in the morning? We could meet at
 

8:00, go over it. Is that okay?
 

MS. MUNN: Okay.
 

DR. ZIEMER: You'd rather meet tonight, huh,
 

Wanda?
 

Well, yeah, the thing is, 8:00 o'clock is
 

what, 5:00 and -­

MS. MUNN: Yes, it's 5:00 a.m., but that's
 

all right. You don't expect much of me. Right?
 

DR. ZIEMER: Well, okay. We'll work it out. 

So we'll recess now and reconvene tomorrow morning
 

at 8:00 -- 8:00 o'clock.
 

(Meeting adjourned at 5:35 p.m.)
 
 

 

 

___________________________ 

 

182 

 

C E R T I F I C A T E
 

STATE OF GEORGIA : 

: 

COUNTY OF FULTON : 

I, Steven Ray Green, Certified Merit Court
 

Reporter, do hereby certify that I reported the
 

above and foregoing on the 14th and 15th day of
 

August, 2002; and it is a true and accurate
 

transcript of the proceedings captioned herein. 

I further certify that I am neither kin nor
 

counsel to any of the parties herein, nor have any
 

interest in the cause named herein.
 

WITNESS my hand and official seal this the
 

14th day of September, 2002. 

STEVEN RAY GREEN,
 

CERTIFIED MERIT COURT REPORTER
 

CERTIFICATE NUMBER: A-2102
 
183 

Presidential Advisory Committee
 

Department of Health and Human Services
 

Centers for Disease Control and Prevention (CDC)
 

National Institute for Occupational Safety and Health
 

(NIOSH)
 

Advisory Board on Radiation and Worker Health
 

VOLUME II
 

The verbatim transcript of the Meeting of
 

the Advisory Board on Radiation and Worker Health
 

held at the Hyatt Regency Cincinnati, 151 West Fifth
 

Street, Cincinnati, Ohio, on August 14 and 15, 2002.
 

NANCY LEE & ASSOCIATES
 Certified Verbatim Reporters
 P.O. Box 451196
 

Atlanta, Georgia 31145-9196
 

(404) 315-8305
 
 

184 

C O N T E N T S
 

August 15, 2002
 

Registration and Welcome, Dr. Paul Ziemer, Chair.190
 

Rev Board Discussion - Special Exposure Cohort NPRM 

Comments on the Rule . . . . . . . . . . 191
 

Board Discussion - Process to Review Completed Dose
 

Board Discussion - Special Exposure Cohort NPRM
 

Administrative Housekeeping and Board Work Schedule
 

Reconstructions . . . . . . . . . . . . .288 

Public Comment Period . . . . . . . . . . . . . .325
 

Comments on the Rule . . . . . . . . . . 359
 

Board Discussion . . . . . . . . . . . . . . . . 394
 

. . . . . . . . . . . . . . . . . . . . .432
 

Public Comment Period . . . . . . . . . . . . . .439
 

Adjourn . . . . . . . . . . . . . . . . . . . . .440
 

Court Reporter's Certification . . . . . . . . . 441
 
 

 

185 

P A R T I C I P A N T S
 

CHAIR
 

ZIEMER, Paul L., Ph.D.
 

Professor Emeritus
 

School of Health Sciences
 

Purdue University 

Lafayette, Indiana 

EXECUTIVE SECRETARY
 

ELLIOTT, Larry J.
 

Director, Office of Compensation Analysis and Support
 

National Institute for Occupational Safety and Health
 

Centers for Disease Control and Prevention
 

Cincinnati, Ohio
 

MEMBERSHIP
 

ANDERSON, Henry A., M.D.
 

Chief Medical Officer
 

Occupational and Environmental Health
 

Wisconsin Division of Public Health
 Madison, Wisconsin 

ANDRADE, Antonio, Ph.D.
 Group Leader 

Radiation Protection Services Group
 Los Alamos National Laboratory
 Los Alamos, New Mexico
 

DeHART, Roy Lynch, M.D., M.P.H. 

Director
 The Vanderbilt Center for Occupational and Environmental
 Medicine
 Professor of Medicine
 Nashville, Tennessee
 

ESPINOSA, Richard Lee 

Sheet Metal Workers Union Local #49
 

Johnson Controls
 

Los Alamos National Laboratory
 

Espanola, New Mexico
 
186 

GADOLA, Sally L., M.S., R.N., COHN-S
 

Occupational Health Nurse Specialist
 

Oak Ridge Associated Universities
 

Occupational Health
 

Oak Ridge, Tennessee
 

GRIFFON, Mark A.
 

President
 

Creative Pollution Solutions, Inc. 

Salem, New Hampshire
 

MELIUS, James Malcom, M.D., Ph.D.
 

Director
 

New York State Laborers' Health and Safety Trust Fund
 

Albany, New York
 

MUNN, Wanda I. 

Senior Nuclear Engineer (Retired)
 

Richland, Washington
 

PRESLEY, Robert W. 

Special Projects Engineer
 

BWXT Y12 National Security Complex
 

Clinton, Tennessee
 

ROESSLER, Genevieve S., Ph.D.
 Professor Emeritus
 University of Florida 

Elysian, Minnesota
 
187 

INVITED SPEAKERS
 

Mr. Jerry Steele, Department of Veterans Affairs
 

Mr. Michael Schaeffer, Defense Threat Reduction Agency
 

Dr. Neil Otchin, Department of Veterans Affairs
 
188 

STAFF/VENDORS
 

CORI HOMER, Committee Management Specialist, NIOSH
 

MARIE MURRAY, Writer/Editor
 

STEVEN RAY GREEN, Certified Court Reporter
 

AUDIENCE PARTICIPANTS
 

Everett "Ray" Beatty, Sr.
 

Gary F. Benjamin
 

Eula Bingham
 

Joe Carson
 

Liz Homoki-Titus
 

Eric H. Kearney
 

Jeffrey L. Kotsch
 

Bruce D. Lawson
 

Mark Lewis
 

Bill McGowan
 

Richard Miller
 

Leon Owens
 

Susan Pinney
 

Herman Potter
 

Marybeth Potter
 Louise S. Presley
 Sam Ray
 Robert G. Tabor
 Rose Toufexis
 Jerry Tudor
 
189 

TRANSCRIPT LEGEND
 

The following transcript contains quoted material. 

Such material is reproduced as read or spoken.
 

In the following transcript a dash (--) indicates an
 

unintentional or purposeful interruption of a sentence. 

An ellipsis (. . .) indicates halting speech or an
 

unfinished sentence in dialogue or omission(s) of word(s)
 

when reading written material.
 

In the following transcript (sic) denotes an
 

incorrect usage or pronunciation of a word which is
 

transcribed in its original form as reported.
 

In the following transcript (phonetically) indicates
 

a phonetic spelling of the word if no confirmation of the
 

correct spelling is available.
 

In the following transcript "uh-huh" represents an
 

affirmative response, and "uh-uh" represents a negative
 

response.
 
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P R O C E E D I N G S
 

(8:30 a.m.)
 

DR. ZIEMER: Good morning, everyone. I'm
 

going to call the group back into session for our
 

second day on this sixth meeting of the Advisory
 

Board on Radiation and Worker Health. The record
 

will show that all the members are present, although
 

they're not all at the table.
 

DR. MELIUS: Except Henry.
 

DR. ZIEMER: Oh, Henry left. I'm sorry,
 

Henry had to leave, so all members except for Henry
 

Anderson, who was not able to be here for this
 

second day.
 

Before we get to the agenda items, I'd like
 

to make a couple of announcements. Number one, to
 

remind everyone, including the Board members, to
 

register again today your attendance here. They
 

actually register for both days separately so
 

everyone -- observers, staff and Board members -­

please register your attendance in the book on the
 

table in the rear.
 

Those who -- members of the public who wish
 

to address the Board, please sign up there at the
 

table, as well.
 

Board members, sometime before you leave
 
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today, if you have preparation time hours that you
 

need to turn in, turn those in to Larry Elliott.
 

Later on in the meeting we'll have some
 

brief time for any additional administrative
 

housekeeping items, but let's now move on to the
 

agenda items. The first item is discussion on
 

Special Exposure Cohort. This is in relation to the
 

comments that we wish to develop and submit -­

actually to submit to Secretary Thompson which will
 

become our comments on the rule-making.
 

You need to have before you, as we discuss
 

this item, three pieces of paper. The first -- or
 

three items, there's more than three pages. The
 

first item is the packet that was handed out
 

yesterday called -- it says at the top Advisory
 

Board on Radiation and Worker Health, comments on
 

proposed rule 42 CFR part 83. That packet has five
 

pages, the first two pages of which have some
 

comments on specific sections -- draft comments,
 

really; the third page of which has some comments by
 

Wanda; and then the last two pages are some comments
 

from Tony, so have that handy.
 

The second item which we will utilize as we
 

go into discussion on this is a two-pager that says
 

ta the top General Comments. You should have found
 
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192 

it by your seat there yesterday. It's not
 

identified. It's a highly secret document. 

Actually it's authored by Jim Melius and so you can
 

make a note of that and you can even date it 8/15,
 

but it has five items on it and in a moment I will
 

ask Jim to lead us in a little discussion of these
 

items, which are some thought-provoking items which
 

will mostly relate to this rule-making.
 

And then the third item is being distributed
 

right now, and these are some comments that Mark
 

Griffon has proposed that we consider, as well. And
 

these are hot off the press so I've not had a chance
 

to look at them, but Mark has prepared these
 

comments as an outcome of our discussion at the last
 

meeting, so there's some statements here regarding
 

the issue of accuracy or what is sufficient
 

accuracy, some information on clarifying the issue
 

relating to non-SEC-listed cancers, and thirdly,
 

definition of endangered health. So we'll take a
 

look at those comments, as well, as we proceed here.
 

Now just to get us underway, on the first
 

packet, the statements there are suggested comments
 

to be made section-by-section. If we take Wanda's
 

comment, which is mainly on one of the words, the
 

word being, in section 83.1, "proactive" -- Wanda
 
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felt that that word had certain connotations that
 

might be undesirable and she's suggesting an
 

alternate word. I think the word was "diligent".
 

And then Tony's comments were mainly to
 

restructure 83.1 to provide an actual suggesting
 

wording. It's a slight modification of the wording
 

that was there, and we can come back to that, and
 

then to add some comments for section 83.2. So
 

those, all taken together, result in rather modest
 

modifications to the first two pages that you have.
 

Now let me ask you to just put those aside
 

for a minute because I think before we get into any
 

details on wording anything, I'd like us to consider
 

some of the related issues that have been raised.
 

First of all, let's take a look at Jim's
 

document -- and Jim's agreed to lead us through
 

this, and I've spent a little time myself and I
 

think some of the others have in thinking about
 

these questions and how they might possibly be
 

addressed in some suitable way in the rule-making. 

But Jim, if you would lead us through your concerns
 

there and then let me ask, as we proceed, that
 

people respond to Jim's questions and give us input
 

so we can get a feel for what others are thinking on
 

these issues.
 
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194 

DR. MELIUS: The first comment concerns the
 

relative balance between the two approaches to
 

developing Special Exposure -- new Special Exposure
 

Cohorts. And I think as we discussed at the last
 

meeting and the NIOSH staff, in response to some of
 

our questions, is that the emphasis in the current
 

approach is -- a rule is on developing Special
 

Exposure Cohorts after an individual has gone
 

through the process and NIOSH has been unable to
 

complete the dose reconstruction. And NIOSH
 

envisions that as the major way of people entering
 

new Special Exposure Cohorts being developed.
 

And my concern about that is that that's
 

going to delay the process because a person has to
 

go all through that process. It's going to be a
 

difficult dose reconstruction 'cause you eventually
 

get to the point where you can't do it, so -- but
 

that's going to take some time and effort to
 

determine that you can't do it. Then you have to go
 

through the whole process of developing the Special
 

Exposure Cohort, which is the petitioning process,
 

the report and so forth. And that's just going to
 

take a longer period of time.
 

Secondly, it's going to be sort of a
 

difficult process from the claimant's point of view
 
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195 

'cause meanwhile one person's going to have
 

submitted a claim, other people, maybe from the same
 

work site or same area, are going to be submitting
 

claims. They're not going to know what's going on
 

and it's going to take a longer significant period
 

of time to pull all that together. And I also don't
 

think it's a very efficient approach to doing this. 

And given the large number of claims that are
 

pending or that we believe to be in the pipeline
 

coming down here, that I think a more -- I won't use
 

Wanda's unfavorite word there, proactive, but an
 

approach that relied more on the petitioning process
 

would be more efficient 'cause it would allow up
 

front the designation of some Special Exposure
 

Cohorts, an active process to determine who would
 

qualify, whether there was adequate dose information
 

available to be able to do individual dose
 

reconstructions on those in that group. And
 

eventually, as those cohorts got designated, it
 

would be a much more efficient process because there
 

would be a larger number of Special Exposure Cohorts
 

or you'd get there quicker, I guess is the -- is my
 

feeling on that.
 

I think it's also much more understandable
 

and easier for the claimants to interact with that
 
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process, rather than waiting for the individual and
 

not understanding very easily, it's not a very
 

transparent process figuring out what's happening
 

with your individual claim and whether you qualify
 

and how much information is needed and so forth,
 

that more emphasis on the petitioning approach I
 

think would be a -- I think it's just a better
 

overall approach and a more efficient approach and a
 

better use of the available resources for this -­

for the designation of Special Exposure Cohorts.
 

So I guess what I would be recommending is
 

that they put more emphasis and make the petitioning
 

process a little bit easier in terms of providing
 

better guidelines and making that a little bit more
 

direct for encouraging people to apply through that
 

process than -- rather than waiting on all the
 

individual claims to have gone through that process. 

I think we had some discussion of this last time, so
 

that's not a new idea. It's something we did talk
 

about at the last meeting.
 

Okay, do you want to discuss that?
 

DR. ZIEMER: Yeah, let's discuss them as you
 

present them, while they're -- okay. Roy?
 

DR. DEHART: I don't recall that there was
 

anything in the rule itself that prevents
 
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197 

petitioning and that worker representatives can
 

prepare a petition for a group of workers, probably
 

workers independently could prepare a petition. And
 

would the fact that an individual in that petition
 

have applied as a single individual for dose
 

reconstruction in any way inhibit the process from
 

going forward as a petitioned group?
 

DR. MELIUS: NIOSH would have -- I don't
 

know of anybody's even thought through with it. 

There's a lot of complications to this process with
 

this mix of individual claims and group claims going
 

on at the same time. And we talked about yesterday
 

with the non-SEC cancers, there's some situations
 

out there with -- over different time periods of
 

work within the SEC period, outside the SEC period. 

How do you define the course? That everybody in the
 

cohort has to not be able to do dose reconstruction? 

You may not know that until you've done some
 

individual cases. It may be that one person in that
 

work group had great monitoring and nobody else did,
 

and we know that the exposures were variable enough
 

that one can't extrapolate from that one individual
 

to everybody else very well.
 

I think if you look at the second and third
 

comments here, particularly the third comment, I
 
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198 

think I just -- there seems to be more of a barrier
 

set up in terms of the petitioning process and I
 

think I would like to see it made a little
 

friendlier process, and more emphasis put on that in
 

terms of the outreach and the activities going on to
 

encourage people to go through that process. And if
 

I remember correctly from last meeting, NIOSH was
 

saying they were emphasizing the opposite approach,
 

through the individual one, so I think it's just a
 

question of emphasis rather than a question of
 

either/or.
 

MR. ELLIOTT: Ted had stood. I don't know
 

if he has a comment.
 

DR. ZIEMER: Ted? Or do any of the staff
 

have comments on Roy's question about simultaneous
 

petitioning?
 

MR. KATZ: Sure. I didn't stand, I just sat
 

upright.
 

DR. ZIEMER: Well, once you do that, you're
 

in trouble.
 

MR. KATZ: I'm just teasing. Yes. I mean
 

in either case, whether simultaneously someone's
 

petitioning for a class and someone else has in a
 

claim seeking a dose reconstruction who would be
 

part of that class, in either case, however that
 
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199 

works, one of the first things we're going to have
 

to figure out is whether we can do dose
 

reconstructions for these individuals. And in that
 

respect, I mean there's no delay incurred because
 

we're going to have to figure out whether we can do
 

dose reconstructions. If a class -- if you petition
 

for a class to be added, we still have to answer
 

that question. We still have to go through the work
 

that we'd have to do with an individual dose
 

reconstruction if it comes to us that way to
 

determine whether we can do a dose reconstruction. 

And I don't want to belabor the point, just -- but
 

there's no inherent delay here whatsoever because we
 

have to determine that -- answer that question first
 

anyhow.
 

DR. ZIEMER: Okay, thank you.
 

MR. ELLIOTT: I would like to add, also,
 

that I truly don't believe we emphasized one
 

approach over the other. We're offering an
 

opportunity of two approaches. We weren't
 

emphasizing that the individual claim and dose
 

reconstruction being able to be conducted was the
 

primary approach. What we emphasized was that an
 

individual, once diagnosed, needs to file a claim
 

immediately so that their medical benefits would
 
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200 

start at the time of filing.
 

DR. ZIEMER: Other comments? I suspect that
 

part of the concern is more the appearance -- and
 

maybe it's the wording that seems to put the burden
 

on the individual petitioner, even though the intent
 

may be to have it go either way. That was a concern
 

that arose last time, that perhaps it appears that
 

the petitioner must go through a certain process
 

first before they can even think about this
 

alternative.
 

Let's have some other comments. Yes, Tony. 

Tony and then -- oh, okay.
 

DR. ANDRADE: Well, I tend to agree with
 

Jim. It's pretty clear that in 83.7(a) that groups
 

of employees, one or more employees, can petition. 

However, there doesn't seem to be enough, as Jim
 

states, emphasis that group petitioning could also
 

-- that group petitioning might be the desirable way
 

to get into the system. And it's only that it's a
 

matter of emphasis, and it's not to emphasize one
 

approach versus the other. It's just to bring out
 

some clarity, some clarification. And I wouldn't
 

mind suggesting a simple language addition that
 

would say that, for example, a group of petitioners
 

who believe they have collectively been subjected to
 
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201 

a special situation or something to that effect. 

And it could very well be pointed out in one simple
 

phrase, I think, in 83.7.
 

DR. ZIEMER: Robert?
 

MR. PRESLEY: I also agree -- Bob Presley. 

But I have one comment. A lot of these people are
 

deceased. They don't know that they're in a group,
 

and I think it behooves us to be able to go back in
 

and look at that and maybe have some input to be
 

able to put those people in a group. And you know,
 

we're working with people that don't have a clue of
 

what their spouse did or their father did, and so I
 

think it -- we need to look at that a little bit
 

broader.
 

DR. MELIUS: Can I just comment? I think
 

that's a very good point and I think if you wait
 

until individuals apply, they're going to be ill and
 

probably older. And getting the information from
 

them, the burden on the families to try to provide
 

some of the necessary information will be that much
 

more. If the cohort's designated up front, then you
 

don't have to go through that process and so forth
 

to do that.
 

I think and agree with what Tony's
 

suggestion was, too. And I think if you go to
 
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number three suggestion down here, which is just one
 

of the follow-ups to this, is that the way the
 

rule's written now for the petitioning process,
 

there has to be -- I forget the wording used -- a
 

positive affirmation that the records don't -­

exposure records don't exist, and that's a -- I
 

think that's a question of wording, but that's a
 

burden.
 

And then there's this thing, or. It's an
 

or. It's not an absolute requirement. Or a health
 

physicist or other dose reconstruction expert has to
 

review the information and submit a report with it. 

And it's not an absolute requirement, but I think it
 

certainly implies a heavier burden for the
 

petitioning process. I think that could be taken
 

care of in the rule by putting in a third "or" into
 

that. That, one, yes, you ought to find out if dose
 

information's available to the extent that that's
 

possible to do, but also providing some sort of
 

guidance for what other information. It may be it's
 

some sort of internal report that's available or an
 

outside review that's pointed out that this group
 

was not monitored for a period of time and there was
 

a potential for significant exposure, so forth. But
 

not implying that someone has to go out and get an
 
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203 

expert to come in and help them do the job that I
 

think people are expecting NIOSH to be doing as part
 

of this process. I mean I can see the reason for
 

the petitioning including some rationale for why it
 

should be a special cohort, but I don't think one
 

can expect the petitioner to do all the proving, so
 

to speak, 'cause that's difficult. And I don't
 

think this is what NIOSH intended when they wrote
 

this, based on our discussions at the last meeting. 

But it certainly is implied in the language there
 

and I think that's something we can fix with some
 

other suggested phrasing in there.
 

DR. ZIEMER: Other comments? Yes, Tony.
 

DR. ANDRADE: Tony Andrade again. What I
 

see here, Jim, is two issues that we're trying to
 

work at the same time. And one is to try to
 

emphasize to the public that, in a very balanced
 

way, they can apply -- they can petition as a group
 

or they can apply individually. And when they do
 

apply either way, one of the comments that we have
 

not yet discussed actually gives NIOSH some
 

responsibility to help along that process, either
 

for the individual or for the group that's doing the
 

petitioning. And I think that that was the first
 

comment that I had suggested but that it hasn't -­
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204 

we haven't yet talked about it.
 

DR. ZIEMER: Okay. Any other comments now
 

on the first item? I think we've -- pro or con.
 

(No responses.)
 

DR. ZIEMER: Okay. Then let's go ahead with
 

the second one, Jim.
 

DR. MELIUS: Second one? Okay. And I
 

should add that this comment ties somewhat to I
 

think one of Tony's comments at least that was from
 

the last meeting, and also one of Mark's comments
 

this time, and certainly my major concern about this
 

regulation is the fact that NIOSH has not provided
 

any guidance or guidelines for how they will make
 

the determination that there is not adequate
 

information to do a -- so that it's not feasible to
 

do a dose reconstruction with sufficient accuracy. 

And I think that's a major deficiency of the
 

approach that's being proposed here, on several
 

fronts.
 

One is the one hand they are doing the -­

saying that a dose -- it is not possible to do the
 

dose reconstruction, appropriate dose
 

reconstruction. At the same time implying that in
 

order to meet the health endangerment criterion that
 

there is enough information in order to be able to
 
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205 

make that calculation.
 

Secondly is that one has these -- I mean
 

there's different situations here and for people on
 

the outside looking at this process, either as their
 

own claims are being handled or as they are
 

approaching the petitioning process as a group, they
 

really do not have an understanding of what -- what
 

do they have -- what information do they have to
 

provide or what -- how will their information be
 

evaluated to determine whether they qualify for a
 

Special Exposure Cohort. How will NIOSH make the
 

determination that there is not adequate data
 

available to do -- I think as it says in the law -­

to do a dose reconstruction with sufficient
 

accuracy, it's not feasible to do that. And I
 

really think that's a significant problem and I
 

think the whole program would be better over the
 

long term if NIOSH would wrestle with that question
 

and come up with a set of guidelines. And I
 

recognize it's not easy to do 'cause there's lots of
 

different ways of doing a dose reconstruction and
 

lots of different sources of information that one's
 

pulling together. But it's so critical to this -­

the way this rule is constructed that I think that
 

there needs to be some guidelines provided. And my
 
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preference would be those guidelines go for public
 

comment because it is going to be such an important
 

determination made on the part of NIOSH.
 

DR. ZIEMER: Tony?
 

MR. GRIFFON: Just a point -­

DR. ZIEMER: Oh, Mark, I'm -­

MR. GRIFFON: No, I just wanted to mention
 

that my point number one on my comments is almost
 

the same so we could probably discuss it at the same
 

time.
 

DR. ZIEMER: Good, okay. Yeah. Just pull
 

Mark's thing there and kind of put them side-byside.
 

MR. GRIFFON: They're the same point.
 

DR. ZIEMER: Determination by NIOSH that it
 

cannot complete a dose reconstruction for claimant. 

Thank you.
 

MR. GRIFFON: Okay, sorry.
 

DR. ANDRADE: I would like to point out that
 

section 83.9 does indeed list guidelines that point
 

out when a dose reconstruction might be found
 

inadequate. And I would defer to the experts -- to
 

Ted and to Jim -- to comment if they wish to on that
 

particular section because it does list out general
 

guidelines as to when dose reconstructions are
 
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inadequate. So maybe they can help answer that. I
 

felt that in general it did a fairly good job.
 

Now the specific question as to whether data
 

are accurate to a certain degree, I believe falls
 

into this as a subset -- as a question that would be
 

one of the parameters that is looked at in
 

determining whether a dose reconstruction is
 

adequate or not. So I think we need to answer
 

Mark's question -- and it's your question, as well,
 

Jim -- but I think we would need to do so in terms
 

of what's in 83.9.
 

DR. ZIEMER: Further comment? Okay. Mark,
 

are you -­

MR. GRIFFON: Can -- I'm just -- it's table
 

one in 83.9, is that what you're looking at, Tony?
 

DR. ANDRADE: Correct.
 

MR. GRIFFON: Yeah. I don't think -- I mean
 

from my standpoint, I don't think that answers my
 

question. That is sort of what the petitioner would
 

be -- would have to provide to get in the gate, so
 

to speak. But I mean for sufficient accuracy, what
 

I was -- and in my comments, and I've had dialogue
 

on the side with NIOSH staff on this. I mean the
 

question of is there a quantitative way to define
 

this, I think that's difficult, to say the least. 
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208 

Jim's shaking his head. Anyway -- but there may
 

also be qualitative, and I can't say I've explored
 

or exhausted options on this, but there may be
 

qualitative metrics that would -- and for instance,
 

and this is just a for-instance, you might consider
 

whether all or a percentage of the TLD or film data
 

was available for -- I'm thinking of it as -- for
 

the class, all or a percentage, I'm not -- and
 

bioassay data was available for all relevant
 

radionuclides and -- let's see, and the data was
 

consistent with the knowledge of site processes and
 

NIOSH could complete -- I mean those are very sort
 

of qualita-- and I'm not saying those are the ones,
 

but that's the idea of you could lay out some
 

qualitative metrics that gave a sense of the
 

threshold that it's going to take to reconstruct
 

sufficiently accurate. And I think I know the
 

response I'm going to get, but Jim's standing up.
 

DR. ZIEMER: Yeah, and I think we want to
 

hear from staff on this. I guess we've all kind of
 

felt intuitively that one of the issues is that we
 

don't really know fully what the parameters are. 

That sort of begs the question because if we don't
 

know what those parameters are, then certainly the
 

claimants won't and so what are the rules of
 
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engagement is sort of what it gets down to.
 

DR. MELIUS: Or how do we review those.
 

DR. ZIEMER: Yeah. Jim.
 

DR. NETON: Thank you. Jim Neton. I
 

actually agree with Mark to a certain extent -­

surprise. I think we have to get away from the
 

concept -- and I agree with the qualitative nature
 

of this. The term "accuracy" means a lot of
 

different things to a lot -- many people, but we
 

have to couch this in terms of sufficient accuracy
 

to be able to make, in terms of our efficiency
 

process, a determination whether the person falls on
 

the left side or the right side of the compensation
 

bar. That's -- and so if we cannot determine
 

something with sufficient accuracy, in my mind, all
 

that really means is that we could not make a
 

definitive determination using the efficiency
 

process that it fell either to the left or to the
 

right of the 50th percentile at the 99th percentile,
 

of course. So you allow the efficiency process to
 

work. You start with your low/low, low/high -- you
 

know, what we were talking about yesterday -- and
 

you keep working your dose reconstruction till you
 

run out of facts, of factual evidence.
 

Once you run out and you realize, just like
 
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Mark was saying, I'm still missing chunks that I
 

can't fit into this puzzle, I have no idea what this
 

person's dose was for 15 years; I can't find it and
 

he's still on the low side of compensation. The
 

only choice is either say the claim is denied or we
 

just can't complete it. We just do not have enough
 

information to make this claim complete. So it
 

really -- it's a qualitative issue, but I don't
 

think -- you know, you just know when you've
 

exhausted all possibilities and a claimant still is
 

not in -- possibly over the 50th percentile, you
 

just have to say we can't complete it. It sounds
 

squishy, but that's really the way it's got to work
 

in practice, I think, unless someone else can come
 

up with a better approach.
 

DR. MELIUS: Can I -- but that is the
 

problem with this approach. I think you've wrestled
 

well with this issue of do you make the 50 percent,
 

and that is what complicates this issue. But at the
 

other end, if you're looking at a group of people,
 

they may have -- their dose may accumulate up with
 

what information you have to different points, like
 

ten percent, 40 percent, all over the place. Well,
 

at what point do you then say there's not sufficient
 

information for that group? Or are you going to
 
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deny half the group? I mean how are we going to
 

form a group out of this -­

DR. NETON: Well, that speaks to setting -­

determining the class. I mean if there's a class
 

that you can really -- we need to do our job very
 

well in defining that class down to its narrowest
 

common denominator. Who falls in that class that we
 

really don't have the information for. If we
 

clearly have information for half of that class that
 

we can do and -- they just won't be in the class.
 

DR. MELIUS: I just think you have to
 

operationalize that into guidelines in some ways to
 

have some consistency in the program, some
 

transparency, some knowledge so the claimants
 

understand they're being treated fairly in that
 

process, and so we can review it. And I think that
 

has to be written out in some way operationally how
 

you're going to handle that particular issue. And I
 

think that effort is really absolutely necessary to
 

making this process fair.
 

DR. ZIEMER: Roy.
 

DR. DEHART: I think there's one other step,
 

too, to consider here, which reinforces the idea of
 

being as precise as one can in guidelines, and that
 

is the appeal. As this stands now, it is so soft, I
 
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wonder how a judge would assess this. And I would
 

think that it's going to be harder to sustain a
 

position under appeal with these kinds of
 

guidelines, as soft as they are.
 

MR. KATZ: Can I just -­

DR. ZIEMER: Yeah.
 

MR. KATZ: Can I just speak to that point? 

I really -- as is explained in the dose
 

reconstruction rule, where we can't do a dose
 

reconstruction, we have to lay out the wherewithal
 

-- why it is we can't do that dose reconstruction
 

very clearly in that report. So I mean that's what
 

would come before a judge, that kind of information. 

What is the information lacking that prevents us
 

from doing a dose reconstruction that the judge
 

would evaluate. So they will get very clear
 

information at that point in time when we make a
 

determination that you can't do a dose
 

reconstruction.
 

And I just wanted to address then the second
 

point, Dr. Ziemer, that you raised -- that Jim
 

raises that it's unfair to the petitioners if we
 

can't tell them with more crystalline clarity when
 

we can't do a dose reconstruction because then they
 

won't know whether they're going to make it yet or
 
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not, whether they're going to make it into the
 

class. But we're not burdening the petitioner with
 

actually proving that we can't do a dose
 

reconstruction at all. I mean that's our burden. 

And they're free to petition and start the process,
 

press the button for it to go, without making -­

they don't have to make that case. So it is a
 

problem in the sense that they won't know at the
 

front end what the outcome of their petition's going
 

to be because they won't be able to answer the
 

question, well, can they in fact do a dose
 

reconstruction or not. But they can get the process
 

going. They can get us set to work on doing the
 

work to evaluate that question. Thank you.
 

DR. MELIUS: Let me -­

DR. ZIEMER: Sally and then Jim. 

MS. GADOLA: I just had a question for Ted. 

Could you give us some examples as what you would
 

actually write in that report as to why you couldn't
 

do the dose reconstruction?
 

DR. NETON: Ted just tapped me on the
 

shoulder, so I guess I'll come up with an example. 

I think it's sort of -- to complete what I was
 

saying earlier, is if we did the dose reconstruction
 

and we move so far and found maybe 75 percent of the
 
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available information, found bioassay results, air
 

monitoring results, all that sort of thing, but
 

maybe the external dosimetry component was missing
 

and we had no co-worker data, really no good source
 

term to hang our hat on, we would say that this
 

person's dose record is incomplete; it cannot be
 

completed; we've searched high and low, there is no
 

component that we can use to estimate his external
 

dose and therefore we can't complete it.
 

Now that being said, it's possible -- and
 

you know our efficiency process. We don't always
 

have to have complete information. If a person -­

based on the merit of just their internal results -­

is over 50, we won't bother to even search for the
 

rest of that information. But in those cases where
 

the components that we do have do not put the person
 

over the bar, we'll have to identify which pieces of
 

those information are missing that we feel could add
 

dose to their claim, to their case. So I mean I
 

can't -- I could go on.
 

MS. GADOLA: I think that helps clarify a
 

little bit, at least in our own minds, and maybe
 

that's where some of this questioning comes from
 

because that's still sort of vague.
 

DR. NETON: Right. But it really ties in
 
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with our efficiency process again. We just keep
 

going and pulling the thread as far as we can go
 

until we run out of possibilities. But if we can't
 

find all the possible sources of exposure and
 

identify them, then that's when we pull the plug and
 

say we can't go any further.
 

The other option's to deny the claim or send
 

the claim to Labor with an incomplete dose
 

reconstruction and unjustly have them deny the claim
 

because we don't have all the information. But
 

there's no very really good quantitative -- I mean
 

we could describe this qualitatively is sort of what
 

I'm sketching out here, and maybe that would help. 

I don't know.
 

MS. GADOLA: Thank you.
 

MR. KATZ: Can I just add to that, Jim,
 

because something that I think I've already heard,
 

and Jim will correct me if this isn't right, but
 

this is sort of a simpler example to your question,
 

what might be in that report. Well, say there's an
 

incident -- a circumstance where a number of workers
 

were around a pile of -- a pile, a swamp or whatever
 

of radioactive materials, no one's certain what
 

those radioactive materials were and in what
 

quantities and so on, and that's all the
 
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information. There's no dosimetry information, no
 

personal dosimetry information, there's no area
 

dosimetry information. I mean that may be a
 

circumstance where again you say we don't have the
 

wherewithal to estimate doses there because all we
 

have is some possibilities for what sort of
 

radioactive materials were in that swamp, and we
 

don't know their quantities, either. I mean that's
 

just another example, maybe simpler.
 

DR. ZIEMER: Jim?
 

DR. MELIUS: Two comments, one to one of
 

Ted's earlier comments. I mean I don't think just
 

because a person can apply for it doesn't mean there
 

isn't some burden to let them know what they're
 

applying for or what -- how they qualify. I can
 

apply for Social Security disability. I don't -- or
 

VA disability. I don't think I make it on a lots of
 

grounds, but it doesn't stop me from applying for
 

it. Fortunately there are guidelines on the
 

application that sort of tell me whether I qualify,
 

what's my military history, so -- I mean I think you
 

have to provide some guidance out there.
 

The other corollary of this is -- the other
 

part of when we're looking at this is that are the
 

doses that you are reconstructing being done with
 
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sufficient accuracy? I mean because when you say
 

you can't do the dose reconstruction, well, are you
 

-- which side are you erring on, so to speak? Are
 

you erring on the side of doing a bad dose
 

reconstruction, not sufficient accuracy? Or are you
 

erring on the side of saying you can do a dose
 

reconstruction, even -- you can't do a dose
 

reconstruction and therefore a person's qual-- I 

mean it cuts both ways, and without some sort of
 

guidance at that lower level, that level where you
 

can't do it or you can't achieve sufficient
 

accuracy, I think -- to me it's just very
 

problematic. I think, Jim, you're articulating it
 

better than you have when I've asked this question
 

before 'cause I think there's more experience and
 

that we've talked about it some more and so forth,
 

but I really think that needs to get into a set of
 

guidelines or something for us as a committee, for
 

you as a program, to be able to do this with some
 

kind of consistency and for people on the outside to
 

be able to understand the process. And I agree it's
 

not easy and it's going to take some time and
 

effort, and it's not like you don't have other
 

things to do, but in the long term it seems to me it
 

would really be very -- very helpful and I think
 
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it's necessary.
 

DR. ZIEMER: Incidentally, on this accuracy
 

issue now, the way the thing is being bounded, it's
 

not an accurate process. By favoring the client by
 

assuming worst-case, you are actually being more
 

inaccurate but more favorable to the claimant. 

Accuracy does not necessarily help the claimant. I
 

mean if you -- if you tried to pin everything down
 

-- I mean the cases we looked at, for example, the
 

low/low case, they gave every benefit of the highest
 

possible exposure, not -- I would say it was
 

probably very inaccurate, because accuracy has to do
 

with how close you are to the real number. All of
 

these were over-estimates. You know, you say what's
 

the highest possible dose the person could possibly
 

have gotten under these circumstances, so accuracy
 

doesn't necessarily help the client. So I'm not
 

sure that that's what's being looked for on some of
 

these cases. That's just a comment.
 

Jim Neton.
 

DR. NETON: I was just going to -- you spoke
 

to the issue I was going to bring up, which is these
 

are not accurate. As Mike Schaeffer pointed out
 

from DTRA yesterday, they're not epidemiologic
 

studies. They're -- the idea is to over-estimate
 
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the dose, to quickly process it and if it still
 

accurately falls on the correct side. I mean this
 

is not mathematical accuracy. This is compensation
 

decision accuracy that I think that we're speaking
 

to here. And if we can over-estimate someone's dose
 

by an order of magnitude or just be extremely
 

generous and the probability of causation falls at
 

15 percent, then we've made an accurate dose
 

reconstruction. We've accurately determined that
 

that person falls on one side or the other. We
 

haven't determined, we've actually decided that the
 

dose is not going to be high enough to get over the
 

bar.
 

So it may be instructive to go over a few
 

dose reconstructions generically with the Board at
 

some point to demonstrate that process. I know the
 

working group has looked at them and has a sense
 

now, but maybe in a future meeting we could do a few
 

de-identified, very generic cases that would maybe
 

shed some light on this issue.
 

DR. ZIEMER: Let me point out that in 83.9,
 

as a starting point, the criteria for the Special
 

Exposure Cohort -- there's two criteria, starting
 

point, insufficient records and insufficient
 

information leading to inability to do a dose
 
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reconstruction.
 

Now in a practical sense -- and I'm just
 

trying to now push the envelope a little bit -- it
 

seems to me, Jim, that you're saying all right, what
 

about the claimant, what do we tell him when -- if
 

he's applying. Question one, do you have reason to
 

believe that your dosimetry records are incomplete
 

or insufficient -- or something like that. You're
 

saying what are the series of questions you would
 

ask that would serve as the parameters for somebody
 

to even know whether they're in such a cohort.
 

DR. MELIUS: Correct.
 

DR. ZIEMER: What kind of questions would
 

you ask?
 

DR. MELIUS: Uh-huh.
 

DR. ZIEMER: Is -- I mean just as a starting
 

point.
 

DR. MELIUS: Correct, and how do you -- is
 

defining insufficient and incomplete.
 

DR. ZIEMER: And what does that mean? What
 

is -- incomplete, does that mean a film badge is
 

missing? Not necessarily.
 

DR. MELIUS: Right.
 

DR. ZIEMER: Okay. Wanda -­

DR. MELIUS: Could we just go back to -­
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'cause I think Jim Neton just sort of -- has been
 

talking about what is sufficient accuracy for this
 

process, and I think you articulate that well. But
 

sort of going back to the opposite and what is
 

insufficient, it's such that you cannot do the dose
 

reconstruction for a group that they qualify as a
 

Special Exposure Cohort. And I think that's what we
 

have to wrestle with, when you reject that
 

individual because there's insufficient or
 

incomplete records or insufficient information like
 

that. I think that's the crux of it and it's
 

getting some explanation now. And it's not just for
 

the claimant. I think it's for the program to have
 

some consistency and for us to be able to review
 

that program. I mean we're going to be taking a
 

sample. We're not going to review every one, so
 

looking at that consistency is by what rules you -­

guidelines you follow in doing this on that.
 

DR. ZIEMER: Okay. Wanda.
 

MS. MUNN: It sounds as though the question
 

is how do you prove a negative. If anyone here
 

knows how to prove a negative, I would like them to
 

step forward now because it's a question that's
 

bothered me for a long, long time, and I suspect
 

most of the rest of us.
 
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When someone says that's all there is, there
 

ain't no mo', how can I prove that there ain't no
 

mo'? And I don't believe I can do that. I don't
 

believe that I can contrive language that would make
 

it appear that I'm doing that. It is, I think,
 

incumbent upon us to try to see that the language is
 

as reasonable as it can be. And this current
 

language appears to be quite reasonable, unless you
 

can somehow prove a negative.
 

If there are ways that we can define what
 

constitutes the arrival at that negative point, then
 

perhaps we can belabor this until we identify what
 

that language is. I personally don't see that
 

there's language that will suffice to do that. When
 

we no longer, when the Agency no longer, when the
 

individual can no longer provide further
 

information, then that's all there is. So what
 

language do we put into a rule-making that says when
 

we've found everything that we can find, we can't
 

find any more?
 

I guess I am at a loss to know how we can be
 

more flexible, because really you do have to be
 

flexible for each and every case. The amount of
 

information that you're going to get is, in my
 

experience, never perfect. We will have to work
 
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with imperfect information. The decision's already
 

been made. We will make every effort to see that
 

the imperfection lies in the benefit of the
 

claimant. I see no further step that we can take
 

unless someone has magic language.
 

DR. ZIEMER: Thank you. Other comments? 

Wanda, let me just ask you. The question then, as I
 

understand what you're saying, you actually then
 

feel that the language that's in here now is
 

sufficient to provide what is needed for both the
 

petitioning process or is it just this issue of the
 

guideline part -- that more detailed guidelines are
 

not necessary, as you see it?
 

MS. MUNN: I do not believe that we can
 

structure language which will provide adequate
 

guidelines without unduly burdening the Agency and
 

the petitioner to the point where we're asking for
 

the impossible.
 

DR. ZIEMER: Other comments? Mark.
 

MR. GRIFFON: Yeah, I guess the other area
 

-- and we're going to come up to this in one of the
 

other comments, also, but the other area where sort
 

of Jim's comment on insufficient butts up on this
 

process, and a concern that I would have from the
 

claimant's standpoint is you pull all the strings,
 
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as Jim said. You do the most conservative possible
 

estimate process for the dose reconstruction, and
 

you determine that you can't do a dose
 

reconstruction. And then -- but then the Agency is
 

still able to do or calculate for that class a -- or
 

for that potential class a potential dose to compare
 

it to -- compare to the level of endangerment. And
 

I think that is also going to be a -- that's why I'm
 

trying to look for that line of where -- a point
 

where you say you don't have data -- you've looked
 

at everything and tried everything and you just
 

don't have data to do an individual dose
 

reconstruction, and yet you turn around and you can
 

still do a class -­

DR. ZIEMER: Which implies that you do know
 

MR. GRIFFON: Huh?
 

DR. ZIEMER: Which implies that you do know
 

enough to make that -­

MR. GRIFFON: Right.
 

DR. ZIEMER: -- determination.
 

MR. GRIFFON: Right. And -- well, that's
 

the question. And I know that they're
 

distinguishing that by saying the class would be a
 

potential sort of a worst-case dose, but it still -­
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you know, I guess that line's not anywhere described
 

or there's no guidelines on how -- where that line
 

is, even. And I guess that's what we're wrestling
 

with.
 

MR. KATZ: Dr. Ziemer, can I -- can I just
 

explain that a little further? 'Cause this is a
 

concept that's gotten misunderstood a couple of
 

times now, but that was closer to it there. So
 

we're -- I mean the first thing we're doing is
 

coming up with that benchmark, what dose would be
 

health endangerment. The only question then that's
 

put to the health physicist, the technical staff at
 

that point is could radiation doses have reached
 

that level or higher? They're not estimating what
 

those radiation doses were, just asking the question
 

could they have reached or exceeded that benchmark.
 

And that is, I think, an exceedingly lower sort of
 

burden in terms of what they have to do -­

MR. GRIFFON: Than being able to -­

MR. KATZ: Than being able to estimate -­

MR. GRIFFON: -- complete the dose
 

reconstruction. Than being able to complete a dose
 

reconstruction -­

MR. KATZ: Right -­

MR. GRIFFON: -- that's how your defining
 
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sufficient accuracy.
 

MR. KATZ: -- than being able to actually
 

estimate what that dose was to those individuals. I
 

mean there they can then draw on experience as -­

throughout the DOE program as to what sort of doses
 

can be associated with what little they know about
 

the radiation source term in those instances, they
 

can draw on all that experience to make a judgment
 

as to whether doses could rise to that level. And
 

just to make a -- and you know, analogies are always
 

a little bit ham-fisted, but just to make an
 

analogy, I mean if we're going to talk about the
 

weather for a second here, and if we have the
 

meteorologic records on a century of the weather,
 

but in 1945 those were wiped out throughout the
 

country, we have no records on the weather in 1945,
 

say, you could reasonably have all that other data
 

for 1945 for Atlanta in December, you could make a
 

judgment as to whether it could have been 65 degrees
 

in December or on a day in December, whether it
 

could have been that high or higher. That wouldn't
 

be estimating -- making a judgment that the weather
 

was 65 degrees in December, which is what you're
 

doing when you're doing a dose reconstruction. 

You're making a judgment as to what the dose
 
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actually was. You're just saying could it have
 

reached that level, and that's what the hump those
 

assessors are doing and I think the -- there's a
 

whole lot of information in this world about what
 

sort of doses are associated with source term and so
 

on, and to be able to make those rough judgments is
 

well within their ability.
 

Then once they make that judgment, just to
 

remind you, that judgment then comes before the
 

Board and is open to public scrutiny. And if anyone
 

else in the world can say then well, you know, I
 

know of an instance somewhere where dose
 

approximated that level associated with this sort of
 

circumstance or whatever, that gets brought into the
 

equation then. So it doesn't stop with our
 

technical staff making that judgment, although
 

they'll have a lot of information to draw on there. 

But it goes on to the public and others. So I just
 

thought it'd be helpful to sort of clarify that for
 

you because it has a bearing on this.
 

DR. ZIEMER: Is everybody clear on what the
 

differential here? Yeah, Jim.
 

DR. NETON: I just have one more thing, and
 

maybe there's another way to look at this. I've
 

heard some -- Mark say a little earlier about we're
 
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going to come up with this incremental dose, even
 

though we say we can't estimate it. And one way to
 

look at this is the way it's specified, is we're
 

really trying to determine is the probability of
 

causation able to get to 50 percent or greater,
 

given that circumstance. We take that -- we could
 

actually run IREP, for example, and determine -­

it's an extra three rem of dose given that would be
 

required in that cohort to exceed the 50 percent. 

All it would require NIOSH to do is to say is that
 

plausible, given where the person was working, that
 

cohort was working, that there was a potential for
 

that additional three rem of exposure. We don't
 

know what it was. All we're saying is is it even
 

possible.
 

MR. GRIFFON: I'm not sure I understand what
 

you mean by an additional three rem of exposure.
 

DR. NETON: Well, or -- let's say we did -­

we pulled the thread, as we said, and we looked at
 

every possible avenue except the internal side. And
 

the probability of causation for that dose
 

reconstruction arrived at 25 percent, given the
 

partial information that we had. We could actually
 

back-run IREP and say what -- how much more dose is
 

that person going to need to get over 50 percent,
 
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and given the exposure scenario and circumstances
 

surrounding that cohort, is it plausible at all that
 

that exposure could have -- that exposure
 

environment could have existed? I mean it's sort of
 

a different way of looking at it, but we're not
 

actually calculating a dose. We're trying to
 

estimate what -- was there sufficient dose in that
 

environment to endanger health.
 

MR. GRIFFON: But I guess you go back to the
 

concern of if you didn't have sufficient information
 

up front to do the dose estimate, then I guess the
 

concern from the potential claimant's standpoint
 

might be how can I be sure that they, even in the -­

even in their worst-case scenario, sort of in trying
 

to estimate whether there's enough dose there to
 

push me over, whether they have the information -­

enough information to even -- for example, you know,
 

what if you assume that -- you know, based on all
 

the process records you have, all the site profile
 

information you have on a certain facility, they
 

always handled the depleted uranium and actually the
 

truth was that they had recycled uranium with hefty
 

levels of transuranics that were accumulating in
 

certain processes where some of these individuals
 

were working, even on your worst-case scenarios
 
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you're going to miss the boat drastically for your
 

internal dose estimates if you only assumed uranium
 

as opposed to neptunium, plutonium, other potential
 

exposures -­

DR. NETON: That's correct.
 

MR. GRIFFON: So the question is, you know
 

-- I guess the question is, you know, how do you -­

you know.
 

DR. NETON: That's a different issue, I
 

think. I mean you're assuming we've done a bad job
 

doing our homework there at that point, we've made a
 

mistake. We have not identified all the possible
 

source terms. I mean I think we have to start
 

saying, with the SEC, that we've identified all
 

possible source terms. I'm not saying we always
 

will, but that's our job. And given that, is that
 

transuranic contamination that was unmonitored
 

sufficient to move that over into -­

MR. GRIFFON: But I guess the premise for
 

petitioners is that you don't have information. You
 

know, that's one of the basic premises is that -­

you know, for this group, this class, they already
 

went over that hurdle where you couldn't reconstruct
 

individual doses, so you already know you're looking
 

at a class that you're lacking information on.
 
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DR. NETON: Right, but hopefully by that
 

point, though, we would know the potential source
 

terms that were in the environment that were not
 

monitored. I mean that's part of the dose
 

reconstruction. It's like go out and identify all
 

those source terms and then make the decision -- you
 

know, a missing neutron dose is a good example of
 

that, as well. I mean did they monitor neutrons
 

properly? No. Okay, can we go back and reconstruct
 

this neutron dose properly? If not, was there
 

sufficient neutron exposure in this reactor
 

environment to put that population over 50 percent? 

And we're not saying every claimant in that
 

population was over, but it's not possible to assign
 

a dose to any individual, so they would just all be
 

over automatically.
 

MR. GRIFFON: Yeah, I guess I understand
 

what you're saying.
 

DR. ZIEMER: Actually as you discuss it, you
 

realize that the staff in fact has a scheme, and I
 

think, Jim, you're saying that the scheme doesn't
 

show up here.
 

DR. MELIUS: Scheme doesn't show up here,
 

and I think the scheme has been articulated well for
 

this issue of when there's not sufficient
 
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information or the records are incomplete. I think
 

it's a different -- maybe it's done by a series of
 

scenarios or whatever as to how those will be
 

handled. I think they're articulating it better
 

than when I've asked the same question at earlier
 

meetings, and better -- as well as I think they've
 

given some thought to this issue with the
 

endangerment criteria. And again, the endangerment
 

determination is going to come to us for review, so
 

there's a peer review system or a outside advisory
 

review system built into that process. On these
 

individual determinations, there's not. We have a
 

sampling that's going on and I think that's where -­

you know, with thousands of claims, we need some
 

sort of -- a set of guidance for how you're going to
 

handle those. And I think it can be done. I
 

disagree with Wanda. I don't think we're trying to
 

prove a negative, we're just trying to determine -­

have some guidelines on how we will put things into
 

different categories, given the basis of the
 

information that we have, or don't have. And I
 

think that ought to be written out in some way.
 

DR. ZIEMER: And somehow in the rule-making
 

I think, taking both of those into consideration,
 

one would not want the rule-making to be so
 
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proscriptive that you lose the flexibility and
 

therefore cut out some folks in the process. So
 

somewhere between no guidelines and minimal -- or
 

very proscriptive, there's a point where the
 

guidelines perhaps are such that everybody sort of
 

understands how things are going to proceed, but
 

there's sufficient flexibility to handle those
 

things that you didn't think about in advance.
 

DR. MELIUS: In my -- what I wrote up here,
 

I recommended they go out for further rule-making on
 

this 'cause I think it needs some public comment if
 

it's something that -- I mean an alternative is to
 

change -- clarify some of the language in here so
 

it's better understood. And then develop an
 

internal guidance document that comes back to the
 

committee for review and discussion and that would
 

be sort of the operational guidance for what they're
 

doing that, which is how we've done this in other -­

some of the other situations, dose reconstruction
 

rule. Really the IREP is mostly in the background. 

It's not in the regulation other than its use, and
 

so that may be another way of handling this
 

situation. But I just -- I feel very strongly it
 

needs to be in writing and it needs to be something
 

that's gotten some input.
 
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DR. ZIEMER: Well, as I've looked at 83.9 -­

section 83.9, it appears to me that, at least
 

conceptually, a lot of the information is there. It
 

may need to be articulated in a somewhat different
 

structure so that it takes the form of what might be
 

more appropriately labeled as guidelines that would
 

help both the petitioner and maybe even the Board
 

understand the process. I have a feeling that part
 

of this has to do with the clarity with which we
 

think this is spelling out to people exactly what
 

the rules are on this.
 

DR. MELIUS: Correct, and then how will the
 

decisions be made? As I said, talking about
 

thousands of claims, so it's not -- we're not going
 

to be -- individually discuss these or -- and so I
 

don't think the instances are going to be so rare
 

that a case-by-case approach is going to be
 

adequate.
 

DR. ZIEMER: Shall we go ahead and look at
 

your number three?
 

DR. MELIUS: Number three we've really
 

discussed already and -­

DR. ZIEMER: Yeah, it's -­

DR. MELIUS: I'm going to move to number
 

four and five together and just -- let me do five
 
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first 'cause then I think it backs into number four.
 

This was written before Larry updated us
 

yesterday and DOE, but I mean it's clearly critical
 

to this process that there be complete records made
 

available, and particularly this issue of making a
 

determination that there's not sufficient
 

information available. And so access to the records
 

and complete records are going to be really I think
 

very necessary because if not, then it's going to be
 

a very chaotic process if a set of records suddenly
 

shows up three years later or whatever or delayed
 

for whatever reason, and we've already determined a
 

Special Exposure Cohort based on those records not
 

-- thinking those records weren't available. I mean
 

it's -- I don't know what the -- what exactly we'd
 

do in that case. And I really think we need to go
 

on record as a Board stating that this is critical
 

and that this MOU with DOE has to be in place. I
 

mean it's been a long time and I understand how hard
 

it is. I don't want to put Larry on the spot with
 

this. But I think we really need to say -- we've
 

talked about it at other meetings, but I think we
 

need to go on record with these -- with our comments
 

on these rules that it's critical that this MOU be
 

in place for this process to be workable.
 
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DR. ZIEMER: I suspect in this case that
 

such a comment perhaps would be apart from the
 

comments on the rule-making, could be a separate
 

comment of some sort to encourage the completion of
 

the MOU, or at least to identify to the Secretary
 

that the Board feels that MOU is a very important
 

step that needs to come to completion. We recognize
 

that -- at least from the NIOSH side -- they are
 

working very hard for this to be brought about, and
 

I don't think any of us thinks that the problem is
 

on the NIOSH side in coming to completion on this
 

thing. And we also -- I think there's some level of
 

angst amongst us as to, even with the MOU, will all
 

the records needed appear. And that's something
 

that we'll have to work with very diligently.
 

One thing that perhaps is -- that sort of
 

helps is as records are obtained, we see
 

inconsistencies, that tells you that something's
 

missing. So there will be opportunity to begin to
 

compare records from groups and so on to see whether
 

there is a consistent picture. There's been hints
 

and -- maybe not just hints, allegations of adjusted
 

records. But you know, you can't do that completely
 

and have it go undetected. It's like juggling the
 

books. You know, the threads go out and at some
 
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point things don't match up and the bottom lines
 

don't balance. So some of that could come to light,
 

we just have to be diligent.
 

But the MOU is the starting point and
 

certainly worth emphasizing the need for closure on
 

that.
 

DR. MELIUS: Possibly in the cover letter
 

with the comments, I don't know, or a separate
 

letter.
 

But comment number four is -- may be
 

premature, but I'm concerned about how long this
 

process is taking and could take. And it may be
 

that the rate-limiting step is going to be getting
 

the records, and not knowing what's in the MOU is -­

and how they've worked out time frames is difficult. 

But there ought to be some consideration to how do
 

you do a time -- when do you -- when is it no -­

when have you waited too long or is it taking too
 

long to complete this process, because then it
 

becomes I think very unfair to the claimants if this
 

process drags on for years and years with that. And
 

there ought to be some time frame involved -- and
 

maybe this is tied in to the guidelines on
 

determining when the information isn't available. 

If you're just not going to be able to do this and
 
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complete this in a timely fashion, then I think
 

there needs to be some determination made that this
 

is complete and that the -- I think the claimant
 

ought to be awarded if there's going to be
 

inordinate delays in completing the process, doing
 

that. And yeah, there are resource issues involved
 

and so forth, but unless sort of a time line is -­

frame and expectations developed in terms of how
 

quickly claims can be going through this process,
 

then I think it's going to become more and more
 

problematic. And so we ought to be starting to pay
 

attention to the time frame. I mean Larry has to
 

get this contract awarded and get geared up. It may
 

not be appropriate now, given this initial surge of
 

requests and so forth, but there ought to be some
 

expectation out there for -- that people will go
 

through this process in a reasonable length of time
 

on the NIOSH end and that we as a committee ought to
 

be monitoring that in some way.
 

MS. MUNN: This issue of the MOU is of such
 

magnitude, and I think should not be mixed in with
 

our comments on the specific rule-making. In any
 

case, the implementation of that MOU would fall into
 

different hands than the individuals who would be
 

working with the rule-making. I'd like to suggest
 
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that we move forward with all due haste to prepare a
 

letter suggesting that this Board urge the
 

Department of Energy to work diligently at preparing
 

and negotiating an MOU with our agencies to make
 

that exchange of information possible quickly.
 

DR. ZIEMER: Wanda, I don't know if you were
 

just making that as a comment or a formal motion,
 

but -­

MS. MUNN: I was making it as a motion.
 

DR. ZIEMER: Okay, a motion that the
 

transmittal to the Secretary this time include a
 

statement urging completion of the MOU as soon as
 

possible.
 

MS. MUNN: A separate letter.
 

DR. ZIEMER: A separate letter. Okay, the
 

motion is that there be a separate letter, separate
 

from the comments -- or separate from the cover
 

letter with the comments.
 

MS. MUNN: Right.
 

DR. ZIEMER: And that's a formal motion. Is
 

there a second?
 

DR. DEHART: I second.
 

DR. ZIEMER: Second. Discussion? Tony.
 

DR. ANDRADE: Paul, I would like to propose
 

that that letter indeed -- first of all, I'd like to
 
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say that I wholeheartedly support that motion. 

However, I would also like to suggest that some of
 

the words that Jim has used here, including those
 

that allude to the timely availability of complete
 

exposure records, should become part of what we are
 

urging the Secretary to do. I think that is -- I
 

think that is all-important. That forms really the
 

crux of what we want and what is needed from that
 

MOU.
 

DR. ZIEMER: The sentence that the MOU must
 

provide an adequate assurance that complete records
 

will be made available in a timely fashion. Is that
 

the phrase you're -­

DR. ANDRADE: That's correct.
 

DR. ZIEMER: And Wanda, do I understand your
 

motion to include that?
 

MS. MUNN: Correct.
 

DR. ZIEMER: Yes. I knew she included that. 

Yes, Roy.
 

DR. DEHART: I simply would ask NIOSH if
 

such a letter is -- would be deemed helpful, 'cause
 

sometimes there are political ramifications of this
 

sort.
 

MR. ELLIOTT: I appreciate that question,
 

and I do believe that in this instance it would be
 
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well-received by the Secretary as to what this
 

Board's concerns are in this regard and kind of what
 

your thoughts are about timely submission of
 

information to us to help process the claim.
 

DR. DEHART: 

DR. ZIEMER: 

MR. PRESLEY: 

DR. ZIEMER: 

MR. PRESLEY: 

of the -- or -­

DR. ZIEMER: 

Okay.
 

Further discussion?
 

Bob Presley.
 

Bob?
 

Would that specify DOE as one
 

This would specifically speak
 

to the MOU between NIOSH and DOE.
 

MR. PRESLEY: You might look into NNSA then
 

because a lot of your records or stuff's going to
 

have to come from NNSA.
 

DR. ZIEMER: But is not -- the DOE is the
 

agency mandated under the law here to make the
 

records available, I think even from their
 

contractors. Maybe Larry, you can clarify that.
 

MR. ELLIOTT: You're both right.
 

DR. ZIEMER: Is there going to be an MOU -­

MR. ELLIOTT: No, there's only going to be
 

one MOU between the Department of Health and Human
 

Services and the Department of Energy. But when it
 

comes to classified information, the NNSA has some
 
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purview. And the -- I can -- I'm not speaking out
 

of school. The current draft that we have fronted
 

speaks to that and includes NNSA. And at this point
 

in this juncture, the DOE has in fact agreed to that
 

and offered some additional language to that
 

particular section that would -- that NNSA has to
 

buy into and support 'cause they'll have a
 

commitment under the MOU. So if that actually goes
 

forward and goes through to signature, that will be
 

existent in the document.
 

DR. ZIEMER: Further discussion? Mark.
 

MR. GRIFFON: Yeah, just along those lines,
 

I think we might consider also asking a timely
 

release of DOE records, but also the atomic weapons
 

facility records. I'm not sure if that would be
 

useful in this letter to actually -- because I know
 

that's been a problem currently getting that -­

DR. ZIEMER: Are you talking about the
 

contractors?
 

MR. GRIFFON: Well, the MOU with DOE -- DOE
 

to provide some of those atomic weapons facility
 

records, as well -- the timely release of those
 

records.
 

MR. ELLIOTT: Well, they're -- that's
 

covered. That's covered. DOE's umbrella
 
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responsibility covers not only the DOE-recognized
 

weapons complex sites, but also those older AEC, AWE
 

contractors. And whatever they can do to afford us
 

entree and access and provision of information from
 

AWE's, that has to be covered in this agreement.
 

MR. GRIFFON: I just got the impression that
 

that was a particular issue in terms of what the
 

role of DOE was as opposed to the role of NIOSH, you
 

know, and I think that we might strongly recommend
 

that DOE take on that task of getting those records
 

and getting them to you. That's all I was...
 

MR. ELLIOTT: Certainly would welcome that
 

assistance, yes.
 

DR. ZIEMER: Other comments? Before we
 

vote, if this motion passes, I'd like to ask which
 

two of you will volunteer to draft the language of
 

the -- this will be just one paragraph to be
 

inserted in a separate letter. Wanda, do you want
 

to work on -­

MS. MUNN: Oh, sure, I'd love to do that.
 

(Laughter)
 

DR. ZIEMER: Well -­

MS. MUNN: That's fine, yeah.
 

DR. ZIEMER: Wanda, who made the motion -­

and who seconded that motion?
 
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(Laughter)
 

DR. ZIEMER: I don't want to penalize people
 

for making motions. Actually, maybe Jim, you would
 

be willing to work with Wanda to -- I think you can
 

incorporate some of Jim's words, and it's just a few
 

sentences.
 

MS. MUNN: Yes. Yes, it's brief.
 

DR. ZIEMER: And touch base with staff to
 

make sure we've covered the bases.
 

MR. ELLIOTT: And we would gladly help you
 

as much as we possibly can, without crossing the
 

line. But I would suggest that you refer to the
 

Act, and there's some specific language that you
 

might want to incorporate to augment your argument.
 

DR. ZIEMER: Okay. Are we ready to vote on
 

the motion? Okay, all those who favor the motion, 

say aye. 

(Positive responses) 

DR. ZIEMER: All those opposed, say no.
 

(No responses.)
 

DR. ZIEMER: Motion carries with -- any
 

abstentions?
 

(No responses.)
 

DR. ZIEMER: No abstentions. Okay, thank
 

you. So that takes care of that one.
 
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Okay. Now Jim, I think we've completed the
 

discussion on your items. I want to move to Mark's
 

items. Mark, if you would lead us through your 

items. 

MR. GRIFFON: Well, we've discussed number 

one, so I think we can just skip that. And I would
 

recommend maybe just talking about number three
 

first and then maybe -- maybe I would call on Ted to
 

answer number two for the entire Board. We
 

discussed this at breakfast, so he can answer pretty
 

much every question. I think it would be useful for
 

the Board to hear his response.
 

First -- number three is the definition of
 

endangered health, and I guess the -- you know, this
 

does tie in to what we were -- a little bit what we
 

were just discussing. I guess I feel more
 

comfortable on the sufficient accuracy definition if
 

the endangered health definition were more like the
 

original SEC. In other words, it was based on
 

duration of employment of a class within a certain
 

area along with monitored or should-have-been
 

monitored -- and the reason I say that is just the
 

discussion we're having back and forth with Jim
 

Neton, you know, that -- I wasn't suggesting that
 

NIOSH wouldn't have done their homework so much as
 
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that if they had done their homework and had all the
 

source term information and a number of these
 

factors, even in the absence of personal records,
 

TLD's or urinalysis, it seems to me they may be able
 

to -- with the conservative assumptions that they've
 

talked about -- make an estimate of individual
 

doses. And you know, so the question is if you
 

can't -- you know, if you've exhausted -- as Jim
 

says, pulled every string and you reach a point
 

where you say we cannot, for this class, define with
 

sufficient accuracy their doses, their individual
 

doses, I think that that next step to some I think
 

is going to -- and even -- you know, I'm wrestling
 

with it and I think -- I agree with Jim Melius that
 

the explanations are clearer and the logic is
 

clearer, but I'm still wrestling with this -- you
 

know, it's a little bit counter-intuitive, but -­

you know, even though you didn't -- you exhausted
 

everything and you couldn't determine individual
 

doses, but then you're going to come up with a
 

number -- or -- well, back-calculate a number from
 

IREP, a ceiling at which -- you know, and they try
 

to see if there's any way they could have reached
 

that ceiling, so to speak. And that's where I get a
 

little concerned because if you've exhausted -- if
 
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you've pulled all the strings and have all the data,
 

I wonder where that line is between there when -­

you know, that you couldn't do the individual dose
 

reconstructions but you have enough to kind of
 

generate a number, a worst-case number to get this
 

sort of quantitative measure of health endangerment. 

And I wonder if it would just be more useful to go
 

back to a more qualitative measure of health
 

endangerment, and that's the issue, so...
 

DR. ZIEMER: Okay. I think it's very easy
 

to articulate scenarios where you could have this
 

situation. Let me give you one. I've got a group
 

of workers who work with 15 microcuries of carbon
 

14. They are not badged, 'cause you're not going to
 

be able to pick up the C-14 beta on a badge. They
 

are not bioassayed because they don't reach the
 

threshold for which it's required. So if you come
 

back ten years from now or 20 or 30, you will find
 

no records of dose for any of these individuals. 

You could not do a dose reconstruction. There's no
 

information, except that they worked with 50
 

microcuries of carbon. So what would you do as a
 

worst-case scenario?
 

You'd say well, okay, let's suppose they
 

somehow had their beaker filled with their carbon
 
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labeled something-or-other and they drank it and
 

ingested the full amount, and you'd calculate a -­

an internal dose and come up with a number. Say
 

okay -- and it's below some value. That's really
 

worst case. Now -­

MR. GRIFFON: Well, let me -- this is great
 

example, 'cause let me ask Jim Neton, in that
 

situation do you think there's sufficient
 

information to estimate individual doses with
 

sufficient accuracy? Can you complete a dose
 

reconstruction?
 

DR. NETON: You've got to go back to the
 

efficiency process.
 

DR. ZIEMER: Upper limit.
 

DR. NETON: We could upper limit that and
 

say the highest dose in that entire population was
 

-- let's pick a number, 500 millirem, and therefore
 

you're done. I mean the efficiency process -­

DR. ZIEMER: You assume everyone did that,
 

which they couldn't because they couldn't all
 

consume -­

DR. NETON: Right.
 

MR. GRIFFON: But those are individual dose
 

reconstructions.
 

DR. NETON: But that is.
 
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MR. GRIFFON: So you could do it, huh?
 

DR. ZIEMER: I don't know if that is.
 

DR. NETON: That would -- I would call that
 

a dose reconstruction under the efficiency process
 

that we applied -­

MR. GRIFFON: People weren't required to be
 

badged -­

DR. NETON: -- in the worst-case scenario -­

MR. GRIFFON: -- so if it was worst-case,
 

they didn't trigger it.
 

DR. ZIEMER: Is that a dose reconstruction?
 

DR. NETON: Yes, that would be a completed
 

dose reconstruction.
 

DR. ZIEMER: All right. 

MS. MURRAY: Overlapping conversations, he 

can't take it. 

DR. NETON: Maybe we could take that one
 

step further, though, and it was five curies of
 

carbon 14. There were 100 workers in the lab. We
 

have no idea which worker did what in that
 

laboratory and they all had access to the carbon 14. 

And a dose reconstruction -- a quick and dirty
 

calculation would indicate that yes, it's possible
 

that one person could have gotten sufficient dose to
 

-- got a POC greater than 50 percent. A dose
 
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reconstruction is not possible at that point. We
 

don't know which worker was there, but yet there was
 

sufficient magnitude of dose in that laboratory to
 

have possibly endangered the health of that cohort. 

That, by definition, then would be -- a dose
 

reconstruction can't be done. We don't know, and
 

it's endangered their health, possibly. Not
 

necessarily every worker. Maybe one out of 100, but
 

we have no idea of -- we have no ability to assign
 

any individual dose to any of those people.
 

MR. GRIFFON: Yeah, it's difficult to play
 

these what-ifs on the fly, but I mean I would also
 

-- you know, you might think of -- with a more hot
 

lab like that, you might question -- you might have
 

badged workers, to so -- these are what-ifs, but
 

anyway -­

DR. ZIEMER: Right, or you might have
 

bioassays.
 

MR. GRIFFON: Right, right.
 

DR. NETON: Yeah, maybe that's not a great
 

example, but let's go back in the DOE environment
 

where we've had workers who have been exposed to
 

large quantities of gamma out in the field that were
 

contractors that we're aware of in some of our cases
 

that were never badged. In fact, they were never
 
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even registered as having been at the site, although
 

they certainly, by affidavit and what-not, have been
 

demonstrated to have been there. So similar
 

circumstances, you have curies of radioactive
 

material. A person is in that environment working
 

there for four or five years. In that situation
 

there's certainly potential, and we know they're not
 

badged. We have examples of this already.
 

MR. GRIFFON: I guess for this I just turn
 

back to the intent of the statute and I -- I do -­

you know, I get the impression that a lot of these
 

dose reconstructions are going to be completable,
 

you know.
 

DR. NETON: I think so.
 

MR. GRIFFON: So -­

DR. NETON: I felt that from the beginning.
 

MR. GRIFFON: So given that, I guess, you
 

know, the intent -- going back to the intent of the
 

statute, you know, that -- there's sort of an
 

admission that we don't have the data to reconstruct
 

your dose, a certain claimant's dose or a certain
 

class's dose, I'm sorry. Then to go that next step
 

and try to quantify the health endangerment, I guess
 

that's where I'm a little concerned that okay, we
 

already say we don't have adequate -- this is an
 
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individual program. We're trying to come up with
 

worker compensation decisions for individuals and if
 

we -- if there's an admission that the records were
 

not complete enough to allow us to an individual
 

dose reconstruction, then why not just look at it -­

okay, let's not -- you know, I think then you're
 

taking the next step and saying we don't have enough
 

to do the individual dose reconstruction -- here's
 

where I get a little uncomfortable. We don't have
 

enough to do the individual dose reconstruction, but
 

we think that this -- somehow we're pretty sure that
 

this source term and the information about the
 

processes on the site is complete enough that we can
 

do a worst-case estimate, and that's where I lose a
 

little bit of faith, maybe, that -­

DR. NETON: But also on top of that, we have
 

no idea which workers were in those situations which
 

would have received the larger exposures. You can
 

imagine 100 workers in a facility where a large
 

cesium source is not monitored, you don't know which
 

ones were sitting maybe out in the hallway,
 

somewhere else -- this is 50 years later. It's 

just not possible to reconstruct that. So your
 

alternative is to just be extremely claimantfriendly and everyone that comes through just say
 
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well, you were in a situation that would potential
 

endanger your health and make -- do a dose
 

reconstruction very favorable and pass them all
 

through the process.
 

MR. GRIFFON: Yeah, I -­

DR. NETON: I mean that's sort of the
 

equivalent of having an SEC, in my mind.
 

MR. GRIFFON: Well, I'm not saying it
 

shouldn't be a rigorous process to determine -- to
 

narrow -- I mean I'm not arguing for broadening the
 

class infinitely. I'm just saying that, you know,
 

the examples of -- for examples, you know, with
 

processes where you were working with recycled fuel,
 

you know, process information shows that
 

transuranics will be isolated or concentrated in
 

certain sub -- you know, certain processes, certain
 

buildings, and I think you can do a reasonable
 

effort to determine what subset of workers were in
 

those areas, and that's a work duration thing. You
 

might say anyone who worked in that process area
 

where the -- you know, that process was going on for
 

over a year and should have been monitored for this
 

stuff but was not, that is good -- you know, we
 

couldn't calculate your individual dose. That's the
 

precursor to all this is we couldn't calculate your
 
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individual dose.
 

DR. NETON: Right.
 

MR. GRIFFON: And then the next thing is -­

DR. ZIEMER: But we can get a bound then.
 

MR. GRIFFON: Right, let's make sure that -­

you know, the check for endangerment of health would
 

be just that you worked in those processes where -­

you know.
 

DR. NETON: Well, you're suggesting that we
 

wouldn't look at endangered health based on -­

MR. GRIFFON: That's the -­

DR. NETON: -- probability of causation.
 

MR. GRIFFON: That's the question, and I
 

know it's a fundamental question.
 

DR. NETON: Well, I think the Act says that
 

we have to determine if their health was endangered. 

That's a criteria. I mean that's one of the
 

conditions that we're tasked with looking at. And
 

endangered health is the fact that there was an
 

unmonitored material -- that doesn't pass that test,
 

I don't think. Unmonitored material doesn't
 

necessarily endanger health to the definition which
 

we've adopted which is to have caused cancer as
 

likely as not.
 

MR. GRIFFON: Yeah, I don't have the Act
 
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right here with me, but I'm not sure the Act
 

specifies how you would define endangered health.
 

DR. NETON: No, it doesn't.
 

MR. GRIFFON: Or interpret endangered
 

health. Right?
 

DR. NETON: No, but the rule does. I mean
 

we've taken that approach, endangered health -­

MR. GRIFFON: Yes, the rule does now, yes. 

But that's what I'm commenting on.
 

DR. NETON: If you believe in a linear, no
 

threshold hypothesis, then any atom that wasn't
 

monitored potentially endangered their health. You
 

have to have some objective criteria to quantify
 

that. I mean you just can't say because there was
 

an unmonitored small amount of material, that that
 

endangered health. There may be a one in 100,000
 

chance of endangering the health, but is that really
 

what we're tasked with doing? I don't think so.
 

MR. GRIFFON: I see your point.
 

DR. MELIUS: I think what's bothering us
 

with this is we've got this IREP model which is a
 

very elegant model for taking into account
 

uncertainty and given (inaudible) based on whatever
 

is available in terms of epidemiological and other
 

health information. And then we wed it up with this
 
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situation that Mark is just describing -- I've gone
 

through some examples with him -- and we do this
 

very convoluted calculation -- leukemia and two
 

different tumor types -- somehow imply a certain
 

amount of accuracy to that process, I think more
 

accuracy than it may deserve. And you worry that it
 

would become sort of an arbitrary decision as to how
 

you would make that determination. Then how do you
 

then calculate how -- what's -- who is the cohort? 

What's the duration of people -- you know, how -- is
 

it anybody that would have been in that laboratory
 

over that period of time or is it they have to be
 

there for 30 days, how do you make that calculation. 

And in a situation where we've already said there's
 

insufficient data to do individual dose
 

reconstruction and -- it just seems to be a very
 

convoluted way of making this determination. I
 

think it sort of implies that there's a stronger
 

basis for the determination than we really have. I
 

think -- use Ted Katz's analogy, it's like having
 

him go outside and look at the weather one day and
 

run in to this supercomputer that then will
 

calculate what the average temperature's going to be
 

in Atlanta that day, and you're sort of making -­

you know, you ask Ted to come up with well, is it
 
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going to rain or not and Ted runs in and presses the
 

button and does all these calculations. But Ted's
 

guess is -- sort of bothers me a little bit as how
 

we're going to rely on that versus somebody else's
 

guess as to what the weather will be that day. And
 

then we do a calculation that somehow implies that
 

that's a good guess. You know, I don't know.
 

MR. GRIFFON: I also -- I do understand and
 

I appreciate Jim's response that -- and I don't
 

think -- you know, when I go back to the statute, I
 

certainly don't think the intent was to try to
 

include people in the Special Exposure Cohort like
 

vendors that were on the site once a week -- just an
 

example, but just a vendor coming in once a week,
 

wasn't badged, wasn't monitored, we didn't know
 

anything about his dose and -- you know, but the
 

chances are very small that he had any significant
 

exposure. That's not the intent and so I appreciate
 

your response that way, but -- you know, and I'm not
 

sure how to -- I'm not sure how to put that other
 

trigger on there, but I have a concern of just this
 

notion that you can -- that you've exhausted all
 

your possibilities for individual dose
 

reconstruction and yet you're going to try to in
 

some way quantify this endangered health aspect. So
 
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I'm still wrestling with it myself, but that's -­

that's the concern.
 

DR. ZIEMER: But it appears that the
 

methodology is not one like the weather case where
 

you're trying to predict the weather. It's more
 

like what's the worst possible -- what's the hottest
 

day you can have in December, and use that as the
 

upper limit. So you can say well, it's unlikely,
 

statistically, that some level which you have
 

decided is out here somewhere -- that the weather
 

will be hotter than some value in Atlanta in
 

December. So we're working way out at the extreme
 

of the prediction. Remember that these are
 

prediction models. There still is a chance for
 

error in any of these. There still is a chance that
 

someone who has a cancer caused by radiation will
 

not be compensated, but the chance is very small -­

but not zero. Okay?
 

And I think in the way they're approaching
 

this, it says basically we're trying to find worst
 

case. We can't reconstruct dose, but we can bound
 

it in a reasonable way that is fair to anyone -­

it's not the Coke machine guy who comes in for a
 

minute, but it's the worker who's in there. And
 

usually on these cohorts you're specifying when they
 
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worked there. And some may have been there a month
 

and some may have been there a year, but they still
 

qualify if they were there when certain things were
 

there, which is set within the boundary of the
 

cohort.
 

MR. GRIFFON: Well -- go ahead, Jim.
 

DR. MELIUS: I think there's two things,
 

though, that are still a concern. One is that
 

there's going to be situations where the
 

information's going to be very weak. And that
 

initial number that Jim and his staff is going to
 

come up with is going to be -- have a very flimsy
 

basis. Not their fault. I mean good judgment and
 

everything, but just there's so little information. 

And then we're sort of plugging that number into
 

this very fancy calculation. I mean it's -­

And the second thing is why are we doing
 

this, given -- knowing the fact that this is going
 

to be, in many cases, a very weak number, based on
 

judgment and so forth, all -- given that. Then
 

we're doing this averaging between leukemia and some
 

other cancer. I mean it just -- that calculation -­

the two calculations and so forth just seem to me
 

not appropriate, given the nature of the number
 

we're doing. It seems to me it implies more
 
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accuracy than -- the number than is probably
 

warranted by the situation that this process is
 

meant to handle, and I just think it's sort of an
 

unnecessary step to take and tends to be arbitrary
 

and why do that. But again, we're going to -- we,
 

as a committee reviewing these -- the NIOSH report,
 

we're going to be looking at the basis for that
 

number. Now I mean that's really what we're going
 

to be looking at and providing some input to that
 

and so forth, so that may take care of this issue. 

But it's still -- I worry about the situations where
 

there's just so little information and we're trying
 

to make that information fit into this calculation.
 

DR. ZIEMER: Rich.
 

MR. ESPINOSA: Well, I also see a
 

possibility to where there's going to be a lot of
 

information provided, but the information might not
 

be sufficient to do a dose reconstruction or
 

possibly put these members on a cohort. For
 

example, there's electricians at CMR in Los Alamos
 

pulling wire. They're pulling wire through three or
 

four different lab rooms a day to where they're
 

exposed to four or five different isotopes, but
 

they're not on a bioassay program, but they are
 

badged with the TLD that's biased to one or the
 
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other.
 

DR. ZIEMER: Roy?
 

DR. DEHART: Jim, I understand your concern. 

What is your consideration for the alternative? How
 

would you do it, other than just taking the whole
 

cohort and awarding?
 

DR. MELIUS: Well, you could either come up
 

with, first of all, some duration type of
 

calculations. It's not clear to me yet how they're
 

going to consider duration and exposure. And I
 

would certainly simplify this process of doing the
 

two cancers and so forth. I just don't think that
 

-- I just don't think it makes sense, given how weak
 

this data is going to be. So I would get rid of
 

that doubling -- that consideration of two different
 

types of cancers and so forth.
 

MR. GRIFFON: And along those lines, Roy,
 

the -- I mean I think where -- to get to this point,
 

we've also seen that you've got to go over that
 

first hurdle, that they couldn't calculate an
 

individual dose with sufficient accuracy. And I
 

think from what we've seen in -- I think they're
 

going to -- even for the low/low cases where they -­

you know, they're going to use worst-case data,
 

worst-case estimates if they're nowhere near 50
 
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percentile, they're not even going to reach that
 

next hurdle of okay, we can't -- you know, they're
 

going to give them the best, most -- you know,
 

benefit of the doubt and try to do an individual
 

calculation if they don't reach that hurdle. So I
 

think that throws away that concern of are we going
 

to be putting people in this class that really had
 

no chance of any -- I mean that would -- that's my
 

notion, anyway, is that you're going to lose those
 

in that process. You know, those that had no
 

significant chance of any significant exposure. 

Then once you've reached that, you say okay, but for
 

-- you know, we can't define this dose. Then I
 

think -- you know, I think that step of just a
 

duration-based approach and -- you know, should have
 

been monitored or were monitored approach might be
 

adequate. That's my opinion, because I think those
 

other ones are going to fall off before you get -­

before you meet the first set of criteria, which is
 

can you estimate with sufficient accuracy. And you
 

know, sufficient accuracy is defined is complete the
 

dose reconstruction for purposes of compensation. 

It doesn't have to be -- as we've said before, it
 

doesn't have to be an accurate dose, it just has to
 

be accurate enough to make a determination for
 
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causation. So that, I think, could get -- you know,
 

I hear the concern about well, we don't want to just
 

be adding people to this class that really had no
 

potential of any significant exposure at all. I
 

think that's part of the reluctance to go to a
 

qualitative measure for endangered health. But that
 

would be my rebuttal is that I think that's -- those
 

are going to fall off in that way.
 

DR. ZIEMER: Mark, where are we on your -­

we did number three. Sufficient accuracy, we sort
 

of covered that before, and do you want to -- we
 

need to take a break.
 

MR. GRIFFON: We should take a break 'cause
 

number two is very complicated and maybe Ted can
 

look at number two during the break and step through
 

those responses because -­

DR. ZIEMER: Yeah. Let's take our break and
 

recognize we also have to discuss the dose
 

reconstruction recommendations yet, too. Fifteen
 

minutes, folks.
 

(Whereupon, a recess was taken.)
 

DR. ZIEMER: We'll return to our business. 

I have one housekeeping item, and that concerns the
 

minutes of the meeting which we approved, but I
 

pointed out that I would like you to individually
 
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provide your editorial changes or -- the misspellings or anything like that. I have a master
 

copy -- this is Cori's master copy -- and anyone who
 

has editorial changes we'd like you to mark them in
 

the master copy.
 

How many of you have such changes? Let me
 

see. Okay, I'm going to start this around with
 

Wanda. Mark yours in and then pass it on to the
 

next person, just as we go here. Just mark yours in
 

there so that they're all in that one copy. This is
 

in addition -- this does not include the actual
 

substantive changes that we made yesterday. We
 

already have those on the record, so these are just
 

the editorial changes, any grammatical or spelling
 

or whatever, that kind of thing.
 

Now let's return to Mark's document and the
 

clarification of issue regarding SEC class applying
 

for non-SEC-listed cancers. And Mark, before you
 

get into this, I want to ask a question which I
 

think is part of this and also I think relates to
 

Richard Miller's question yesterday, the question
 

about combining of the special cohort upper boundary
 

dose values with other doses. And maybe Jim, you
 

can help us answer this.
 

Under the guidelines and procedures, could a
 
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person who has a period of work -- let's say they
 

were Special Exposure Cohort period -- or
 

potentially Special Exposure Cohort period, but
 

perhaps didn't meet that criteria. Let's say that
 

it was determined that their dose could have been no
 

more than let us say ten rem. And then the
 

calculations showed that it was not sufficient to
 

meet the probability of causation for that
 

situation. But in addition to that, at some other
 

location perhaps, they had monitored doses and dose
 

reconstructions could be done, and suppose it was
 

found that they had another ten at one location and
 

five at another. The question is, can they add in
 

the hypothetical dose from the period for which dose
 

reconstruction was not done, and add that as an
 

upper bound to the other doses that could be
 

reconstructed? I think that -- that's sort of the
 

nature of what Richard Miller was asking about
 

the -­

MR. GRIFFON: And that's my question 2(c)
 

here is exactly that.
 

DR. ZIEMER: Right.
 

MR. GRIFFON: Yeah.
 

MR. KATZ: Well, actually I think 2(c)'s
 

different.
 
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MR. GRIFFON: Is it?
 

MR. KATZ: But -- yeah, because that's
 

asking for the class, would the class determination
 

I think you're getting at there, can -­

MR. GRIFFON: I think that's what he said.
 

MR. KATZ: -- dose is up.
 

DR. ZIEMER: But if they're in a class
 

that's been approved, they're getting compensated
 

already, so that's a moot point. Right?
 

MR. GRIFFON: No, potential -- go ahead,
 

answer his question.
 

MR. KATZ: Potential class, they're not
 

really in a class. Let me -­

MR. GRIFFON: Answer his question.
 

MR. KATZ: Well, let me -- I'm going to go
 

through all of these really -- why don't I just go
 

through all of these, instead of starting at the end
 

there.
 

An individual's in an SEC class but has
 

exposures outside of that time period, location, et
 

cetera that defines the class, and the question is
 

can that individual apply for compensation outside
 

of the procedures of the Special Exposure Cohort to
 

the DOL. And that's already answered. That's
 

actually not a policy issue at all. Right now and
 
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always -- the Department of Labor, when they get a
 

claim for a cancer that is not an SEC cancer, that
 

claim will come to us for dose reconstruction. So
 

there's no barrier for an individual who doesn't
 

have an SEC cancer, a specified cancer, coming to us
 

for dose reconstruction. There's no even decision
 

or appeal they have to make.
 

MR. GRIFFON: And that question was put in
 

there more as a clarification. I -­

MR. KATZ: Right, so I'm clari-­

MR. GRIFFON: -- was a little concerned
 

about the statement that Richard Miller read
 

yesterday from the transcripts in New York seemed to
 

interpret things differently and that's -­

MR. KATZ: Right, let me -- and that's -­

you know, he said some Federal official -- it's me. 

I'm the responsible party. I'm speaking very
 

narrowly in that case because I think people, for
 

the most part, were understanding that with the
 

atomic weapons employers that their whole facility
 

and work experience would be -- comprise the class. 

But anyway, that's my -- if I had to do it over
 

again, I wouldn't make a narrow expression like
 

that. I did -- I did it. So -­

MR. GRIFFON: That was just for
 
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clarification.
 

MR. KATZ: So send me back to Buffalo.
 

(Laughter)
 

MR. KATZ: Please don't. So if so, can the
 

dose assigned to the class be added to the
 

individual -- that's, I think, the question Dr.
 

Ziemer's raising just now. Can you take -- so say
 

you don't -- say you don't -- I guess there are two
 

scenarios here, really. Say the situation were you
 

don't add a class. There's a petition for a class
 

and you determine the dose wouldn't make that
 

minimum threshold of possibly causing a specified
 

cancer. And the question would be then so that
 

you'd come up with some -- how high could it have
 

been, the dose. You'd come up with some number
 

there. Would you add that into the individual dose
 

reconstructions. And we haven't crossed that bridge
 

to -- we didn't think down this lane to answer that
 

question. I mean it's certainly a question that's
 

germane for our dose reconstruction procedures and
 

we're going to have to answer it, but we haven't. 

So I can't stand up here now and tell you what -- we
 

would take that dose or half that dose or not take
 

that dose or what, but I agree, that's an issue. It
 

belongs here with the Board as an issue, too, and
 
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we'll have to resolve it.
 

But let's then take the other situation
 

where you have added a class -- I'm sorry.
 

DR. ZIEMER: Let me interrupt, but
 

nonetheless, if that person then -- if you were
 

doing a dose reconstruction, that would be a period
 

of time in their history for which you would have to
 

do something.
 

MR. KATZ: Thanks.
 

DR. ZIEMER: Right?
 

MR. KATZ: Thanks, that's -­

DR. ZIEMER: And the logical thing to do
 

would be to do the upper-bound calculation that you
 

would have done anyway for the class.
 

MR. KATZ: So that's an option, right. And
 

that's something that has to be -­

DR. ZIEMER: It's a kind of dose
 

reconstruction.
 

MR. KATZ: Exactly right. That's an option. 

That's something that's going to have to be decided,
 

but we haven't -- we never -- we didn't get to that
 

question yet. Okay?
 

Then we have the situation -- the different
 

situation of we've added a class. Okay? And that
 

window -- some individuals -- in the same situation,
 
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some individuals have exposures from other periods,
 

and then they also have their experience during that
 

period in place covered by the class.
 

MR. GRIFFON: Okay, I'm not sure your
 

example's -- I think you're reviewing a potential
 

class here. Right? And then you're considering -­

MR. KATZ: Well, I mean -­

MR. GRIFFON: -- exposures outside the
 

window? Okay, go ahead. Go ahead.
 

MR. KATZ: If it's a potential -- I mean it
 

really -- there are two -- if it's a potential
 

class, we're going to have to resolve the issues of
 

whether we can do a dose reconstruction and so on. 

I don't think that helps clarify -- I mean really
 

there are two scenarios at the end of the day is
 

whether the class is added or not. And the reason
 

those are distinct -­

DR. ZIEMER: If they are, the other doses
 

don't matter then 'cause they're compensated.
 

MR. KATZ: If they are, for the other
 

cancers -­

MR. GRIFFON: And if they're not -­

MR. KATZ: -- they're compensated.
 

MR. GRIFFON: That's the question, if
 

they're not.
 
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MR. KATZ: We've addressed the situation of
 

if they're not -­

MR. GRIFFON: No, no, no, no -­

MR. KATZ: -- if the class is not added.
 

MR. GRIFFON: -- if the class is not
 

added -­

MR. KATZ: Then that's what I just
 

explained, if the -­

MR. GRIFFON: No, then for class
 

determination, can you add previous exposures?
 

MR. KATZ: That's the third -- let me go to
 

that last. Okay? That's the last of your questions
 

and I promise I'll get to that.
 

MR. GRIFFON: I thought you were there. I'm
 

sorry.
 

MR. KATZ: I'm sorry. Again, so we've
 

answered the question of what happens if the class
 

is not ultimately added. Then we have a decision to
 

make, and the Board has a role here, too, I suppose,
 

advising us on this.
 

But here's the other scenario. We add a
 

class, and we just went through how we would do
 

that, right, how we would make that determination. 

In that case, we don't actually have an upper-bound
 

estimate radiation dose 'cause we didn't do a dose
 
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estimate. All we answered was the question, could
 

the dose have exceeded some benchmark, but we didn't
 

put a cap on that. And in many cases, the cap may
 

be -- you know, the sky's the limit, almost. Right? 

It could be exceedingly high.
 

So in that case we don't have the same
 

material to work with in terms of what we would do
 

for the individual who has a different cancer and
 

has doses outside of the class. Right? What we
 

will do there, again, I think -- I think we're going
 

to need to consider that situation and the advice of
 

the Board, but it's -- again, we did not imagine our
 

way down that path, so that's why we don't have a
 

procedure. But anyway, it's an issue for the dose
 

reconstruction process.
 

So then the final question which Richard
 

raised yesterday and you have raised again here,
 

which is what about -- I think I have this right. 

What about considering the individual's doses
 

outside of the class period as an element -- as
 

facts to contribute to whether you add that class or
 

not. Right? Do I have that right?
 

MR. GRIFFON: Yeah.
 

MR. KATZ: Right.
 

MR. GRIFFON: And this is kind of the -- you
 
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know, this is -- and I don't know how often the
 

situation might even arise, but it's the borderline
 

case where you're reviewing a class -- a potential
 

class -­

MR. KATZ: Right.
 

MR. GRIFFON: -- and they don't meet that
 

hurdle.
 

MR. KATZ: Right.
 

MR. GRIFFON: But maybe they've all had
 

previous exposures or some of them have had previous
 

exposures, significant exposures -­

MR. KATZ: That were recorded.
 

MR. GRIFFON: -- do you take those into
 

account when you're considering that class or not,
 

and that's -­

DR. ZIEMER: Or how does that differ from
 

the first case?
 

MR. GRIFFON: That were reconstructable. 

Right, that were -- the earlier exposures were
 

reconstructable.
 

DR. ZIEMER: That's similar to the case we
 

talked about before then.
 

MR. GRIFFON: But -­

DR. ZIEMER: You've got one part
 

reconstructable, one part not.
 
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MR. GRIFFON: Except in this case you're
 

making a decision on the class instead of on the
 

individual dose reconstruction. Right?
 

MR. KATZ: Right. The first case -­

MR. GRIFFON: So you're adding the dose to
 

one instead of the other -- you know.
 

MR. KATZ: Right. The first case is really
 

simple because we're just completing the dose
 

reconstruction. The second case, you're saying how
 

do we -- and again, we did not think there, either. 

And I believe -- and I'll just have to say that
 

vaguely because I'm not certain -- the way the
 

regulation's written now, I don't think you could
 

take the exposures outside of the time period and
 

bring them into consideration of the class.
 

Now the problem -- I mean there may be
 

circumstances like that where everyone had the same
 

exposures outside that were monitored but then hence
 

also had exposures within -- the issue that
 

certainly has to be satisfied is that they all have
 

to have a common exposure experience to be
 

considered as a class, so we're going to have to
 

satisfy that criterion.
 

DR. MELIUS: Could you define the class
 

based on their -- in a way that would include a
 
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criteria for additional individual exposure? That
 

would be one way of approaching it.
 

MR. KATZ: I think the way you define -- I
 

think you would -- I mean to get at this, I think
 

you would simply define the class beyond the period
 

when the records were inadequate, but including the
 

period when records were adequate as well as the
 

period when records were inadequate to come up with
 

-- do you understand what I'm saying?
 

DR. MELIUS: Yeah, that's another -­

MR. KATZ: And then -- but everyone would -­

in the class would have to meet both of those -- in
 

other words, elements. They would have to be during
 

the period when records were adequate, as well as
 

the period when records were inadequate. Do you
 

understand? Does that make sense?
 

DR. MELIUS: That would be another option. 

I mean -­

MR. KATZ: Right. That's the one I can
 

imagine.
 

DR. MELIUS: I think there are a couple of
 

options for doing this and it may depend on the -­

probably on the particular situation. Pardon me if
 

this is very convoluted, but...
 

DR. ZIEMER: Have we completed yours, Mark?
 
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MR. GRIFFON: Yes.
 

DR. ZIEMER: Okay. Now I want to add one
 

more thing into the mix here for Special Exposure
 

Cohort, and that is to input into our sort of
 

knowledge base the outcomes of the Town Hall meeting
 

-- meetings, because they may be pertinent to know
 

what the public comments were. So Ted, this would
 

be a good time I think for us to hear your summary
 

on some Town Hall comments. Is Ted still here?
 

DR. MELIUS: While Ted's returning to earth
 

here, can I just make one comment on that -­

DR. ZIEMER: Sure. 

DR. MELIUS: -- last section? 

DR. ZIEMER: Sure. 

DR. MELIUS: I think one of our 

recommendations might be, as a Board, is that NIOSH
 

review these regs to make sure that they don't
 

preclude any of these options for dealing with some
 

of these situations. I don't think we can ask them
 

at this time to develop every possible scenario, but
 

make -- try to go through this and make sure they
 

haven't precluded some of the options for the future
 

in terms of -­

DR. ZIEMER: And that argues for
 

flexibility, which was one of the issues that I was
 
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concerned about if we became too proscriptive.
 

DR. MELIUS: Right.
 

DR. ZIEMER: Okay. Ted, are you set?
 

MR. ELLIOTT: While he's getting -- cutting
 

the lights and all of that to present, I would just
 

inform the Board that the transcripts from the last
 

two Town Hall meetings should be up on our web site
 

and available for anybody who wants a hard copy upon
 

request the first of next week -- early -- perhaps
 

Tuesday of next week.
 

UNIDENTIFIED: That'll be fun to read.
 

MR. ELLIOTT: I'm sorry?
 

UNIDENTIFIED: I said that should be fun to
 

read.
 

MR. KATZ: Okay. So I'm just going -- I'm
 

just going to give you a flavor for the comments we
 

received, both on the rule and on other matters,
 

too, because in fact we received a lot of comments
 

and questions and so on on matters outside really
 

the parameters of this rule. But it was very useful
 

I think for us to be out there explaining things for
 

lots of people who don't understand much related to
 

dose reconstruction, and other issues, as well.
 

So one of the first questions we received
 

everywhere -- almost everywhere, I'm sure -- was why
 
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didn't Congress include us in the cohort. Why is
 

the burden of proof higher for us? And sort of
 

following along these lines, couldn't Congress have
 

included us, for example, because we worked with the
 

same radioactive materials that they used at the
 

gaseous diffusion plants. Those came to us
 

afterwards, so why aren't we there? Or because
 

maybe our exposures are likely to be higher than
 

they were there? But we heard this first.
 

DR. ZIEMER: What did you tell them?
 

MR. KATZ: Well, we explained that we don't
 

have reporting really from Congress to be able to
 

give them a clear answer as to how Congress decided
 

on the locations that would be included originally
 

in the cohort.
 

So -- and similarly, why aren't our
 

illnesses covered? Why is cancer the only health
 

outcome covered among illnesses related to radiation
 

or radioactive materials?
 

Why aren't all toxic exposures covered? We
 

had questions in Los Alamos about what about nonionizing radiation, and we had questions I think at
 

all locations about chemical exposures.
 

Why aren't employees of the AWE's covered
 

who worked during periods when there was residual
 
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contamination? We had a lot of questions about
 

that, about the defined periods currently of the
 

AWE's, and we explained to them what's going -­

ongoing with our radiation -- residual contamination
 

study that we're doing and what the status of that
 

is.
 

And then lots of questions along Jim's
 

continuing concern about how long it will take to do
 

a dose reconstruction or determine that we can't; to
 

obtain contractor support for the dose
 

reconstructions; to decide the outcome of a
 

petition. And there was concern about delay arising
 

from the Congressional review period. I think
 

everywhere that sort of raised consternation, sort
 

of visible consternation. And you know, we
 

experienced a lot of anger about the duration that's
 

already -- the water under the bridge, how much time
 

has gone by on all of this and their claims awaiting
 

adjudication.
 

And questions about what's a class, how it's
 

defined, how large or small it can be. Can it be a
 

whole facility, so on. And we had recommendations
 

at some of these meetings that their -- they
 

believed their facility should be added as a class.
 

This is a question that we've actually dealt
 
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with at length in this Board meeting already, so I
 

won't go into it at length, but this is my
 

statement, sort of drew this out. Can members of a
 

class opt out of a class that's been added? And as
 

I explained, they wouldn't need to opt out. They
 

would automatically come to us -- this relates to
 

situations where people have cancers that are not
 

covered -- not a covered -- under the Special
 

Exposure Cohort procedures and they would come to us
 

for a dose reconstruction in any event
 

automatically.
 

Can a claimant withdraw a claim before
 

adjudication is final and submit a petition? I mean
 

this -- presumably their concerned well, if they
 

find out down the road that their dose is likely to
 

be low, can they instead take another route and
 

submit a petition for a class.
 

And just to answer that -- but I mean
 

there's nothing -- there is nothing in the
 

procedures that preclude them from doing that. They
 

can, at any point, submit a petition. We don't
 

limit them based on that.
 

Why does a claimant have to petition if
 

NIOSH cannot do a dose reconstruction? This was
 

sort of the question of why do we have to petition
 
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at all in that case? Why don't you just simply go
 

on about evaluating a class?
 

DR. ZIEMER: What was your answer?
 

MR. KATZ: And I'm sorry, the answer -­

we've talked about that here, too, is as we read the
 

law, the law requires a petition to start the
 

process.
 

Why are the SEC procedures so complicated? 

And then we had we had a whole -­

I mean -- there's a great quote from John
 

Adams I could give here, but maybe I'll pass. Why
 

are the -- do you want me to give that?
 

John Adams was asked -- this could not be
 

recorded, but John Adams was asked by a Frenchwoman
 

once why the American form of government was so
 

complicated, and his response was well, you could
 

take all the wheels out of a watch, but it wouldn't
 

necessarily tell time.
 

And lastly, how will NIOSH reconstruct
 

doses? There were lots of questions about how would
 

you reconstruct a dose given this situation or that
 

situation, given that records may not be complete,
 

and so on.
 

But that -- I mean I think that's a decent
 

flavor of what we heard on the road.
 
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DR. ZIEMER: Okay, let's see if there's any
 

questions for Ted on the issues discussed at these
 

Town Hall meetings.
 

DR. MELIUS: Could you give us some idea of
 

what the turnout was at the different meetings?
 

MR. KATZ: Yeah -- oh, yeah, I'm happy to. 

So the first two meetings, Buffalo was under 20 and
 

Ohio -- just outside of Cincinnati -- was again
 

under 20. And I think that is in part a product of
 

the very little lead time we had between announcing
 

the meetings and the meetings being convened, and
 

the fact that newspapers hadn't gotten out a story
 

in advance of the meeting and so on.
 

So -- and then out west we had really much
 

better turnout. At Hanford we had about 350 -- I
 

haven't actually seen the numbers, but I've heard
 

that a number of times and it looked like that. We
 

had to open up another room to fit all these people. 

They were going right out the hotel lobby and into
 

the street. So there was about 350 at Hanford and
 

then at -- near Los Alamos in Espanola there were
 

approximately 50 to 60, I think.
 

DR. MELIUS: And in the Buffalo meeting,
 

which is some of the older atomic weapons plants or
 

-- was the flavor of the questions or the nature of
 
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the questions different or did you get -- we really
 

haven't talked a lot about dealing with those
 

employers in this committee and I'm just curious as
 

to are there -- given time periods involved and some
 

of their eligibility issues, were there any
 

particular things that came up that the Board should
 

be cognizant of in terms of working with those
 

employers?
 

MR. KATZ: Jim's standing up, I'll have him
 

give -­

DR. NETON: I think the key issue in my
 

mind, we had a number of questions related to
 

residual contamination and period of covered
 

employment. I mean that was a good theme for a
 

large part of the meeting, why they had to work in a
 

certain defined time period to be eligible to apply
 

and who set those time periods and are they going to
 

be changed and that sort of thing. A lot of
 

frustration from the people in that area.
 

MR. KATZ: Then the other sort of
 

distinctive thing at Buffalo was -- I mean it was
 

clear this would -- this makes sense probably to
 

everybody, is that they had even less information
 

than at the other sites about everything in general,
 

and a lot of pent-up frustration related to that.
 
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Go ahead, Mark.
 

MR. GRIFFON: I was just going to ask if Jim
 

or Ted can expand on the residual contamination
 

report -- from what I understand, their report was
 

-- a study was required, is ongoing. I'm not sure
 

where that stands now.
 

MR. ELLIOTT: I'll speak to that. The sixmonth progress report which was due to Congress at
 

the end of June is going through inter-department
 

clearance right now and OMB approval so that it can
 

be sent over to the Hill.
 

DR. ZIEMER: Okay. Are there further
 

questions?
 

(No responses.)
 

DR. ZIEMER: It appears that there are not. 

Thank you, Ted, for that report.
 

MR. KATZ: Thank you.
 

DR. ZIEMER: Now we're going to return to
 

this topic of the Special Exposure Cohort after
 

lunch. I will ask the working group if they would
 

mind maybe sitting around the lunch table together
 

and discussing the form of the document that we
 

prepare. We want to get sort of on the table for us
 

yet this morning the report of the dose
 

reconstruction working group so that we have that
 
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before us, as well. And Mark, if you could lead us
 

through now your current -- I think there's a
 

handout. Did everybody get it?
 

MR. GRIFFON: Did it circulate to everyone? 

I'm not sure.
 

DR. ZIEMER: We have a -­

MR. ELLIOTT: It has been placed at each
 

person's -­

DR. ZIEMER: -- version 2.0 of the working
 

group -­

DR. NETON: No, we -- that was a draft that
 

we distributed early for review by just the working
 

group.
 

MR. GRIFFON: Yeah, we were planning on
 

meeting at the break to go -- 'cause I -­

DR. ZIEMER: Okay, so you don't want to sort
 

of -­

MR. GRIFFON: Well, that would be the
 

question from me to the working group since I did a
 

lot of this last night and they didn't have a chance
 

to look at it.
 

DR. ZIEMER: I gotcha.
 

MR. GRIFFON: I don't know if they're ready
 

to give it to the entire Board or if they have
 

comments for me and changes that we want to make
 
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first. I didn't have a chance to -­

DR. ZIEMER: I'll leave it up to the working
 

group. Do you want to have any input on this before
 

-- are you -­

MR. GRIFFON: They've had input, don't get
 

me wrong. We discussed all this -­

DR. ZIEMER: No, no, I know you have.
 

MR. GRIFFON: Yeah, yeah.
 

DR. ZIEMER: Go ahead, that would be my -­

MR. GRIFFON: You think it's okay?
 

DR. ZIEMER: Yeah, I would -­

MR. GRIFFON: I think we can distribute this
 

then to the entire Board and I can go quickly
 

through it. It's not that -- it shouldn't take that
 

long.
 

(Pause)
 

MS. MURRAY: Dr. Ziemer, may I ask a
 

question while he's distributing this?
 

DR. ZIEMER: Uh-huh.
 

MS. MURRAY: This afternoon when you go over
 

the SEC rule, will that be the clarification of the
 

answers to all these questions? Because frankly,
 

from the discussion this morning and my notes, I'm
 

not sure that I'm clear on what the answers were to
 

all of them.
 
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DR. ZIEMER: Right, I'm not sure that we're
 

clear on what the answers are, either, but to the
 

extent that we're able to address those and come up
 

with some language, I think we're hopeful that many
 

of those will be at least addressed in some way.
 

MS. MURRAY: Great. I just wanted to make
 

sure I hadn't missed anything.
 

DR. ZIEMER: No, if your notes are
 

confusing, they're very much reflecting the meeting,
 

I think.
 

DR. MELIUS: The answers are yes, yes, no,
 

maybe.
 

MR. GRIFFON: Should I give -- I mean people
 

haven't looked at this. Do you want to -­

DR. ZIEMER: Maybe you could lead us through
 

it, huh?
 

MR. GRIFFON: Okay. It's not that -­

DR. ZIEMER: Yeah, it's not that extreme.
 

MR. GRIFFON: -- different. It's version
 

two of the last -- which we approved by vote of -­

sort of an original scope of work for the dose
 

reconstruction -­

DR. ZIEMER: And remember, if you want to
 

have the early version, it's the attachment two on
 

the minutes -­
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MR. GRIFFON: Right.
 

DR. ZIEMER: -- so if you need that -­

MR. GRIFFON: And for the most part, this is
 

a redline strike-out type version -­

DR. ZIEMER: Of that.
 

MR. GRIFFON: -- except for the -- it
 

doesn't completely hold true 'cause of my edit. I
 

didn't start doing that till mid-way through, but
 

anyway, I'll point out where the differences are.
 

I tried to expand a -- based on what we were
 

discussing yesterday and what we went over the last
 

couple of days, we tried to refine, at least a
 

little bit further, some of this initial scope for
 

the dose reconstruction review. The independent
 

panel section, we -- yesterday we did talk about
 

establishing a criteria, sort of a professional
 

criteria that we would look at or that we would
 

draft for NIOSH then to do the -- go through the
 

procurement process and hire these independent
 

experts. We haven't -- we didn't have NIOSH's RFP
 

and we wanted to look at that language, so we didn't
 

really include that in there, but we're still
 

planning on adding that to the independent panel
 

section.
 

DR. ZIEMER: Mark, could I interrupt and -­
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MR. GRIFFON: Uh-huh.
 

DR. ZIEMER: -- maybe we can get some
 

comments on each section as we go here.
 

MR. GRIFFON: Sure.
 

DR. ZIEMER: On independent panel, could you
 

clarify the working group's -- how you envision -­

when you talk about the two Board members and one
 

expert, is my understanding you're envisioning this
 

as not necessarily being the same two people for
 

each review, but that this workload would be
 

distributed in some way amongst the total Board
 

members, including the newer people coming aboard,
 

so we -­

MR. GRIFFON: Yeah, that is correct and we
 

need to -- we didn't -- we didn't know how to
 

describe that, I guess. A rotating basis or
 

something like that, but the intent is that the two
 

Board members participating in the panel would
 

rotate and hit everybody so we can spread the
 

workload.
 

MR. PRESLEY: The panel will meet prior to
 

the meeting so it won't be a separate meeting. It
 

might be the day before.
 

MR. GRIFFON: Yeah, that was just another
 

consideration that we had just to reduce the travel
 
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burden on everyone and everything to try to -- for
 

the most part, we see the independent expert doing
 

the bulk of the work on these reviews, then pulling
 

that in with the two Board members and giving the
 

two Board members an overview and sort of a
 

preliminary read on it, and then the next step would
 

be to present to the entire Board. So that's kind
 

of the sequence there. But we'll refine that
 

language to reflect that it'd be a rotating -- two
 

Board members would be on a rotating basis.
 

DR. ZIEMER: Another question here, Mark.
 

MR. GRIFFON: To be assigned by the working
 

group. Maybe I'll add that in, too -- no.
 

MR. ELLIOTT: I'd like to understand this as
 

best I can. So let's say if you had 30 dose
 

reconstructions that you were going to review in -­

from one quarter, the first quarter.
 

MR. GRIFFON: Uh-huh.
 

MR. ELLIOTT: As I understand this, you
 

would identify two experts, let's say, and identify
 

in that sample of dose reconstructions those which
 

would require certain members of this committee to
 

recuse themselves from, so you'd match up with that
 

individual expert two members who were not
 

conflicted.
 
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MR. GRIFFON: Right.
 

MR. ELLIOTT: And you'd come in a day before
 

-- everybody that's engaged in this, identified to
 

be engaged in this would come in the day before a
 

Board meeting, per se, and run through all the dose
 

reconstructions with the individual Board members
 

who were responsible for assisting or working with
 

the consultant, and so you're going to have people I
 

guess floating in and out of that. Is that the way
 

you see it kind of working?
 

MR. GRIFFON: Yes, except that I think for
 

any set of cases, the team will stay the same. I'm
 

not sure if I -­

MR. ELLIOTT: Oh, okay.
 

MR. GRIFFON: -- exactly understood your
 

question, but I think that for -- say once you have
 

-- once we select cases and they're assigned to an
 

expert -­

MR. ELLIOTT: So the three might have -­

MR. GRIFFON: I think the intent -­

MR. ELLIOTT: -- five of the 30 to look at.
 

MR. GRIFFON: Right, right, right.
 

DR. ZIEMER: And if I could insert again
 

here, this current wording makes it appear that
 

there are only two groups, two sets of two, but in
 
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essence there could be three or four groups. It's
 

even conceivable to me, depending on the workload,
 

that you might have three or four subgroups meeting
 

with -­

MR. GRIFFON: That's correct, and -­

DR. ZIEMER: -- the expert to handle -- you
 

know, this group has five or six or ten dose
 

reconstructions and another group and another group
 

could even be meeting the same day and the same
 

place.
 

MR. GRIFFON: That's correct, and that's a
 

reflection of our last couple days -- I missed that
 

on editing, but -- at 11:00 o'clock last night. Is
 

that all on the independent panel section?
 

DR. DEHART: Let's carry it the one step
 

further. The next day then, what we're envisioning
 

currently is that the panel would present to the
 

Board their recommendations. Let's say that the
 

recommendations for 20 of the reviews are benign and
 

they would be presented to the Board for approval by
 

exception. That is, if Board members want to pull
 

one out for more detailed review, that certainly
 

could happen, but we would present a list of cases
 

that we would -- hopefully would pass through the
 

Board, but the Board would approve every one. And
 
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then there would be a set, as well, that the group
 

-- the panel felt needed the Board's review.
 

DR. ZIEMER: Full Board.
 

MR. GRIFFON: Right. Right, and we --

yeah, we discussed that a little. I didn't put that
 

-- you know, I didn't get that far in our language
 

there, but that's a reflection of our discussions.
 

I think also -- you know, I'm just thinking
 

now, this is a personal opinion that comes to mind,
 

is that the two Board members meet with the expert,
 

you may look at ten cases. You may say -- the two
 

Board members may feel that eight of those are ready
 

to go to the entire Board and these other two -­

they may have questions for the expert to go back
 

and, you know, review -- so there may be a triage
 

there before -- you know?
 

MR. ELLIOTT: That's great, it informs the
 

question I was about to ask 'cause I'm trying to get
 

an understanding of the realm of recommendations
 

that might be coming forward from these panels. And
 

it certainly could be without exception we recommend
 

the Board approve. And here's another one with -­

we have some exceptions or concerns about it and we
 

want the full Board to review. And here's another
 

category where the panel has looked at it and
 
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advised the consultant that they need to go back and
 

do some more work, some more research or some more
 

evaluation of the dose reconstruction. Is that
 

pretty much the realm of -­

DR. ZIEMER: But let me insert here. Let's
 

keep in mind that the Board is not approving every
 

dose reconstruction. This is an audit sort of 

thing. 

MR. ELLIOTT: That's correct. 

DR. ZIEMER: I don't know if that's the
 

right term, but it's a quality control step.
 

MR. GRIFFON: Right.
 

DR. ZIEMER: We we're not talking about the
 

Board having to approve things before the -- in
 

fact, in many cases the decision will have been made
 

and perhaps the compensation paid. This is an
 

after-the-fact quality control step.
 

MR. GRIFFON: Uh-huh.
 

DR. ZIEMER: It's like a tax audit that said
 

did you do it right last year; if not, you've got to
 

change something. So bringing these to the Board
 

for approval should only have the connotation that
 

we're bringing to the Board the fact that the
 

procedure -- the audit procedure is -- on these has
 

been done and we've -- the staff -- the quality is
 
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sufficient. So it's only -- I think, only approval
 

in that sense, not that it's okay now to pay this
 

claim. Okay?
 

MR. ELLIOTT: Absolutely, and I appreciate
 

that clarification.
 

DR. ZIEMER: Is that the right
 

understanding?
 

MR. ELLIOTT: Yeah, because these would be
 

completed dose reconstructions they're going to see
 

and the decisions may or may not have been made at
 

that point in time to DOL, but DOL has it in their
 

adjudication effort.
 

DR. MELIUS: But I think we have to
 

recognize that -- hopefully it will be rare; it may
 

not happen at all -- that there could be a
 

circumstance where there would be a systemic -- an
 

issue with dose reconstruction that the Board would
 

DR. ZIEMER: Right.
 

DR. MELIUS: -- disagree, would recommend
 

that NIOSH change, and then there'd have to be a
 

decision -- I think probably with NIOSH and DOL
 

people involved -- do you need to go back and relook at some of these.
 

DR. ZIEMER: Right, exactly.
 
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MR. GRIFFON: Absolutely. 

DR. MELIUS: I mean I don't think we can -­

DR. ZIEMER: That's the intent. 

DR. MELIUS: Right, but we're not -- yeah, 

okay. 

MR. GRIFFON: Right, okay. Case selection 

-- ready to move on? Okay. In the case selection 

we just -- really just modified some wording. Most
 

of this we've discussed already. The strata we
 

modified a little to reflect NIOSH's own internal
 

process, the NIOSH efficiency process which Jim has
 

described, which sort of involves the way they're
 

going to handle cases when they come in, whether
 

they're very low potentials or very high potentials
 

and in between, and we're going to sample along
 

those strata. A simple explanation, Jim, I think
 

that's fair.
 

And along with the site, time period and
 

diversity were the other strata that we would look
 

at. The other clause we added in there -- the
 

second paragraph says that we're -- feel the
 

appropriate sample size is approximately two to
 

three percent. And this, as we've discussed before,
 

is consistent with the DTRA approach. That's sort
 

of where we got that number from with -- and we also
 
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discussed of -- cases will be selected on a
 

quarterly basis by the working group, so our working
 

group will stay in existence with a small role, but
 

we will stay in existence for the case of selecting
 

cases on a quarterly basis, and the working group
 

will continue to track those cases that are
 

selected. And the tracking piece is important
 

because we discussed the situation where the hopper
 

of cases that are ready may all be from Hanford, and
 

we want to get our reviews going so we randomly
 

select, but the only cases available are from a
 

limited number of sites, but we want to keep in mind
 

that we want to cover all our strata of all the
 

sites and time periods or a percentage of the sites
 

and time periods. So we thought we could achieve
 

that by this ongoing tracking, details of which I
 

cannot answer right now, but that's the nature of -­

the flavor of what we're trying to achieve there.
 

Questions on that part?
 

MS. MUNN: You stumbled across another one
 

of my favorite buzzwords, diversity. What diversity
 

are we diverting here? Are we talking about types
 

of work? Are we talking about types of people? 

What diversity? I just -- the word is so confusing
 

to me.
 
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MR. GRIFFON: I'm going to defer this to a
 

team member that came up with that.
 

DR. DEHART: Obviously we're going to look
 

at gender, because gender plays a role. So you know
 

what I'm going toward. It'll be race, ethnic kinds
 

of issues so that it's a balance. We have reviewed
 

some of a variety of backgrounds of individuals.
 

MS. MUNN: Well, it may surprise you to know
 

that I think the type of work and the level of
 

involvement in certain kinds of work is probably a
 

more important diversity issue than either of those.
 

DR. DEHART: We're hoping that the site
 

selections will pretty well take care of that. If
 

we find that it isn't, we certainly will adjust
 

that. But the diversity as used here is in terms of
 

the personnel issue.
 

MS. MUNN: Okay.
 

DR. ZIEMER: Comment?
 

DR. MELIUS: Now you have me a little
 

confused. But are -- what about the words you
 

struck out, which were -- I was thinking of a
 

diversity of claim decisions, which were awarded,
 

claims denied, claims -­

MS. MUNN: Uh-huh.
 

DR. MELIUS: -- non-reconstructed. Are you
 
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going to look at that diversity, also, or stratify
 

in that in some way in terms of doing your sampling,
 

or is that what you're calling the NIOSH efficiency
 

process?
 

MR. GRIFFON: We thought that was -- at
 

least the intent is that the NIOSH efficiency
 

strata, the categories, are going to achieve that
 

same end.
 

DR. MELIUS: I think I agree with you -­

MR. GRIFFON: Yeah.
 

DR. MELIUS: -- though I would prefer some
 

language that's a little clearer 'cause I'm not sure
 

that anybody outside of this table and the NIOSH
 

staff understands what the NIOSH efficiency
 

categories are.
 

MS. MUNN: I guess I might feel NIOSH
 

decision categories might better identify, in my
 

mind, what I think we're after.
 

MR. GRIFFON: Yeah, I -- that's actually the
 

term that NIOSH -- I was trying to be consistent
 

with their internal language on that, and they are
 

calling it the NIOSH efficiency process. Yeah, I'm
 

open for changes on that or if we can better clarify
 

it -­

MR. ELLIOTT: I would ask that we avoid
 
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that, Wanda, because we don't make the decision. I
 

don't want to confuse the claimant with that, that
 

there's a decision being made by NIOSH. I'm sorry.
 

MR. GRIFFON: We're certainly open for -­

you know, we -­

DR. ZIEMER: I think the point is, as far as
 

Jim's question is concerned, your intent is not to
 

exclude those -- that spread of awards versus
 

denials and so on, so that'll be included.
 

MR. GRIFFON: I mean we may -­

DR. ZIEMER: And actually this is really -­

presumably it's a statistical random sample. The
 

random sample, by itself, to some extent should do
 

the stratification except that claims may not come
 

in randomly in the sense that they may -- some sites
 

might be over-represented, so that's why they're
 

trying to stratify, I think. Otherwise, a random
 

sampling would cover the types -- the various types
 

of claims, the -- all the things you're talking
 

about -­

MR. GRIFFON: Another possibility -­

DR. ZIEMER: -- that's your random -­

MR. GRIFFON: -- that might address Jim's
 

issue is that the struck-out language, we might be
 

able to leave that in and then parenthetically say
 
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based on the NIOSH efficiency process -- you know,
 

through the NIOSH efficiency process, 'cause I think
 

we do get those categories, yeah.
 

DR. MELIUS: No, I'm comfortable with what
 

you're doing, I'm just concerned -­

MR. GRIFFON: I know.
 

DR. MELIUS: -- some of this is for -- is
 

the credibility of the program -­

MR. GRIFFON: Oh, yeah, sure.
 

DR. MELIUS: -- and we have to communicate
 

-- you know, one of these drafts when we were -- got
 

a document together -- communicate and I want to
 

make sure that the claimants and people out there
 

understand what we're doing, that's all.
 

MR. ELLIOTT: I'd like to make a couple of
 

comments for your consideration. Maybe you
 

discussed this in your working group. Did you
 

discuss weighting? The only weighting you show here
 

is weighting based upon number per site. What about
 

weighting on this category of denial or -­

compensability or non-compensability and weighting
 

-- I'm thinking of -- if I were making this decision
 

for you, I'd say the heaviest weight should be on
 

that middle category that the most work is going to
 

be expended upon, so that's one question or comment.
 
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And the other comment that I would offer you
 

for consideration is that to work in here a sentence
 

on -- with language that says you reserve the right
 

or you have the ability to change these -- the
 

selection -- case selection criteria as claims come
 

forward and time progresses. You may see a
 

different mix that you want to achieve.
 

MR. GRIFFON: The first one we did discuss,
 

and maybe I can massage some words there to have
 

weighted into -- the intent was to weight on those
 

NIOSH efficiency strata -­

DR. ZIEMER: And you could -­

MR. GRIFFON: -- just as you said. That
 

makes sense to us, too.
 

DR. ZIEMER: Mark, possibly you could simply
 

add "and other criteria that arise in the course of
 

your evaluations" or -- you need a sort of a catchall that would allow you the flexibility of
 

considering other criteria that may not be obvious
 

right now. I think that's what probably you're
 

saying.
 

MR. GRIFFON: Is it? Yeah, okay. We'll try
 

to do that. I also -- you know, I am mindful when
 

we're doing this of having concrete guideline -- not
 

too much -- you know, too much flexibility so that
 
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we're vague in what we're doing, you know.
 

Any more on the case selection?
 

DR. ZIEMER: Go ahead.
 

MR. GRIFFON: The scope and protocol, the
 

first paragraph there was in the last -- for the
 

most part, in the last report. We modified one
 

bullet there, in number one, slightly. And then the
 

next page, on the top of page two, this was entirely
 

new draft of sort of a protocol, so this is sort of
 

-- the first piece being the broad scope and then
 

this sort of a protocol on how the panel would
 

conduct the dose reconstruction reviews. And we
 

talked about the type of review, and this is just
 

what we've considered.
 

Mainly in our discussions the last two days
 

we talked about sort of a basic level and then
 

advanced level, or a more comprehensive level I
 

guess might be a better word, actually. And then in
 

previous meetings -- and I added this in, going
 

through my notes last night -- we did discuss
 

possible blind reviews. And I should note that when
 

I said -- so we have these three categories, basic,
 

advanced and blind. And I would think that the
 

blind -- we haven't put numbers or percentages on
 

these, but I would expect that the blind reviews
 
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would be a small percentage of the overall cases
 

that the panels review. But we think -- yeah.
 

MR. ELLIOTT: I'm lost on blind. What do
 

you mean by blind in this context?
 

MR. GRIFFON: Blind means -- no, don't put
 

that in there. Blind means -- I -- just a blind
 

review where NIOSH would provide -- and let me make
 

sure I get this right -- the administrative record,
 

everything NIOSH used to calculate an individual's
 

dose and then the panel would themselves come up
 

with the -- or generate the form that would feed
 

into IREP, rather than be provided that up front.
 

MR. ELLIOTT: So you're saying blind to the 

inputs. 

MR. GRIFFON: Right. 

MR. ELLIOTT: I understand now. You would 

not see what the determination would be from the
 

dose reconstruction.
 

MR. GRIFFON: Right.
 

MR. ELLIOTT: That's what you'd be blind to.
 

MR. GRIFFON: That's right.
 

MR. ELLIOTT: I understand now. Thank you.
 

MR. GRIFFON: Okay. So if you -- I'll just
 

-- if I can go through this sort of broadly, a basic
 

review -- A, B, C and D are in both the basic and
 
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the advanced review and sort of broke it up into
 

categories. Review data gathering. B is review
 

interview and documentation provided by the
 

claimant. C is the review of the internal dose
 

estimates. D is review of the external dose
 

estimates. And let's see, the main difference -- I
 

guess people can read through -- I don't want to go
 

through every line on this, but the main difference
 

between the basic and the advanced is if you look at
 

A, there's a number three that was added which says
 

review the entire administrative record to determine
 

if relevant information exists which was not
 

considered by NIOSH. Whereas in the basic review,
 

we would just look at what NIOSH used in doing the
 

dose reconstruction. And as we learned in the last
 

couple of days, Jim Neton said that on the database
 

system, those records which NIOSH uses for the
 

actual reconstruction will be at the top of the
 

hyper-linked file so you'll have all the -- and
 

they'll be distinct from the rest of the
 

administrative record. So it'd be a less compre-­

the basic would just entail looking at that as
 

opposed to looking at the entire administrative
 

record. The entire administrative record already
 

for some of these cases is upwards of 300, 400, 500
 
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pages of various records, so that's much more
 

comprehensive review.
 

Also in C and D you'll see the expanded -­

numbers four and five in both C and D are the same,
 

but they're -- in the advanced version they're
 

looking at the -- determine whether dose estimate is
 

consistent with relevant radiological information
 

within the NIOSH site profiles. And NIOSH is
 

establishing site profiles for all the sites, and
 

this is -- this is actually something we discussed
 

at length in the last day or so, that this is a real
 

place where this review panel can have value-added
 

to make sure that -- 'cause this is one of the
 

things that we hear in public meetings, et cetera,
 

that -- you know, we want to make sure that this
 

panel double-checks and make sure that dose
 

reconstructions are not just being conducted based
 

on personnel records, or at least those -- if they
 

are done on those personnel records, they're checked
 

to some extent against site profile data so that
 

there's not major inconsistencies, that something's
 

missing.
 

And five is similar along those lines,
 

compare case information and assumptions with
 

relevant co-worker case information and assumptions
 
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for consistency. And that's the idea of having -­

you know, of five or six operators from the Hanford
 

300 area, if you're looking at one with -- in
 

isolation in the basic review and in the expanded
 

review we might do cross-checks and make sure that
 

similar assumptions were made -- were appropriate,
 

et cetera. That sort of thing. And that's -­

And then the blind, the last thing on the
 

bottom after all my deleted things, is the blind
 

dose reconstruction, which we just, to some extent,
 

described there with Larry. And then -- you know,
 

and then on the next page, which is sort of that the
 

-- that would be the report -- reports results to
 

the Board.
 

DR. ZIEMER: And so, Mark, you envision that
 

every one of the reviews, the panel would have some
 

sort of a documentation that said, for example,
 

determine whether all assumptions used in dose
 

determination are appropriate. Yes.
 

MR. GRIFFON: Yeah, this was sort of -­

DR. ZIEMER: You would have a -­

MR. GRIFFON: Along the lines of what -­

DR. ZIEMER: -- written report and you'd
 

report that to the Board, we determined that all
 

assumptions are appropriate, that the data are
 
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consistent, et cetera, down the list. Or if there's
 

questionable ones, you would raise that and -­

MR. GRIFFON: I think -- I expect that the
 

expert would be going into this protocol and then
 

the two Board member -- the panel would agree on
 

that, you know, those conclusions. And then they
 

would -­

DR. ZIEMER: And there actually -- there
 

would be documentation that -­

MR. GRIFFON: Right.
 

DR. ZIEMER: -- of such an agreement and -­

MR. GRIFFON: Right. This was -- this draft
 

here of the protocol was done in the spirit of your
 

idea of -- or several people's ideas of a checklist
 

sort of concept, yeah.
 

DR. ZIEMER: Okay, any comments or 

questions? 

DR. MELIUS: Yeah. 

DR. ZIEMER: Jim. 

DR. MELIUS: I think the working group did a 

very good job with this. I think it -- I have one
 

question as to whether -- I guess this would be for
 

the advanced reviews. One of the I think major
 

concerns in terms of credibility of the process is
 

the issue of what information is available that
 
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wasn't -- was not made available or was not included
 

or not considered in your review. And that you seem
 

to be approaching that purely from a records review
 

point of view. You're looking at the site profile. 

You're looking at the administrative record and so
 

forth. Did you give any consideration, as part of
 

the review, of going back to people at the site and
 

asking some of the site experts -- and we can talk
 

how to define that -- about should other information
 

be considered for a person working in that area? 

And I think that -- I know that -- my understanding
 

from NIOSH for their site profile are going to have
 

that process, but I'm not sure that that -- when
 

NIOSH does that that we're -- have a way of
 

ascertaining whether or not -- how complete that
 

site profile is. And would it be sort of valueadded enough to make it worth the -- is the effort
 

worthwhile to go back and talk to some people from
 

the site and -- just to make sure that all relevant
 

information is included, has been considered. I do
 

think that could help the process some.
 

DR. ZIEMER: Let me respond as a -- first
 

and -- it sounds on the surface like a good idea. 

I'm wondering about the practicality. That's a
 

separate kind of audit. That's not an audit of the
 
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dose reconstruction. That's an audit of the datagathering thing, which may be a good thing to do. 

I'm not sure that's a burden we want to put on the
 

dose reconstruction subgroup, so we may want to
 

think about that as a separate question. How do we
 

have assurance that, number one, it's not -­

probably not a simple task for this Board to go on
 

to sites and do that, but aside from the logistical
 

thing, perhaps we need to think about is there a way
 

to develop some level of comfort with the
 

information that's used in the site reconstruction
 

-- or the site profiles.
 

MR. GRIFFON: Yeah. I mean, you know, we
 

certainly -- and this is my biggest issue since I've
 

been on this -- but I guess what we were trying to
 

do was to -- and I certainly have concerns about the
 

site profiles and the -- NIOSH's staff power. You
 

know, do they have the resources and are they
 

getting the data to build these site profiles to be
 

what we would like them to be. We tried to bound
 

this dose reconstruction review to look at -- to tag
 

into those site profiles, but also my feeling is
 

that our Board needs to also push and make sure
 

NIOSH has the resources to make sure those site
 

profiles -- and a thought that I've been considering
 
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is the idea of having some sort of site-specific
 

boards or panels of professionals, workers that
 

assist NIOSH in developing those site profiles. But
 

that's a whole 'nother set of work -­

DR. ZIEMER: That's my point. I don't
 

think -­

MR. GRIFFON: Yeah.
 

DR. ZIEMER: -- the dose reconstruction -­

MR. GRIFFON: I think -­

DR. ZIEMER: -- groups can do that.
 

MR. GRIFFON: Well, I think we -- in our
 

scope we did say that we would review the quality of
 

the data used for the dose reconstruction, and I
 

guess I was trying to push that as far as I could
 

and then -- but I -- and that's why I'm saying that
 

that -- maybe to push this from two sides makes
 

sense to make sure that these site profiles are
 

beefed up as best as possible, and then actually the
 

dose reconstruction review -- reviewers, the panels,
 

will be reviewing those site profiles and they will
 

have a lot of that substantial data that Jim might
 

be talking about, but I don't know. Yeah.
 

DR. MELIUS: Well, it seems to me, though,
 

that this is one of the opportunities to check on
 

that. We're hiring a consultant. We've had the
 
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site profile -- site profiles will have sort of
 

developed a list of some of the experts, people that
 

are familiar with the site and could be helpful and
 

that some process for that consultant to go back and
 

just check with those people for this particular
 

work area where this person worked or case, was
 

there some other information that should be
 

considered in some way. And we're not talking about
 

doing it on everybody. We're just doing on the ones
 

-- you know, the second tier here.
 

MR. GRIFFON: Yeah.
 

DR. MELIUS: And I think it would provide
 

one check on that process. I agree that the site
 

profiles themselves may need some sort of review
 

process, also, and we don't want to get this whole
 

process bogged down in that. But to me, if we're
 

going to look at dose reconstruction and the
 

information -- I think it might be able -- possible
 

to do that. I share concerns about the logistics
 

and so forth and how complete that can be, but this
 

seems to be the opportunity. We're drawing a
 

sample. We're -- I don't know if that frightened
 

you and you fell off the -- but it seems to me that
 

if we beef this part of it up, it might be able to
 

take care of that at the same time now.
 
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MR. PRESLEY: I don't think you want to put
 

that on an industrial hygienist or -- not an
 

industrial -- but an HP's back, do you, because he
 

doesn't know -- the people that we're going to be
 

hiring to do this, the majority of them have had no
 

experience into what the workers have done. You're
 

going to have to have somebody go back with a little
 

bit of experience to see that in the areas. I think
 

you're going to -- that's why -- I'm like Larry. I
 

think it's going to have to be a separate portion of
 

this. 

MR. GRIFFON: I think that's almost an 

argument for it. 

MR. PRESLEY: Yeah, I agree. I'm arguing 

for it, but I think it's going to have to be a
 

separate -­

DR. ZIEMER: You're asking who should really
 

do that. Right?
 

MR. PRESLEY: That's exactly right.
 

DR. ZIEMER: Well, certainly the quality of
 

the information is still a part of this, and it may
 

be that in the process that certain kinds of
 

questions could be identified that might form the
 

basis for developing a process for going back and
 

doing what you're talking about. I think it could
 
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be a fairly substantial task. To just ask the
 

question on any particular site or any subset of a
 

site, do we have the site profile for this operation
 

at Hanford.
 

DR. MELIUS: Yeah. No, I understand that
 

part. I just worry for the credibility of the
 

process if we haven't done that and claimants are
 

there concerned about well, they just didn't take
 

into account -- they didn't consider the fact -­

this happened or that happened or there was this
 

exposure and -- that didn't come up and no one seems
 

to be paying attention to that. And I think that
 

could occur.
 

DR. ZIEMER: One thing we might think about,
 

and this would probably be the subject of perhaps
 

the next meeting, would be to say okay -- NIOSH is
 

developing the site profiles and they've gathered
 

information from various sources -- to say okay,
 

let's look at that in some way. Let's start with an
 

audit of what we got and how we got it, and then
 

think about what strings do you pull or what the
 

next -- I don't know that we can solve that here,
 

but I think that might be an issue that we want to
 

put on the issue board for future consideration.
 

DR. MELIUS: But can I just add -- if we can
 
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have some way of going back and testing that site
 

profile versus -­

MR. GRIFFON: Right.
 

DR. MELIUS: -- these actual cases, is it -­

are they helpful enough?
 

MR. GRIFFON: That's -- I just made a note
 

to that effect, Jim. I think that might be
 

something we can add in to test, even on a
 

percentage of the advanced, maybe even, you know. 

Maybe it's not all of the advanced ones, right.
 

DR. ZIEMER: Larry has a comment and then I
 

think Tony and then Roy.
 

MR. ELLIOTT: Just to make sure that we're
 

all working with the same understanding, the site
 

profiles are -- they're going to be developed, and
 

right now I'd say they're fairly sketchy, and
 

certainly you could spend your time looking at what
 

a site profile might look like at this point in
 

time. But I think you'd be better benefitted in
 

spending your time, as we get to a point where it
 

may make more sense, to expend the effort and the
 

time to look at what the site profile speaks to.
 

Certainly I think it does make a lot of
 

sense for the comprehensive review stage to take a
 

sample or where you think it's appropriate to have
 
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the consultant make contact with whoever is
 

appropriate at a given site, ask that question. 

This is the information I've seen and used; is there
 

anything else we didn't have that wasn't used, that
 

should have been -- that you are aware of. And
 

maybe we can -- we can make that happen, I think.
 

In the examples of the dose reconstructions
 

you all witnessed this week, I think you also saw
 

some instances where information was provided that
 

was not used. And I would ask how do you account
 

for the -- in the quality of a dose reconstruction,
 

how that's been handled. I don't see that addressed
 

here. You know, where in instances the claimant
 

said I've got this information. I'm searching here
 

to see how you handled -- in your review, in a
 

quality of the dose reconstruction process -- that
 

the claimant understood why it was not used or why
 

it didn't make sense to use it. I think that is
 

just as important -- you know, when a claimant comes
 

forward with information that they've spent time,
 

money and their own energy in collecting and
 

assembling, and then they don't see it used, we're
 

going to hear as many complaints on that side of the
 

fence as we are on the other side of the fence, I
 

think.
 
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MR. GRIFFON: Yeah, I think we -­

MR. ELLIOTT: And I don't see that addressed 

here. 

MR. GRIFFON: (Inaudible) maybe not 

extensively enough -- and I'll remind that -- was
 

drafted at 11:00 last night. I thought we tried to
 

capture that in the review of the interview and
 

documentation provided by claimant, determine
 

whether NIOSH appropriately addressed all
 

allegations made by the claimant and assure that the
 

interview information is consistent with the data
 

used in the dose estimate. And then in the first -­

number three on the -- or A-3 on the advanced, the
 

distinction between the basic and the advanced was
 

that we're reviewing the entire administrative
 

record, which from my understanding of how NIOSH is
 

-- you know, the administrative record includes all
 

the data they got. They may not have used some of
 

that data and the independent expert and panel would
 

be able to then -- then they have to go through all
 

that administrative record, and if they found
 

certain things that they thought were relevant to
 

the dose reconstruction but were not considered by
 

NIOSH, then they've have a -- they'd question it.
 

MR. ELLIOTT: Thank you.
 
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MR. GRIFFON: So I think that's where we got
 

it.
 

MR. ELLIOTT: I think it's covered then.
 

DR. ZIEMER: Tony?
 

DR. ANDRADE: I just wanted to comment that
 

it's not entirely clear in my mind yet what
 

comprises a site profile, but as the discussion has
 

evolved I think I've got a couple of ideas and I
 

think that eventually we're going to see that a,
 

quote, site profile is going to come about and maybe
 

-- how shall I say it -- even a technical area
 

within a site profile will come about from many
 

different avenues, one being the dose reconstruction
 

process itself and the interviews that are done for
 

that process; number two, well-known accidents that
 

have been documented; and number three -- and this
 

is true probably more so in recent years than in the
 

early years -- the development of databases of
 

incidents in which we know there have been updates
 

or intakes of radioactive material.
 

And for example, at our plutonium facility
 

we have developed a site profile that goes back
 

fairly -- a fairly long ways that we use as a prior
 

distribution for Bayesian* analysis or for looking
 

at the possibility that a real intake has occurred. 
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So if we're going to choose to develop these things,
 

I think we're going to have to develop -- we're
 

going to have to realize the diversity of sources of
 

data that we're going to have to use to build these
 

as we go along.
 

Did Jim want to respond to that?
 

DR. NETON: I was just going to amplify on
 

what Dr. Andrade said. It's true, a site profile is
 

that and more. All of those things go in there. 

What I would like to say, though, is a site profile
 

is a dynamic thing. And Larry's right, right now we
 

don't have a volume of information in there, but
 

they are growing as we do dose reconstructions.
 

In many cases, some of the simpler ones that
 

the working group saw, we needed very little site
 

profile information to construct a dose. We needed
 

to know very limited things, like frequency of badge
 

exchange and maybe the detection limit of a badge
 

and what the badge consisted of and we could be
 

finished.
 

In the more complicated cases, as we get
 

into those middle ground cases where we need to pull
 

out all stops, that's where the site profile's going
 

to grow dramatically, where we have four classes of
 

information in site profiles -- characterization of
 
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the internal monitoring program, the external
 

monitoring program, the medical radiation monitoring
 

program, and the environmental monitoring program. 

There are four key areas that we're expanding on,
 

and only in those cases typically where we go to a
 

full-blown dose reconstruction would all four of
 

those areas be exercised or utilized. So it is
 

possible to have limited site profile information
 

yet have dose reconstructions move forward, and I
 

think that's what the Board would see now if they
 

actually took a snapshot. But down the line I think
 

it might make some sense where we start doing cases
 

where we have no monitoring and we're going to rely
 

on air sampling data and that sort of things that
 

are -- that may be in there, environmental area
 

surveys, that sort of thing. It might be better to
 

-- down the line to look at those profiles.
 

MR. GRIFFON: I guess also in some way I'm
 

not sure if this falls into internal and external,
 

but I think some sort of process -­

DR. NETON: Right, source-term knowledge,
 

that sort of thing. I think you saw a good example
 

of that on an AWE where we went out and really tried
 

to pull all the stuff that was in there.
 

MR. GRIFFON: Right. But as everybody's
 
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realizing -- I mean this is not a small task, and
 

from what we could gather in our tour of the
 

facility, the site profiles are, as Larry said,
 

sketchy at this point. They're -- and there is a
 

massive undertaking, I would say, to get those up to
 

speed. And another concern I would have is that I
 

know that dose reconstructions are going to feed
 

into that process to help you fill out that, but I'd
 

hate to have the cart before the horse -- is that
 

the expression? I mean I hate to be -- you know, if
 

we don't have a full picture and then we have to go
 

back and redo dose reconstructions again for a lot
 

of people because we missed something -­

MR. ELLIOTT: We don't want to do that. And
 

please understand that as soon as this contract's
 

awarded, there's going to be a group in the
 

contractor that we're going to sit down with and
 

that's their primary responsibility.
 

MR. GRIFFON: Right.
 

MR. ELLIOTT: Start the research effort, put
 

the site profiles on the table -­

MR. GRIFFON: I understand.
 

MR. ELLIOTT: -- figure out what information
 

gaps exist in those profiles and let's get them
 

filled.
 
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MR. GRIFFON: Right. 

MR. ELLIOTT: Okay? 

MR. GRIFFON: Right. 

MR. ELLIOTT: Move on that, because it's 

going to aid the individual dose reconstructions as
 

the individual dose reconstructions aid the
 

profiles, and we need both -- we need to track these
 

at the same time and put as much emphasis on both
 

tracks as we can.
 

DR. ZIEMER: Roy and then -­

DR. DEHART: I would caution the Board on
 

expanding this audit activity. This is an
 

administrative paper audit, if you will. And to
 

make it an investigative audit, to go into the work
 

site -- by phone, in person, whatever -- is going to
 

complicate, delay -- and I'm not speaking in
 

opposition of doing that, but don't do it with this
 

process.
 

DR. ZIEMER: Thank you. Jim?
 

DR. MELIUS: No, Wanda had her -­

DR. ZIEMER: Oh, were you up first, Wanda? 

Go ahead.
 

MS. MUNN: I almost hesitate to broach this
 

because I recognize how involved it might become. 

But in the process of doing site profiles, would
 
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323 

there be a value to having that material, as it
 

develops, be available on the web site for other
 

individuals to provide data that perhaps might not
 

be in the official record, which would be helpful? 

And I recognize, as I ask that question, that the
 

quality of information that you get might be
 

questionable and that the quantity of it might be
 

overwhelming. But it's simply a question. Would
 

that be of value in assisting to accommodate the
 

goal of site profiling that you have in mind?
 

MR. ELLIOTT: Well, you know I'm a big web
 

site person. I think we've got the best web site
 

going, and I think this would be a certain
 

beneficial aspect to see this information provided
 

publicly. And the benefit I see in that is somebody
 

out there may say hey, I've got a piece of
 

information I don't see there. Have you not found
 

this?
 

Certainly it's going to be problematic for
 

us to do so, given -- you know, I can envision large
 

amount of information -- we've already got a large
 

amount of information on our web site, but this will
 

take us to another whole level, so we'd have to
 

evaluate that. But I think the benefit outweighs
 

the difficulty.
 
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MS. MUNN: Be ready for it.
 

DR. NETON: I do think that's a good idea. 

And we already plan on having this on our intra-net
 

internally to use for our contractor. I would say,
 

though, that certain pieces of it may not be able to
 

go on the general web. We plan on having these
 

drill-down menus where it will take you down to
 

specific cases and classes of workers so that ends
 

up being part of the profile information, so it
 

would have to be generic monitoring information, not
 

any claimant-specific type stuff.
 

DR. ZIEMER: But something to be considered. 

Jim? 

DR. MELIUS: I would just add that while 

these site profiles are currently not very robust, I
 

think it's all the more important that there be some
 

process to check that now. And whether it's this
 

working group or another working group, how we
 

figure out that process, I don't know procedurally,
 

but I think we need to consider that and figure a
 

way that we're going to provide some affirmation of
 

that information within the constraints of resources
 

and time for doing this. And it may be that down
 

the road when these profiles are -- you know, a few
 

years from now when they're much stronger, then that
 
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process -- that part of the process will be less
 

important. But until then, I think -- I'm just real
 

worried that people are going to question the
 

results -- question our review of the results unless
 

we find some way of taking that into account.
 

DR. ZIEMER: Other comments? We're
 

approaching the noon hour and we have a public
 

comment period. I have three individuals who've
 

requested speaking times from up to ten minutes
 

each, which means 30 minutes. So I'd like to ask if
 

any or all of the three -- Bruce Lawson, Jerry Tudor
 

and Bob Tabor -- we have Tudor and Tabor -- can any
 

or all of you would be willing to wait till after
 

lunch to speak? If it's a problem, we'll do it now.
 

MR. TUDOR: The only problem I have, I would
 

like to -- if it would be first thing after lunch,
 

that would be fine. I just don't feel like, you
 

know, I need to stay that late.
 

DR. ZIEMER: Okay, let's have you -- we'll
 

go right now. I just want to check with the other
 

folks.
 

You're okay after lunch and you're okay
 

after lunch? Okay.
 

Let's go then with -- let's see now, this is
 

-- you are -­
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326 

MR. TUDOR: Tudor.
 

DR. ZIEMER: -- Tudor. Okay, Jerry. Why
 

don't you address us now then, Jerry. Do you want
 

to use the podium, if you want to go up to the
 

podium or -­

MR. TUDOR: Nah.
 

DR. ZIEMER: -- either one? Right here,
 

okay.
 

Jerry is with -- is from Clinton, Tennessee,
 

USOL.
 

MR. TUDOR: Yes.
 

DR. ZIEMER: Thank you.
 

MR. TUDOR: Yes, I'm Jerry Tudor and I'm
 

with USOL and that's United Sick, Oppressed
 

Laborers, who's a sick organization, Oak Ridge, and
 

I'm with CHE, who's the Coalition for a Healthy
 

Environment. And we met with our Congressman in Oak
 

Ridge yesterday, or his aides, and he informed us
 

it'd be next year before any laws could be passed to
 

change anything about this.
 

The problems I see with it is the amount of
 

time to become a special cohort is ridiculous, you
 

know, because -- I've already been applied a year,
 

so should they determine that DOE don't have
 

records, then I have to wait another year to year
 
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327 

and a half? Is that not the time limit?
 

DR. ZIEMER: There is a 180-day waiting -­

MR. TUDOR: Yes, plus -­

DR. ZIEMER: -- period after something is
 

filed before -­

MR. TUDOR: Plus -­

DR. ZIEMER: -- Congress approves it, yeah.
 

MR. TUDOR: Plus you have 200 days to act on
 

it after that. Okay.
 

DR. ZIEMER: Right, so there is a time span,
 

right.
 

MR. TUDOR: And most people are sick, you
 

know. I have fourth stage prostate cancer, and a
 

lot of people are already upset with the amount of
 

time it's, you know, been taking on this. And
 

another problem I have with -- when I set at home
 

and read the minutes of the meeting and the calls
 

and whatever and May the 29th -- 8th on a
 

teleconference call, y'all said that the majority of
 

the claims would be denied. Well, that bothers me. 

And you know, looking at it from a sick worker, you
 

know, if y'all are saying the majority of the claims
 

will be denied already, before any dose
 

reconstructions are done -- they're up to seven now
 

-- you know, that kindly (sic) bothers me. And they
 
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said there'd be a lot of mad people, and they will
 

be, you know.
 

And another thing with -- problem with
 

comparing me to somebody that worked in -- chemical
 

operator, which that's what I was, you can't compare
 

me with a person that worked at the other end of the
 

room even because I done a job different from him. 

I might have been exposed to a bunch and he might
 

not have been exposed to any. I might not have been
 

exposed to any he's exposed to a bunch, you know.
 

And working at Y-12 all those years, I know
 

records were inadequate. I also know that if a
 

program had a bunch of money in it, they clocked my
 

time to that program. I may have not even worked on
 

that program. I may have been doing something over
 

here -- cleaning -- sweeping the floor, cleaning up
 

a spill or something, and was charged to a job that
 

I didn't do, you know. And that creates a problem
 

when you start doing dose reconstructions and you
 

look -- say well, he done this this day. That is
 

not the way it happens at Y-12. I'm sure some of
 

you know this. And I just thought I'd come up today
 

and, you know, try to get my two cents in.
 

DR. ZIEMER: Thank you, Jerry, for those
 

comments. Now we always like to provide an
 
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opportunity for the Board, if they have questions or
 

want anything clarified, to see if there are any
 

questions or feedback for Jerry.
 

(No responses.)
 

DR. ZIEMER: Okay. And your remarks will
 

appear in the record, as well. Thank you.
 

MR. TUDOR: Thanks a lot.
 

DR. ZIEMER: Thank you very much. Let's now
 

recess for lunch and right after lunch we'll hear
 

from Bruce and Bob, and then we'll return to our
 

session on the Special Exposure Cohort.
 

DR. MELIUS: What time?
 

DR. ZIEMER: We're due back at 1:30. We
 

want to be prompt on that because I know starting at
 

3:00 some people have to start bailing out.
 

(Whereupon, a luncheon recess was taken.)
 

DR. ZIEMER: Okay, I'll call the session
 

back to order. We would like to hear now from Bruce
 

Lawson. Bruce is with PACE Medical Screening
 

Program and is from Oliver Springs, Tennessee. And
 

Bruce, glad to have you here to address us this
 

afternoon.
 

MR. LAWSON: Thank you. And for those of
 

you who don't know, Oliver Springs is a suburb of
 

Oak Ridge.
 
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As he said, I'm Bruce Lawson. I worked at
 

the K-25 site at Oak Ridge, which is one of three
 

DOE facilities in Oak Ridge. I was a craftsperson. 

I was there a little over 30 years. The last nine
 

years I was the union health and safety
 

representative for the site and just a couple of
 

general comments. I'll keep this brief. I hate to
 

be the first speaker after lunch. Everybody's
 

wanting to -- anyway.
 

I saw first-hand what Joe Carson alluded to
 

yesterday, some of the things he mentioned about
 

records, and I saw exactly what he was talking
 

about. I saw industrial hygienists, health physics
 

people and safety people, professionals, silenced
 

and their minds changed by a simple frown. It
 

didn't take any pressure at all to get them to
 

rewrite records, redo reports. As a matter of fact,
 

they were under the onus to clean up reports before
 

DOE ever saw them. So what -- most cases, what DOE
 

saw, the final analysis was a cleaned-up or very
 

much edited version of what actually took place.
 

I now work with the local worker health
 

protection program, the medical screening. We -­

very often we're the first point of contact for the
 

claimants in this EEOICPA thing. We meet the
 
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individuals face-to-face and we hear -- I could
 

repeat, but I won't, a lot of the comments that you
 

heard at the public meetings that was referred to
 

earlier. We hear that every day, many times -- of
 

course similar verbiage.
 

Most of our claimants are not -- I wouldn't
 

say most, but a large portion of them are
 

uneducated, almost to the point of being illiterate. 

Their spouse, be it a husband or wife, said very
 

little, if anything, about what they did at work,
 

what their job was, what their job duties,
 

especially. So they know virtually nothing about -­

they just know -- and in our case, we see people who
 

weren't even sure which one of the three plants
 

their husband worked at. And they were told, of
 

course, you don't talk about what you did years ago,
 

and they certainly don't understand this process. 

To them, it's much too complicated and they don't -­

they're not -- they just don't understand dealing
 

with bureaucracy and Federal procedures.
 

We -- a lot of them can't get their records
 

from DOE, and a lot of them can't get their records
 

from local physicians and hospitals. I know of one
 

case where this lady -- and this is a person who is
 

existing on Social Security. They wanted to charge
 
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this lady $300 to give her her medical records. She
 

couldn't afford it. She walked away. She came to
 

us. We made some phone calls and was able to
 

persuade them to give them to her.
 

But anyway, we've seen a lot of people throw
 

up their hands and quit because they can't deal with
 

the established bureaucracy as it is. They get a
 

couple of requests for information, the claims
 

office -- the DOL claims office loses their records
 

and so on and they write back for more
 

documentation, and they just throw up their hands in
 

disgust and say I knew I couldn't do it anyway.
 

Based on what I've heard about dose
 

reconstruction and the requirements -- recordkeeping from DOE, we're very, very wary of it. We
 

believe that more -- far more deserving claimants
 

will be denied than actually paid. And there again,
 

around the Oak Ridge area, all too often the word on
 

the street is if you didn't work at K-25, you can
 

forget it. It's -- you know, people have their
 

claims in the pipeline for over a year, and the word
 

is getting around. I talked to Dr. Bingham*
 

yesterday and their business is way down. So is
 

ours, not quite to the extent -- what she said, but
 

it is down. But that's -- word of mouth in any kind
 
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of business is the best advertising, or worst
 

advertising you can get. And right now, we're
 

getting some very negative word of mouth
 

advertising, the entire process is.
 

I applaud your efforts, and especially what
 

you mentioned this morning about streamlining the
 

process, getting on with it, get -- get these claims
 

moving, get them through. And I know you guys are
 

bound by the law, but in the back of your mind,
 

remember, these people were probably -- most of them
 

were probably exposed to far greater hazards from
 

chemicals than they were from the radiation
 

exposures that they got. So don't feel the least
 

bit hesitant to go ahead and push a claim through
 

that's questionable in my mind because these people
 

are definitely deserving. Most all of them are.
 

That was about it. I just jotted down some
 

notes that I thought you might want to hear from the
 

street, and that's where we are, street level.
 

DR. ZIEMER: Thank you, Bruce. Let me ask
 

if any of the Board members have questions for
 

Bruce.
 

DR. MELIUS: I have one.
 

MR. LAWSON: Sure.
 

DR. MELIUS: Thank you for your comments,
 
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Bruce. What -- do you have any ideas on how we deal
 

with this situation where the official records may
 

not be truthful or accurate, accurately reflect
 

people's exposures? Would we get -- be able to get
 

that information from interviewing some of the
 

people down there or how do you get at that? I mean
 

I know it's not easy, but do you think people are
 

generally aware of the issue when the records are
 

not being -- have not been properly kept for a
 

period of time or -­

MR. LAWSON: Not in every case, certainly,
 

but there are some that are. We did a lot -- I say
 

we, I'm talking about our local union there and the
 

international did a lot of risk mapping where we
 

called the workers themselves. And there again, I
 

heard reference to expert -- site experts. If there
 

are experts at these sites, it's those guys who were
 

out there every day -- and ladies, of course -- who
 

were out there every day with their hands on. They
 

knew what was going on in this area as opposed to -­

someone mentioned earlier that you could be at the
 

opposite end of the room doing an entirely different
 

procedure, different process, which is true. But we
 

gathered people together and -- with maps of the
 

buildings, different areas -- what was here, what
 
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went on and so on -- and from that we -- we have a
 

lot of information.
 

DR. ZIEMER: That suggests that perhaps
 

there's another source of information that could be
 

tapped into -­

MR. LAWSON: There is, yes. 

DR. ZIEMER: -- your risk mapping. 

MR. LAWSON: There certainly is. Mark 

Griffon was involved in a lot of this, the sessions
 

that we did.
 

DR. ZIEMER: And that is information that
 

would not derive from requests to DOE, I assume. Is
 

that correct?
 

MR. GRIFFON: That's correct, yeah. But
 

this is -- I think medical surveillance program data
 

was actually explicitly mentioned in one of the
 

regulations or the -- yeah -­

DR. ZIEMER: Right.
 

MR. GRIFFON: -- and this is all under the
 

medical surveillance -- DOE medical surveillance
 

programs.
 

DR. ZIEMER: So it is available via the DOE
 

route, then, or not? This sounded like a
 

separate -­

MR. LAWSON: Probably if you request the
 
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right document, would be my guess.
 

DR. BINGHAM: Well, I'm a PI on one medical
 

surveillance project, and these are cooperative -­

DR. ZIEMER: You need to identify yourself.
 

DR. BINGHAM: Eula Bingham, the University
 

of Cincinnati College of Medicine, Department of
 

Environmental Health. The PI, the -- I'm the PI on
 

this one. These are cooperative agreements and
 

because the workers were so concerned about DOE and
 

its reputation and so forth, we were very careful. 

And we agreed not to give it to them. I mean if a
 

worker decides to give it, that's their choice, and
 

we have them read a confidentiality agreement and so
 

forth. But the data belongs really to the project
 

and it's only given in de-identified form. And
 

theoretically that could be done by each of the
 

projects, not by DOE.
 

Now certainly DOE could encourage the people
 

who have the projects to do it, but they do not own
 

the data. The only thing they would own that we
 

have is if monitoring data for a certain facility,
 

then they own that and that's covered under the
 

Privacy Act. So I think you'd have to go to the
 

different surveillance projects and ask that, and I
 

think most people would be happy to share what they
 
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have.
 

As a matter of fact, we've already shared
 

some of the information with NIOSH on what we called
 

institutional histories of some of the sites where
 

we knew what the processes were and during what
 

periods of time. Not perfect, but at least
 

something.
 

So -- but for this, the actual owning of the
 

information is for each project, but you know, you
 

could never give up identified data. That's up to
 

each worker. Is that right?
 

MR. GRIFFON: I guess I was thinking more
 

along the lines of the summary reports, which are -­

all the de-identified summary reports which capture
 

-- at least may help in the site profile side of
 

things. Certainly the interviews and the identified
 

data, Eula's correct on that.
 

MR. LAWSON: And what we call the needs
 

assessment documents where we had the initial
 

meetings, in a generic form.
 

DR. ZIEMER: It seems to me we'd want to
 

make sure those got into the system if they're -­

MR. ELLIOTT: Yeah, let me speak to this a
 

little bit, and I appreciate Eula speaking on it, as
 

well. And she's certainly very accurate, DOE
 
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doesn't own much of this information, and so we've
 

been working with several of the PI's and in some
 

specific situations regarding perhaps construction
 

workers, we've been working for the Center for
 

Protection of Worker Rights for -- trying to put in
 

place a sole-source contract with that -- with a
 

consortium under the Center for Protection of Worker
 

Rights to get information from these different
 

programs for five different sites, the work historyrelated information for construction workers. And
 

also we should be aware that any one of the former
 

workers who go through the program are given
 

information back to them individually which should
 

be part of their claim. They can submit it as part
 

of their claim, and so that personal, individual
 

information can be utilized as it comes from the
 

individual. And we certainly -- every time we deal
 

with a claimant and we identify that they were a
 

member of a former worker screening program, we ask
 

do you have this information and it certainly would
 

be beneficial if you would provide it. And so
 

that's one way we try to get around this issue of
 

the individual information and not having a release
 

form signed through the whole program.
 

MR. ESPINOSA: What are the five sites?
 
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MR. ELLIOTT: Well, there's -- we're still
 

working on the negotiation of this agreement, solesource agreement with CPWR on it. I can't go into
 

it at any more detail than that right now.
 

DR. DEHART: Again, thank you for your
 

comments -- Roy DeHart. There was a point of
 

clarification. You had mentioned that in Oak Ridge
 

the word is that if you didn't work at K-25, forget
 

it. Under the special cohort, the gaseous diffusion
 

operation was covered. Did it cover anyone working
 

in the reservation -- in the K-25 reservation
 

itself, or just specific site and operational
 

activities?
 

MR. LAWSON: Just the K-25 site. Of course
 

we had a lot of workers who transferred between
 

sites. That happened very frequently. But if they
 

worked as much as 250 days -­

DR. DEHART: In that building?
 

MR. LAWSON: -- at K-25, they -- we're a
 

special cohort.
 

DR. DEHART: Okay.
 

MR. LAWSON: They would be considered.
 

DR. DEHART: And when you say K-25, you're
 

talking about K-25, the building -­

MR. LAWSON: The gaseous diffusion plant
 
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itself.
 

DR. DEHART: -- the building.
 

MR. LAWSON: The physical -- physical plant
 

MR. PRESLEY: No, no.
 

DR. ZIEMER: The site.
 

DR. DEHART: The whole site. Okay.
 

DR. ZIEMER: The site.
 

DR. DEHART: The whole site. Okay.
 

DR. ZIEMER: Other questions for Bruce? 

Thank you very much.
 

MR. LAWSON: You're very welcome.
 

DR. ZIEMER: All right. Now we'll hear from
 

Bob Tabor. Bob's been with us before from Harrison,
 

Ohio. Bob, are you here?
 

MR. TABOR: Yes. I'm Bob Tabor -- Robert
 

G., for the record. I'm a member of the Fernald
 

Atomic Trades and Labor Council. I work at the
 

Fernald site, 21-year veteran there, millwright by
 

trade and a labor representative. I spoke to you
 

folks in the past and I guess the first thing I
 

would like to say is I'm happy about the new members
 

of the Board and glad to see that that issue's been
 

addressed and the addition of those folks. I'm also
 

happy to be able to be here again, you know, to
 
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participate and listen to the Board's activities. 

Doing so certainly helps elevate the learning curve
 

because without a doubt to say, this is a kind of a
 

complex issue, some of these things are.
 

And I guess on that note, some of the things
 

I'd like to talk about, it'd be really hard for me
 

to reiterate those things in such a manner that I
 

might get as detailed as some of you who really
 

understand the science behind this. So some of my
 

comments will basically be in reference and in
 

general, because the things I've been thinking about
 

the last few days that I would like to comment to
 

have been explored by a lot of conversation and
 

discussion here this morning, so I just want to
 

reiterate the issues that Mark brought up and that
 

Jim brought up, especially those on the issue
 

regarding the SEC class applying for non-SEC-listed
 

cancers and those particular issues there. I want
 

to be sure that we give thorough thought to how to
 

adjust or how to fix those type of issues and
 

answers.
 

I mean I recognize that as this whole
 

process evolves there's certain things that were not
 

thought of in the beginning in the rule that have
 

come up that need to be addressed. And I just want
 
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to reinforce the fact that, you know, we need to do
 

everything possible to fix those things so that we
 

don't have a lot of black holes that complicate
 

things as we go down the pike, you know, on making
 

claims.
 

One of the other issues deals with -- let's
 

see here. My concern over the fact that Fernald was
 

unfortunate that we didn't get ourselves as -­

identified as part of the original cohort groups,
 

such as Paducah and Piketon. And in lieu of that,
 

it leaves us in a position to possibly explore what
 

is now before us, which is the Special Exposure
 

Cohort, those particular avenues. And one of the
 

things that bothers me a little bit is that the
 

rule-making or the guidelines, if I'm expressing
 

that correctly, that was set forth for the original
 

cohort groups, that those same things are not true
 

for that of the Special Exposure Cohorts, and so I
 

have some concerns relative to the equity in that
 

process. That's about the best way I can explain
 

that I think we've talked a little bit about it here
 

this morning in detail, but I want to reiterate
 

that.
 

And then I guess in part of that thought
 

process comes the issue that Mark touched on
 
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relative to, you know, the endangered -- the
 

definition of an endangered health. There seems to
 

be some complicities (sic) there, in my mind,
 

relative to how we're going to approach, you know,
 

defining that with respect to maybe dose
 

reconstruction of the individual and possibly what
 

that might be -- you know, for the site or something
 

to that effect. It's difficult for me to talk to
 

that somewhat in detail, but I think Richard's
 

touched on it, as well as we've addressed that issue
 

here this morning. And I just, once again, want to
 

reiterate those two particular areas that we need to
 

work on for good clarification.
 

One of the other things that came to my mind
 

this morning in some discussion and it came up a
 

couple of times, and I'd like to touch on it again. 

Let me grab my notes here. There was -- you know, I
 

had asked -- I was writing down some questions I
 

asked -- I asked myself a couple of questions I
 

guess I really knew the answer to, but let me just
 

read those. I said to myself here, you know, some
 

questions.
 

I said in doing the dose reconstruction, is
 

the only category of collected data, you know, that
 

of consideration for doing the reconstruction would
 
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be that of just exposure records. Well, I got to
 

thinking about that and said now, Bob, that's -- no,
 

there's other things that are considered, as well. 

And then it posed a question in my mind, you know,
 

does the nature of where you worked in an operation
 

and what maybe the individual did and what they were
 

exposed to, does that have bearing on the
 

development of the dose reconstruction? And the
 

answer to that is well, yes, it does.
 

Then my thought process went to the
 

questions that were generated or the conversation
 

that was generated this morning under the issue of
 

-- let me think here a second -- the memorandum of
 

agree-- I mean memorandum of understanding relative
 

to what are we going to do about DOE and getting
 

additional information, and what is that information
 

going to be limited to. I think you've heard me
 

speak a few times in the past over my genuine
 

concern about the record-keeping processes,
 

especially with respect to the record-keeping
 

processes -- well, wait a minute, let me back up. 

Maybe not the record-keeping processes, but the
 

retention of records at some of these sites, and
 

especially of those sites who are kind of on the
 

short list.
 
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Now by the short list, I mean sites that are
 

destined for closure in the near future. At one
 

time here for a while there was this moratorium on
 

the disposal of records, and I think I mentioned the
 

last time that that moratorium has been lifted. Now
 

a lot of those records are going to be on processes
 

that we did at the site, the various types of, you
 

know, things that went on -- you know, where the
 

people worked, what they did. I was hoping that
 

something that might be generated in addition to
 

maybe a special letter which you folks indicate that
 

maybe you should write to the DOE or Congress
 

addressing the memorandum of understanding relative
 

to information, that we might address the fact that
 

maybe they should reimpose a moratorium on these
 

records. Because as these sites close, it's going
 

to be really, really hard to find these things. 

Without a moratorium, they can ship that stuff off
 

to anyplace and it just gets hidden in a -- you
 

know, in the closet. And then you have information
 

that you may need, other than just the medical
 

records on the individual to make certain decisions,
 

obtaining that information gets only that much more
 

difficult when you don't have availability to those
 

records. And I have a big concern over that and was
 
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disappointed in the fact that they have lifted that
 

moratorium. So I would like to reiterate that
 

aspect for your consideration and whether or not you
 

would like to address that in your letter or if it
 

ties into that or if it's something you should
 

address, you know, independently, you know. Because
 

Fernald's probably going to be one of the first
 

sites, other than Weldon Springs, that's going to be
 

what we call, you know, a closure site that's come
 

to completion. We have a lot of retired employees
 

right currently and, you know, and as these things
 

-- as these issues crop up and these applications
 

become more familiar with the employees and that
 

they make application, you know, for compensation,
 

the record issue might get real muddy. So I wanted
 

to reiterate that.
 

So other than that, I believe I don't have
 

any other comments for today. At least that's what
 

I've jotted down.
 

DR. ZIEMER: Thank you very much. Again,
 

let's see if we have questions -- yes, Tony?
 

DR. ANDRADE: Seems we don't have enough
 

microphones to go around the table. Sorry about
 

that, Bob.
 

MR. TABOR: Okay.
 
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DR. ANDRADE: Bob, I haven't been -­

truthfully, I haven't been keeping up with what's
 

going on with moratoriums on -- moratorium on
 

records-keeping. Do you know if this permits sites
 

to actually destroy records or is it directing sites
 

to send records to other facilities?
 

MR. TABOR: I'm not certain. It's not
 

really totally clear in my mind. Moratorium means,
 

you know -- in my mind means don't do anything with
 

them, in the sense of like destroying, or you have
 

to keep what you've got. I think when they lift the
 

moratorium, exactly what the total guidelines are on
 

what you can do with the records, quite frankly, I'm
 

not so sure the DOE has developed a true, pure, good
 

set of guidelines on what you can get rid of and
 

what you can't.
 

Now let me give you just a far-fetched
 

scenario. I think that probably you could destroy
 

maybe cash register receipts from the cafeteria, and
 

that wouldn't be any big thing. And they're not
 

going to -- whew -- put that stuff out someplace in
 

a big vault. But then there's this other set of
 

delicate records that will have a greater meaning,
 

you know, to -- you know, to our future citizens or
 

our future society, certainly may have a greater
 
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meaning to an organization like ourselves and the
 

processes that you're involved in. I don't know
 

exactly what their rule-making is going to be on how
 

they're even going to approach this.
 

I've had some discussion with some higherups, at least at the field level, asking them since
 

the moratorium has been lifted, what are your
 

guidelines for how you're going to go about this, if
 

you have a plan, and what specific records. Quite
 

frankly, my impression is is I'm not so sure that
 

they have guidelines in place to say you can do this
 

to this extent or you can do that to that extent. 

I'm not really sure about that, if you want to know
 

the truth. But I have concern about it because my
 

impression is okay, if a moratorium is lifted, then
 

begs the question what you're just asking, just what
 

can you get rid of. And even to complicate things
 

more, what you may retain, where's it going to go.
 

DR. ZIEMER: We have a comment from Larry
 

and then from Bob.
 

MR. ELLIOTT: The moratorium on destruction
 

of records for epidemiologic purposes has not been
 

lifted.
 

MR. TABOR: That is correct.
 

MR. ELLIOTT: It is still in place, and so
 
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in that regard, any system of records that has use,
 

utility, benefit to epidemiologic studies and the
 

understanding of exposure associated with health
 

outcome, are protected. And NIOSH has, in the last
 

12 years, a long history of involvement in advising,
 

arguing with, recommending to, working with DOE on
 

making sure that those records are intact and
 

retained and not destroyed. I know that the healthrelated energy research branch at NIOSH, which I was
 

the branch chief for, has worked very closely with
 

the people who do record reviews across the sites.
 

What I think you're very accurate and your
 

point is very well-taken on, Bob, is what happens to
 

those records that are protected when a site closes
 

down, and where do they go and how do we find them. 

And that's been our concern for a number of years as
 

to the finding aids and the systems of records that
 

are protected for these purposes and how to make
 

sure that they're not lost in a Federal archive
 

somewhere and they are retrievable and traceable. 

And that's something we have commented on and been
 

concerned about, and I think that's where I hear
 

your point dwelling and hitting home with me very
 

strongly.
 

But the moratorium on destruction of
 
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records, in my understanding -- unless you have some
 

memo within DOE I have not seen yet -- has not been
 

lifted.
 

MR. TABOR: Well -­

MR. ELLIOTT: It's still intact.
 

MR. TABOR: And I agree with you there,
 

Larry. I understand that things like medical
 

records, and then you framed it as epidemiological
 

records and things like that, my impression is that
 

yes, there's not a moratorium to lift that. I mean
 

in other words, those things have to be -- stay
 

intact. But you're right, the issue is where may -­

you might find them in the future.
 

I think that what I'm also referring to here
 

is things that might be associated that people would
 

look at or you folks may look at in developing maybe
 

probability of causation -­

MR. ELLIOTT: But it's all records. We have
 

been integral in deciding with DOE what systems of
 

records -- and it's not only the medical records,
 

it's not only the dose records, we have targeted the
 

process records -­

MR. TABOR: Okay.
 

MR. ELLIOTT: -- the processing information
 

records, the changes in historical practices at a
 
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given site, employee benefit records, the PSQ's -­

MR. TABOR: Okay.
 

MR. ELLIOTT: -- we say don't destroy those
 

MR. TABOR: Well, maybe that's not been
 

clear to us in the past, but those are the things
 

that I have concern about, you know -­

MR. ELLIOTT: And if you go -­

MR. TABOR: -- process records.
 

MR. ELLIOTT: If you go into DOE's routine
 

use authority under the Privacy Act that gives NIOSH
 

routine use authority to access those records,
 

you'll see a long list of systems of records. And
 

those systems of records, by their nomenclature,
 

will give you an indication of the variety of
 

information that's protected. And it's not only
 

just medical and dose, it's a long whole list of -­

there must be -- I recall like 27 different systems
 

of records that we said we need to see. And we had
 

to make some very strong arguments for why a certain
 

system of records was important to -­

MR. TABOR: Yeah, well, that would be my
 

concern.
 

MR. ELLIOTT: -- research and understanding
 

of exposure and health outcome.
 
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MR. TABOR: Okay.
 

DR. ZIEMER: And let's see, Robert had a
 

question or a comment.
 

MR. PRESLEY: I agree on some of these
 

records. In the past three years that's what I've
 

worked on extensively. And I know at Paducah
 

there's stuff -- when the new company took over -­

out the door. Or in a trailer. And we're in the
 

process of going through some of that stuff.
 

The other thing is, Larry, I think what we
 

need to do is send that letter out again, because a
 

lot of the people -- the new companies are taking
 

over. You've got the new contractors. They are
 

looking at that old data as -- this is not mine, I
 

have no responsibility. Then I put my people in the
 

records center. They don't know the difference
 

between a purchase order and a -- I hate to say it
 

-- and a medical report. Those things get shoved in
 

a box. They get sent to Atlanta with a destruction
 

date and they're gone.
 

MR. ELLIOTT: I think you're absolutely
 

right. I think -- you know, the point you make is
 

different than what Bob was making earlier that -­

where the record go is one thing, but
 

acknowledgement of a contractor or the records
 
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manager at a certain site, who's new to that site
 

and new to DOE's process, may not have found that
 

memo that said moratorium on destruction of records
 

for epidemiologic purposes covers these systems of
 

records. I agree, I think that would be a very
 

important thing to articulate in your letter.
 

MR. TABOR: Well, a reminder would probably
 

really help because the only thing that I can attest
 

to -- you know, in these closure sites where cleanup is really I mean robust and it's in full swing, I
 

will tell you that going through three contractors
 

over 21 years out there that the closer you go and
 

the faster the pace gets, it is a administrative
 

merry-go-round, and I mean it is really, really
 

hard, not only to find people that are responsible
 

in those areas to figure out what's going on and
 

where things are at that particular stage in time as
 

opposed to where things were just a few years
 

before.
 

So you know, what Robert had to say there,
 

there's a lot of validity in that. I mean it
 

becomes very difficult, so maybe a reminder like
 

that would really be good and we need to keep our
 

finger on the pulse of things.
 

DR. ZIEMER: Thank you, Bob, for a very
 
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important point that you raised.
 

Now we have one more person who has
 

requested time, and that is Mark Lewis. Mark is
 

with PACE and from Waverly, Ohio. Mark?
 

MR. LEWIS: Thank you. Hi. First I want to
 

thank everyone for putting the time and effort that
 

you've been putting into this. It's very important
 

to all of us nuclear workers and other people
 

throughout the country at the weapons facilities and
 

I applaud your efforts for that.
 

I have some topics I'd like to talk about as
 

pertaining to site profiles, expert groups and
 

record keeping. They all tie in together, what
 

we're talking about.
 

First of all, the site profiles. I have the
 

privilege of being the coordinator of the local
 

worker health protection program in Piketon, Ohio -­

dose screenings some of you guys were alluding to a
 

while ago, Larry was, and the thing we found out
 

about site profiles, a lot of the records that we
 

needed to get ahold of through the plant exposure
 

records, they were either incomplete or nonexistent. And by getting ahold of -- we called
 

expert groups of workers, former workers -- we got
 

ahold of some former workers and we put together a
 
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risk-mapping session. This risk-mapping session and
 

focus groups. The risk-mapping session where I set
 

people down at tables, give them a map and have them
 

go back -- like taking a snapshot of the past of the
 

plant.
 

We found out, just like you mentioned, some
 

of the buildings used today for certain processes
 

that weren't used for that process years ago. A lot
 

of exposures -- you'd think a building would be
 

clean. For instance, at our site we have a building
 

we have shipping and receiving in. And years ago it
 

was where they sampled high grade uranium. So
 

within the walls of that building, inside with
 

people working there, they was drilling or something
 

in the walls, the maintenance man, they would be
 

going through a space and time with some of that
 

dust could have transuranics in it or whatever, you
 

know. So we found that the workers were our experts
 

at that time.
 

We got all the records we could from the
 

plant, but that, mixed in with the workers, led us
 

to know more of what to screen for today, you know,
 

in our screening program.
 

The risk-mapping part is very important. I
 

think, you know, if you went to a site to talk to
 
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somebody, you know, they'd give you all the records
 

they'd have from the company, you know, that's
 

running the facility now. But don't forget to talk
 

to some of the retired people.
 

And the dynamics of this risk mapping, too,
 

is worthwhile because you get two or three people
 

together that worked together for a while. You
 

know, you want to get like with like people. You
 

get process operators, for instance, at one -- one
 

day. Get all the people who did welding at another
 

time, and these people could be retired now -- most
 

of them were. They'd see each other and their
 

memories would click more. And the collective
 

memory of those people was more valuable to us,
 

really, than any hard data that we had. I just
 

wanted to share that with you.
 

Also, pertaining to past -- I'm just going
 

to talk about neutron exposure at our Portsmouth
 

site. There was numerous studies done at the
 

Portsmouth site -- gaseous diffusion site pertaining
 

to, you know, exposures and all. But none of them
 

ever did come back and say there was neutron
 

exposures. Our own in-house -- the union activity,
 

our safety reps and stuff, suggested that hey, we
 

had some deposits in some lines and the potential
 
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could be there for neutron exposure. And we asked
 

specifically for NIOSH to come in and just do
 

neutron exposure. And sure enough, that's what they
 

found, we had neutron exposure that we weren't
 

monitored before, see, before. So you know, just
 

going by your past histories of safety studies at
 

different sites may not clearly reflect what you
 

have. I can't emphasize enough about how workers
 

could be involved in it.
 

Now a lot of you may know that a gentleman,
 

Jeff Walburn*, works at our site. The company has
 

-- I heard was mentioning earlier yesterday
 

something about maybe somebody forgot to do
 

something or whatever, but there's cases -- in Jeff
 

Walburn's case, and it's in Congressional records
 

and the company's got letters, too -- where they
 

said yeah, we zeroed your dose for liability
 

purposes. And it's in Congressional records and in
 

memos, you know. So there's a lot of vidility (sic)
 

out there, you know, saying that it was done
 

intentionally in some cases, so -­

In my own record, I started working at the
 

site when I was 21 years old in the fire department. 

I got into a serious exposure situation where I had
 

high grade weapons material on top of my anti-C's*
 
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358 

from the fire department. And I ran out of air,
 

went outside to get some more air in my bottle. A
 

guy unzipped my suit, all the stuff fell down on top
 

of my head -- maybe that's why I am the way I am
 

today, I don't know -- but it all fell on me and
 

eventually I got exposed real bad, you know. I had
 

no skin left on my face for a long time and I went
 

through a lot of hassle.
 

Well, in '88 I had some heart trouble and I
 

thought I'm going to go get my records and just sit
 

down and see what I was exposed to. Well, guess
 

what? There's nothing there. Nothing happened that
 

day or for them weeks that followed.
 

So I thought I wanted to at least mention
 

those to you, and that's about all I had. 

Especially when, you know, you go to do the site
 

profiles, don't forget the retired people -- all
 

right? The retired workers and the risk mapping. 

That's all.
 

DR. ZIEMER: Thank you, Mark. Let me again
 

ask if anyone has questions for Mark.
 

(No responses.)
 

DR. ZIEMER: Okay. Thank you for your input
 

on that.
 

Now we need to return to the topic of
 
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Special Exposure Cohort.
 

DR. MELIUS: Can I ask -- sort of figure
 

where we are procedurally, I guess. We spent a lot
 

of time this morning talking about this and I'm not
 

sure where we're going in terms of getting comments
 

in to NIOSH and how you want to proceed on that.
 

DR. ZIEMER: Well, what I'll do here is
 

summarize. The working group met during the noon
 

hour, and I'll summarize where we think we are and
 

get some feedback from the Board members.
 

Just for planning purposes, Mark, does your
 

working group have some further things that you're
 

going to want to present today, or are -- I mean
 

you're not under any pressure to come to a final
 

document. You got a lot of input this morning for
 

refining and -­

MR. GRIFFON: Right. Not for today.
 

DR. ZIEMER: -- I think you can move forward
 

with what you have, so -­

MR. GRIFFON: Yeah, and we did mention that
 

we might want to have a conference call in the near
 

future -­

DR. ZIEMER: Right, but -­

MR. GRIFFON: -- to probably -­

DR. ZIEMER: -- in terms of today's meeting,
 
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I think we're okay on that. I had planned -- I
 

thought we had put in the agenda, but I'm not seeing
 

it, to at least have a little discussion relating to
 

-- how can I describe it? Let me call it personnel
 

issues at NIOSH. Actually an issue that was raised
 

by Mr. Miller and perhaps we'll have time to at
 

least discuss -- I think -- it has to do with
 

whether or not the manpower is sufficient,
 

particularly in dose reconstruction and so on. This
 

is not an item that Larry has asked me to raise. It
 

can be very -- it can be a little ticklish for the
 

Board to get involved very deeply in hiring and
 

manpower levels at the Agency, but at least some on
 

this Board have raised concern about whether or not
 

there's enough staffing to get the job done. And
 

perhaps we can at least discuss that a little bit.
 

I do want to at least get us up to date on
 

where we are on the Special Exposure Cohort. We're
 

still shooting for having comments ready by the
 

25th, I think, of August. Is that the -- or 26th.
 

MR. ELLIOTT: The 26th is the last day.
 

DR. ZIEMER: The comment deadline. So let
 

me tell you what we've done so far, kind of taking
 

all of the input from this morning, Jim's comments,
 

Mark's comments and the ones that we had prior to
 
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that.
 

What we're looking at now would be a letter
 

to the Secretary which included with it a series of
 

comments relating to specific parts of the 42 CFR
 

83. Some of those were ones I described this
 

morning.
 

That is, in section 83.1 to reformat the
 

wording in the manner that Tony had suggested. That
 

would be the first paragraph on that page. Plus
 

utilizing Wanda's word for proactive, the word
 

"diligent" in identifying and assisting employees;
 

adding a section 83.2 with the wording that Tony had
 

suggested for that section in his item two. That
 

wording is that a section would be added to state a
 

cancer claimant whose dose reconstruction was
 

completed, but whose claim did not qualify for
 

compensation, cannot reapply for or use the
 

procedures for designating classes of employees as
 

members of the special cohort as a route for
 

appealing a decision, that it is not an appeal
 

process. Section 83.10, as shown on the sheet,
 

83.13 as shown, 83.15 as shown.
 

Now we then looked toward dealing with
 

specific things, and let me refer to Jim's comments
 

-- and these overlap a bit with Mark's. First of
 
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all, on the first comment where Jim has recommended
 

NIOSH should modify the approach envisioned by this
 

rule to place more emphasis on the group petitioning
 

process. We note that section 83.7 actually
 

identifies both the group petitioning process and
 

the individual, so our thought here was to use the
 

preamble -- and the preamble will be reformatted, is
 

our understanding, so that there will be descriptive
 

information pertaining to the various sections. So
 

there would be a preamble that would have a portion
 

relating to section 83.7. And our suggestion here
 

is that there be language in the preamble that would
 

sound something like this, and I'll give you the
 

rough draft that the committee came up with this
 

noon.
 

Quote, NIOSH should emphasize the group
 

petitioning process, parentheses, as opposed to the
 

individual petitions, and explain or describe
 

possible types of groups that might consider
 

petitioning; e.g., a group of workers who believe
 

they have been subject to an undocumented exposure
 

at a facility.
 

So basically then -- end of quote. So
 

basically the preamble would be used to sort of
 

emphasize the group petitioning process and give an
 
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example, and that might be expanded on, but that at
 

least was our initial recommendation for dealing
 

with that.
 

On the second item -­

DR. ANDRADE: Paul -­

DR. ZIEMER: Yes. Oh, yeah, please -- and
 

any of the working group can help out here. Tony,
 

please.
 

DR. ANDRADE: Just a tiny suggestion. This
 

is word-smithing, but nevertheless I think it's
 

important in light of the fact that we're not trying
 

to give higher weight to one process versus the
 

other. Instead of using the words "as opposed to" I
 

would suggest something like "vis a vis" or
 

something along those lines.
 

DR. ZIEMER: NIOSH should emphasize the
 

group petitioning process vis a vis -­

DR. ANDRADE: The individual.
 

DR. ZIEMER: Okay, I gotcha. This is not
 

final wording right now. This is our draft and we
 

may have to have a conference call and at least get
 

final wording out for -- and even do a phone vote
 

later this month.
 

Now on the issue of guidelines, we struggled
 

with that quite a bit. And where we landed on this
 
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was to ask -- and our comment would suggest that the
 

-- ask the staff, in the preamble again 'cause the
 

preamble is more like a guide, to add some words to
 

section (e) under -- I guess it's section (e). 

Section (e) on page 42964, that's the Federal
 

Register page. And this would come in in the
 

paragraph that says (reading) commenters asked HHS
 

to define the conditions under which NIOSH would not
 

have sufficient information.
 

And basically, Jim, I think your question
 

was when do we know we don't have sufficient
 

information.
 

Now as we read through the preamble, it was
 

our feeling that to some extent they have described
 

this, but it may be helpful to concisely put this
 

all up front and say that by sufficient information
 

we mean incomplete information on radiation source,
 

incomplete information on processes and practices,
 

incomplete information on source terms. So it would
 

spell out what it is that we're talking about when
 

we mean incomplete.
 

There was a feeling amongst our group that
 

it would be difficult to go beyond that. If you
 

drive down to the next question and say well, what
 

is incomplete source information or what is
 
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incomplete dosimetry information, we can't say it's
 

one missing film badge or it's seven or it's 25 or
 

something. So at this point we're saying the
 

guidelines would have the nature of describing the
 

types of things where the judgment is that there's
 

not enough information in this category to complete
 

the dose reconstruction. And that -- it seemed to
 

us that that would allow sufficient flexibility so
 

that it was not completely proscriptive to those
 

doing the work, but still identified for those
 

petitioning what it is that we're looking for or
 

what it is that's missing. And one could even then
 

have -- if it were an application that said are
 

these pieces of information missing from your
 

records and therefore you are petitioning on that
 

basis. So that's where we landed on that one.
 

Item three we think now is being covered
 

already by our previous section one where we are -­

is it previous section one? Where we are asking
 

NIOSH itself to be more aggressive, formerly known
 

as proactive, more diligent in identifying and
 

assisting employees. And again we ask the Board if
 

that will address the issue, but at least that's
 

where we landed on that.
 

And then finally -- of course your item five
 
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we've already covered in a separate motion, and item
 

four I think we -- we think we ended up this morning
 

as realizing that probably we can't insert the time
 

limit into this. Was that -­

DR. MELIUS: Yeah, I think it's -­

DR. ZIEMER: -- everybody's understanding? 

We discussed it and so our recommendation was not to
 

include anything on that. So what I've just
 

described now is the nature of what the
 

recommendation would be and I think we'd like some
 

feedback as to whether or not -- and it would have
 

to be worded and we would do that together with a
 

cover letter and distribute that for a final vote,
 

but I want to at least get an early measure of level
 

of comfort with such comments. Or if there are some
 

major issues that remain undealt-with, we need to
 

identify those.
 

I might also add, I believe that if
 

individuals have issues that they don't -- and the
 

Board is not able to, as a group, deal with, they
 

could always be submitted as an individual's. Is
 

that not the case, Larry? Nothing prevents Board
 

members, as individual citizens, to submit comments,
 

but -- and you may want to address that. Is that -­

MR. ELLIOTT: No, you're absolutely correct,
 
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367 

an individual Board member may submit comments as an
 

individual.
 

DR. ZIEMER: Right. We don't lose our
 

citizen privileges.
 

MR. GRIFFON: Paul, did the working group
 

address my -- you know, the three -- I know one of
 

them overlapped Jim's, but the other two were -­

DR. ZIEMER: Let me go back to yours here
 

and see what -- you know what?
 

MR. GRIFFON: Ran out of time.
 

DR. ZIEMER: We missed -- was it the
 

sufficient accuracy issue that you're asking -­

MR. GRIFFON: No, that overlapped with
 

Jim's, I think, but especially the number three, I
 

guess the endangered health question.
 

DR. ZIEMER: Actually, we didn't. I'm
 

sorry, I think we ran out of time and so that -­

that does not imply that this was not important. 

What -- and maybe we can get some feedback right
 

now. How can we handle that one?
 

Is -- I want to start -- let me ask Ted
 

first. Ted -- or maybe Jim -- Jim's there? 

Whoever. Is it the staff's feeling that they have
 

in fact defined endangered health in a manner that
 

is fully consistent with the law? That is, it's
 
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based on the law. He obviously has to answer that
 

yes. Right?
 

UNIDENTIFIED: He'd better.
 

DR. ZIEMER: But you understand -- I need to
 

rephrase the question. Have you stopped beating
 

your wife, Ted?
 

(Laughter)
 

DR. ZIEMER: This says the current
 

definition of endangered health relies on an
 

estimate of potential dose and expresses some
 

concerns. Does the -- we need to consider whether
 

endangered health itself is fully and adequately
 

defined in the draft here.
 

MS. MUNN: Well, it certainly -- I'm
 

assuming that everyone is relying on the same
 

footnote that I am for that definition, where the
 

footnote says (reading) HHS interprets the statutory
 

language, endangered the health -- see 42 USC
 

4384q(b)(2)* -- to mean there is a reasonable
 

likelihood that the radiation dose may have caused a
 

specified cancer. That's a quote from the statute.
 

DR. ZIEMER: That's the definition here.
 

MS. MUNN: Right. Since claimants cannot be
 

compensated as members of the cohort for any adverse
 

health effects other than certain cancers under the
 
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relevant portions of the law. It appears to me that
 

that's defined by the law already.
 

DR. ZIEMER: I believe this is how NIOSH has
 

defined it, based on the law.
 

MS. MUNN: Based on the law, uh-huh.
 

DR. ZIEMER: Those words may not be in the
 

law itself. Ted?
 

MR. KATZ: No, no, the law used the term
 

"endangered the health". HHS had to interpret what
 

that means, and what you're reading is -- it was
 

HHS's interpretation of that. And you know, of
 

course, as Dr. Ziemer said, we believe it's
 

consistent with the law or it wouldn't have gotten
 

out.
 

DR. MELIUS: But are you saying it's the
 

only -- it's not the only definition that's
 

consistent with the law.
 

MR. KATZ: It's -­

DR. MELIUS: There are other ways of -­

wouldn't you say there are other ways of
 

operationalizing that that would be consistent with
 

that, or are you saying that's the -- this is the
 

only one?
 

MR. KATZ: I'm not precluding that there's a
 

possibility of another way of operationalizing this. 
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I just -- we didn't come up with it. We didn't
 

imagine it.
 

DR. ZIEMER: I think you could argue to some
 

extent it is driven by the law itself. I mean I
 

suppose I could argue that you could say that it's
 

-- endangerment is 50 percent or more likely than
 

not at the 50 percent confidence level rather than
 

99. I mean it's a definitional thing.
 

DR. MELIUS: Correct. But I'm just saying I
 

don't believe that the -- the law is very vague on
 

this and what they mean by endangerment, and I don't
 

think this is necessarily the only way that that can
 

be interpreted. In fact, I personally think that
 

they're taking a relatively narrow interpretation of
 

what is in the law and what my understanding is in
 

the background, and it certainly contrasts with how
 

some of the other Special Exposure Cohorts were
 

designated. They were designated based on a
 

duration of exposure and a question of whether or
 

not they were monitored or should have been
 

monitored -- facility, which I think sort of begs
 

the question of a level of endangerment or level of
 

risk in that. So I think there certainly -- the law
 

implies some other approaches could be utilized.
 

DR. ZIEMER: At the end of the day, you
 
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still -- you end up having to have some criteria,
 

and it's a little difficult for me to see that you
 

could use -- that it would be proper to use a
 

criteria that's different from the criteria that are
 

being used with the regular dose reconstruction
 

'cause that's -­

MR. GRIFFON: Why? Explain your logic for
 

that. Why would you think that would be improper
 

since in one case you can estimate doses but in the
 

other case you already said that you cannot estimate
 

doses, so why would it be improper to use a
 

different -­

DR. ZIEMER: Because the way that they're
 

doing it here does a group estimate and caps it and
 

makes a -- it's not an individual dose
 

reconstruction, but it makes a -- it makes what I
 

would call a reasonable estimate that their dose is
 

below the same bar. You're basically saying
 

everybody in that group is either over or under that
 

-- well, let's say if they're in the cohort, they're
 

over the bar, that same bar that you're using.
 

DR. MELIUS: I don't interpret the
 

calculation that's being done to necessarily -- in
 

that way -- probably 'cause we have very little
 

guidance for how that will be done. I mean what I
 
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find to be illogical -- I don't know if that's the
 

right term -- is just the basic fact that you're
 

doing -- you've said you can't do a dose
 

reconstruction, yet you're basing endangerment on a
 

dose reconstruction of some sort, and the -- I'm not
 

saying that's not an approach that can't be used,
 

but I think it has some fundamental problems with it
 

that concern me, and I don't think it's the only
 

approach that's -- certainly not the only approach
 

that's prescribed by the legislation. I don't think
 

this is an easy issue, either, so I'm not trying to
 

trivialize or say that NIOSH's effort wasn't an
 

effort that should not be considered by -- I mean,
 

for example, for the other -- some of the other
 

Special Exposure Cohorts, it was working one year
 

and being badged or working a job that should have
 

been badged, I think is the terminology. Now
 

concern that was is well, would there be -- would we
 

encounter other situations where people may have
 

been badged as a precaution, even though recognizing
 

that very little likelihood they would have had
 

exposure and in case would we be allowing them into
 

the cohort inappropriately. I don't know whether it
 

would be the cafeteria workers, I don't know what
 

the right example is or -- Well, in that case, one
 
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could argue that one would have enough information
 

to be able to do a dose reconstruction enough to say
 

that they wouldn't qualify. Are there situations
 

where that's -- they're going to fall in between or
 

be complicated from either of these approaches?
 

UNIDENTIFIED: Yeah, I think it's a -­

DR. ZIEMER: So even the statement "should
 

have been badged" has certain implications on both
 

nuclides and doses and so on. I mean -­

DR. MELIUS: Should have been monitored, I
 

mean. Excuse me.
 

MR. GRIFFON: Monitored or should have been
 

monitored.
 

DR. ZIEMER: Oh, should have been monitored. 

Well, either one of those.
 

MR. GRIFFON: Either way, yeah.
 

DR. ZIEMER: Yeah, so there are certain
 

implications, as soon as you do that, that there are
 

some levels.
 

DR. MELIUS: Yeah.
 

MR. GRIFFON: Right, right.
 

DR. ZIEMER: Mark, you had -­

MR. GRIFFON: That there's some significant
 

level, right. I mean I -- just to pick up on Jim's
 

point -- I wish Jim Neton were still here, but I
 
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think that we heard NIOSH's efficiency process is
 

actually going to exclude those insignificant dose
 

cases from getting over that first hurdle of
 

sufficient accuracy. They're going to be able -­

like Jim said, they're going to be able to do an
 

individual dose reconstruction 'cause they're going
 

to make all these worst-case assumptions and they're
 

likely not to -- even with all the worst-case
 

assumptions, they're not going to trip the 50
 

percentile, they're out of the potential class
 

automatically, so that to some extent addresses that
 

concern about just putting in -- potentially opening
 

up this class for people that had very little or
 

insignificant exposures.
 

And I think the other -­

DR. ZIEMER: Well, but that still is
 

dependent on that bar being at that same level that
 

you talked about earlier. They're still comparing
 

it with the probability of causation of 50 percent
 

at the 99 level 'cause they're using the same -­

MR. GRIFFON: But that's for individual dose
 

reconstructions.
 

DR. ZIEMER: Right.
 

MR. GRIFFON: That's the way they do that,
 

right.
 
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375 

DR. ZIEMER: Right. 

MR. GRIFFON: Right. I'm not sure I 

followed your point on that. But anyway, if -- you 

know, the other reason for arguing for this
 

definition of endangerment that's not tied to -- and
 

I agree with Jim, this is a complicated issue, but
 

the other argument for not tying it to an IREP sort
 

of approach is just -- in addition to what I just
 

said, the hurdle should catch those low ones, but
 

also the secondary thing is that this sort of
 

counter-intuitive nature, especially to the
 

potential claimants, that they couldn't do my dose
 

reconstruction but then they were -- they had enough
 

data to reconstruct the class's dose and we still
 

got booted out, you know. I can see that sort of
 

scenario playing out. And then -- you know, so if
 

you had another sort of criteria for endangered
 

health, you may get to the same end as -- and in
 

fact if your efficiency process works and you have
 

another way of defining endangered health, we may
 

end up at the same end point, but I think it would
 

at least be more understandable to the public and
 

seem less sort of counter-intuitive. I mean I still
 

am concerned about that situation where you're
 

trying to -- you're doing a sort of worst-case dose
 
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for a class when you're -- when we're clearly
 

concerned about the extent to which these site
 

profiles can be built up and -- you know.
 

DR. ZIEMER: Yeah, Roy.
 

DR. DEHART: Endangering to health is almost
 

a fatal error in this document. The definition -­

many physicians would say radiation, per se, is
 

endangering to health if you believe in the linear
 

effects, so I think the definition is a poor choice
 

to begin with. And what we're trying to do is turn
 

a -- I guess a sow's ear into a silk purse with
 

trying to box that in. It's an unfortunate
 

definition to have to deal with.
 

MR. GRIFFON: Yeah, but I wonder if the
 

author is -- intended that language for that very
 

reason.
 

DR. DEHART: Politically, it may have been.
 

DR. ZIEMER: Other comments? Yeah, Larry.
 

MR. ELLIOTT: I think when we, within the
 

staff, dealt with trying to address this issue -­

and you're absolutely right, Dr. DeHart, this is an
 

unfortunate piece of meat that we've been given
 

that's full of gristle to try to chew and swallow,
 

we were looking for a test of reasonableness. 

What's the test of reasonableness here? Endangered
 
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the health. What dose would it take to have
 

resulted in endangered the health? And achieve a
 

balance of parity with those that would not -- that
 

would have to go through dose reconstruction where
 

dose reconstruction could be done, and I think
 

that's how we approached this. So maybe -- I don't
 

know if that helps or hinders your thinking about
 

this or not, but perhaps if you had an alternative
 

suggestion on another option for -- to be considered
 

on how to define endangered the health in this
 

regard and achieve a balance of parity in a test of
 

reasonableness.
 

DR. ZIEMER: Tony?
 

DR. ANDRADE: After going through this
 

proposed rule several times -- and there are several
 

shortcomings and we are starting to deal with most
 

of them, but this is a tricky one. Every time I
 

tripped over this particular one, in my simple mind
 

I felt that because this legislation deals with
 

special circumstances under which somebody might be
 

considered -- again, and not as an appeal, but might
 

be considered again for compensation, given that new
 

information has come to light about a facility -- a
 

facility profile, if you will, whatever that may
 

mean at this particular point in time -- about an
 
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undocumented exposure which one or many people claim
 

to have been subjected to, then my proposal would be
 

to try to tie this definition to this new event that
 

could potentially have caused additional dose to be
 

added to the person's original dose. It's a simpleminded way of looking at things, but it is a way
 

that a special cohort could be formed, logically. 

I'm struggling with this even as I speak, so if the
 

experts can rebut what I said or give reasons why
 

that would not make any sense, I'd appreciate it.
 

DR. ZIEMER: One possibility -- I think Mark
 

has suggested, and let me read the words 'cause
 

maybe this will help us. At the very least, this
 

needs to be explained further within the regulation,
 

and it's because of the counter-intuitive issue -­

MR. GRIFFON: Right.
 

DR. ZIEMER: -- so it may be that we can
 

raise this in the comment and indicate the concern
 

that's reflected in the Board and ask the staff to
 

explain it further within the regulation. Now I
 

don't know what that would mean in terms of how that
 

would play out unless we're at a point where we can
 

suggest what those words might be.
 

MR. GRIFFON: I was just going to -- I was
 

actually going to ask Tony if he could restate -- I
 
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think I understood what you were proposing, but
 

could you restate that? I'm sorry, I just want to
 

follow your...
 

DR. ANDRADE: I'm just saying that processwise, a person may end up with a, quote, incomplete
 

dose reconstruction. However, if new information
 

has come to light with respect to a situation that
 

the person may have been in or that NIOSH has
 

identified with respect to the facility that they
 

worked in, that in itself will result in an
 

additional dose than that that was originally
 

considered in the first dose reconstruction.
 

And maybe it'll take IREP again to calculate
 

what this additional dose is, but it may be that
 

which could be defined as the additional
 

endangerment or whatever this purports to be.
 

DR. ZIEMER: I'm not clear, though, how that
 

helps in the definition here.
 

DR. MELIUS: Actually when I first
 

interpreted what you said, it actually did help me
 

and let me tell you what I thought you said, which
 

is that if you -- if you think about this, it's
 

going to deal with I guess maybe two situations. 

One is the unexpected has been found. Go back to
 

the enrichment plants, the transuranics, we just -­
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nobody thought or not enough people thought or
 

however you want to do that, and you have a surprise
 

and what do you do? And you can't go -- you know,
 

to go back and try to recreate and reconstruct, you
 

can't, so that's one situation this should cover.
 

The second situation this should cover is
 

when there just -- it's an old facility and they
 

just weren't monitoring and -- just 'cause the means
 

weren't available at the time and maybe all the
 

records on sources aren't as good as they would be
 

now and so forth and so on, and therefore we -­

we're just totally befuddled in trying to do a dose
 

reconstruction.
 

When I worry about the current approach that
 

NIOSH uses to endangerment, I worry about the second
 

situation, where there's just very, very little
 

information and that they're just going to be making
 

a wild guess at what -- at what would -- what number
 

you put into that endangerment calculation that
 

they're going to do. I don't think, for the
 

surprise thing where you know it's a big exposure,
 

that it probably matters. But it could be
 

problematic when there's just very little
 

information and no monitoring and no records. And
 

we really are just going to be guessing at that.
 
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381 

The opposite situation we worry about is we
 

don't want to include the trivial or non-exposure in
 

this, so how do we come up with a definition that
 

would exclude that, but not I think rely on what
 

could be an arbitrary guesstimate at what their
 

exposure should be. And maybe there's just enough
 

different situations maybe there would be more than
 

one way of approaching this. I don't know, I -- and
 

we don't have all the examples, but I do think the
 

endangerment is -- the Special Exposure Cohort is
 

the surprise exposure and just the non-existent
 

monitoring and records. And maybe if we distinguish
 

those, it helps. Maybe it doesn't.
 

DR. ZIEMER: Wanda?
 

MS. MUNN: Well, I guess I still come back
 

to the footnote again, and to the original rulemaking where this term, endangered the health of the
 

members of the class, is used just as it's beginning
 

to identify what bases are necessary in order to
 

establish the finding of a special cohort. And it
 

includes a finding of short-term radiation health
 

effects for other members of that class and
 

identification of radioactive materials that they
 

didn't know about before, as Jim was just saying, a
 

description of shortcomings of radiation protection
 
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382 

measures. And all of the things we're talking
 

about, it seems to me, are in the rule. And since
 

this entire law is based only on radiation-induced
 

cancers, then I guess, to me, that -- with that
 

background and what's already here -- I understand
 

that there is some concern there may be other ways
 

of defining endangered the health, but this
 

definition that's given here that NIOSH has
 

developed, in this context, appears appropriate. 

Because what they're saying is there's a reasonable
 

likelihood that this radiation dose may have induced
 

the cancer and under these certain circumstances.
 

I guess if we have better ways of
 

identifying exactly what that means, if it were -­

if it were further unidentified, if these
 

descriptions were not given here below, then I would
 

have the same concerns that everyone else does, but
 

-- what does endangered the health mean -- but the
 

law says we're talking about only radiation-induced
 

cancers and here are very specifics about what that
 

endangerment might have resulted from. Are we
 

beating a dead horse? I mean can we get any -- if
 

we can get any better than this that would give our
 

potential claimants broader consideration, then what
 

is that?
 
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383 

DR. MELIUS: I think we're saying the
 

alternative -- an alternative is, 'cause I think
 

there are probably others, also, is that it would
 

apply to a situation where NIOSH is unable to
 

complete a -- it's not feasible to do a dose
 

reconstruction with sufficient accuracy and the
 

person has worked at least one year in a facility in
 

a area where they were monitored or should have been
 

monitored, and probably would need to flesh that out
 

with some definitions by -- what means by monitored
 

or should have been monitored.
 

MR. GRIFFON: And I mean I keep coming back
 

to this point, but this is a two-pronged test, and
 

sufficient accuracy is the first test. And if I
 

give in on having a more precise definition of
 

sufficient accuracy -- you know, the way NIOSH
 

defines sufficient accuracy right now is they can
 

complete a dose reconstruction and -- you know, an
 

individual dose reconstruction. And we know -- I
 

mean from our review of some of our cases, we know
 

that for these likely low/low situations, to use the
 

NIOSH efficiency process they likely have low
 

exposures to internal and low exposures to external. 

They're going to take those through and give them
 

every possible -- given the data they have -- worst­
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384 

case scenarios, individually test that case against
 

IREP, as they should, and those are going to drop
 

out, the very low, insignificant exposures. The
 

ones that miss -- and that's why I'm focusing on
 

it's a two-pronged test, you know, it's not -- they
 

were just trying to define endangered health in
 

isolation where -- it's a two-pronged test. They
 

have to get over that first hurdle first.
 

DR. ZIEMER: But they're still testing it
 

against IREP.
 

MR. GRIFFON: They're still testing the
 

individual dose reconstruction against IREP. 

Correct.
 

DR. ZIEMER: Right.
 

MR. GRIFFON: As they should, as they do all
 

the time. Correct. But the class against IREP is a 

different question. 

DR. ZIEMER: Right. 

MR. GRIFFON: Right. And then I'm saying -­

you know, so you get rid of these insignificant
 

cases by their own process by that definition of
 

sufficient accuracy -- I would argue by such a broad
 

definition of sufficient accuracy you're able to get
 

rid of those insignificant or lower doses, lower
 

dose cases. They won't be in that class. They
 
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385 

won't make that hurdle. And then since you're -- by
 

not being able to calculate a dose with sufficient
 

accuracy, can't -- I mean complete a dose
 

reconstruction for these folks, I think you have to
 

kind of say if they made that hurdle that far, he's
 

-- we're really -- the data we have left, can we
 

really use that data to kind of do the -- as Jim
 

said, to kind of do this worst-case estimate to
 

compare against that bar for the class in IREP or
 

should we have just another set of criteria similar
 

to the original SEC. And so I think of it as this
 

two-pronged test.
 

And I would also have problems if I thought
 

that a lot of the -- I mean I don't think it's
 

equitable if a lot of the -- just because you can't
 

reconstruct the doses but they likely had very
 

insignificant exposures and they make it into this
 

class, that's not equitable. That's not what we're
 

looking for here. But I think we're -- the NIOSH
 

efficiency process and that definition of sufficient
 

accuracy protects against that. I think Jim Neton
 

said that to me either on the record or on the side
 

here earlier, so that's how I'm trying to grapple
 

with this.
 

DR. MELIUS: If I can just add, I think with
 
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386 

the current approach they're using or proposing to
 

use, that I take comfort in the fact that we're
 

going to, as a committee, be reviewing those. Those
 

will be part of the petitions that come to us. I
 

worry about how we're going to make that assessment,
 

evaluate the decisions that they've made because I
 

-- again, we don't have much information and they're
 

making a guesstimate of some sort in order to fit it
 

into this -- to these IREP calculations that they're
 

proposing, and how are we going to assess whether
 

those are appropriate to do or how do we evaluate
 

those? And I think we're going to be hard-pressed
 

-- and particularly to keep them consistent from
 

situation to situation so that we're treating
 

everyone who would fall into a Special Exposure
 

Cohort, or potentially would, in a fair manner, that
 

we're making the same assessment for a cohort at
 

Hanford that we would at one at Oak Ridge or
 

wherever. And where we'll be dealing with some
 

very, very different situations. Your laboratory
 

example we talked about this morning as compared to
 

a production facility and so forth. Where
 

admittedly we don't have enough information to do a
 

very good sort of quantitative evaluation of that
 

risk.
 
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387 

DR. ZIEMER: I don't know what the process
 

was on the original cohorts. I wasn't involved. 

But someone made a determination that there had to
 

be a certain length of time and perhaps there had to
 

be some -- there had to be some indication that
 

there were certain types of materials around, even
 

if it wasn't -- people weren't monitored. So there
 

must have been at least a kind of group estimate as
 

to what potential doses might have been, like the
 

screening process, that says it's very conceivable
 

somebody could have been there and gotten more than
 

a few millirem -- pick the number. I don't know
 

where -- somebody must -- in the thinking process,
 

somebody must have had a bar that says they could
 

easily have been up here somewhere. I don't know
 

what the process was. But I mean where did these
 

times come from? They can't be completely
 

arbitrary. I mean how would they -- well, maybe
 

they are. Congress did all this without any
 

scientific input. All right.
 

No, I mean rationally speaking, there's
 

still -- whether you explicitly say that there's
 

some test, dose test or you do it more indirectly
 

and say okay, even intuitively -- I mean I think I
 

could intuitively take a number of -- say if
 
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388 

somebody's working with these things for a year and
 

we weren't monitoring them, I can guess that there
 

could have been situations where they got pretty
 

high doses. I don't know how -- does anybody know
 

how that was done and -- okay, please.
 

MR. MILLER: Richard Miller. I will only
 

offer you this much, that this was an administration
 

proposal when it came forward as the one year, but
 

it had been based on discussions with the Justice
 

Department about the RECA model which uses a working
 

level month criteria for compensability. And so
 

what they did was -- and they looked at the RECA
 

amendments that were done in 2000, in fact, which
 

had been passed as part of what was then S-1515, and
 

in that legislation you will see actually
 

foreshortened periods of time compared to the old
 

RECA, so they -- the one year threshold was sort of
 

-- the whole concept of using a time period, Dr.
 

Ziemer, was derived from the RECA model of
 

compensability. They used time or duration in the
 

mines or in the mills or in the shipping and
 

transfer operations as the criteria.
 

DR. ZIEMER: All right. But see, in
 

general, that implies -- in the radon case it's a
 

concentration times the time and you get a -- an
 
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389 

intake value, but indirectly, somebody is measuring
 

that against some standard. But I'm at a loss as to
 

where we really go with this. It's -- whether we
 

specify it in terms of time or other parameters, we
 

are either directly or intuitively saying that
 

there's some point at which there's an endangerment. 

And maybe my endangerment level is different than
 

somebody else's, but it's somewhere there.
 

And we're sort of -- we sort of end up, I
 

think, saying it's the way NIOSH has done it, is
 

that a reasonable -- is that one reasonable way to
 

do it or is that completely unreasonable?
 

MS. MUNN: No, it's reasonable.
 

DR. ZIEMER: Obviously there's other ways to
 

do it. Is there a better way? Is there -- or is
 

the issue simply one -- but yeah, people don't quite
 

understand this, or does it make sense intuitively,
 

and I'm trying to grapple a little bit with -- I
 

think, in principle, you end up doing the same
 

thing. Wherever is you do it and draw some lines,
 

you're doing sort of the same thing. So how do we
 

do it in a way that is reasonable and also does not
 

seem, for those out there, to be black magic.
 

DR. MELIUS: To reiterate the concerns on
 

this one, to both, one is that it -- the current
 
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390 

proposal is, one, it's counter-intuitive. Okay? 

Which I think poses problems with people viewing it
 

from the outside, a claimant, a group of claimants.
 

Secondly is that I think it is quite arbitrary in
 

terms of how the dose will be selected, and that
 

also is going to cause problems -- again, from your
 

-- someone applying for this program or evaluating
 

this program or for us reviewing these decisions -­

as to how it is being applied. I think the
 

advantage of a time frame, albeit an arbitrary one,
 

is that it's understandable, it's transparent, and
 

it can be applied and we're -- you know.
 

DR. ZIEMER: Yeah. I was going to say that
 

certainly the counter-intuitive issue -- I certainly
 

agree with that. The other, I think, is as much
 

arbitrary -- I mean whatever time interval you
 

choose obviously is as arbitrary as any other, so -­

so in any -- it sort of gets down to what is a
 

reasonable way to approach it.
 

DR. MELIUS: Just one quick thing is that
 

the 250 days has the advantage of being consistent
 

with what's already being in the law. That's -­

DR. DEHART: My question dealt more or less
 

with consistency, as well. Is this the first time
 

in a rule that this has been defined this way? This
 
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391 

is the proposed rule, so if there is to be a change,
 

this is where it would have to be since it doesn't
 

-- it isn't preceded by another...
 

MR. ELLIOTT: I'd consider that if you
 

establish 250 days as the requirement, that might go
 

counter, in some instances where the class may not
 

have spent 250 days, or you may need more than 250
 

days to reach whatever criteria you use for
 

endangerment of health, so that's why we stayed away
 

from that. And in fact, we felt that it was
 

appropriate to say that -- and here I would like to
 

speak to -- comment about the arbitrary nature of
 

what you were talking about, Dr. Melius. I think
 

once you -- what we have not done clearly, in my
 

mind, is articulate clear and well enough what we
 

see happening here, and that is that the class
 

definition that we bring forward for the Board's
 

review would establish what the class -- the time
 

frame that would be appropriate, in our mind, that
 

would support the test for endangerment of health
 

and is appropriate for the given situation that the
 

class experienced. And I think you would see all of
 

that laid out. We don't -- we should perhaps
 

prepare a mock-up example of a class definition. I
 

don't know if that would help or not.
 
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392 

And I think there's also a hang-up here -- I
 

think Jim tried to speak to this earlier this
 

morning, Jim Neton, about if the counterintuitiveness here is based upon we can't do a dose
 

reconstruction but we can put a dose in and
 

determine whether or not health was endangered,
 

you've got to come at that just the opposite way. 

You've got to come in from IREP and say okay, what
 

is the most -- worst case likely scenario here this
 

class experienced, which is the radionuclide most of
 

concern, and what's the most likely answer that
 

would result from that -- from an exposure to that? 

And so you don't plug in a dose number, you plug in
 

the demographics of the class as it's defined into
 

IREP and you see what the 50 percent at the 99th
 

percent probability -- credibility limit dose is,
 

and then that's the test of reasonableness that
 

we've been talking about.
 

If that, on the face of it, looks
 

reasonable, we're going to come forward and say we
 

recommend that this class be added. But if it's not
 

reasonable, we're going to say that, as well. So
 

maybe that's where we've lost you all, or maybe
 

where we're not understanding what you're talking
 

about, or maybe passing by each other.
 
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393 

DR. ZIEMER: Okay, Jim.
 

DR. MELIUS: Yeah, just back to one comment. 

In trying to think through this -- and again, we
 

don't know all the potential situations involved,
 

but I don't think that there would be very many
 

where there would be exposure less than 250 days -­

a situation where you wouldn't be able to do the
 

dose reconstruction in a way that -- have enough
 

information to do that that would still pass this
 

test, as you develop it. But I'm guessing, too, on
 

that. We just don't know. So I think -- I'm not
 

real worried about the false negatives in that
 

group, but it could occur with this situation.
 

I also don't want to be -- repeat my soap
 

box speech too many times, but I think this does go
 

back to this issue which I'm going to talk about
 

some more if I'm not satisfied with how we resolve
 

this, is this whole issue of defining when we can -­

how we're going to do these dose reconstructions,
 

when we cannot do them, how it applies in different
 

situations. And I suspect if we spent some time
 

working on that issue and then came back and we're
 

talking about this regulation and this situation, I
 

think a lot of it would be easier to -- discussion
 

would be easier for all of us. But we are dealing
 
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394 

in a vacuum and -- to a large extent 'cause we
 

haven't really -- at least I haven't -- don't see
 

the criteria there for when you will and when you
 

will not be able to do dose reconstructions. I
 

think you're starting to get away from case by case
 

in terms of the presentation, but it's still, to me,
 

very arbitrary. And I think it makes this
 

discussion that much more difficult, also.
 

DR. ZIEMER: Any more comments?
 

UNIDENTIFIED: Why don't we take a break?
 

MR. GRIFFON: That's a good comment.
 

DR. ZIEMER: It's 3:15. Let's take a 15­

minute break and we'll reconvene.
 

MR. ELLIOTT: I remind you all I need your
 

preparation time.
 

(Whereupon, a recess was taken.)
 

DR. ZIEMER: In order to think about
 

reaching some level of closure today, one of the
 

ideas that has arisen during the break is to perhaps
 

do two things. One is, on this issue of clarifying
 

the definition on health endangerment would be to
 

have the document that we send to the Secretary
 

indicate that at least some of the Board members are
 

concerned about NIOSH's definition. The other
 

option would be to endorse the definition and vote
 
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395 

it up or down as far as the Board is concerned. My
 

personal feeling is that it would be useful to at
 

least have our document reflect the concern of those
 

members -- and it could be a majority, actually -­

but reflect both of those views by indicating, for
 

example, that the definition that's being used in
 

the document is of concern to some of the Board
 

members. That doesn't address the issue of exactly
 

what a better definition would be, unless we were to
 

come up with something, or those who have expressed
 

the concerns would come up with some alternatives.
 

And then the other issue, and Jim indicated
 

just before the break that he was still somewhat
 

concerned about how the guidelines are defined for
 

the issue of determination of special exposure -- or
 

determination of when you can't do a dose
 

reconstruction. And I think has a potential way of
 

addressing that, also, in the document that might be
 

satisfactory to all concerned.
 

Jim, why don't you suggest that one first
 

and then we'll back up to the other one.
 

DR. MELIUS: Okay. What if the Board makes
 

a recommendation that NIOSH develop a set of
 

guidelines for how they will be making the
 

determination as to when a dose reconstruction
 
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396 

cannot be adequate -- completed with sufficient
 

accuracy, et cetera, the verbiage that's in the
 

regulation and so forth, and do that -- that would
 

be presented to the Board for review. So it would
 

not be part of the change in the regulation, per se,
 

but it would be something that would come back to us
 

as a Board to review so we would better understand,
 

provide better guidance on how they do that. So
 

similar to how we've done with the dose
 

reconstruction. We have a framework that's in the
 

regulations, and then we have a -- some
 

implementation documents that we have reviewed at
 

various points. Same with the IREP.
 

DR. ZIEMER: And so in the document itself,
 

are you suggesting that in the preamble where these
 

sort of broad guidelines are given that there simply
 

be some words that suggest that the staff would
 

develop operational guidelines for use, and they
 

wouldn't be part of the rule.
 

DR. MELIUS: They would then pin -- we ask
 

them -- I think we formally ask for that in our
 

recommendations and that they come back to the Board
 

for review.
 

DR. ZIEMER: And there could be a sentence
 

inserted here saying that such guidelines would
 
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397 

exist, and I would simply ask Jim to construct a few
 

sentences which we would insert in that section.
 

Okay. Now back to the other issue, the
 

definition of endangerment of health, Jim, what is
 

your feeling on having a statement in the -- I ask
 

Jim and maybe Mark 'cause I think the two of you
 

have this concern. What about having a statement in
 

the document -- it might actually be in the cover
 

letter, or it could be associated with the
 

definition where -- that footnote definition, to
 

indicate at least some of the Board members are
 

concerned with that operating definition. I don't
 

know what we would do with that at that point, other
 

than -­

DR. MELIUS: Well, I think if we had a
 

statement that a number of Board members or some
 

Board members -- I can talk about the wording -­

have concerns about this definition and this
 

approach that's being proposed by NIOSH and suggest
 

that NIOSH -- and carefully review this approach and
 

consider alternative approaches, and I think we've
 

talked about one approach -- such approach.
 

DR. ZIEMER: I just bounce that off the
 

group. We were trying during the break to see
 

whether we could find a kind of -- I don't know if I
 
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398 

want to call it middle ground, so much as a way to
 

comment and raise the issues, particularly -­

including those which are of concern to maybe not
 

the full group, but at least some members of the
 

group. How do the others feel about that approach. 

Roy? 

DR. DEHART: I agree with both points, but I 

would also add that there needs to be a sentence or
 

two -- some kind of explanation of why there was
 

concern on the definition.
 

DR. ZIEMER: Right, and you could even
 

reference the definitions used in the other
 

legislation or the statutes, yeah. And again, Jim,
 

would you be willing to draft a few lines that we
 

could insert there and -- yeah.
 

DR. MELIUS: Yeah, I'll draft Mark to pull
 

something off his computer. I think he's written
 

some of this.
 

DR. ZIEMER: Now let me ask the group
 

overall -- and again, we're not voting today, but I
 

wanted to see if we've -- have we covered -- with
 

those two methods of handling those two issues and
 

the other ones, have we covered everything that we
 

would need to address in this document?
 

DR. MELIUS: Can I ask one question of -­
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399 

DR. ZIEMER: Sure.
 

DR. MELIUS: -- Larry and -- when people
 

write in to DOE requesting records -- I'm thinking
 

in terms of the class petitions, and you have a
 

requirement that people have one of two items, a
 

letter from DOE saying those records do not exist,
 

or a report from a health physicist or dose
 

reconstructionist, I'm concerned that the burden of
 

doing the second one is a lot for people to do. If
 

they want to do it, fine. I think -- and you have
 

it as an "or". I'm worried that -- I'd like to be
 

reassured that the DOE does respond when they don't
 

-- can't find the records and say they don't have
 

this. My personal experience with FOI's is when you
 

put them into an Agency and they don't find the
 

records, you never hear from them 'cause they don't
 

find them. And those are the most frustrating ones
 

to pin them down. And I don't want people having to
 

chase after a letter saying there aren't any
 

records. It's Wanda's proving the negative.
 

MR. GRIFFON: And you're asking the
 

petitioner to do that.
 

DR. MELIUS: Yeah, and in the petition
 

you're asking them to do that. If they do it
 

routinely, where we can assure that they routinely
 
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400 

-- fine, I'm not worried about it.
 

MR. ELLIOTT: I can't speak for DOE, but I
 

can speak about our experience in listening to
 

claimants and in public meetings, and it runs all
 

over the board. It runs over the board from -- I
 

got my information back, I didn't like what I got
 

and I asked for more; I got it back, I liked it -­

to I haven't heard a word. And it seems to me that
 

it varies from site to site, for individual to
 

individual. But I would also add this in my
 

response to you, that our intent in putting that
 

there was not to force -- I don't believe, and Ted
 

can correct me if I'm wrong 'cause I wasn't privy to
 

all of the discussions among staff in crafting this
 

language -- was not to force an individual claimant
 

to do one or the other or either. But if they had
 

it, it certainly added credence to their petition.
 

MR. GRIFFON: That's not the way it's
 

worded.
 

MR. KATZ: No. I mean it's a requirement,
 

one or the other. Let me just clarify, the dose
 

reconstructionist report or whatever -- I mean we
 

especially had in mind, why that's there as an "or",
 

is not for someone to go out -- and we didn't think
 

-- we didn't imagine that happening, someone going
 
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401 

out and hiring themself (sic) someone to review DOE
 

records, but really to address the situation -- some
 

of this sort of work has been done already and
 

someone could just grab, at hand, something off the
 

shelf to make their case. And then -- I mean -- and
 

you probably want to recall, too, you made a
 

suggestion for something in addition to this, which
 

is if there have been studies elsewhere, published
 

studies, whatever, that address this lack of records
 

for certain cohorts of workers or so on. That
 

should be a third alternative. That's not in there
 

right now so you probably want to comment on that,
 

as well.
 

DR. MELIUS: But I guess my concern is that
 

you've made it a -- the "or" is a requirement. Is
 

required either to have the health physicist's
 

report or -- we add a third one, or this outside
 

report, or a response from DOE saying the records
 

don't exist. And if they're unable to get that
 

response, they can't apply.
 

MR. KATZ: Right. And the assumption we
 

made is that DOE would have to respond to them when
 

they make the request. And another assumption we
 

made is that in cases where a petitioner is having
 

no luck getting a response, we'd hear about it and
 
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402 

then we could help them -- put pressure on DOE to
 

respond to their inquiry. 'Cause I mean most
 

government agencies I thought are bound under Foyle*
 

to respond, but -- so that's sort of a revelation to
 

me that they actually can ignore a Foyle request
 

'cause that's legally binding, I thought.
 

DR. MELIUS: I would then -- personally, I
 

guess I would suggest for that one that they have
 

documentation that they've made a good-faith effort
 

to obtain records and were unable to should suffice,
 

rather than having them have to wait six months to
 

get DOE -- I mean I don't argue with the need for
 

them to have tried to get records if they do exist
 

and not just to flood you with petitions for things,
 

but they ought to -- you know, if they can give you
 

the letter they sent and didn't get a response in 60
 

days or whatever.
 

MR. KATZ: Right, and let me -- Richard just
 

reminded me that in the case of the AWE's you're not
 

-- there's no government -- there's no government to
 

be, but -- so that's a case aside, as well.
 

DR. MELIUS: I think we can take care of
 

that specific language. I just want to -­

DR. ZIEMER: Roy?
 

DR. DEHART: I haven't heard that we did
 
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403 

anything regarding the storage of records. We were
 

going to comment on it, I thought, perhaps in the
 

letter. Didn't we decide to do that with regard to
 

the letter that was to be written on the MOU? The
 

issue of record storage.
 

DR. ZIEMER: Actually when we did the MOU
 

resolution, we hadn't talked about the record
 

storage. The record storage came up today. I think
 

that -- I think I heard that the -- Larry was
 

talking about reissuing the reminder, but -- or -­

MR. ELLIOTT: Well, it's not my job to
 

reissue the reminder; it's DOE's. And I would
 

encourage you in your letter about the MOU to speak
 

to this. The storage of records, the archival of
 

records, retention of records, the moratorium and
 

resubmitting -- re-notifying across the complex that
 

there is a moratorium and these records have
 

importance -- maybe this is the leverage you really
 

should apply is not only importance for
 

epidemiologic research, but importance for
 

compensation.
 

MS. MUNN: Yeah, that's easy.
 

MS. GADOLA: Can I just address that simply?
 

DR. ZIEMER: Yes.
 

MS. GADOLA: To reiterate the importance of
 
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404 

what Larry just said and of the Board addressing
 

that issue is from hearing what I've been hearing
 

from people who have been trying to obtain records
 

in Oak Ridge. Some of the problems they have
 

encountered is that due to the storage of different
 

contractors, records are stored in different ways. 

Some were stored under people's last names, some
 

were stored under years. Some of them they have no
 

-- not been able to locate, but they know they must
 

be there someplace. They have also found folders
 

that have pages of medical records that have never
 

been put in files because they said well, the files
 

are here somewhere but we can't find them or we
 

don't have time to find them. Some of them they
 

discovered were put in with the personnel file in a
 

different file. Like the medical file is in with
 

about three other files that pertain to personnel
 

records, then -- and other ones are in a separate
 

box that has just medical records in it. So I
 

think the more that you emphasize the importance of
 

this, the better record-keeping we're going to have
 

and people are going to get reminded. And it has
 

changed hands because there are some people that do
 

know the rules, some people that are professionals. 

As Bob knows, you encounter some people that
 
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405 

understand the whole process very well, and then you
 

get others that don't have a clue.
 

DR. ZIEMER: Thank you. I think actually
 

the memo to the Secretary will probably have to be
 

limited to asking DOE to re-issue or to remind
 

people about the storage issue. This is a whole
 

additional thing on how DOE keeps its records or -­

MR. PRESLEY: Right now this will be a great
 

thing, too -- Bob Presley -- because DOE is in a
 

process of trying to either upgrade or redo what
 

they do with a lot of their records. They're right
 

now in the process of redoing this, so it would be
 

wonderful to get something out on this. This is the
 

time to do it.
 

DR. ZIEMER: Is there a particular past memo
 

that could be referenced to the Secretary that
 

covers that, and then we can reference that and say
 

the information that -- previously issued in
 

memorandum such-and-so should be reissued? Okay,
 

thank you. Staff will run that down.
 

DR. MELIUS: One other issue I think we
 

talked about before. I just wanted to make sure
 

everyone agrees it should be in our comments. That
 

was from Mark's set of comments and it was number
 

two, clarify the issue regarding SEC class applying
 
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406 

for non-SEC-listed cancers. I think what we were
 

going to recommend and NIOSH said they were going to
 

do was that they were going to work out procedures
 

for dealing with these different situations. And
 

then our recommendation for these -- for these set
 

of regulations is that NIOSH review those and make
 

sure that the current regulations would not preclude
 

any approaches that might be used to deal with these
 

situations. I think that's just sort of a technical
 

legal wording issue. I don't know of any verbiage
 

right now that might be a problem, but there -- I
 

haven't looked at it from that point of view, but I
 

think we ought to make sure that gets captured. And
 

I don't think there's any objection to that.
 

DR. ZIEMER: What -- can you -- just so I
 

have it in my record here, what section are we
 

talking about? Is it on the regulation on the -- or
 

the definition of the class and the listing of
 

the -­

DR. MELIUS: I think so, I just -- I don't
 

want to pick on Ted, but I get worried if he
 

misinterpreted or mis-spoke or got misquoted on it
 

that -- was thinking of something and I'm just -­

just want to make sure we're not -- I just hate to
 

have to reopen the reg. just to deal with some minor
 
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407 

thing.
 

DR. ZIEMER: I think it would be the section
 

that says the individual -- if they're determined to
 

be part of an SEC class defined -- let me see. It's
 

the issue of the non-SEC-listed cancers, is it not?
 

DR. MELIUS: Yeah. 

DR. ZIEMER: And I'm looking for where that 

appears. 

MS. MUNN: Well, the specified ones are
 

listed in 83 -- is that -­

DR. ZIEMER: Specified cancers, those
 

specified cancers I guess is what we're talking
 

about.
 

UNIDENTIFIED: Is it 83.11?
 

DR. ZIEMER: Section 83.11?
 

MR. KATZ: Can I make a suggestion? I think
 

you're not going to find -- I mean I'm not sure what
 

part of the rule we need to look at hard to make
 

certain this concern is addressed. I think that's a
 

real concern that Jim raised, and I think if you -­

if it's enough that the Board specifies that -­

their concern that classes of employees can be
 

defined in such a was as not to preclude that sort
 

of scenario, I think that'll handle it, and then we
 

-- I mean it's going to take some serious looking to
 
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408 

see what, in the construction of this rule right
 

now, might get in the way. But I don't think you're
 

going to solve it quickly, flipping through the
 

rule.
 

DR. ZIEMER: So this will be a general
 

comment, not referenced to a particular section
 

right now. Thank you.
 

Anything else?
 

(No responses.)
 

DR. ZIEMER: Now since all of this has been
 

developed in the public meeting, can we then
 

distribute the text to everyone and the web site
 

prior to having a conference call? This no longer
 

has to go through the working group, I believe would
 

be -- okay.
 

So what I will do is collate all this with
 

the additional verbiage that is provided and we'll
 

get this distributed to everyone in preparation for
 

a conference call, the time of which we will need to
 

designate yet today. Is that agreeable?
 

Let's look right now at calendars, if we
 

could, for that.
 

MR. ELLIOTT: And while you're looking for
 

your calendars and your time, let me explain what
 

will have to happen here. We'll have to announce in
 
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409 

the Federal Register that the Board will convene a
 

conference call to deliberate and vote upon the
 

language to present your comments on this notice of
 

proposed rule-making. And we need to know today
 

which day you want to have your conference call
 

'cause we're going to have to announce that early
 

next week in order for it to be out there in time. 

And as we did the last -- the conference call back I
 

think in February, we will allow the public an
 

opportunity during that -- to listen in on that
 

conference that you have and provide any comment at
 

that point. Anything else, Cori, that I need to
 

share with them on this? I think we -- we have to
 

-- there are some things we have to put in place,
 

like Federal Register notice. We'll get everybody
 

lined up on a call-in number and get that out to
 

you. But this should be the only real business you
 

should take care of that particular day.
 

DR. DEHART: What's the earliest date, do
 

you think, from your perspective?
 

MS. HOMER: From my perspective? When does
 

this have to be placed by?
 

DR. ZIEMER: We need to have it by the 26th
 

of August, and that's very -- probably very close to
 

the earliest date that they can -- there's not a
 
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410 

whole lot of time. Today is -­

MS. HOMER: Okay. Let's see if we can go 

for the 21st -­

DR. ZIEMER: As the earliest.
 

MS. HOMER: -- or the 22nd as the absolute
 

earliest.
 

DR. ZIEMER: Okay, let's just check timing,
 

'cause we need to also get stuff out to people for
 

them to look at. How's the 26th itself, Monday the
 

26th?
 

DR. DEHART: Can you get that turned around
 

to get it submitted then?
 

MS. MUNN: I don't think you can do that in
 

a day.
 

MS. HOMER: Yeah, is it possible to submit
 

it within a day?
 

DR. ZIEMER: If we agree on the telephone
 

call -- who has to have it that day?
 

MR. ELLIOTT: It has to be postmarked that
 

day. Postmark it to the Secretary and a copy that
 

goes to the regulatory docket.
 

DR. ZIEMER: Okay, so we're better if we
 

back it up a little bit, in case there's some
 

changes.
 

MS. HOMER: What about the 23rd?
 
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411 

DR. ZIEMER: 23rd, Friday the 23rd -- bad? 

How many -- for whom is the 23rd not feasible? Not?
 

DR. MELIUS: Not. That's -­

DR. ZIEMER: Not. 

DR. MELIUS: -- good for me. 

MR. GRIFFON: Not so good.
 

DR. ZIEMER: Not so good.
 

MR. GRIFFON: The 22nd is better, but I can
 

do it if I have to.
 

DR. ZIEMER: 22nd? Is the 22nd okay?
 

MR. ESPINOSA: What time frame?
 

DR. ZIEMER: Well, in terms of New Mexico
 

time -- we won't do it at 7:00 in the morning New
 

York time.
 

DR. ZIEMER: Late morning? East coast time,
 

late morning?
 

MS. HOMER: Late morning, early afternoon?
 

MR. PRESLEY: Early afternoon would be
 

better for me.
 

DR. ZIEMER: Early afternoon? How is say
 

1:00 p.m. eastern daylight time?
 

MR. PRESLEY: On the 22nd. Right?
 

MR. ELLIOTT: About a week from today.
 

DR. ZIEMER: Is that enough time, Cori, one
 

week?
 
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412 

MS. HOMER: Yes, that'll be enough time.
 

DR. ZIEMER: Can we get a recorder?
 

MS. HOMER: Ray? 

THE COURT REPORTER: A week from today? 

MS. HOMER: Yeah. 

THE COURT REPORTER: Have this ready? 

MS. HOMER: I'm sure we can get a reporter.
 

DR. ZIEMER: No, we don't need that ready.
 

MR. ELLIOTT: No, no, you don't -­

The conference call, can you attend the
 

conference call.
 

THE COURT REPORTER: Oh, a week from today?
 

MS. HOMER: Marie, how's your schedule?
 

MS. MURRAY: Oh, you want me on it, too?
 

MS. HOMER: Uh-huh.
 

MS. MURRAY: Hold on.
 

MS. HOMER: 1:00 p.m., how long do you
 

expect the call -­

DR. ZIEMER: One hour.
 

MS. HOMER: Just one hour?
 

DR. MELIUS: 1:00 p.m. eastern?
 

DR. ZIEMER: Is that okay for recorders?
 

THE COURT REPORTER: Yes -- well, she's
 

checking. It is for me.
 

MS. MURRAY: Thursday's good. The 23rd's
 
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413 

not good. Well done, y'all.
 

DR. ZIEMER: So ordered. Open your e-mail
 

just before the call. No, no, we'll try to get it
 

out early in the week.
 

MR. ELLIOTT: We'll send an e-mail. We'll
 

send it via e-mail and we'll also put it on the web
 

site, and if anybody's in travel status or needs us
 

to get it to them by Fed Ex or a hard copy somehow,
 

we'll do our very best to accomplish that.
 

MS. HOMER: If you know where you're going
 

to be ahead of time, I'm sure we can Fed Ex it to
 

you. 

DR. MELIUS: Can I ask one other -­

DR. ZIEMER: You bet. 

DR. MELIUS: -- quick procedural question. 

And this is something I don't understand at all, so
 

hopefully somebody does.
 

We're talking about a number of changes to
 

this document, and you're going to be developing a
 

number of other guidance documents. You're going to
 

be dealing with the issue of how to deal with the
 

non-SEC cancers and so forth. Is there advantage to
 

having this as a -- rather than as a final rule, as
 

an interim final rule? Does that give you more
 

flexibility in terms of being able to adopt some
 
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414 

other changes and sort of notify people that you're
 

going to be working on this -- 'cause there are some
 

things that aren't worked out here yet and...
 

MR. ELLIOTT: Go ahead, Ted, if you want to
 

answer that.
 

MR. KATZ: Let me just explain what an
 

interim final rule, issuing that would do. That
 

would mean that you could operate and you could deal
 

with petitions, but that at some point in the future
 

you can produce then a final rule that changes
 

things. Now I think you're still required -- if you
 

change things substantially beyond what the public
 

has had an opportunity to have input on, you would
 

have to actually issue another interim final rule
 

because you have to give the public opportunity. 

But -- so what it would -- the difference is, I
 

guess, if we issue a final rule now and we want to
 

change things, what we would have to issue later is
 

a notice of proposed rule-making again and then go
 

to a final rule. And the problem with that is the
 

notice of proposed rule-making is not effective law. 

But I guess it'd be a -- you'd still be operating
 

under your existing final rule while you were doing
 

that, so you'd be changing an existing rule. So I
 

-- I'm not entirely certain, you know, what the
 
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415 

difference would be, but certainly it would allow
 

you to make changes in the future. Whether you'd
 

have to issue another interim final rule or not
 

would depend on what those changes were.
 

DR. MELIUS: But it just seems to me we're
 

wrestling with a number of issues that we as -­

being NIOSH, the Board here -- trying to determine
 

this endangerment issue, how we'll make
 

determinations in terms of there not being enough
 

information, the issue of how do you do the non-SEC
 

cancers and how we fit them into rule-making. And
 

if there are advantages to doing it that way -- and
 

plus at the same time we'll be gaining -- NIOSH will
 

be gaining experience, we'll be gaining experience
 

reviewing some of these situations. I think -- I
 

can certainly see better information, more
 

information coming from NIOSH as you're starting to
 

review more petitions and recognizing different
 

situations. Ted and I were talking at the break
 

about acute exposures and which is the best way of
 

handling them under -- in terms of looking at
 

endangerment and I just think -- if there are
 

advantages like that, I think it may be something
 

that ought to be considered. Maybe we ought to
 

recommend that it be considered as a way. And it
 
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416 

would also allow things to -- claims to be
 

processed. At the same time it would sort of notify
 

people that look, we're still looking at this and
 

aren't -- you know, may make some changes down the
 

road and are still considering changes to improve
 

this process.
 

DR. ZIEMER: Any comments or reactions? 

It's -- Mark?
 

MR. GRIFFON: Yeah, I think that would also
 

be -- I mean just the case history alone I think
 

would be helpful to all the Board. You know, we're
 

playing a lot of what-if games with different
 

scenarios and how they're going to play out. I
 

think it'd be useful for NIOSH, too, to see how this
 

definition of endangerment is going to play out and
 

how -- versus the sufficient accuracy side of
 

things. So I would think that would be helpful to
 

have it as a interim.
 

DR. ZIEMER: Wanda?
 

MS. MUNN: I don't know how I got on this
 

see-saw with Jim and Mark on the other end. But
 

aren't we in real danger of running up against time
 

and energy limitations of both the staff and this
 

Board every time we say oh, good, let's have another
 

rule-making? Aren't we really creating some
 
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417 

potentially unsurmountable problems because of our
 

concern over one or two issues that we would like to
 

have very clearly delineated that possibly may never
 

be delineated? I understand the rationale behind
 

wouldn't it be nice if we could make this an
 

interim, but I also foresee an enormous amount of
 

time and public hearings and all that being done
 

repeatedly, at great cost of both time and effort of
 

everyone concerned. I don't want to shortchange
 

anybody, but I have some real hesitation of saying
 

oh, yeah, let's just make -- let's make this the inbetween time and we'll think of a lot of good things
 

in the meantime and have another rule-making. It
 

seems like we're stretching ourselves and staff when
 

we start thinking of not doing this in as crisp a
 

manner as we can now. I know we're time-constrained
 

now, but I can't imagine we'd be less so later.
 

DR. MELIUS: I guess I would -- if I
 

understood the explanation why, it's to the
 

contrary. This allows some changes to be made,
 

certain types of changes, without having to repeat
 

the whole rule-making process, so it should, if
 

anything, save time and effort on the part of the
 

staff and everyone else involved in looking at this,
 

that there could be adjustments of this rule -­
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418 

would allow the work to go forward, which we all
 

want. We want this to go forward. At the same time
 

it would allow some adjustments without necessarily
 

requiring a full rule-making again. Now if they're
 

going to make major adjustments, yes, that requires
 

a full rule-making. But if they're going to make
 

non-major adjustments -- which I think they may very
 

well do -­

MS. MUNN: Define non-major.
 

DR. MELIUS: Yeah, I know. It's sort of
 

like a negative, you know, proving the negative.
 

DR. ZIEMER: I wonder if we could ask Ted,
 

how difficult is it to make minor adjustments in a
 

final rule, as compared -- what is the real
 

advantage of an interim final rule, other than the
 

nomenclature is -­

MR. KATZ: Well, the final rule -- I mean I
 

suppose it's not that hard if it's just a most minor
 

technical adjustment, you can issue that pretty
 

readily. But really otherwise, a final rule, you
 

can't make changes without giving public notice and
 

going through rule-making again. So again -- and I
 

can't -- sorry about this negative bit thing here,
 

but I can't tell you what the bright line is for
 

what is substantial changes to the rule that the
 
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419 

public would not have been able to foresee, but I
 

think there's language along those lines, really,
 

that the public has to be able to sort of foresee
 

how the changes arose out of what they were privy
 

to, so -- that would trip it otherwise. So if you
 

don't trip that line, then you can go from an
 

interim final rule to a final rule that has changes
 

in it, but they're just foreseeable changes, I think
 

-- changes that arose out of what the public had to
 

consider and the Agency had to consider previously.
 

DR. ZIEMER: It sounds like either way if
 

the changes are substantial, then you still go
 

through a much more extensive process. If the
 

changes are not substantial, you don't have much
 

process either way. So how does it differ?
 

DR. MELIUS: The advantage is -- I think the
 

advantages -- I mean the technical change to the
 

final rule are really minor things. You change the
 

name of the Agency, and even sometimes that's gone
 

to announced rule-making, but I think it's little
 

technical things like that, or the decimal point
 

missing or whatever -- you know, something like
 

that. What we're talking, if there's adjustments to
 

the rule that have been part of the public comment
 

and have just taken some more experience to be able
 
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420 

to decide which is the best way to go and then you
 

don't have to go through another process. So it has
 

advantages for -- I hate to use this -- moderate
 

changes as opposed to really minor.
 

MR. ELLIOTT: Well, I'm coming at this from
 

a perspective of having to talk to the Secretary's
 

office about this, and I know there's a considerable
 

interest in the Office of the Secretary to put this
 

in place to address the concerns of people across
 

the weapons complex about wanting to petition. I
 

would suggest to you that -- I don't know, I'm not
 

saying this is what the Secretary would do, but I
 

think the Secretary has some very conservative
 

counsel that would speak in his ear and say until
 

there is a final rule, you should not make a final
 

decision on a petition. So if you're operating
 

under an interim final rule and we need to be
 

careful and cautious here about adding a class that
 

we may wish we hadn't have added or it may not have
 

been -- we have to go back and revisit that each
 

time for everything that was -- every petition that
 

came forward under the interim final and we took
 

action upon.
 

I think that you have addressed this issue
 

by making the recommendation about operational
 
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421 

guidelines. I think that's where -- I'm enthused by
 

that. I think that's the appropriate place to
 

handle these different changes that come forward. 

Those things -- those are the operational guidelines
 

that you would see, you'd react to, you'd work with
 

us on, and that's where we can -- I think we can
 

gain some ground. But if you go forward, you want
 

to go forward, that's certainly your prerogative as
 

a Board to go forward with a recommendation. But I
 

would just ask you to consider what you might be
 

facing with the Secretary making a decision on a
 

petition under an interim final.
 

DR. ZIEMER: I guess I would also be
 

concerned about the public perception of an interim
 

rule and what the implications of that might be with
 

respect to how claims are handled, that it's kind of
 

the picture that well, the system really isn't ready
 

to go yet so how do I know my claim is really going
 

to be handled the way it would or should be. I
 

don't know what the perception would be out there. 

It may or may not be.
 

An interim final rule -- we're hearing a lot
 

of -- you know, people are dragging their feet
 

getting this system in place. It sounds like -- it
 

sounds like the Agency's dragging along again. 
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422 

That's what I'd be concerned about.
 

DR. DEHART: Roy DeHart. I think the
 

potential downside from the political perspective
 

could be severe here if they decided not to start
 

allowing us to review petitions. We can't afford
 

that. We can't -- we can't be seen by the claimants
 

as being obstructive. We've got to move forward, I
 

think.
 

DR. MELIUS: I think we can couch our
 

recommendation -- we're making a recommendation. 

They can consider it. They -- it can be outweighed
 

by counsel's advice that the Secretary shouldn't
 

make a designation until they've got a final rule in
 

place. We've gone from -- this was guidelines to
 

regulation, and I -- so who knows where the right
 

place to stop is and I think we put forward -- it
 

has some advantages. If it has a serious downside
 

like that, then I would hope that the Secretary
 

would not listen to us. I suspect the Secretary
 

wouldn't listen to us in that case. But we don't
 

know that and I think Larry's speculating, probably
 

on more facts than I have and more experience with
 

this, but let's -- if it would help. I don't think
 

it's -- if it's -- people see that things are being
 

processed, then it won't be a perception issue. If
 
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423 

it's -- holds up processing, yeah, obviously people
 

are going to be concerned. If anybody sat here and
 

listened to us today in trying to -- wrestling with
 

all this stuff, they'd probably be glad we get
 

anything recommended and out, so...
 

DR. ZIEMER: Further comments on this?
 

(No responses.)
 

DR. ZIEMER: Again, I think this is one
 

where there's a little bit of a split and the
 

possible solutions would be either, one, to vote it
 

up or down, or two, to indicate in the cover letter
 

that some of the members have suggested that the
 

interim final rule process be considered. Is
 

that -­

DR. MELIUS: Yeah, I think that's proper.
 

MS. MUNN: I'd prefer to vote it up or down.
 

UNIDENTIFIED: Make the motion.
 

MS. MUNN: I move that we vote up or down. 

I would prefer that this become a final rule.
 

DR. ZIEMER: That's sort of two motions. 

Are you making a motion that we vote on this issue
 

or are you making a motion that -- what is your
 

motion?
 

MS. MUNN: I move that we vote on this
 

issue.
 
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424 

DR. ZIEMER: Okay. And is there a second to
 

that?
 

DR. MELIUS: Well, are we going to vote on
 

it today or at the telephone conference call?
 

MS. MUNN: No, now.
 

DR. ZIEMER: The motion is to vote on this
 

now as to whether or not it appear in the document. 

Is there a second to that motion?
 

(No responses.)
 

DR. ZIEMER: I hear no second. So do I
 

interpret that to mean that the others -- I don't
 

know fully how to interpret that at this point.
 

Tony, did you -- are you making a motion?
 

DR. ANDRADE: Yeah, I'd like to make a
 

motion here. I'd like to be as specific as I
 

possibly can be. I'd like to move that we vote up
 

or down on whether the rule go forward.
 

DR. ZIEMER: As a rule?
 

DR. ANDRADE: As a rule, with
 

recommendations sent to the Secretary that have been
 

adopted today. However, and this may be a different
 

motion, with respect to the two -- I believe two
 

issues that exist, that those issues be taken care
 

of in language to be adopted in either guidelines or
 

a preamble to the rule that will go forward. It's
 
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425 

complicated. It's a complicated motion, but it's -­

I think it handles everything all at once.
 

DR. ZIEMER: As I understand the motion,
 

which is not yet seconded, it's a motion to adopt
 

all of the items that we've previously discussed,
 

although we don't have the wording before us, which,
 

if adopted -- I'm not sure what that does and we
 

still are going to need the wording, right, for -­

and we had already agreed to a meeting at which we
 

would vote on this, but nonetheless, your motion is
 

to adopt now those items that we had previously
 

discussed. Is that -- and that did not include this
 

issue of interim rule or was that part of that?
 

DR. ANDRADE: What is the best way to
 

proceed?
 

DR. ZIEMER: All you've covered is
 

everything but the interim rule, because the other
 

items I think we've agreed on how we're going
 

forward. We haven't agreed on the interim rule
 

issue, so your motion would be to basically adopt
 

the others. I think we still need to refine the
 

wording though.
 

DR. ANDRADE: Okay. Then let's take it step
 

by step. In which case, I move that we do not
 

pursue a path that includes an interim final rule.
 
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426 

DR. ZIEMER: Okay. The motion to not pursue
 

a path that includes an interim final rule is
 

essentially a motion not to say anything in the
 

document to the Secretary about an interim final
 

rule. Is that -- is that the motion?
 

DR. ANDRADE: That's the motion.
 

MS. MUNN: Second that.
 

DR. ZIEMER: And that's seconded. Now
 

discussion on that motion. Mark?
 

MR. GRIFFON: Well, I mean I think several
 

Board members have addressed this as a possible -­

this sort of resolution -- potential resolution to
 

this problem of operating in a vacuum of how these
 

cases or how these petitions are going to fall out. 

And I think that's -- that's part of the reason -­

and actually Henry Anderson at the last meeting made
 

this as a recommendation -- or I don't know -- you
 

know, not a formalized recommendation, but he
 

brought this concept up of a possibility of an
 

interim final rule, so I think a number of us feel
 

that that might be -- and you know, understanding -­

and I agree with what Jim pointed out, that you
 

know, these -- if there's downfalls, then the
 

Secretary's going to consider both sides and, you
 

know, make that decision. But there is at least
 
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427 

some up side to it. We feel there could be some
 

benefit to that, or some members feel there could be
 

some benefit to that.
 

DR. ANDRADE: That's precisely why I'm
 

calling for a vote.
 

DR. ZIEMER: The vote -- if you vote yes,
 

that will mean that the document does not say
 

anything about an interim rule. If you vote no,
 

that provides, if desirable, an opportunity to state
 

that some members have this concern.
 

DR. MELIUS: I have a -- yeah.
 

DR. ZIEMER: It would not necessarily have
 

to be a recommendation.
 

DR. MELIUS: I guess I have a procedural
 

concern about our committee. We've operated by
 

consensus and by adopting documents that reflect
 

that consensus and not by voting on individual
 

recommendations. And I think we're in a little
 

awkward spot here because we had -- led to believe
 

there would be a conference call -- a document
 

produced and that we'd be reviewing and voting on -­

agreeing on -- or reaching -- trying to reach
 

agreement on particular language, and we really
 

haven't completed that process. And just sort of
 

changing our procedures and our approach and sort of
 
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428 

-- certainly has some implications for how long the
 

conference call will be a week from Thursday.
 

DR. ZIEMER: The Chair is going to call a
 

five-minute comfort break while you chat amongst
 

yourselves.
 

(Whereupon, a recess was taken.)
 

DR. ZIEMER: Are we all comfortable again? 

Before we were so rudely interrupted by the Chair, I
 

think that -- I think to some extent, Jim, what I
 

heard you saying, through my discomfort, was that a
 

sort of plea for operating on this issue in a
 

similar manner to some of the others and maybe
 

allowing the document to the Secretary to suggest
 

that at least some members suggest that the
 

Secretary consider this as a possible path to take,
 

but if that were done, it would not have the weight
 

of being a recommendation of the full committee but
 

would at least raise the issue, I think is what you
 

DR. MELIUS: I think that's correct. That's 

fair to -­

DR. ZIEMER: And so I guess I'm interpreting 

what the outcome of a vote, if a vote is yes, to
 

sustain the motion, then the note to the Secretary
 

would not mention this issue. A vote to defeat the
 
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429 

motion would keep the door open for what you're sort
 

of requesting, and that is to allow this to be
 

mentioned as a sort of -- I don't know, minority
 

report or something like that, or at least -­

DR. MELIUS: Well, I'm trying to avoid
 

minority -­

DR. ZIEMER: No, no, no, it wouldn't have
 

such words, just say some of the members have
 

suggested.
 

DR. MELIUS: Right. Much as we've tried to
 

make sure members who aren't here are available and
 

get to participate and review things, I think this
 

is similar to what's -- it should try to reflect
 

what the committee has talked about. And there may
 

be times when we do need to vote on these issues. I
 

don't want to preclude that 'cause that's a way of
 

evaluating how we -- what we believe and so forth. 

But at the same time I think if we can deal with it
 

sort of through the wording and sort of reflecting
 

what we've recommended, I think -- I'd prefer that,
 

but -­

DR. ZIEMER: If the motion were defeated,
 

the issue would arise in the final document again in
 

terms of the wording itself. Tony?
 

DR. ANDRADE: I just wanted to say that I
 
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430 

have no objection to continuing the discussion. And
 

what I'm proposing here is really a two or threestep process that will be followed. Number one is
 

determining whether this body believes that there is
 

value-added in holding -- or standing up an interim
 

final rule. That's step number one.
 

Step number two is to have our telephone -­

our teleconference, during which time we will
 

discuss the final language that we will be
 

suggesting for the final rule, whether it exists in
 

the preamble or in the body of the rule itself. And
 

perhaps at the same time people will have thought
 

through some of the questions that have been brought
 

to -- brought up on the floor and maybe we'll have
 

-- or somebody will have a clearer definition from
 

the staff or from among our body.
 

Or we will decide at that time -- which
 

might be step number three -- to address these I
 

think last two issues that we're grappling with,
 

which are difficult, but nevertheless I think
 

handleable in the long run. For example, in
 

guidelines that will be developed or some other
 

vehicle.
 

So again, I'm not proposing to break up the
 

way we've normally done business. It's just that
 
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the only path forward that I can see at this
 

particular point so that we can move on, allow NIOSH
 

to begin its work as quickly as possible, and for us
 

to get as much of those things that we are in
 

consensus about into the rule as quickly as
 

possible, is to go down this path -­

DR. ZIEMER: To the final rule.
 

DR. ANDRADE: -- to the final rule.
 

DR. ZIEMER: Okay. Are you ready to vote on
 

the motion?
 

MS. MURRAY: May I ask for clarification on
 

the two issues, whether it's an interim final rule
 

or not? Those are the two issues? What are the two
 

issues?
 

DR. ZIEMER: The motion is to whether or not
 

this committee would include in its recommendation
 

to the Secretary that he consider issuing this as an
 

interim final rule or not. The motion was that it
 

be issued as a final rule, so voting yes for the
 

motion is to preclude its being discussed in the
 

letter as an interim.
 

MS. MURRAY: Gotcha. Thank you.
 

DR. ZIEMER: Is that everybody's
 

understanding? So if you vote yes for the motion,
 

you are voting to identify it as the final rule, in
 
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432 

which case nothing is said to the Secretary. Voting
 

no doesn't -- it doesn't preclude stating that some
 

members suggest it be issued as a final rule. Okay.
 

All who favor the motion, say aye.
 

(Affirmative responses)
 

DR. ZIEMER: All who oppose the motion, say
 

no.
 

(Negative responses)
 

DR. ZIEMER: Okay, I'm going to call for a
 

show of hands, so all in favor, raise your hand. 

One, two, three, four in favor.
 

All opposed, raise your hands. One, two,
 

three, four. The Chair votes against the motion. 

The motion dies -- or is not carried.
 

Okay. Now I think we're back to where we
 

were. We will vote on the full document at the
 

telephone conference. I will ask Jim for an
 

additional sentence or two on that interim rule
 

issue. You still have an opportunity to wipe it
 

out, if his words aren't good enough, at the final
 

vote.
 

The time of the next meeting. Actually
 

there is one other item that -- there's housekeeping
 

issues. Maybe I will ask that we at least have on
 

the record this item that was raised by a member of
 
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433 

the public raising concern about the -- not by a
 

member of the public today, but by a member of the
 

public in an e-mail to me -- concern as to whether
 

NIOSH had sufficient staffing to actually handle the
 

workload that is before them. This is a little bit
 

difficult forum to discuss that because if you ask
 

any manager in a Federal facility if they need more
 

staff, that's an automatic yes. But on the other
 

hand, it could be discussed in the framework of what
 

the Board sees as the workload and a little bit of
 

feeling now, at least by the working group, is the
 

staffing level. And knowing that a contractor is to
 

come aboard soon and help with the real dose
 

reconstruction -- I guess I will only ask the Board,
 

are you concerned about the workload and the
 

staffing levels, from what you see?
 

DR. MELIUS: Yes.
 

DR. DEHART: Yes.
 

MR. GRIFFON: Yes. 

DR. ANDRADE: Definitely. 

MR. PRESLEY: Definitely. 

DR. ZIEMER: Let the record show that
 

virtually all the Board members expressed some
 

concern about the staffing levels.
 

Now do I interpret that to mean that you all
 
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434 

feel that there's too many staff members?
 

(Laughter)
 

DR. ZIEMER: There is a general concern
 

amongst the Board that the staffing may be pretty
 

minimal for the job that's ahead. I'm not sure that
 

it's appropriate for us to raise this with the
 

Secretary as an issue at this point because I don't
 

know that we have all the facts in terms of what the
 

workload is. Perhaps when the contractor comes
 

aboard very soon, we will have a better feel for
 

this and can address it in the future. I at least,
 

as a starting point, wanted to have it on the
 

record. And perhaps we would even put it on our
 

little action item as something we want to look at
 

on an ongoing basis to make sure that the staffing
 

level is sufficient to carry out the mandate of what
 

is before you.
 

Again, I want to make it clear to everyone
 

that Larry has not had any contact with me on this
 

issue to ask me to raise this. This has come from a
 

completely different source, member of the public,
 

and I just wanted to at least see if that reflected
 

everyone else's sort of perception of the issue. 

Anyone have any particular additional comments along
 

this -­
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435 

DR. MELIUS: Given the hour, I will try to
 

make this very short, is that I think I would ask
 

for the agenda for the next meeting to include an
 

update on hopefully the contract's awarded, how that
 

contract's going to be managed, how we stand in the
 

claims process and what we foresee -- the staff
 

foresees down the future to -- in terms of handling
 

this program so that we can have some discussion.
 

DR. ZIEMER: Thank you. Okay,
 

administrative housekeeping. Cori, what items do
 

you have for us?
 

MS. HOMER: Well, most of you have at least
 

sent in a voucher and it's been prepared. Not all
 

of you have been reimbursed. I think there's one
 

that I received -­

DR. ZIEMER: Previous meeting, right?
 

MS. HOMER: From the previous meeting. 

There is one I received and was not able to get to,
 

as it got to my desk the day before I left.
 

Salary issues, if anybody has not been paid,
 

please let me know.
 

One more item 'cause the fiscal year is
 

closing. I need your vouchers mailed back to me as
 

soon as possible. I must have them on my desk
 

within two weeks. We have to file an annual report
 
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436 

and that has got to be compiled -- the costs of the
 

Board, including travel, has to be compiled prior to
 

that report being prepared.
 

Also, roster changes. If any of your
 

information has changed on the roster, if you would
 

like to switch addresses from your home to your
 

office or vice versa, please let me know so that I
 

can update the agenda.
 

And if you haven't already done so, please
 

let Larry know -- write down your time, preparation
 

time and outside time getting ready for either the
 

work group and/or the Board meeting, and let Larry
 

sign off on that and give it to me so I can submit
 

it for salary payment.
 

DR. ZIEMER: Okay. Thank you.
 

MR. ELLIOTT: I would like to add to Cori's
 

list that if your employment status changes or
 

anything on your OGE-450, you know what that thing
 

is; that's your declaration of conflict of interest
 

issues, we need to call for that again. So if any
 

employment change happens or anything changes that
 

would reflect upon that form, please file a new form
 

and call me and we need to discuss it. Thank you.
 

DR. ZIEMER: Now time of the next meeting. 

We had blocked off -- at least according to my
 
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calendar -- October 15 and 16 as a possible date. I
 

think we had a back-up date, also.
 

MR. ELLIOTT: I think we had 14, 15 and 16.
 

DR. ZIEMER: And November 18th and 19th was
 

also blocked off.
 

Okay, October 15th and 16th is basically two
 

months from now. We are assuming, I think, that the
 

dose reconstruction -- or the contractor will be up
 

and running by then. We have some items on our
 

master list to address. We have perhaps some dose
 

reconstruction groups to be underway, perhaps, and
 

test out the system and so on. Is October still
 

good?
 

I had a note in my book that we were
 

thinking about meeting in Santa Fe. Is that still
 

good for y'all? Richard say oh, yeah. And do we
 

know logistically, Cori, or staff, is that -­

MS. HOMER: I actually have checked into a
 

couple of sites -­

DR. ZIEMER: Okay, so that's -­

MS. HOMER: -- independent contracts on that
 

basis.
 

DR. DEHART: Was there a holiday problem?
 

MS. HOMER: Yes, it was a government holiday
 

on the 14th.
 
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DR. ZIEMER: On the 14th.
 

MS. MUNN: Columbus Day. It doesn't keep me
 

from traveling.
 

DR. ZIEMER: Is it a major problem?
 

MR. ELLIOTT: It's not a staff issue.
 

DR. ZIEMER: Right. Then we will proceed
 

with those dates for Santa Fe. It appears to be
 

still clear on everybody's calendar. I think we'll
 

have plenty of items to address at that point.
 

Do you anticipate, Mark, that any of the
 

working groups would meet ahead of that or -­

MR. GRIFFON: The panels? No, we won't have
 

a -- I mean we're hoping that we -- at least by
 

conference call -- start to resolve and start the
 

procurement process -­

DR. ZIEMER: The procurement process and
 

maybe -­

MR. GRIFFON: I doubt that we'll have -­

DR. ZIEMER: Okay, but you can work -­

MR. GRIFFON: Right, right.
 

DR. ZIEMER: Okay. Any other comments on
 

that? Then we'll proceed with that schedule,
 

develop the -­

UNIDENTIFIED: And the dates are?
 

DR. ZIEMER: The actual meeting dates would
 
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be the 15th and the 16th, so many will have to allow
 

the 14th for travel and the 17th for travel.
 

We do have on the agenda one last
 

opportunity for any other public comments. I have
 

not received notes that there -- oh, Bob? Okay,
 

thank you. Bob, please proceed.
 

MR. TABOR: Can I do that from here?
 

DR. ZIEMER: Yes.
 

MR. TABOR: Bob Tabor again, for the record. 

Folks, all's I wanted to say is one thing, and it's
 

not real specific upon me -- it's not real specific
 

about the fine detail which you're involved here. 

It's kind of an over-arching comment. But at one of
 

the meetings I pointed out that -- do not forget
 

that we need to do the right thing right the first
 

time and do the right thing right for the right
 

reasons. If this stuff is not really clear and not
 

clean and it's not ready, I would beg you, don't do
 

it until it is. And if it requires extending or
 

whatever kind of process you go through to say hey,
 

we need more time, I think that from a worker
 

perspective I would rather wait to have something
 

right than to take and rush ahead just to show
 

progress. You know, for whatever those words are
 

worth. So if you need additional time, you know,
 
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even in your public comment period, I know it's done
 

many times in the government stuff. They set a
 

date, but you find that there's a lot of interest
 

out there in a particular topic matter and people
 

will request -- we want more time to take in comment
 

on this and work through this. And I'm just saying
 

I know you're doing your very best. But you know,
 

from a worker perspective, please, do the right
 

thing right, as best you can the first time and for
 

the right reasons. And if you need more time, take
 

more time.
 

DR. ZIEMER: Thank you, Bob. That's
 

basically measure twice and cut once. Right? For
 

the tailors. Right? Thank you.
 

Any other items to come before us?
 

(No responses.)
 

DR. ZIEMER: Anything for the good of the
 

order?
 

(No responses.)
 

DR. ZIEMER: If not, we're adjourned.
 

(Meeting adjourned at 4:50 p.m.)
 
 

 

 

___________________________ 

 

441 

 

C E R T I F I C A T E
 

STATE OF GEORGIA : 

: 

COUNTY OF FULTON : 

I, Steven Ray Green, Certified Merit Court
 

Reporter, do hereby certify that I reported the
 

above and foregoing on the 14th and 15th day of
 

August, 2002; and it is a true and accurate
 

transcript of the proceedings captioned herein. 

I further certify that I am neither kin nor
 

counsel to any of the parties herein, nor have any
 

interest in the cause named herein.
 

WITNESS my hand and official seal this the
 

14th day of September, 2002. 

STEVEN RAY GREEN,
 

CERTIFIED MERIT COURT REPORTER
 

CERTIFICATE NUMBER: A-2102