'"";' ,.

Spedai exposure Cohort Petition wxfer the EneIgy ~ ~~.,.tional

I8nessCon1p8n88tion~

U.s. Department of Health and Ruman SerVf;CeS

CenIBr8 Ix- t:M&ea&e ~ and ~

Nafk¥1af kdIJf8 1x-0000.IpetionaI Safe(y ~ HeeIth ;

I

OMS Number: 0920.{)639 Expif98: ~1/lOO7 i SDeCiai ExDOSure Cohort Petition - Fonn 8

D.1 Labor Organization Information:

'NMie of Organization

POsition of Contad. Person

0.2 Name of Petition Representative:

D.3 Address of Petition Representative:

D.4

D.5

0.6

10.7

City State ~ Zip COdeTelephone Number of Petition Representative: ( , -

Email Address of Petition Re~ntatJve:

Period during which labor organization represented employees cove.- by this petition

(please attach documentation): Start End -

Identity of other labor organizations that may represent or have represented this clas of

employees [If known): .

.V'4I 

. ~~ .",', ' - . w ~\"~".{t"."\.'.. -. ' ~ ',' -""'~ .~. """'-..c.- ~ ' -'., ~ , '4. t, .. '-:"~~~ ~~~'",. ~~"'..;W:'.w ,:..".. '. , ..:- .:-:;';,~,.~::}::'::~..; to :e-,,}o~~w~ "-' ". "'~v.~'.;~ ~~..:,~'=';E;'~,:.';:. .' 'w .'~.":::1f.~7.~,~~~...:.'. ..:"":"'C~"'.- . ~~ c.

Name or Social Security Number of First Petitic..-
Is ~~ ~~ Obort~ ~ '.

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u.s. Depar~of ~ - ~Se ~ . I , '- - -CerdBS"b'Us88I8~aIKI~

-

OMS Nwar: 0920-0639 ~ O5fJ1flOO7; " ' . , 'D.o-' ~ ' '- .. 4 "' 7 SDeCjaI Exoosure Cohort :Petition - Fonn B

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N.ame_ofDO£OrA~F~~ S~.~ A/AT'IDAJA'-L~;"R~~V;~t~.R'n- ~-

--_Locations ~-I3QV"' at the Facility relevant Jo this'petition: D.,;,:RAt' :"'ta.nJ~~ P~UOR;§~~gAJl"A LAoAn RA -r~ A_~ ,,' - v

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List job titles and/or job duties of employees Included in the class. In addition, you can list by

name any ind"lviduals other than petitioners identified on this form who you believe should be

Included in this cJ~:

-

p i.. ~ A~E' ~GA' ~E t- SuPPLWJtJ,dAlT'A L .-:: ~.#nJ ft\ A-Y I 04\.J ~~k L

cA Employment Dates relevant to this petition:

Start -L ~; """/7l End "~1"17"

S1art Erid

Start End

Is the petition based on one or more unmonitored, unrecorded, or Inadequately monitored or

recorded exposure inCidents?: ... Yes a No

If yes, provide the date(s) of the incident(s) and a complete description (attach additional pages

as n~~ry):

,J

,.-:. . -. -- -' ' --

Name or Social SeaJrity Number of Rrst Petilioner:L~ =

~
Special Exposure Cohort Petition

~ the En8gy ~ ~1patiQIa1

IBriess CcJ."1Ip6I-~~ Ad

u.s. Department 01 Health and Human' SelVices

Cer8s tK Disease' Cor*d and ~

~ k1SDJte b' ~ Safety ~-tfeaIIh

OMB N"umber: 0920.()639 ExpIres: 05t31QOO1 '. '. P..-5Gf7

-

§~ial Exposure Cohort P~n - Fonn B

! """m::,'~ 3t !east one of the foUowing e~ In this section bych ecking the appropriate 00x ~ providing

; U!O t\7qujiOO infOffilation related to the seleCtion. You are not required to complete more than one entry.

.1 ., l/We have attached either documents or statements ~ded by affidavit that indicate that

radiation expQSW'8S and radiation doses potentially incurred by members of the proposed class,

that refate to thiS petition, were not monitored, either through pelSCnal monitoring or through area

monitoring.

(Attach documents and/or affidavits to the bad( of the petition form.)

Describe as completely as possible, to the extent it might be unclear, how the attaa'led

documentation and/or affidaYit(s) indicate that potential radiation exposures were not monitored.

- Pl.gR5~ SA'J; SIC!.. SL,P9LrS'Jfl6.111rAL .:.i;;"POR,.. A TIO/\J-=

- l!J;A_Y .Ill" 7.0(>1. '-

C.2 W II We have attached either documents or statements provided by affidavit that indicate that

radiation monitoring records for members of the proposed class have been lost, falsified, or

destroyed; or that there is no infonnation regarding monitoring, source, source tenn, or process

from the site where the employees worked.

(Attach documents and/or affidavits to the back of the petition form.)

DescnDe . as CO~ly as 'PosSibie, io ~ extent It mi~ be unclear. how the attached . . '" ,.. ., ,

doalmentation and/or affidavlt(s) indicate that radiation monitoring records for members of tl)e

proposed class have been lost, altered illegany. or destroyed.

PL4As~ ~e'P' ~~~=C;L'PP.L~i!)~NT"L r~IQ8~~~

-~:.y .if):1 ~OO~ f) -

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',:::,:,;; '.#::.;:~: ';"':... ;-.. .-. . . P8rtFfs_continuedonthe.fo"owing~ge.'1"; '.;..;J~' "'~'";': . ~~~... '.."

. '..'.. ,,-, ~.. ,-~. ":'.. ."""'X-'..". . I

--- Name or Social Security Number of FII'st Petitioner:
,.

All Petition~rs should sign and ~ ~ ~n. A~um. of three persons may sign the petition.

_.;..'~q_JD"'-

Date

'Sf'griaiiJre

Date Signature

Name or Social Security Number of First Petitioner:

Signature Date

Notice: Any person who knowingly makes any false statement. misrepresentation. oonceaIment of

fact or any other ad of fraud to obtain compensation' as provided under EEOICPA or wOO.

-knowingly aa'.eP1s (X)n1pensation to which that person is not entitled is subject to civil or

admnistJative remedies as well as felony aiminal proseaJtion and may, under appropriate

criminal provisions. be punished by a fine or imprisoM1ent or both. I affinn that the information:

provided on this form is aca1rate and true.

~

,0' end""'. UI IS,IUlIIlUoI. -. '--- _0'- ~~. Offirs of Compensation Analysis arKi Support ~~~ ___"00 - - _._, o.._, ~ ,-~ 

NIOSH . 4676 Columbia Parkway. Ms.c.-47

Cincinnati. OH 45226
..

I Special Expos!..,. Cohort Petition

ur.-.hEnergyEm~~pationa/

IHnea Corr~" lIi:iIl Ad

u.s. Department of Health and H~ ServiC88

c.1I8fs b' DI8-.e COf*oI .,., ~

Nati(I!18IInatiute b ~P8Ikx1aI Safety arxS H88Ith I

OMS ~ ~ ~ 05/31fZOO7

- - P8ge7of7' : Spedai Expoeure Cohort ~on -=- Form B

Public Burden Statement

-

Public reporting burden for this ooIIedion of informatk)n is estimated to average 300 minutes per fe&pa1Se,

indOOing time for reviewing instructions, gathering the 1nfonnatkx1 needed. and completing the fonn. If you

have any comments regattling the burden estimate or any other asped of this ~ of infot -.. .~

I indl.Kflng suggestions for redudng this burden, send them to roc Reports Clearance Ofticer. 1600 Clifton

Road, Ms.e.11 , Atlanta GA, 30333; A nN:PRA 0920-xxxx. Do 00\ seOO 1he competed petition form to ~is

address. Completed petitions are to be submitted to NIOSH at the address provided in these instructions. PeIsons .are not required to respond to the infom1ation ~ on this form unless it displays a aJrTentIy

valid OMB number.

Privacy Act Advisement

I in aaxxdance with the Privacy Act of 1974, as amended (5 U.S.C. § 552a), you are hereby notified of the

I following:

The Enefgy Employees ~patiCK\8J Illness Compensation Program Act (42 U.S.C. §§ 7384-7385)

(EEOfCPA) authorizes the President to designate additlonaJ classes of employees k> be fnduded m the

Special Exposure Cohort (SEC). EEOICPA authorizes HHS to implement Its responsibilities with the

assisbK'a of the NationaIlnstiblte for ~paOOnal Safety (NIOSH), an Institute of the. Centers for Disease

.: Coofn)I aoo Preventk>n. Infonnation OOCained by NIOSH in OOMection with petitions for Including additional

" d~ of employees in the SEC wi11 be used to evaluate the petition and report findings to the Advisory

Board on Radiation and Wofi(er Health and HHS. .

! Reoords contairnng identifiable infonnation beoome part of an existing NIOSH system of recorda under the

I Privacy Act, 09-20-147 -OCaJpationaJ,HeaIth Epidemiological Studies and EEOICPA Program Records.

I HHS/COCINIOSH.- These records are tJeated in a confidential manner, unless otheIWise compelled by law.

Dfsdosures that NIOSH may need to make for the processing of your petition or other purposes are isted , belaN. . ' "

~ N/OSH may need to disclose personal identifying information to: (a) the Department of Energy, other federal

agenaee. o~er government or private entities and to private sedor 8ffip(oyers to pennit these entities to

retrieve records required by NIOSH; (b) identified witnesses as designated by NIOSH so that these

irxfividuals can provkie information to assist with 1he evaluation of SEC petitions; (c) (X)ntJ'adoIS assisting

NIOSH; (d) colla:borating-researchef's, under certain limited circumstances to conduct further investigatio,.;

(e) Federal, state and local agencies for law enforcement purJX)Ses; and (f) a Member of Congress or a

Congressional staff member in response to a verified inquiry. I

i This notice applies to aU fonns and infommtional requests that you may receive fnxn NtOSH in oonnedion

I wIU'I the evaluation of an SEC petition.

I Use of the NIOSH petition fonns (A 8fKf B) is voluntary but yoor provlsk)n of Information required by these

forms is mandatory for the oonsideration of B petition, 8S specified under 42 CFR Part 83. Petitions that fail to

provkie required infom1ation may not be (X)nSfdered by HHS.

Name or Social Security Number of Pm Petitioner:
II

SPECIAL EXPOSURE COHORT PEnnON

~LEMENTAL INFORMA nON A .,, /~

;~/;Jj;(;O~ ~

Sedion E.!: The name of the DOE Facility is Sandia National Laboratoryy Livermore.

CaIiftJrnia.

Section E2: The location at the Facility relevant t.Q this petition is the X-Ray DiffiactiOD and

Fluorescence Laboratory, B - --. _.ease see enclosed affidavit ftom . --

-

Section E.3: The job titlM J!nd duties were as follows. This x-ray lab only ~1oyed two people. M ~ - ~..~-- -Jm ( ~ MI-.

was the lead engineer and I was the supporting teChnician. We both saiPpO[tC(! the opa"ation of the

laboratory and shared responSibilities. Our job duties required being in the vicinity of the X-I1.y

~.bines while they were eoel"gize4. However, my every day respoDSl'bi1ities included sample

preparation, sample analyses. x-ray diffractometer and IX>wder camera cah"brati~ and

maintenance of the X-ray fluOreSCalce units and the x-ray generators. Performing these Wks

required being very near the ionizing radiation source and having physical contact with the

Jaboratory equipment, again while the x-ray ma~.hJnes were :fully energized. CoDseq\JeDtly, I was thf!!'efore subject to greater amounts of radiation expo~ during my tenure. - -. :d

o!1tinLtM to operate the x-ray lab after my deparmre, but on a limited scale.

Seajon E.4: Employment.dates relevant to. this petition are ftom t ). 1971 to.

1978..

Section E.S: This petition is based on unmonitor~ unrecorded, and inadequately monitored

exposures. The X-Ray Diffiaction and Fluorescence Laboratory utilized io~ radiation

produced by Norelco X-Ray generators to characterize a multitude of weapons grade elements and

compounds, of which were radioactive. toxic, and classified. My employment required a "Q" level

clearance as many of the components ofwbich we worked on were "ClaSsified". All of the work,

~~I~ S3D!ple p'rep~.on and x-ray analyses, were performed in the laboratory with just the room air ventilation, a lab coat, ana. a dosimeter worn behind mY -- Clearance badge. Sanaia did

not provide any permanently mounted instrwnentation fur continuous recording of the ionizing

radiation that was being emitted about the laboratory on a daily basis. A portable Geiger deteCtor

was often used to check for abnorma1 circumstances where there were significant radiation

leakages. Shieldjn,g devices were utilized whenever possible. however they did not conform to

today's standa.. - j I bad to fabricate our own custom-made x-ray shielding devices

to compensate fur classified components. Consequently. io~ radiation exposures were

inevjtab]e and pretty muclJ an eveIY day incidei]t. as some scattered radiation 'Would be emitted.

even under the very best ciralmstances. Exposures were even greater during diffi"actometer

alignment. speci~~. and oversized sample preparation and analyses. In summary, due to the Jack

of monitors and poor perromJing dosimeters radiation exposures and radiation doses were

unmonitoTed, unrecorded. and inadequately monitored. Dosimeters are discussed in detail in

paragraph F .1.

The Norelco x-ray generators were normally energiz«l daily at 40 Kilovolts and 20 miIliamps.

X-ray analyses would typically take the entire day and fr~ extended into the evening hours.

as data collection took numerous hours and even days. I often returned to work in the evening to

continue analyses and monitor the x-ray equipment.
~ F.I: This petition is further mpplanaJted by'an Iffidavit that indicates, that m*nown

radiation exposmes and radiation doses were mcmiecl In addition to-tht;-fact that there Wa'e g

any room ars monitors, "-.- has si1M a couple of diff~aIi. exampJes in his affidavit

regarding dosimeter badges and 00w they Wa'e i!:Iad-~iate in lIK1nitoring the type' of ioDi7ing

radiation that we were exposed to. His di..CQ~~~ SUPIK>rts the ongoing debate of how the data

co~ from -d1ese dommetm sIxmId m:t be relied 'IipOO to determine ones' radiatioIi exPoSUl'e IIMi

dose reconstnlctioo. &~, the lack of room &rQ UKmitors and the Imsatisfactory use' of

~~ ]eft the worker with radiation expOStU'es that wa-e not monitored.

Section F .2: The basis for proposing that radiation,.mOiJitoring records have beeIl kJst or

possiIiy destJ'Oyed can furtbtI- be ~~-ffied by citing an expoSJre ~-~ that cx:amed in

February of 1978. While calibrating a diffi'actomaer I received an ~d~v elevated expoue of

ionimg radiation to my fingers of my right hand, right 81'ID, bead, and the upper trunk of my body

wha1 ~ x-ray beam safety interlock shmoff failm ~ expoSD'e I was receiving ~ tmooticed

lmt11 a 1ater step in the procedure called for a ftuof'escalt ~ to be placed in the x -ray beam to

vezify alignment. The x-ray generator was energized at 40 Kilovolts and 20 miDiamps during the

exposw-e. The geDefmor was immediately de-~'giz.ed and ~~ report was filed. Sandia's

H~J!h aId Safety DepartDDlt ~~ the iDcidait. As I was wearing ~ ~ appuYai

dosimetry device, safety fepressltaUves attempted to reconsb'Uct he iDcideot with tmespOsed

dosimeta's to doaJmeDt he potential x-ray expoaJre and an estimated radiation dose. In 1

2004, I req~ JJ,1Y do~ records :from Sandia. I was Salt doSmetry records for only a six

~ pmiod - - . - - - After making a ~ request, Iwas told that 00 other dosimdIy

data records or even documalta1ion regarding the accident report could be recova-ed and that all

av~ of ISieving the ~ have been eJ:~Jsted Unfort1m8tely, the aucial time period from

are no longer avaiJab1 . ~ I attempted a third ~ after being

iufu&-med that dosimeter records were now avaiJabte. Again, I was sent dosimetry ~-di fix' the

same six-year period. Incidalt report records were not available either. I have EIldosed my Record

of ()(nJPatianal ~1l Dose u.t I ~~ from SaOOia National Laboratories, LiVerlJK)fe, California OD - - J . Years of exposure and dose records are apparently missing. In

summary, this incidmt fintber indicates that ramation exposures and the md-..iation dose that I

ioom"ed are unknown due to lost dommetery records and missiug ~ deot reports. In COIx:k&on.

~~~~Y. !~. ~-~ -~~ _it~JIMt_J..~-~ ~~J!Ite.8.\.they-Wa:e- - -

inadequate at monitoring and recording the io~ radiation exposures that I received.