1608 SPRING HILL ROAD, SUITE 400 • VIENNA, VIRGINIA • 22182 • 703.893.6600 • FAX 703.821.8236 

September 20, 2007 

Mr. David Staudt 

Center for Disease Control and Prevention 

Acquisition and Assistance Field Branch 

Post Office Box 18070 

626 Cochrans Mill Road – B-140 

Pittsburgh, PA 15236-0295 

Re: Contract No. 200-2004-03805, Task Order 3: Transmittal of Draft SCA-TR-TASK3-0005, 

Rev. 0, Review of Close-Out Interview Procedure, ORAUT-PROC-0092 

Dear Mr. Staudt: 

SC&A is pleased to submit to NIOSH and the Board its review of ORAUT-PROC-0092, Review

of Close-Out Interview Procedure, ORAUT-PROC-0092, SCA-TR-TASK3-0005, Rev. 0, dated 

September 20, 2007. This report has been subjected to a review for Privacy Act-related 

information and has been edited accordingly. 

Though this SC&A report is part of our deliverable under Task Order 3, it is being submitted 

under separate cover because, like our review of ORAUT-OTIB-0052 (dealing with 

reconstructing doses to construction workers), the review of PROC-0092 required extensive 

analysis, and we believe it is especially important to the program. 

If you have any comments or questions, please contact me at 732-530-0104. 

Sincerely, 

John Mauro, PhD, CHP 

Project Manager 

cc: P. Ziemer, PhD, Board Chairperson A. Makhijani, PhD, SC&A 

Advisory Board Members H. Behling, PhD, MHP, SC&A 

L. Wade, PhD, NIOSH M. Thorne, SC&A 

L. Elliott, NIOSH H. Chmelynski, SC&A 

J. Neton, PhD, NIOSH J. Fitzgerald, Saliant 

S. Hinnefeld, NIOSH J. Lipsztein, SC&A 

L. Homoki-Titus, NIOSH K. Robertson-DeMers, CHP, Saliant 

A. Brand, NIOSH S. Ostrow, PhD, SC&A 

J. Broehm, NIOSH K. Behling, SC&A 

C. Ellison, NIOSH T. Bell, Saliant 

L. Shields, NIOSH Project File (ANIOS/003) 

 D. Sundin, NIOSH 
Draft Report 

NATIONAL INSTITUTE FOR 

OCCUPATIONAL SAFETY AND HEALTH 

ADVISORY BOARD ON RADIATION AND WORKER HEALTH 

TASK 3: REVIEW OF NIOSH/ORAUT PROCEDURES AND METHODS 

USED FOR DOSE RECONSTRUCTION 

Review of Close-Out Interview Procedure, ORAUT-PROC-0092 

Contract No. 200-2004-03805 

SCA-TR-TASK3-0005, Revision 0 

Prepared by 

S. Cohen & Associates 

1608 Spring Hill Road, Suite 400 

Vienna, VA 22182 

September 2007 

Disclaimer 

This document is made available in accordance with the unanimous desire of the Advisory Board 

on Radiation and Worker Health (ABRWH) to maintain all possible openness in its 

deliberations. However, the ABRWH and its contractor, SC&A, caution the reader that at the 

time of its release, this report is pre-decisional and has not been reviewed by the Board for 

factual accuracy or applicability within the requirements of 42 CFR 82. This implies that once 

reviewed by the ABRWH, the Board’s position may differ from the report’s conclusions. Thus, 

the reader should be cautioned that this report is for information only and that premature 

interpretations regarding its conclusions are unwarranted. 
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Document No. 

SCA-TR-TASK3-0005 

Effective Date: 

Draft – September 20, 2007 

S. Cohen & Associates: Technical Support for the 

Advisory Board on Radiation and Worker Health 

Review of NIOSH Dose Reconstruction Program Revision No. 

0 - Draft 

Review of Close-Out Interview Procedure, 

ORAUT-PROC-0092 Page 2 of 67 

Task Manager: 

 ______________________ Date: ____________ 

Arjun Makhijani, PhD 

Project Manager: 

 ______________________ Date: ____________ 

John Mauro, PhD, CHP 

Supersedes: 

N/A 
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TABLE OF CONTENTS 

Executive Summary.........................................................................................................................4 

1.0 ORAUT-PROC-0092 ― Close-Out Interview Process.......................................................8 

1.1 Background Information: Interview Objectives .....................................................8 

1.2 Review Timeline....................................................................................................10 

1.3 Content and Organization ......................................................................................11 

2.0 Overview of Procedure Used in the Close-Out Telephone Interview ...............................12 

3.0 Strengths of ORAUT-PROC-0092 ....................................................................................15 

4.0 Procedure Review Checklist..............................................................................................16 

5.0 Significant Findings Pertaining to Procedures...................................................................21 

5.1 Review of Finding 1...............................................................................................21 

5.1.1 Close-Out Interview Observation (Case #3)..............................................22 

5.1.2 Close-Out Interview Information Gathered during Site Expert 

Interview ....................................................................................................26 

5.1.3 Suggestions for Improvement related to Finding 1....................................29 

5.2 Review of Finding 2...............................................................................................30 

5.2.1 Suggestion for Improvement related to Finding 2 .....................................35 

5.3 Review of Finding 3...............................................................................................35 

5.3.1 Suggestions for Improvement related to Finding 3....................................38 

5.4 Review of Finding 4...............................................................................................39 

5.4.1 Suggestions for Improvement related to Finding 4....................................40 

6.0 References..........................................................................................................................41 

Attachment A: OCAS-1 Form ......................................................................................................42 

Attachment B: Close-Out Interview Observation Notes ..............................................................43 
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EXECUTIVE SUMMARY 

The close-out interview is a critical time in the process of adjudication of a claim. It is the last 

time that the claimant can provide substantive information that could affect dose reconstruction 

during the NIOSH dose reconstruction process. It is the time when the claimant must sign the 

OCAS-1 form stating that they understand the implications and finality of the stage of the 

process as regards the dose reconstruction. If they do not sign it within 60 days, National 

Institute for Occupational Safety and Health (NIOSH) may administratively close the case. The 

claimants are so informed. 

The facts provided by the claimant prior to and during the close-out interview process set the 

stage for any administrative review that may occur if the claim is denied. The administrative 

review is submitted to the Department of Labor (DOL) and not to NIOSH or the Department of 

Health and Human Services.1

In view of the crucial nature of the close-out interview, SC&A has carefully reviewed the 

procedure for conducting these interviews (ORAUT-PROC-0092, Rev. 00). SC&A observed, 

firsthand, three close-out interviews (one with an energy employee and two with survivor 

claimants) for claims that were still being processed, on condition that SC&A personnel make no 

comment whatsoever during the interview. SC&A also drew on close-out interview information 

in another case that came to its attention during a site expert interview. SC&A would like to 

thank NIOSH and the Oak Ridge Associated Universities Team (ORAUT) for arranging the 

complex process of close-out interview observation, as well as access to the site expert, whom 

SC&A contacted and advised that SC&A was using this site expert’s close-out interview 

information in this report (with the site expert’s name, site, job type, and other identifying 

information redacted to protect privacy). 

SUMMARY OF FINDINGS 

Finding 1: The close-out interview procedure does not ensure that the HP Reviewer and dose 

reconstruction group fully address claimant concerns raised during the close-out interview. The 

procedure has many gaps relating to response to claimant concerns. The gaps identified in 

regard to response to claimant concerns are as follows: 

(1) ORAUT-PROC-0092 has serious gaps related to a lack of specificity about what 

information should be referred to an HP Reviewer and to the dose reconstruction 

department of ORAU. It also lacks specificity in the level of detail that claimant 

concerns should be researched. For instance, there is no explicit requirement to carefully 

check whether all information corresponding to the concerns has been appropriately 

taken into account in the dose reconstruction. 

1

 SC&A was informed by OGC that DOL regulations do not have an “appeals” process, it is an 

administrative review. OGC editorial comment for clarification of September 12, 2007, made to SC&A as part of 

the PA review of the draft of this report. However, SC&A notes that ORAUT used the term “appeal” as part of one 

of the close-out interviews observed by SC&A (see Attachment B). 
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(2) The procedure also has no specifications or examples of what kinds of follow-up are to 

be expected when detailed information is provided. In two cases examined by SC&A, 

the claimants provided specific information. Yet, the evidence is that the underlying data 

were not reviewed in one case and no attempt was made to obtain the relevant reports in 

the other. In the latter case, the date on the final dose reconstruction actually predates the 

close-out interview, despite the fact that the employee provided detailed new information 

during the close-out interview. 

(3) The level of detail in documenting the close-out interview process during the follow-up 

call was very different in the two cases discussed above. In the first case, the HP 

Reviewer provided a much more detailed summary in the close-out interview record than 

in the second case. The lack of specific documentation procedures for research and for 

the communication of the resolution of concerns creates the potential for inconsistency 

and arbitrariness in how concerns are researched, communicated, and resolved. 

(4) In both cases, substantive information provided by the claimant was not addressed by a 

dose reconstructor. In one case, SC&A is aware that the information was not referred to 

the dose reconstructor. In the second case, this can be inferred from the identical 

language in and dates on the draft and final dose reconstructions. 

(5) The HP Reviewers, who make key decisions about researching claimants’ concerns and 

who communicate with the claimants, do not have health physics qualifications or 

experience in dose reconstruction, according to the managers of the program.. 

Finding 2: The procedure makes no substantive provision for ensuring that the claimant actually 

understands the dose reconstruction and its implications for compensation prior to signing the 

OCAS-1 form, even when the claimant complains that they do not understand the “lingo.” 

Finding 3: The fact that the signing of the OCAS-1 form (if it has not been signed before) occurs 

in the context of the close-out interview may create pressures on ORAUT personnel to get the 

signature before being certain that all issues of concern to the claimant have been fully 

addressed. 

Finding 4: The procedure does not ensure that the claimant has all the information that was 

essential to the dose reconstruction prior to the close-out interview. This can hamper the 

claimant in deciding whether or not to submit additional data or information at the close-out 

interview stage. 

SUGGESTIONS FOR IMPROVEMENT 

(1) Claimants should be informed that HP Reviewers are not health physicists. The term 

“HP Reviewer” should not be used to refer to personnel without qualifications or 

experience in Health Physics. 

(2) The potential for inconsistency and for arbitrary judgments by HP Reviewers should be 

significantly decreased by detailed written guidelines for and examples of how concerns 
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should be researched and when they should be referred to the dose reconstruction group. 

The two examples discussed in this review can be used as case studies for lessons learned 

in developing those guidelines. 

(3) The procedure should include instructions that HP Reviewers should make detailed notes 

about what was done to address claimant concerns and how they were resolved. This 

should include specific references to documents reviewed, personnel consulted, and 

details of how the issues were resolved during the follow-up call. 

(4) All claimant concerns relating to dose, data, intakes, exposure, or incidents should be 

referred to the dose reconstruction group for a response. The response should fully 

address the concern and should be in writing. The written document should be provided 

to the claimant as part of the follow-up process. 

(5) The interviewer should clearly communicate to the claimant the implication of the dose 

reconstruction for compensation with a declarative statement. Claimants should be told, 

according to the dose reconstruction, whether the claim is likely to be compensated or not 

compensated, with the caveats that (1) DOL may return the dose reconstruction for reevaluation, and (2) the decision on compensation is made by DOL. Qualified health 

physics personnel who are trained to communicate non-technical information to the 

general public or have a track record of doing so successfully should answer the 

claimant’s questions during all follow-up calls and in cases where the claimant states that 

they do not understand the information in the draft dose reconstruction. 

(6) A health physics professional should be available in real-time during the initial close-out 

interview (though not necessarily be on the line) in case there are concerns or questions 

that the interviewer cannot address, but that could be resolved relatively expeditiously by 

a health physicist familiar with the claimant’s file. 

(7) Claimants should be given access to the records, documents, and procedures pertaining to 

their dose reconstructions without having to request them. The specific Workbook 

version used for the dose reconstruction should be noted in the draft dose reconstruction 

report sent to the claimant. The draft dose reconstruction report should offer to make that 

Workbook and other materials available to the claimant, should they wish to have them. 

SC&A notes that the Workbook is now a part of the claimant’s file. 

(8) All Workbooks used in dose reconstructions should be archived. 

SC&A observed three close-out interviews and examined two cases of close-out interviews in 

which the claimant provided information and expressed concerns that required follow-up. The 

fact that substantial issues arose in the small number of cases sampled would raise questions 

about the extent of the problems, even without further information. In these cases, however, the 

problems appear to arise largely from gaps in the existing procedure and from technical 

judgments by HP Reviewers, who have no health physics qualifications or dose reconstruction 

experience, according to the managers of the program (see Attachment B). This raises a clear 

possibility that the problems regarding lack of adequate follow-up to the claimant concerns may 
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be systemic. This needs to be further investigated by NIOSH, given the crucial nature of the 

close-out interview in the dose reconstruction and compensation process. Likewise, it would be 

highly desirable for the Advisory Board on Radiation and Worker Health (Advisory Board), 

directly or via the Working Group, to investigate how widespread the problems identified above 

may be. 

A part of this investigation might consist of re-interviews by the Advisory Board or through the 

Working Group of the two claimants’ cases discussed above, provided they are amenable to that, 

of course. This would help in evaluating the adequacy of changes in the close-out interview 

procedure that NIOSH/ORAUT might propose. It would also throw some light on the worker 

interview and site expert documentation procedure, and the ways in which that information, as 

well as information in the Computer-Assisted Telephone Interviews (CATIs), is being used. 

SC&A recognizes that the site expert documentation is being reviewed separately by the 

Advisory Board, and is making this comment here in the interest of facilitating a coordinated 

review of various kinds of input provided to NIOSH and ORAUT.
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1.0 ORAUT-PROC-0092 ― CLOSE-OUT INTERVIEW PROCESS 

This review is part of SC&A’s Task Order 3, under which procedures relating to dose 

reconstruction for energy employees and associated tasks, such as interviews with claimants, 

used by NIOSH and its contractor, ORAUT, are evaluated at the direction of the Advisory 

Board. This report provides a review of the ORAUT procedure for conducting close-out 

interviews, Close-Out Interview Process, ORAUT-PROC-0092, Rev. 00, August 17, 2005 

(Shatto and Hawkins 2005a). This report should be read in conjunction with the review of the 

procedures for conducting CATIs with claimants, which is to be found in Chapter 5 of The 

Review of NIOSH/ORAUT Procedures and Methods Used for Dose Reconstruction (SC&A 

2005a). 

The close-out interview is the last step in the process of dose reconstruction prior to NIOSH’s 

finalization of a dose reconstruction report, which is sent to the DOL to provide dose estimates 

necessary for adjudication of a claim under Part B of the Energy Employees Occupational Illness 

Compensation Program Act of 2000 (EEOICPA). ORAUT-PROC-0092 describes the purpose 

of the procedure as follows: 

The purpose of this procedure is to provide the process requirements for the 

scheduling, performance, and follow-up of a Close-Out Interview(COI) for the 

Oak Ridge Associated Universities (ORAU) Team Dose Reconstruction Project 

for the National Institute for Occupational Safety and Health (NIOSH). [Shatto 

and Hawkins 2005a, p. 4] 

1.1 BACKGROUND INFORMATION: INTERVIEW OBJECTIVES 

 

NIOSH offers the claimant two opportunities to provide input to their dose reconstruction. The 

first is the CATI. This interview process allows claimants the opportunity to provide NIOSH 

with additional information relating to individual job responsibilities; the potential for exposure 

to various radionuclides and materials; the frequency of dosimeter changes; the methods and 

frequency of various types of bioassay monitoring of internal burdens of radionuclides; the type 

of workplace monitoring, such as air sampling, survey, and area access controls; and 

involvement in incidents or unusual events. By design, the interview process is, therefore, an 

integral part of the dose reconstruction process. 

To ensure completeness of the dose reconstruction process, NIOSH must also conduct a closing 

interview after a draft dose reconstruction has been reviewed by the claimant. The closing 

interview (which may take more than one session to complete) provides the claimant an 

opportunity to ask questions about the dose reconstruction, and a final opportunity to provide 

additional information that may be pertinent to the claim. Key elements of the closing interview 

are specified in 42 CFR 82.10(l) and (m): 

(l) After providing the claimant with a copy of a draft of the dose reconstruction 

report to be provided to DOL, NIOSH will conduct a closing interview with the 

claimant to review the dose reconstruction results and the basis upon which the 

results were calculated. This will be the final opportunity during the dose 
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reconstruction process for the claimant to provide additional relevant 

information that may affect the dose reconstruction. The closing interview may 

require multiple sessions, if the claimant requires time to obtain and provide 

additional information, and to allow NIOSH time to integrate the new 

information into a new draft of the dose reconstruction report. NIOSH will 

determine whether to grant requests for time to provide additional information, 

based on whether the requests are reasonable and the claimant is actively seeking 

the information specified. 

(m) Subject to any additional information provided by the claimant and revision 

of the draft dose reconstruction report under § 82.10(l), the claimant is required 

to return form OCAS-1 to NIOSH, certifying that the claimant has completed 

providing information and that the record for dose reconstruction should be 

closed. Upon receipt of the form, NIOSH will forward a final dose reconstruction 

report to DOL, DOE, and to the claimant. [Emphasis added.] 

Some initial comments about dose estimates and probability of causation (POC) are important, 

since clarity about these values is critical to a clear communication with the claimant during the 

close-out interview. 

NIOSH does not do the final calculation of the POC on which the compensation decision is 

based or make the compensation decision. That estimate is made by the DOL and communicated 

to the claimant as part of the final decision made by the government. (The claimant has a right to 

an administrative review of that decision.) However, a large part of NIOSH’s dose 

reconstruction procedure is based on estimates of which claims are likely to be compensated and 

which are likely to be denied. In the former case, a “minimum” dose estimate is made, because 

in NIOSH’s judgment, the POC would already be greater than 50%t at that dose. Since the case 

is likely to be compensated, an additional expenditure of resources is deemed to be unwarranted. 

For all such minimum dose estimates, NIOSH’s professional and technical judgment is that the 

case would be compensated, though as a procedural matter, the DOL can, and sometimes does, 

send the case back for re-evaluation. 

Similarly, a large number of dose reconstructions are based at least partly on efficiency 

procedures for making maximum dose estimates. Such procedures are supposed to ensure that 

the resulting estimates are at the upper limit of scientifically plausible values, generally well 

above what the claimant’s own dosimetry information and work history would yield if used to 

estimate dose. NIOSH adopts such an efficiency procedure only in cases where NIOSH 

estimates that the POC is likely to be below 50% at this maximum dose value. 

Furthermore, the DOL’s probability of causation calculation is based on the NIOSH dose 

reconstruction, unless the DOL sends the dose reconstruction back to NIOSH for re-work, which 

it has done in a small minority of cases. At least in those cases where NIOSH uses minimum or 

maximum efficiency procedures for all or part of a dose reconstruction, NIOSH has an 

understanding of the implications of the dose estimate for the DOL’s probability of causation 

calculation, should the DOL accept the dose reconstruction as sent by NIOSH. These facts are 
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important to this review insofar as they impact the claimant’s understanding of the draft dose 

reconstruction, which is a principal objective of the procedure. 

An OCAS-1 form accompanies the dose reconstruction report sent to the claimant. The OCAS-1 

form is provided in Attachment A for reference. By signing the form, the claimant indicates that 

they do not have any more information to share with NIOSH that might be relevant to the dose 

reconstruction. A signature on this form does not mean the claimant agrees with the dose 

reconstruction. The OCAS-1 form must be signed within 60 days from the time that the claimant 

receives the draft dose reconstruction report; a failure to do so enables NIOSH to 

administratively close the case (NIOSH 2006a, NIOSH 2006b). This is stated in the letter to the 

claimant accompanying the draft dose reconstruction: 

Once we receive the signed OCAS-1 form from you, we will send the final copy of 

the dose reconstruction report to the DOL for adjudication of your claim. We will 

also send you and the Department of Energy a copy of the final dose 

reconstruction report. It is important that you return the properly signed OCAS-1 

to us within the above-described timeframe so that there is no delay in the 

adjudication of your claim. We will not forward the dose reconstruction report to 

DOL for adjudication without receipt of a properly signed OCAS-1. If we do not 

receive the OCAS-1 within the timeframe described above [60 days], we may 

administratively close the dose reconstruction and notify DOL of this action. 

The close-out interview, therefore, serves not only to give the claimant an opportunity to provide 

more information, should they have it, but also as a marker in the process of NIOSH’s 

completion of the dose reconstruction. 

Given all of the above, the close-out interview is a critical point in the claims process. 

1.2 REVIEW TIMELINE 

February 13, 2006 – A work group meeting was held in Cincinnati that included discussions related to 

the CATI and close-out interview processes. Key items discussed included the following: 

• NIOSH/ORAUT development of a new introductory packet for the claimant containing a 

two-page introduction letter and several fact sheets, including “Review of the Claims 

Process,” “Detailed Steps in the Claims Process,” “Dose Reconstruction – Frequently Asked 

Questions,” “Employment History and Verification,” “Glossary of Terms,” and “Overview of 

the Claims Process Under the Act.” 

• SC&A requested a copy of this packet to assist in the review of ORAUT-PROC-0090. 

• SC&A requested that NIOSH/ORAU provide a copy of the training manual given to 

interviewers. 

Since ORAUT-PROC-0090, which covers the initial telephone interview (the CATI), is not 

substantially different from the prior procedures that it consolidates, the work group removed 

this item from the SC&A procedures review list. SC&A’s review of the CATI procedures is in 
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Chapter 5 of SC&A 2005a. However, the close-out interview procedure has not been reviewed 

before by SC&A. The timeline for that review has been as follows: 

• October 11, 2006 – SC&A observed three close-out interviews to evaluate this interview 

process. 

• October 13, 2006 – As a result of questions raised in the close-out interview by one of the 

claimants, a follow-up interview was conducted with an HP Reviewer. SC&A also observed 

this follow-up interview. SC&A was provided with an opportunity to ask questions to those 

involved in interviewing the claimant, as well as their supervision, before and after the followup call. 

• October 16, 2006 – SC&A forwarded a follow-up question to NIOSH/ORAUT related to 

statements made by a claimant regarding employment at additional sites. 

NIOSH/ORAUT spoke with the claimant and provided a summary to SC&A. 

• July 26, 2007 – NIOSH provided to SC&A a copy of an information packet available to 

claimants that explains the dose reconstruction process and also provides a glossary of 

terms. 

1.3 CONTENT AND ORGANIZATION 

This portion of the Task Order 3 report is limited to the review of procedures pertaining to the 

close-out interview process for claimants. This review is represented below in Sections 2.0 

through 5.0, which are followed by a list of references and two attachments: 

• Section 2.0 provides a brief description of the procedures under evaluation 

• Section 3.0 identifies those elements of the procedure that SC&A considers positive 

strong points 

• Section 4.0 consists of a summary review of findings (or checklist) 

• Section 5.0 describes significant findings pertaining to applicable procedures, summary 

conclusions, and suggestions for improvements 

• Section 6.0 provides a list of references 

• Attachment A: OCAS-1 Form 

• Attachment B: Close-out Interview Observation Notes 

The format of the checklist in Section 4.0 and the scoring system follows the procedures for this 

task approved by the Advisory Board. 

SC&A notes that comments regarding the qualifications of the ORAUT interview personnel are 

based on the interview with ORAUT. That interview is documented in Attachment B.
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2.0 OVERVIEW OF PROCEDURE USED IN THE CLOSE-OUT 

TELEPHONE INTERVIEW 

To comply with the objectives specified in 42 CFR 82.10(c), NIOSH developed a formal stepby-step process for conducting close-out interviews. The procedures set forth in ORAUTPROC-0092 have the objective of enabling the interviewer to review the draft dose 

reconstruction report with the claimant, and offer them an opportunity to discuss additional 

relevant information that may affect the dose reconstruction. The purpose of ORAUT-PROC0092 is to provide the process requirements for the scheduling, performance, and follow-up of a 

close-out interview for the dose reconstruction project. After completion of the close-out 

interview, the claimant is asked to sign and send in the OCAS-1 form to NIOSH within 60 days 

of the date of receipt of the draft dose reconstruction indicating that they have no other 

information to present. NIOSH has established a Close-Out Tracking Utility used to schedule 

the date and time for the close-out interviews (Hawkins and Shatto 2005). Specific comments 

from claimants are documented in the NIOSH OCAS Claims Tracking System (NOCTS) 

telephone log. The OCAS-1 form and the Authorization for Representation (if necessary) 

represent the only paper records generated in this process. A biweekly process quality review is 

conducted to identify and resolve close-out interview discrepancies. 

When the claimant asks technical questions or expresses concerns about the dose reconstruction 

report (DRR) that the interviewer cannot address, or provides additional information that may be 

relevant to the dose reconstruction, the interviewer documents the information “in as much detail 

as possible” (ORAUT-PROC-0092, p. 9) in the telephone log. The claimant’s questions are 

entered into the “Task 5 Feedback Loop.” [Note: Task 5 refers to the ORAU Team Dose 

Reconstruction group.] An HP Reviewer then researches the claimant’s concerns and questions, 

and arranges a follow-up call with the claimant. At this stage, the procedure does not require a 

contact with the dose reconstruction group; it assumes that the call back will be made by the HP 

Reviewer without such contact (ORAUT-PROC-0092, p. 10). SC&A notes that the procedure 

does not prohibit the HP Reviewer contacting the dose reconstruction group before the first 

follow-up call. However, according to the steps in the procedure, a health physicist would 

become involved only if the claimant continues to have concerns after two close-out interview 

calls: 

6.4 Follow-up for a close-out interview 

HP Reviewer 

6.4.1 Obtains claim numbers for follow-up calls from the Close-Out 

Tracking Utility. 

6.4.2 Researches the claimant’s concerns and questions. 

6.4.3 When the interview is ready to be scheduled, sends a request to the 

Schedulers. 
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applicability within the requirements of 42 CFR 82.

Scheduler 

6.4.3.1 Schedules a follow-up close-out interview in accordance with step 6.1. 

HP Reviewer 

6.4.4 Conducts the follow-up close-out interview at the scheduled time. 

6.4.5 If the claimant is satisfied with the responses and has no further 

questions: 

6.4.5.1 Completes the steps in step 6.3.3. 

6.4.5.2 Sends an e-mail to the designated Group Leader as well as the 

original Interviewer to notify them that the close-out interview has 

been completed. 

6.4.5.3 Enters responses to the claimant’s questions and concerns into the 

“Task 5 Feedback Loop” tab in the Close-Out Tracking Utility. 

6.4.5.4 If the claimant has additional questions that need research, explains to 

the claimant that the ORAU Team will call them back at another time. 

6.4.5.4.1 Details the additional questions in another “Task 5 Feedback Loop” 

request. 

6.4.5.4.2 Repeats the above steps starting from step 6.4.2. 

6.4.5.5 If the claimant has questions in which [sic] the HP Reviewer cannot 

answer and that need to be answered by Task 5, goes [sic] to step 

6.4.6. 

The first time that the procedure requires a contact with the Task 5 group is if the follow-up call 

did not resolve concerns and the claimant had “additional questions that need research.” 

Therefore, the claimant would get indirect feedback from the dose reconstruction group only on 

the third call, according to this procedure. A dose reconstructor or other health physicist never 

actually places the call himself/herself. 

For questions outside the purview of NIOSH, including questions about the POC, the claimant is 

asked to contact the Department of Labor (DOL). The close-out interview is completed after the 

DOL sends its response. 

In addition to its designated function of reviewing the dose reconstruction report with the 

claimants and giving the claimants an opportunity to provide additional information, the closeout interview is a means of interaction between NIOSH and the claimants, allowing NIOSH the 

opportunity to engender confidence in the dose reconstruction process. It is, therefore, an 
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important element in the relationship that NIOSH establishes with the public. Effective close-out 

interviews must consider both elements. 

SC&A requested that Arjun Makhijani and Kathryn Robertson-DeMers (two members of the 

SC&A team) be allowed to observe three close-out interviews (one with an energy employee and 

two with survivor claimants). In the course of the third close-out interview, technical questions 

were raised by the claimant that had to be referred to an HP Reviewer for a response. SC&A 

also requested that they be allowed to observe the follow-up close-out interview conducted by 

the HP Reviewer. Although the claimant was informed that members of the SC&A team were 

listening in on the interview, SC&A was not allowed to address NIOSH or the claimant during 

the interview. In addition, SC&A was not permitted to make any follow-up calls to, or other 

form of contact with, the claimant, because these cases had not yet been adjudicated and any 

comments or contact might affect that process in an impermissible way. SC&A also discussed 

the three interviews with the personnel who conducted them and their management. Because of 

their relevance to SC&A’s review of the procedure, the reader is strongly encouraged to 

carefully examine the compilation of the aforementioned interviews and the follow-up discussion 

with staff in Attachment B.
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applicability within the requirements of 42 CFR 82.

3.0 STRENGTHS OF ORAUT-PROC-0092 

The following strengths were noted in the procedure, OCAS-1 form, and the dose reconstruction 

report letter: 

• The logistical aspects of scheduling close-out interviews appear to be appropriately laid 

out. For the initial close-out interview, the scheduler calls the claimant to schedule the 

close-out interview 2 weeks after the draft dose reconstruction report is mailed to the 

claimant. Individuals are assigned as “floaters” on a weekly basis to conduct close-out 

interviews on the spot when requested by the claimant. Adequate Privacy Act protections 

are built into the interview process. The interviewers exhibit both good telephone 

etiquette and sensitivity to the claimant in going through the dose reconstruction step by 

step. The interviewers verify demographic data and document any discrepancies in the 

telephone log. 

• The latest revision of the dose reconstruction report is more understandable than previous 

versions in presenting issues in layman’s terms. This makes it easier for the interviewer 

to walk the claimant through the key parts of the draft dose reconstruction report. 

• Provisions are made for the examination of questions raised by the claimant, and for recontacting the claimant with answers. These include referral of questions to an HP 

Reviewer and potentially also to the dose reconstruction group. 

• Provisions are made for quality assurance checks on discrepancies identified in the Closeout Tracking Utility and for the subsequent correction of these discrepancies. There is a 

staff person designated to do “overall quality control reviews” ORAUT-PROC-0092, 

p. 4). 
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* Rating system of 1 through 5 corresponds to the following: 1=No (Never) or Poor, 2=Infrequently or inadequate, 

3=Sometimes or adequate with deficiencies, 4=Frequently or good, 5=Yes (Always) or excellent. N/A indicates not 

applicable. 

NOTICE: This document has been reviewed for Privacy Act information and has been edited accordingly. 

NOTICE: This report is pre-decisional and has not been reviewed by the Advisory Board for factual accuracy or 

applicability within the requirements of 42 CFR 82. 

4.0 PROCEDURE REVIEW CHECKLIST 

SC&A evaluated ORAUT-PROC-0092 in its entirety. Table 1 is a checklist of objectives that 

SC&A designed under the first phase of Task Order 3 to evaluate whether the procedure 

adequately supports the dose reconstruction process. 

Table 1. Procedure Review Outline/Checklist 

Document No.: ORAUT-PROC-0092 Effective Date: 8/17/2005 

Document Title: Close-Out Interview Process 

Reviewer: Arjun Makhijani/Kathryn Robertson-DeMers 

No. Description of Objective Rating 

1-5* 

Comments 

1.0 Determine the degree to which the procedure supports a process that is expeditious and timely for dose 

reconstruction. 

1.1 Is the procedure written in a style that is clear and 

unambiguous? 

3 The portions regarding 

documentation of the close-out 

interview are very clear. The term 

“Health Physics Reviewer” is 

misleading and connotes that a 

qualified health physicist will 

address technical questions raised 

by the claimant, whereas this is 

frequently not the case. Critical 

decisions about what should be 

referred to a health physicist are 

made by the HP Reviewers, none 

of whom have qualifications in 

health physics. 

1.2 Is the procedure written in a manner that presents the data 

in a logical sequence? 

5 

1.3 Is the procedure complete in terms of required data (i.e., 

does not reference other sources that are needed for 

additional data)? 

5 

1.4 Is the procedure consistent with all other procedures that 

are part of the hierarchy of procedures employed by 

NIOSH for dose reconstruction? 

3 There is no requirement to connect 

the closing interview to the CATI. 

The rationale for not using specific 

information provided from the 

CATI in the dose reconstruction is 

not required to be explained to the 

claimant. 

1.5 Is the procedure sufficiently prescriptive in order to 

minimize the need for subjective decisions and data 

interpretation? 

2 for interview 

steps and 1 for 

follow-up to 

claimant 

questions 

The procedure does not give 

examples of substantive 

information that must be 

documented in detail. The 

procedure does not provide 

information on how claimant 

questions are researched and 
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* Rating system of 1 through 5 corresponds to the following: 1=No (Never) or Poor, 2=Infrequently or inadequate, 

3=Sometimes or adequate with deficiencies, 4=Frequently or good, 5=Yes (Always) or excellent. N/A indicates not 

applicable. 

NOTICE: This document has been reviewed for Privacy Act information and has been edited accordingly. 

NOTICE: This report is pre-decisional and has not been reviewed by the Advisory Board for factual accuracy or 

applicability within the requirements of 42 CFR 82. 

Document No.: ORAUT-PROC-0092 

Table 1. Procedure Review Outline/Checklist 

Effective Date: 8/17/2005 

Document Title: Close-Out Interview Process 

Reviewer: Arjun Makhijani/Kathryn Robertson-DeMers 

No. Description of Objective Rating 

1-5* 

Comments 

answers determined. Procedure 

does not provide guidance for 

documentation of the close-out 

interview, leaving much room for 

subjective judgment 

(see Finding 1). 

2.0 Determine whether the procedure provides adequate guidance to be efficient in instances where a more 

detailed approach to dose reconstruction would not affect the outcome. 

2.1 Does the procedure provide adequate guidance for 

identifying a potentially high POC as part of an initial 

dose evaluation of a claim? 

N/A 

2.2 Conversely, for claims with suspected cumulative low 

doses, does the procedure provide clear guidance in 

defining worst-case assumptions? 

N/A 

3.0 Assess the extent to which the procedure accounts for all potential exposures and ensures that resultant 

doses are complete and based on adequate data in instances where the POC is not evidently clear. 

3.1 Assess quality of data sought via interview: ---- 

3.1.1 Is scope of information sufficiently comprehensive? 2 All claimants are at a disadvantage 

when reviewing the DRR provided 

from NIOSH. This report is highly 

technical and difficult for a layman 

to understand. Terms such as 

underestimate and overestimate are 

not adequately defined. Claimants 

do not have access to the DOE 

medical and dosimetry files for 

comparison to the DRR. Some 

claimants appear to be confused 

between POC and the dose 

numbers and the significance of 

each. The term “claimant 

favorable” may imply that a person 

is going to be compensated, when 

the contrary may be true. (See 

Attachment B and below.) Dose 

reconstructor or a qualified HP is 

never directly available to the 

claimant to fill the gaps. See 

Findings 2, 3, and 4. 

3.1.2 Is the interview process sufficiently flexible to permit 

 unforeseen lines of inquiry? 

4 for initial 

close-out 

interview and 1 

Claimants are offered the 

opportunity to ask questions of the 

interviewer, and if there is a follow 
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* Rating system of 1 through 5 corresponds to the following: 1=No (Never) or Poor, 2=Infrequently or inadequate, 

3=Sometimes or adequate with deficiencies, 4=Frequently or good, 5=Yes (Always) or excellent. N/A indicates not 

applicable. 

NOTICE: This document has been reviewed for Privacy Act information and has been edited accordingly. 

NOTICE: This report is pre-decisional and has not been reviewed by the Advisory Board for factual accuracy or 

applicability within the requirements of 42 CFR 82. 

Document No.: ORAUT-PROC-0092 

Table 1. Procedure Review Outline/Checklist 

Effective Date: 8/17/2005 

Document Title: Close-Out Interview Process 

Reviewer: Arjun Makhijani/Kathryn Robertson-DeMers 

No. Description of Objective Rating 

1-5* 

Comments 

for follow up 

close-out 

interview 

up, the HP Reviewer. Technical 

questions are not answered in real 

time, and a follow-up interview 

must be scheduled. The nature of 

the follow-up is not explained 

well. This unavailability of an HP 

in real time further detracts from 

the process because the claimant 

cannot pursue a certain line of 

thinking or determine the 

usefulness of additional 

information being offered. 

Retaining a thread of thought for 

days or weeks even with all the 

paperwork would be difficult for 

anyone, but would be especially 

difficult for claimants who usually 

do not have all the relevant 

documentation before them. 

Survivor claimants are at a 

particular disadvantage. 

3.1.3 Does the interview process demonstrate objectivity, 

 and is it free of bias? 

3 for 

employees and 

2 for survivors 

Process is objective in going 

through the dose reconstruction 

report. The procedure has no 

specific provision for responding 

to complaints about the difficulty 

that claimants have in 

understanding the dose 

reconstruction report. The 

procedure leaves room for undue 

and substantial subjectivity in 

addressing technical information 

provided by claimants. This 

problem is general, but it would be 

expected to affect survivor 

claimants more. 

3.1.4 Is the interview process sensitive to the claimant? 5 for etiquette 

and 

2 for substance 

of the 

communication 

The interviewers conducting the 

close-out interviews exhibit good 

telephone etiquette and try to 

answer the claimant questions to 

the best of their ability. 

The procedure does not have a 
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* Rating system of 1 through 5 corresponds to the following: 1=No (Never) or Poor, 2=Infrequently or inadequate, 

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applicable. 

NOTICE: This document has been reviewed for Privacy Act information and has been edited accordingly. 

NOTICE: This report is pre-decisional and has not been reviewed by the Advisory Board for factual accuracy or 

applicability within the requirements of 42 CFR 82. 

Document No.: ORAUT-PROC-0092 

Table 1. Procedure Review Outline/Checklist 

Effective Date: 8/17/2005 

Document Title: Close-Out Interview Process 

Reviewer: Arjun Makhijani/Kathryn Robertson-DeMers 

No. Description of Objective Rating 

1-5* 

Comments 

specific way to respond to frequent 

statements of claimants that dose 

reconstructions are difficult to 

understand. This puts the claimant 

at a serious disadvantage because 

they don’t know what to ask or 

what information may influence 

the dose reconstruction outcome. 

The absence of a thorough 

procedure to resolve issues can 

make the discussion of signing the 

OCAS-1 form in the same phone 

call complex and confusing for the 

claimant. See Findings 2 and 3.

3.1.5 Does the interview process protect information as 

 required under the Privacy Act? 

5 

3.2 Assess whether the procedure adequately addresses 

generic as well as site-specific data pertaining to: ---- 

3.2.1 Personal dosimeters (e.g., film, TLD, PICs) N/A 

3.2.2 In vivo/In vitro bioassays N/A

3.2.3 Missing dosimetry data N/A

3.2.4 Unmonitored periods of exposure N/A

4.0 Assess procedure for providing a consistent approach to dose reconstruction regardless of claimants’ 

exposures by time and employment locations. 

4.1 Does the procedure support a prescriptive approach to 

 dose reconstruction? 

N/A 

4.2 Does the procedure adhere to the hierarchical process 

 as defined in 42 CFR 82.2? 

N/A 

5.0 Evaluate procedure with regard to fairness and giving the benefit of the doubt to the claimant. 

5.1 Is the procedure claimant favorable in instances of 

 missing data? 

N/A 

5.2 Is the procedure claimant favorable in instances of 

 unknown parameters effecting dose estimates? 

N/A 

5.3 Is the procedure claimant favorable in instances where 

 claimant was not monitored? 

N/A 

6.0 Evaluate procedure for its ability to adequately account for the uncertainty of dose estimates. 

6.1 Does the procedure provide adequate guidance for 

 selecting the types of probability distributions 

 (i.e., normal, lognormal)? 

N/A 

6.2 Does the procedure give appropriate guidance in the 

 use of random sampling in developing a final 

N/A 
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3=Sometimes or adequate with deficiencies, 4=Frequently or good, 5=Yes (Always) or excellent. N/A indicates not 

applicable. 

NOTICE: This document has been reviewed for Privacy Act information and has been edited accordingly. 

NOTICE: This report is pre-decisional and has not been reviewed by the Advisory Board for factual accuracy or 

applicability within the requirements of 42 CFR 82. 

Document No.: ORAUT-PROC-0092 

Table 1. Procedure Review Outline/Checklist 

Effective Date: 8/17/2005 

Document Title: Close-Out Interview Process 

Reviewer: Arjun Makhijani/Kathryn Robertson-DeMers 

No. Description of Objective Rating 

1-5* 

Comments 

 distribution? 

7.0 Assess procedure for striking a balance between the need for technical precision and process efficiency. 

7.1 Does the procedure require levels of detail that can 

 reasonably be accounted for by the dose reconstructor? 

N/A 

7.2 Does the procedure avoid levels of detail that have only 

 limited significance to the final dose estimate and its 

 POC? 

N/A 
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5.0 SIGNIFICANT FINDINGS PERTAINING TO PROCEDURES 

5.1 REVIEW OF FINDING 1 

Finding 1: The close-out interview procedure does not ensure that the HP Reviewer and 

dose reconstruction group fully address claimant concerns raised during the close-out 

interview. The procedure has many gaps relating to response to claimant concerns. 

The gaps identified in regard to response to claimant concerns are as follows: 

(1) The procedure does not prescribe how claimant questions should be researched and how 

answers should be determined. 

(2) There are no clear criteria for the type of claimant information that would require a 

review by a health physicist, or for a review of the CATI or dose data in the claimant file. 

(3) There is no explicit requirement to carefully check whether all information corresponding 

to the concerns has been appropriately taken into account in the dose reconstruction. 

(4) There are no clear criteria for documentation of the close-out interview or of the followup calls. This creates the potential for inconsistencies between interviewers and for 

omission of important information. 

(5) The HP Reviewers, who make key decisions about research of the claimants’ concerns 

and who communicate with the claimants, do not have health physics qualifications or 

experience in dose reconstruction, according to interviews with their managers (see 

Attachment B).2

(6) There are no specific requirements for documentation of the response provided by the 

dose reconstruction group when concerns are referred to them. This creates the potential 

for inconsistency in how concerns are addressed and prevents holding the dose 

reconstruction group accountable in cases where the concerns were not fully addressed. 

As noted above, ORAUT-PROC-0092 provides the interviewer with a step-by-step process for 

setting up and going through the interview. When the claimant asks questions about the DRR 

that cannot be answered by the interviewer, or additional information is provided, the interviewer 

documents the concern or information “in as much detail as possible” in the telephone log. The 

claimant’s questions are entered into the “Task 5 Feedback Loop.” However, the procedures do 

not require the interviewer to inform the claimant about the qualifications of the HP Reviewers 

who respond to technical questions that cannot be answered by the interviewer or provide clear 

information on how claimant questions are answered and researched. 

 

2

 The SC&A observers requested that ORAUT provide them with the qualifications of the HP Reviewers, 

but due to procedural issues, they were not available in time. 
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According to the procedure, the HP Reviewer does the research on the concerns and makes the 

follow-up call; contact with a health physicist is not required at this stage. But the procedure 

does not provide the HP Reviewer with examples, specific guidance about what to research, or 

when it may be necessary to refer to the dose reconstructor before calling the claimant back. On 

the contrary, the procedure implicitly assumes that the HP Reviewer will be able to resolve all 

concerns without resorting to contact with, or information from, the dose reconstructor. 

If the claimant still has concerns during the follow-up interview that the HP Reviewer cannot 

address, the HP Reviewer documents these concerns and requests a response from the Dose 

Reconstruction Group Manager. The latter then provides a response, which the HP Reviewer 

must understand and communicate it to the claimant. Neither the dose reconstructor nor any 

other member of the dose reconstruction group ever speaks directly to the claimant. For 

questions outside the purview of NIOSH, including questions about the POC, the claimant is 

asked to contact DOL and is provided with the contact information to do so. 

These procedural steps require the HP Reviewer to make substantive decisions on what 

information is relevant to the concerns expressed by the claimant and whether those concerns 

could affect the particular dose reconstruction. Guidelines on or examples of when claimant 

concerns might affect a dose reconstruction, and hence require the input of the dose reconstructor 

or other health physicist, are not provided in the procedure. 

The lack of specific guidelines and examples is a particular problem, because none of the four 

HP Reviewers is a health physicist or has experience in dose reconstruction, according to their 

managers (Attachment B). Without defined criteria, there is unlikely to be consistency in the 

way in which technical information provided by the claimant during the close-out interview is 

handled, with the likelihood that it could be mishandled. This appears to have been the case in 

the following two instances that SC&A examined, where the claimant expressed technical 

concerns during the initial portion of the close-out interview: 

(1) Information given during one of the close-out interviews observed by SC&A on October 

11, 2006 (Case #3). 

(2) Information provided by an employee during a site expert interview done by SC&A 

while reviewing a TBD. 

We will review the specifics of each case to illustrate the critical importance of having a 

specified procedure to evaluate the technical information provided by claimants during the closeout interview and to report back to them once the investigation is complete. 

5.1.1 Close-Out Interview Observation (Case #3) 

In the close-out interview observed by SC&A (conducted by Rachel Hume, ORAUT), the 

claimant described a situation where the energy employee (claimant’s spouse) was sent to other 

facilities for in-vivo counting. In the initial submittal of the claim, the claimant provided a letter 

from a national laboratory indicating that the results of the in-vivo testing from the national 

laboratory were not in agreement with the in-vivo counts from the facility where the employee 
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worked (home facility). The claimant was concerned about the discrepancy mentioned in the 

correspondence from the host facility, and asked whether this information was taken into account 

in the dose reconstruction. The claimant raised serious concerns regarding the accuracy of the 

data from the home facility, and specifically stated that the readings in the home facility were 

“low” and “false:” 

Rachel Hume (ORAUT): Did he work there at [the national lab] or was he just 

tested there? 

Claimant: He was just being tested there. The letter showed that readings at [the 

site where he worked] were way off. 

Rachel: I am making handwritten notes. I want to send this over so reviewers 

can look at it. So they said records of [the site where he worked] were off? 

Claimant: Yes, Low. Very low. [Sentence deleted regarding matter not 

concerning dose reconstruction.] He visited [the national lab] once. They said 

his readings were all wrong. I know he went to another place too and I don’t have 

anything on that. I don’t have any information on the other facility. 

Rachel: Is there something else you want to go over or specific questions? 

Claimant: No, a lot of this I don’t understand. I just don’t understand how you 

came to this conclusion [about probability of causation] based on false 

information. 

In response to this question, the interviewer documented the details of the concern and forwarded 

the question to an HP Reviewer. 

SC&A’s review of the claimant’s DOL and DOE file identified the letter submitted by the 

claimant, in addition to external, urinalysis, and in-vivo monitoring data (DOL file, pp. 72-83). 

The letter and a corresponding incident report were not available in the DOE file. The national 

laboratory in-vivo monitoring data was listed under the mobile unit data in the energy 

employee’s dosimetry record. Sending individuals to other sites for in-vivo counting is usually 

the result of an incident. The claimant did state that the employee was “constantly hot” and that 

other employees were sent with him to the national laboratory. Furthermore, the national 

laboratory recommended that the individuals be counted at Battelle Pacific Northwest 

Laboratory, since the discrepancies had not yet been resolved. There are no data available in 

either the DOE or DOL file related to further in-vivo counts at Battelle, although the claimant 

indicated that the energy employee was sent for monitoring at more than one offsite location. 

Not only are there questions related to whether the national laboratory information was used in 

the dose reconstruction, but the completeness of the dosimetry file is also in question. There is a 

letter in the file indicating the date that the employee was to be sent to Battelle, but there are no 

actual measurements from Battelle in the file. 
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applicability within the requirements of 42 CFR 82. 

The information provided by the claimant was specific (including the name of the national 

laboratory). The letter relating to that laboratory’s measurements was also provided by the 

claimant. The allegations made by the claimant based on the claimant’s understanding of the 

material were of the most serious kind – false information in the dose record and systematically 

low in-vivo counts. The claimant was emphatic and repeated the problem many times. 

After the follow-up call, SC&A asked questions of the HP Reviewer regarding the process and 

how the HP Reviewer responded to the claimant’s question. 

SC&A: Did you look at the [national lab] data she was talking about before 

making the call? 

Brian Kaske (ORAUT): No. That was the DR’s decision as to whether to look at 

it or not. I did not look it. 

SC&A: Brian represented that the DR was claimant favorable. She had 

mentioned that the [national lab] lung count was higher than the [site name] 

count. But you did not look at [national lab] data or verify with DRist? 

Brian: No, I did not. We assume that all data was used. 

SC&A: But Rachel told her that she would refer the specific issue of the [national 

lab] measurement to the HP Reviewer. The claimant mentioned it at least a 

dozen times, that the [national lab] measurement being higher was the critical 

problem in how she viewed the dose reconstruction. She said that the higher 

measurement from [national lab] was the issue for her. Do you agree that she 

mentioned it at least a dozen times between the close-out interview and the 

reviewer call? 

Ray: Yes, she did mention it at least a dozen times. 

SC&A: I just want to make sure. Did you look at all at the [national lab] data 

before assuring her that the dose reconstruction was claimant-favorable, given 

that that was her main problem? 

Brian: I looked at a letter in the claim file. 

SC&A: Did you look at any data from [the national lab]? Any measurement to 

check if the actual value of lung burden or intake used from the urine data in the 

dose reconstruction was claimant favorable compared to the measurement from 

[national lab] she was putting before you? 

Brian: I did not look at any numbers. I looked at the letter from [the DOE 

contractor] stating that [national lab’s] measurements were different than [those 

of the site]. 
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applicability within the requirements of 42 CFR 82. 

SC&A: Yes, I heard you read that to the claimant. Thanks. I just wanted to 

verify whether you looked at the [national lab] data, because that is what the 

claimant put forward. 

There were data available and clearly identified as national laboratory in-vivo data in the DOL 

file immediately following the letter referenced in the above discussion. Furthermore, the site 

was unable to explain the discrepancy between the site measurement and the national laboratory 

measurement, which is why the matter appears to have been referred to Battelle Pacific 

Northwest Laboratory (Battelle). No information from Battelle is in the DOE or DOL files. 

SC&A is not making any comment about the alleged discrepancies or the dose reconstruction. 

SC&A notes the following as relevant to this review of the close-out interview procedure: 

• The claimant raised what appear to SC&A to be substantial and technically difficult 

issues 

• In the view of SC&A, a referral of the matter to the dose reconstruction section appears 

to have been warranted, given the nature and timing of the measurements (in-vivo and 

bioassay) 

However, the dose reconstruction group was not contacted as part of the review of the claimant’s 

concerns. This means that neither the dose reconstructor nor any other HP became aware of the 

claimant’s concerns during the close-out interview process. The HP Reviewer who responded 

simply assumed that the dose reconstruction was claimant favorable, without any technical 

review of the data. He also assumed, without checking with the dose reconstructor, that all 

relevant information, including the data that the claimant was referring to, had been taken into 

account. He did not look at any data himself before recontacting the claimant. Nor did he clarify 

any of the other issues raised by the claimant, such as whether the data were “false” or “wrong,” 

or the possibility that the employee had been moved about from one area to another, including to 

chemical operator work. According to notes on the follow-up interview prepared by the HP 

Reviewer, the in-vivo results were not used in the dose reconstruction. The HP Reviewer 

explained that the urinalysis records were used to assign missed internal dose. It was explained 

to the claimant that the assumptions made were claimant-favorable and took into account the 

potential for exposure that may not have been captured in the energy employee’s record. It was 

noted that the claimant understood and accepted these responses (Kaske 2006). Despite the fact 

that the claimant accepted the responses, it is clear that the in-vivo results were not re-considered 

after the claimant raised concerns, and that the claimant concern related to “false” data was not 

specifically addressed. The HP Reviewer did not discuss the incompleteness of the DOE file 

with the claimant. SCA’s review of the DOL and DOE files indicate letters relating to 

inconsistent in-vivo count data were absent from the DOE dosimetry file, but present in the DOL 

file. As noted, the employee appears to have been sent to Battelle, but those data were not 

available at all. 

SC&A observed that the initial interviewer’s notes were rather brief, but were substantive 

enough (including the use of the term “false” to describe the allegation about the on-site in-vivo 

data) to have communicated the gravity of the allegations to the HP Reviewer. Hence, the first 

part of the procedure appears to have been successful, so far as summarizing the main issue, 
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though we note that there was an error in the notes of the call. (The notes state that the employee 

was sent to the national laboratory for “medical testing,” whereas the employee was sent for invivo counting. However, the letter about the in-vivo counting in the claim file would have 

cleared up any confusion on this count). 

SC&A has concluded that the concerns raised by the claimant were not adequately researched 

and evaluated by the HP Reviewer. The actual research done by the HP Reviewer to respond to 

the claimant’s concerns, such as the names of the documents reviewed and names of the people 

who were contacted, is not documented and not required by the procedure to be documented. 

The HP reviewer affirmed that use of urine data was clamaint favorable without actually 

reviewing either the urine data or the in-vivo data, or getting the opinion of the dose 

reconstructor to check out that issue. 

Given information observed in the file by SC&A and the statements of the HP Reviewer himself, 

it is evident that the HP Reviewer did not conduct an evaluation of the claimant’s question that 

could be described as careful or responsive to the claimant’s core technical concerns about 

“false” data, “wrong” data, and contradictions between the site data and the national laboratory 

data. 

 

Furthermore, SC&A has concluded that the concerns raised by the claimant were serious enough 

to have merited a review by a health physicist of the data provided by the national laboratory, 

and a check to see whether the dose reconstruction was actually claimant favorable. In any case, 

the matter should have been referred to the dose reconstructor (via the Manager of the dose 

reconstruction task – Task 5 for the ORAUT). It would have been the responsibility of the dose 

reconstructor or another health physicist to decide whether the data were “false” or not, and 

whether the dose reconstruction could be reaffirmed to be claimant favorable without addressing 

the unresolved issue of the specific in-vivo counts of concern to the claimant. It was 

inappropriate for the HP Reviewer to reaffirm that technical judgment to the claimant without 

any reference to the dose reconstructor or to the underlying data. 

The procedural root of this problem is the lack of specific guidance, with examples, for the HP 

Reviewer as to when to refer a case to the dose reconstruction part of the ORAUT. The HP 

Reviewer makes the first determination whether the information provided by the claimant affects 

dose reconstruction and if it should be referred to the dose reconstructor, although they are not 

trained in dose reconstruction. There is a mechanism in place to refer questions to the dose 

reconstruction group, but this is only required if a second follow-up call is deemed necessary by 

the HP Reviewer. 

5.1.2 Close-Out Interview Information Gathered during Site Expert Interview 

SC&A conducts site expert interviews in the course of preparing for a TBD review. The SC&A 

procedure includes interviews with workers representing various job types, so that SC&A can 

benefit from the different kinds of experience and expertise of the workers at the site. This 

interview was with an employee whose job likely required presence during and after incidents. 

The energy employee had a skin cancer on a part of the body that would be expected to be 

vulnerable to deposited radionuclides, notably in the absence of anti-contamination clothing. In 
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the CATI, the employee indicated that he used respirators and anti-contamination clothing “only 

in the 1990s.” The employee started work in the 1970s, and indicated being involved in many 

incidents with radiological materials present. It is clear that this was in the nature of the energy 

employee’s job. No specific dates were offered, but the employee did list one specific 

radioactive element involved. 

The draft dose reconstruction was sent to the energy employee in 2005. It contained the 

following about the use made of the CATI (redacted for privacy): 

The record of the telephone interview was evaluated carefully by the dose 

reconstructor. During the interview, it was mentioned that several tasks or 

locations associated with [redacted] job assignments involved radiological 

material or areas. This is typical for radiation workers at DOE facilities, and the 

dosimetry practices are designed to record exposures associated with these 

environments. There were no specific events mentioned that indicate [redacted]

was involved in a radiological incident. In addition, no radiological incidents 

were reported by the Department of Energy. Therefore, no additional 

information affecting the dose reconstruction was identified.

The draft dose reconstruction failed even to mention that the claimant had asserted involvement 

in many incidents or that the nature of his job made it likely that he would be involved in 

incidents. Moreover, the skin cancer involved a part of the body that is not normally monitored 

for external exposure. The draft dose reconstruction does not refer to any method that was used 

to relate the dose recorded on the badge to the site of the cancer. The job descriptions in the 

draft dose reconstruction did not accurately reflect those in the Employer data header in the 

CATI. The employee was advised not to sign the OCAS-1 form and that ORAUT would get 

back to him. 

SC&A is not providing this background information as a comment on the dose reconstruction, 

but as a reflection of important gaps in the interview procedure and in connecting the substantive 

technical information in interviews (both the CATI and the close-out interview) to the dose 

reconstruction. Given that the employee was evidently very knowledgeable, he raised objections 

during the close-out interview and again stated he had been involved in incidents. This time, he 

was able to provide very substantial details about one incident and a 5-year time window during 

which the incident occurred. He named three co-workers who were involved with him. He 

provided information on where the incident files were likely to be located, and stated that such 

records would not be in the employee’s DOE file. It would be surprising if the type of incident 

he described did not have an incident report associated with it, even if it was not in the 

individual’s DOE file. There is no record in the close-out interview log that any attempt was 

ever made to locate the incident report or contact any of the coworkers. 

The close-out interview follow-up interview notes are sparse. In fact, the HP Reviewer’s followup comments merely indicate that an explanation of the claimant’s questions regarding his work 

was provided, and that the claimant was satisfied. During the site expert interview, this 

individual expressed misgivings towards the method of internal dose assignment, which indicates 

the claimant was not satisfied (Walsh 2005). The follow-up notes do not have any substantive 
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information on how the matter of incidents was resolved. The employee did sign the OCAS-1 

form and was denied. 

These details are also relevant to this procedure review because of events subsequent to the first 

close-out interview. The paper trail indicates that the dose reconstruction was not changed at all. 

Further, the date on the final dose reconstruction predates the close-out interview and is the 

same as the draft dose reconstruction. The language regarding use of claimant information in the 

final dose reconstruction is identical to that in the draft dose reconstruction and does not refer to 

the information provided by the employee on the specific incident. In other words, the draft dose 

reconstruction was made final as it was prior to the close-out interview, and it was sent to the 

claimant and DOL with a cover letter following the date of the close-out interview. 

From the above facts, one may infer that both the information in the CATI and the much more 

specific information in the close-out interview about incidents were not adequately researched or 

completely ignored. Since the date of the final dose reconstruction letter precedes the close-out 

interview, and since it is identical to the draft that was sent prior to the close-out interview, there 

is no documented record that any attempt was made to recover the files from the department 

referred to by the claimant. The close-out interview record does not even indicate that an HP 

Reviewer looked at the information, nor does it indicate that the dose reconstructor was informed 

about the specific data provided about an incident, including a rather narrow timeframe for the 

type of incident that occurred, which was an unusual occurrence. 

This reinforces the conclusion from the first example discussed above that the close-out 

interview procedure has a serious gap regarding what information from the claimant must 

be referred to the HP Reviewer and then, in turn, to the dose reconstruction department of 

ORAUT. 

The following conclusions emerge from the two case studies where SC&A examined 

documentation of the follow-up to the initial close-out interview because the claimant provided 

information relevant to dose reconstruction: 

(1) ORAUT-PROC-0092 has serious gaps related to a lack of specificity about what 

information should be referred to an HP Reviewer and to the dose reconstruction 

department of ORAUT. 

(2) The procedure also has no specifications or examples of what kinds of follow-up are to 

be expected when detailed information is provided. In both cases examined, the 

claimants provided specific information, yet the evidence is that the underlying data were 

not reviewed in one case and no attempt was made to obtain the relevant reports in the 

other. In one case, the date on the final dose reconstruction actually predates the closeout interview, despite the fact that the employee provided detailed, new information 

during the close-out interview. 

(3) The level of detail in documenting the close-out interview process during the follow-up 

call was very different in the two cases discussed above. In the first case, the HP 

Reviewer provided a much more detailed summary in the close-out interview record than 
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in the second case. The lack of specific documentation procedures for research and for 

the communication of the resolution of concerns creates the potential for inconsistencies 

and arbitrariness in how concerns are researched, communicated, and resolved. 

(4) In both cases, substantive information provided by the claimant was not addressed by a 

dose reconstructor. In one case, SC&A is aware that the information was not referred to 

the dose reconstructor. In the second case, this can be inferred from the identical 

language in and dates on the draft and final dose reconstruction letters. 

5.1.3 Suggestions for Improvement related to Finding 1 

The following suggestions for improvement relate to Finding 1: 

(1) Claimants should be informed that HP Reviewers are not Health Physicists. The term 

“HP Reviewer” should not be used to refer to personnel without qualifications or 

experience in health physics. 

(2) The potential for inconsistencies and for arbitrary judgments by HP Reviewers should be 

significantly decreased by detailed written guidelines for and examples of how concerns 

should be researched and when they should be referred to the dose reconstruction group. 

The two examples discussed above can be used as case studies for lessons learned in 

developing those guidelines. 

(3) The procedure should include instructions that HP Reviewers should make detailed notes 

about what was done to address claimant concerns and how they were resolved. This 

should include specific references to documents reviewed, personnel consulted, and 

details of how the issues were resolved during the follow-up call. 

(4) All claimant concerns relating to dose, data, intakes, exposure, or incidents should be 

referred to the dose reconstruction group for a response. The response should fully 

address the concern and should be in writing. The written document should be provided 

to the claimant as part of the follow-up process. 

SC&A has observed three close-out interviews and examined two cases of close-out interviews 

in which the claimant provided information and expressed concerns that required follow-up. The 

fact that very substantial issues arose in this small number of cases would raise questions about 

the extent of the problems, even without further information. But in these cases, the problems 

appear to arise largely from the gaps in the procedure, and from the technical decisions about 

what to review and not to review by HP Reviewers, who have no health physics qualifications or 

dose reconstruction experience, according to ORAUT (see Attachment B). This raises a clear 

possibility that the lack of adequate follow-up of claimant concerns is systemic. This needs to be 

determined, given the crucial nature of the close-out interview in the dose reconstruction and 

compensation process. Therefore, it would be highly desirable for the Advisory Board directly 

or via the Work Group to investigate how widespread these problems may be. 
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A part of this investigation might consist of re-interviews by the Board, directly or through the 

Work Group, of the two claimants’ cases discussed above, provided they are amenable to that, of 

course. This would help in evaluating the adequacy of changes in the close-out interview 

procedure that NIOSH/ORAUT might propose. It would also throw some light on the workerinterview and site-expert documentation procedure and the ways in which that information, as 

well as information in the CATIs, is being used. SC&A recognizes that the site expert 

documentation is being separately reviewed by the Advisory Board and is making this comment 

here in the interest of assisting a coordinated review of various kinds of input provided to 

NIOSH and ORAUT. 

5.2 REVIEW OF FINDING 2 

Finding 2: The procedure makes no substantive provision for ensuring that the claimant 

actually understands the dose reconstruction and its implications as part of DOL’s 

compensation decision prior to signing the OCAS-1 form, even when the claimant 

complains that they do not understand the “lingo.” 

The interviewers exhibited good telephone etiquette and sensitivity to the claimant in going 

through the dose reconstruction step by step. However, during the course of the close-out 

interview observations, comments were made by claimants indicating that they did not 

understand the dose reconstruction report. Examples are presented below: 

Claimant 1 Close-Out Interview 

Gwen Knox (ORAUT): Radiation exposure is measured in rem – that is a unit of 

radiation. We use it in calculating Probability of Causation (POC). We only 

looked at dose to the lung. The estimated dose of XXXX rem produced more than 

50%; once this threshold is crossed we do not consider the case any farther. This 

case used a partial estimation of dose. Do you have any questions at this point? 

Claimant: A lot of it I don’t really understand. 

and 

Claimant: So he was exposed to radiation? 

Gwen: Yes. 

Claimant: I thought when he wore the badge it would tell you the dose. 

Gwen: His badge measured external radiation. He did wear a badge. 

Claimant: I don’t really know because my guy never spoke about it. I am kind of 

left in the dark. He never really talked to us about anything. I was pretty young 

at the time. 
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Gwen: This is common due to security at this time. That’s why we don’t just rely 

on interviews, but we rely on several sources of information, including site 

records and technical basis documents. 

Claimant: As far as I understand, which is not a lot of it. My guy was exposed to 

at least 50%. 

Gwen: That is the probability of causation. It was greater than 50%, so his 

cancer was more likely than not caused by radiation. However, NIOSH does not 

make the formal determination. The DOL is responsible for determining the 

Probability of Causation. 

Claimant 3 Close-Out Interview 

Rachel Hume (ORAUT): Is there something else you want to go over or specific 

questions? 

Claimant: No, a lot of this I don’t understand. I just don’t understand how you 

came to this conclusion [about probability of causation] based on false 

information. 

Rachel: This needs to be looked into, but for now let’s go on to the bottom of 

page 4. The information used for the dose reconstruction included dosimetry 

results from the Department of Energy, technical basis documents, and 

procedures. 

and 

Rachel: Let’s talk about ambient dose. Though he was monitored, onsite ambient 

dose, that’s a dose that he might have received while outside, was assigned to 

him. 

Claimant: I don’t understand that. 

Rachel: Is this something you want me to go over? 

Claimant: I don’t understand it. I don’t understand the lingo. This is not in the 

medical records. 

Rachel: This is dose that is added that may not have been recorded. Onsite 

ambient dose would not be in his medical records. 

Claimant: So that is separate from the mobile unit that was completely off? 

Rachel: Yes. Let’s go to internal dose. 
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The interchanges illustrate the attempts that interviewers make to clear up misunderstandings; 

however, the nature of the information is so complex that essential issues may still not be 

understood or even properly addressed. For instance, in the case of Claimant 3, the term 

“ambient dose” was briefly explained, but the claimant did not appear to understand it. 

Claimant 1 was confused between probability of causation and dose. 

The second concern of Claimant 3 about “false information” was referred to the HP Reviewer. 

The issue of the probability of causation came up in that context. It provides further evidence 

that claimants may be confused between POC calculated by DOL and the dose estimates 

compiled by NIOSH, and the significance of each. The interchange between the HP Reviewer 

and the claimant in Claimant 3 is very instructive on this point. The claimant stated during the 

close-out interview and then during the follow-up interview that he/she did not trust the site, that 

the site data were “wrong” or “false,” and that a national laboratory had produced higher 

readings. The HP Reviewer reviewed a letter, but did not review the underlying data prior to the 

call. The interviewer also stated that the claim was likely to be less than 50% POC. That is the 

context of the following exchange (Attachment B, emphasis added): 

Brian Kaske (ORAUT): On page 8, it says that recycled uranium was processed 

at [site name] and that was assumed also. It has plutonium, neptunium, and 

technetium in it. These were included also. He had confirmed positive dose since 

his urinalysis did show that his measurements were greater than the minimum 

detection limit. A claimant-favorable assumption of Type S was used for the 

[Cancer type], and Type F was used for the [cancer type]. He has multiple acute 

intakes, which were assigned for the [organ name] system and a concurrent dose 

for [organ name]. The dates are there for assumed acute intake dates. They also 

used an assumption that the uranium was enriched. This is also claimant 

favorable. The dose was assigned beyond that in the records. 

Claimant: That’s good. That’s what was bugging me. I sent the records in, 

including his appointment log. 

Brian: Yes, we have his appointment logs. Any other questions? 

Claimant: I think that is what was bugging me. Also the notes I sent by Dr. 

XXXX. His appointment log is in the claimant file. I sent it in, because we could 

not get in touch with Dr. XXXX. 

Brian: All those materials will be sent to the Department of Labor when the dose 

reconstruction report is forwarded. Anything else? 

Claimant: If you need anything else? I guess that was it. It was just bugging me 

that all this was wrong. I wouldn’t trust anything from [site name]. 

Brian: Okay. Acute intakes were assigned based on [Name’s] positive urinalysis 

results. In addition to this, a chronic exposure was assigned to account for 

missed dose. All of these assumptions made this DR claimant-favorable. 
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Claimant: Yes 

Brian: The next step is to send in the form if you feel all your questions have been 

answered. 

Claimant: In other words, all this is favorable. Where do we go from here? 

Brian: We need the OCAS-1 signed and returned, as long as we have covered all 

your questions. 

Claimant: If you think all this is favorable, I will go ahead and sign it. I don’t 

know where we go from here. [My daughter] did not think it was very favorable. 

She said they really worked him over. I was very skeptical.

Brian: I do want to confirm a couple of things. On page 4 under the dose 

reconstruction overview, it says that even under these [claimant-favorable] 

assumptions, NIOSH has determined that with further research and analysis, the 

probability of causation won’t be 50% or greater.

Claimant: How much does it have to be? 

Brian: That’s a good question. This is individual-specific and is based on the 

person’s date of birth, hire date, termination date, cancer type, and unique 

monitoring history. The dose reconstruction report does not provide a 

percentage, but it provides a dose. XXXX rem was received by the XXXX and 

XXXX rem was received by the XXXX. This is not a POC. 

Claimant: So what does it mean? 

Brian: It’s the amount of radiation energy that NIOSH assumed he could have 

received. They are amounts of energy. This is not a decision.

Claimant: I don’t see how the Department of Labor could be any different. 

There is enough evidence here to prove the claim. 

Brian: The Department of Labor determines claim outcome. NIOSH does not 

adjudicate claims. If they deny you, you can appeal. 

Claimant: I don’t know how they could come up with another decision. 

[Sentences not related to dose reconstruction deleted.] 

Brian: It’s OK to be skeptical. 

Claimant: I am an old lady and I have seen a lot of dishonesty. 
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Brian: Let me give you my number, so you can contact me if you have any 

questions. 

Claimant: Is this the same as Rachel’s? 

Brian: As you continue through the process, feel free to call me or the DOL. It 

will take about 2-8 months for a decision. Claimants have said it is closer to 

2 months. 

Claimant: Very good. 

Brian: You can call the DOL Cleveland office to find out the status of the claim. 

You can call to ask them anything. 

Claimant: They are good at providing me with a note. 

Brian: The contact information for DOL is on any correspondence. Are there 

any other questions? 

Claimant: No 

Brian: Two things will be different on the final DRR. First, the DRAFT will be 

changed to final. Second, there will be nothing included to sign. Once you 

receive this report, this indicates the DR has been sent to DOL. 

Claimant: That will be good. 

Brian: Labor will provide a decision. 

Claimant: With all this information, I don’t see how they can deny it. It was 

enough to kill him. 

Brian: If you are denied, there is a process to appeal the claim. Best of luck! 

Give me a call if you need further assistance. 

The above interchange is illustrative of the potential for confusion between a “claimantfavorable” dose reconstruction and a favorable result regarding compensation in the absence of a 

clear distinction between the two being made in the context of the discussion. SC&A notes that 

the NIOSH Glossary of Terms sent to the claimant does state that the dose reconstruction is used 

to determine the POC. Furthermore, the HP Reviewer made a statement about probability of 

causation being less than 50%, but made no clear statement that a determination of less than 50% 

POC would mean denial if the DOL accepted the NIOSH dose reconstruction report. 

The claimant’s next question, “How much does it have to be?,” appeared to be related to a 

threshold for compensation. It was perhaps not understood that way. But the issue of outcome, 
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given the dose estimate, was not addressed. Rather, the answer was about the variation in level 

of dose required for different organs for a 50% POC. 

The claimant apparently continued to believe that the claim was likely to be compensated (“With 

all this information I don’t see how they can deny it.”). This impression was not corrected by the 

HP Reviewer, but followed with a conditional statement (“if you are denied”) and a “best of 

luck!” 

The claimant was apparently convinced enough by this interchange to set aside his/her 

skepticism that she/he signed the OCAS-1 form the same day as the above interchange. It is 

unknown if she contacted her daughter, who “did not think it was very favorable,” prior to 

signing the form. The radiation-related claim (Part B claim) was denied. 

42 CFR 82 states that the closing interview should “review the dose reconstruction results and 

the basis upon which the results were calculated” with the claimant. If the claimant cannot 

understand the basis of the dose reconstruction, a significant part of the purpose is defeated. This 

is made more problematic by the fact that the close-out interview is the last opportunity for the 

claimant to provide information during the NIOSH dose reconstruction process that could affect 

their claim. 

5.2.1 Suggestion for Improvement related to Finding 2 

(1) The interviewer should clearly communicate to the claimant the implication of the dose 

reconstruction for compensation with a declarative statement. Claimants should be told, 

according to the dose reconstruction, whether the claim is likely to be compensated or not 

compensated, with the caveats that (1) DOL may return the dose reconstruction for reevaluation, and (2) the decision on compensation is made by DOL. 

5.3 REVIEW OF FINDING 3 

Finding 3: The fact that the signing of the OCAS-1 form (if it has not been signed before) 

occurs in the context of the close-out interview may create pressures on ORAUT personnel 

to get the signature before being certain that all issues of concern to the claimant have been 

fully addressed. 

As noted above, the claimant has a 60-day period after receipt of the draft dose reconstruction 

report in which to sign the OCAS-1 form. If the claimant does not sign it in that time period, 

NIOSH may administratively close the case. The claimant, therefore, faces considerable 

pressure to sign this form. 

At the same time, the close-out interview is the last time that the claimant can provide more 

information for the dose reconstruction during the NIOSH process or get concerns resolved 

about whether and how information previously supplied was used. This creates a pressure on the 

claimant in the opposite direction—of making sure that all information has, in fact, been given to 

NIOSH, and that it has been taken into account properly. 
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SC&A understands the need for a time limit to sign the OCAS-1 form. However, the 

enforcement of that provision in the face of a statement that the claimant does not understand the 

dose reconstruction report or in the context of concerns not having been fully researched raises 

equity concerns. SC&A is making this statement in the context of the lack of any provision in 

the procedure to ensure that the claimant manifestly understands the basics that are at issue: 

• How the work done by the employee and the information in the CATI are related to the 

dose reconstruction 

• How the concerns raised were substantively researched and addressed 

• What the dose estimate and the POC have to do with compensation 

• Whether the case will be compensated or not if the dose reconstruction is accepted by 

DOL 

SC&A understands that the procedure does go through these points to some extent, except the 

last one, but the claimant statements of a lack of understanding were made in the context of 

NIOSH/ORAUT explanations. This occurred in two of the three cases that SC&A observed. 

Neither of the telephone log summaries noted that the claimant stated that they did not 

understand the dose reconstruction letter or the “lingo;” hence, the statements of a lack of 

understanding were not only unaddressed, they were not even noted. 

The fact that the appeals process at the DOL level is limited to challenging factual information 

used in dose reconstruction makes the gap in the procedure all the more burdensome. The DOL 

Final Adjudication Branch (FAB) review process includes a statement that it is NIOSH that has 

“full authority” to do dose reconstruction, and that the NIOSH methodology could not be 

discussed by DOL. This appears to limit the extent to which a claimant can challenge the 

NIOSH dose reconstruction (DOL 2005), as evidenced by the following statement made by the 

DOL to claimants who appeal: 

You have objected specifically that the NIOSH dose reconstruction failed to show 

enough exposure so the DOL could find that your cancer was at least as likely as 

not related to your employment. At this time I would like to say something about 

the NIOSH dose reconstruction. NIOSH is given full authority under the 

regulations that govern the Act to conduct the dose reconstruction used by the 

Department of Labor to determine the probability that a cancer is related to 

employment. I am not permitted to discuss the way in which NIOSH goes about 

preparing the dose reconstruction report. However, I can discuss issues of a 

factual nature regarding the information you provided to NIOSH, and challenges 

to the application of NIOSH’s methodology. I am here to take your objections and 

enter them into the evidence of record but I am not permitted to consider 

objections to NIOSH methodology at this time. 

The statement of the OCAS-1 form that a claimant can “seek review of this NIOSH dose 

reconstruction after DOL makes a recommended decision on my claim” does not adequately convey 

the limited nature of the review opportunity provided by the Final Adjudication Board, as represented 
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by the above quote. There is, therefore, an especially heavy burden to get the close-out interview 

procedure right in all aspects to ensure fairness and accurate communication. There is also a need to 

ensure that the claimant understands the dose reconstruction report prior to signing the OCAS-1 form, 

and to document that process carefully. 

SC&A notes that NIOSH/ORAUT does emphasize during the close-out interview that the 

claimant should not sign the OCAS-1 form until all their questions are answered. It is the lack of 

substantive provisions in the procedure to deal with situations in which claimants do not 

understand the dose reconstruction that raises questions about the signature to the OCAS-1 form 

in that context. The problem is compounded by the potential lack of technical thoroughness 

(documented in the process of this review) with which claimant technical concerns are handled at 

the close-out interview stage. 

SC&A understands that the information is inherently complex and a full understanding requires a 

great deal of technical knowledge that the vast majority of claimants do not possess; but the 

essential content must be understood by the claimant, and NIOSH must ensure that it is 

understood. It would take a qualified person with experience in both health physics and in 

successfully explaining things in non-technical language to communicate the essential content of 

the draft dose reconstruction to the claimant. Highly complex information can be conveyed 

clearly to non-technical audiences—it has been done. It is essential that it be done in the closeout interview process. 

Experience has shown that the simple explanations that are at the same time full and accurate 

usually take the most expertise in both science and communication. Yet, the close-out interview 

procedure makes no provision for a health physicist who knows how to communicate with nonprofessionals in the field to ensure that the pressure to sign the OCAS-1 form does not override 

the resolution of the concerns. On an even more elementary level, there is no provision in the 

procedure for a full and frank discussion between the dose reconstructor and the claimant on the 

dose reconstruction report. The HP Reviewers, while responsible for the research and evaluation 

of claimant technical questions or concerns upon referral, do not possess adequate technical 

qualifications, as was clear from SC&A’s discussion with the ORAUT: 

SC&A: Does a health physicist ever call [the claimant] back? 

ORAUT: They do not receive a review by a health physicist or a call back from 

an HP. If a substantive judgment on details in dose reconstruction is necessary, 

the HP Reviewer would call the DRist. As long as I recall, HPs have not been 

involved in calling claimants. 

... 

SC&A: What are the qualifications of the HP reviewers? Do they have health 

physics degrees? 

Ray: Reviewers are not health physicists by qualification, by degree, or trade. 

They review health physics information and call the claimant back and let them 
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know the result. If necessary, they will call the original DRist to give them the 

review information. 

SC&A: Do any of the four HP reviewers have a background in health physics or 

are any of them a CHP? 

ORAUT: None of them are health physicists or CHPs. They all have 4-year 

degrees. 

SC&A: This is surprising. It may be a misunderstanding on our part, but I have 

always understood that a health physicist calls back if there are questions the 

close-out interviewer cannot answer. The only discussion we have had with 

NIOSH about this is whether there should be a health physicist on tap while the 

close-out interview is going on, or whether they should call back later. So this is 

new information to us. How about the supervisors? 

ORAUT: Per an established NIOSH agreement and direction, the dose 

reconstructors are not made available for closing interviews or follow-up calls, 

but rather supplemented with Task 4 HP Reviewer staff. Direction has been 

provided that the dose reconstructor priority is reconstructing dose for claimants. 

Also, the dose reconstructors have not been trained in claimant communications. 

Rather, claimant communications is facilitated by Task 4 Health Physics 

Reviewers working closely with the assigned dose reconstructor as necessary. 

[Emphasis added.] 

Furthermore, 

SC&A: In what fields do the four HP reviewers have degrees? 

ORAUT: The reviewers are not qualified to do a dose reconstruction. All have 

4-year degrees and training, including on-the-job training. One has a degree in 

chemistry. I can’t recall the others.

SC&A could not confirm the qualifications of current HP Reviewers, as employee information 

was not available. Furthermore, it was noted that interviewers and HP Reviewers involved in the 

close-out interview process do not have to provide a conflict or bias web disclosure form. 

5.3.1 Suggestions for Improvement related to Finding 3 

(1) Qualified health physics personnel who are trained to communicate non-technical 

information to the general public or have a track record of doing so successfully should 

answer the claimant’s questions during all follow-up calls and in cases where the 

claimant states that they do not understand the information in the draft dose 

reconstruction. 
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(2) A health physics professional should be available in real-time during the initial close-out 

interview (though not necessarily be on the line) in case there are concerns or questions 

that the interviewer cannot address, but that could be resolved relatively expeditiously by 

a health physicist familiar with the claimant’s file. 

5.4 REVIEW OF FINDING 4 

Finding 4: The procedure does not ensure that the claimant has all the information that 

was essential to the dose reconstruction prior to the close-out interview. This can hamper 

the claimant in deciding whether or not to submit additional data or information at the 

close-out interview stage. 

The draft dose reconstruction report, the OCAS-1 form, and a cover letter explaining the next 

steps in the process are provided to the claimant prior to the close-out interview. Documents 

available for review by NIOSH in the dose reconstruction process (e.g., the site medical and 

dosimetry files, work history information, and incident reports) are not available to the claimant 

unless a specific request for these records is made. In some cases, claimants have made a request 

to DOE to obtain this data; however, this can be a slow process. If a Freedom of Information 

Act request is needed for ancillary material, it could also be a costly process. There is no 

requirement at present that all personal dose information and the details of the dose 

reconstruction be provided as a matter of course to the claimant. 

The dose reconstruction report contains a list of references to the standard documentation, such 

as the site profile volumes and OCAS dose reconstruction procedures. These can be downloaded 

from the OCAS web site and, at least in principle, should be accessible; however, the web 

addresses of the references are not provided. There are no references to essential documents, 

such as the workbooks, that were used in the dose reconstruction. The procedure, therefore, 

contains a significant gap in not providing for a contingency that a claimant may want or need 

more detailed information about how their dose reconstruction was done before NIOSH sends 

the case to DOL. One of the most important gaps is the lack of detailed explanations about what 

was done with claimant-provided information, data, and documents. 

Lack of access to claimant-specific records retrieved from the DOE prevents the energyemployee claimant from identifying issues related to completeness and accuracy of the DOE 

records. During the course of site visits, SC&A identified instances where access to the DOE 

file would have assisted the claimant in identifying gaps in the record. For example, during 

interviews for one of the site profile reviews, an individual indicated she started as a radiation 

worker and was monitored much earlier than her dosimetry records indicated. Monitoring 

records were available for only 2 of the 20-plus years she worked at the facility. Medical records 

showed that she had received physicals as an employee of the plant for the time period she 

indicated. The availability of her medical records to her allowed her to question the 

completeness of her records. Furthermore, a number of individuals who are in possession of 

their DOE files have indicated that the information was incomplete, particularly regarding 

incidents. SC&A has raised the issue of the potential incompleteness of DOE personnel files in 

regard to incidents since its review of the Savannah River Site Profile in 2005 (SC&A 2005b, 

Section 5.10). 
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Due to the secrecy under which much of the early DOE (and predecessor agencies) work was 

conducted, the survivor is at a further disadvantage. Energy employees often did not speak about 

their work or maintain records at home or explain them to their family members. The 

importance of such records was illustrated by Case #3 in the SC&A close-out interview 

observation discussed above. In this case, the energy employee had made a request for his 

dosimetry records prior to his death, so the spouse had a critical piece of information that 

allowed her to raise some important questions. In most cases examined by SC&A (for instance, 

by examining CATIs), spouses are not in possession of such records. 

5.4.1 Suggestions for Improvement related to Finding 4 

The technical complexity of dose reconstructions and the lack of specific explanations about 

non-use of claimant-provided information in the draft dose reconstruction report make it critical 

that either the dose reconstructor or another experienced HP explain the document to the 

claimant when the latter states they do not understand the dose reconstruction report or elements 

of it: 

(1) Claimants should be given access to the records, documents, and procedures pertaining to 

their dose reconstructions without having to request them. The specific Workbook 

version used for the dose reconstruction should be noted in the draft dose reconstruction 

report sent to the claimant. The draft dose reconstruction report should offer to make that 

Workbook and other materials available to the claimant, should they wish to have them. 

(2) All Workbooks used in dose reconstructions should be archived. 
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6.0 REFERENCES 

42 CFR Part 82, 2002. “Methods for Radiation Dose Reconstruction Under the Energy 

Employees Occupational Illness Compensation Program Act of 2000; Final Rule,” May 2, 2002. 

ABRWH (Advisory Board on Radiation and Worker Health) 2006. ABRWH Working Group 

Meeting, Hebron, Kentucky. February 13, 2006. 

DOL (Department of Labor) 2005. “FAB Review Process,” EEOICP Part B Procedure Manual, 

Chapter 2-1300, Washington, DC. March 2005. 

Hawkins, H.A. and Shatto, D.M., 2005. Close-out Tracking Utility, ORAUT-TRNG-0045, Rev. 

00, Oak Ridge Associated Universities Team, Cincinnati, Ohio. June 22, 2005. 

Kaske, B., 2006. Notes from HP Reviewer Follow-Up Call with Claimant. October 13, 2006. 

NIOSH (National Institute for Occupational Safety and Health) 2005a. Statement by the 

Claimant Closing the Record on a NIOSH Dose Reconstruction under the Energy Employees 

Occupational Illness Compensation Program Act, Form OCAS-1, OMB No. 0920-0530, NIOSH 

Office of Compensation Analysis and Support, Cincinnati, Ohio. May 2005. 

NIOSH (National Institute for Occupational Safety and Health) 2005b. Energy Employee 

Occupational Illness Compensation Program Act (EEOICPA) Dose Reconstruction Telephone 

Interview, NIOSH Office of Compensation Analysis and Support, Cincinnati, Ohio. August 23, 

2005. 

NIOSH (National Institute for Occupational Safety and Health) 2006a. DOL to NIOSH and back 

to DOL, Detailed Steps in the Dose Reconstruction Process under the Act, Cincinnati, Ohio. 

NIOSH (National Institute for Occupational Safety and Health) 2006b. Glossary of Terms, 

NIOSH, Cincinnati, Ohio. December 2006. 

SC&A 2005a. The Review of NIOSH/ORAUT Procedures and Methods Used for Dose 

Reconstruction, SCA-TR-Task3, Rev. 0, S. Cohen & Associates, McLean, Virginia. January 

2005. 

SC&A 2005b. Review of the Site Profile for the Savannah River Site, SCA-TR-Task1-003, 

Rev. 0, S. Cohen & Associates, McLean, Virginia. March 2005. 

Shatto, D.M. and Hawkins, H.A., 2005a, Close-Out Interview Process, ORAUT-PROC-0092, 

Rev. 00, Oak Ridge Associated Universities Team, Cincinnati, Ohio. August 17, 2005. 

Shatto, D.M. and H.A. Hawkins, 2005b. Computer Assisted Telephone Interview Process, 

ORAUT-PROC-0090, Rev. 00, Oak Ridge Associated Universities Team, Cincinnati, Ohio. 

June 21, 2005. 

Walsh, C., 2005. Notes from HP Reviewer Follow-Up Call with Claimant. October 20, 2005. 
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ATTACHMENT A: OCAS-1 FORM 

Statement by the Claimant Closing the Record on a NIOSH Dose Reconstruction under the 

Energy Employees Occupational Illness Compensation Program Act 

I, [Name] (NIOSH Tracking Number XXXXX), a claimant under the Energy Employees Occupational 

Illness Compensation Program Act (EEOICPA), certify that in signing this form, I have read, understand, and affirm 

that the following statements are true: 

1) I am not in possession of any additional information that has not already been provided to NIOSH for 

completing a dose reconstruction” to estimate the radiation doses incurred by the employee; and, 

2) I understand that NIOSH will forward a final dose reconstruction report to the Department of Labor (DOL), so 

that DOL can continue adjudication of my claim and produce a recommended decision and then a final decision 

to accept or reject my claim; and, 

3) I understand that NIOSH can not forward the dose reconstruction report to DOL for adjudication without receipt 

of a properly signed OCAS-1 form within 60 days of my receipt of this form and NIOSH may administratively 

close the dose reconstruction and notify DOL of this action if I do not provide a properly signed OCAS-l form 

within this 60-day period; and, 

4) I understand that my opportunity to seek a review of the NIOSH dose reconstruction occurs when my claim is 

with DOL and occurs only after DOL produces a recommended decision to deny my claim; and, 

5) By signing this form, I do NOT certify or imply that I agree with NIOSH decisions indicated in the draft 

NIOSH dose reconstruction report concerning how NIOSH has used or not used information I have provided for 

the dose reconstruction; and, 

6) By signing this form, I do NOT certify or imply that I agree with the findings of the NIOSH dose reconstruction 

and I understand that I may seek review of this NIOSH dose reconstruction after DOL makes a recommended 

decision on my claim. 

Notice: I affirm that the information provided on this form is accurate and true. Any person who 

knowingly makes any false statement, misrepresentation, concealment of fact or any other act of fraud to obtain 

compensation as provided under EEOICPA or who knowingly accepts compensation to which that person is not 

entitled is subject to civil or administrative remedies as well as felony criminal prosecution and may, under 

appropriate criminal provisions, be punished by a fine or imprisonment or both. 

Signature________________________________________________ Date __________________

Public Burden Statement 

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including 

time for reviewing instructions, gathering the information needed, and completing the form. If you have any 

comments regarding the burden estimate or any other aspect of this collection of information, including suggestions 

for reducing this burden, send them to CDC Reports Clearance Officer, 1600 Clifton Road, MS-D-74, Atlanta, GA 

30333; ATTN:PRA 0920-0530. Do not send the completed interview form to this address. Please complete and 

return this form using the enclosed pre-addressed, postage-paid envelope. Persons are not required to complete this 

form unless a currently valid 0MB number is displayed. 

NIOSH ID: XXXXX
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ATTACHMENT B: CLOSE-OUT INTERVIEW OBSERVATION NOTES 

The following notes of the close-out interview process relating to three claimants conducted by 

ORAUT on October 11 and October 13, 2006 were prepared by SC&A. By prior arrangement 

with NIOSH/ORAUT, the close-out interviews were observed by Kathryn Robertson-DeMers 

and Arjun Makhijani of SC&A. The draft notes were reviewed by CDC for Privacy Act 

considerations and by the ORAUT participants in the call. 

Participants: 

ORAUT: Pat Kraps, Ray Weaver, David Shatto, Rachel Hume, Gwen Knox, and 

Brian Kaske 

SC&A: Kathryn Robertson-DeMers and Arjun Makhijani 

Notes are not verbatim, except where phrases are in quotation marks. SC&A personnel agreed in 

advance not to say anything at all during the call, because the claims in question had not yet been 

adjudicated. They were allowed to interview the ORAUT interviewers after the completion of 

each call. This procedure was strictly followed. Claimants were informed that SC&A personnel 

were on the call. That script was provided to SC&A (Addendum A). Privacy information has 

been removed. 

Case #1: This was the first of three close-out interviews observed by SC&A. It was with a 

survivor. The interviewer was Gwen Knox of ORAUT. 

Interviewer went over the employment and cancer type at the beginning of the interview. 

Gwen: Do you have your dose reconstruction report? 

Claimant: Yes 

Gwen: Turn to page 4 of the dose reconstruction report. It says that your father was employed at 

[site name] from [date] to [date] and that he was diagnosed with [cancer type] and [cancer type]. 

Is this information correct? 

Claimant: Yes 

Gwen: Radiation exposure is measured in rem – that is a unit of radiation. We use it in 

calculating Probability of Causation (POC). We only looked at dose to [the organ of concern]. 

The estimated dose of XXXX rem produced more than 50%; once this threshold is crossed, we 

do not consider the case any farther. This case used a partial estimation of dose. Do you have 

any questions at this point? 

Claimant: A lot of it I don’t really understand. 
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Gwen: The report is technical and I will try to put it in terms that you can understand. Now we 

will go over the information used in the dose reconstruction. Your father wore a dosimeter 

badge and was monitored for internal exposure with urinalysis. This means a urine sample was 

collected to determine if he had inhaled or ingested radioactive material. [SENTENCE 

REDACTED]. Please go to page 5 of the dose reconstruction report. The dose reconstructor 

only had to use the internal dose to reach a POC of 50%. His external dose was not calculated, 

since the probability of compensation was greater than 50% without it. This approach is allowed 

under 42 CFR 82, the Code of Federal Regulations that governs us in this program, and the 

procedures that we follow. 

As for his internal dose, he could have received it in any of two ways: (1) acute dose, which he 

could have received very quickly, and (2) chronic dose, which he could have received over a 

long period of time. He was exposed to plutonium, uranium, and neptunium. We use the most 

claimant-favorable approach. They looked at solubility type. Type S goes through your 

“digestive system” at a slow rate. He went through a lung count, which gave how much 

radioactivity he had in his lung. MDA is “Minimum Detection Radioactivity.” The internal 

monitoring tells what he received and when he received it. These measurements have units of 

pCi, which is a form of radiation measurement. 

Gwen: Are there any questions at this point? 

Claimant: No. 

Gwen: Alpha radiation was the most important in this case. They list reasons why the dose 

calculated is “a smaller dose.” It shows the different types of radiation energy, “because they 

can affect everyone differently.” One may be able to penetrate the body. The distance also 

matters—one may travel inches and the other may travel hundreds of feet. We are not going to 

say the dose is a high or low amount, because radiation affects everyone differently. We just use 

it in calculating the probability of causation. 

Then there are the references that were used in the dose reconstruction. The table in the back of 

the dose reconstruction shows the calculations about what he was exposed to. Do you have any 

questions at this point? 

Claimant: So he was exposed to radiation? 

Gwen: Yes. 

Claimant: I thought when he wore the badge, it would tell you the dose. 

Gwen: His badge measured external radiation. He did wear a badge. 

Claimant: I don’t really know, because my guy never spoke about it. I am kind of left in the 

dark. He never really talked to us about anything. I was pretty young at the time. 
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Gwen: This is common, due to security at this time. That’s why we don’t just rely on interviews, 

but we rely on several sources of information, including site records and technical basis 

documents. 

Claimant: As far as I understand, which is not a lot of it. My guy was exposed to at least 50%. 

Gwen: That is the probability of causation. It was greater than 50%, so his cancer was more 

likely than not caused by radiation. However, NIOSH does not make the formal determination. 

The DOL is responsible for determining the Probability of Causation. 

The form on the back of the dose reconstruction report has to be signed and returned. The 

system indicates NIOSH has already received a signed form from you. 

Claimant: I thought this was done and over with some time ago. I did not know it was going on. 

Gwen: This program has four different parts. 

Claimant: I was not told that. 

Gwen: There is one for radiation, one for beryllium, one for chemicals, and one for asbestos. 

Claimant: Now you have explained to me what I did not know before. There are a lot of words 

in this letter that I don’t understand. What is this XXXX? 

Gwen: That is the ICD code. When you go to the doctor, they assign a code for the type of 

cancer. 

Claimant: When I got the paper, I thought, “this is still going on?” I thought it was done then. 

Gwen: I am sorry that you were not better prepared. This is not an accurate statement. 

Claimant: No one said anything about four different parts. 

Gwen: I am glad I was able to help you with that. 

Claimant: I knew he wore a badge. He said he had to change there and take a shower there. All 

of the other stuff—I was too young and do not remember. 

Gwen: I can give you the Department of Labor phone number and they can answer any 

questions you have about the program. Cleveland 1-888-859-7211. They can give you the 

status. 

Claimant: Will they tell us the radiation? 

Gwen: No, they will tell you the probability of causation and the status of the claim. We will 

send you the final dose reconstruction, since you have already sent in your signed OCAS-1 form. 
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The probability of causation will be sent to you by the Department of Labor. They will let you 

know about your claim. I understand that it takes between 2 months and 8 or 9 months for them 

to get back to you, depending on their case load. Do have any more questions? 

Claimant: No. 

Gwen: If you do, call me with any questions at1-800-790-6728 and ask for Gwen. 

End of first interview. 

Case #2: This was the second interview observed by SC&A. It was with an energy 

employee. The interviewer was Rachel Hume of ORAUT. The employee was from a site 

that is part of the Special Exposure Cohort. The length of the Close-out interview was ~20 

minutes. The initial part of the interview followed the same format as that in Case #1 and 

is abbreviated here. 

Rachel: Do you have the draft dose reconstruction report? It is dated September 29, 2006. 

Claimant: Just a second. I have to go get it. 

Rachel: Do you see the Dose Reconstruction Overview section on page 4. 

Claimant: What was that now? 

Rachel: The Dose Reconstruction Overview on the top of the page. 

Claimant: Okay, I’m there now. 

Rachel: Go to DR Review, page 4. Is employment and cancer information correct? 

Claimant: Yes 

Rachel: NIOSH is focusing on the organ affected by cancer. In your case, NIOSH is 

reconstructing dose to the XXXXXX. The XXXX rem was the dose to the organ affected by the 

cancer. Rem stands for roentgen equivalent man, a unit of dose in this report. It is not a 

percentage. The probability of causation is less than 50%. Further analysis will not produce a 

probability of causation greater than 50%. We don’t look at that number; the Department of 

Labor will be looking at the probability of causation. They are looking to answer the question, 

“was the cancer at least as not caused by occupational exposure?” Was there at least a 50% 

chance that the cancer was caused by radiation? Do you have any questions? 

Claimant: No. I am taking it in. 

Rachel: At the bottom of page 4 in the last paragraph it states: 
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Rachel read: 

NIOSH has determined, and the Secretary of Health and Human Services has 

concurred, that radiation doses at XXXX cannot be reconstructed unless there are 

actual radiation monitoring data for the energy employee. Therefore, since no 

radiation monitoring data exist for [Name], and no estimation techniques can be 

employed to derive a radiation dose for his prostate cancer, the only dose that has 

been assigned in this assessment was that received from occupationally required 

medical X-rays. 

Rachel: On page 5, there is a section call Occupational Medical Dose: 

Rachel read: 

The dose received from diagnostic X-ray procedures that were required as a 

condition of employment was included in the dose reconstructed for the prostate. 

Based on information in the Technical Basis Document for Atomic Energy 

Operations at XXXXX, using the XXXX XXXX, and with an assumed annual X-ray 

procedure for each year of employment, an X-ray dose of XXXX rem was 

assigned. 

Rachel: Then let’s go on. In your case, no radiation dose data exist. The Secretary of Health 

and Human Services has determined that doses cannot be calculated at this site. So, in your case, 

only medical x-ray dose was assigned. It was XXXX rem, due to chest x-rays; it was 

XXXX rem from a lumbar spine x-ray. The total is XXXX rem. This was the total dose 

assigned in your case, and it was medical dose. Your dose reconstruction states on page 6 that 

occupational dose cannot be determined without records. Do you have any questions? 

Claimant: You were supposed to have monitoring badges, but I never did have one, because I 

was never in the line of work. 

Rachel: Any further questions? 

Claimant: I have sent in my [OCAS-1] form. 

Rachel: Did you have questions about the form? 

Claimant: No. 

Rachel: The form asks whether you have more information to give NIOSH about your dose 

reconstruction; you did not. If you have more information, we are happy to take it into account. 

The next and last thing you will get from NIOSH is final DR report. You don’t have to reply to 

that. The dose reconstruction will also go to the Department of Labor. If they deny your claim, 

you can seek a review. There is an appeal process that is part of the law. When you sign the 

OCAS-1 form, we are not asking you to certify that you agree with NIOSH. The Department of 

Labor can take from 2 to 8 months to get back to you once they get the dose reconstruction 
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report from us. They will send you a letter. I will give you my phone number -1-800-790-6728. 

Ask for Rachel. Did you have any other questions? 

Claimant: No. 

Rachel: Is there anything else I can help you with? 

Claimant: No 

End of interview 

Case # 3: This was the third close-out interview observed by SC&A. It was with a survivor 

claimant. The interviewer was Rachel Hume of ORAUT. The introductory remarks were 

along the same lines as in Case #1 and were not repeated in the notes below. 

Rachel: Did you receive your report? 

Claimant: Yes 

Rachel: Do you have it with you? 

Claimant: Yes 

Rachel: Please turn to the Dose Reconstruction Overview on page 4. I show [name] employed 

at XXXX from XXXX to XXXX as a XXXX. Is this correct? 

Claimant: Yes. 

Rachel: Your husband was diagnosed with XXXX and XXXX. Is this correct? 

Claimant: I guess. When he was diagnosed with the second cancer, I tried to contact Dr. XXXX 

in XXXX. I could not get in touch with him. I could not get in touch with him due to lapse of a 

long time to get exact date. He had his XXXX removed and a biopsy done. 

Rachel: Let’s go over the dose reconstruction report. External dose is received from radiation 

outside the body and is measured with a dosimeter. Internal dose is caused by radioactive 

material taken into the body. NIOSH is concerned with the dose to each of the affected organs. 

Rem is the unit of measurement for dose. 

POC is a phrase you will be seeing more often. This is a calculation performed by DOL to 

determine the claim outcome. 

Claimant: What does that mean? 
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Rachel: DOL is looking to see if the POC indicates that cancer was as likely as not to be caused 

from radiation. It was a claimant-favorable dose reconstruction. The probability of causation 

did not reach 50%. NIOSH does not decide on the compensation. That is the Department of 

Labor, which will get back to you. 

Claimant: There had to have been because of his records? Does this have to do with the 

inaccurate readings? His cancer could not have been caused by anything else. Does this have to 

do with the readings that they had there at XXXX that were inaccurate? They sent him to several 

different labs. I sent a letter from them [Another Site] that said that the calculations at [the site 

where he worked] were wrong, and that there was a different kind of mobile unit that would be 

better. 

Rachel: Part of the record that was used in dose reconstruction was what the DOE provided [to 

NIOSH]. But I did see where you talked about the mobile unit. Are you referring to wholebody count? 

Claimant: The whole thing. A couple of them [workers] went to [a national lab]. When they 

were hot, they were taken out of that building where they worked and put in another building. I 

did not see anything in the records that showed he worked in the hot areas. I did not see 

anything that stated that he was sent outside of that [hot] area into other areas. 

Rachel: When we get new information, we will send it to a Health Physics reviewer. Did he 

work at [the national lab]? 

Claimant: No, they sent him to [the national lab] because he was constantly hot. That’s where 

that letter comes in, because they said it was completely hot. So I don’t know how you could 

state that, unless the doctors said something. 

Rachel: Did he go to the XXXX? 

Claimant: They were going to send him to XXXX and even to New York. I asked for his 

records. The others, I don’t have anything on that. First, there were three men, and then there 

were two men. 

Rachel: Did he work there at [the national lab] or was he just tested there? 

Claimant: He was just being tested there. The letter showed that readings at [the site where he 

worked] were way off. 

Rachel: I am making handwritten notes. I want to send this over, so reviewers can look at it. So 

they said records of [the site where he worked] were off? 

Claimant: Yes, Low. Very low. [Sentence deleted regarding matter not concerning dose 

reconstruction.] He visited [the national lab] once. They said his readings were all wrong. I 

know he went to another place, too, and I don’t have anything on that. I don’t have any 

information on the other facility. 
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Rachel: Is there something else you want to go over or specific questions? 

Claimant: No, a lot of this I don’t understand. I just don’t understand how you came to this 

conclusion [about probability of causation] based on false information. 

Rachel: This needs to be looked into, but for now, let’s go on to the bottom of page 4. The 

information used for the dose reconstruction included dosimetry results from the Department of 

Energy, technical basis documents, and procedures. 

Claimant: What is this based on? 

Rachel: The back of the report shows the references used. Let me have you turn to page 11. 

You will see list of references, which is referred to in the body of the report. 

Claimant: What is that based on? The findings from [the site where he worked] or what? 

Rachel: Some of them are findings from [the site where he worked]. 

Claimant: Is that from the surgeons and the doctors? 

Rachel: No, these are not from medical doctors. Some of the references provide methods for 

dose reconstructions. NIOSH reviewed all the information that was gathered during the claim. 

The list of references provides information on external dosimetry. These reference documents 

are used as guidelines. 

Claimant: What did you say his job description was?

Rachel: XXXX. 

Claimant: They showed him on TV [doing his job]. This doesn’t sound like [the job description 

he was given]. [Two sentences regarding job discussion deleted.] 

Rachel: You saw him on TV when he was [job description]? 

Claimant: Yes. I saw him [job description]. They showed a lot of that on TV. My husband was 

suspicious of [the DOE contractor]. There was one guy who disappeared. They had to change 

and shower. They found this fellow’s glasses and street clothes. They found him in a tank and 

they said he must have tripped and fallen in there. My husband distrusted the whole atmosphere 

of the place. 

Rachel: Let’s go on to page 5 under Dose Estimate. This explains how the dose was assigned. It 

tells you what dose was received outside the body and what was received inside the body. 
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Read by Rachel 

[Name] was monitored for external photon and electron radiation exposure from 

[dates]. [Name] was assumed to have no potential for external exposure during 

the short time frames at the beginning and ending of his employment, when he 

was not monitored. Electron radiation was considered in this evaluation, because 

it would not have added dose to the cancer sites. 

Claimant: What were the dates for monitoring? 

Rachel: Let’s go over the information. From XXXX when started to XXXX, he would not have 

been monitored. Then, at the tail end of his employment, XXXX to XXXX, he was not 

monitored. 

Claimant: That’s strange. Why was he not monitored? Even though it was wrong. 

Rachel: At the beginning of employment, he may have had to wait for his security clearance to 

come through. 

 

Rachel read 

Individual dosimeter results were used to reconstruct [Name’s] dose. 

Corrections to the reported doses were applied as described above. Missed dose 

was not assigned, because reported dose was recorded for each cycle that 

[Name] was monitored. 

Claimant: That’s what it was. I did not understand missed dose. Why did he have missed dose? 

Rachel: Let me further explain. When they refer to missed dose, it means that for some reason, 

a dose was not reported or it was below detection limits. They wore the badges or TLDs for 

some time, like a month at a time. When the TLDs were being read, they would receive a new 

badge. 

Claimant: At the end, they let them wear their watches. 

Rachel: Personal watch? 

Claimant: Yes. Personal watch. 

Rachel: Were they testing the watch? 

Claimant: Yes. But he wasn’t allowed to talk about that. A lot of things he wasn’t able to talk 

about. 

Rachel: Let’s talk about ambient dose. Though he was monitored, onsite ambient dose, that’s a 

dose that he might have received while outside, was assigned to him. 
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Claimant: I don’t understand that. 

Rachel: Is this something you want me to go over? 

Claimant: I don’t understand it. I don’t understand the lingo. This is not in the medical records. 

Rachel: This is dose that is added that may not have been recorded. Onsite ambient dose would 

not be in his medical records. 

Claimant: So, that is separate from the mobile unit that was completely off? 

Rachel: Yes. Let’s go to internal dose. The assumption was made in the calculation that he had 

chronic exposure. 

Rachel read: 

Internal dose monitoring records for radionuclides were reviewed. Some 

measurement results for non-naturally occurring radionuclides showed an 

activity less than the level of detection for the given radionuclides and bioassay 

method. A comparison was made of [Name’s] urine sample results and lung 

count measurement results. [Name’s] urine sample results were used in the dose 

reconstruction as a claimant-favorable assumption. To account for any potential 

undetected dose for [Name], who participated in internal dose monitoring 

programs, internal dose was assigned based on a chronic intake assumed to have 

occurred through [Name’s] employment period (XXXX, through XXXX). 

Claimant: That says a lot -- chronic exposure. 

Rachel: Turn to page 8 at the bottom of the second paragraph. 

Rachel reads: 

Recycled uranium was first introduced at the site in 1961. Therefore, all uranium 

intakes after 1961 are assumed to have an associated plutonium-239, 

neptunium-237, and technetium-99 intake. The resultant intake dates were 

chosen based on a fit between the projected excretion rates and [Name’s] 

bioassay data. The ICRP 66 lung mode with default aerosol characteristics was 

assumed. 

Rachel: At the beginning of the paragraph, it talks about other assumptions. 

Rachel reads: 

Internal dose monitoring records for radionuclides were reviewed. Some 

measurement results for uranium showed activity greater than the level of 

detection. To account for potential uranium intakes for [Name], multiple acute 
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intakes of absorption type S (for the XXXX) dose and absorption type F for the 

XXXX dose were assumed to have occurred on [various dates]. The assumed 

activity used in the assessment was enriched uranium (specific activity = 

1.616 pCi/μg). In addition, the uranium intake was assessed at 100% U-234; this 

is a claimant-favorable assumption. 

Rachel: Did you have any questions? 

Claimant: It says they used 100% U-234. All I wanted to know was that it was claimant 

favorable. 

Rachel: Let’s go on to the Environmental Dose. 

Rachel read: 

[Name] worked in various locations during his employment at the [name of site]. 

It was assumed that he might have been occupationally exposed to environmental 

levels of radioactive material while working at the [name of site]. These 

radionuclides were determined to account for more than 95% of the potential 

missed dose from inhalation pathways (for years and radionuclides that have not 

already been assessed for dose based on positive bioassay results or missed 

dose.) 

Turn to page 10 of the report. 

Rachel read: 

[Name] was exposed to various sources of radiation during his employment at the 

[name of site]. [Name’s] whole body deep dose of record as provided by the 

Department of Energy is XXXX rem. The reconstructed estimated dose to [Name] 

was calculated to be XXXX rem to the XXXX and XXXX rem to the XXXX. 

Claimant: [Name] had mentioned units he had been in. This was like working in the chemicals. 

He’d say they moved me again. I don’t know what was in the other departments. What’s the 

difference between DOE and NIOSH info? 

Rachel: Go to page 4 of the dose reconstruction report to the last paragraph. 

Rachel reads: 

During this dose reconstruction, the primary data source was the dosimetry 

records obtained from the Department of Energy (DOE). In addition, specific 

parameters were applied to dosimetry records in order to assign organ dose 

based on information in the External Dose Reconstruction Implementation 

Guideline and the Internal Dose Reconstruction Implementation Guideline. 
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ORAUT Technical Information Bulletins and Technical Basis Documents were 

also used in this dose reconstruction (see References). 

NIOSH requests monitoring data from the plant where an individual worked. The primary data 

source was dosimetry from DOE. NIOSH requests monitoring data from DOE. 

Claimant: But they are in error. That is what is bugging me. 

Rachel: If it is OK with you, I would like to present this to the Health Physics Reviewer and let 

them know that you think the results were in error. We will get back to you. In the meantime, 

don’t sign your OCAS-1 form. 

Claimant: I hope you get back to me within 60 days. If it is more, I will have to send it in. 

Rachel: I want you to hold on to that. 

Claimant: We found out all this information was in error. I can’t see where there would be any 

differentiation with him since they did cut and paste from [DOE records]. 

Rachel: Any more questions? Let me give you my phone number. It is 1-800-790-6728. I am 

often on the phone, and if so, please leave a message and I will call you back. Anything else that 

I should tell the Health Physics Reviewer? 

Claimant: Well, no. I am concerned about the differentiation between the records. 

Rachel: If there is anything else, we are more than happy to take information about that. 

Claimant: They told us that it would be helpful and we sent it in. I’ll ask the kids and see if they 

have anything. If my son comes up with a question that I had not thought of, I will let you know. 

End of interview 
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After the close-out interview observation, SC&A had the opportunity to discuss the process 

with the interviewers, Rachel Hume, Gwen Knox, and their managers, David Shatto and 

Raymond Weaver. 

Kathy: There are activities that occurred prior to our joining the interview. Could you tell us 

what they were? 

Ray: The claimant was read a special script regarding the interview. The script indicated a 

statement that the call was being monitored by Sanford Cohen and Associates. 

[Ray read the portion of the script addressing SC&A participation in the call. This portion of the 

script was provided by ORAUT and is available in Attachment A]. 

Kathy: Was that call logged? 

ORAUT: A log was also created of this introductory conversation. During the course of this 

introduction, the interviewer mentioned that the phone conversation may be monitored for 

Quality Assurance purposes also. 

Kathy: What does the review of the claimant file consist of? 

ORAUT: We read the dose reconstruction report, the phone logs, the CATI, and the claimant 

file. We basically try to go through all the documents in the NOCTS database. 

Kathy: Was there a release signed to allow us [SC&A] to participate? 

Ray: No. 

Kathy: Was the permission just verbal? 

Ray: Yes. If they had objected, we would have found another claimant. 

Kathy: Is there a part of the script that says the call may be monitored? 

Ray: Every time, we tell them the call may be monitored for quality assurance. In this case, the 

script I sent you replaced that standard language. 

Kathy: Who will review the information from the last case? 

Ray: She was referring to an HP Reviewer, who will make a detailed review and will get back to 

the original “DRist” [dose reconstructionist]. 

HP Reviewer: A detailed review of the entire file is completed. If it is perceived that the 

additional information will affect the claim, the claim is referred back to the DR. 

SC&A: Do you always get back to the dose reconstructor?
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Ray: More often than not. If we can’t make the determination without it, we do not. If there are 

technical details about the dose reconstruction about which there are questions, then we get back 

to NIOSH. 

SC&A: I did not understand the role of NIOSH, since the dose reconstruction is done by 

ORAUT. 

Ray: There are occasions we believe where information is not material to dose reconstruction. 

So we contact the NIOSH reviewer who reviewed the claim, and ask them if they can make the 

determination for us. In addition, there are claims assigned to Battelle. Those go through 

NIOSH. We don’t contact Battelle directly. 

SC&A: How often does HP referral happen? Just an idea would be fine, if you don’t have a 

percentage in mind. 

Rachel: That percentage is low. 

Gwen: I agree. 

SC&A: You will get a chance to review this interview before it is finalized. Who does the call 

back with the HP review? 

ORAUT: That would be a Task 4 HP Reviewer. We have four of them on our staff and they 

coordinate the scheduling of the follow-up. 

 

On October 13, 2006, SC&A had a discussion about the follow-up call with managers Ray 

Weaver and David Shatto, prior to the Case #3 follow-up call by the HP Reviewer, Brian 

Kaske. 

SC&A: What are the qualifications of the HP reviewers? Do they have health physics degrees? 

Ray Weaver (ORAUT): Reviewers are not health physicists by qualification, by degree, or 

trade. They review health physics information, and call the claimant back and let them know the 

result. If necessary, they will call the original DRist to give them the review information. 

SC&A: Do any of the four HP reviewers have a background in health physics or are any of them

CHPs? 

ORAUT: None of them are health physicists or a CHPs. They all have 4-year degrees. 

SC&A: This is surprising. It may be a misunderstanding on our part, but I have always 

understood that a health physicist calls back if there are questions the close-out interviewer 

cannot answer. The only discussion we have had with NIOSH about this is whether there should 

be a health physicist on tap while the close-out interview is going on, or whether they should call 

back later. So this is new information to us. How about the supervisors? 
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ORAUT: Per an established NIOSH agreement and direction, the dose reconstructors are not 

made available for closing interviews or follow-up calls but rather supplemented with Task 4 HP 

Reviewer staff. Direction has been provided that the dose reconstructor priority is reconstructing 

dose for claimants. Also, the dose reconstructors have not been trained in claimant 

communications. Rather, claimant communications are facilitated by Task 4 Health Physics 

Reviewers working closely with the assigned dose reconstructor as necessary. 

David Shatto (ORAUT): I am not a health physicist, but have 20 years of experience in the field. 

Ray: I am an environmental scientist and have 20 years of experience in health physics. I don’t 

do dose reconstructions, but am familiar with them and know them. But neither of us has gone 

through training for dose reconstruction. 

SC&A: In what fields do the four HP reviewers have degrees?

ORAUT: The reviewers are not qualified to do a dose reconstruction. All have 4-year degrees 

and training, including on-the-job training. One has a degree in chemistry. I can’t recall the 

others. 

SC&A: Who reviews the records of the claimants when questions arise? 

ORAUT: We would have an HP Reviewer look into their concerns. The reviewer makes a 

judgment about the concerns brought up by the claimant. A call is scheduled to address those 

concerns. 

SC&A: It was my understanding that an HP would review new information. Does a health 

physicist ever call back? 

ORAUT: They do not receive a review by a health physicist or a call back from an HP. If a 

substantive judgment on details in dose reconstruction is necessary, the HP Reviewer would call 

the DRist. As long as I recall, HPs have not been involved in calling claimants. 

SC&A: So what preparation has been done to call back the claimant from Rachel’s interview of 

October 11? 

ORAUT: In this case, the information was reviewed by an HP Reviewer. We are going to 

determine what information is available and if it was reviewed in the DR. 

SC&A: What has been done till now in preparation for the call? 

ORAUT: We have reviewed available data before the completion of the dose reconstruction 

report. We did a more thorough review of the DR report and the IREP input sheet. We go into 

detail in the review. If new information is available, we review that. 

SC&A: Is that information in the DR file? 
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ORAUT: It appears that there is information in the file. 

SC&A: Is there a [report from the national lab referred to by the claimant] in the file? 

ORAUT: Claimants sometimes get confused. 

SC&A: Who did the review? 

Ray: Brian Kaske (ORAUT) is going to be doing the call. I also did a quick review of the file. 

SC&A: Can I ask you a few questions pretending I was the claimant to get an idea of how you 

would answer them? 

ORAUT: OK. 

SC&A: Did you conduct a co-worker interview for this claim? 

ORAUT: No. 

SC&A: Why wasn’t there any monitoring data before XXXX, though he started work in 

XXXX? 

ORAUT: We don’t know if that could be answered definitively. Rachel told her we may not 

know, but maybe it was during the waiting period for the security clearance. The start date for 

employment was [date]. The DOE response shows monitoring began on [date]. 

SC&A: Would the HP Reviewer handle that question? 

ORAUT: The review would explain that data for these years was not provided. The reviewer 

would explain that an onsite ambient dose was assigned, because he was an unmonitored 

employee. 

SC&A: What is a dose conversion factor?

David Shatto: We don’t get that question. It is to convert whole-body dose to the organ in 

question. 

SC&A: How do you explain anterior/posterior exposure and dose conversion factors? 

ORAUT: This issue could be fielded by a reviewer if it is simply factual about what was done, 

or it could be referred to an HP for a response. Usually, the interviewers are capable of 

answering that question, and if not, HP Reviewers are capable of answering. 

SC&A: Did you find any incident reports that caused him to be shipped off to [the national lab]? 

Who would answer a question like that? 
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ORAUT: That’s a question that HP Reviewers would try to address. There is an incident report 

in the file, but we don’t know if it is the same one. 

SC&A: We have heard that the Department of Labor says that they cannot deal with DR, even 

when the individual may disagree with the dose reconstruction. So if they can’t raise the 

disagreement with you and can’t raise it with DOL, then it seems it falls through the cracks. 

ORAUT: If an individual has objection to the DR report we will pass on their objection to the 

HP Reviewers. If after they sign the OCAS-1 form, the DR report is finalized and they are not 

happy, we cannot change the DR. If it is technically correct, then there is nothing we can do. 

We are not involved in the appeal process. Before the dose reconstruction is sent to DOL, they 

are asked for additional information. If they have new information, we look at it. 

SC&A: At the end of the day, who is responsible for settling a difference of opinion about a 

dose reconstruction between claimant and NIOSH? 

ORAUT: It isn’t clear that the DOL doesn’t listen to the claimant. If a claimant disputes where 

information was not used or improperly used, they can send the DR back to NIOSH. 

SC&A: Health physicists at DOE sites are concerned that their credibility is being affected by 

the DR process, because the maximum dose calculations do not correspond to the dose of record. 

Do you feel like you are communicating the fact that dose reconstructions are for compensation 

and not for regulatory purposes, like at the DOE site? 

ORAUT: We go over the point about how the dose reconstruction is done, when it is 

maximizing, with the claimants. 

SC&A: How does the scheduling work? 

ORAUT: We like to schedule interviews in advance, because that way, we can get a lot done. 

But sometimes we get calls from claimants who want their close-out interview on the spot. So 

we have “floaters” who answer these on-the-spot requests. Interviewers are assigned to be 

“floaters” on a weekly rotation. 

SC&A: When there are multiple claimants, do you do close-out interviews one-on-one or 

separately? 

ORAUT: It depends on the claimant. But we do normally separate them, unless the claimants 

request that it be done at the same time. There are privacy issues involved, so we cannot ask that 

the close-out interviews be done together with several claimants for the same claim. 

SC&A: How do you document the close-out interview? 

ORAUT: Every call is documented in the telephone log of NOCTS. It goes into detail as to 

what was spoken about. 
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SC&A: There is not a CATI-type report? 

ORAUT: No. There are details in the phone log about what was said. And there is the OCAS-1 

form that is returned, generally following the close-out interview. 

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SC&A observed the HP Reviewer’s follow-up call to Case #3 regarding the issues the 

claimant raised during the close-out interview on October 11, 2006. The HP Reviewer was 

Brian Kaske of ORAUT. 

Brian Kaske (ORAUT): As we have discussed, this call is being monitored by SC&A, the 

Advisory Board’s contractor. This call may also be monitored for quality assurance. 

Claimant: This is the problem. The Department of Labor, where you got your data, is wrong. 

The mobile unit at [site name] was way off. My husband and a couple of others got hot so many 

times that they sent them to [the national lab]. And [the national lab] said the unit was wrong 

from the get-go. I sent in the letter from [the national lab]. My whole case depends on this. 

Everything that he was led to believe at [site name] was not the case. The biopsies from the 

doctors should have been looked at. I could not get in through with Dr. XXXX because he is too 

old and too much time has gone by. I sent in a log that he [her husband] had been keeping. Did 

you not look at the oncologist report and the other material in your information? 

Brian: Can I have you turn to Page 4 of 15 under the Dose Reconstruction Overview section. 

Are the Diagnosis date and type of cancer correct? 

Claimant: I don’t know. You should know. I sent in the materials. 

Brian: I can tell your cancer was verified on the claim by the Department of Labor. Questions 

about diagnoses should be addressed to them. 

Claimant: I can’t do that. I gave you all the information possible. I have just about had it. It is 

very difficult for me to do this. I would recommend that all of you get together and get those 

things that I have sent in and look at them with the understanding that what you got [from DOE] 

was wrong. 

Brian: We appreciate your patience. 

Claimant: What you got from [site name] is completely wrong. 

Brian: I do see a letter that was sent from [DOE contractor]. Can we clarify which letter you are 

referring to when you say there is a letter from [the national lab] to [the DOE contractor]? 

Claimant: No, that is not right. 

Brian: The letter indicates that [the national lab] stated that the results of the body counts – 

including your husband’s – the results of the in vivo counting at [the national lab] are not in 

accord with the results are at [site name]. [Brian read a statement from the letter relating to the 

mobile in vivo counter results.] 

Claimant: That’s right. But they never said once what their counts were. 

Brian: The letter says the men should go to [another lab] for further testing. 
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Claimant: They sent him a couple of places. I don’t recall if he actually went to the XXXX. 

Brian: I don’t think they went to XXXX. I can tell you how the dose reconstruction was done in 

the dose reconstruction report. If you look at page 7 of 15, you will see missed dose. 

Claimant: That’s right, he had missed dose. They had to send him to another department. 

Brian (read): 

A comparison was made of [Name’s] urine sample results and lung count 

measurement results. [Name’s] urine sample results were used in dose 

reconstruction as a claimant favorable assumption. 

Although there was a record of lung count measurements, the lung count results were not used in 

the DR. Do you disagree with the use of urine sample results? 

If this goes to the Department of Labor, you are not required to agree with the results 

beforehand. Points 5 and 6 of the OCAS-1 form say that by signing the form, I don’t certify that 

I agree with the decisions. That includes in this case your husband’s lung count data. If you 

disagree with that decision, you can appeal. 

Claimant: Okay. If I do not agree with the dose reconstruction, where do I go from here? 

Brian: Paragraph 5 of the form reads: 

By signing this form, I do NOT certify or imply that I agree with NIOSH decisions 

indicated in the draft NIOSH dose reconstruction report concerning how NIOSH 

has used or not used information I have provided for the dose reconstruction...

This would include any concerns with the lung count information. 

Claimant: I think the urine would provide the best results. They were surprised at [the national 

lab] about his XXXX. 

Brian: We have all the urinalyses on your husband. He has urine samples above the minimum 

detectable limit. 

Claimant: Yes, we knew that at the hospital – they mentioned that. I am not in disagreement 

with that. 

Brian: Can we turn to 7 of 15 where it talks about missed dose? 

Brian read: 

To account for any potential undetected dose for [Name], who participated in 

internal dose monitoring programs, internal dose was assigned based on a 
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chronic intake assumed to have occurred throughout [Name] employment period 

([date] through [date]). 

Claimant: That’s right he had missed dose. They had to send him to another department. 

Brian: On the same page, the second to last sentence says: 

In addition, the uranium intake was assessed as 100% uranium-234; this is a 

claimant-favorable assumption.” 

Since he worked at [site name] after 1961 when recycled uranium was processed, a dose from 

plutonium, technetium, and neptunium was assigned. 

Claimant: That’s what was in the department. 

Brian: On page 8, it says that recycled uranium was processed at [site name] and that was 

assumed also. It has plutonium, neptunium, and technetium in it. These were included also. He 

had confirmed positive dose, since his urinalysis did show that his measurements were greater 

than the minimum detection limit. A claimant-favorable assumption of Type S was used for the 

[Cancer type], and Type F was used for the [cancer type]. He has multiple acute intakes, which 

were assigned for the [organ name] system and a concurrent dose for [organ name]. The dates 

are there for assumed acute intake dates. They also used an assumption that the uranium was 

enriched. This is also claimant favorable. The dose was assigned beyond that in the records. 

Claimant: That’s good. That’s what was bugging me. I sent the records in, including his 

appointment log. 

Brian: Yes we have his appointment logs. Any other questions? 

Claimant: I think that is what was bugging me. Also the notes I sent by Dr. XXXX. His 

appointment log is in the claimant file. I sent it in, because we could not get in touch with Dr. 

XXXX. 

Brian: All those materials will be sent to the Department of Labor when the dose reconstruction 

report is forwarded. Anything else? 

Claimant: If you need anything else? I guess that was it. It was just bugging me that all this 

was wrong. I wouldn’t trust anything from [site name]. 

Brian: OK 

Acute intakes were assigned based on [Name’s] positive urinalysis results. In addition to this, a 

chronic exposure was assigned to account for missed dose. All of these assumptions made this 

DR claimant-favorable. 

Claimant: Yes 
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Brian: The next step is to send in the form if you feel all your questions have been answered. 

Claimant: In other words, all this is favorable. Where do we go from here? 

Brian: We need the OCAS-1 signed and returned, as long as we have covered all your questions. 

Claimant: If you think all this is favorable, I will go ahead and sign it. I don’t know where we 

go from here. [My daughter] did not think it was very favorable. She said they really worked 

him over. I was very skeptical. 

Brian: I do want to confirm a couple of things. On page 4 under the dose reconstruction 

overview, it says that even under these [claimant-favorable] assumptions, NIOSH has 

determined that with further research and analysis, the probability of causation won’t be 50% or 

greater. 

Claimant: How much does it have to be? 

Brian: That’s a good question. This is individual-specific and is based on the person’s date of 

birth, hire date, termination date, cancer type, and unique monitoring history. The dose 

reconstruction report does not provide a percentage, but it provides a dose. XXXX rem was 

received by the XXXX and XXXX rem was received by the XXXX. This is not a POC. 

Claimant: So what does it mean? 

Brian: It’s the amount of radiation energy that NIOSH assumed he could have received. They 

are amounts of energy. This is not a decision. 

Claimant: I don’t see how the Department of Labor could be any different. There is enough 

evidence here to prove the claim. 

Brian: The Department of Labor determines claim outcome. NIOSH does not adjudicate claims. 

If they deny you, you can appeal. 

Claimant: I don’t know how they could come up with another decision. [Sentences not related 

to dose reconstruction deleted.] 

Brian: It’s OK to be skeptical. 

Claimant: I am an old lady and I have seen a lot of dishonesty. 

Brian: Let me give you my number, so you can contact me if you have any questions. 

Claimant: Is this the same as Rachel’s? 

Brian: As you continue through the process, feel free to call me or the DOL. It will take about 

2–8 months for a decision. Claimants have said it is closer to 2 months. 
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Claimant: Very good. 

Brian: You can call the DOL Cleveland office to find out the status of the claim. You can call to 

ask them anything. 

Claimant: They are good at providing me with a note. 

Brian: The contact information for DOL is on any correspondence. Are there any other 

questions? 

Claimant: No 

Brian: Two things will be different on the final DRR. First, the DRAFT will be changed to 

final. Second, there will be nothing included to sign. Once you receive this report, this indicates 

the DR has been sent to DOL. 

Claimant: That will be good. 

Brian: Labor will provide a decision. 

Claimant: With all this information, I don’t see how they can deny it. It was enough to kill him. 

Brian: If you are denied, there is a process to appeal the claim. Best of luck! Give me a call if 

you need further assistance. 

End of interview 
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applicability within the requirements of 42 CFR 82. 

After the follow-up call, SC&A had a discussion with the interviewers Rachel Hume and 

Gwen Knox, the HP Reviewer Brian Kaske, and manager Ray Weaver. 

ORAUT: That is a pretty common follow-up call. 

SC&A: Did you look at the [national lab] data she was talking about before making the call? 

Brian: No. That was the DR’s decision as to whether to look at it or not. I did not look it. 

SC&A: Brian represented that the DR was claimant favorable. She had mentioned that the 

[national lab] lung count was higher than the [site name] count. But you did not look at [national 

lab] data or verify with DRist? 

Brian: No I did not. We assume that all data was used. 

SC&A: But Rachel told her that she would refer the specific issue of the [national lab]

measurement to the HP Reviewer. The claimant mentioned it at least a dozen times, that the 

[national lab] measurement being higher was the critical problem in how she viewed the dose 

reconstruction. She said that the higher measurement from [national lab] was the issue for her. 

Do you agree that she mentioned it at least a dozen times between the close-out interview and the 

reviewer call? 

Ray: Yes, she did mention it at least a dozen times. 

SC&A: I just want to make sure. Did you look at all at the [national lab] data before assuring 

her that the dose reconstruction was claimant favorable, given that that was her main problem? 

Brian: I looked at a letter in the claim file. 

SC&A: Did you look at any data from [the national lab]? Any measurement to check if the 

actual value of lung burden or intake used from the urine data in the dose reconstruction was 

claimant favorable compared to the measurement from [national lab] she was putting before 

you? 

Brian: I did not look at any numbers. I looked at the letter from [the DOE contractor] stating 

that [national lab’s] measurements were different than [those of the site]. 

SC&A: Yes, I heard you read that to the claimant. Thanks. I just wanted to verify whether you 

looked at the [national lab] data, because that is what the claimant put forward. 

End of interview. 
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NOTICE: This report is pre-decisional and has not been reviewed by the Advisory Board for factual accuracy or 

applicability within the requirements of 42 CFR 82. 

SC&A Requests: 

During the course of the discussions with the ORAUT staff, the following items were requested 

from NIOSH. 

• The special script prepared for this interview to indicate to the claimant that Arjun and 

Kathy. (Action Completed) 

• Interviewer training manual compiled by ORAU (pending). It is ORAUT’s 

understanding that all requests must go through NIOSH for these types of documents. 

• NIOSH Dose Reconstruction Packet (pending completion) 

The following procedures are currently being used for conducting close-out interviews and 

subsequent reviews. 

• ORAUT-PROC-0090, effective date 6/21/2005 

• ORAUT-PROC-0092, effective date 8/17/2005. 

Addendum A to the close-out interview notes 

Script for call provided by ORAUT to SC&A 

The following script was read to each claimant prior to the start of the close-out interviews that 

were observed by SC&A. 

This call is being monitored by Sanford Cohen and Associates, the technical 

support group for the President’s Advisory Board. They are listening in to ensure 

we’re covering and answering all necessary information within the dose 

reconstruction report.