ABRWH

Advisory Board on Radiation and Worker Health

December 29, 2016 

The Honorable Sylvia M. Burwell 

Secretary 

Department of Health and Human Services 

200 Independence Avenue, S.W. 

Washington, D.C. 20201 

Dear Madam Secretary: 

Advisory Board on Radiation and Worker Health

Enclosed for your information is a report prepared for you by the Advisory Board 

on Radiation and Worker Health (the Board). The Board conducts independent 

reviews of selected radiation dose reconstructions completed by the National 

Institute for Occupational Safety and Health (NIOSH) in accordance with the 

requirements of the Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA) of 2000. The purpose of the Board’s review process, 

as mandated by the EEOICPA, is to advise you on the “scientific validity and 

quality of radiation dose estimation and reconstruction efforts being performed for 

purposes of the compensation program.” 

This report was prepared by the Board’s Subcommittee for Dose Reconstruction 

Reviews, with input from the full Board. It was approved by the full Board on 

November 30, 2016. This report covers the Board’s review of 232 individual 

dose reconstructions conducted since the Board’s last Report to the Secretary in 

2009. The two reviews represent over one percent of the total number of 

radiation dose reconstructions performed by NIOSH during this time period. 

These reviews are generally representative of the overall worker population and 

work locations covered by the EEOICPA program. The reviews were prioritized 

to focus on radiation dose reconstructions that involved more comprehensive 

dose reconstruction procedures, and on those dose reconstructions for which 

errors in dose reconstruction could have a greater impact on claimant 

compensation decisions. 

 

The Board’s review of the 232 dose reconstructions identified 626 findings, and 

of these findings only 22 (4%) were judged to have the potential to significantly 

impact the resulting dose reconstruction. Given the greater complexity of the 

cases reviewed in this report, compared to the 2009 Report, the Board believes 

that there has been improvement in the NIOSH dose reconstruction process. 
1 

Advisory Board on Radiation and Worker Health 

Findings for 232 Dose Reconstruction Review Cases (Sets 6-13) and 

Comparisons to the First 100 Dose Reconstruction Review Cases

December, 2016 

INTRODUCTION 

Under the Energy Employees Occupational Illness Compensation Program Act 0f 2000 

(EEOICPA), the Advisory Board on Radiation and Worker Health (the Board) is required to 

“verify a reasonable sample of the doses” calculated by the National Institute for Occupational 

Safety and Health (NIOSH) through their radiation dose reconstructions for claimants with 

cancer who apply for compensation. In the early years of the program, the Board established 

methods and procedures for conducting these verifications. The Board also established the 

Subcommittee for Dose Reconstruction Reviews (the Subcommittee) to select cases for review 

and oversee the reviews which were conducted by our technical contractor. The Board initially 

established a target of reviewing 2.5 percent of the individual dose reconstructions conducted by 

NIOSH, but later modified this target to 1 percent. This reduced target was based on the 

substantial amount of time and effort required to reach the original target and the judgment of the 

Board that a 1 percent sample would be adequate. 

The Board’s last report to the Secretary of the Department of Health and Human Services (the 

Secretary) was issued in 2009 and covered the first 100 cases reviewed by the Board. The 

current report covers the review of an additional 232 individual cases. The following report 

provides background information on the methods used to select cases for review, the review 

procedures and methodology, the findings of this review, and the Board’s conclusions and 

recommendations. 
2 

OVERVIEW OF REVIEW PROCEDURES 

The Board’s Subcommittee for Dose Reconstruction Reviews selects the cases to be reviewed in 

consultation with the full Board. The cases eligible for review include only claims that have 

been fully adjudicated by the Department of Labor (DOL). The cases for this review were 

selected based on several criteria that have been modified over time to obtain better 

representation of all facilities, work eras, occupations or types of work, and cancer types. Also, 

selection was targeted to include the more comprehensive dose calculations (so-called bestestimates) and dose estimates that were closer to the compensable level (Probability of Causation 

in the range from 45 to 52 percent). The reviewed cases and their selection are described in 

more detail below. 

The cases were referred to the Board’s technical contractor -Sanford Cohen & Associates 

(SC&A) - which provides technical and scientific expertise to assist the Board in conducting our 

work). SC&A staff then reviews the case files and repeats the dose reconstruction procedures 

utilized by NIOSH for that case and attempts to verify the NIOSH findings. The contractor then 

prepares a report on its findings for each case including any errors found in how the dose 

reconstruction was conducted. The report presents a systematic review of the findings following 

a standard template and evaluation process that also addresses the severity of each finding. 

Findings with the greatest potential impact on the dose reconstruction calculation are rated as 

being more serious. 

The contractor’s report on each case is first presented to two Board members for initial review 

and discussion of that case. All Board members participate in this phase of the review process 

with each Board member assigned to review a limited number of cases. SC&A’s report on each 

case is modified in light of the Board members’ reviews and sent to NIOSH for comments and/or 

clarification. Then the report on each case is presented to the Subcommittee for review and 

discussion. The Subcommittee resolves any differences between the contractor and NIOSH or 

the contractor and the Subcommittee regarding the review findings. The Subcommittee finalizes 

a report on the findings for each case reviewed. In addition to the specific case review findings, 

the review process may also reveal potential problems with the specific procedures or documents 
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used in the dose reconstruction process. These may be referred to NIOSH or to other Board 

work groups or subcommittees for further evaluation. 

For a small proportion of the reviewed cases, the Board follows a slightly different procedure in 

that the Board’s contractor independently calculates the dose estimates (rather than just verifying 

the NIOSH calculations.) These are referred to in the report as “Comprehensive” or “Blind 

Reviews”. A report is prepared on each of these cases, reviewed by NIOSH, and then finalized 

by the Subcommittee.

FINDINGS 

Cases Sent to NIOSH for Reconstruction 

As of November 1, 2015 the Department of Labor (DOL), which administers EEOICPA, 

reported a total of 44,789 case claims sent to NIOSH, of which 42,714 cases (95.4%) had already 

been returned to DOL for a compensation decision, with the remaining 2,075 (4.6%), both new 

and returned, still under review at NIOSH . The 42,714 cases returned to DOL included both 

dose reconstructions and Special Exposure Cohort (SEC) cases compensated due to inability to 

estimate the radiation dose with sufficient accuracy and reasonable likelihood of health 

endangerment. (Administratively some of the latter cases were processed individually by NIOSH 

while and until the SEC classification was determined, and others directly by DOL if and after 

the SEC class was approved.) 

Types of Dose Reconstruction 

The cases reconstructed since the Board’s inception fall into three basic types: 1) ‘best-estimate’ 

dose reconstructions; 2) ‘over-estimated’ dose reconstructions; and 3) ‘under-estimated’ dose 

reconstructions. NIOSH’s overestimating approach is an efficient way to process claims which 

are evidently non-compensable upon initial examination. This time saving method confirms the 

initial observation and is employed only for non-compensable claims. Under-estimation is 

similarly a time saving approach used for claims that are evidently compensable upon initial 

examination. Once the evidence of compensability is confirmed, a more precise estimate of dose 

is not necessary. The best-estimate approach is used for cases that are not clearly compensable 
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or non-compensable upon initial examination and gives the most precise estimate of dose in 

order to make a decision on compensation. [Note that dose reconstructions are not undertaken for 

claims in facilities approved for SEC classes. In claims for facilities with SEC classes for which 

the cancers declared are not among the 22 that are compensable under the SEC provisions of 

EEOICPA, a partial dose reconstruction is undertaken, enabling DOL to make a compensation 

decision based on the fraction of radiation doses that remain feasible to reconstruct.] 

Dose Reconstruction Cases 

At the conclusion of the dose reconstruction reviews for Sets 6-13, which are the focus of this 

part of the report, NIOSH reported a total of 31,534 cases with completed dose reconstructions 

sent to the DOL. The remaining cases were primarily SEC cases, but also included some cases 

returned to DOL for administrative reasons. The distribution of types of dose reconstructions 

(DR’s) for these claims, made since the inception of the program in 2001, is as follows (Table 1): 

Table 1. Types of Dose Reconstruction for the First 31,534 DRs* 

Best Estimate Over-Estimate UnderEstimatePartial

2,452 (7.8%) 18,960 (60.1%) 8,104 (25.7%) 2,018 (6.4%)

* Completed as of Nov. 1, 2015.

Thus a majority of the claims submitted involved over-estimated dose reconstructions, and an 

overwhelming majority (85.8 percent) either over- or under-estimates. Only 7.8 percent were 

reconstructed based on the more precise but more time-consuming best-estimate method. Partial 

dose reconstructions (conducted for cases whose workplace is included in the Special Exposure 

Cohort but whose types of cancer are not eligible for compensation without a dose 

reconstruction) comprised the remaining 6.4 percent.

Following the initial Report to the Secretary in 2009, the Board recommended to NIOSH to 

decrease the percentage of cases involving over-estimates (resulting in denial of compensation) 

through more frequent use of best-estimates for dose reconstructions. However, over-estimates 

remain in frequent use in order to complete dose reconstructions on a timely basis within 

available resources. 
5 

Overall, 13.4 percent of the cases were for claims made by female employees. No data were 

collected on race or ethnicity of the cases except for those filing for skin cancers, for whom 

differences in overall incidence rates by race are scientifically observed and thus needed to be 

taken into account in the dose reconstructions.

Dose Reconstruction Cases Reviewed 

Of the dose reconstruction cases reviewed for this report, the Subcommittee under the direction 

of the Board and with technical assistance from NIOSH, the NIOSH subcontractor Oak Ridge 

Associated Universities (ORAU), and the Board’s technical contractor (SC&A), has been able to 

undertake more reviews of best-estimate dose reconstructions. Although best-estimate dose 

reconstructions are relatively infrequent among all cases processed under the NIOSH program, 

they are particularly important in that errors could potentially result in DOL being advised to 

make incorrect compensation decisions. Also best-estimates require much more sophisticated 

calculations, more complete records, and more challenging professional decisions to bridge 

information gaps both plausibly and claimant favorably. Hence reviews of best-estimates test the 

dose reconstruction process more effectively than over- and under- estimated cases. 

Cases for review were selected primarily from among best-estimate dose reconstruction cases 

already adjudicated by DOL. The criteria used in selecting these cases were Probabilities of 

Causation (POCs) between 45 and 55 percent (more recently between 45 and 52 percent), 

appropriate representation of facilities (Department of Energy and Atomic Weapons Employers, 

diversity of occupations, diversity of decades worked and lengths of time worked, and diversity 

of cancer types.) More recently, gender has also been included as a selection criterion. 

Of the 232 recently reviewed cases, 193 (82%) were best-estimates, 32 (14%) were overestimates and 7 (3%) were under-estimates. Thus, a total of 17% of reviewed cases were either 

over- or under-estimates. These results stand in sharp contrast to the results from our 2009 

Report on the first 100 cases reconstructed in which 93 percent were either over- or underestimates. (Table 2) 
6 

Table 2. Types of Dose Reconstruction Reviews 

Cases Reviewed

(Yr. of Report to Secretary)

BestEstimateOverEstimateUnderEstimate

First 100 cases (2009) 7 (7%) 76 (76%) 17 (17%)

Next 232 cases (2016) 193 (83%) 32 (14%) 7 (3%)

The review of the first 100 cases that were largely processed as over- and under-estimates 

reflects the imperative to rapidly process the large initial batch of claims during the early years of 

the EEOICPA program and eliminate the resulting case backlog. As the program has matured: 

 The backlog of dose reconstruction cases has now been reduced so that about as many 

individual cases as are sent to NIOSH quarterly are processed during that quarter; 

 Many site exposure profiles for covered facilities have been completed based on site 

document research and visits by NIOSH and Board members, and much of this work has 

been reviewed through the establishment of 37 different site-specific Board Work 

Groups, and

 Many more analytical procedures have been developed, documented, and automated 

where feasible, based on staff input and the activities of the Board’s Procedures Review 

Subcommittee so that dose reconstruction decisions are now better regularized and more 

uniform. 

As a result, best-estimate dose calculations now comprise more than four-fifths of the cases 

being reviewed.

Findings among Reviewed Cases 

In examining the 232 cases from Sets 6-13, the Subcommittee reviewed a total of 626 findings 

(an average of 2.70 per case) in which there were initial differences between the dose 

assessments for individual cases made by NIOSH and those made by the Board’s technical 

consultants (after initial review by individual Board members). These findings were then 

discussed first by the respective staffs and then by the Subcommittee. Of the 626 findings, 513

(82%) were ultimately determined to be of potentially low impact on the compensation decision, 

91 (15%) of potentially medium impact, and 22 (4%) of potentially high impact. 
7 

A finding is categorized to have a low impact if it has only a marginal impact on the 

compensation decision, involving for example a minor quality assurance concern, a minor factual 

or technical clarification, or a change in estimated dose (increase or decrease) of only a few 

millirems (mrem). A finding is found to be of medium impact if it was related to some change in 

procedures, a more involved discussion or clarification of the DR methods, or involved a change 

in dose of greater than a few mrem up to a few rem. A finding is considered to be high impact if 

it prompted a major change in procedures that would affect several cases, or if it involved a 

change in assigned dose of several rems or more. 

The 22 potentially high-impact findings affected 17 of the cases reviewed by the Subcommittee. 

Three of these 17 cases had two potentially high-impact findings, and one case had three. Thus, 

seven percent of the 232 cases reviewed had potentially high-impact findings.

As a result of discussion and review of these findings, the compensation recommendation related 

to a Probability of Causation was noted to be changed in only one case (0.3% of cases reviewed

by the Dose Reconstruction Reviews Subcommittee). In this case, the NIOSH dose 

reconstruction had resulted in a positive compensation decision, whereas the determination of the 

Subcommittee would have below the level for compensation. The claimant-favorable 

assumptions made by NIOSH in response to the original claim were the best information 

available at that time. The Subcommittee findings were based on additional information not 

available initially to NIOSH.

As might be expected, the above result of 2.70 findings per case is 32 percent less than the 3.98 

per case reported in 2009. However, the distribution of impacts in this report (82% Low, 15% 

Medium and 4% High) is quite similar to those from the 2009 report (86% Low, 12% Medium 

and 3% High). This result may reflect the fact that the dominant over- and under-estimations in 

the first report were broad assessments, not likely to present major differences in dose 

reconstruction estimates. For this report, dominated by best-estimates, the chances for 

differences were far greater. Due to improved assessment procedures and protocols implemented 

by NIOSH, the percentage of high-impact findings has been kept low – that is, these two effects 

have counteracted each other to keep the percentage of high-impact review findings low. 
8 

In addition to assessing the degrees of impact of deficiencies for each case reviewed, the 

Subcommittee began in Set 6 to assess and categorize findings by type of issue or issues 

involved in these deficiencies. The types of issues and their distribution among findings for the 

232 cases are presented in Table 3. 

Table 3. Findings by Type of Deficiency for Sets 6-13*

Category Type of Deficiency No. Of Findings

A Was the proper judgment made regarding placing a 

person physically at a work location? 

13 (2%)

B Were all exposure scenarios considered (i.e., neutron, 

thorium)?

28 (4%)

C Were the correct external dose model and assumptions 

used?

253 (40%)

D Were the correct internal dose model and assumptions 

used?

134 (21%)

E Is it a quality concern? 95 (15%)

F It does not meet any of the above criteria. 103 (16%)

 Total 626*

*NOTE: Some of the 232 cases had more than one type of deficiency. 

As is clear from Table 3, the greatest source of findings (40 percent) is disputed modeling or 

assumptions about external doses, followed by the same (21 percent) for internal doses. The 

former deficiency often reflects differences about the radioactive materials to which an energy 

employee was exposed. If a discrepancy is found in a reviewed case, all similar cases that have 

not already been compensated, are reviewed by NIOSH, and provided a new dose reconstruction 

when appropriate. If the new dose reconstruction would modify the compensation decision, the 

Department of Labor will take appropriate action to reverse the earlier decision. It should also be 

noted that NIOSH utilizes the same process of reconsidering and revising dose reconstructions 

upon its own review and improvement of dose reconstruction data and methods, independently 

of the Board’s review. 

Observations among Reviewed Cases 

In addition to the findings under review, SC&A consultants made 206 observations (slightly less 

than one per case reviewed). Observations, which began being noted and recorded in Set 8, are 

instances where SC&A had comments or questions about NIOSH/ORAU dose assessments 

which were discussed by the parties and reviewed by the Subcommittee to confirm that proper 

procedures were followed and applied correctly. If not confirmed, the instances initially assessed 

as observations were changed to findings and re-examined appropriately. Thus, none of the 206 

observations recorded resulted in a change of estimated POC. 
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Number of Dose Reconstruction Cases Reviewed 

As of November 1, 2015, the Board had reviewed since its inception 332 cases among the 31,534

cases filed which required dose reconstruction. Thus, the Board has completed reviews of 1.05 

percent of all such cases filed as of this date, achieving its current goal of 1 percent of all such 

cases reviewed. Initially the Board had set a goal of 2.5 percent, as reported to the Secretary in 

2009, reflecting our experience of conducting reviews, 93 percent of which were over- and 

under-estimates. However, the Board’s decision to increase the percentage of best-estimate cases 

slowed down the review process. Subsequently, the Board approved reducing our goal to 1 

percent of all Dose Reconstruction cases. This goal has been met. The Board fully expects to 

continue meeting this goal during the next operational period. 

Distribution of Dose Reconstruction Sites across Employment Sites 

In addition, the Subcommittee, under the Board’s direction, has worked assiduously since 2009 

to assure that cases selected for review represented an appropriate cross-section of all the plants 

and facilities for which compensation claims have been made. The breakdown of employment 

sites covering Sets 6-13 is presented in Figure 1. Sites with only one or two cases reviewed are 

represented collectively with 38 sites having one case reviewed and 26 having two. 
10

In Figure 2 the blue bar next to each of the 26 large and medium sites represents the number of 

cases needed to be reviewed in order to achieve 1 percent of all Dose Reconstructions reviewed

for that site. [NOTE: The Board’s goal is 1 percent reviewed of the total of all claims involving 

dose reconstruction cases, not 1 percent of all claims for any given facility. Some facilities, for 

example, may deserve greater attention due to the complexity of the DR’s involved.] In Figure 2 

the second bar next to each site is the sum of cases which have been reviewed since the inception 

of the program, combining those for the first 100 cases (in red) and those for the next 232 cases 

(in green). Thus if the height of the red-green bar for the reviewed exceeds that of the blue bar, 

then the reviews undertaken by the have exceeded 1 percent of the Dose Reconstructions for that 

site. 

As indicated for the 26 named sites in Figure 2, the Board has met or exceeded the measure of 

one-percent reviewed for 11 of them and has not met this measure for the other 15 named sites. 

For sites with one or two reviewed cases (Figure 2, bottom two lines) the Board has far exceeded 
11

1 percent reviewed, with 82 reviews completed when 53 would have been needed to achieve 

one-percent reviewed. This gives evidence that sites with small numbers of claims were 

appropriately covered in the review process. 

Distribution of Probabilities of Causation among Cases Reviewed 

Figure 3 shows the distribution of Probabilities of Causation (POC) among cases reviewed in 

Sets 6-13. Cases with POC between 45-52% have been targeted for selection in the recent past 

since slight errors in these have the potential to change the compensation recommendation from 

non-compensated to compensated or vice versa. Thus, almost one-third of the case reviews 

(30%) since the 2009 Secretary’s Report have been in the POC range of 45 to less than 50 

percent. This is a major increase in reviews in this POC range, compared to only 5% of reviews 

in this range for the first 100 case reviews reported in 2009. This reflects both the increased 
12

percentage of best-estimate cases reviewed since 2009 and our focus on assuring correct 

compensation decisions. 

Another subgroup, those cases with POC from 50-52%, have also been targeted recently along 

with the 45 to <50% group. For the subgroup from 50-52% the Board wants to assure that slight 

errors in this subgroup have not resulted in erroneous compensation decisions. As a matter of 

policy when such errors are found, the inappropriately-compensated claimant is not asked to 

return his/her compensation money. However, finding such errors can help both the Board and 

staff avoid such compensation errors in the future. Even with this focus, however, the percentage 

of reviews in this report (21%) which have POC at or over 50% is less than the corresponding 

value of 27% in the 2009 Report. This reflects a sharp decline in under-estimation cases since 

2009. Similarly the percentage of cases reviewed with POC below 45% has declined from 68% 

before 2009 to 49% in this report, in this instance reflecting a decline in over-estimation reviews 

since 2009. The bottom line in both of these instances is that the Board is now more clearly 

focused on reviewing cases for which small errors in radiation dose reconstruction can change 

the compensation decision, hence seeking further to minimize possible errors in the final 

compensation decision.
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Distribution of Dose Reconstruction Reviews by Years of Employment 

Figure 4 shows the distribution of dose reconstructions by years of employment. As noted twothirds (67%) of the 232 persons for whom doses were reconstructed and reviewed by the 

Subcommittee worked in EEOICPA-covered facilities for 20 years or more, 13% for 10 to 20 

years and 20% for less than 10 years (average 24.1 years).

The present results reflect a slight average increase in years of employment compared to those 

reported in the 2009 Report at 53% for 20 years or more, 21% for 10 to 20 years and 26% for 

less than 10 years, respectively (average 22.4 years). This is not surprising since the current 

report has been developed six years after the first, allowing more years of employment by 

claimants before developing cancers and/or applying for claims. Also in the ensuing years since 

the 2009 Report, the trends for 5-year relative survival rates of cancer victims have continued to 

rise, allowing claimants more years of employment before they file their claims if they so 

choose. 

Distribution of Cases Reviewed by Risk Model 

Figure 5 presents the breakdown by type for 28 cancers. The types with the largest numbers of 

cases evaluated are Non-melanoma Skin (63 cases), All Male Genitalia (47 cases), Lung (45 
14

cases), and Urinary Tract (36 cases). Half of the urinary tract cases are cancers of the bladder and 

the other half cases excluding the bladder. These results are similar in distribution to those 

reviewed for the first 100 cases. 

Distribution of Cases Reviewed by Decade First Employed 

Figure 6 presents the distribution of 232 cases by decade first employed. Fully 72 percent of the 

cases reviewed were first employed before 1960: 49 percent were from the 1950s, 21 percent 

from the 1940s and 2% from the 1930s. As expected given the decades-long latency periods of 

most cancers, these percentages have declined in more recent decades from 18% in the 1960s to 

6% in the 1970s and 4% in the 1980s. None were reviewed in this cohort from the 1990s or later. 

Comparing these results with those from the 2009 Secretary’s Report, there is now a large 

increase in the percentage of cases reviewed from before 1960 (72%) compared to 51% in the 

earlier report. 
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Comprehensive or Blind Reviews 

To further assure the accuracy of claimants’ dose reconstructions and hence POCs, the Board 

adopted a policy in 2012 of initiating more comprehensive (so-called blind reviews) in a limited 

number cases – that is, tasking SC&A independently to conduct dose reconstructions for cases 

already reconstructed by NIOSH and comparing the results, which are then reviewed by the 

Dose Reconstruction Reviews Subcommittee. While this process is resource-intensive, it is a 

better way to quantify how well two independent dose reconstructors can interpret the same data 

and identify decision points that could result in inconsistencies in dose calculations. During the 

past two years, the program has solicited six blind review cases per year .So far fourteen cases 

have been reviewed using this process, of which thirteen reviews have been completed and one is 

still under examination. All thirteen completed reviews are in agreement with respect to their 

compensation decisions. (Table 4) This is quite good agreement given the selection of cases 

which needed best-estimate assessments (typically resulting in POCs in the 45-52 percent range), 

the complexities of these dose reconstruction calculations and the absence of extensive internal 

and external dose measurements for many individuals. 
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Table 4. Blind Case Reviews 

Blind Case No. (Facility) POC by SC&A POC by NIOSH/ORAU

A. First contract period

1. Portsmouth Gas Diffusion 49.35% 48.75%

2. X-10 48.00% 43.63%

B. Set 17 Blinds

3. Allied Chemical & Dye DR under review DR under review

4. Fernald 38.12% 48.27%

5. Hanford 43.18% 45.27%

6. Rocky Flats 42.65% 47.51%

7. Savannah River 51.00% 51.39%

8. Y-12 and X-10 50.47% 50.46%

C. Set 20 Blinds

9. Nevada Test Site 40.59% 41.17%

10. Hanford/Weldon Springs Plant 40.71% 42.49%

11. Hanford/Pacific NW Natl. Lab. 36.43% 42.31%

12. Rocky Flats 43.78% 42.91%

13. Brookhaven Natl. Lab. 51.05% 52.54%

14. Y-12 49.48% 49.46%

Of the 13 completed cases in Table 4, nine were found to have one or both of their estimated 

POC’s between 45 and 52 percent. The median of the absolute value of the difference between 

estimated POC’s was 1.8%. The average value of these absolute differences was 2.5%. While 

these figures give pause for cases in which POC’s are near 50%, it should be noted for all of 

these estimates, both results were either above or below 50% and hence in agreement regarding 

compensation recommendations. 

Other Board Review Activities 

In interpreting the findings of these individual case reviews, it is important to consider this 

review process in the context of other reviews conducted by the Board. The dose reconstructions 

are based on a large number of technical documents that provide a description and history of the 

activities at each facility covered by the legislation and potential sources of radiation exposure 

for people working at that facility over time. In addition, there are a large number of other 
17

reference documents and procedures that are used in the dose reconstruction process. These 

documents are continually being revised and updated to reflect newly available information and 

adapted to improve the dose reconstruction process. The Board has reviewed, or is in the process 

of reviewing nearly all of these documents and often recommends changes to these documents 

that are then implemented by NIOSH. 

In addition, there have been many petitions to add designated groups of people working at 

specific facilities during designated time periods to the Special Exposure Cohort. NIOSH 

evaluates these petitions to determine if there is adequate information available to conduct 

individual dose reconstructions. If not, the group is added to the Special Exposure Cohort, and 

these people are eligible for compensation for specific cancers without individual dose 

reconstructions. The Board then reviews the NIOSH evaluation and makes a recommendation to 

the Secretary of DHHS whether or not to add the group to the Special Exposure Cohort. 

These other review activities by the Board have a large indirect effect on the Board’s verification 

of dose reconstructions. Often while an individual case is being reviewed or after the review, a 

procedure or other technical document used in the dose reconstruction may have changed due to 

the availability of new information or in response to a recommendation from the Board’s review, 

or the claimant may be added to the Special Exposure Cohort. The Board’s review of the 

individual case does not reflect those potential changes. It relies only on the procedures and 

information in place at the time that the original dose reconstruction was done and does not 

attempt to incorporate any subsequent modifications. However, as noted above for individual 

case reviews, NIOSH does review all individual dose reconstructions that may be impacted by a 

change in procedure or other technical document used in the dose reconstruction, recalculate the 

estimated POC when appropriate, and notify the Department of Labor if the compensation 

decision might change. 

Conclusions 

1. The Board’s review of 232 individual dose reconstructions yielded 626 findings. Only 22 

(4%) of these findings (occurring among 17 cases) had the potential for a significant 

impact on the outcome of the individual dose reconstruction. Given that the cases 
18

selected for review in this second report were much more likely than those in the first 

report to have findings that could have a significant impact on potential compensability 

of the case, these findings indicate that the NIOSH dose reconstruction process has 

improved compared to our earlier findings based on the review of the first 100 cases. 

2. Most of the findings with the potential for a significant impact on dose reconstruction 

were due to the limited availability of exposure and other data from the facility where the 

individual worked. The dose reconstruction process often relies on documentation that is 

still available from work done 50 or more years ago. Dose reconstructors must use their 

professional judgement to estimate the claimants’ exposures based on this often 

incomplete information. Differences between the original dose reconstruction and the 

recalculation of the dose by the reviewer(s) is not surprising under these circumstances. 

3. The limited number of more comprehensive reviews (so-called Blind Reviews) also show 

good agreement between the NIOSH dose calculations and those of the Board’s 

contractor. One of the more comprehensive case reviews was deferred until a more 

complete review of all of the data from the facility where the claimant worked could be 

conducted. 

4. The above three conclusions along with the Board’s ongoing reviews of the NIOSH dose 

reconstruction procedures provides the Board with a high level of confidence that the 

dose reconstruction process is scientifically sound. However, the methods and 

information used for dose reconstruction process are not static. As new information on 

the many sites covered by this program becomes available and better methods are 

developed to estimate dose, the methods used for dose reconstructions need to 

continually change to reflect this new information and methods. 

Recommendations 

Based on the findings of this review and the Board’s further deliberations, the Board 

recommends the following: 

1. The Board should continue the individual case review process consistent with the 

current goal of reviewing one percent of the dose reconstruction cases. 

2. The Board should modify the review process to make it more efficient and timely by 

focusing more effort on the critical parts of dose reconstruction evaluation. 

3. The Board should continue conducting the more comprehensive (so-called blind) 

reviews at the current rate. 
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4. The Board should initiate a process to conduct reviews focused on evaluating the 

consistency and accuracy of dose reconstructions for cases where the dose 

reconstructors must make individual judgments about what exposure data or other 

information should be used for conducting the dose reconstruction and where these 

choices are not prescribed by the guidance documents applicable to that site. For 

example, these reviews could focus on the consistency of the dose reconstructions for 

several cases with similar work histories at a given site or the consistency in the 

application of co-worker models for a specific exposure situation. The Board should 

work with the Dose Reconstruction Reviews Subcommittee, NIOSH, and the 

technical contractors to identify key targets and methodologies to implement these 

more focused reviews. 
Many of the current findings result from the limited availability of relevant 

technical and work process exposure information from facilities that first operated 

over 50 years ago. 

Our review of these 232 dose reconstructions, and our ongoing review of the 

NIOSH procedures used for dose reconstruction, provide the Board with a high 

level of confidence that the radiation dose reconstruction process is scientifically 

sound. 

Finally, the Board has made several recommendations for your consideration, to 

modify and improve its review process. 

We hope that you will find this information useful and informative. 

Sincerely, 

James M. Melius, M.D., Dr. PH. 

Chairman, ABRWH 

Enclosure 

[Signature on File]