Jack J. Fix
Fellow of the Health Physics Society APR 25 ong)
Certified by the American Board of Health Physics :

April 17, 2001

Larry J. Elliott

Acting Director

Office of Compensation
Analysis and Support

National Institute of Occupational
Safety and Health

4676 Columbia Parkway

Cincinnati, Ohio 45226

Dear Larry:

Thank you for the opportunity to provide input to the development of an occupational
illness compensation program. I propose that a program be implemented that:

e Evaluates all worker concerns regarding illness resulting from Department of
Energy, predecessor agency, contractor and subcontractor employment.

¢ Utilizes medical, dosimetry and industrial hygiene technical review boards to

assess potential worker exposure to hazardous agents, review records of exposure
and evaluate the potential for disease causation based on known estimates of risk.

Provides for partial awards for morbidity as well as mortality based on disease
diagnosis, the association of disease and potential exposure, and the calculated risk.

© Calculates risks liberally in favor of workers to enhance overall acceptance of
compensation program and to reduce litigation costs.

¢ Provides for medical monitoring of workers that receive compensation and the
outcome of this monitoring to be incorporated into ongoing research regarding
exposure, risk and disease incidence.

¢ Treats retired and employed workers, and their families, equally.

It is generally recognized that relatively few workers will qualify for compensation
using the probability of causation (POC) methodology and the criterion of “more
probable than not” (i.e., POC > 50%) that radiation caused the disease. The nation’s
nuclear weapons operations involved potential worker exposure to many types of
physical and chemical agents in addition to radiation. Assessment of the adequacy of

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Jack J. Fix
Fellow of the Health Physics Society
Certified by the American Board of Health Physics

monitoring for these non-radiological agents and the availability of records associating
exposure to individual workers is challenging but important to implementing a credible
occupational illness compensation program. Certainly, there is significant uncertainty
in any retrospective assessment of exposure particularly for non-radiological agents.
The review boards should base recommendations for compensation or denial on the
known association of the specific disease of diagnosis and exposure to identified
hazardous agents. The review boards should have the latitude to recommend full
compensation based on their technical review of individual worker circumstances.

For workers with little evidence of exposure to physical and chemical agents
associated with the specific disease of diagnosis, the POC methodology should be used
to provide full or partial compensation from radiation exposure similar to the system
used in the United Kingdom since 1982 (morbidity since 1987). DOE radiation
records should be an important, if not primary, element of the review process. Partial
awards should be provided based on the POC using a graduated scale (i.e., higher
dosed workers receive proportionately greater award). Uncertainty in recorded dose
should be considered in calculating the POC.

For workers who are currently living with the disease, medical monitoring should be
provided similar to military personnel access to medical care or the existing DOE
medical surveillance of retired workers. NIOSH access to medical information should
be required of all workers, and their families, who receive compensation. This
information should be incorporated into ongoing research regarding the association of
disease with potential occupational exposures.

Sincerely,
s GG 5 4 <

ack ¥ Fix
107 Jackson Court
Richland, WA 99352

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