THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

PUBLIC HEALTH SERVICE 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH 

convenes the 

ADVISORY BOARD ON 

RADIATION AND WORKER HEALTH 

The verbatim transcript of the Meeting of the 

Advisory Board on Radiation and Worker Health held 

at The Garden Plaza Hotel, 215 South Illinois 

Avenue, Oak Ridge, Tennessee, on May 19, 2003. 

 VOLUME I 
 

 

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C O N T E N T S
 

May 19, 2003 

REGISTRATION AND WELCOME 

Dr. Paul Ziemer, Chair. . . . . . . . . . . . . . . . . 7 

Dr. John Howard, Director NIOSH. . . . . . . . . . . . 11 

Mr. Larry Elliott, Executive Secretary . . . . . . . . 12 

PROGRAM STATUS REPORT 

Mr. David Sundin, NIOSH - OCAS. . . . . . . . . . . . .12 

DOL PROGRAM STATUS REPORT 

Mr. Shelby Hallmark, DOL, OWCP. . . . . . . . . . . . .43 

RECENT IREP MODIFICATIONS AND RECOMMENDED UPDATES 

Mr. Brian Thomas, SENES Oak Ridge, Inc. 

Dr. Iulian Apostoaei, SENES Oak Ridge, Inc. 

. . . . . . . . . . . . . . . . . . . . . . . . . . . .63 

THE UK COMPENSATION SCHEME FOR RADIATION LINKED DISEASES 

Mr. Michael Lewis, Mr. Andy Slovak, Mr. John Billard, BNFL 

. . . . . . . . . . . . . . . . . . . . . . . . . . . .81 

WORKING GROUP REPORT: DOSE RECONSTRUCTION REVIEW PROCESS 

Mr. Mark Griffon . . . . . . . . . . . . . . . . . . .123 

AWARD PRESENTATION . . . . . . . . . . . . . . . . . . .143 

FUTURE CONSIDERATION OF UNCERTAINTY IN IREP 

Dr. Owen Hoffman, SENES Oak Ridge, Inc. . . . . . . . 144 

A REFRESHER AND UPDATE ON REF'S ASSUMED IN IREP 

Dr. David Kocher, SENES Oak Ridge, Inc. . . . . . . . 173 

NAS REPORT ON REVIEW OF DTRA DOSE RECONSTRUCTION PROGRAM 

Mr. Dennis M. Schaeffer. . . . . . . . . . . . . . . .204 

BOARD DISCUSSION/WORKING SESSION: REVIEW PROCESS OF 

COMPLETED DOSE RECONSTRUCTIONS . . . . . . . . . . . . .226 

PUBLIC COMMENT PERIOD . . . . . . . . . . . . . . . . . 227 

ADJOURN . . . . . . . . . . . . . . . . . . . . . . . . 263 

COURT REPORTER'S CERTIFICATE . . . . . . . . . . . . . .264 

 TRANSCRIPT LEGEND
 
 

 

 

 

 

 

 

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The following transcript contains quoted material. 

Such material is reproduced as read or spoken. 

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

unintentional or purposeful interruption of a sentence. An 

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

sentence in dialogue or omission(s) of word(s) when reading 

written material. 

In the following transcript (sic) denotes an incorrect 

usage or pronunciation of a word which is transcribed in its 

original form as reported. 

In the following transcript (phonetically) indicates a 

phonetic spelling of the word if no confirmation of the 

correct spelling is available. 

In the following transcript "uh-huh" represents an 

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

response. 

In the following transcript "*" denotes a spelling 

based on phonetics, without reference available. 

In the following transcript (inaudible) signifies 

speaker failure, usually failure to use a microphone. 
 

 

 

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

(By Group, in Alphabetical Order) 

 BOARD MEMBERS
 

CHAIR
 

ZIEMER, Paul L., Ph.D. 

Professor Emeritus 

School of Health Sciences 

Purdue University 

Lafayette, Indiana 

EXECUTIVE SECRETARY
 

ELLIOTT, Larry J.
 

Director, Office of Compensation Analysis and Support 

National Institute for Occupational Safety and Health 

Centers for Disease Control and Prevention
 

Cincinnati, Ohio 

MEMBERSHIP
 

ANDERSON, Henry A., M.D. 

Chief Medical Officer 

Occupational and Environmental Health 

Wisconsin Division of Public Health 

Madison, Wisconsin 

ANDRADE, Antonio, Ph.D. 

Group Leader 

Radiation Protection Services Group 

Los Alamos National Laboratory 

Los Alamos, New Mexico 

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

Director 

The Vanderbilt Center for Occupational and Environmental 

Medicine 

Professor of Medicine 

Nashville, Tennessee 

ESPINOSA, Richard Lee 

Sheet Metal Workers Union Local #49 

Johnson Controls 

Los Alamos National Laboratory 

Espanola, New Mexico 
 

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GIBSON, Michael H. 

President 

Paper, Allied-Industrial, Chemical, and Energy Union 

Local 5-4200 

Miamisburg, Ohio 

GRIFFON, Mark A. 

President 

Creative Pollution Solutions, Inc. 

Salem, New Hampshire 

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

Director 

New York State Laborers' Health and Safety Trust Fund 

Albany, New York 

MUNN, Wanda I. 

Senior Nuclear Engineer (Retired) 

Richland, Washington 

OWENS, Charles L. 

President 

Paper, Allied-Industrial, Chemical, and Energy Union 

Local 5-550 

Paducah, Kentucky 

PRESLEY, Robert W. 

Special Projects Engineer 

BWXT Y12 National Security Complex 

Clinton, Tennessee 

ROESSLER, Genevieve S., Ph.D. 

Professor Emeritus 

University of Florida 

Elysian, Minnesota 

STAFF/VENDORS
 

CORI HOMER, Committee Management Specialist, NIOSH 

STEVEN RAY GREEN, Certified Merit Court Reporter 
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 AUDIENCE PARTICIPANTS
 

ADLER, TIM 

AHRENHOG, STEVEN 

APOSTOAEI, A. IULIAN 

BECK, WM. L. 

BELL, GLENN 

BILLARD, JOHN 

BOGARD, RHONDA 

BRASWELL, TODD 

BROCK, DENISE 

BROOME, GINA 

DEHART, JULIA 

FOLEY, PHILLIP 

GADOLA, SALLY 

HALLMARK, SHELBY 

HENSHAW, RUSS 

HILL, JEFF 

HINNEFELD, STU 

HOFFMAN, OWEN 

HOMOKI-TITUS, LIZ 

HOWARD, JOHN 

HUFF, JENNIFER 

JESSEN, KARIN 

KATZ, TED 

KOCHER, DAVID 

LAWSON, BRUCE 

LAWSON, JACOB HOWARD 

LEWIS, MICHAEL 

LOURD, PATRICK C 

MARTIN, FAY M. 

MILLER, RICHARD 

NETON, JIM 

POTTER, HERMAN 

POWELL, STEVE 

PRESLEY, LOUISE 

SCARBROUGH, CARL 

SCHAEFFER, D.M. 

SCHALENTER, JANE 

SLOVAK, ANDY 

SOULEYRETTE, MICHAEL 

STEWARD, JOHN 

SUNDIN, DAVE 

TABOR, BOB 

TANKERSLEY, BILL 

THOMAS, BRIAN 

TOOHEY, R E 
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TURCIC, PETE 

YIIN, JAMES 

ZIEMER, MARILYN 

P R O C E E D I N G S
 

(9:10 a.m.) 

REGISTRATION AND WELCOME
 

CHAIR
 

DR. ZIEMER: Good morning, everyone. I'm going to call 

the meeting to order. This is meeting 16 of the 

Advisory Board on Radiation and Worker Health. My name 

is Paul Ziemer and I serve as Chair of the Board. 

Let me begin by welcoming all of you to Oak Ridge, and 

I feel I can do that in a valid way since this is my 

old stomping ground. I spent the first year of my 

marriage actually here in Oak Ridge, and last night 

Marilyn and I drove up to the old apartment. I don't 

think I'd want to live there anymore. I don't think 

they've painted it since we left, many years ago. 

In any event, welcome to Oak Ridge. It's great to have 

all of you here, some local folks as well as those 

who've come from out of town. 

We'd like to remind you to, if you haven't already done 

so, to please register your attendance with us this 

morning. There's a registration book back on the table 
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where Cori Homer is standing back there, and we ask 

that all of you register, whether you're Board members, 

staff, government staff people, members of the public 

or others. 

Also if you are a member of the public and wish to 

participate in the public comment period later today, 

we ask that you sign up so that we have some idea of 

how many do wish to address the Board during that 

public comment period. 

I'm not going to introduce the Board members to those 

who are observers, but the Board members names are on 

the placards, so you can see who they are. I see that 

there is an empty seat. Is Mike Gibson not going to be 

here today? 

MR. ELLIOTT: He's here somewhere. 

DR. ZIEMER: He's here somewhere. Okay, so the record 

will show hopefully at some point that we have a full 

attendance of the Board. And also, as Board members or 

other speak, we do ask that you identify yourself so 

that the recorders are able to make a record of that as 

the transcript is prepared. 

There are a number of items on that table over here on 

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my left which include everything from the charter of 

this Committee to minutes of past meetings and other 

documents. So if you are interested in any of those, 

we invite you to make yourself -- or help -- help 

yourself to those, and I'm walking around looking for a 

piece of paper that I set aside. But if there are 

documents that you wish, those are all available. Help 

yourself to those. 

We have a special privilege this morning and a special 

guest that I want to introduce, and that is Dr. John 

Howard. Dr. Howard is the Director of the National 

Institute for Occupational Safety and Health, NIOSH, 

and we're very pleased that he is with us this morning. 

Prior to becoming Director for NIOSH, Dr. Howard 

served as chief of the Division of Occupational Safety 

and Health in California's Department of Industrial 

Relations, a position he held since 1991 until his more 

recent appointment as Director of NIOSH. In that 

capacity in California he headed up an occupational and 

public safety program that involved a staff of nearly 

1,000, so quite a large operation there. 

Prior to his appointment as NIOSH Director, Dr. Howard 

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also was an assistant professor of environmental and 

occupational medicine at the University of California 

at Irvine, and he's also served as medical director and 

chief clinician of the Philip Mandelker AIDS Prevention 

Clinic, which is an AIDS community clinic in Los 

Angeles. He's also been assistant counselor to the 

Undersecretary of Health and Human Services. 

Dr. Howard began his career in occupational health as 

an internist for the University of California, Los 

Angeles School of Medicine on a pulmonary fellowship 

program at Cedars-Sinai Medical Center in Los Angeles, 

and during his clinical work he worked very closely 

with asbestos-related situations, particularly 

asbestos-exposed shipyard workers, and his work has 

been published on occupational lung disease related to 

asbestos exposure. 

He did his doctoral work in medicine at Loyola 

University and has a Master's in occupational health 

from the Harvard School of Public Health, and has other 

academic degrees and many other credentials that I 

won't go into today. In fact, already my introduction 

is probably longer than what he's going to say because 

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he's going to simply give us a brief greeting. So with 

that, Dr. Howard, welcome and we're very pleased to 

have you with us today. 

DIRECTOR NIOSH
 

DR. HOWARD: Thank you, Dr. Ziemer, and it is -- your 

introduction is definitely longer than what I was going 

to say. I just wanted to express my appreciation for -

- for all of the work that you do here on the Board. 

When I first came to my job in July, I received 

periodic e-mails about your meetings, and I thought 

after the fourth or fifth one in rapid succession, I 

though my, these people actually do work. And so I 

just want to compliment you on your dedication and 

professionalism and all the hard work you're doing with 

this program, and to assure you that, even though I've 

been very tardy in getting here to one of your 

meetings, I'm very interested in what I'm going to 

learn in the next two days. And certainly I've been 

exposed to all the issues that you all are struggling 

with through -- through Larry and others in the 

program. So I just want to say that you have the full 

support of the Institute and the Institute leadership, 

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as well as the Department of Health and Human Services 

in the work that you're doing. 

So thank you for having me here today and I hope to 

learn a lot over the next couple of days. Thank you. 

DR. ZIEMER: Thank you again, Dr. Howard. We also 

provide an opportunity for Larry Elliott from -- our 

Executive Secretary, to make any opening comments. And 

Larry, if you have any, this is the time. 

EXECUTIVE SECRETARY 

MR. ELLIOTT: Thank you. I just want to welcome 

everybody to Oak Ridge. It's nice to see a good crowd, 

and I look forward to a productive two days. And I 

hope everyone has an interesting and informative twoday meeting. Thank you. 

DR. ZIEMER: Now we're going to turn our attention to 

our regular program status report. Dave Sundin of the 

NIOSH staff is here with us again, and Dave, if you'll 

come -- there he is -- and present your summary to us. 

PROGRAM STATUS REPORT
 

MR. SUNDIN: Is the podium mike on, the lavaliere? Can 

you hear me back there? 

Well, I'll also say good morning and welcome to 

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beautiful Oak Ridge. I think this is probably the 13th 

face-to-face meeting. Paul mentioned 16 meetings, I 

believe is the count, counting the teleconferences. 

But in any case, clearly an active Board. 

I wanted to present a brief overview of the program 

status. I'll use the basic approach that we've used in 

previous meetings. 

Department of Labor has transferred over 12,000 cases 

to NIOSH for dose reconstruction since we began 

receiving cases in October of 2001. Actually close to 

13,000 by now. These statistics are as of last Friday. 

As you're probably aware, we continue to send a letter, 

a fact sheet, a brochure and a refrigerator magnet to 

each claimant, to let them know that we've received 

their claim. And we also explain to them in those 

materials what dose reconstruction is and how they can 

contact us to monitor progress. Recently we've 

modified this initial contact letter to include the 

name of a specific public health advisor who is 

available to provide specific information on their 

claim. The letter now also introduces and explains 

ORAU's role in the process, and we provide the ORAU 

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toll-free telephone number. 

Of course we log each case into our computerized claims 

tracking system. We electronically scan all the 

documents in each case file, and we also create and 

maintain a paper file system. We've been making some 

significant improvements, and in particular recently, 

some improvements in our database management systems 

and connections to permit us to operate more 

efficiently and exchange information appropriately with 

ORAU, our contractor. 

You can see that the majority of claims involve 

employees who worked at DOE sites, but about 16 percent 

involve employment at Atomic Weapons Employer sites, or 

AWE's. 

This chart shows the rate at which we've been receiving 

cases from the four district offices of DOL by month. 

The number of cases peaked at 1,031 in August of 2002 

and has trended generally downward since then. I think 

it's probably too early to determine whether this is a 

short or a long-term trend, however. 

Each case file we receive from DOL does list the 

verified covered sites where the Energy employee 

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worked, and so we use this information to direct our 

requests for radiation exposure information to the 

appropriate DOE points of contact. In some cases, of 

course, the employee may have worked at several covered 

facilities. We're usually able to issue these requests 

for DOE exposure information within two weeks of 

receipt of the case from the Department of Labor. 

We've sent out nearly 12,000 requests for personal 

radiation exposure information to our DOE points of 

contact, and we've received responses to 63 percent of 

these requests. Some of these responses we know 

contain incomplete information, which means that 

follow-up requests to DOE for additional information 

will be required before dose reconstruction can proceed 

in those cases. About 20 percent of our requests are 

more than 60 days outstanding, and these cases are 

highlighted in a periodic e-mail status report that we 

send to each of the DOE points of contact and the DOE 

Office of Worker Advocacy. 

This table shows how many requests for personal 

exposure information are going to I guess what you'd 

call the Big Eight DOE offices, and how many responses 

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we've currently received. And as you can see, the Oak 

Ridge operations office has received more requests and 

provided more responses than any other DOE office by a 

considerable margin, almost two, two and a half times, 

perhaps, of the -- as the Savannah River site. 

We continue to work closely with DOE's Office of Worker 

Advocacy and the designated points of contact at the 

sites to ensure that we get the kind of exposure 

information needed to conduct dose reconstructions in a 

timely manner. And I will say that DOE has facilitated 

our participation in periodic teleconferences with 

their points of contact and the records retrieval staff 

at each of the sites, and they have also taken specific 

steps to add resources and improve the processes at 

certain sites. 

As you probably know, a telephone interview is offered 

to each claimant to permit them to add information 

which may be relevant to reconstructing the radiation 

dose, and the award of our support contract has 

substantially increased our capacity to conduct 

interviews. And until a recent office move temporarily 

interrupted the work of the interviewers, or at least 

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slowed it down, their monthly production was climbing 

steadily. As of today we've conducted interviews with 

more than 2,600 employees and survivors. This chart, I 

should say, doesn't include a significant number of 

interviews that actually were conducted in April and 

May and which will be logged into our system when the 

interview group gets reconnected. 

We have conducted several secure interviews using 

appropriately-cleared interviewers in a secured 

location to address concerns raised by the claimants. 

I am happy to be able to report to you that the number 

of completed dose reconstructions being sent back to 

Department of Labor for final adjudication is steadily 

increasing. Nearly 300 cases are currently assigned to 

a health physicist for dose reconstruction, and draft 

dose reconstruction reports have been sent to claimants 

in 137 cases. Seventy-three of those have been 

approved by the claimants and returned as final dose 

reconstructions, including a complete -- and have been 

sent to Department of Labor, along with the complete 

administrative record. Six of those final cases 

represent claims from Oak Ridge. 

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While we know that every performance measure is 

significant in this program, we're particularly pleased 

to see the number of completed dose reconstructions and 

dose reconstructions assigned actually begin to rise. 

We know we've got a ways to go before we achieve the 

more than 200 dose reconstructions per week target that 

we need to actually begin to make progress against our 

current backlog, but we feel like we're on the path and 

making progress. 

We want claimants to be able to contact us, and they 

continue to do so. The number of phone calls received 

in OCAS has increased substantially each quarter as we 

receive more and more claims. We're currently 

receiving approximately 80 phone calls per day, and 

we've responded to nearly 30,000 calls since the 

program was launched in October, 2001. Some of those 

calls are related to setting up and actually conducting 

interviews, but the majority of them really are 

claimants and their representatives checking on a claim 

status. 

Our web site continues to be a valuable source of upto-date information about the program and a vehicle for 

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communication with claimants and others interested in 

EEOICPA. We've received over 1,600 claim-related emails, and our goal is still to respond to every one of 

them within 24 hours. 

I'd like to draw your attention to some recent 

developments and accomplishments which I think are 

worth noting. Our Memorandum of Understanding between 

HHS and DOE was signed by the Deputy Secretaries of 

both Departments on April 4th, 2003, and that document 

is available on both the DOE and HHS-OCAS web site for 

your review. 

As you know, the public comment period for our proposed 

Rule for adding classes of employees to the SEC closed 

on May 6th. And in addition to the Board's comments, 

the Docket Office received comments from 16 other 

groups and individuals and we're now considering all 

those public comments. 

DOE has periodically asked that we appoint additional 

physicians to their physician panels which have a role 

in evaluating claims under Subtitle (D) of EEOICPA. We 

recently transmitted a list of 33 additional physicians 

to DOE, which brought the total number of appointed 

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physicians to nearly 80, and we will be appointing 

approximately 30 more physicians soon, and will 

continue the process of seeking out and identifying 

qualified candidates for these panels. 

In late March OCAS approved a Technical Basis document 

which had been developed by ORAU which established the 

basis for developing an exposure matrix for the 

Bethlehem Steel Corporation in Lackawanna, New York. 

This document, which is also available on our web site, 

will permit us to complete virtually all of the 

approximately 435 Bethlehem Steel claims. 

Also, and this is not news to most, a solicitation for 

proposals has been issued for contract technical 

support to the Board's review of the NIOSH dose 

reconstruction program following a pre-proposal 

conference which some of you attended in Cincinnati on 

April 30th. These proposals are due in the NIOSH 

contract office I believe May 28th. 

And we continue to add the staff necessary to achieve 

the numerous tasks which are in front of us. OCAS 

currently has 35 employees in Cincinnati and three 

additional staff assigned to support our efforts from 

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Atlanta and Washington, D.C. We are in the process of 

recruiting to fill a few remaining vacancies. ORAU 

currently has more than 170 full-time equivalents on 

their staff. 

As required under our contract with ORAU, we've 

negotiated production goals as part of our plan to 

reduce the backlog of claims which are awaiting dose 

reconstruction, and this plan calls for completion of 

nearly 6,000 draft dose reconstruction reports this 

calendar year, and that's through developing a capacity 

to produce a minimum of 200 dose reconstructions per 

week by July. 

So I thank you for your attention. I'll try to answer 

any questions you might have at this point. 

DR. ZIEMER: Thank you very much, Dave. Let me begin 

by asking a question of the third slide, which is cases 

received from DOL by month, and it has 2001, 2002 and 

2003 in there, if you see that slide. It's a bar 

graph. 

MR. SUNDIN: Right. 

DR. ZIEMER: I don't know if you can back up to it, but 

it doesn't appear to me that there's enough months in 

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there to correspond to those years. Am I seeing 

something here? It seems to me there ought to be 

approximately 12 bars per years, if my advanced 

mathematics are correct. 

Okay, it's starting in mid-year, so the year is not --

the year's in the middle, I gotcha. Okay. Now I 

should have figured that out. 

MR. SUNDIN: So it runs from October 2001. 

DR. ZIEMER: Either that or it's a Federal year or 

something here. Okay. A leap year. So 2002 is 

centered on -- so I can use any six bars to the right 

and left and I've got a year. Is that what you're 

saying? 

MR. SUNDIN: January of 2002. 

DR. ZIEMER: Okay. What I'm going to claim then is 

2003 isn't centered on its year. It's -- okay. 

MR. SUNDIN: I'd better re-graph this one. 

DR. ZIEMER: Okay. Well, it wasn't clear what months 

was there. Okay. Thank you. 

Other questions? Yes, Jim. 

DR. MELIUS: I have some questions on your progress 

with the number of DOE sites. I don't happen to 

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remember all the numbers, but I think Savannah River, 

Idaho, some of the other sites seem to have an awful 

large percentage of claims that were -- or say 

significant at over 150 days. What are you doing to 

resolve those and how are you -- what are you doing to 

sort of track progress and get those back on board? 

MR. SUNDIN: Right. Well, the story behind each of 

those sites is slightly different. We are working with 

the Office of Worker Advocacy and the site personnel 

themselves, but without going into a lot of detail, the 

story at Idaho, for example, involves the need to index 

a lot of records that simply have not been indexed so 

we expect that once that sort of front-end task is 

completed, then the rate at which we get responses will 

increase a lot. 

Pick another site, Jim. There is a story behind each 

one of them and it's different. 

DR. MELIUS: Savannah River, is that --

MR. SUNDIN: Yeah. 

DR. MELIUS: -- one that you're having problems that 

looks like it's maybe getting better? 

MR. SUNDIN: It is. 

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DR. MELIUS: I don't remember --

MR. SUNDIN: It is, and that is exactly the story. 

They were a little bit I guess -- shall we say slow 

getting out of the blocks, but in terms of the kind of 

responses we're getting from them now, we believe 

they're reasonably complete and they have added 

additional staff, in fact, to start being able to move 

their output up. So I think there it was just a 

question of them not getting started as early as some 

others. 

DR. MELIUS: And how do you communicate these issues to 

the claimants? I mean 'cause you have -- I don't know, 

say 1,000 or more claimants that are sitting there --

it's been close to six months where they've been just 

basically not -- sitting there, the claims have. 

MR. SUNDIN: Well, we always tell the claimants exactly 

what the situation is, as best we understand it. And 

we do tell them that the targets we establish for DOE 

response is 60 days, and some sites are able to meet 

that, some sites are not. We can tell each one of the 

claimants exactly how many days that their response has 

been with the DOE. We can tell them if we have gotten 

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a response, let them know that. But in terms of 

providing -- and we also tell them what we know about 

that particular site, what they're doing to help 

improve that response. 

DR. MELIUS: But do you proactively -- do you 

communicate with them? I mean -- I mean a lot of these 

people, you know -- it's a difficult process and if 

they're sitting there -- they don't ask you what 

happens, I guess is my -- my question. 

MR. SUNDIN: Well, we have -- I mean there is some 

information on our web site which sort of bears on this 

issue. We haven't profiled each individual site's 

response profile like this on our web site, and we have 

not gone out with mailings to claimants to sort of keep 

them updated. We're considering that, but -- so it is 

on a case-specific basis as people call in. 

DR. MELIUS: Seems to me that if this is going to be a 

recurrent problem that some communication -- I mean the 

claimants deserve some communication. If they haven't 

heard from you in, you know, 90 days or 60 days or 

whatever on a -- you know, what's happening with their 

claim, I think they deserve some communication, you 

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know, from you about what's going on -- the problem is 

getting dose information or you've requested more, 

whatever that -- that's going on or that's delayed 

getting the program started and whatever. But it seems 

to me that that would be the least you could do, rather 

than let -- you know, have them sit there trying to 

figure out what's going on. 

DR. ZIEMER: And Larry's got a response also here. 

MR. ELLIOTT: Yes, Dr. Melius, we certainly agree with 

you and we think the claimants do deserve recurrent 

contact from us on a regular basis. We are -- as Dave 

said, we're considering how best to do that. We're 

targeting the groups that we need to reach out to, 

those that were the early claims. We're working up the 

communication vehicle that we're going to use for each 

of those targeted groups. 

I would offer this, though, that the majority of those 

callers that we get are really a minority of the whole 

claimant population. We hear frequently from 

claimants, and in that minority there is a relatively 

few that contact us. But we're not losing sight of 

what you're suggesting, that even though we're not 

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hearing from the majority of the claimant population, 

we need to maintain our contact and our dialogue with 

them, and we are working toward that end. 

DR. MELIUS: It's just precisely that that worries me. 

It's this -- the people you don't hear from are the 

ones that I think also deserve some communication from 

you. I have some other questions, but why don't you 

let somebody else go on and I'll --

DR. ZIEMER: Let's get -- I think we had Roy and then 

Robert and then Tony. 

DR. DEHART: Roy DeHart. My question addresses this 

estimate of 6,000 dose reconstructions completed by, I 

assume, the end of the calendar year, '03. Is that 

realistic? We're talking about only seven months 

remaining, essentially, to accomplish that task. 

MR. SUNDIN: Yes, I think it is realistic. There's 

been a lot of groundwork put in place that will, we 

believe, permit us to achieve those kinds of goals, and 

those goals were developed in discussions and full 

consultation with our contractor, ORAU. So it'll be a 

big rise. It'll be a challenge, but much of what we've 

been doing now is put the machinery in place to change 

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that level of production. 

MR. PRESLEY: Dave, Bob Presley. Could you elaborate a 

little bit on some of the problems you're having in Oak 

Ridge with the records? 

MR. SUNDIN: Well, it's one of the better sites, Bob. 

I think they've done a good job of responding to this 

high volume of requests that we've gotten. In terms of 

having a general sense of the quality and completeness 

issues, if any, I don't have that because I'm not 

really in the stream of reviewing them. There aren't a 

huge number of severely late cases out of Oak Ridge, so 

I -- I would have to say that on the whole -- you know, 

unless others want to correct me -- I would say that 

they're not problem-free. There've certainly been 

cases where we've had to, you know, give them a notice 

that this is overdue, but I would say that they've been 

very responsive. 

MR. PRESLEY: Thank you. 

DR. ANDRADE: Tony Andrade from Los Alamos. I agree 

with Dr. Melius that there should be some kind of 

communication. However, if the communication simply 

states that the dose reconstruction effort is awaiting 

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dose records and leaves it at such, you potentially are 

in a situation in which you are slamming a site. In 

our -- at our laboratories, for example, one employee 

may have had film dosimetry, a two-chip thermoluscent -

- thermoluminescent dosimeter, and now we're using the 

six-chip TLD. On top of that, there could have been 

neutron dosimetry, track-etch* dosimetry and then 

dosimetry for various types of isotopes. So when you 

ask for the records for one employee, it is not a 

trivial process in many instances to recover the data 

and then deconvolute the data from committed effective 

dose equivalent back down to annual dose. So I know 

that, on a per-person basis, it is a -- somewhat of a 

task to send back precisely what NIOSH is looking for. 

So all I -- all I say is that that communication, if 

it's too simplified, can give the wrong impression. 

DR. ZIEMER: Jim, you had another question? 

DR. MELIUS: I have some more, but I think Mark was 

ahead of me. 

DR. ZIEMER: Oh, I'm sorry, I didn't see Mark, but we 

have a response from Jim Neton. 

DR. NETON: This is Jim Neton from NIOSH. I'd just 

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like to comment that we are ramping up -- ORAU's 

ramping up with the dose reconst-- I mean the computerassisted telephone interviews, as you saw, so we've 

completed almost 3,000 interviews at this point, so 

claimants are being directly contacted by us. They are 

contacted in writing prior to the interview, and they 

receive a follow-up summary of their interview after 

that. The rate at which ORAU can accomplish interviews 

is now around 1,000 a month, so I think you'll see that 

many of those early claimants will be contacted in the 

near future directly by NIOSH. 

DR. ZIEMER: Thank you. Okay, now Mark. 

MR. GRIFFON: Yeah, just a follow-up on some of -- on 

the 6,000 cases question and -- you mentioned that a 

lot of the groundwork has been laid for -- you know, to 

make this -- to make that possible. I'm wondering 

about the site profiles, if -- and you might not be 

able to give us a status report, but I'm curious if we 

can get some status on the -- maybe before the end of 

this meeting, a status report on where the site 

profiles stand across the board. I think the last time 

we saw them, they were -- well, very -- very differing, 

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depending on the site. Some had a lot of information, 

some had very little, so I'm just curious where that 

stands. 

MR. SUNDIN: I didn't bring that into this 

presentation, Mark. There probably are -- well, Jim 

can give you more details. I know that some of them --

several of them are being worked on. 

DR. NETON: I can comment in general, and we're not 

prepared really to discuss the exact sequence of the 

site profiles at this meeting, but we are moving 

forward with the exposure models, as you noticed last -

- two meetings ago, I believe, where we discussed the 

Bethlehem Steel model. There are two flavors of site 

profiles or Technical Basis documents, as we call them. 

One is an exposure model, which is what was done with 

Bethlehem Steel, where there were no bioassay data, no 

individual monitoring data, so ORAU was -- relied on 

the air sample data that was available and generated 

distributions about some central tendency of exposure 

for that model. 

The other type of site profile would be the actual data 

where we have bioassay monitoring records and those 

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sort of pieces of information, and we are fleshing out 

the detection limits and monitoring frequencies and 

those sorts of things. 

We have in house a completed site profile -- a draft 

site profile for Savannah River site. That's being 

reviewed by our staff now and we hope to have that 

finalized within the next month or so. There are a 

number of other site profiles that are being developed 

in parallel. We're not -- this is not a linear effort, 

so there is an entire group devoted to doing nothing 

but Atomic Weapons Employer site profiles, and there 

are other groups assigned to the various -- to the 

larger sites where we can cover I think 90 percent of 

the claims with something like 20 or 21 site profile 

documents. And so that's -- that's the plan right now. 

But the only completed draft in-house we have is 

Savannah River, and actually there is a Bloxon Chemical 

Atomic Weapons Employer model we're also reviewing at 

this time. 

DR. ZIEMER: Thank you. Mark, follow-up on that? 

MR. GRIFFON: Yeah. I guess the -- the main reason I 

reflect on this is that, you know, one of the concerns 

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that we've heard for years is -- is the concern with 

dosimetry data. And coming into this Board, I think 

we've -- we've discussed this issue, and my fear is 

that, 6,000 cases pending, that there's going to be --

I guess certainly it seems that you're going to turn to 

dosimetry data first, but in order to test the adequacy 

of those dosimetric records for purposes of this 

program, I think there has to be some site profile 

information, some site data to -- to make sure that --

that you're not just using already-suspect data to --

to make a conclusion on a compensation claim. So I 

think that was one of the central themes coming into 

this program. There was a lot of concern about 

dosimetric records and I think, you know, we -- there 

should be a lot of attention paid to that. 

DR. NETON: Yeah, I would comment that we don't take 

any dosimetry information at face value when it comes 

in. I mean we -- we do investigate it and make sure 

the individual monitoring results were of sufficient 

technical quality to be able to reflect the conditions 

in the work place. Although I do agree there are some 

scenarios that are more complicated than others, but I 

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think that if we can validate the bioassay monitoring 

record, monitoring record -- monitoring program, and 

the film badge or TLD monitoring program, I think we 

can go ahead and work with that at face value if it 

appears to be a valid measurement. 

DR. ZIEMER: And Jim, you have another question? 

DR. MELIUS: Yeah, back to the -- a couple of 

questions, actually, but first of all, back to the 

progress on the program. It's very hard for us -- at 

least for me sitting here to get a handle on the hangup. Why's it taking so long to get the program going, 

and it's I think equally hard for the claimants, as 

well as, you know, the number of members of Congress 

that have expressed some concern recently about the --

how slow the process has been. And we keep hearing 

that you're going to gear up and so forth. I just 

quite don't understand what the hang-up is over the 

last -- you know, what's holding up progress for the 

last few months in this program. You've staffed up 

with your contractor, yet it seems that we have, at 

most, 200 or 300 claims that are sort of close to being 

completed in the process that are out for review that 

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you're reviewing. And I can't tell -- is the issue the 

contractor, is the issue the -- your staff? You know, 

are you adequately staffed yet in order to be able to 

handle all these claims? And I guess -- you know, I 

hear number of going for around 6,000 by the end of the 

year, I really find that hard to fathom, given what's 

gone on so far with the program, particularly to 

maintain some quality and so forth to it. So am I not 

understanding something about the process or --

MR. SUNDIN: Well, I just -- I think -- it depends on 

what you focus on to measure progress. Certainly, as I 

said, we're all happy to see the end product start to 

come out the pipeline, but I would say that we've --

being on the inside of the program, working shoulderto-shoulder as I do day to day with some very highly 

motivated people, that they're doing the very best they 

can on behalf of all claimants. I would say that 

there's been a substantial amount of progress made to 

basically lay the groundwork and develop the processes 

which lead to what I think many people focus on as the 

sole progress indicator, which is completed dose 

reconstructions. So I don't -- I don't --you know, 

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this is a program which came into being and had to be -

- a whole organization created, so I -- I think we've 

made very good progress in getting to where we are now. 

DR. MELIUS: Then can you just tell me in more detail 

what your -- what has been the progress? Is the -- is 

all this time spent getting set up, as you say, or 

whatever -- are you adequately staffed to be able to 

handle the number of claims coming over to you, review 

them? 'Cause I think that's -- you know, we -- you've 

described what the contractor's doing, that's -- may be 

fine and so forth. But how about at the NIOSH --

staffing, 'cause that's also another potential 

bottleneck and you really didn't provide much detail on 

where you stand with that. 

MR. SUNDIN: Well, I indicated we're at about 35 people 

right now and recruiting for a few more vacancies. I 

think we've designed the organization to basically 

provide enough health physics capability to review each 

and every completed dose reconstruction, a sufficient 

number of public health advisors to be able to interact 

with claimants and to handle the case referrals when 

they come from DOL and then submit them back, and 

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certainly we've got some IT professionals that are 

working with us to develop the very most efficient 

database system that we can. So I would have to say 

that we've -- we've sized our staff and our 

organizational plan to -- appropriately to meet what we 

think the -- what the requirements are going to be at 

the kind of production level that we're anticipating. 

DR. MELIUS: Do you have a system that tracks each 

claim and can tell you statistically where you -- where 

it is in the process and where things are getting 

slowed down, if they're getting slowed down? I mean 

we're getting bits and pieces of a tracking system 

here, you're -- you know, when it goes out for dose 

records. 

MR. SUNDIN: Yes, we do. We've got a really pretty 

good system, which is evolving as we identify new needs 

for it. But yes, we can track each claim through all 

of the significant steps that a claim goes through on 

its way to completion. And that system, of course, can 

drive management reports, as needed, and all the other 

kinds of uses that one makes of that kind of data. So 

yeah, we have a fairly detailed system of tracking each 

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claim. 

DR. MELIUS: And if I'd be correct, then four months 

ago that would have shown that the hold-up was at the 

interview end, getting people out to interview and --

and getting claimants interviewed. Now it would appear 

to be getting from the interview into a final dose 

reconstruction and review. Is that... 

MR. SUNDIN: Well, I mean that is the way the pig moves 

through the python. At the outset there were a lot of 

claims that weren't even automated, that then a DOE 

request had not been made. So as each claim is with us 

longer, then it progresses more toward the end of the 

process. We do have significantly more interviewers 

doing interviews right now, so that -- that trend as 

you see is going up fairly sharply. There will be a 

lag between that and the dose reconstructions as these 

claims then find their way to a dose reconstruction. 

So I don't know that there's any single hang-up. I 

think we've got things sort of balanced. It's just 

that the life cycle of a claim will lead to more things 

being done on claims that are supposed to be done early 

on a claim than later. 

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DR. ZIEMER: All right. Henry, you have a question? 

DR. ANDERSON: Yes, I just wanted to get a bit of 

information on the -- on what you're going -- or what 

your strategy is for those that are now getting out to 

the 150-day plus as far as information on those. It 

would seem to me some of those may well be ones that'll 

end up with incomplete records and would be a special 

cohort person and -- and my question really is at what 

point do you decide that, you know, you now need to go 

into a secondary strategy as to how -- you know, are we 

ever going to find records on these people. So part of 

it is, do you know how many of those are simply that 

the specific sites haven't gotten to the record so you 

don't really have any information on it, or have they 

started, gotten records and said boy, there really 

ought to be records on XYZ, but we can't find them yet 

and so they're continuing to hunt, in which those are 

going to be the more problematic than it's simply a 

massive backlog and they don't have the staff to begin 

the process, so those are sitting there basically cold, 

waiting to get started, versus those they've processed 

to a certain degree and they have some records but 

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there should be more and they haven't located them yet 

and at some point you're going to have to close the 

system off and say now then these are -- those go into 

a Plan B as to how we're going to deal with them. 

MR. SUNDIN: Sure. No, good point. We obviously don't 

want endless searches to go on when there's no prospect 

of finding something. So far I don't believe we've had 

many responses from DOE that said I have exhausted --

we have exhausted all of our search strategies and have 

found nothing, end of story. But that's clearly what 

we need to call for at a certain point. Many of these 

sites that we believe are on productive searches or 

indexing strategies that will actually yield 

information, but clearly at some point we need DOE to 

tell us that they've reached the end of that line, and 

we've not gone back with that sort of call yet to any 

sites. 

DR. ZIEMER: I'd like to ask the staff if it might be 

doable at our next meeting to give us a little more 

detail on the site profile issue, perhaps a more formal 

update on that. Is that something we could schedule 

for the next meeting? 

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Do we have additional questions for Dave at this point? 

DR. MELIUS: I have one --

DR. ZIEMER: Jim, yes. 

DR. MELIUS: -- or two separate issues. One is on --

and I may not be recalling this correctly 'cause I --

you don't have in in the table -- the DOE Memorandum of 

Understanding went out. I recall when I read that it 

surprised me a little bit, there was a -- something in 

there to the effect that each completed dose 

reconstruction would -- applied in individuallyidentified form, would go to DOE also? 

MR. SUNDIN: Yes. 

DR. MELIUS: What's the basis for that? 

MR. SUNDIN: It's statute. 

DR. MELIUS: Okay. Secondly, at one of our recent 

meetings we talked about conflict of interest 

statements being up on the web site for Oak Ridge AU 

staff, and when I looked at the web site recently it 

looked like at least half of them were missing. Is 

that an --

DR. ZIEMER: Who can --

DR. MELIUS: -- issue or something? 

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DR. ZIEMER: -- respond to that? 

MR. SUNDIN: You're looking at the ORAU web site? 

DR. MELIUS: Yeah. 

DR. ZIEMER: ORAU's web site? Dick Toohey, can you 

respond? Or Jim? 

DR. TOOHEY: Dick Toohey, ORAU. We're hanging them up 

right now. What happened -- and I'll freely admit, I 

dropped the ball on that one. A couple of meetings ago 

we had a request to change that form to include atomic 

weapon employer development, so we sent new forms out 

to all the people. We have gotten them back in and 

they are -- I think they're all scanned now and being 

hung up there on the web site, so they should all be 

out there for the people directly involved in dose 

reconstruction. You know, we're not putting them up 

for computer programmers and folks not directly 

involved in the dose reconstructions themselves. 

DR. ZIEMER: Understood. 

DR. MELIUS: And then finally one request for our next 

meeting. Could we get a more detailed way of 

presenting the progress in terms of these claims, where 

things are in the process, number of claims at each 

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stage and so forth and what progress is being made, 

'cause I just find it very hard to -- give us snapshots 

and it's very hard to see where -- how things are 

moving through the process or where there are potential 

problems. Understand -- I mean I'm not asking for a 

response. 

DR. ZIEMER: Yeah. They would need to identify how to 

do that in terms -- you're asking for how many are at 

this stage -- we're seeing some of the stages. You're 

asking for the intermediate points, I think. 

DR. MELIUS: And there may be different ways of 

presenting it. I don't -- 'cause things are changing 

and apparently rapidly, so I -- but... 

DR. ZIEMER: Perhaps in terms of the framework of the 

questions that have been asked, you get the sense of 

what's being asked for. 

MR. SUNDIN: Yeah. No, I do. I made a note of it, 

Jim, and if you -- certainly if you have any preferred 

formats, let us know. 

DR. ZIEMER: We do need to move on here. We have a 

very full agenda for this meeting. Let me move us 

forward. We have a related report on the DOL, 

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Department of Labor's status on their part of the 

program. We're going to hear from Shelly Hallmark --

Shelby Hallmark. Shelby has been with us before, but 

let me just remind you all who Shelby is. He was named 

Director of the Office of Worker's Compensation 

Programs for Department of Labor in June of 2001. He 

had been Deputy Director of that office beginning back 

at about 1990, and also served a couple of times as 

acting director, but now is the Director of that 

office. 

He's been with the Department of Labor since 1980. He 

had a whole series of assignments over the years, 

starting -- or including responsible positions in 

Employment Standards Administration's Office of 

Management, Administration and Planning. He's also 

served as Chair of the Secretary of Labor's Strategic 

and Performance Planning Work Group in '98. He led the 

Department of Labor's 1999 to -- well, really current, 

I guess, to 2004 Strategic Plan, and its year 2000 

Annual Performance Plan. So Shelby, we're pleased to 

have you with us this morning to give us an update on 

the Department of Labor's part of this program. 

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DOL PROGRAM STATUS REPORT
 

MR. HALLMARK: Thank you for that overly-long 

introduction, Dr. Ziemer. Even I wasn't interested in 

that stuff. 

(Laughter) 

All right. Well, it's a pleasure to be here, and I 

asked Larry if I could make a few remarks here this 

morning for the Board because I think it's useful for 

you to hear about where the ultimate product of -- at 

least the Part B portion of the Act is standing. And 

we're in pretty good shape. We're obviously further 

ahead than NIOSH is in the -- as we move along the 

process of cases moving down this line. 

Am I coming through back there? Is that okay? All 

right. 

Basically we have a fully functioning program now. We 

are in a posture where we've worked out our 

relationship with NIOSH and with DOE, with Justice, 

Social Security, unions, contractors. There's a lot of 

different groups to be dealing with, and I think that's 

one of the challenges that we all face in this program 

in trying to pull together a very large number of 

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players. We're pleased to say that we have a great 

relationship I think with all of the groups that are 

listed, and in particular with NIOSH. They've worked 

extraordinarily closely with us and we're pleased with 

that. 

Energy has come along, and in answer to your question, 

Mr. Presley, about Oak Ridge earlier, we're pleased 

that we've been getting faster responses on our 

requests for records as we go to the sites, and 

especially at Oak Ridge where we have obviously a big 

volume. So the whole system is now at a point where 

it's working much more effectively. 

We've gotten about 42,000 claims, and you'll see data 

in this -- in these charts that are both listed as 

claims and as cases. Obviously there are -- each 

individual person can file a claim, and so if you have 

a survivor claim, there could be five claims, all 

associated with one worker, which would be what we call 

a case. 

We've paid out about half a billion dollars now, a 

little over the $562 million or thereabouts. 

We have about 300 Federal and contractor workers 

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involved in our program in sites around the country, 

most of them in our district offices and our national 

office, between our legal folks -- they count as 

people, too, you know -- just barely. And our final 

adjudication branch, which is spread all over the 

country, also. 

As I say, we've got about 42,000 -- almost 43,000 

claims now. We have received about 8,000 claims so far 

this fiscal year, since October. We expect to get 

about 12,000 to 18,000 by the end of September, which 

is a big spread. And this slide indicates my 

expectation that as NIOSH cases come out of the 

pipeline, we will see an upsurge in cases. We don't 

know that for sure. We've had some indications, but 

it's possible that we'll have another upward blip. 

This is a quick refresher on the types of claims we've 

had, and you probably can't read these tiny little 

print in the back, but the yellow is cancer. That 

would be both SEC and NIOSH dose reconstruction cases, 

about 28,000, 29,000. Beryllium is about 2,000. 

That's sensitivity. About 1,800 CBD claims, about 800 

silicosis claims, under 5,000 RECA claims and a very 

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large number of other, which are basically -- this 

19,000 or so are basically folks who filed Part B 

claims who really are entitled to Part D claims, and 

that's taking the wrong door, basically. 

There's our break of claims by employees, living 

workers and survivors, and as you see there, it's 

mostly survivors, 57 percent. 

This is status of our cases right now, and this is a 

slide I think I showed back in Santa Fe, which -- and 

I'm proud of the changes that we've made here. In 

Santa Fe you'll remember we had about 20-some-odd --

27,000 cases over here on the right, total cases, but 

we had about 8,000, 9,000 cases in the pending status, 

which meant our district offices were still doing 

something about them. Now that's 3,000, so that's less 

than ten percent, and we're looking at basically new 

cases that have come in in the last few months that are 

in that pending action category. Then they move across 

to the final -- they actually -- they go to a 

recommended decision, then they either go to a final 

decision or to the far column over there, which is sent 

to NIOSH. Those are the two possible outcomes that 

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we're looking at pending a NIOSH decision. So you can 

see we're in -- we're fairly current at the present 

time in our process. 

This is just a slide that gives you a basic -- a little 

breakout of the types of cases that are in that 19,000 

that I pointed out earlier which are not covered under 

our Part B program. A lot of lung cases, some just 

other other, which -- a compilation -- heart cases, 

asbestosis, COPD, renal failure -- even hearing loss, 

which in that case I think hearing loss doesn't even 

apply in most cases to the Part D situation. 

This is just some basic program data, where we are in 

various different categories. Obviously we keep a lot 

of data and can give the Board more if you'd like to 

see it. This is a figure that I have pointed to in the 

last time I spoke with you, which is that we still are 

not paying very many medical benefits. That's about 

$10 million out of a total of $562 million in benefits, 

and that's -- suggests that we probably should be 

paying more, that people are not bringing the claims to 

us for medicals. 

This gives you another breakout of the outcomes of our 

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final decisions. As you see there, 11,000 denials, the 

-- I believe that's purple bar is the other. That's 

the not covered conditions. Again, that's that group 

of cases that really should have gone through the other 

door to Part D. And so that's really skewing our 

outcomes. These are the sort of traditional worker 

compensation issues -- is the person really an employee 

of one of the covered places, is it a survivor who is 

eligible under our program, can they link the condition 

to the employment, is there sufficient medical. Those 

are the kind of traditional Workers' Comp denial 

categories beyond the ones which come in as basically 

the wrong door. 

So this is our outcome level right now. I think when I 

showed you this slide in Santa Fe it was the other way 

around. It was 60 percent approvals, 40 percent 

denials. Now it's 70 percent denials, 43 percent 

approval. If you take out the Part D cases that came 

to us that are not applicable, that approval rate goes 

up to 70 percent. 

And this tells you something about the timeliness of 

our processing. We have established goals for two 

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different categories of cases. One is our -- the basic 

DOE contractor site and RECA, which is 120 days down 

here (indicating). And the other -- and the up above 

is the AWE, beryllium vendors and subcontractors, which 

is up at the top. And our goals were 120 days for the 

straight -- what we thought would be straightforward 

cases and 180 days for the more complicated cases where 

we have to go searching for employment records. And as 

you see there now we're meeting those goals on average, 

178 days for the AWE beryllium and 113 days plus for 

our DOE/RECA cases. And I -- that's been a -- hardfought to get to that point, and we are getting better 

every day. 

Of the cases we've gotten back from NIOSH -- and our 

numbers are a little bit different. I don't know, 

there may be some cases in the mail, Larry, I'm not 

sure. Our folks, as of last week, told me we had 48 

cases back from you. If there's another 25 out there, 

we're glad to get them, too. There's 135, by the way, 

in full disclosure, which we've gotten back because we 

sent it to NIOSH and it didn't require a dose 

reconstruction, either the -- there are some cases, 

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like CLL, which early on we decided were in a different 

category, did not receive a dose reconstruction. And 

other cases where the individual, for example, may have 

later been determined to be part of an SEC and so there 

was not a dose reconstruction required, or the claimant 

died or other kinds of circumstances. So there's some 

that have come back to us for those reasons. And then 

-- but of the 48 that we've gotten back, we've accepted 

80 percent at the first recommended decision level. 

We've accepted 13 out of 14 at the final level -- it 

takes a little while to get from one step to the other 

-- but we're anxious to get the rest of them. 

As you've heard this morning, we expect to get 6,000 

dose reconstructions through the end of this calendar 

year, and we are gearing up to accept them. We have a 

target of completing the first stage, the recommended 

decision, in three weeks of the receipt of the case 

from NIOSH, and I think we can meet that. And then the 

time from the time you get a recommended decision to 

when a final decision is issued can vary, depending on 

what the outcome is and how long the claimant takes to 

consider his or her options, but that won't be any 

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different than it is now. And we will -- as my last 

bullet says, we will move our cases around as we need 

to, because we expect to get clumps of cases. Our 

cases are geographically split among our four offices 

in Seattle, Denver, Cleveland and Jacksonville. We 

expect that because of the site profile approach, NIOSH 

is going to send us largely clumps of completed dose 

reconstructions which may overwhelm an individual 

office and that'll require us to distribute the 

workload to make sure that we meet these goals we have 

to move these cases through very promptly. 

Just a few statistics about our cases that come in from 

Tennessee, about 5,600 cases so far. You see there we 

referred 2,300 to NIOSH, recommended decisions on 

3,000. We've paid 1,500 claimants here in Tennessee 

about $167 million. 

And this just shows you briefly what the status of 

those cases are. This is similar to the earlier slide. 

Of the 5,600 cases only 445 are pending, and that 

means you're current with workload coming in the door. 

The cases in Tennessee are mainly cancer, but a fairly 

good number of beryllium sensitivity and chronic 

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beryllium disease, 51 silicosis cases there and 2,000 

other, which are the -- you know, Part D cases, 

basically. The silicosis cases could be in effect Part 

D, people who have filed the wrong thing, because only 

miners at the Nevada Test Site and Amchitka are 

eligible for benefits for silicosis per se under this 

program, although these people could have been there 

and moved to Tennessee, so that's a possibility, also. 

And I just show this slide, this is -- this shows a 

little bit about our expectations of claims receipts, 

and these data on the left as far as worker population 

came to us from DOE long ago. I think David Michaels 

gave us these. And I don't know that they are 

absolutely correct. They certainly don't include the 

whole penumbra of subcontractor and in some cases 

construction workers, and so that number may be low in 

that respect. But you see the number of claims we've 

received in the three different Oak Ridge sites and the 

percent of the population that has claimed. And these 

percentages are a little higher than they are in some 

areas, some other sites, but much lower, for example --

and interesting that K-25 is seven percent. Paducah's 

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similar plant is 36 percent of the known population has 

filed, and Portsmouth is 14 percent. So that's 

interesting in terms of the possibility that there may 

be other claims out there in the Oak Ridge area which 

are -- which could come in and which are possibly 

eligible cases. Again, given the vagaries of the 

estimation of the population, that's not a high 

science. 

Just this last slide to say that we are continuing to 

do outreach, and the previous slide suggests that. We 

are -- we expect that there are other people out there 

who could file, and I don't expect you to be able to 

read that fine print back there. Don't strain 

yourself. But we're trying to do a lot of things. We 

still have our resource centers that are delivering 

help at the sites, including here in Oak Ridge. We 

have traveling resource centers. We're trying to get 

them out to as many locations as we can where we don't 

have a permanent office to try to address needs of 

people who haven't come forward. We're working with 

unions and other groups who have lists or information 

about people that we might contact directly. We're 

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trying to do things with media, public service 

announcements, that sort of thing to get words out to 

people who are not even close or no longer affiliated 

with any of the communities or unions or other 

activities. And we have our web sites, et cetera, et 

cetera. So we're looking for ways to try to improve 

our outreach so that we make sure that everyone who is 

in fact eligible for this program comes forward. We 

don't want people to come forward and file claims who 

are not eligible, but if they are, they have a 

possibility, we want them to know about it and we're 

looking for as much help from as many different sources 

as we can -- as we can find. 

And that's, in a nutshell, where we are with the 

Department of Labor so far. Can I answer questions? 

DR. ZIEMER: Yes, thank you very much, Shelby. Who has 

a question? Okay, Roy first. 

DR. DEHART: Roy DeHart. Would you better define Part 

D and specifically does it include mechanical injuries, 

such as backs, necks, that sort of thing? 

MR. HALLMARK: Part D of course is the part of EEOICPA 

that is administered by the Department of Energy and 

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Tom Rollo*'s group. As I understand it, Part D covers 

occupational illnesses caused by exposure to toxic 

agents, and I believe their regulation defines toxicity 

as not including such things as hearing loss and other 

sort of mechanically-conceived injuries. I think they 

did include toxicity -- they did include radiation as a 

toxic substance, although that I guess is -- there's 

some debate -- definitional debate about that, but that 

is included as part of the array of cases that you can 

take to the Part D portal. And everyone should 

understand that Part D -- individuals who are eligible 

for Part B are also eligible to apply separately to DOE 

under Part D, so you can go both ways. 

The other column that I was citing to are people who 

are not eligible for Part B at all. They may be 

eligible for Part D, and you should know that as we 

receive cases and claims from those individuals, we 

inform them on a regular basis -- oh, you filed a claim 

for asbestosis; we don't cover asbestosis, these people 

over here do. And we give that information to them. 

DR. ZIEMER: Jim and then Rich. 

MR. ESPINOSA: He answered it. 

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DR. ZIEMER: Oh, he answered your question. Okay, Jim 

then. 

DR. MELIUS: Okay. I hope Dave or Larry will find the 

missing 25 cases and let us know. 

MR. HALLMARK: We hope they're -- they're coming soon. 

DR. MELIUS: They're in the mail, right? 

MR. ELLIOTT: Well, let me answer that right now 

because I signed 12 finished ones last Friday, so there 

is a lag time between us and getting them to DOL, so 

they're not only in the mail, they're there. 

DR. MELIUS: We just want you to know we're keeping --

keeping an eye on you. 

What is the -- you may not -- I don't know if you know 

this or not, but with the SEC claims, what's the trend 

been with them? Have they seemed to be going up, going 

down in terms of numbers filed and... 

MR. HALLMARK: I can't say for sure because our -- the 

data that I see on a weekly basis is split out by site, 

but they don't -- there -- there could be claims in 

Paducah or Portsmouth that are either dose 

reconstruction cases because they have a cancer that's 

not one of the -- one of the 22 that's listed in the 

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statute, or they could be beryllium or they could be, 

you know, other things. So I'm not sure. I will say, 

though, that Paducah's volume of claims that have been 

coming in has stayed high. In part I think that's --

just reflects the fact that our resource center and the 

assistance that we get from PACE and other folks in 

Paducah is really intense there and so we find, for 

example, there's more -- there's more focus and more 

outreach to subcontractors I think in the Paducah site 

than some of the others. It's hard to say. I mean the 

percentage I showed there for Oak Ridge is six to seven 

percent. I think in Hanford it's four percent. So 

there are some sites where it's very, very low, and 

that's four percent against a number of employees in 

Hanford that doesn't even count any construction 

workers, and I've heard estimates of as high as 100,000 

construction workers out there. So Hanford is very 

low. It's hard for us to know what the -- you know, 

what all the socioeconomic and other kinds of factors 

are, but we're trying to swim against that and see if 

we can't get people to come forward who in fact are 

eligible. 

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DR. MELIUS: Well, certainly at the SEC sites people 

are getting compensated so --

MR. HALLMARK: There shouldn't be any --

DR. MELIUS: Whereas the other claims that are not yet 

are at a very, very low rate, so --

MR. HALLMARK: That's right. 

DR. MELIUS: -- that certainly gets -- word gets out 

and --

MR. HALLMARK: But as I say, it's clear that -- if 

these data are anywhere near accurate, it's clear there 

are a lot of K-25 employees who either haven't filed at 

all or, you know, maybe they -- you know, maybe because 

the population was older here, you know, they've 

dispersed and they just haven't gotten the word. 

DR. MELIUS: Right, yeah. No, no, I think -- and I 

agree that there's a lot more outreach that can be done 

for these. One of the concerns of the Board has been 

people that might have -- be sort of partially eligible 

for an SEC. They worked, you know, some number of days 

there, but not enough to be eligible at a particular 

site, but then would have time at another part of a DOE 

complex, either another part of the site that's not SEC 

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eligible or at another site that's not an SEC site. 

And there's really -- it raises some difficulty in 

terms of how do you do dose reconstruction and so 

forth. Is there any way within your system of keeping 

track of that -- or maybe NIOSH can, I -- you know, 

those claims I assume would come in for an SEC --

initially identified possibly as an SEC. Then if it's 

discovered that they don't meet the employment 

requirement, do they -- do they get tagged in some way 

when they go over to NIOSH 'cause --

MR. HALLMARK: I -- I don't know. Pete Turcic, who is 

the director of the Energy program, is sitting back 

there, may be able to answer this better. It's my -- I 

don't know how many would fall into that category, but 

clearly at the point that we made the judgment that 

there were less than 250 work days that would qualify 

the individual as an SEC recipient or claim, we would 

then start to process it as a NIOSH referral. And 

whether that -- you know, whether we have any kind of 

tag on it that says this was a partial SEC or not, I 

don't know. Pete? 

MR. TURCIC: Yes, we can track those claims, and we do 

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send them to NIOSH for a dose reconstruction. I 

believe we have some 400 or so claims, like from 

Paducah, for example, that are in for dose 

reconstructions. 

DR. MELIUS: Okay. 'Cause I mean one of the -- on 

Larry's long list of things to do, I mean, one of the 

issues is that there is some regulation-related things 

that have to be dealt with that haven't been addressed 

yet with those, and I was just trying to get a sense 

of, you know, is it a priority or -- you know, are 

there many of these? I expect there'll be a fair 

number of them, just given the nature of employment at 

these sites and so forth. 

MR. ELLIOTT: I don't have the numbers at my disposal 

right now, but we need to make sure we're clear on 

this. There are two types of claims here. There is 

those that are SEC but non-presumptive cancer claims 

which are sent over to us to do dose reconstruction. 

DR. MELIUS: Right. 

MR. ELLIOTT: And in that category, they may only have 

that site. Then there's this other category where they 

worked at an SEC site but not for the full time period 

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required, and they may have worked at other sites. 

That's the category you're getting at with your comment 

about dose reconstruction and our regulation. Yes, we 

can track both of those. We do track both of those. 

We can identify them in our tracking system as to which 

claim fits into which category. 

MR. HALLMARK: And I would assume that of the 400 that 

Pete just suggested from Paducah that the vast majority 

of those are in the other kinds of cancer category as 

opposed to less than 250 work days. Now again, 

Paducah's done a better job of finding subcontractors 

and so they are more likely to have ferreted out people 

who were on-site for a small period of time or maybe 

intermittently over a long period. 

DR. ZIEMER: Mark Griffon has a question. 

MR. GRIFFON: Just a follow-up on some data, and I 

don't know if you keep this kind of data, but curious 

if you had any statistics on the types of cancers and -

- overall and then broken out by site. 

MR. HALLMARK: Cancers, as in primary? 

MR. GRIFFON: Yeah, number of claims, type of primary 

cancer. 

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MR. HALLMARK: Yeah, we have --

MR. GRIFFON: Do you track --

MR. HALLMARK: I don't have it with me, obviously. 

MR. GRIFFON: I mean is that something that can be 

provided to the Board possibly? 

MR. HALLMARK: Yes, absolutely. 

MR. GRIFFON: And the second is, do you -- do you track 

job categories or job -- job titles is interesting. 

Job categories would be more interesting to me. 

MR. HALLMARK: That's not an element of our data 

system, and it's one that's very difficult to get your 

arms around, but we do -- you know, obviously we do 

have the cancer data. 

DR. ZIEMER: Other questions for Shelby? There appear 

to be none. Thank you very much. 

MR. HALLMARK: Thank you. 

RECENT IREP MODIFICATIONS AND RECOMMENDED UPDATES
 

DR. ZIEMER: Now we're going to move to an update on 

IREP and some recent modifications and updates. We 

have two individuals with us today from SENES. One is 

Brian Thomas. Brian basically is a nuclear engineer. 

He's got his undergraduate and graduate degrees from 

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the University of Tennessee. He specialized in health 

physics, risk assessment, uncertainty analysis. He's 

had over ten years of experience in qualitative 

uncertainty analysis, extensive experience in 

developing and programming complex computer models, 

including the IREP model -- or the NIOSH-IREP model. 

And also let me introduce the other individual, who is 

Iulian Apostoaei -- is that close enough? And --

MR. THOMAS: I think Apostoaei would be the --

DR. ZIEMER: Right. We don't know whether we're using 

an American pronunciation or Greek or whatever, but Dr. 

Apostoaei is very experienced in radiological 

assessment, and actually did his doctoral work 

involving the uncertainties of internal dose factors 

from ingestion of Strontium-90. He's used the most 

recent ICRP models and is currently developing 

computational tools for determining acute and chronic 

intakes from plutonium -- or for bioassay data from 

plutonium intakes, estimating doses. This was a 

project I think originally came out of the University 

of Colorado and supported the epidemiological studies 

of the Rocky Flats workers. 

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He's also been involved in dose reconstruction projects 

at Idaho National Engineering Laboratory and for CDC. 

He's worked on some of the historical Iodine releases 

here in the Oak Ridge area, estimating doses of risks 

from cancer from exposures in the Hanford area, so a 

great deal of work involving dose reconstruction, 

epidemiological tables -- radioepidemiological tables. 

He's one of the main authors of IREP, so we're very 

happy to have him here today and please give us the 

recent modifications and updates and related --

MR. THOMAS: We'll certainly do that. Thank you for 

those introductions, Dr. Ziemer. 

Let me start by saying that this projector system is 

really fancy and organized and -- so I applaud whoever 

thought of this idea to have all presentations on the 

same machine -- real streamlined. The only downside to 

this is that we had to have our talks ready two or 

three weeks ago, and this -- just so you know, this 

kind of goes against our longstanding tradition of 

making last-minute changes at midnight before a talk, 

so midnight rolled around last night and it felt weird. 

Okay. Iulian and I are going to tag team on this 

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presentation. I'm going to first take you through four 

changes that have been made to IREP over the past --

actually these changes just got made, but IREP hasn't 

changed for, as you know, many months. 

On May the 1st of this year IREP was updated to version 

5.2.1. Each of the changes that I discuss today are 

extremely minor, which is the reason that we felt that 

a minor difference in the version number was warranted. 

This first slide that you'll see just briefly runs 

through the updates, then I have at least one slide 

prepared for each of these updates, so we'll get into 

more details. Back last October Russ Henshaw from 

NIOSH introduced to the Board this idea of the minimum 

latency adjustment functions for leukemia and for 

thyroid cancer. Then again in March he presented a 

more finalized approach at how this would be handled. 

These changes have now been implemented. 

When entering the radon exposure information for 

someone exposed to radon, in the previous version there 

was a pull-down menu. It let the user select total or 

annual. Turns out total -- never used. We removed 

that pull-down menu to avoid confusion, doesn't make 

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any difference in the final outcome. 

We've added some help. It's basically a link to tables 

that are already in the NIOSH-IREP technical 

documentation. We've provided links to those PDF 

versions that can be downloaded, and we've provided a 

help button that will give guidance when the dose is 

being entered on which radiation type to select. 

Now all of these updates are discussed on the OCAS web 

site. There's a really detailed paragraph there that 

gives these details. 

Now when I talk about latency here, I'm talking about 

the time between exposure and when the cancer was 

diagnosed. The previous version of NIOSH-IREP assumed 

a two-year minimum latency for leukemia and three years 

for thyroid cancer, and so the word minimum there is 

the key, because if an individual was exposed and then 

got leukemia within two years or thyroid cancer within 

three years, they were given a zero probability of 

causation. All other cancers in the model would at 

least give some small probability. There was no 

uncertainty assigned for that minimum latency period. 

It was two years and it was three years. The PC was 

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zero. 

In the new model these revised latency adjustments now 

result in non-zero risk for all times since exposure, 

so even one year after, you're going to get a non-zero 

result. And this change also results in no decrease in 

probability of causation in any of the time since 

exposure compared to the previous version. 

Okay, now we get into this radon exposure change. The 

pull-down menu that I mentioned in the previous version 

allowed you to enter it as total or annual. The 

revised version now just asks the user to enter 

everything on an annual basis. Just like entering dose 

information for an exposure, it's best to have it per 

year. The model can handle that much better, so this 

ensures that the latency period for lung cancer is 

properly accounted for -- and this kind of goes back to 

the previous slide. If someone got lung cancer two or 

three or four years after their exposure, entering 

their exposure information annually would allow the 

code to properly account for that, plus this simplifies 

the input screens for radon exposures. 

Cancer model help, this is the help button right on the 

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primary input screen that gives guidance for the cancer 

-- cancer type, cancer model pull-down menu. There's a 

very full list of cancer models there to choose from, 

but it's not every single cancer type that's out there. 

And so the tables that NIOSH put together -- it's 

about six, seven, eight pages long that give all the 

cancers and then which cancer model in NIOSH-IREP to 

select. Once you click that help button right from the 

primary input screen, you can download the complete 

NIOSH-IREP technical documentation, as well as tables 4 

and 7. Here's what it looks like, and the red circle 

indicates where the button has been added. When you 

click on that, it takes you to this screen. You can 

download table 4, which is the cancer models to be 

used, the primary cancer sites. If all you know is a 

secondary cancer site, table 7 is the place to go. 

Then you can click here to download the complete 

documentation. 

We've added a help button also to give guidance on 

which radiation type to select. This would be alphas, 

electrons, those sorts of things. This has primarily 

been added for the general public that might access the 

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site and want to look through these sorts of things. 

Our dose reconstructors at ORAU are very knowledgeable 

on all these sorts of things and they know which one to 

select themselves, but this is a very well-written help 

file. David Kocher will go into some more details this 

afternoon about this one. 

In that help file there there are important 

distinctions made between exposures that were internal 

and external exposures. 

This is a screen shot of the previous version. The 

radiation type, pull-down menu that I am discussing was 

here (indicating). In the new version we just simply 

added a help button there (indicating). 

So those are the four changes that we've made to update 

version 5.2.1. We're so excited you guys are here in 

our hometown and we've got four of our staff here to 

talk to you today. 

Iulian, if you'll come ahead, we're ready to get into 

some details about our recommended updates. 

DR. APOSTOAEI: Can you hear me? Yes. Thank you for 

introducing me, and I think you pronounced my name 

very, very well. That's one of the best pronunciations 

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I've ever heard around here. So I hope you can 

tolerate my accent, too, so... 

Brian discussed about modifications that have already 

been implemented in IREP. I'm going to talk about some 

-- some updates that we here at SENES highly recommend 

to NIOSH and to the Advisory Board. We're going to 

talk about a couple of updates. The first one relates 

to bone cancer. Bone cancer and especially for the 

latency period for bone cancer. 

At this point bone cancer has a latency period which is 

assigned the same value as for all solid tumors, which 

is about ten years. And it seems, based on more recent 

research that we did, that the latency should be lower 

than ten years -- an average of ten years, maybe about 

five years. And this change would be very claimantfriendly because it will produce risks at lower times, 

shorter times after exposure. 

Another recommended update has to do with the 

application of the risk coefficients for thyroid 

cancer, and I'm going to discuss about this update in 

more detail. 

As we speak, in IREP the thyroid risk coefficients for 

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exposure at ages less than 20 are reduced by a factor 

equal to the radiation effectiveness factor for X-ray -

- X-rays. And this represents the state of knowledge 

that we had about a year or so ago when we first 

released IREP. And here is the rationale behind this 

reduction factor. 

IREP uses a risk coefficient obtained from studies of 

individuals exposed to high energy gamma rays and was 

designed to make use of them. We have risk 

coefficients for individual exposed to high energy 

gamma rays for all cancers other than for thyroid. The 

risk coefficients for thyroid cancers are obtained from 

a pooled analysis of studies of children exposed to Xrays and also gamma rays, and also adults exposed to Xrays and gamma rays. It just turns out that the risk 

coefficients for children are dominated by the studies 

in which patients were exposed to X-rays, and adults --

the risk coefficients for adults are dominated by the 

gamma rays -- by the exposures to the gamma rays by the 

A-bomb survivor studies. 

We believe that X-rays are more effective in inducing 

thyroid cancer than high energy gamma rays, and David 

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Kocher will talk about this a little bit later on, and 

I think you had a presentation on the effectiveness 

factors. 

So of course if the risk coefficients for thyroid 

cancer for childhood exposure are dominated by X-rays 

and X-rays are more effective in inducing cancer, then 

we had to reduce them by a factor equal to their 

effectiveness factor. 

However, we learned some more about the studies, these 

pooled analyses, and we learned that really there is no 

important difference between the risk coefficients from 

exposure to X-rays and the risk coefficients from 

exposure to high energy gamma rays. And let me show 

you a sample of the data. 

Here this graph shows the risk coefficients for an 

exposure to radiation at exposure less than 15. The 

numbers in green here are the studies in which children 

were exposed to X-rays and the part in blue is the 

study for the A-bomb survivors. As you can see, if we 

look at the risk coefficients from the A-bomb 

survivors, the risk coefficient does not -- is not very 

different from the risk coefficient that would be 

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obtained when we pooled all this data together. So 

some of the risk coefficients from exposure to X-rays 

are lower, some of them are higher. When you mix them 

up, you will get a risk coefficient that is very close 

to the one obtained from gamma rays. 

So a possible explanation for such an effect is that 

the X-ray exposures were applied to the patients in the 

fractionated mode, therefore induced a lower risk, in a 

similar way as a DDREF is applied. 

So the conclusion is that the risk coefficients from 

the pooled analysis which comes from X-rays and gamma 

rays combined are consistent and that a good surrogate 

for the risk coefficient that we need would be those 

from exposure to high energy gamma rays. 

So our recommendation is to update the application of 

risk coefficients for thyroid cancer by removing the 

reduction factor for exposure at ages less than 20. 

Let me show you what kind of an effect this actual 

recommendation has. These are the risk coefficients, 

which are the excess relative risk per any dose for 

thyroid cancer as a function of age at exposure, and 

these are the values currently implemented in IREP. 

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And you can see a decrease in the risk with age at 

exposure with only one exception. Here there is an 

increase here at age 20 because these values have been 

artificially reduced and the data that we have on 

thyroid cancer indicated there risks should decrease 

continuously. 

If we apply this update, the risk coefficients, now in 

blue, you will see that there will be no difference for 

exposures in adult. The risk coefficients for ages at 

exposure 50 and 20 will be increased and, you know, the 

data will now show -- the risk coefficients will show a 

continuous decrease with age at exposure. 

Just a reminder, this update will affect only a small 

portion, will affect only categories -- exposure at 

ages 15 to 19, so it's probably a very small impact on 

the total number of claims. But nevertheless, this --

we believe that this proposed update is scientifically 

defensible. It's also claimant-friendly for age at 

exposure under 20. It increases the risk. And also 

will -- has already been approved by the National 

Cancer Institute and they already implemented in their 

version of IREP, which is the new version of the 

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radioepidemiological tables. So we believe that it's 

probably best to include these updates, even in the 

current -- in the new version of IREP and this is our 

recommendation if you want to consider it. Thank you 

very much. So let us know -- both of us --

DR. ZIEMER: Thank you. We'll open the floor for 

questions to either of the presenters, and I think in 

addition I might point out that two of the other SENES 

people are here. Owen Hoffman and David Kocher are 

also here with us today at -- I believe they're both 

still here, but let's address our questions to the two 

presenters here, if there are questions. 

Okay, Dr. Roessler. 

DR. ROESSLER: The -- one proposed update affects the 

ages under 20. How many people -- I mean that doesn't 

seem like it's really pertinent to this particular 

study. It may be pertinent in a big --

DR. APOSTOAEI: Yes, the cutoff for the claims is age 

15, so --

DR. ROESSLER: But in reality, how many people actually 

would fall in that category? 

DR. APOSTOAEI: Very few. Very few. 

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DR. ROESSLER: Yeah, I just wondered about that. 

DR. ZIEMER: Thank you. Other questions? This Board 

gave a kind of approval to the previous update. We 

didn't think the previous one was overly significant, 

but we went on record as being in agreement with it. 

It's never quite clear where the line is between 

significant and a non-significant update. I'm not sure 

anybody knows exactly where that is. I believe that 

this is being presented to as a -- more of a tweak. In 

fact, it's -- shows, as the change in the number of the 

version, it's seen I think by the group as being not a 

significant update. It certainly is claimant-friendly. 

It affects, as Dr. Roessler suggested, very few 

potential claimants, but nonetheless the Board may want 

to be on record as to whether they are supportive of 

this proposed change, although it -- I don't believe 

it's required. Larry. 

MR. ELLIOTT: NIOSH is taking this into consideration 

and we're talking with our colleagues at NCI about it. 

I would offer also that there are no claims relevant 

to this particular change, and we would -- if we 

thought it was something we'd like to see done, we'd 

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bring it to the Board for your --

DR. ZIEMER: So your staff is not --

MR. ELLIOTT: -- your deliberations. 

DR. ZIEMER: -- yet at a point where you're making a 

recommendation --

MR. ELLIOTT: No. 

DR. ZIEMER: -- to the Board. 

MR. ELLIOTT: No, we're not. 

DR. ZIEMER: So it would be premature I think then in 

that case for us to take any action today, but if you 

have questions, we certainly want to raise them. Dr. 

Melius. 

DR. MELIUS: Can I ask Larry a question? I'm a little 

confused procedurally. What about the -- the bone 

cancer change, the -- or where do you -- where does 

NIOSH stand with --

MR. ELLIOTT: Well, we're -- we'd like to hear more 

about that ourselves. We'd like to know more about 

that. We -- I think the first I've heard about it was 

this morning. 

DR. MELIUS: Okay. 

MR. ELLIOTT: I don't know if Jim or others had heard 

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about the bone cancer modification, but we're in 

concert with NCI as much as possible and we're talking 

with Charles Land and others there about what -- what 

this would mean for the program. 

Once we have one of these that we think we need to 

bring to the Board, we will. These were -- these 

things were for informational purposes to let you know 

that this is on -- on the horizon, and we need to get 

out thoughts collected and understand what they mean to 

the program. 

DR. ZIEMER: Okay. Thank you. Other questions or 

comments? Tony and then Mark. 

DR. ANDRADE: I'd be curious, perhaps you have a number 

at the top of your head, and if not, that's okay. If 

we can hear it later, that'd be nice. What were the 

sizes of the cohorts in the studies that produced these 

new results about the effectiveness, say for example, 

in the case of children, X-rays being just as effective 

as high energy gamma rays for production -- for the 

generation of cancer? 

DR. APOSTOAEI: There are tens of thousands of 

children, including the exposures of children --

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DR. ZIEMER: Is the mike on? I mean --

DR. APOSTOAEI: No, excuse me. Can you hear me? 

DR. ZIEMER: Maybe just raise it up a little. 

DR. APOSTOAEI: Yeah, so the studies that -- included 

exposures to X-ray by -- the children by X-rays 

contained thousands of -- and tens of thousands of 

children, and this is a much larger number than the 

number of children included in the A-bomb survivors. 

And for adults, we have only the A-bomb survivors, with 

very few exposures by adults to X-rays. 

DR. ZIEMER: Mark? 

MR. GRIFFON: I think you just answered my question. I 

was going to ask for a breakout of -- of the older age 

groups, what studies you relied on there, but I think 

also Larry answered that they're still reviewing this 

so --

DR. APOSTOAEI: The way the data is organized right 

now, I think exposures as an adults contain only 

exposures -- to the A-bomb survivors from Japan, so... 

DR. ZIEMER: Okay. Thank you very much, gentlemen, for 

that input. 

Just before we take a break I want to call attention to 

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the Board to the fact that tomorrow afternoon we will 

be dealing with some minutes. The tab near the back of 

your packet which is labeled draft minutes, meeting 11 

-- that's the February meeting -- you are going to be 

receiving shortly -- this morning or early afternoon --

a substitute packet. This -- this early draft has 

subsequently been reviewed by the Chairman and marked 

up and there will be a new -- more concise draft, I'll 

call it and describe it that way -- which will replace 

this, which will require somewhat less reading for you 

tonight as you prepare for tomorrow's docket. But in 

any event, at that point you can -- well, you're 

certainly welcome to read through these minutes, as 

well. Maybe you'll like them better than the 

Chairman's version. But in any event, there will be an 

official draft that you'll receive sometime today. 

Cori will distribute it. 

With that, let's take a 15-minute break. 

(Whereupon, a recess was taken.) 

THE UK COMPENSATION SCHEME 

FOR RADIATION-LINKED DISEASES
 

DR. ZIEMER: We're pleased to have some special guests 

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with us today who are going to introduce us to the 

United Kingdom's Compensation Scheme for RadiationLinked Diseases. That's the UKCSFRLD. That's what we 

would call it here, and I don't know how we would 

pronounce that. In any event, we're pleased -- and let 

me introduce briefly all three of the gentlemen who are 

here with us today. 

Michael Lewis -- and when I give your name, just wave 

so everybody knows who is who -- or whom. Michael 

Lewis is a health physicist. He's had 18 years of 

experience with the -- in the United Kingdom in the 

nuclear industry there. Since March of 2001 he has 

been Executive Secretary of the United Kingdom 

compensation scheme, and in that role he's responsible 

for management and operation of the scheme. He's the 

only full-time officer of the compensation scheme, 

although he's able to call on numerous colleagues in 

the scheme's members for assistance in building case 

assessments. 

And then John Billard is National Secretary with the 

Trade Union Prospect, which has 105,000 members, mainly 

in science and engineering in the United Kingdom. He's 

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been very active in promoting the compensation scheme 

for actually a little over a decade now. 

And then Dr. Andy Slovak is the Chief Medical Officer -

- British Nuclear Fuel, BNFL is -- I don't know if I'd 

want to call them the contractor, but they're the group 

responsible for handling this, and he's their chief 

medical officer and is responsible for development of 

standards and review of the company's Occupational 

Health Services, and then he has an oversight role in 

the medical aspects of radiation protection and 

radiation science, including epidemiology, 

radiobiology, genetics, and in these cases this extends 

to chairing the UK compensation scheme's Technical 

Working Party, as they call it. That's the body that's 

charged with tracking developments in the technical 

fields that are relevant to the scheme and recommending 

necessary changes. 

So we're pleased to have all three of these gentlemen 

here. Let's see, we're going to begin with Mr. Lewis, 

and then Mr. Billard and then Dr. Slovak. 

MR. LEWIS: Good morning, ladies and gentlemen. It's a 

pleasure to be here to be able to tell you something 

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about the UK Scheme, which is what we call it, rather 

than the UKCSRLD. 

As you can imagine, we've observed the development and 

inception of your compensation program with a great 

deal of interest, not least because of the number of 

potential challenges it presents to the operation of 

our own scheme. I would also hope that this 

opportunity will give yourselves some chance to 

appreciate how another system works, and may even go as 

far as informing some of the decisions you have to make 

along the way. 

What I'd like to do is tell you something about the 

background and history of our scheme, and explain 

something of how we process individual cases and how we 

manage the scheme between the effective owners, the 

unions and the various employers. 

John will then tell you something of the union 

perspective of the scheme. Andy will, as the chairman 

of the scheme's Technical Working Party, will discuss 

some aspects of the technical basis that we use. 

To understand why we have the scheme in the first 

place, it's perhaps necessary to understand the legal 

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situation in the UK. In the UK we have a thing called 

the Nuclear Installations Act, which requires that any 

site where nuclear operations occur needs to have a 

site license. And that Act also says any company that 

holds a license is responsible for the harm caused by 

those operations. There's no need under the Nuclear 

Installations Act to prove negligence, so simply by 

proving that any harm that you suffer has been caused 

by those nuclear operations would lead the employer to 

be liable, or at least the license -- the site licenseholder to be liable. 

And under that Act there were five trades-unionsponsored actions against BNFL in the late 1970's. The 

first thing to know is that they were very lengthy. It 

took around five years for them to get started and then 

to get to the steps of the court. They were very 

expensive. There aren't any official figures on how 

much, but between the employers and the unions we're 

talking well into -- you know, well over ,1 million, UK 

money. 

They were very traumatic for the families concerned 

because they were under immediate spotlight for five or 

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six years, as well as under a great deal of pressure in 

their own local community. And eventually they were 

settled out of court, which doesn't really mean that 

you've got the greatest success out of the legal system 

that's possible. 

The reaction to this from BNFL and the unions was that 

there was a great deal of concern -- the distress 

caused to the claimants and the families, the duration 

and the actual financial cost to both parties. BNFL 

were concerned that it might actually be possible for a 

claimant to win such a claim. The unions were still 

concerned that it was very difficult to actually prove 

causation in a court. 

And both wanted a workable alternative as a way 

forward, but it was clear that if there was going to be 

a workable alternative, it would have to be faster than 

the court process. It would have to cost both the 

employer and the unions a lot less money. It would 

need to be more generous to the claimants to give them 

an incentive to come to any alternative rather than 

going to court. And obviously it would need to be much 

less traumatic to those involved in making claims. 

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After a great deal of discussion between the two 

parties, the Compensation Scheme came into being at the 

end of 1982, initially for a trial period of five 

years, and the first claim was actually received in 

November, 1982. At that time the Scheme took mortality 

cases only, cases where the claimants had died of a 

radiation-linked disease. It was unique at the time in 

that it used the causation probability methodology, and 

that methodology was based on an excess absolute risk 

model which was derived from ICRP 26, which was -- at 

that time was felt to be the best scientific basis. 

After that initial period of operation, the Scheme was 

reviewed in 1966 (sic) and both parties felt that the 

operation had been successful and decided to carry on. 

At that time we also extended the Scheme to include 

morbidity cases, cases where the claimants were still 

alive, and the PC methodology was reviewed and 

generally supported by the publication of the NIH 

radioepidemiology tables over here in 1985 and the 

associated NRC review. 

We did actually further revise the technical basis in 

1991 following the publication of BEIR V, and that 

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remains the basis of our Scheme today. 

The way we process cases is that every application has 

to pass a test of eligibility, and we then screen. If 

the screening test is passed, we then do a more 

detailed investigation, which is called a factual 

report. That's used to determine the case, and it then 

moves to payment, which, to use a -- we use the UK 

legal term, which is quantum. Quantum in the UK is the 

amount of money you pay in a settlement for an injury 

claim. 

The eligibility criteria that we have under our Scheme 

is that claimants must have been employed by one of the 

Scheme participating employers, they must be a member 

or have been a member of one of the Scheme 

participating unions, and they must either have a 

radiation dose record with the employer or at least 

there must be sufficient evidence so we can infer an 

occupational radiation exposure history to allow us to 

causation probability calculation. And obviously they 

must have contracted or died from a disease that's 

covered by the Scheme. And if those cases -- if cases 

are eligible, we then move to screening. 

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The idea of screening is to identify potentially 

successful cases. We take the dose history which are 

collated and, in some cases, slightly enhanced by what 

we call protocols, which are agreed procedures for each 

of the employers who compile dose histories. In some 

cases we do use upper bound data in order to speed the 

process of the case through the screening period. We 

assign one of six schedules, which are our dose risk 

models, dependent on the ICD(8) coding of the disease 

that the claimant is diagnosed with, and that -- they 

are the basis that we use to make the causation 

probability calculation. 

If the case produces a causation probability of less 

than 15 percent, it's deemed to have failed the 

screening process. I then inform the Union, and the 

Union informs the claimant and in almost all cases 

that's an end of the matter. If a case achieves a 

causation probability of 15 percent or greater, there 

is then a deeper investigation of the case done in 

terms of a factual report, and that factual report is 

then used as the basis for the final determination of 

the Scheme, which again is a causation probability 

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calculation. 

Based on the causation probability that comes out of 

the factual report, we employ a system called 

proportional recovery. This means that if you achieve 

a causation probability between 20 and 30 percent, you 

will receive a quarter of quantum, which is the full 

sum payable. And then it goes on a sliding scale up to 

50 percent, and 50 percent and over, claimants would 

receive the full sum of compensation, exactly as they 

would in UK law. 

There were a small number of cases where special 

factors apply, where the Scheme schedules may be 

confused or confounded, and those cases are determined 

by what we call an expert panel. The types of cases 

the expert panel would look at are cases of leukemia 

where there is evidence of radiation exposure below the 

age of 21, respiratory cases with any evidence of a 

smoking history which achieve a causation probability 

of 15 percent or greater, and female breast cancer and 

thyroid cancer cases which achieve a causation 

probability of 15 percent or greater. And the panel 

determines a fractional payment in exactly the same way 

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as the payment schedule does. 

Once a claim is awarded payment, it then moves to 

quantum. The idea of quantum is that the full sum is 

calculated in exactly the same way as a case would be 

if it was successful in a UK court. The employer and 

the Union both appoint solicitors at this point who are 

solicitors experienced in dealing with quantum matters, 

and they agree the full sum. The payment fraction is 

then applied and that determines the settlement that's 

given to the claimant. 

We have a set of agreed time scales for trying to 

process cases. The principal time scale that we work 

to is the six months to issue screening data. That's 

the point at which the claimant would know whether they 

were going to receive payment or not. There's the 

opportunity at that point for claimants to challenge or 

to raise any concerns they have about their assessment, 

but the rule of thumb we work to is that within six 

months we try to let claimants know whether they are 

going to get something or not. And we achieve that in 

about 70 to 80 percent of cases, depending on the 

employer. 

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The Unions then have three months to respond to 

screening data if the case has failed, or one month if 

it passes. I mean obviously if it passes, there's 

probably a lot less dialogue to take place between the 

Union and the claimant. 

The factual report is prepared within three months by 

the individual employer, agreed within one month by the 

Union, and then determined -- usually in a matter of 

days rather than a month -- once it is agreed. So the 

total target time scale is to run through the Scheme --

and if you like, all the I's dotted and all the T's 

crossed -- in nine months for failed cases and 12 

months for cases which pass. 

There is an alternative to the use of our Scheme. 

Again, our Scheme is not prescribed by legislation. 

It's a voluntary agreement between the employers and 

the Unions, so we can't make it compulsory and we don't 

seek to make it compulsory. Claimants can still take 

legal action under the Nuclear Installations Act, 

although the only thing we ask is if they are claiming 

under the Scheme, that they stay any legal action for 

the duration it takes us to assess that case under the 

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Scheme. And if an employer pays a settlement to a 

claimant, I think it's fairly common sense that the 

employer asks the claimant to sign that they will not 

pursue the employer under the Nuclear Installations Act 

for the compensation they've just been paid. 

And one important feature is that the participants --

principally the employees and the Unions -- are bound 

by the principle of the Scheme. That means the workers 

have the security that the Scheme is available to them, 

with all its generosities over and above the UK legal 

process. And it also means that the employers are 

protected in some respects in that the -- in that 

Unions will not support cases through the courts where 

it is more appropriate for them to come through the 

Scheme. 

If we look at the number of cases handled, I think if 

you compare these to the sorts of figures that David 

Sundin was talking about earlier, you can see that in 

one fell swoop last May we've gone from being a world 

leader to a drop in the ocean. In 20 years we've 

handled just about 1,100 cases. It's more a reflection 

of the size of our nuclear industry, I think, than any 

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personal inefficiency. Around 50 or 60 of those cases 

are currently ongoing, and in total 94 cases have 

resulted in payment. One of the important things to 

notice about those 94 is that 66 of those have been 

made at less than full payment, so if they'd have gone 

through the UK legal system and the UK legal system had 

adopted a similar assessment procedure to that we use, 

they wouldn't have achieved a payment in court, whereas 

we've given them compensation. And the total we've 

paid out so far -- again, you know, we're talking about 

drops in the ocean compared with you -- we've paid ,5 

million out so far, which is of the order of $8 

million. 

The way we manage the Scheme is that each employer or 

historical group of employers has a Compensation Scheme 

Management Board, and they manage issues pertaining to 

those particular employers, and there are five of those 

at the present time. I won't go through them, but 

there they are. 

The way a Management Board operates is that it's 

established by the Unions and the employer signing a 

morbidity and mortality agreement, and they are pretty 

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much identical documents throughout the five Management 

Boards. The employer provides dosimetry protocols 

which are vetted by the Technical Working Party and 

endorsed by both employers and managers on the 

Management Board -- sorry, employers and Unions on the 

Management Board. And the Management Board has its own 

internal procedures for dealing with claims. 

Management Boards nominate one management 

representative and two Union representatives to sit on 

the Scheme Council, which is the overarching management 

board of the Scheme, which makes sure that the Scheme 

operates consistently across the whole of the employer 

group. The Council meets once a year, and is actually 

chaired by the BNFL UK Management Board chair, and it's 

advised on technical matters by the Technical Working 

Party. 

I also mentioned we have an expert panel who consider 

some of the more difficult -- technically difficult 

cases. The expert panel is a group of internationallyrecognized independent scientists. The independence is 

important there. They are independent from the Scheme 

process otherwise, and from each of the employers and 

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Unions, so we are able to offer the comfort to 

claimants who are assessed by the panel that their 

deliberations will be out with any -- any interests of 

the participants. And at the moment they're averaging 

about one meeting a year. They usually consider two or 

-- two, three or four cases at their meetings. 

We also have this body, the Technical Working Party, 

which I won't dwell on because Andy's going to speak 

about that. Andy, as BNFL Chief Medical Officer, 

chairs that body, and it exists to advise principally 

counsel, but also the management boards on technical 

matters. 

The way that we usually demonstrate the success of our 

Scheme is the way that it's expanded from BNFL in 1982 

throughout the UK nuclear industry. The United Kingdom 

Atomic Energy Authority joined in '87, Urenco* and the 

nuclear generators joined in '93, the Ministry of 

Defense and the atomic weapons establishment joined in 

'94, nuclear dockyards in '97, and a company called 

Babcock Naval Services -- who've just taken over 

running two of the nuclear submarine bases in Scotland 

-- are joining this year. 

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We've also expanded throughout the UK trades unions. 

Initially the Union members were those unions who 

represented the BNFL work force, and there were five of 

them. As the Scheme has extended through the other 

employers, the other trades unions who represent their 

work force have joined, and we now have all the unions 

in the UK nuclear industry represented, and they cover 

the majority of workers within the industry. 

And I think that's probably the appropriate point at 

which I'll hand over to John, who will say something 

about the union perspective. 

MR. BILLARD: Good morning. Can I say first of all I 

have to congratulate you on the work you're doing in 

relation to your compensation arrangements for 

radiation workers, and I'm pleased to say something 

about the trade union involvement in the Scheme, which 

Mike has so far explained. 

And the first think I think is important for us is that 

the -- we have a collective agreement with the 

employers in the UK, which effectively means that the 

agreements are not legally enforceable, in common with 

all other collective agreements in the UK. This is --

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our Scheme is an alternative to legal action, as Mike 

has explained. Therefore the agreement we have is 

known as -- it's "Binding in Honor" between the 

parties. It would, therefore -- there will be nothing 

to prevent any one of the parties walking away from it, 

but that would cause a number of industrial 

difficulties. And over the last 20 years I think we 

can truthfully say that all parties have worked 

together very well to make the Scheme the success it 

is. 

The Scheme, as originally devised, was designed only 

for trade union members, and the reason for that of 

course is the nuclear industry in the UK -- highly 

regulated, highly organized, the great majority of 

workers in the UK nuclear industry aren't trade union 

members. So therefore it naturally fell to the trade 

unions to organize on their behalf in relation to the 

creation of the Scheme and its developments in 1992. 

Now as Mike has said, the alternative is a lengthy 

process, and we are there to give a service to our 

members. And it's absolutely essential that those who 

are taking part in the Scheme have whole and complete 

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confidence in what is being done on their behalf. 

We're there to present personal injury claims, if 

necessary. And as Mike has said, we wanted to avoid 

the lengthy and protracted and expensive process of 

legal action. 

But the important thing is -- I'm sure you will have 

experienced this -- a worker is in the nuclear 

industry, experiences radiation during their working 

life, gets cancer and therefore of course there is a 

direct link which the claimant or the relatives seek to 

make, and therefore in order to persuade them or 

convince them in the event their claim is not 

successful -- and that's nine times out of ten, as far 

as our Scheme is concerned -- then those claimants have 

to be satisfied that the Scheme we're operating is 

operating under the latest scientific and medical 

knowledge. And that means that the members who are 

involved in claiming or their relatives or dependents 

would have to be able to go to them to say that we, on 

their behalf, have confidence in the outcome. And that 

same confidence has led employers to join the Scheme in 

the same way that Mike has described. And the history 

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of the UK nuclear industry is one of a public sector 

industry. 

Nuclear research and development, nuclear in defense, 

has always been part of the UK public sector. But 

we've now moved to the stage where much of that is now 

operated by the private sector, and certainly the 

decommissioning task which is going to go on for 

another 50 or 80 years is going to be a private sector 

function and therefore we require those private sector 

employers to join the Scheme. And they have to have 

the same confidence that we do, because clearly if 

we're talking about private sector employers, we're 

talking about private sector money which may be paid in 

compensation. 

Therefore one can see that the relationship between the 

parties in respect to trade unions, employers and the 

management of the Scheme is effectively a tripartite 

arrangement, and I've described it as a three-legged 

stool. If one is removed, then the thing collapses. 

Trade unions and employers have good relationships and 

they have bad relationship. They are there to --

unions are there to represent their members. The 

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employers are there generally to represent their 

shareholders or their interest. And the employer/trade 

union relationship, going back well over 100 years, 

occasionally has its confrontational aspects. But I 

can say that as far as we're concerned in relation to 

the compensation Scheme, we operate a dance floor 

rather than a boxing ring. And we are there to work 

together for the good of claimants and indeed the good 

of employers. 

Now nevertheless, in relation to the very interesting 

developments that we've been listening about and 

reading about in the US program, there are some issues 

for the workers, and that is why we are particularly 

interested in making this presentation and hearing what 

you have to say. 

One of the things that immediately struck my attention 

was the concept of the Special Exposure Cohort, and I 

think when I first read details of the US program it 

was the SEC which stood out immediately. I think when 

I'd gotten beyond that and started to read and 

understand a little more about other aspects of your 

arrangements, it became clear to me you were very much 

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closer to what we have been trying to do over the last 

20 years, but the Special Exposure Cohort of course 

cuts out a whole series of stages. In other words, you 

worked at Place A, you worked there for Time B, you got 

Cancer C, therefore you get money. 

Now I have to say we've probably got quite a few 

thousand members in the UK who would like that Scheme, 

as well. Mike, for example, would probably be out of 

most of his job. I guess Andy wouldn't have a lot to 

do, either. But the difficulty is -- and I have to say 

that we do have a number of locations in the UK where 

radiation dose records haven't been kept as carefully 

as they should have been, and I'm talking about 20, 30 

years ago; no doubt where practices were interesting, 

to say the least, and which have certainly changed as 

the industry has matured, and therefore there is an 

attraction. However, our judgment is, as trade unions, 

is that we would never be able to persuade any employer 

to join such an arrangement because they would see it 

as a liability -- a big liability, particularly --

particularly if you're dealing with the private sector, 

which we are, because there's no government money 

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directly -- no government money directly involved in 

the operation of this Scheme. 

There are other interesting aspects of your scheme 

which I'm pleased to learn more about, and that is in 

relation to generosity factors. I know Andy will say 

something about that when he takes over from me 

shortly. I suppose if we take any one particular case, 

particularly one which might be on the -- right on the 

limit of where the compensation is paid or not, and we 

apply that case to your scheme, that individual may be 

successful under your scheme and not ours. But 

obviously that could equally work both ways. Our 

judgments are that, taken as a whole, generally the 

success rate of your scheme compared with ours, 

excepting the SEC, is broadly about the same. 

So I conclude on those comments, ladies and gentlemen. 

It's been a pleasure to talk to you. And if you have 

any questions, I'll deal with those at the end, and I 

hand over to my colleague, Dr. Andy Slovak. 

DR. SLOVAK: Thanks very much, John. I'm going to 

briefly run through -- review some of the technical 

issues in the Scheme. And particularly I'm going to 

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draw out some comparisons with your scheme and some 

rather particular features about where it's going. 

I'll preface these remarks by saying that I had 

wonderful sense of familiarity with the delays and the 

frustrations and the irritations associated with the 

setup of your scheme. The running of it, I can assure 

you, will be just the same, and especially any 

challenges and adaptations in the future. 

I was particularly taken also with the concept of pigs 

going down pythons, and I should add to that that 

greasing is sometimes difficult, and it doesn't get you 

past the pinch point. 

Very briefly, you will see a series of resonances in 

what you're doing and what we've been doing for over 20 

years, and the process of the Technical Working Party 

of which I chair is to make sure that all of these 

factors march in line with the advancement of science 

and understanding in these areas. 

Our technical basis, as Mike has said, is based on BEIR 

V. We have a relatively simple set of schedules in 

comparison with yourselves, with many things tucked 

into something of a dust bit of other tissues, and 

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we're going to have an extremely fruitful time in the 

future, considering all of the issues associated with 

your -- your many schedules and our relatively few, and 

how that works for different people. 

Here's the technical headlines of what we think are 

going to be some interesting areas and some possibly 

difficult areas of intercomparison between the US and 

the UK scheme. I've already highlighted the seven 

versus 34 dose models that you have, some of which I 

would say -- and perhaps slightly controversially --

may be straining scientific credulity a little. 

There are a number of differences in the way that we 

approach dosimetry. We mainly use statutory dose 

records and some reconstruction. We don't make 

adjustments for the way the dosimetry was done for the 

geometry of the radiation nor the tissue attenuation. 

And also we have this use of the 50 percent causation 

probability value, rather than the 99 percent 

confidence interval. 

We also have some cancers which are quite specifically 

non-eligible. These are the ones that many of you who 

have a technical interest will recognize, and some of 

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them are arguable, and some of them no doubt will be 

argued in the future. 

Like all good nuclear scientists, we can't actually 

leave well alone, so that we've taken BEIR and we've 

adjusted various aspects of it to make life easier for 

ourselves, and also to provide some level of in-built 

generosity to claimants. And I think one of the most 

interesting things I've already learned from this 

morning is that, similar to ourselves, there is a 

spirit here in this meeting of wishing to be generous 

and wishing to err on the side of benefitting claimants 

rather than taking some kind of narrow, legalistic sort 

of highly scientific point of view. 

Now we come to what the Technical Working Party does. 

This is the dance floor, although I have to tell you 

that I don't dance so good, and many of the members 

would have some difficulty in doing it, but 

nevertheless, it is a scientific dance floor. Any 

party can raise an issue, a scientific issue, and this 

is done at a council or a board management level rather 

than a technical level, so we are told what to do by 

our political masters, if you wish. It is then down to 

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us to come back to them and say well, you know, this is 

how we see the problem. This is the technical scope of 

the problem, this is how far we're going to go. And 

they will say okay, that seems sensible. Or they will 

ask us to go 'round and think again. Once we get into 

the Technical Working Party, we tend to be very 

inclusive. Anyone can come along who is representing 

one of the parties to the discussion, and we'll listen 

to all inputs very carefully and factor those into the 

discussion. So it's very much a forum, and again, 

there is some resonances with one of the papers that we 

had just before the break of a free and open discussion 

of scientific issues and a consensual agreement to the 

approach then taken. 

The next item here just shows some examples of issues 

that we've addressed over the last few years. Again, 

I keep on saying this, there will be all sorts of 

resonances of familiarity here -- non-uniform neutron 

dose; update of site histories, very important and not 

sometimes immediately obvious and has some kind of 

agreement -- agreed view of what happened on particular 

sites and when it happened and things like that, very 

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useful to the operation of the Scheme. 

Quite clearly, you guys have come in like the whales 

and suddenly we're the minnows. You know, minnows get 

a little bit agitated when whales come along, so you 

know, we want to carefully watch what you're doing and 

very much interact with what you're doing for the 

future. Hopefully it'll be very much a bipartite 

approach, and one of the things that we've done which I 

think is perhaps an example of the sort of maturity of 

the Scheme is that we've begun to look ahead and say 

well, you know, what happens when you're going to start 

getting specific genomic proteomic* markers of 

radiation related disease, how that's going to affect 

the compensation scheme, are there going to be winners 

and losers. It may comfort you to know that our 

conclusion was well, it's much too early to decide. 

So moving on now to what I think are the main horizon 

issues for us technically, we do think that there's 

going to be considerable benefit and value in having 

some kind of level of formal interchange at a 

scientific level with yourselves. We quite clearly 

have a set of resonances and sympathies in our attitude 

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and approach. 

We are awaiting with great eagerness, as I suspect you 

are, the advent of the new, somewhat-delayed NIH 

tables, and any pressure you can bring to draw those 

forward would be greatly appreciated. 

And another one which I think is going to get very 

difficult is non-cancer outcomes, which are beginning 

to come up in A-bomb survivors associated with 

radiation dose. Perhaps something not for the 

immediate future, but certainly just over the horizon. 

Okay, so we conclude -- I guess we conclude on time. 

It's been argued to you, and I think the very fact that 

three of are wearing suits and ties can turn up in the 

same place at the same time, that the Scheme has 

demonstrated over 20-plus years that it enjoys 

continued support, not only from the employers and the 

unions, but also from the scientific community. This 

is supported by its extension throughout the UK nuclear 

sector. We are -- we note and obtain comfort from the 

fact that you're using the same basic methodology as we 

are in terms of causation probability. However, the 

DoE scheme does raise some issues for us in the UK. 

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Now I do know that that's a slightly challenging 

statement, particularly as we've left the word but we 

still have much in common there. We -- I'll repeat 

what I said a little bit earlier. We are very keen to 

maintain a functional scientific dialogue, particularly 

and importantly for the benefit of claimants to produce 

an outcome which is fast, caring and hassle-free. 

That's the end of what I have to say. We're very happy 

to take questions and I'm inviting my colleagues to 

rejoin me for that. 

DR. ZIEMER: Thank you very much, and we'll begin 

questioning with Dr. Roessler. 

DR. ROESSLER: I was going to ask Mike this question, 

and then John, but I think you're the right one to ask 

now, Andy, that you have talked a little bit more about 

the updating of science, or using the best science. 

And now that the new dosimetry is out from Hiroshima 

and Nagasaki, and now that it appears it won't take 

very long for it to continue on and get to -- so that 

BEIR VII will be able to finish up, I assume you have a 

team ready then to go to evaluate BEIR VII and be ready 

to make any adjustments, if necessary. 

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DR. SLOVAK: Well, we certainly have that very much in 

focus, and you know, the guy who's going to lead that 

is standing in front of you -- or would be if I wasn't 

actually retiring quite soon, so my successor will be 

doing it. But yeah, I mean we've been watching that 

one coming and we will undoubtedly need to have fairly 

extensive dialogue. 

One of the things that we don't do is rush to judgment, 

particularly in a bipartite structure, it is necessary 

for the scientific impact of something as important as 

that to resonate 'round the scientific community and 

also 'round the trades union and employer communities 

for a little while before we draw all the strands in 

and come to some kind of view. I was also actually 

involved in the BEIR V reassessment, and that took 

about a year and a half to two years to settle down. 

DR. ZIEMER: Wanda Munn. 

MS. MUNN: I can't over-emphasize how marvelous it is 

to hear the experience from UK and see the similarities 

and be painfully aware of the differences in your 

situation and what we're dealing with here. I have 

some curiosity as to whether or not your experience 

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with your equivalent of our Department of Energy, which 

appears to be only about ten years in length as opposed 

to the entire Scheme, whether you have found that your 

experience with that particular work force is different 

than your experience with the broader commercial work 

force. 

DR. SLOVAK: I'll turn to John to give the first answer 

to that. My views may be slightly more trenchant than 

his. 

MR. BILLARD: Most of the workers in the UK nuclear 

industry once upon a time worked for the public sector, 

but we have had an extensive privatization program over 

the last ten, 15, now nearly 20 years. And it's been a 

matter for the unions to make sure that terms and 

conditions transfer, and therefore we primarily made it 

an objective for private sector employers coming into 

the industry that they would join the Scheme or be part 

of the Scheme. And I'm very pleased to say that so 

far, in respect of new employers coming into the 

industry, taking on existing workers, we have not yet 

had a refusal. And I think that is -- that is a credit 

to the way the Scheme operates, based on science, based 

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on knowledge. 

I think there's a point you should note, and that is we 

never close a case. We might tell a claimant that 

they're unsuccessful, but their file doesn't go in the 

bin. In the event that there is a development in 

medical or scientific knowledge, the case would 

reopened if there's a chance of a settlement. All 

these factors lead to a confidence level which has 

meant that as far as the union side is concerned, there 

is no difference in approach between employers, whether 

they're in the public sector or the private sector, and 

we're very pleased about that. 

DR. SLOVAK: Does that fully answer the question? 

MS. MUNN: That's fine. 

DR. ANDRADE: It was amusing to hear your remarks 

regarding our Special Exposure Cohort provisions, but 

I'm curious. Given the fact that you need to have 

bioassay or dosimetry records to follow up on a 

particular case for the Scheme, what would happen if, 

for example, there was a criticality event, there was 

no criticality dosimetry involved, but yet there were 

several witnesses to the -- to the fact? 

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MR. LEWIS: In that case we would look towards the 

employer's technical people to make some assessment of 

the potential doses to individuals involved in an 

incident like that. And that would be placed on record 

within the Scheme. Such a paper, and any paper that's 

produced regarding technical issues like that is, in 

the first place, discussed by the Technical Working 

Party, but it has to be endorsed by the appropriate 

Management Board. So whether it was to do with a 

criticality, whether it was to do with, for instance, 

an emission in the radiation monitoring regime over the 

years, it would effectiv-- within the Scheme be a 

transparent process and, you know, would require the 

endorsement of all parties. 

That is one thing -- I think one thing we didn't 

mention in the presentations is that our Scheme runs by 

consensus. Within the individual meetings there's no 

vote and there's no bloc voting. Everything is agreed 

through the Chair by consensus by all parties. And 

certainly, given that my job is to run the Scheme 

independently and on behalf of the interested parties, 

it makes my job a lot easier that the decisions are 

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made that way. Is that -- is that okay? 

DR. ANDRADE: Yes, thank you. 

MR. GRIFFON: Along -- along a similar path as Tony's 

question, I'm just curious how your dose reconstruction 

process is similar or dissimilar to the one that we've 

outlined for this program and -- and along with that, 

I'm wondering if you involved -- you did any sort of 

interviewing of claimants and used that as part of your 

-- your registration efforts. 

MR. LEWIS: No, we -- we don't interview claimants, 

except in the event that claimants raise certain 

specific issues, either at the outset of the claim or 

when the screening data is issued to them by the union. 

In which case we're talking -- out of 1,000 cases, 

we're talking less than a dozen cases where, you know, 

we have arranged meetings with the claimants, a union 

representative and technical representatives from the 

employers to discuss those concerns to identify whether 

in fact those concerns would lead to the assessment of 

doses additional to those already taken into account by 

the dose record. And if so, the employer's technical 

people would then -- as I mentioned to Antonio, the 

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employer's technical people would then do whatever dose 

reconstruction was necessary, and that would be 

channeled through the Technical Working Party and 

eventually agreed by both unions and employers and 

applied to the case. 

MR. ELLIOTT: You used a term, Mike, that struck me as 

another difference between our two -- the Program and 

the Scheme, and that is transparency within the Scheme. 

Here in the States, our transparency is effected 

through these public meetings and the oversight, the 

consensus advice generated from this advisory body. Do 

you see that as being an issue as a difference between 

us, the Program and the Scheme? 

MR. LEWIS: No, I think that's more of a cultural 

difference between the UK and the USA. I mean the way 

we consider democracy in the UK is that democracy is 

channeled into democratically-elected bodies or groups 

who then are empowered to act in whatever way they see 

fit under their (inaudible). And I think within the --

the way that works in the Scheme is that the union is a 

democratically-elected and constituted body and they 

represent the claimants who, you know, have a 

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democratic process within the unions, but the unions 

are the representatives within the Scheme. 

Now whether it's because our scheme was conceived 20 

years ago and 20 years ago you didn't have publiclyheld meetings like this, I don't know. I mean whether 

that -- whether that is something that would change in 

the future, again, I don't know. But certainly for the 

moment, you know, we -- the -- all parties are 

represented, either through the employer 

representatives or the union representatives, and 

that's the way the democracy works within the Scheme. 

DR. SLOVAK: Yeah, I'd like to just add something to 

that. We -- the Scheme is over 20 years old and it 

retains a high level of trust, and it sort of builds up 

its own steam of trust, if you like. One of the areas 

in which certainly the UK and much of Europe is lagging 

is in the provision of public information and public 

exposure of these issues to a broader set of 

constituencies. 

Now under the Nuclear Installations Act, there are such 

bodies, and those issues can be raised in those bodies, 

and the nuclear ones are called Local Liaison 

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Committees. So you can have these discussions. 

By and large, our experience is that these issues have 

not been brought up, but I don't know whether that's an 

expression of confidence or whether they've got more 

important things to do. But we can do it, and so in 

fact there is actually not as much difference as you 

would think. 

DR. ZIEMER: Thank you. Roy? 

DR. DEHART: As an extension of that issue, has it been 

necessary for the Technical Working Party to use any 

external quality assurance measures or assessments? 

DR. SLOVAK: We've never done so. We would be 

perfectly happy to do so, should either party take a 

view on any particular issue. I mean it's that 

flexible if either -- I mean our essential purpose is 

to obtain a consensual position. But if we had an area 

of disagreement or if there was a party which felt that 

it would be useful to do that, then we could 

accommodate that simply by saying well, that's what 

we're going to do from now on or that's what we're 

going to do for this particular issue because it seems 

desirable. 

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DR. ZIEMER: No further questions or comments? One 

more here. 

MR. ELLIOTT: I'd just like to thank you all three for 

coming to the States and spending time with us this 

week. They will be in Cincinnati with us for the 

remainder of the week, and we'll be having some of 

these technical discussions, but we certainly 

appreciate your presence here today and your very valid 

comments to this Board. Thank you. 

DR. ZIEMER: Yes, indeed, it's been very helpful. Is 

there -- the Department of Labor representative also 

has a comment here. 

MR. HALLMARK: Sorry to drag this out, but since we 

have this opportunity, it's wonderful to hear and I 

second the thanks from the Board for your presentation 

to hear about people who've been doing this for 20 

years as we struggle to get started. But I had a 

couple of questions I wanted to ask. One is, you 

mentioned the SEC and your not having an SEC, but you 

did have something called a Special Factors Panel, 

expert panel that you elaborated that addresses itself 

apparently to specifically difficult cases. And I 

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wondered since you had such a seemingly successful 

strategy for resolving disputes among the parties, why 

you would need this further group to resolve the really 

difficult disputes. That's one question. 

DR. SLOVAK: All right. Well, we'll both try and 

answer that. The Expert Panel was set up at the 

inception of the Scheme, partly I think because of the 

reasons that have been expressed by several questioners 

about trustworthiness and reliability and external peer 

review. What has actually happened within the Scheme 

is that the role of the Expert Panel has actually been 

narrowed as we've gained experience with operating the 

program. It's still very useful to have them because 

we do get the occasional tough one, and it's a good 

idea -- maybe this is sort of the underlying purpose of 

your question, really, is it is useful to get a second 

opinion on some of these things. Also, because they're 

extremely distinguished scientists, they will raise 

issues and feed them back into us where they don't 

think that we're quite clear about we're doing. We've 

certainly brought things back into the technical 

structure in order to do that. 

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MR. LEWIS: Just to reiterate on what Andy was saying, 

really I think the Panel -- I personally would view as 

a representation of the strength of the Scheme rather 

than a weakness. We recognize that in constructing our 

schedules there are some small areas where particular 

features of particular cases might mean that the answer 

you would get from using the dose risk relationships 

presented by the schedules may not answer all questions 

for all cases. So the Panel really exists, in the way 

they work at the present time, to consider more deeply 

those cases where the schedules don't give you a 

particularly reliable answer for all sets of 

circumstances. 

DR. ZIEMER: Did you have an additional question? 

MR. HALLMARK: I had one last question, which is I 

heard I think Andy indicate that he had an assessment 

of the success rate being experienced so far, other 

than in the SEC, here in the United States. I'm not 

sure that that's really a mature number. And I guess 

this is more a comment than a question. I'm not sure 

you're able at this point to take -- make much of a 

sensible judgment about how the success will flow from 

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the NIOSH process, and I guess the question that's 

imbedded here is what impact will that have on the 

confidence issue you're raising in the UK if in fact 

the success rate is higher through the NIOSH process? 

DR. SLOVAK: It was John actually who said that. And 

it was the state where I was going to nudge him a 

little bit and say well, that was very kind of him to 

say so and we'll watch your experience with some 

interest. I think that's the polite way of putting it. 

Quite clearly we would be quite concerned if large 

differences began to appear. It would put an enormous 

amount of pressure -- I suspect more on our trade 

unions than ourselves, which is why he's here and John 

may want to add to this -- to seek a review of the 

whole process. But, you know, we will see. And if 

there is any problem -- if in the intercomparisons 

there are problems, we will have to address them. 

MR. BILLARD: I simply endorse those remarks. We've 

run our Scheme pretty successfully over the last 20 

years, but we're certain to have things to learn in the 

future. And in the same way that science and medicine 

is developing in the treatment of cases, I think 

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jointly we're likely to experience such future changes, 

which I'm sure will be beneficial. But if -- if -- we 

have about a ten percent success rate, you see, and 

that's been pretty consistent over the past 20 years. 

And if you're coming -- if, as time goes by, you start 

to come up with something which is, you know, 

reasonably significantly different to that, we are not 

going to get science and medicine to defend us. We're 

going to have to start to get some political elements 

coming in, which we will have to deal with. But I 

think time will tell. But I think, having heard what 

we've heard so far about the US DoE program, we're 

reasonably confident that we won't have these 

difficulties, but we'll see. 

MR. LEWIS: If I could just add one thing, I think it 

would also go to how the dose profile of your potential 

claimant population compares to ours. Certainly within 

our Scheme there are quite striking differences between 

each of the employers. For instance, if you compare 

some of the BNFL claimants who worked in some of the 

reprocessing buildings in the fifties, sixties and the 

early parts of the seventies, the sorts of doses 

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they've received over their working lifetime are vastly 

higher than somebody who spent 30 years working on an 

AGR power station. And whilst you could make the 

general comment about success rate, I think you would 

have to understand, you know, what the underlying dose 

profile you were dealing with between the two 

industries was. I mean I would guess that there would 

be areas where there's a great deal of comparison, but 

there may also be a few areas where you might have 

experienced a particularly high rate of claimant 

success where, you know, there may not be such striking 

comparisons with the UK nuclear industry. 

DR. ZIEMER: Thank you very much. This has been very 

helpful and I'm sure we'll both be looking at each 

other as the years progress here, but we do, again, 

appreciate your time, sharing with us not only today 

but with the NIOSH staff the rest of the week, so thank 

you very much. 

MR. LEWIS: You're welcome. 

WORKING GROUP REPORT 

DOSE RECONSTRUCTION REVIEW PROCESS
 

DR. ZIEMER: We're going to proceed to a report of the 

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dose reconstruction work group. Mark Griffon is going 

to give us that report. Also I'd point out that we 

have another part of our agenda devoted to this topic 

so that even though it may look like we're 

shortchanging it a little bit here, we do want to break 

at noon. But Mark, you understand that we do have 

additional time tomorrow so that if you're unable to 

complete all your -- in fact I think you probably will 

not complete everything 'cause you may have some 

additional things under preparation that will come to 

us tomorrow. 

And Mark, if you would, when you begin your report, 

also include a brief summary of the meeting with the 

potential contractors that was held in Cincinnati in --

earlier this month, actually. 

Board members, let me point out that you should have 

received recently in the mail a summary of the meeting 

of the work group in Cincinnati, a summary of that 

meeting with the potential contractors. What did we 

call that meeting, the --

MR. ELLIOTT: Pre-Bidder's Conference. 

DR. ZIEMER: -- Pre-Bidder's Conference. If you did 

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not receive that summary, please let Cori know, but it 

was not exactly a set of minutes, but it was a summary 

of what was done. 

And Mark, if you can recall also who attended that 

conference on behalf of the Board --

MR. GRIFFON: I will --

DR. ZIEMER: -- if you'll --

MR. GRIFFON: -- try, yeah --

DR. ZIEMER: -- share that, too. 

MR. GRIFFON: -- if I miss someone, you can fill in. 

Let me just start -- this is a -- boy, I can't even see 

my own overheads. This is a -- I wanted to give a 

little background for those in the audience that 

haven't been following our working group work. This 

working group has been established to look at how the 

Board -- the Board's role in reviewing the dose 

reconstruction activities that NIOSH is conducting, and 

the Board is required by statute to review the 

scientific validity and quality of NIOSH -- of NIOSH's 

dose estimation and dose reconstruction efforts. And 

what -- so far our work -- where we've gone with this 

work is that we're going to look at individual dose 

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reconstruction reviews, we're going to look at site 

profile and worker profile reviews, petition -- Special 

Exposure Cohort petition reviews, as well as a review 

of the procedures used by the -- by NIOSH. 

And to complete this effort, the Board has determined 

and NIOSH is helping to hire a contractor to assist the 

Board in doing these reviews. We -- the working group, 

along with the entire Board, assisted in the 

development of the actual task order contract, and it 

was recently published. NIOSH -- as Paul just 

indicated, NIOSH recently had a pre-bidder meeting 

where we entertained questions and the working group --

some of the working group members were present. Let me 

-- let me -- I -- Paul was there, myself, Tony Andrade, 

Rich Espinosa and -- was that it? I think -- and Bob, 

I'm sorry. Bob Presley was there, yeah. And we -- we 

entertained questions from potential bidders at that 

meeting. And I think where that stands, and I'll have 

a schedule at the end of this presentation, but the 

bids are due June 2nd, and we're hoping to get all this 

on line by this -- by the early September time frame of 

this year so that we can have a contractor in place 

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that will assist the Board in reviewing all this stuff 

and reviewing dose reconstructions. So that's just a 

little bit of background. 

The working group, as a -- let's see, you can see --

you can see I'm very prepared for this. I can't see my 

own overheads so I don't know where I'm going with this 

presentation. 

The working group's tasks -- let me just -- yeah, let 

me put that on. 

(Pause) 

 How's that? 

UNIDENTIFIED: That's good. 

MR. GRIFFON: Is that all right? 

UNIDENTIFIED: Yes. 

MR. GRIFFON: All right. The working group tasks --

and some of these overheads will show up from last 

meeting's efforts, but I've filled in some gaps on 

them. We're -- are now in the process of looking at --

developing draft procedures for the review process, 

developing procedures for case selection, and develop 

the individual task orders. So we have the task order 

contract, and out of that we have to develop individual 

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task orders for certain tasks that we are going to ask 

the contractor to do. 

As part of our effort, we went to ORAU. I did a little 

follow-up visit to NIOSH after the pre-bidder meeting 

where we looked at the database that NIOSH has set up, 

and we -- we just wanted to get a sense of what the 

files look like. What does a completed dose 

reconstruction look like, what does the administrative 

record look like, what kind of files can we expect to 

be in this review, what kind of records are in this 

review. We tried to walk through our draft procedures 

for the basic and the advanced review against some of 

the -- a couple of these example cases, these completed 

dose reconstructions. 

We -- so far what we've done, we've developed the basic 

and advanced case reviews, and we focused on individual 

case report forms. We actually have drafted two of 

those. Since I was tardy in getting my handouts to the 

Committee, we don't have copies right now. But 

essentially these -- these forms sort of track the task 

orders themselves and look at the data-gathering 

elements, the interview process and the actual dose 

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estimation process, those three elements that are 

outlined in the task order contract which -- I don't 

know if we have handouts of that stuff here today, but 

-- which we've looked at before. 

The summary report form, the difference here is that we 

-- we envision the contractor will assist in -- or will 

write up a report for each individual review, but also 

will write a summary of a group of cases that they 

might have done, and that will be a presentation. So 

that'll be more of an executive summary type of format 

where they look at sort of aggregate findings from a 

group of cases, and that's the sort of presentation we 

envision back to the Board to all Board members. 

On this first part, the individual case review, we --

in the working group we keep reminding ourselves that 

this whole process is the responsibility of the Board. 

And we have talked about before, and I'll bring it up 

again, the fact that the Board members will be involved 

with the contractor. And we've envisioned different 

schemes on this which I think we have to nail down 

fairly shortly, hopefully at this meeting, of how the 

Board members might rotate in and work with contractor 

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staff. So you might have a group of ten cases and two 

Board members are assigned to work with the contractor 

for those ten cases, so they would -- they would get --

those two Board members would be more engaged on the 

details of that review. The rest of the Board would 

certainly get the sort of executive summary of those 

reviews but wouldn't have to be involved in -- in all 

the details of those cases, sort of -- that's partially 

an attempt to space the work out, but also partially an 

attempt to make sure the Board is not just totally 

relying on the contractor but is involved in the 

process, as well. 

The last item is the Board report form, which would be 

the report that the Board would then forward to Health 

and Human Services. 

This -- as we did -- as we drafted these procedures, 

one thing that strikes me in this review is the -- as I 

said, they're direct from the task -- task order 

contracts, and if you have that language in front you, 

you'll notice that some elements are fairly subjective, 

such as the one I noted here, that -- this is -- is 

much -- a lot of judgment or subjective input has to be 

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given consideration in this review. Other items are 

very prescriptive, you know. We -- I think we have one 

item that says did NIOSH receive all the data requested 

from DOE. Well, that's a fairly prescriptive element. 

But there's others that are fairly subjective and are 

going to require a lot more input and elaboration 

probably by the contractor in the report. It won't 

just be a simple yes or no response to some of these 

items. 

We also -- another thing that came from the discussions 

on these two report forms was the question of the 

individual case versus the summary findings. And I 

think we talked about the prim-- one primary purpose of 

this effort is to get a sense, program-wide, if there's 

-- if there's problems that are leading to across-theboard problems in the program, if we can get a sense of 

that in the summary findings more. But I think we also 

have a question of if an individual case -- if the 

contractor -- actually the Board makes a determination 

that there was some errors in the case that would 

result in a change in the outcome, it might push it 

over the 50 percentile mark, then we have -- that's a 

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question we have. You know, what if -- what if we run 

into those kind of situations, what -- how do we --

what recommendations do we make to NIOSH, how do we 

handle that procedurally. So those -- those issues 

came up when we were walking these through. 

Then -- this is another thing, and I -- this morning 

our working group just met real quickly to go over some 

of these things, and I -- I don't know why I did this, 

but I volunteered us for a couple of things in the next 

two days which I think we can really hammer out while 

we're all here. One of them is this process, so I'll 

volunteer the working group to take a stab at a first 

draft of this. We -- and certainly this afternoon we 

can discuss it more to get it all out on the table. 

The process of how, you know, when we -- we select a 

case, the case then -- well, even to the point of, you 

know, the administrative record is put on a CD maybe 

for distribution to the contractor. Can the -- can the 

Board members also get that CD. There's some Privacy 

Act questions there. 

Once the contractor reviews, then how do we assign 

Board members to work with the contractors on certain 

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cases, when do we meet -- how do we coordinate the 

meetings. We talked about coordinating them such that 

they could be held prior to Board -- prior to Board 

meetings so we wouldn't have to travel too frequently. 

And then right down to the presentation of the final 

report from the designated Board members with the 

contractor back to the full Board, how would that be 

handled. So we -- we want to -- to sort of spell that 

out in a procedure format and then have a draft for the 

Board so that we can sort of tear it apart and mark it 

up and make -- make something that's going to be 

workable for all of us. So that is -- that is 

hopefully on our agenda for tonight. 

The case selection process -- this is one thing that --

that we did work on at NIOSH by -- by looking the 

database and with some help from Dick Toohey, who 

actually gave me some statistical data on -- at least 

as it exists on the day we were out there, some 12,800 

cases I think were there. We -- we got a sense of a 

cross-section of cases by site, by other demographics. 

And we -- previously we've talked about the 2. --

sampling approximately 2.5 percent of all the cases and 

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establishing a matrix of the selection criteria so that 

we would sort of do it and -- we're not completely --

I'm not completely sure in my mind how this is going to 

work because the number of com-- we're only going to 

look at reviewing completed cases, so the number of 

completed cases keeps growing, so I'm not sure how 

we're sampling that pool to fill in our matrix as the -

- as the sample pool is growing. But we can -- we can 

work that out, I'm sure. 

But the idea then is to -- based on the cases sampled -

- fit them into a matrix of parameters that we've 

outlined, and I have those on another spreadsheet if 

you want to pull those up, some that the working group 

has considered, at least. 

This is probably very hard to see in the back, I'm 

sure. Can you slide it over, Jim? Sorry. There, just 

slide over to field A, yeah. Right over here where you 

were. 

(Pause) 

DR. ZIEMER: Just go to the right a little bit --

there. 

MR. GRIFFON: There. Not a big fan of Excel, huh? No. 

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The tracking -- I just labeled this tracking ma-- this 

is very draft, very preliminary, but we -- we had some 

-- some data that we thought was worth using. The site 

group on the left-hand side and I put site/group. If 

you'll notice on the -- we sorted -- I had a -- a sort 

of these by the number of claims, again, a snapshot in 

time. And the highest to lowest basically is on the 

left-hand side. That count, if you look, is actually 

the number of claims times 2.5 percent, so that'll give 

the number that we would sample. You know, that we 

want to meet -- that we want to get out of Savannah 

River site. 

As we go down, on the bottom -- the very bottom of 

number 29 you can see industry groups. The question 

is, when you get to a point where you have less than --

the number of claims at an individual site are less 

than one percent or -- say one percent of the entire 

claims available, you really can't sample two or three 

percent of that, you know, group. It -- there's not 

many cases there to sample. So we thought about 

grouping those and hopefully -- with NIOSH's help, 

grouping those by like industries. I think there's 

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several of those AEC sites that can probably be grouped 

by similar types of industries -- uranium processing or 

that sort of thing. So then from those industry 

groups, we would sample a total number of 47 out of 

those -- all those other groups --

DR. ZIEMER: Mark, clarify column E, what is column E? 

MR. GRIFFON: Column E -- okay, column E -- all right, 

so -- so over here -- there's -- there's several 

different criteria here that -- we've got -- different 

parameters that we want to fill this matrix in on. One 

is the site, right, or location. The other is cancer -

- cancer type, and cancer type, this is a percentage of 

DR. ZIEMER: Well, take oral cavity and pharynx, that -

-

MR. GRIFFON: Right, if you --

DR. ZIEMER: Go back to column B. Does that say there 

were 37 of those at the Savannah River site? 

MR. GRIFFON: No, it says that there were -- there were 

-- 2.4 percent of all -- of the overall cases or eight 

would be the number we'd want to sample. 

DR. ZIEMER: Oh. What is the 37? 

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MR. GRIFFON: Thirty-seven, they -- there -- there's 

sort of -- I didn't put divid-- fancy dividers, but 

this goes with this parameter and this next two are 

with cancer. 

DR. ZIEMER: Oh, I --

MR. GRIFFON: I should have -- I should have --

DR. ZIEMER: So 37 SRS cases --

MR. GRIFFON: Right. 

DR. ZIEMER: Okay, I'm -- those don't go together then. 

MR. GRIFFON: We can format this a little better, yeah. 

DR. ZIEMER: Gotcha, gotcha, okay. 

MR. GRIFFON: It's in very raw, user form here. So the 

parameters mainly to look at are the site, the cancer 

type, job group, the decade first employed, and you'll 

notice on the decade first employed -- or maybe you 

won't notice -- the decade first employed, we had 

forties, fifties, sixties, seventies, eighties. We 

certainly weighted the sampling -- or we propose 

weighting the sampling of that toward the earlier years 

because we think that's -- that's when more of the --

more of the issues as far as dose reconstruction would 

be found. 

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Then the primary radiation type, you have external, 

gamma, neutron, beta and also internal, and I just 

listed some I -- this is not sup-- intended to be 

extensive at this point, but I think we -- the notion 

is that we'd want to at least see some cases where you 

did plutonium reconstructions, some internal dose 

plutonium reconstructions, obviously. That's an easy 

one. But how many and the breakout of that, I don't 

have right now. 

The final column, which you can't quite see, is the 

outcome. Outcome is, you know, either approved or 

denied, and we talked about weighting the sampling of 

those by less of the approved cases to be reviewed and 

more -- you know, more weighted toward the denied 

cases, 80 percent on the denied side. So again, the 

idea is that you sample randomly from an existing pool 

and say I pull out a case and it's a Savannah River 

case, it -- it's a supervisor first employed in the 

fifties, a primary exposure was of plutonium and it was 

a denied case, so you sort of fill in your checks as 

you go along and until we meet these numbers, 

basically, and that's the sort of initial proposal of 

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how we will work this tracking. 

There may be some parameters that -- we had a laundry 

list of parameters I think that we started with. These 

are the primary ones I think that kept coming up. 

Certainly if I missed something, that's something for 

dialogue. But that's where we are on that and --

(Pause) 

The other element which I volunteered my -- my team 

members for this morning was that we want to develop 

the task orders, and -- and we -- we feel this -- we 

wanted to have these in the hopper by the time the 

contract is awar-- contract or contracts, I should say, 

are awarded in early September. We want to have these 

task orders ready to say okay, here, you know, give us 

an estimate on these and let's get the ball rolling. 

So the idea -- we think fairly easily that we can at 

least get a draft of a basic review, advanced review 

and a procedures review because after eight versions of 

the primary contract and going through all that 

language many times, I think we've -- we've got some --

some language that we're all pretty happy with, and 

it's fairly specific so we think we can pull a lot of 

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that from those sections of the original task order 

contract to develop these task orders. And we're going 

to try to draft some of that this evening, too. 

The only question I -- or request I would have is from 

-- laughing at me. The only question I would have from 

NIOSH on that is -- is if we need certain formatting 

for those contracts, we'd look to assistance from them 

on that. 

And then -- then we have some discussion items that 

have come up through our -- our meetings in Oak Ridge, 

through our various discussions on these procedures, 

and I think these would be good items for this 

afternoon's agenda when we have further discussions on 

this. One -- one question is the Board and contractor 

access to data, and when I say that, I mean to NIOSH 

data and also to other records or reports which may be 

DOE or AEC records. The question I brought up earlier 

about the NIOSH data was -- Larry can probably expand 

on this a little more, but there is a question of how 

we -- how we are going to be able to deliver the 

administrative record for a certain case file to either 

the contractor or -- or I guess more problematic might 

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be the Board members that are involved in that review. 

Also the question there, which I don't think any of 

these are unworkable, but the question -- other 

questions are the site profiles or worker profiles. If 

the contractor's working remotely, they won't be on 

line on NIOSH's system where they can quickly go to all 

those documents, so how are we going to -- if they need 

these other documents -- or procedures or tech basis 

documents -- how are they to be provided. 

And then on the bottom, the Board and -- and/or 

contractor access to site personnel and/or NIOSH/ORAU 

staff. I think there might be instances where the 

review contractor, along with Board members, may want 

to turn to a technical expert, a health physicist from 

the particular site or a retired health physicist from 

a particular site that might have even been noted in 

the administrative record. We just question whether 

that can be done or how that can be done, whether that 

has to be done through NIOSH to that individual or --

you know, how that might work was another question that 

came up. 

A couple more items. Also a big issue that we've -- we 

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batted around earlier in developing this task order 

contract was the Board and contractor access to 

claimants for follow-up, and whether we can -- whether 

we can basically re-interview or -- or follow up on 

their interview. There -- as we know, there are no 

transcripts from these interviews so there's no record 

there to review. We did table this issue so that we 

could get the contract out, but I think we as a Board 

have to take that up again and see if we -- where we 

want to go with that. 

And then I think I already -- I already said a piece on 

this, the individual versus the summary reviews and the 

question of whether it would change an outcome. 

And I think -- yeah, the last thing is the schedule, 

and if I got any of this wrong, Larry, you -- or Jim, 

you can correct me. We did have the bidder meeting on 

April 30th. Work group completes draft task orders --

you notice there's no date there yet; we're working on 

it. Final proposals due June 2nd, and then there's 

going to be a technical review which should be 

completed by the end of June, contract award early July 

and task orders awarded by early September. Is that 

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accurate? So that's what we're pushing for and that's 

part of the reason we want to push to develop these 

task orders soon and maybe get a draft here so that we 

can get a final one at our next Board meeting. 

DR. ZIEMER: This is a good point now to -- to recess. 

We will pick up discussion on this and have a chance 

for additional questions after lunch, about midafternoon. 

Some information relating to lunch, Cori has menus from 

various eating establishments in the area. I think 

also -- at least I have -- I guess I got here a menu 

from this hotel, but all of these things -- Cori, are 

they back there? I believe there's a lot of eating 

places around close by. 

MS. HOMER: The only information I have is from this 

hotel. 

DR. ZIEMER: Oh, we have information only from this 

hotel. Okay, but there are other eating establishments 

around the area. 

So we're recessed until 1:30. 

(Whereupon, a luncheon recess was taken.) 

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 AFTERNOON SESSION 

 AWARD PRESENTATION
 

DR. ZIEMER: Before we begin the formal afternoon 

session, we have a pleasant task to perform. One of 

the original members of this Board, Sally Gadola, who 

is an Oak Ridge person, lives here in Oak Ridge, works 

here in Oak Ridge but who's no longer on the Board, but 

is here visiting with us today. We're pleased to have 

Sally back here, and Sally, if you would please come 

forward and I'm going to call on John Howard, the 

Director of NIOSH, and on Larry Elliott, who's 

Executive Secretary of our Board, to make a formal 

recognition for you and to recognize that year or so 

that you shared with us on this Board. We're very 

pleased that we can do this today. We do all thank you 

for the time that you've shared with us. So here's a 

formal presentation. John. 

MR. HOWARD: At last, a job that I have here. On 

behalf of the Department of Health and Human Services 

and Centers for Disease Control and Prevention, I want 

to award you a certificate for your service, and I'd 

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like to read it to everyone. 

This certificate is presented in recognition and 

appreciation for service on the Advisory Board on 

Radiation and Worker Health of the Centers for Disease 

Control and Prevention as a member, signed Julie Louise 

Gerberding. 

So it's my pleasure to present this to you. 

MS. GADOLA: Thank you very much. 

(Applause) 

 MS. GADOLA: It has really been a great honor and a 

privilege to serve on this Board, this very 

distinguished Board. I've met some terrific people. 

The expertise here is just overwhelming, but especially 

I am touched by the workers and their families and 

those that have spoken to us, and it just keeps 

reminding us what an important job this is. And I know 

how hard NIOSH has fought to make this as fair as 

possible. And I would just encourage all of you to 

continue your hard work, and thank you again for 

letting me serve you. 

(Applause) 

FUTURE CONSIDERATION OF UNCERTAINTY IN IREP
 

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DR. ZIEMER: We'll return now to the regular agenda. 

We're pleased to continue with some information on 

IREP, particularly focusing on uncertainty issues, and 

then a little refresher on IREP, so we have with us 

Owen Hoffman. Dr. Hoffman's been with us before. 

We're glad to have him back with us again, and Owen is 

going to kick it off with this discussion on 

uncertainty in IREP. 

Let me just mention, and I realize now -- I didn't know 

this morning -- that many of these biographical 

sketches are on the table back there, but I'll give a 

couple of abbreviated sentences, Owen, to save you as 

much time as possible. 

But Dr. Hoffman basically got his doctorate in ecology 

at the University of Tennessee, and he currently is 

president and director of SENES Oak Ridge, 

Incorporated, Center for Risk Analysis. Dr. Hoffman's 

had several decades of experience in evaluation of 

risks to humans from the release and transport of toxic 

materials, particularly chemicals, radionuclides in 

terrestrial and aquatic systems. So he's also active 

in many professional areas. He's a member of the 

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National Council on Radiation Protection and 

Measurements, the so-called NCRP, and he's also a 

corresponding member of the International Commission on 

Radiological Protection. Owen, we're pleased to have 

you back with us today. 

DR. HOFFMAN: And I'm pleased to be here in front of 

you and also would like to personally welcome you to 

our hometown of Oak Ridge. 

The topic is future considerations of uncertainty in 

IREP, and for those of you out there that don't know 

what IREP means, it's the Interactive 

RadioEpidemiological Program, actually developed right 

here in Oak Ridge. And when you go on line to test 

drive it, it's actually being driven from servers 

within our Oak Ridge office. 

The methodology used to quantify uncertainty in IREP is 

-- maybe I'll try this thing 'cause I don't like the 

sound of my voice coming in and out. Is this on now? 

Yes. 

The methodology in IREP was actually derived from the 

same methodology that we employed from 1965 -- from 

1995 to 1998 in the Oak Ridge dose reconstruction. So 

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for those of you who followed the work that we did here 

in the Oak Ridge health studies, it's the basic 

methodology that's now being used in the Interactive 

RadioEpidemiological Program. And one major area where 

this program differs from the scheme being applied in 

Great Britain is full -- the full disclosure of 

uncertainty in a quantitative manner. 

Now the uncertainty in IREP is meant to reflect our 

current state of knowledge. That means when knowledge 

improves, the uncertainty should be updated. What I'm 

going to present here are areas where I feel IREP might 

be updated in the near future. 

In one case, I will point to an area -- namely lung 

cancer and cigarette smoking -- where there are active 

efforts by the National Cancer Institute to update it 

based on new information that has come in from the 

follow-up of the Japanese cohort. 

Now the prime envisioned updates of course will be the 

revised risk coefficients from the Japanese survivors. 

As Gen mentioned, the dosimetry has now been 

officially revised. The cancer data will shift from an 

emphasis on mortality to an emphasis on incidence. We 

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would expect new data to emerge now within the next one 

to two years, especially with the ongoing efforts 

within BEIR VII of the National Academy of Sciences. 

I would expect also improved statistical methods of 

dose response analysis to occur, maybe even some 

Baysian* approaches, that would take information about 

those organ sites for which we have lots of information 

and applying that as a prior distribution to those 

organ sites for which little information is needed. 

Now within the worker community there has been concern 

expressed that the sole basis for the risk estimates, 

with the possible exception of radon and lung cancer 

and radiation and thyroid cancer, the sole basis of 

risk estimates has come from the Japanese cohort. But 

yet there's many studies on worker cohorts that aren't 

included in the IREP program. Perhaps in the near 

future there may be some efforts that are undertaken to 

combine datasets. I'm not saying replace the Japanese 

survivor data with worker cohort data, but complement 

the Japanese survivors data with worker data, perhaps 

even giving subjective weights based on the strengths 

and limitations of each of the studies. This could 

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occur. 

Another area where I envision updates in the state of 

knowledge to modify the uncertainty estimates in IREP 

would be a re-evaluation of the assumptions used in 

transferring risk between the Japanese cohort and your 

U.S. populations. And the primary reason for this reevaluation is to look at the sensitivity of risk to 

differences in the baseline cancer rates. And to what 

extent these baseline cancer rates differ among workers 

than among the general U.S. population, to what extent 

the models used for transferring from one population to 

another, are more likely to be either additive or 

multiplicative rather than some hybrid. 

Currently, with the exception of stomach and breast 

cancer, we assume a lack of knowledge distribution that 

spans the entire spectrum between sub-additive and 

super-multiplicative, with very little weight given to 

the possibility of strict additivity or multiplicative 

relationship in the transfer from Japanese to the U.S. 

population. I think a re-evaluation might conclude 

that increased weights to either extremes might be 

justified. 

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Now this slide I want to pass through, but I was told 

we couldn't have hidden slides in the presentation, but 

I'm going to effectively hide this slide because that 

has been put into the presentation primarily to explain 

additivity and multiplicative transfer models for those 

who ask the question, but if you don't ask the 

question, we don't need to discuss it. It's in your 

handouts, however. 

An area where I know that Richard Miller is especially 

interested in changing assumptions within IREP has to 

do with the assumption on the low dose and dose rate 

effectiveness factor whereby standard assumptions are 

that the risk due to chronic exposure to radiation at 

low doses will be lower than the risks observed when a 

cohort has been exposed at high doses to an acute 

exposure situation. However, I think that recent data 

on cohorts exposed to fractionated and chronic external 

radiation and chronic exposure to internal emitters may 

substantially update our current knowledge. 

Now because of uncertainties in epidemiology and 

uncertainties in dose reconstruction for those cohorts, 

I think the distinctions that are within a factor of 

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two is going to be difficult to make, and therefore to 

say that the low dose and dose rate factor is indeed 

one or two, that's going to be different -- difficult 

to make, but I think new mechanistic information from 

recent low dose investigations with cellular and 

complex biological systems might add some light to the 

interpretation of these new epidemiological datasets. 

What do I anticipate? Well, I anticipate that there 

may be a reduction in the overall uncertainty 

distribution that we currently have in IREP for the low 

dose and dose rate effectiveness factor, and a possible 

decrease in the central estimate, whereby every 

decrease in the central estimate would bring about an 

increased risk, and every increase in the risk per unit 

dose would bring about an increase in the probability 

of causation. 

The next two slides are just there as examples to show 

you the types of distributions for solid tumors, except 

breast and thyroid cancer, and for -- the distribution 

for breast and thyroid cancer currently in IREP. And 

what I -- I'm away from the mike now, but basically 

what I envision is some of the weight given to factors 

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down in this range may go down, some of the weight 

given to factors in this range may go up (indicating). 

Based on a re-evaluation of additional information 

sets than we had available to us at the time, we put 

the present version of IREP into place. 

Now there's one area that I mentioned where there's 

action underway already, right now, by the National 

Cancer Institute to update what's in IREP, and this 

deals with this -- the interrelationship between lung 

cancer, radiation and smoking. The impetus for this 

revision has come from a recent paper published this 

year by Don Pierce and his colleagues at the Radiation 

Research Foundation and the publication is in -- I 

believe it's the March issue of 2003 in Radiation 

Research. This paper indicates that the interaction 

between radiation and smoking is most likely additive, 

meaning that the probability of causation at the same 

dose for a smoker will go down and the probability of 

causation at the same dose for a non-smoker will go up 

from what's in IREP. 

There's less evidence for synergism between heavy 

smoking and external radiation. What this means is you 

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look at the risk from radiation, it's simply added to 

the risk from smoking, without there being a strong 

interaction effect. At least that seems to be the case 

for moderate and heavy smokers and somewhat arguable 

for light smokers. 

In the present version of IREP we have a very strong 

difference between males and females. The new paper 

suggests that this difference is small and in fact is 

statistically insignificant. 

In the current version of IREP there is no association 

with age, either age at time of exposure or the age at 

which the disease is diagnosed. The new paper by 

Pierce suggests a very strong age at time of diagnosis 

effect, and in fact this effect seems to be consistent 

with what has been observed for other solid tumors 

within the Japanese cohort. The paper includes a 

caution, however, not to extrapolate the results of 

this paper to the current assumptions to radon 

exposure and lung cancer because the mechanisms of 

action of small particles of the decay products of 

radon depositing in the upper regions of the lung and 

full uniform exposure to external radiation, these 

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mechanisms are inherently different. 

Looking at this paper, I have come up with some 

preliminary -- well, preliminary -- let me call them 

not results, but preliminary implications of what 

appears to be the overall effect, assuming that the 

results from the Pierce paper are a more close -- a 

more accurate representation of our current state of 

knowledge. The implications to the current values in 

IREP are as follows: the IREP estimates of probability 

of causation are potentially underestimated for males 

whose lung cancers were diagnosed before age of 50, 

regardless of smoking history, and for females who were 

light smokers. Probability of causation would be 

underestimated for males who were light smokers and 

their diseases were diagnosed between the age 60 and 

70. 

On the other hand, the IREP values of probability of 

causation are potentially overestimated for non-smokers 

who were diagnosed with lung cancer over the age of 50, 

for moderate to heavy smokers with lung cancer 

diagnosed after the age of 50, and for females who were 

heavy smokers. And I'll show you some direct examples 

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of that, and these examples are also in your handouts. 

The examples I'm going to show you are derived from the 

estimates published by Pierce that are modified for the 

effect of age at the time of diagnosis of disease, 

smoking history and gender effects. And they're going 

to be compared with the values that are in NIOSH-IREP 

derived directly from the Japanese survivors prior to 

being adjusted for transfer to the U.S. population, and 

uncorrected and biased due to errors in the Japanese 

dosimetry. Now the reason for this is to make the two 

values as closely comparable as is possible. So for 

those of you who have copies of the Pierce paper, you 

will see that the values on this slide are identical to 

the values in the paper, with just a couple of 

exceptions. 

The first is that the scale is logarithmic so that we 

can see clearly what is happening with the smoking 

effect. The confidence intervals have been increased 

from one standard error to two standard errors, so that 

we have a good representation of a 95 percent 

confidence interval. In the following estimates these 

values will be modified to account for the age at time 

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of diagnosis -- and let me just say, this is a big 

effect, whereby early ages at time of diagnosis, such 

as the age under 40, could be as much as six to seven 

times higher than the risk associated with ages over 60 

-- and in gender. Now gender in this case is a small 

effect. It's about a factor of 1.3 upwards for 

females, a factor of 1.3 downwards for males. And then 

we will compare it with the values currently in NIOSHIREP. 

So for example, the next slide shows the values for a 

non-smoker male, these are males who have not smoked. 

These are the values from Pierce, and so it shows a 

strong age at diagnosis of disease effect whereby the 

highest risks are for the youngest ages and the lowest 

risks are for ages over 50, with the lowest being even 

over 70. 

Let's look at how NIOSH-IREP compares to this. Now it 

takes your eyes a little bit to get adjusted to these 

figures, but here's what you look for. If the 

confidence bounds from Pierce go above the bands from 

NIOSH-IREP, there is a chance then for NIOSH-IREP to 

underestimate the results from Pierce. If the 

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confidence bounds from Pierce go below these bands, 

then there is a chance for overestimation. So in this 

case we have some chance of underestimation for the 

early ages at time of diagnosis of disease for nonsmoking males, but a substantial chance for 

overestimation at later ages. 

And we'll go through each of the categories now for the 

subsequent slides. For light males, we've seen -- for 

light-smoking males, we see strong evidence for 

potential underestimation of risk when lung cancers are 

ascertained before the age of 50. 

Next slide. For moderate smokers, there is a modest 

chance for overestimation for the early ages at onset 

of disease -- for underestimation in this area and for 

overestimation for the older ages at onset of disease. 

Next slide. For heavy smokers it's the same pattern. 

And if you were to look at NIOSH-IREP you would find is 

that the distinctions between moderate and heavy 

smoking -- in fact, even light, moderate and heavy 

smoking, the distinctions are minuscule in IREP. We 

include those categories, but when you analyze the 

differences in results, one would wonder why we even 

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bothered making the distinctions. 

The distinctions are much larger in the new data from 

Pierce. So here for heavy smokers we can see 

substantial overestimation by NIOSH-IREP in the older 

ages at time of ascertainment of disease, and a slight 

chance for underestimation at the youngest ages of 

ascertainment. 

For females, in IREP, as I mentioned, we have very 

large differences in risk as a function of gender. 

This difference diminishes in the data by Pierce. For 

females you'll see a large chance for overestimating 

risk at older ages at time of diagnosis of disease for 

females who didn't smoke. 

Because of the way the multiplicative and additive 

model interacts within IREP, the uncertainty in the 

risk coefficients for the light-smoking female are 

actually suppressed, but giving rise then to 

substantial overestimation for the risks given for 

those who have disease at older ages and substantial 

underestimation for younger ages at time of 

ascertainment of disease. A strong effect of 

overestimation for the older ages at time of 

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ascertainment for moderate smoking females, and for 

heavy smoking females the same effect, just slightly 

more enhanced in the direction of the overestimation of 

risk. And in this case it even includes overestimation 

of the younger ages at the time of ascertainment of 

disease. 

Now this is a comparison between the data in the Pierce 

study and the data now used in IREP. And the 

indications are yes, indeed, there is an opportunity to 

make adjustments, and I just would like to report that 

Charles Land is in communication with Don Pierce at 

RERF and he is -- well, in fact, he's made the decision 

to hold up the publication of the NIH version of IREP 

code until these updates are included. The updates may 

or may not be consistent with the differences that I've 

just shown you because there are many other 

considerations that Charles is taking into account. 

And in fact it does appear that he may even include an 

age at time of exposure effect in addition to the age 

at time of ascertainment. 

Okay, that's one of the big areas where there could be 

updates. What are some others? Well, radiation 

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effectiveness factor is certainly an area where 

additional information could lead to enhancing our 

state of knowledge, and that could lead to an update. 

But that's the subject the David Kocher is going to 

talk about after I'm finished here, so I'll let David 

talk about that. 

But by way of introduction, I want to alert you to our 

own concerns about the weight of evidence for the 

effectiveness of X-rays versus that of high energy 

gammas. 

Now what's the overall effect of future updates into 

NIOSH-IREP? Well, as has been discussed many times 

amongst yourselves and amongst us, placing a decision 

criterion for eligibility of compensation claims at the 

upper 99th percentile of the probability of causation 

rewards for uncertainty. And if improved state of 

knowledge decreases the uncertainty but has no effect 

on the central estimate, fewer claims would be rewarded 

-- or awarded, and therefore there is disincentive then 

to engage in updating the IREP code to reflect an 

improved state of knowledge, and this is unfortunate. 

However, in updating our state of knowledge, additional 

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claims may become eligible if the central value of risk 

increases as a result of modifications, or if the upper 

range of uncertainty increases, and this would occur --

well, I would expect that to occur if we were to allow 

other cohort datasets to be used to complement the 

Japanese survivors in quantifying the original 

epidemiological data for excess relative risk. 

The problems occur when the -- when no change occurs in 

the central estimate of risk, but uncertainty is 

reduced due to the improved state of knowledge. And 

those will be conditions in which it's going to be 

administratively and even politically difficult to say 

well, your friend who we had time to get to last year, 

under the old version of IREP, he's compensated. But 

unfortunately we have new information now and because 

we didn't get to your claim until this year, we've 

updated IREP and you're not eligible. But I'm sure 

there -- I would imagine in those situations there 

would be administrative decisions made so that we would 

try to preserve the maximum amount of fairness in the 

system. 

I'm open to any questions. 

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DR. ZIEMER: Dr. Roessler wants to start the questions 

here. 

DR. ROESSLER: Your last statement was so dramatic that 

I pretty near forgot my question. But you talked about 

the Pierce data and the changes that could occur. My 

concern when you were talking about it and looking at 

how the changes might affect the probability of 

causation were that you'd have to have -- feel that 

it's a really strong study before those changes could 

be implemented. But then you said that Dr. Land, in 

making his recommendations to NIH, was taking some 

other factors into consideration. And what are those 

other factors? 

DR. HOFFMAN: Well, primarily what's been found in 

statistically analyzing the relationship of lung 

cancer, radiation and smoking is now the relationship 

is not dramatically dissimilar from what is seen for 

other solid tumors. And so it is the information for 

other solid tumors now that adds extra weight to the 

justification for the update. 

What has happened is that the original Japanese cohort 

-- actually the incidence of smoking wasn't that high, 

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because during and right after World War II, cigarettes 

weren't that prevalent to the Japanese. It's the 

younger members of the cohort that began smoking 

excessively. And it's that signal that has now 

manifested itself into the more recent studies. Turns 

out now that the frequency of lung cancer in the 

Japanese cohort and that of the U.S. population is not 

as different as it once was. And accounting for these 

age differences in smoking, as well as the strong 

difference between males and females -- females don't 

smoke that much in the Japanese population, but most of 

the compromises to a healthy lifestyle occur in the 

male population. And so taking this evidence into 

account, the Pierce study has justified its updates and 

in my discussion with Charles Land, he considers this 

to be serious enough to consider the updates, primarily 

because there are groups, if we were not to update 

IREP, who would not be compensated. 

But the prime evidence he's taking into account is the 

-- the additional evidence is the similarities seen for 

other solid tumors. 

DR. ZIEMER: Jim? 

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DR. MELIUS: Yeah, thank you for a very good 

presentation. I want to go back to another issue. 

That's the issue of the worker populations and how we -

- what we do about -- about them 'cause it seems to me 

that has a -- a lot of concern on the part of claimants 

and so forth, and there's always going to be sort of a 

-- a major criticism or concern about this -- this 

whole -- whole process. And now this question's for 

you, but it's also for the Committee and -- and Larry 

as to sort of how do we get engaged in a process that 

can start to address that concern. I think when we 

talked about this last time, part of -- one of our 

ideas was well, we need to -- NIOSH was going to update 

us, which I believe they'll do tomorrow about the 

worker studies underway, but I thought -- your 

presentation sort of triggered me to -- sort of some 

thoughts. How do we get this process go-- seems to me 

we need to have some ongoing effort to start to address 

the -- start to make some comparisons and to look at 

some ways that those studies could be utilized in IREP 

and utilized in -- if only to say that they -- you 

know, it's not ready yet, it's not time yet or 

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whatever, but it may be there are different approaches 

to doing it. You mentioned some which I guess --

again, made me think about this -- was the idea of what 

does it do to uncertainty and so forth rather than, you 

know, is the -- cohort's large enough or whatever and 

do that. So I don't know if you have any thoughts, 

Owen, or anybody else does on sort of how we get a 

process going that would start to -- 'cause I think 

it's going to take us some time to do this. It's not 

something we can do in a meeting or two, but it's 

something if we got somebody working on it, you know, 

maybe a year from now or several months from now we 

could have, you know, a product that we could start to 

talk about and think what might -- might be done. So 

Owen first --

DR. HOFFMAN: Well, the reason I include this in my 

talk is I recognize that the uncertainties in IREP --

they're not statistical uncertainties. These are more 

degrees of belief, they're more of a Baysian 

quantification of state of knowledge. And when we get 

into quantification of state of knowledge, all the 

evidence -- all the evidence available should be taken 

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into account. Currently because the Japanese data is 

the gold standard and because we based it on the 1994 

data on cancer incidence -- I mean that's what we've 

benchmarked the risk assessments within IREP upon, but 

it doesn't mean that at some future date other datasets 

couldn't be brought to bear so that we have a more 

complete expression of the state of knowledge within 

the uncertainty estimates. 

Now how to do this, whether one takes my approach and 

gives subjective weights to each of the independent 

studies, or whether one does a med analysis or whether 

other -- other types of approaches are used, I mean 

that's basically up to NIOSH, this Committee and the 

epidemiological branch of NIOSH in concert with Fadesh 

Amensei* I think to -- to undertake. And maybe some of 

this will be forthcoming within the update of BEIR VII. 

DR. MELIUS: Yeah, just to follow up on that, is there 

some way that you've thought about this, Larry, of, you 

know, commissioning some group to do an evaluation or 

at least to start to pull some of this information 

together in a way that might -- and bring it to bear on 

this 'cause I've not seen that done in any sort of 

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systematic way. 

MR. ELLIOTT: Right, we haven't done that, but we're --

the only reason why is we're anxiously waiting to see 

what the BEIR VII committee does. You know, once they 

come out with their final report, it's not only going 

to talk about where the States -- United States' Energy 

employees occupational health studies are at, it's also 

going to talk about the new -- the dose reconstruction 

for the LSS. That's going to be very interesting to 

see. 

There's also radiobiology coming out of that review, so 

we're anxiously awaiting that. And dependent upon what 

that report says, yes, then we'll have to make a 

decision. Did they take it far enough, in our opinion? 

If not, then we need to commission, or perhaps under 

contract support, get somebody working on these things 

to pull this information together for use. 

DR. MELIUS: Remind me that the -- our estimated 

completion for BEIR VII. 

MR. ELLIOTT: Well, I talked just this past week with 

people on that committee, and it's likely to show up 

sometime next year -- and not early next year, probably 

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mid-year, if not later. 

DR. MELIUS: No reflection on Dr. Land, but I just keep 

-- finalization of his work -- IREP keeps getting 

extended out also, so -- in true epidemiological report 

fashion, another... 

DR. HOFFMAN: As you know, we're working closely with 

Dr. Land, and I think -- to be very honest with you, I 

would say it's out within six weeks. 

DR. ZIEMER: Tony has a question. 

DR. ANDRADE: Following up on the whole idea of just 

when something like this might be ready to come out, if 

you will, and to be evaluated for inclusion or 

consideration -- for inclusion in IREP, you know, 

Baysian statistics relies very heavily on having a good 

prior. But studies have shown, even Monte Carlo 

studies, on prior distributions that if you vary them 

somewhat, they're pretty robust so long as you have 

good basic data. So it may not require cohorts of tens 

of thousands or 10,000 to make an assertion about 

whether or not you've reached some sort of interval of 

confidence. 

In the data you showed with respect to smoking --

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light, moderate and heavy for males or females -- do 

you have any idea what sort of populations they were 

looking at, the number or --

DR. HOFFMAN: It was a subset of the full cohort. What 

-- I'd have to revisit the whole paper to say what 

fraction that -- it wasn't the full cohort. It was a 

fraction of the cohort, but I think that fraction was 

on the order of 30 percent. 

DR. ZIEMER: Jim, you have another --

DR. MELIUS: Yeah, just back to the worker population 

issue again, I still think even given that time frame 

on BEIR VII that if NIOSH could think about some ways 

to get that process going beforehand that would not, 

you know, sort of undercut or be undercut by BEIR VII 

but be a way of starting to work -- make some progress 

on that 'cause I hate to put this off another three or 

four years before the -- the issue gets evaluated in 

some way. Now maybe it's not possible to do 'cause 

BEIR VII is so -- such a comprehensive relook at 

things, but I think it might be helpful. 

Back on the smoking issue, I guess my question is --

for Larry and NIOSH is what are your thoughts on 

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addressing this? I didn't realize that Charles Land's 

completion was in six weeks. 

DR. HOFFMAN: If it weren't for this, it'd be out now. 

DR. MELIUS: Yeah, I know, I know. That's what I'm 

saying. 

MR. ELLIOTT: Yeah, we were hoping it'd be out by now 

and we, too, have been in communication with Charles. 

And you know, it's been a three-way communication -- us 

to SENES and SENES to NCI and us to NCI. Let me assure 

the Board that we've not finalized any cases -- lung 

cancer cases yet where a smoker was found to be a noncompensable case. All our lung cancer cases that have 

gone forward have been compensable. We wanted to bring 

this before the Board because we knew the Pierce 

article was out. We appreciate Owen's working up some 

examples. It kind of starts us thinking about these 

kind of situations. We're very much interested in the 

Pierce paper. It's one paper, though. It's just one 

set of findings. And I think there's only 620-some 

lung cancer cases that were evaluated and only 300 of 

those had smoking. Is that right? Something like 

that? So -- to get back to your question earlier, so 

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yeah, we're looking at it. We're considering it and 

we're thinking through what we see there. That's about 

all we can say at this point in time. 

DR. MELIUS: Press you on this a little bit, can -- can 

we say that it's something that we can -- should be 

ready to deal with at the next meeting or --

MR. ELLIOTT: I don't think we're going to be ready to 

deal with this at the next meeting if you're going to 

meet within the next two months. 

DR. MELIUS: So what, six months from now? I mean --

MR. ELLIOTT: Well, I'm not going to -- I'm not going 

to give you a commitment as to when you're going to be 

-- we're going to be ready to present something to you. 

We've got a lot of legwork here to do. We're going to 

do that with SENES. We're going to do that with NCI, 

and we're going to reach out to other experts and get 

what -- what their thoughts are on this before we bring 

it to the Board. 

DR. ZIEMER: Henry? 

DR. ANDERSON: Yeah, this is -- perhaps is more of a 

technical question. It seemed on all of your odd 

graphs, like on the smoking things, you -- all the age 

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groups had the same confidence interval size, and I 

would have thought that, given the small number of 

cases that -- I mean the number of lung cancer cases in 

those people under age 40, there are people who would 

argue that's a different cancer than in older group, 

but I would have thought confidence intervals as you 

age ought to get narrower because of the larger number. 

And the other, of course, excess relative risk, is 

often driven by the denominator or the base background 

level as the background rate goes up, getting really a 

-- large numbers of excess relative risk is difficult, 

just -- I mean physically there you've -- everybody 

would have to have the disease if the background's low, 

so it is somewhat size of the population driven, and 

that's -- I just ask what your thoughts or how you 

might go about --

DR. HOFFMAN: Well, yes, and you remember initially I 

said I was going to give you some initial implications. 

Well, buried within that comment was the fact that the 

initial data that we had to start with in the Pierce 

paper doesn't explicitly give us the confidence 

intervals for all these categories. What they give us 

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are the confidence intervals for a different smoking 

category at age 60 to 70 at time of diagnosis of 

disease. Then they give us a table where there are 

just multipliers for the other categories, without 

confidence intervals. So to give you initial 

implications, it was just the simple arithmetic -- the 

multiplication that was done, so don't over-interpret 

the confidence intervals that are in the slides. 

Everything you say is true, and those are some of the 

things that Charles Land is dealing with is the agespecific confidence intervals that would be 

appropriate. 

DR. ZIEMER: Okay. Tony? 

DR. ANDRADE: Just to respond to Jim, my question 

earlier was meant to put this in context, especially 

when you're dealing with analysis -- the Baysian 

probablistic analysis. In other words, you do away 

with (inaudible) stuff. Only until -- and you don't 

know when this really is. Only until you have a 

sufficient prior distribution, one that's really 

populated with a lot of good data, and that can be 

jostled around via Monte Carlo techniques or whatever 

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so you change it around just a little bit, but the 

outcome of probablistic calculations give you the same 

relative confidence levels do you feel comfortable 

about the results of your analysis. And typically, you 

know, even after you've put together a prior, that sort 

of research and analysis takes somebody one or two 

years. So it's a tough science, but it gives 

ultimately better answers. 

DR. HOFFMAN: And for those who have some knowledge in 

Baysian approaches, I just want to say that the 

uncertainties that we produced through IREP, these are 

-- and they're not statistical uncertainties. They are 

like Baysian uncertainties. More technically, they're 

informative priors waiting for the next dataset to come 

in to allow us to update. But the systematic process 

of prior update -- new prior update has yet to occur. 

A REFRESHER AND UPDATE 

ON REF'S ASSUMED IN IREP
 

DR. ZIEMER: Okay. Then I think we're ready to 

continue with the next part of this section, and Dr. 

Kocher is going to come to the podium now. His 

background is in experimental nuclear physics, now 

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senior scientist at SENES and has had over 28 years of 

experience in environmental health physics, including 

development and application of models and databases for 

assessing doses to the public due to radionuclides in 

the environment. He's developed the probability 

distributions of radiation effectiveness factors for 

different types of radiation to represent biological 

effectiveness in causing cancers in humans. 

Dr. Kocher, glad to have you here to speak on this next 

topic, give us an update on REF's. 

DR. KOCHER: Yes, thank you very much. I gave a fairly 

detailed technical presentation on this subject because 

it was completely new at one of your meetings in Denver 

early last July, and I can really summarize part of my 

remarks in about 15 seconds by saying that there have 

been no changes made in the information that was 

presented last July, nor have we received any 

information which clearly indicates that we made a 

gross error somewhere. So basically what I want to do 

today, because it is a difficult subject, is to give 

you more of a broad qualitative overview of what we did 

compared with the more detailed technical presentation 

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last time, and to particularly highlight what I called 

issues. And by that I mean areas where judgment in the 

face of poor data really came to the fore, and these 

indicate areas where possible future work might be 

helpful in improving our state of knowledge about this. 

Next, please. Let me just remind you what these REFs 

are. They are factors in the risk equations which 

represent the biological effectiveness of different 

types of radiation for the specific purpose of 

estimating cancer risks and probability of causation. 

These quantities are different from, but analogous to -

- if you want to have a frame of reference for what 

these things are, they are analogous to quality factors 

and radiation weighting factors that are used in 

radiation protection. 

But there's a fundamental difference between REFs and 

the radiation protection quantities. And that is that 

they take into account uncertainty in our state of 

knowledge. All of these REFs are expressed as 

probability distributions that are intended to 

represent uncertainty, state of knowledge, whatever 

term you like. And I would emphasize also that they're 

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subjective representations of uncertainty. The 

probability distributions that we've developed in many 

cases certainly are not the kind of frequency 

distribution you would get if you could actually do 

experiments to measure these things in humans. They're 

just our best representation of what we think we know. 

The radiation types for which we've developed REFs are 

listed in the next to the bottom line there --

neutrons, alpha particles, photons and electrons. 

Whenever you talk about biological effectiveness, you 

have to have a so-called reference radiation, which is 

the -- the baseline radiation for which you assume that 

the effectiveness is unity and everything else is 

relative to that. And we chose -- our reference 

radiation is high energy photons delivered acutely, 

because that's the radiations to which the A-bomb 

survivors were exposed. And as you've heard many 

times, the A-bomb survivors is the source of almost all 

of our data on radiation risks that are used in IREP to 

calculate PC. 

Now I'm going to skip this slide and the next one, for 

those of you in the handout. These just go over the 

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risk equations that show how an REF is used to 

calculate risk. And I skip it because it's not really 

germane to my overview here about what we did and what 

the problems are. Just remember that REFs are things 

that are used to put biological effectiveness on a 

common scale for all radiation. So the main reason I 

don't go over it is because it's right after lunch and 

glazing eyeballs would result, and we can't have that. 

Okay. So I'm going to spend a few minutes just talking 

about how I went about this. As you may know, there's 

enough radiobiological literature in this area to fill 

this room, and we had no time or intention to go 

through all this literature. But fortunately, quite a 

few experts and expert groups have reviewed the 

radiological -- radiobiological data -- the quantity is 

RBE, stands for Relative Biological Effectiveness. 

This is what you get in basic radiobiological studies. 

There've been thousands of experiments to measure RBE 

for all kinds of endpoints, all kinds of organisms, all 

kinds of radiations. And fortunately this information 

has been extensively reviewed by groups like the NCRP, 

the National Radiological Protection Board in the UK, 

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experts like Tori Kromse* who did the careful 

evaluation of all the data for tritium, so we basically 

relied on the reviews by other groups. 

Now they did not come up with probability distributions 

of the data. We looked at the summaries and 

evaluations of data to derive our own subjective 

probability distributions. This was not done for us. 

Most of the data that we reviewed came from studies in 

small mammals like the mouse and beagle dogs. Lots of 

data on mammalian systems, cells of mammals -- human 

lymphocytes, for example, was a -- is a common 

biological organism that's studied. Unfortunately, 

very limited on humans to address questions of 

biological effectiveness of different radiations. And 

really the key to all of this is that we have to use 

judgment in applying the available data on RBEs for a 

variety of systems and a variety of biological 

endpoints to say that represents the biological 

effectiveness with respect to cancer induction in 

humans. That may be a substantial leap of faith, but 

we cannot really do very much about it. 

Next, please. Okay, I'm just going to go through the 

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different radiation types very quickly. I'm not even 

going to present any numbers, although if people are 

interested in knowing well, what did you assume for 

alpha particles in leukemia, I mean I have the numbers 

with me. We can discuss any of this in detail that you 

want. 

Starting with neutrons, first of all there's clear 

evidence from a lot of studies in mice that there's a 

difference in biological effectiveness for neutrons if 

the endpoint is solid tumors versus leukemias, and so 

we developed separate probability distributions for 

those two types of cancers. The REF is generally less 

for leukemias than for solid tumors. 

We know -- we have some indication from studies, and 

calculations certainly indicate, that the REF for 

neutrons depends on the energy. I mean there's a wide 

range of neutron energies that are potentially relevant 

to exposures to any group that you're interested in, 

ranging all the way from thermal neutrons to really 

high energy neutrons if you're concerned about 

astronauts and people like that. So we developed REFs 

for three different -- actually five bins of energy, 

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but only three different distributions of REF, because 

two of the pairs were the same. The highest REF is the 

first on there, the fission neutrons, the category from 

0.1 to 2 MeV. Somewhat lower REFs for the second line 

that you indicate there, 10 to 100 keV to 2 to 20 MeV; 

and the lowest REF for less than 10 keV and greater 

than 20 MeV. And the reduction on average was about a 

factor of two in going down each of those steps, so the 

bottom line is about a factor of four or less, on 

average, than for fission neutrons. But of course we 

have uncertainty in all of this. 

In addition in the calculation we include -- we have a 

small increase in the REF for either solid tumors or 

leukemias and at any energy under cases of chronic 

exposure. And this accounts for what's called the 

inverse dose rate effect. There's some evidence from 

studies in animals that if you take two experiments 

where you deliver the same dose, if in experiment one 

the dose is delivered acutely and experiment two the 

same dose is delivered chronically, there is some 

evidence that the response is higher in the group that 

gets the chronic dose, so it's an inverse dose rate 

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effect. The biological effectiveness goes up as the 

dose rate goes down. And there's a small correction 

amounting to about 40 percent on average for chronic 

exposures. 

Next, please. Next is alpha particles. Here again we 

have separate distributions for solid tumors and 

leukemias, based on some evidence, again, that the REF 

is substantially higher for solid tumors than it is for 

leukemias. The difference between alpha particles and 

neutrons is that we do not have an energy-dependent 

REF. It's the same for all energies. Basically we're 

concerned only about -- so far we're concerned only 

about alpha particles from radioactive decay. And 

Mother Nature was kind to us, the energy range over 

which these vary is quite narrow. It's like 4 to 8 

MeV, roughly. 

We also included a very small factor to account for 

possible inverse dose rate effect. Here again the data 

are not conclusive as to whether it's real or not, 

especially at the doses and dose rates we're interested 

in, but there's a small effect that averages, I don't 

know, 20 to 30 percent on average. And this is applied 

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in all cases, because all exposures to alpha particles 

from internal emitters are chronic. 

Next, please. Well, this highlights what was one of 

our real areas of challenge. It turns out that alpha 

particles in leukemias is one of the areas on which we 

do have potentially relevant information from studies 

in humans. The unfortunate aspect of this information 

is that it's totally contradictory, and so it leads to, 

you know, a need to really provide judgment to what 

you're doing, and I just want to take a second to 

discuss the problem here. 

There are basically three datasets that we looked at, 

and the first two on there are datasets involving 

humans. Number one there is this group called the 

Thoratrast patients. These were some patients in 

medical studies that were administered a special kind 

of thorium called thoratrast, and there have been 

health studies, follow-ups on these patients over the 

years, and this group of individuals, taken as a whole, 

shows a clear excess of leukemias compared with an 

expected rate in an unexposed population. There's 

clear evidence that this Thoratrast administered to 

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these people has led to increased incidence of 

leukemia. You get this by comparing the leukemia risks 

in this group with the leukemia risks in the A-bomb 

survivors that were exposed to high energy gamma rays, 

and from that you can kind of infer an REF. And we 

developed a -- as you see there, a 95 percent 

confidence interval of the REF between 1.0 and 15 based 

on these data. You know, shows a -- shows a clear 

effect. 

But there are other groups of human populations. One 

is the famous radium dial painters. Second is a group 

of medical patients that were administered radium-224, 

and in this group of patients there's no excess 

leukemia of any kind been seen. In fact, if you assume 

that the standard ICRP models for calculating dose to 

bone marrow from radium in bone, and if you assume that 

those standard ICRP models calculate dose to bone 

marrow correctly, you would infer an RBE for alpha 

particles and leukemias that's certainly less than one. 

If you ignore uncertainty, you would infer an RBE of 

zero. 

So in the case of the Thoratrast patients we see a 

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clear effect. In the case of the patients and other 

people administered radium, we see no effect. 

Well, what I personally think the important issue here 

is that in those two cases the dose is administered in 

quite different ways. Thoratrast is a colloidal 

suspension of a thorium compound, and that suspension -

- that compound tends to remain suspended in bone 

marrow for a substantial period of time, so there's a 

pretty good chance that the radiosensitive tissues in 

red marrow are being irradiated in the Thoratrast 

patients. 

Now of course radium -- its deposit immediately on bone 

surface and then over time is incorporated into mineral 

bone, and so you're basically irradiating bone marrow 

from the skeleton and not from the marrow itself, and 

it's entirely possible that the reason that you don't 

see any leukemias in this population is because the 

alpha particles which have very short range are not 

irradiating the tissues that you're interested in. But 

I don't know. You know, my -- basically what I'm 

saying here is that the dosimetry in those two cases is 

quite different, and that could be the explanation for 

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this. 

A third piece of information has to do with the data 

for fission neutrons. I mean it's been widely held 

that fission neutrons and alpha particles -- and 

there's a lot of evidence for this -- are roughly the 

same in terms of biological effectiveness. So you 

could infer that the REF for fission neutrons in 

leukemias ought to apply to alpha particles, as well. 

And for neutrons you'd be fairly certain that you were 

irradiating the radiosensitive tissues because they --

you know, they penetrate the body easily. 

So what we were faced with here is three different sets 

of information, two of which are on humans and they're 

directly contradictory. And the way you handle this, 

in our view, is not to say well, I'm going to pick the 

one that I think is best and go with it. What we do is 

give a subjective weight to each one of these as being 

plausible. 

Now those numbers -- 50 percent for the Thoratrast 

patients, 25 percent for the other human populations 

and 25 percent for fission neutrons -- that's, you 

know, to be clear about it, fairly arbitrary. It's 

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what gives you a warm fuzzy feeling, and it's certainly 

arguable about that. And I'm going to return to the 

issue of this in my later remarks, but this is an 

example of an area where judgment is absolutely 

essential. You have to take data and try to resolve 

and figure out what you think it means. 

Next, please. This is an important curve. We're 

moving now to the case of photons. This is a 

calculation of the quality factor that was done by the 

ICRU about 15 years ago. Our reference radiation, 

which is high energy gamma rays, sits right here on 

this curve. The calculation shows as you go down in 

energy at about 200 to 250 keV, it's about -- you reach 

a plateau where the quality factor is about twice that 

what it is down here, and below about 30 keV it 

continues to increase (indicating). Now we did not use 

this curve to infer what the REF for low energy photons 

would be. We used this curve to infer over what energy 

ranges would our assumed REFs apply. 

There are lots and lots of data for what's called 

orthovoltage* X-rays, and that means X-rays where the 

tube potential is about 180 to 250 keV, something --

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kilovolts, somewhere in there. But it turns out that 

that's not the energies of the X-rays, of course. The 

X-rays on average have substantially lower energies. 

And typically the average energies from these high 

energy X-ray machines are about 60 to 70 keV, so they 

fall in here. So there's a lot of data in this energy 

range, and we use this curve to assume that whatever 

REF we inferred for photon energies down here would 

apply up some plateau here. And similarly, there's no 

data down here below 30 keV, and we used this curve to 

imply an increase. 

Next. Now for these -- these intermediate energy 

photons, the data -- the energy range for which there's 

a lot of data for higher energy X-rays. This was 

another case where we had to make some inferences based 

on information which could lead to different 

conclusions if you just took one dataset by itself. 

There's a lot -- the only studies of X-rays relative to 

gamma rays per se that we found have to do with 

induction of dicentric* chromosomes in human 

lymphocytes, and I'll discuss later possible weaknesses 

with this dataset. But these data clearly show that 

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for this endpoint that the orthovoltage X-rays are 

clearly biologically more effective than high energy 

gamma rays, without exception -- average value around 

two and a half, something like that. The confidence 

interval -- well, this is not the confidence interval 

for that dataset alone, but between one and about six 

was the confidence interval for that dataset alone. 

We modified that using what I called indirect 

inferences. And these -- let me give you an example of 

an indirect inference. Somebody is doing a study of 

the biological effectiveness of high energy protons, 

say. And that investigator does two studies, one in 

which the reference radiation is high energy gamma 

rays, and he does another study of protons in which the 

reference radiation is X-rays. Well, you can compare 

the RBE that he gets from those two studies and infer 

an RBE for the X-rays, 'cause he gets a different 

answer for his protons depending on what the reference 

radiation is. And by making a comparison, you can --

between the two reference radiations, you can infer 

what the RBE for X-rays was. And it turns out that 

there's about -- I don't know, ten or so studies out 

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there that we found reviewed in the literature where 

you could make an inference. And these studies all 

showed a clear indication that X-rays were biologically 

more effective than high energy gamma rays, without 

fail. 

So we combined those two sets of information together 

to come up with a 90 percent -- 95 percent confidence 

interval between one and five, based on shall we say 

non-human data. 

But there's another set of information out there, and 

this is what Iulian Apostoaei talked about this 

morning, information on induction of thyroid cancers in 

children especially, because there are data for the 

Japanese A-bomb survivors that were exposed to high 

energy gamma rays, and there are lots of childhood 

studies where children of various ages were exposed to 

X-rays, and you can compare the risk per unit dose, the 

ERR per sievert, basically, for those two studies. And 

what Iulian showed is when you look at the dataset, you 

really don't see a statistically significant difference 

between the risk of thyroid cancer in the A-bomb 

survivor children and the risk of thyroid cancer in 

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children exposed to X-rays. You don't see a 

statistically significant difference. And from that we 

inferred that an equal biological effectiveness between 

these two radiations could not be ruled out. 

Now the truth of the matter is, if you look at these 

data and you take the statistical uncertainties without 

bias, without subjective judgment, it neither refutes 

nor supports an assumption that the biological 

effectiveness is the same, it neither refutes nor 

supports an assumption that they're different. But we 

used that information to assign a relatively small 

weight to the possibility that the biological 

effectiveness is the same. 

And there's similar information, although weaker, for 

other cancers. If you look in the latest UNSCEAR 

compilations, for example, they don't show any 

difference in the ERR per sievert between childhood 

exposures to X-rays and -- or adult exposures to X-rays 

and exposure to gamma rays in the A-bomb survivors. So 

here's another case where we apply judgment to say 

we're going to give 75 percent weight to this dataset 

which clearly show an effect, and we give 25 percent 

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weight to this other dataset that is inconclusive. 

Next, please. For photons less than 30 keV, remember 

the curve from the ICRU that -- the quality factor 

increased below 30 keV? We found no data in that 

energy range, but we assumed that that curve described 

an increase relative to the intermediate energy photons 

from that calculation, but we assumed that the 

correction was energy independent. We did not put an 

energy-dependent correction in there. It was described 

by a triangular probability distribution. 

Next, please. Electrons. There is a wealth of data on 

the biological effectiveness of beta particles from 

tritium decay. There's virtually nothing that we've 

found on any other kinds of electrons. The problem 

here is that the energies of electrons from tritium 

decay are very low. The average energy is only about 6 

keV, and we'd be curious of course about the biological 

effectiveness higher than that. And we had to have 

some way to say over what energy range can we apply the 

information on tritium beta particles, 'cause it surely 

doesn't apply just there. It may apply at somewhat 

higher energies. 

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And so we used the following line of reasoning. When 

you do a study to measure the RBE of photons, what you 

are actually measuring is the RBE for the secondary 

electrons that are produced in first collisions of 

photons with atoms. That is what you are really 

measuring. So if you know, for example, that photons 

of a certain energy have an increased biological 

effectiveness, you can derive what the energy range of 

those electrons is that should have the same biological 

effectiveness, and that's basically what we did. All 

you have to know is what's the energy distribution of 

Compton electrons as a function of photon energy, 

what's the energy distribution of photoelectrons as a 

function of photon energy, and what's the relative 

importance of those two processes. 

There again, nature was kind. Either the Compton 

effect is almost everything or the photoelectric effect 

is almost everything, and there's a small energy region 

of up around 15 keV actually where they're more or less 

the same. So you basically use what you know about how 

photons interact to infer something about electrons. 

And from this, to make a long story short, you assume 

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that the tritium data would apply at energy -- any 

energy less than 15 keV, based on how the photon 

quality factor works, and we apply this to average beta 

energies less than this, or energies of discrete 

electrons less than that. 

These problems of Auger-emitting radionuclides in DNA, 

this is a tough problem. Let's just hope that the DOE 

program doesn't encounter this very often. You 

basically are going to have to get help from experts in 

microdosimetry I think to work this out. 

Next. Well, I talked about how you can, you know, use 

your knowledge of Compton scattering in the 

photoelectric effect to infer REFs for electrons where 

you don't have any data, and what is easy to show is 

that this 30 to 250 keV range where we have an elevated 

REF for photons, that corresponds to average electron 

energies between about 15 and 60 keV. 

However, and I think this was a reasonable decision, 

even though you can do this calculation and you have a 

lot of confidence in it, we have not yet adopted an REF 

for this intermediate electron -- energy electron 

range. We still assume that it's one. And there were 

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two reasons for this, 'cause we lacked data in two 

areas. 

First, we don't really have any biological data on 

photon energies greater than about 70 up to about 250. 

Remember, I emphasized the point that these 

orthovoltage X-rays, the average energies are mostly 

around 70 keV or below, so we don't have any firm 

evidence at the higher energy photons that we're 

interested in. And secondly, we don't have any data on 

electrons other than tritium beta particles. Where 

this energy range might possibly come into play is if 

you had anyone exposed to carbon 14. I think nickel 63 

is another one where the betas fall in this energy 

range. 

Next, please. Okay, now I'm going to go back through 

each of the four radiation types and revisit what some 

of the issues are that future activity might be 

beneficial. Starting first with neutrons, we found no 

data on RBE at the lowest energies at the highest 

energies, so we basically had to assume that the 

assumption by ICRP that the RBE was about four times 

less than it was for fission neutrons, we had to assume 

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that that provided a reasonable central estimate. Of 

course we included some uncertainty in this 

extrapolation, but it is an assumption on -- for which 

there's basically no data that we found. In my 

checkered career I actually got a few of these. I used 

to work in an accelerator lab that handled tritium and 

we had deuterium beams and they give high energy 

neutrons. 

There are a few data on these intermediate energies and 

the somewhat higher energies compared with fission 

neutrons, and it turns out that some of the data show a 

decrease, as expected by the calculation. But there's 

some data that show no effect. So the database here I 

would characterize as weak. There's no direct evidence 

that the correction for an inverse dose rate effect 

should be applied under conditions of chronic exposure. 

This is not a big ticket item. It's only, you know, 

30 to 40 percent on average. 

Our REF for the lowest energy neutrons ignores the 

possibility that the REF could in fact be less than 

one, could be substantially less than one, like maybe 

.5. And the reason is, the lower bound of our 

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distribution is at one, but the reason that it could be 

less than one at these energies, when a neutron of this 

very low energy impinges on tissue, the radiation that 

causes most of the dose eventually is high energy 

photons from capture by hydrogen nuclei of the 

neutrons, and those photon -- that photon energy is 2.2 

MeV, and that's quite a bit higher than the cobalt 60 

gamma ray energy of about 1.3 MeV. And calculations 

have suggested that the effectiveness of the 2.2 --

that the effectiveness continues to drop as the photon 

energy increases. But it at most would be a factor of 

two, but probably not that much, but we have no 

accounting of that in the present situation. 

Conversely, the REFs in humans may be overestimated 

when the neutron energy is -- no, the REFs may be 

underestimated when it's greater than .1 MeV. What's 

going on here, in the mammal studies most of the dose 

is delivered by the higher LET radiations because the 

distance through tissue that you have to traverse is 

relatively small. In humans you have to go through 

more tissue, you get more high energy photons that are 

delivering the dose to deep-lying organs and tissues, 

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so that the animal data may in fact overestimate the 

REF in humans at these energies, and we've made no 

accounting for this. 

Now the ICRP has done a lot of calculations of this and 

what they show is that this effect is a very 

complicated function of the neutron energy, the 

particular organ being irradiated and the irradiation 

geometry. 

Next, please. Alpha particles. I talked at great 

length about the problem of what's the REF for alpha 

particles and leukemias. It would be interesting to 

resolve the discrepancies in human data. My basic 

approach to coming up with our hybrid distribution was 

to say look, you probably have trouble with your 

dosimetry models for alpha emitters in skeleton, but I 

don't think you should bury considerations of 

biological effectiveness in your problems in dosimetry. 

If you've got a problem in dosimetry, go fix it. What 

we want to know is, if the dosimetry is done correctly, 

what's the biological effectiveness of alpha particles. 

And so that's the approach we took. But there's a lot 

of work that could be done here, for sure. 

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Again, is the inverse dose rate effect real or not; 

this is a very small deal. Another deal that I don't 

think is very important is that almost all the data on 

RBE for alpha particles, the reference radiation was 

high energy beta particles delivered chronically 

because that's the way alpha particles deliver dose, so 

there's no data relative to what we have assumed as the 

reference radiation. I don't think this is a big 

problem because there is some evidence that these high 

energy electrons and high energy photons have the same 

biological effectiveness as we have assumed. 

Next, please. What about photons? There basically is 

no animal data on X-rays and cancer endpoints. There 

are these studies of cellular effects, effects on 

chromosomes, things like that, but no data on cancer 

endpoints. And one of the criticisms that we got when 

we used the human lymphocyte data to infer this is, you 

know, that okay, induction of these chromosome 

aberrations, that's not cancer yet. And you've all 

heard the stories of you can see chromosome effects in 

all these populations that live in very high background 

areas, but you can't see excess cancers. So it would 

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really be nice if there were animal data on the 

difference between X-rays and gamma rays for cancer 

endpoints. We're assuming that the cell data applied. 

I mentioned before, no data at the lowest energies, 

and these energies between 70 and 250. 

Iulian again this morning talked about the importance 

of fractionation of X-rays and childhood exposures. 

Remember we gave 25 percent weight to an assumption 

that there's no difference between X-rays and gamma 

rays based on the human data, the human childhood data. 

Now what Charles Land has done and what Iulian 

recommended be incorporated is basically say look, what 

you see in those data is the law of compensating 

factors. There is an increase -- there should be an 

increase in effectiveness of X-rays in the childhood 

thyroid cancers, but it's masked by the DDREF because 

those exposures were given in a protracted fashion 

rather than acute. You know, if the RBE is two and the 

DDREF is two, they cancel and you see no effect, which 

is what the data show. So if we really decided that 

the childhood thyroid data really represent high energy 

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investigation of the assumption that 25 percent rate 

should be given to an assumption that there's no 

difference. It would tend to reduce the weight that's 

given to this assumption because you're now assuming 

that the childhood data really do show an effect when 

you consider the fractionation problem. 

Next. The electrons -- there's a lot of data on 

various -- on a large number of different stochastic 

endpoints. There's relatively few data on 

carcinogenesis endpoints, and on average, the RBEs tend 

to be a little bit lower than for other endpoints. Of 

course, given the preponderance of data, we gave the 

greatest weight to the non-cancer endpoints, so this 

could be the same problem that we found for photons. 

But still, these data in general show some increase, 

just less on average than for other endpoints. 

No data on RBE at energies higher than tritium beta 

particles, and the REFs for these very low energy Auger 

electrons -- these typically are less than one keV, and 

they are copious in decays of some radionuclides, these 

ones that decay by so-called electron capture decay. 

And when they are incorporated into DNA, the RBE could 

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be 40, 50, 60, 100 -- I mean it's huge, and so if we 

encounter any situations like this, care is really 

called for. 

Next, please. I was asked to speculate on what we 

might develop that we don't have. It's conceivable 

that in some programs, perhaps not this one, that you 

would need REFs for protons and heavy ions including 

recoil nuclei and fission fragments. 

Do we have any cases of internal exposure to 

Californium 252 in this program? 

DR. NETON: Not yet, no. 

DR. KOCHER: That'll be a hoot if one of those comes 

in, because I -- I swore I was going to look up the 

number and I failed to do it. I think the spontaneous 

fission branch for Californium is like nine percent, so 

you know, good luck. 

Next. And those fission fragments deposit a lot of 

energy over a short distance. 

The last point I want to mention is something that 

Brian Thomas mentioned this morning, is that I 

developed this new help file to guide users in 

selecting radiation types. The menu has 11 different 

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types of radiation, but you're not necessarily going to 

have the data in exactly the form that IREP wants, so 

this request came from NCI, not from NIOSH, because 

NIOSH and its contractors knows -- they know what IREP 

wants and they presumably know how to do it, but you 

know, NCI is passing essentially the same version of 

this code over to the Department of Veterans Affairs to 

handle claims by the atomic veterans. And since I 

served on this committee you're going to hear about in 

the next presentation, I knew that the medical guy at 

the VA is not getting the information that IREP wants. 

I mean I know this. And so I worked up a fairly 

detailed help file, basically to help the medical 

officer at the VA do this correctly. But it also 

should be of general use for anybody who wants to get 

into IREP and play around with it, but the dosimetry 

information they don't quite know what to do with it. 

And I knew this going in when I worked on these REFs, 

but especially was impressed upon me when I tried to 

develop a help file for internal exposure. 

It is clear that if you're not given the information 

that you want, if you're going to make some assumptions 

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about what radiation type to enter, sometimes it's 

straightforward, but it's easy to encounter cases where 

you absolutely have to have your fanny screwed on 

straight. You've got to know about radioactive decay, 

you've got to know about biokinetics, you've got to 

know about sites of deposition and what organs are 

being irradiated. You've got to know a lot. There are 

radiations which could be encountered where four 

different radiation types are emitted in the decay of 

that radionuclide and they all contribute somewhat 

significantly to the dose. You know, these are --

external exposure I think, relatively speaking, is a 

piece of cake. But internal exposure -- I won't say 

problems could arise. You have to know what you're 

doing. You can't fly by the seat of your pants. 

But again, this should not be an issue for NIOSH and 

the contractors because they presumably know all this. 

But I'd be interested in hearing a presentation 

sometime about how they do all this, just to make sure. 

Thank you. 

MR. ELLIOTT: Thank you. Thank you, Dr. Kocher. It 

was a very illustrious, informative presentation. I 

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think it's always good to take us all back -- the Board 

as well as NIOSH staff -- in understanding and 

realizing what the scientific basis and underlying 

assumptions are on -- that we come to grips with on 

radiation effectiveness factors. 

Are there any questions for Dr. Kocher? It was all 

that clear. 

DR. KOCHER: Stunned them again. 

MR. ELLIOTT: We're stunned. Well, I'm sure that 

you'll be able to get him in a moment, if you wish, on 

a one-on-one basis. 

DR. KOCHER: I'll be here till 8:40 tomorrow if anyone 

wants to talk to me. 

MR. ELLIOTT: All right. In the absence of the Chair, 

who had to excuse himself, you're at a break. Be back 

in 15 minutes. 

(Whereupon, a recess was taken.) 

DR. ZIEMER: Before we listen to our next presenter, I 

want to remind members of the public that if you do 

wish to make comments during the public comment period 

which will be at 4:15, please register at the table in 

the back with Cori. There's a sign-up sheet back 

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there. We need to have some idea of how many wish to 

speak so that we can allot the time accordingly, so 

please do that if you haven't already. 

NAS REPORT ON REVIEW OF DTRA 

DOSE RECONSTRUCTION PROGRAM
 

Now our next presenter will be Dennis M. Schaeffer, 

better known as Mike Schaeffer. Mike Schaeffer is here 

representing the dose reconstruction program of the 

Defense Threat Reduction Agency, and more particularly 

he's going to take a few minutes and tell us a little 

bit about the newly-issued report of the National 

Academy of Sciences, and you have in your packet a prepublication copy of the executive summary. The full 

report will be out soon, I guess -- maybe Mike will 

tell us that and there'll be an autograph party at 

Barnes & Noble's on that, Mark -- or Mike? 

MR. SCHAEFFER: Probably around June. 

DR. ZIEMER: Okay. Well, anyway, please welcome back -

- Mike's been with us before, and please address the 

Board at this time. 

MR. SCHAEFFER: Thank you, Dr. Ziemer, for the 

introduction, and I'd like to brief just at the very 

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top level the recent report that was released by the 

National Academy of Science on DTRA's dose 

reconstruction program. 

I apologize for not having any slides today because 

this was given to me at short notice, and so I'll try 

to be brief and take you through the -- just the top 

level details. 

This particular study was commissioned two and a half 

years ago as a result of a Congressional mandate 

following on the heels of a General Accounting Office 

audit of the dose reconstruction program. And one of 

the major recommendations of the General Accounting 

Office was should or should there not be continuous 

oversight that had been somewhat lacking over the years 

in our dose reconstruction program. Keep in mind that 

we have been constructing doses on the order of over 20 

years during the course of our program that started in 

1978. So this report represents an important 

milestone, not only where we are in the program, but 

encompasses the entire experiences that we've had in 

this program from day one. Until your program was 

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kind program. And I just wanted to remind you of all 

of the things that have happened over the years have 

been somewhat embryonic in the early days and 

developing over the later years, and I believe that was 

pretty well the point I made in the overview of the 

program I gave back in August of last year. 

The dose reconstruction study encompassed taking a 

sample of 99 dose reconstructions performed by Defense 

Threat Reduction Agency and its predecessor agency, 

Defense Nuclear Agency, mainly by its one contractor, 

SAIC. Basically some of the issues the committee had 

to deal with were basically three issues, and these 

have been nagging issues over the life of the program: 

Does dose reconstruction represent a valid process. 

Second of all, how does that valid process help in 

working with a compensation program, in this case run 

by the Department of Veterans Affairs. And the third 

most important issue that ties both our program and the 

VA program together is is there sufficient benefit of 

the doubt being exercised through this program that 

gives the veteran the best chance for compensation. 

And of course this report represents a very, very 

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comprehensive study if you read between the executive 

summary and the beginning and the conclusions to the 

end, a very in-depth look at every detail that goes on 

during the course of our constructing doses. 

The National Academy had four basic charges associated 

with dose reconstruction, and then one charge of course 

that applied to the entire program. I will summarize 

the four basic charges that they had before them. 

The first charge was are the doses accurate. And the 

second charge is are the doses as they are reported to 

the veterans and the Department of Veterans Affairs, 

are they reported accurately. The third charge was are 

the assumptions reasonable and credible with respect to 

how we estimate the upper-bound doses. And the fourth 

charge was are the data -- and when I say the data, are 

the records and the historical reports robust enough in 

terms of allowing dose reconstruction to be conducted 

and to be conducted accurately. 

So I'm going to hit each one of those very quickly as 

regards what the Academy found. The first, are the 

doses we reconstruct accurate. The basic finding was 

the average value that we construct for our external 

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doses, while indeed they may be accurate and valid, the 

upper-bound estimates that we provide for those doses 

likely are not true upper bounds at the 95th 

percentile. So it indicates that we have some room for 

improvement there. 

As regards internal dose, it said that for the most 

part the doses that we estimate for inhalation to 

organs, in some cases and many cases are representative 

upper-bound estimates. However, it did mention a few 

scenarios where the upper-bound estimates that we 

provide for inhalation doses are perhaps severely 

underestimated. And they specified the particular 

instance of where we construct doses for areas where 

fallout that's already been deposited on the ground 

from a previous test is impacted by shock wave of a 

current test in that we don't fully account for all of 

the resuspension of the previously-deposited fallout in 

those instances. And of course they don't affect a 

large group of people, but nevertheless it's enough 

that we need to go back and relook at doses we 

constructed -- internal doses for those populations, or 

subpopulations. 

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It also said, internal doses, that we don't pay much 

attention to performing ingestion doses. But the 

perception there is that the ingestion doses do not 

form a large part of the entire internal dose, and the 

consequence of our not paying much attention is 

probably not very consequential to the entire dose to 

the veteran internally. 

The next charge, are the doses reported accurately. 

The answer is the doses we report to veterans and to 

the Department of Veterans Affairs are indeed accurate. 

However, they feel that -- the Academy feels that we 

can do a better job in communicating the upper bound of 

uncertainties, what does this exactly mean, and also 

that the VA in turn can do a better job in 

communicating what the actual risk from that radiation 

really is in terms of inducing cancers and other 

diseases. 

The third charge, are the assumptions credible and 

reasonable, and this is the area where we received 

probably the most criticism, that a lot of the 

assumptions we make for upper-bounding doses are not 

credible and reasonable, and that's from two 

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standpoints. Scientifically we've not taken into 

account a lot of the techniques that are available 

today to do uncertainty analysis on the 95th percentile 

value. We have focused over the years on providing a 

good reasonable estimate -- accurate estimate on the 

central tendency value, but we've not paid much 

attention to the fact that 95th percentile values also 

have distributions of uncertainty. 

On the other hand, the non-scientific part of the 

program, have we incorporated in every case over the 

breadth of the program all that the veteran could give 

to us in the way of personal anecdotes and information, 

and we've not, to a great degree, done that 

consistently across the life of the program. We do it 

better today than we did back at the inception of the 

program. Do we do it the best way possible in terms of 

where we're going in the future? I think that's a 

scenario where we can do even better still in terms of 

making sure that we have consistent ways of 

communicating with the veterans and gaining all the 

information that they have as insights to the process. 

And also what they did. 

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The fourth charge, are the data accurate and robust 

enough to support dose reconstructions. The Academy 

found that the reference sources are sufficient and 

adequate to allow dose reconstructions to be derived 

from available historical data. In fact, they 

commented that data are rather -- rather extensive and 

available to perform dose reconstruction. 

Of course where does this go? One of the items I 

believe I briefed to you in August of last year was 

should the DTRA dose reconstruction program have an 

oversight committee very much like the Energy workers 

program. And that's the subject of the last charge the 

committee had is did they find it appropriate that we 

should have an oversight over the dose reconstruction 

process, independent of the agency. And the answer 

came back yes, and this is sort of where we are today 

on the program, that makes it very much indicative that 

we need to be involved in the type of business you're 

doing because, rather than you having the lessons 

learned from us, I think this is the point at which the 

roles between the two programs are going to reverse and 

that we're going to look to be doing very much the same 

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thing that the Energy workers program is doing to 

actually improve our program. 

Some of the comments we had is we have a plan of course 

to put the recommendations into effect. We believe of 

course that the Academy did a very, very thorough and 

scholarly piece of work in investigating our program, 

and some of the suggestions in there -- or all the 

suggestions are excellent suggestions that will help us 

make the program better. And of course the very most 

important thing with implementing this particular --

recommendations of this report is we need to be able to 

do the best job we can for our veterans who were 

exposed during the atomic test era and the post-war 

occupation of Hiroshima and Nagasaki. And we believe 

that this particular study will take a 20-year-old 

program and push us into the future, should there be 

means to allow us to continue this program. 

I'll take any questions. 

DR. ZIEMER: Thank you very much. Let me comment 

before we have questions, and that -- the comments are 

as follows: First of all, this item was added to the 

agenda very late, as many of you know, and the reason 

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was that the report just came out. And it's our hope 

that we can have a more in-depth time to focus on this 

report, perhaps even at our next meeting, and perhaps 

invite the Chairman of the Academy committee, who I 

believe was John Till -- or else one of his colleagues 

-- to address the group and go into the report in 

depth. Since it's a report of an Academy committee, 

that might be worthwhile. 

It probably would be inappropriate for us to put Mike 

on the spot and ask him to go into any depth today in 

terms of our questioning. I think I would just like to 

limit the questions -- one or two brief questions if 

you have them, and then we're going to move on to our 

next topic. But we do appreciate at least giving us 

this initial glimpse of the nature of the report. It 

has I think the -- certainly the recommendations that 

the committee made are very pertinent I think to us as 

well to look at what they recommended for that program 

and see what kind of parallels we might have with our 

own program here in terms of the oversight, monitoring 

issue, quality control issues, that kind of thing --

and communication with the claimants and so forth. 

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But we have several questions again. Please keep them 

brief and let's not try to get into depth on this 

report today. Okay, Gen -- we'll just go down --

around the table here. 

DR. ROESSLER: Mine is not a question but a comment, 

and I think it's lessons learned for us from this 

report and I think we really ought to study it in some 

detail because there are a lot of them. My impression 

when I read the comments, the deficiencies, is that 

this program already has taken -- you know, is doing 

these things, has -- has learned from it. But I think 

the thing that impressed me as the committee looked at 

the data and talked about quality control, illegible 

data, lack of standard operating procedures, and I 

think that this -- certainly in this program is in 

effect. But we as the Board should make sure that we 

continue to monitor, especially I think the standard 

operating procedures. 

DR. ZIEMER: Thank you. 

DR. MELIUS: Yeah. Yeah, I thank Larry for putting 

this on. I was the one that requested it -- short 

notice -- and others may have, also, but appreciate 

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that. And also, just to echo Gen's, I think it's --

there are things that are underway here that sort of 

obviate some of the potential problems in the program, 

but one thing I have trouble with the report was --

from the executive summary and what we've heard about 

it is sort of what were the more important findings? 

It's a typical Academy report in that we've found a 

problem here, then usually later in the paragraph it's 

buried in saying but it really wasn't that important, 

you know. And it's very hard to judge, of all the 

different sort of potential problems they found, what 

were the more -- you know, most significant, at least 

from your perspective in trying to address, and then I 

have a follow-up question. 

MR. SCHAEFFER: I think the most significant, and Gen 

touched on it very briefly, that I think underlies the 

entire program in terms of moving it forward is you 

look at the life of the program over the last 25 years, 

there's been various forms of two-way procedures. Of 

course better now than they were back then. Likewise, 

SOP, now much better than of course back when we 

started the program, where admittedly some of these 

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procedures were lacking. And I think the way forward 

here is of course the science and the art of developing 

QC procedures and SOP of course have evolved over the 

years, and this is where we need to get back into the 

queue and actually start developing what are those more 

extensive procedures that you see at DOE establishments 

or that you see the U.S. Navy Nuclear Propulsion 

program use in conducting their work. So there's all 

sorts of paradigms that we can draw on today that I 

think would be most important for us to embrace in 

their entirety, but this is an area where, number one, 

I think we need to concentrate a lot of effort. It's 

also one where we can also institute actions right 

away, so that provides a good opportunity. 

Let's see, what's the second issue you brought up? 

DR. MELIUS: Yeah, just one -- I don't know if you have 

any preliminary thoughts. One of the recommendations 

and findings that struck me was this issue of how you 

take into account the veterans', you know, personal 

recollections and information they provide and how to 

you systematize that into the -- your follow-up and 

provide the documentation on that. Any thoughts on how 

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-- I know that's sort of a moving target, but any 

thoughts on sort of where you will go with that 

particular issue? 

MR. SCHAEFFER: That of course represents the next 

equally important area. I think there's three issues 

that are important. The first we just talked -- first 

two we talked about. This is an area where we've not 

been consistent in our practices over the years. 

Again, the Academy report was written in the vein that 

they took the look back to 1983 on some of these doses, 

clear up to 2001. And given the fact that there's 

better degrees of performance here as time marches 

onward. But one of the areas I believe we can do even 

a better job is talking to the veterans, taking into 

consideration what they say. And this is a very, very 

big gray area in terms of our having to work probably 

in a closer partnership with the Department of Veterans 

Affairs. It's very, very important -- very, very 

important that we get the veteran's statement up front 

in this process. And not only is it important that we 

just get a written statement, that we also have the 

opportunity to be able to go back and talk to the 

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veteran about that statement, get into a dialogue up 

front in our process before we even pick up and do a 

dose reconstruction. Although we're doing many of 

these things today, we need to probably do them even 

greater emphasis. And I would say part and parcel with 

the QA procedures and SOP, we need to develop exactly 

what are those processes we -- that we're going to do 

to extract every last bit of information we possibly 

can from the veteran. 

The second area that goes along with that, again, are 

assumptions always valid. I think we need to do 

something very similar that is done in the NIOSH 

program in that we need to sit down and spell out the 

basic assumptions prior to our doing any mathematics to 

assign a dose to the person, either from available 

dosimetry or other radiological data, which the Academy 

of course found -- finds is very robust in terms of 

being able to allow us to do the process. So we need 

to knit those two parts together very, very intimately 

much better, and I think even in terms of eliciting a 

response from the veteran is -- this is what we've got, 

will you shake hands with this so we can move forward 

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with the dose -- realizing again that's going to be a 

very, very precarious process in that some people, no 

matter what we do, no matter how well we make 

assumptions in their favor, may not agree with them. 

DR. ZIEMER: A comment here and then we'll go on --

MR. ELLIOTT: Can I go first? Just for the benefit of 

the public that's here today, this is a pre-publication 

copy. We've provided the Board with the executive 

summary and the title page. The public can go to the 

web site, www.map.edu, and they'll find this report as 

a pre-publication copy. Once the hard copies are 

available, we'll solicit interest from the Board 

members and purchase you a copy for reference, for your 

benefit. 

DR. ZIEMER: All right. Thank you for that comment. 

This is not a NIOSH document that we can make available 

to the public. It's not a government document, so --

but it is available on the web site if people want to 

read it. 

Okay, Mark and then Tony. 

MR. GRIFFON: Yeah, I think a couple of my questions 

were actually captured, and I had several, but I will, 

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as Paul suggested, save some of the more detailed ones. 

One thing I wanted to ask about, there's a reference 

further in the report -- page 127 they talk about the 

exposure profiles and they -- there's a conclusion that 

20 of 99 of these exposure profiles were found to be --

have inadequacies, I think is the phrase -- I'm 

paraphrasing. And yet the overall conclusion, as you 

stated, in the executive summary is that the data was 

overall adequate. Is that consistent or am I -- am I 

misreading that? The exposure profiles I believe were 

used for the individual dose reconstructions. 

MR. SCHAEFFER: I think the basic conclusion the 

Academy made is sound, based on the examination they 

made. We'll admit to you that if you don't read it 

from cover to cover and digest every scientific detail, 

you'll probably lose the flavor with actually how it 

relates to the overall recommendation or conclusion. 

So I would not say based on the 20 that you looked at 

that necessarily they were full-blown inadequacies. 

There were probably lots of gray areas. 

MR. GRIFFON: I gue-- the reason I'm reflecting on the 

exposure profiles is because of the working group's 

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efforts here, too. I just want to find out, from our 

perspective, what we need to build into our system. 

But do you recall why -- and maybe this is putting you 

on the spot too much for the detail, but why there were 

so many inadequacies in those exposure profiles and are 

-- is anything -- have you reflected on ways to change 

that or has that been maybe modified already, how you 

do yours --

MR. SCHAEFFER: I believe that that's going to be taken 

up into the holistic approach we take to correct QC, 

QA, SOP, talking to the veterans. I think that that's 

very, very important that when we do upper-bound 

uncertainties, for instance, it's not just a scientific 

value, it's a part of -- considering all the data from 

the veteran, if the veteran says he's within 100 yards 

of ground zero but there are no available historical 

reports that puts the veteran no closer than 500, then 

we have to hold out the possibility and provide the 

Department of Veterans Affairs an answer that goes 

right with the veteran's statement and leave it to the 

VA, of course, to make the judgment in terms of all of 

the -- the available data as to whether weight is given 

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to an upper-bound estimate at 100 yards versus 500. 

And I think in the past we may have tried to enter 

ourselves into that judgment process more than probably 

we needed to. Again, this takes a lot of work and 

collaboration with understanding what the goals and 

objectives the Department of Veterans Affairs has and 

what are their considerations in making decisions. 

MR. GRIFFON: Just one last follow-up on that. From 

what I understand, you didn't have a interview process 

for the claimants? 

MR. SCHAEFFER: No, we do have an interview process. 

MR. GRIFFON: You do have an interview process. 

MR. SCHAEFFER: But if you looked at it over the 

entirety of the history of the program, there are 

various stages of inconsistency in how we did this, 

maybe less in the earlier days, more in the later days. 

In terms of how we do it today, we wouldn't want -- of 

course capture how we do it today, add a little more to 

it than what we have, but the important part is to 

develop a procedure by which we will do this in 

somewhat of a uniform fashion. 

MR. GRIFFON: And is it a scripted interview now -- I 

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mean now, what you have, is it a scripted interview 

where you go through a set of standard questions with -

-

MR. SCHAEFFER: Give you an example of what we have, we 

have a basic questionnaire that we elicit from the 

veteran with basic name, address, where he lives, basic 

information as to what shot he thought he was at, and 

of course we send that back to the veteran and they 

confirm it and mail it back to us. In terms of what we 

did in the last eight years is we developed, in 

cooperation with the VA, a more extensive questionnaire 

that the VA can hand out to their claimants that we can 

also use when we talk to the veteran to go through and 

touch all the questions and elicit all the information. 

Is it a scripted interview by the type that you're 

talking about, much like NIOSH does? Not quite like 

that, but we do have a standard questionnaire. 

MR. GRIFFON: Yeah, I actu-- the reason I brought it up 

was some of the accounts in the report -- I guess those 

were letters, maybe unsolicited letters from the 

claimants describing what incidents they were involved 

in and they have very in-depth descriptions of what 

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they did during those -- the tests, I guess. 

MR. SCHAEFFER: Right. 

MR. GRIFFON: And the -- I don't know if you couch it 

as in your current pro-- do you try to capture sort of 

work his-- you know, work history that way or do you 

ask them, I don't know -- I was just curious if you had 

a sort of standard set of, you know, questions along 

processes and potential exposures now or if it was more 

open-ended questioning --

MR. SCHAEFFER: Actually it's pretty specific. If you 

looked at the form that's in the VA workbook, as well 

as in our program, it's not only specific to what they 

did, it's specific to the types of test, whether they 

were on the test site, whether they were in the 

Pacific, whether they were in Hiroshima or Nagasaki, 

the forms are -- have different sectors that are 

peculiar to the differences in the types of testing. 

MR. GRIFFON: That's what I was getting at. Thank you. 

DR. ANDRADE: A quick comment and a quick request. I 

don't want to put you on the spot right now and 

hopefully when you report back it'll be interesting. 

Having come from a place that has recently been 

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accosted by the GAO, I know that they tend to make rash 

accusations based on little data. Two of them really 

strike me as completely frivolous. One is how in the 

world do they have the scientific bases to predict or 

to tell you that your beta to gamma factors are off by 

a factor of two or three? Same with the neutron to 

gamma factors. Okay? That means they must know a 

whole heck of a lot more about your study than 

yourselves. Nevertheless, I appreciate the program 

that you all are going to put together to try and 

address some of these issues, but I would really like 

to know what sort of basis they have stated to make 

these kinds of accusations. And not until the veterans 

are indeed interviewed, talked with -- their commanders 

interviewed, et cetera -- will anybody really have a 

clear picture as to what really happened out here. 

MR. SCHAEFFER: Let me address your questions there 

'cause I think both of those issues kind of stand apart 

from the program and where the current body of 

knowledge is. Let's take for instance neutron quality 

factor. It didn't say we failed to use a neutron 

quality factor. What it said we didn't do is, in the 

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upper-bound estimate of a neutron dose, take into 

account the body of knowledge as we know it today, 

reflecting the uncertainty on the quality factor. And 

I believe Dr. Kocher addressed that very well today as 

to what that truly means in terms of application to our 

program. Let's say we apply a quality factor of ten, 

we don't put in the upper-bound estimate that could 

have -- be as high as 20 and as low as five. Similarly 

for the skin dose factor that goes hand in hand with 

the fact that the skin dose is based -- part of that 

external exposure to the skin is based on the upper 

bound of the gamma estimate. And one of the areas of 

the report indicated that our upper bounds are 

somewhere on the order of 1.2 to 1.5, for instance -- I 

hope I'm quoting that correctly -- and the dose should 

be perhaps along the order of magnitude of two to 

three. Put that in the context in the fact that we use 

the upper-bound estimate to come up with the skin dose. 

That's where that particular comment is being 

addressed, as well as of course any uncertainties in 

the quality factor. 

DR. ZIEMER: Okay. Thank you very much. We appreciate 

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this early review of the report, and we'll look forward 

to hearing more on it later. 

BOARD DISCUSSION/WORKING SESSION 

REVIEW PROCESS OF COMPLETED DOSE RECONSTRUCTIONS
 

Now we're going to move our attention to the dose 

reconstruction work group again, Mark. We do want to 

only go till 4:15 on this, so you want to pick up where 

you left off this morning or -- or is there enough time 

for you to do -- I can -- we can move the public 

comment period up if you'd rather not -- can you get 

enough done in 20 minutes to make it worth doing this 

afternoon? 

MR. GRIFFON: No. 

DR. ZIEMER: Okay, and then we'll defer your things 

until tomorrow then -- 'cause we have a session 

tomorrow. You have more to cover than you could in 20 

minutes and you have handouts that will come tomorrow. 

MR. GRIFFON: I'll have handouts tomorrow morning. 

It'll be easier for people to look at something. 

DR. ZIEMER: Okay. Then we will ask for the ledger of 

public comment participants. Just a moment here. 

(Pause) 

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PUBLIC COMMENT PERIOD
 

DR. ZIEMER: Okay, our first individual will be Richard 

Miller. Richard, from GAP, Government Accountability 

Project. Richard? 

MR. MILLER: Hi, it's another city. It's Richard 

Miller, for the record. And there's no breeze blowing 

over the table today, too, I noticed, Dr. Ziemer. 

DR. ZIEMER: There may be now. 

(Laughter) 

MR. MILLER: There's no evidence to support that at 

this time, though, Dr. Ziemer, is there? You're 

generating it at your end? 

It's good that I don't work for GAO, I must say. First 

I just would like to -- 'cause we had a chance to 

listen to all of those wonderful conference calls on 

the Special Exposure Cohort rule, it's the kind of 

thing you almost want to stay up late to listen to. 

But you all -- I just wanted to just reflect on one 

thing, which was that I -- although I have not seen the 

letter, and I don't know whether it could be made 

available here for public dissemination, or maybe you 

all have it, but -- pardon? Whose web site? When? 

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MR. ELLIOTT: Pardon me? 

MR. MILLER: Is it on the web site, did you say? 

DR. ZIEMER: I don't know if it's on the web site yet. 

MR. ELLIOTT: Is that the Board's letter? 

MR. MILLER: The Board's letter, yeah. 

MR. ELLIOTT: To Secretary Thompson --

MR. MILLER: Yes, Secretary Thompson --

MR. MILLER: Yes. 

MR. ELLIOTT: I believe it's on the web site. 

MR. MILLER: As of when? Okay. All right, we'll look 

again. Okay. Well, I think what you agreed upon was 

that the statutory intent of Congress was to -- that 

the 22 listed cancers was in fact a fixed list and 

whatever -- whatever caveats you had, you at least --

it appeared from what I heard and the rumor mill that 

this was the view that the Board had reached as a 

consensus, and if that was the case, I hope that NIOSH 

takes that and HHS takes that to heart. 

I would just like to reflect on something that Dr. 

Melius had raised, which was with respect to the 

incorporation of worker studies. And if I understood 

the response, at least from Mr. Elliott was we'll take 

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up the question of worker studies after BEIR VII. And 

if that's right and if BEIR VII is say two years from 

now or a year and a half from now, we're looking at 

five years after the statute's been enacted before 

NIOSH begins to look at worker studies in its 

compensation model. And I just wanted to reflect and 

remind that the statute, in terms of setting the 

guidelines -- which is your IREP model -- requires that 

you at least take into consideration information on the 

risk of developing radiation-related cancers on work 

place exposures, and I know you all are familiar with 

it, but it just sort of struck me sitting there, we're 

going to have to wait five years to deal with that 

question. Seems to be a long time, and I thought Owen 

Hoffman's suggestion was really quite constructive, 

which is there's -- there are a number of studies out 

there which have come to multiple conclusions, and I'm 

not talking about a single study, but multiple studies 

that have raised questions, for example, as we've 

discussed in the past, age at exposure. Is the slope 

positive or negative with respect to age at exposure, 

and -- and the IREP model in some cases is linear and 

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in some cases it assumes that people are less 

radiosensitive the older they get. And -- and yet 

there are four or five studies out there now by three 

different authors, some of which were funded by NIOSH 

from the HERB branch, which seem to indicate well, 

there's a lot of uncertainty in this area, that -- that 

what we learned about the atomic bomb survivors and 

what we learned about workers are very different, that 

you have a positive -- you may have a negative slope, 

not a positive slope. And if that's the case, is there 

a way that, you know, SENES or others can propose ways 

in which those studies, where there are multiple 

studies -- not a single study but where there are 

multiple studies that seem to confirm that point, and 

it's a worker study -- that that can be accommodated 

sooner rather than later, because the effect, for 

example, on age at exposure is so stark. And yet we've 

got studies out there which seem to cast significant 

findings on worker studies that are different than 

those who were atomic bomb survivors, and we know a lot 

of the issues that came up with the atomic bomb 

survivors that may explain why you have a different 

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result for worker studies than you have from atomic 

bomb survivors such as the healthy survivor effect. 

But I would just like to propose at least for the Board 

to think about grappling with this sooner than waiting 

for BEIR VII, 'cause it seems like that's a long time 

to wait subsequent to enactment. 

The second question I guess I would be interested to 

hear about would be the -- the weight of evidence 

around chronic lymphocytic leukemia. The only reason I 

guess this sort of keeps coming to my attention was --

was -- 'cause I keep getting all these letters from 

claimants who FAX them to me at home and say -- from 

the Department of Labor that says Dear So-and-so, The 

probability of causation from chronic lymphocytic 

leukemia is zero. 

So, you know, curious about the CLL debate and going 

back to BEIR V, what we discover is that the 

statistical question before BEIR V was do we have 

enough cancers that are in excess of what was expected 

for that population, and there were two CLL cases 

identified in the life span study for mortality, and 

there was an expectation of 2.83 deaths from CLL. Now 

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I don't know if that's a statistically stable estimate, 

but I don't think it looks that way to me. It looks 

like a very unstable estimate, and there are a number 

of questions about the misclassification of CLL as it 

is. I mean, you know, hematologists and others will 

tell you it's easy to misclassify it for a number of 

reasons. And there are a number of others who have 

written on this subject extensively about how to treat 

all of the leukemias, and so I would just like to ask 

the Board to -- and maybe NIOSH -- to think about 

whether or not it is worth opening the inquiry, because 

I don't know that it's sustainable to say -- I don't 

know that it's defensible to say there's a zero percent 

probability of causation from any radiation exposure. 

Now in Germany just recently a court in northern 

Germany found, based on the work of Wolfgang Hoffman, 

who I've now learned is not related to Owen Hoffman, is 

-- has -- has -- has developed an extensive review both 

of literature and -- at the cellular level and 

epidemiologic level to indicate that in fact -- this 

was in a particular case involving an individual who 

had up to 400 rem -- was an X-ray technician -- that 

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this was a work-related radiation-related injury. Now 

if that's the case, and granted, it is merely a court 

decision and -- and -- and it was not -- but was based 

on, you know, the scientific weight that was brought to 

the table in that case, is this something worth opening 

up and looking at at this point, or is it a matter 

where the book is closed because it was closed in BEIR 

V or because Charles Land says it's not going to go 

into IREP? And I would just urge you all to think 

about that question and add it perhaps to that lengthy 

list of to-do's. 

Those are my comments. Thank you very much. And I 

want to also compliment the NIOSH and their staff for 

putting together a terrific meeting in terms of 

information, the wealth of individuals you brought 

here, so thank you very much. 

DR. ZIEMER: Thank you, Richard, for your comments. 

Let me ask if any of the Board members have questions 

to ask of Richard? There appear to be none. Thank 

you. 

Next we'll hear from Denise Brock, who represents 

United Weapons Workers and Denise is with us from St. 

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Louis. 

MS. BROCK: Hi, and I ask everybody to bear with me. I 

took notes while I was sitting here so I'll be 

shuffling and reading at the same time. It does not go 

in really good order. And for the record, my name is 

Denise Brock, and I do represent the United Nuclear 

Weapons Workers of the St. Louis region. I am here on 

behalf of all of Missouri Mallinckrodt workers. My 

mother is one of those claimants. I think the Board 

has met her. She is 80 years old and, for the record, 

she has had her phone interview in December and is 

still waiting dose reconstruction. 

Today I do have some comments to make, as well as some 

questions to be raised. First of all, I would like to 

state that this is just not about science. It is also 

about sick workers, dying workers, and the survivors of 

deceased workers. And in some cases it is also about 

incomplete science, things like -- or for example, 

Mallinckrodt. I would like to give just a brief time 

line -- there is a method to my madness. 

In April, 1942 Dr. Arthur Compton, a physicist from 

Washington University, met with Edward Mallinckrodt, 

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Jr. to ask if Mallinckrodt would sign onto a top secret 

project purifying uranium for making the atomic bomb. 

Mallinckrodt agreed, and Mallinckrodt thus steps into 

the forefront of the Manhattan Engineering District, 

later known as the Manhattan Project. 

Here we go with the paper shuffling. One of the first 

goals of the Manhattan Project was to build an atomic 

pile to see if the theoretical chain reaction would 

actually work. The scientists figured that they would 

need 40 tons of uranium oxide and six tons of uranium 

metal, along with graphite, to build the pile. By 

July, 1942 Mallinckrodt Chemical in downtown St. Louis 

was producing a ton of pure uranium oxide a day. The 

magnitude, scope and danger of this effort was 

unparalleled. Using the highest grade uranium ore, 

known as Belgian Congo pitchblende, allowed the Project 

to proceed quickly. The government's ambitious efforts 

to build this atomic pile or atomic weapons supply 

later took some of the very lives they were intending 

to save. 

For 24 years Mallinckrodt used 3,300 employees to 

produce more than 100,000 tons of purified uranium 

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metals -- or materials. At the outset Mallinckrodt was 

concerned about explosions from the ether used in the 

purification process. I understand that in Plant 4 

they were using this to make pure uranyl nitrate. 

The early absence of knowledge about the dangers of 

radiation led to some very cavalier approaches to the 

management of radioactive waste, not to mention the way 

in which Mallinckrodt workers handled these substances. 

For example, when they were handling this Belgian 

Congo pitchblende, the workers would take it off rail 

cars into the plant for processing with little 

protection other than cotton respirators and cotton 

work clothing. 

July of 1942 Mallinckrodt is producing a ton of pure 

uranium daily, but workers are told that they're 

working with uranium oxide SL42-17. Code names like 

green salt, tube alloy, biscuit, juice, oats, cocoa and 

vitamin were given to the various processes, and no one 

was to say uranium. It was top secret. No one really 

knew what they were working with. 

And somewhere between 1943 and '45, workers were told 

that they were performing a patriotic duty. The 

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Federal government built three cities for secret bombmaking -- Oak Ridge, Tennessee; Hanford, Washington; 

Los Alamos, New Mexico. In less than two years 

Mallinckrodt sends materials to all of them, and this 

is just a timeline of part of that. 

And back to the workers, I must reiterate what I've 

said in previous meetings. Claimants get letters 

stating that it could be months or years before dose 

reconstruction is completed on their claims. These 

people do not have months or years. They are dying. I 

have workers that have cancers that have came back. I 

have workers -- claimants that have died while waiting 

for this -- to get finished with their dose 

reconstruction. 

Most recently there has been an influx of Mallinckrodt 

claimants getting ready to have their phone interviews. 

This on one hand is a positive thing; it shows 

movement. But the unfortunate thing is these claimants 

are being sent questionnaires that they claim they 

cannot possibly answer, for several reasons. One was 

what I previously stated. These workers weren't told 

what they were working with. They were -- I say lied 

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to while they were being poisoned. They weren't 

monitored for all radionuclides or isotopes. And then 

you're looking at survivors of these workers. When the 

workers maybe that actually had an idea what they were 

working with were told to keep it secret and they took 

those secrets to their grave, this leaves the 

survivors. You're talking about 70 to 80-year-old 

people having to know things like this. It's almost 

impossible. I have claimants, survivors, women calling 

me crying or coming to my house saying I'm never going 

to get paid, this is a hoax, this is ridiculous, I'm 

just going to give up. I've got people that have 

cancer that are having to have $1,800 shots. I've got 

a mother that can't afford her medicine. She's had a 

quadruple bypass, and it's not an anomaly. These 

people are sick and are waiting for this to be 

expedited, and it's not happening. And I don't think 

it's on purpose. I don't think it's with malice or 

forethought (sic), but it is the truth. It just -- it 

seems like it's stagnating or laying somewhere. 

I've got workers that are living that are sent 

questionnaires that are -- it's actually I think page 

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four, I believe, on the questionnaire, and it actually 

says on there which radionuclides were you exposed to, 

things like tritium, cobalt, actinium, protactinium, 

polonium. These workers don't know what that is. Next 

-- and then it says you can answer yes, no, don't know. 

All respect to Dr. Toohey, he's wonderful. I did call 

him. I had two claimants actually at my house, two 

older men that are very sick, just on the verge of 

tears saying I have no idea what this is. I don't 

know. I wasn't told. So I talked to Dr. Toohey and of 

course Dr. Toohey said they can say no or don't know, 

and obviously they're concerned if they do that, that 

somehow is going to have a negative effect on their 

dose reconstruction. That, too, would be my concern. 

Then you've got something next to it that says isotope. 

They don't know what an isotope is, and then it says 

solid, liquid or gas. And my question to Dr. Toohey 

was, if this stuff concentrated, we don't know if or 

where, could that form change? I mean this is an awful 

lot for these 70 and 80-year-old sick workers or 

survivors of such to know. 

So what I did was I researched what radionuclides went 

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with what facilities, and I put a key there because we 

have three Mallinckrodt facilities. And there wasn't 

enough room, so I made my own paper, then I got the 

isotopes and I filled all that out and I called a 

meeting for those that were getting ready to have their 

interview and I gave that to them so whoever interviews 

these people will be prepared because these people do 

know now what they were exposed to that they didn't 

know then. 

And my question, too -- I do have a question. Some of 

the claimants have, as well. Once that phone 

interview's done -- like I said, my mother had hers in 

December -- the question would be I guess is there a 

site profile completed on Mallinckrodt yet? Is that --

is that finished, completed? 

MR. ELLIOTT: No, it's not completed. It is being 

worked on. 

MS. BROCK: Being worked on. I understand, but I guess 

my confusion here is if there's limited to incomplete 

individual data -- for example, I filed a FOIA request 

on my father on behalf of my mother, and I got a call 

from the Department of Energy stating that they did not 

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have the records or access to such, would I like to 

withdraw my FOIA? I said absolutely not. If you don't 

have it, then you put it in writing. I'll take it to 

my senator. 

Well, then I get a letter in the mail -- actually, I'm 

sorry. Then I understand that they said by not having 

access, the Department of Energy did not own those 

records, the vendor did, and I believe there's a 

statute that says that DOE is to go to that vendor. 

Well, we have a problem there because Mallinckrodt was 

bought out by Tyco*. We have all sorts of problems. 

Make a long story short, I get something back from the 

Department of Energy stating my dad was under Q 

clearance and they've destroyed his records. This 

again is not an anomaly. My concern here is if you've 

got workers and their records are destroyed and they've 

had multiple job titles, multiple exposures, how are 

you going to dose reconstruct them? I have grave 

concerns. I'd like -- I've said this in the past about 

using coworker data. I have workers telling me badges 

were laundered. I have no idea what that means. And 

if you're basing this on site information, we had 

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actinium, protactinium. I recently found out we even 

had beryllium. I mean if -- if the health physicists 

are aware of this, why are you asking the workers when 

they have no way of knowing this? 

DR. NETON: I'd just like to maybe clarify a little 

bit. The purpose of the questionnaire is really not to 

have the claimant provide a detailed response to us, 

although that would be certainly beneficial to us. But 

it's really just to get the record -- a complete 

record. We felt that it's very important for the 

claimant to be able to represent what they felt they 

were exposed to or what they were exposed to, so we 

could compare that to the record that's in the 

Department -- the Department of Energy provides. In no 

way is -- are we relying solely on the claimant's 

response to the questionnaire to complete a dose 

reconstruction. 

MS. BROCK: The next thing I wanted to say was that I 

understand Mallinckrodt produced a residue containing 

radium in the process of recovering uranium from the 

Belgian Congo ore. This residue was known as K-65 

residue. In 1949 about 200 pounds of this residue was 

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shipped to Mound, Ohio. Eighty drums of rather 

inhomogeneous material was supplied by Mallinckrodt 

known as Sperry presscake, which consisted of a matrix 

of iron, protactinium, aluminum, calcium, magnesium, 

cobalt and copper. Kotter* Company also received 

100,000 tons of material from St. Louis, possibly 

tailings in the '60's and '70's. These were from the 

Belgian Congo processing. During the Dodge v. Kotter 

trial a deposition was taken of a Kotter manager where 

he admitted that materials from St. Louis had plutonium 

in them. I'm assuming that must have been -- because 

I've recently researched and found it was PU-244. I'm 

not a scientist or health physicist, so I hope that's 

correct. I understand that's a natural-occurring 

plutonium, and I understand that maybe there was a 

criticality underground in Africa that could have 

caused that. I'm not quite sure if that's correct. 

I would also publicly like to state again -- and please 

don't anyone take this personally, but I just feel that 

Mallinckrodt should be a Special Exposure Cohort, 

especially if there are only two criteria needed to 

meet that. Number one, that the workers were 

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endangered. I think that's a given. And number two, 

that NIOSH cannot dose reconstruct with sufficient 

accuracy. And Senator Bond, which is a senator in 

Missouri, will actually be flying in his DC Labor 

person on the 27th to talk to me about that I've 

briefed their office once, and I am hoping with 

everything I have that -- that this goes through 

because, to me, these workers are dying. It would be 

the quickest way -- it would expedite this. But beyond 

that, they were exposed to things they were never 

monitored for. And unless Larry wants to tell me he 

can go ahead and just slap a 150 to all of them, I just 

think that would be the best way for me to do that. 

I just have a couple of questions if you -- am I taking 

too long? 

DR. ZIEMER: You're okay, Denise. 

MS. BROCK: Okay. Dr. Neton said that the site profile 

was not finished yet. Could you tell the Mallinckrodt 

workers, do you have any idea -- how long do you think 

it will be before the site profile is done or what else 

-- I understand you're getting ready to go to SLU, or 

St. Louis University, and then possibly to Georgia to 

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collect more evidence or more information or data. Do 

you have any idea how long it will take to finish this 

profile before you can start dosing these workers? 

DR. NETON: I think the site profile has been started 

on Mallinckrodt. I know it's been started -- I would -

- I can't give you an exact time frame, but I would say 

it's a matter of months, in the next several months 

it's on the agenda to be finished. We had recently 

completed a data capture effort at the DOE Germantown 

office where we found boxes of Mallinckrodt monitoring 

records that we're going through and assembling. As 

you know, ORAU -- Mallinckrodt has also been studied 

extensively by ORAU, our contractor, in previous 

epidemiological studies, so there exists a large volume 

of records there. So the short answer is that there --

there's a tremendous amount of -- a large amount of 

information available at Mallinckrodt that we need to 

review to develop the site profile. And it in general 

is to the claimant's benefit that we do that so that we 

can make sure that the doses that we assign are 

accurate, and in fact that we do contribute a missing 

dose to their records that may have not been captured 

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in the monitoring program. But it will be a matter of 

several months before it's completed. 

MS. BROCK: And I agree. I mean I would hate to see a 

site profile rushed through. I mean you want to make 

sure that it's not incomplete, that there are things 

there. But my concern, too, is if there are things 

that these workers are not monitored for, such as the 

actinium and protactinium, we've got three types of 

radium, three types of radon gas, just enormous amount 

of things. I know that you say you can use site 

information to dose these workers, and maybe use a 

worst case estimate. How do you keep from 

underestimating that worst case? Maybe I'm just 

confused, but I don't understand how you do that. 

DR. NETON: Okay, it has to do with the uncertainty 

distribution, which we've seen a lot of evidence 

discussed today with Dr. Kocher's presentation, but 

it's similar to that -- to that process. We take a 

look at the available evidence related to the 

monitoring information, and if there is no monitoring 

information on the workers, we'll look at the air 

sampling information. And using that, we'll take a --

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we'll make a best estimate, a best judgment of what the 

most likely exposure scenario was in the work plant. 

But then we will assign a distribution of values about 

that. And in sampling for the probability of 

causation, when it's run through -- we'll assign that 

distribution about the central estimate, and then when 

the Department of Labor runs the probability of 

causation calculation, it will use that distribution of 

all possible exposures to come up with the probability 

of causation. So it's sort of built into the model. 

MS. BROCK: Hypothetically speaking, if I would get 

this SEC to go through, what happens if claims are 

actually dose reconstructed and denied? Is there a 

possibility that I could help those people that have 

been denied? Can they later go into the Special 

Exposure Cohort? Is that a possibility? 

DR. NETON: The rule makes a provision for any time new 

information comes forward, it provide -- either 

discovered by NIOSH or provided by the claimant, Labor 

can reopen the claim and re-evaluate it at that time. 

So that's a definite possibility and that's provided 

for. 

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As far as once the claim has been denied and then being 

moved over to the Special Exposure Cohort, I'm not 

sure. Maybe Ted Katz could shed some light on that 

issue. 

MR. KATZ: I mean if -- if they're denied it through 

dose reconstruction and then they're added to the 

Special Exposure Cohort, there's a lot of steps in 

between that that would explain that, but certainly if 

they're added to the Special Exposure Cohort, then they 

would be compensable claims under the provisions of 

that cohort, yes. 

MS. BROCK: I only have like three more questions, 

sorry. 

The 22 cancers, I understand there's only 22 cancers in 

the Special Exposure Cohort. I do have numerous people 

with prostate cancer, skin cancer. If the Special 

Exposure Cohort goes through and you're saying dose 

reconstruction cannot be done with sufficient accuracy, 

those people fall through the cracks or are they dose 

reconstructed? 

MR. ELLIOTT: We are doing dose reconstructions on 

prostate, skin, for the current SEC cohort members. 

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These folks that you've identified for future classes 

to be added to the cohort would then be without remedy 

at that point because we would be in a position where 

we've said we could not do dose reconstruction for that 

class. 

MS. BROCK: Are you saying that prostate and skin are 

part of the 22 cancers? Did I misunderstand that? 

MR. ELLIOTT: No, no. 

MS. BROCK: No. 

MR. ELLIOTT: I'm saying that currently we are doing 

dose reconstructions for members of the Special 

Exposure Cohort who present with prostate, skin and 

other cancers not of the 22. Now that's what's going 

on now. 

Once the rule -- our rule on Special Exposure Cohort 

classes is in place and we add a class to the Special 

Exposure Cohort, that is under the premise that we 

can't do dose reconstruction. So unfortunately, at 

this point, those folks who present with a cancer not 

on the list of 22 would be without remedy. 

MS. BROCK: Okay, thanks. Now this sort of has to do 

with the Special Exposure Cohort, too, I guess, and not 

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to beat a dead horse because I've brought this up 

before, but we had talked about this smoking. And I 

noticed today that one thing that wasn't mentioned was 

a former smoker, and I understand that RECA actually 

removes the smoking in 2000, so I just think -- I'm 

confused. Isn't it merely to be a consideration? I 

know with smoking it's an automatic pay in the SEC, so 

I'm wondering again if you've got two workers side by 

side, they both present lung cancer, one's a smoker, 

one's a non-smoker, where's the equity? I mean 

nobody's disputing that smoking causes cancer. It's 

about equity, and I'm not understanding how that's 

equitable. 

MR. HENSHAW: Russ Henshaw, NIOSH. I'm not sure, 

Denise, if I can answer this question this time any 

better than last time, but I guess all I would say is 

that smoking in lung cancer is one of the issues we're 

going to reconsider in the future, and hopefully 

incorporate additional studies such as the Pierce study 

that Owen Hoffman reviewed earlier. But beyond that, I 

don't think there's anything we can add to that at this 

point. 

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MS. BROCK: Just two more. The bone cancer, I was just 

a little bit confused as I don't know if that pertains 

to us or not. If you have -- are you saying that the 

latency period should be lowered to five years? Is 

that right, that if a person contracts or diagnosis --

right now is it ten years? It should be lowered to 

five? 

DR. ZIEMER: Owen or one of the SENES people may want 

to address that. My recollection is that they were 

saying the latency period perhaps should be shorter, 

which would be more claimant-friendly, by the way. 

DR. HOFFMAN: Yes, I -- it was in Iulian's presentation 

this morning that this was brought up, and as a 

precursor to the details on thyroid cancer. But 

basically -- and NCI is doing this in the NCI version 

of IREP is -- is correcting the latency for bone cancer 

to allow for some probability of causation when the 

cancers would be presented much earlier than is 

currently considered. And the question is before 

NIOSH, to what extent is this a significant enough of 

an update that they would like their version to reflect 

that assumption as well. 

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MS. BROCK: Thank you. And the next two are just --

are just statements. One would be in reference to 

Shelby Hallmark from the Department of Labor stating 

that any help would be appreciated. I've actually 

talked with the Missouri -- the head of the Missouri 

Building Trades Council and they've actually asked me 

to come in and speak with them. They said that they 

thought that that would generate thousands upon 

thousands of claims, so I'm supposed to go talk with 

them when I get back, after Senator Bond's office, and 

that will cover the iron workers, construction, 

dismantling, cleanup, what have you, so I will be doing 

that next as well. Be really nice if you want to pay 

me, that would -- hook me up, that would be great. 

And I would also like to again ask the Board to please 

come and have a meeting in St. Louis because this is 

really tearing my budget up paying for all that 

paperwork I send out to people to generate claims, and 

then I have to try to get to these meetings, which I 

don't want to miss. But if you would come to St. 

Louis, it would be greatly appreciated and I'm sure I 

can drum up plenty of people for public comment. And 

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thank you very much. 

DR. ZIEMER: Thank you, Denise. Mark, comment here? 

MR. GRIFFON: I just wanted to comment on one of 

Denise's first points about the interview process and 

the question -- I mean it's come up in a couple of 

public commenters about maybe we need -- maybe these 

questionnaires, the interviews, could have a sitespecific component or could have site-specif-- people 

that know these sites better to conduct those. And I 

don't know if any of that is happening, being 

considered, I -- I --

DR. ZIEMER: I thought that Dick Toohey spoke to that 

at the last meeting. I think the answer was yes, but -

-

DR. NETON: No, there's no site-specific component 

because it's an OMB-approved script that we have to 

follow. However, we do afford the opportunity, if the 

claimant suggests something that we could follow up 

on, we would do that. But at this point, we're not 

considering a site-specific script. 

I will say that in general we're not requesting the 

claimant to go through -- it's not our approach usually 

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to go through an entire list of the periodic table and 

ask them if they were exposed or not exposed. The 

intent was to which nuclides, if you're aware, were you 

exposed, and that is a list that would be used to 

invoke maybe some memory. So it's -- and I think where 

the confusion arises, we mail this script at the time 

that the interview is going to be scheduled to the 

claimant, just so they can go over it and get 

comfortable with the lines of inquiry that we're going 

to be, you know, talk through. And I think some people 

receive the script and think that it's a detailed, 

blow-by-blow thing that they're going to have to know 

every answer, and that's maybe where the confusion 

arises. 

MR. GRIFFON: I guess the -- the -- just reflecting on 

the last draft that came out about the interviews, or -

- or the information from workers I guess. They 

weren't really interviews but a provided scripts or 

information of what they did on their jobs, and again 

and again, going through that report, I read that the 

analyst tend -- tended to downplay some of this -- and 

partially because, I think -- or one of their 

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conclusions in the report, and I may be summarizing 

this wrong, but I think was that pulling the string on 

all these things, to use your terminology, was going to 

be very extensive. So my concern is that this 

questionnaire process just doesn't become another check 

mark in the processing of these claims, but rather that 

NIOSH make -- there's some valuable information that 

can be pulled from these claimants, rather than saying 

well, if they can't answer it, we've got the answers. 

I mean I think that -- and I -- go ahead, Larry. 

MR. ELLIOTT: I got to talk to this. 

DR. ZIEMER: Response, Larry. 

MR. ELLIOTT: Let's go back to the start here. You 

know, NIOSH -- I come forward and said we needed to 

have an interview process here. It wasn't part of the 

statutory requirement. We're very much interested in 

hearing what the worker has to say. We interview 

workers on the shop floor in all of our studies, in all 

of our hazard evaluations, and so why not use that 

experience in this program as well. We're very much 

interested in hearing what the worker has to say and 

we're not using it just as a check mark or checklist. 

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I'm sorry, I'm very passionate about this, but I need 

to be passionate about this because NIOSH needs to 

stand here and our integrity needs to stand up, and 

this is part of that. So we're taking this very 

seriously. 

Could we do a better job on getting our interviews in 

the hands of the claimants? I think we can. I think 

we can do a better job of communicating the intent 

behind what we provide in advance of the interview, 

that it's not a -- we don't expect the claimant or the 

survivor of the claimant to have all the answers. But 

what we hope to be able to do is to help fill in some 

gaps that may not exist in the -- and probably don't 

exist, in all cases, in the DOE submittals that we get 

back in our requests for dose information. So that's 

the purpose and the intent behind this and I assure you 

we take it very seriously and we want to hear what the 

worker has to say. 

DR. ZIEMER: That may be a key thing to make sure that 

-- 'cause there may be a mismatch here. It sounds like 

some of these survivors are thinking that the burden is 

on them to come up with all this technical information, 

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so somehow it's not made clear to them that this -- if 

you know something that we haven't culled out already, 

we want to hear what that is. But somehow that message 

needs to be communicated. 

DR. NETON: I agree, I'd just like to comment on one of 

Mark's comments about the site-specific scripts. I 

mean I don't mean to imply we couldn't develop a sitespecific script and get it cleared through OMB, but I 

think that we may sort of predispose the interview at 

that point, you know, if we had a specific list and we 

-- you know, then we wouldn't be able to pull out the -

- if we had a script of nuclides at Mallinckrodt, say 

were you exposed to uranium and they came back and they 

had information and said no, I was exposed to 

plutonium, we wouldn't -- we wouldn't learn that. So 

we try to keep it as an open forum as possible in this 

process. 

MR. GRIFFON: I'm not saying put words in their mouth, 

either, with a site -- you know, some sort of -- that 

you have -- you know, that kind -- but I think there 

could be ways to do it site-specific. And I'm not --

and I know NIOSH's intent is to get this information. 

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I just wanted to -- it's more of a reflection on this 

report that I was just looking at that we need to keep 

our eye on the ball with this and that they may not 

know -- I was just reflecting on the comments I heard 

about -- and my research that they don't know the 

radionuclides necessarily, but they have a lot of 

valuable information that they can provide that when I 

combine it with our other technical information it can 

really validate your scenarios and your site profiles 

and stuff like that. So that's all I was saying. 

DR. ZIEMER: Okay. Thank you. Let's move on then. 

Our next commenter is Philip Foley who is with PACE, 

and Philip is here from Kentucky. 

MR. FOLEY: I'm with the worker health program in 

Paducah, Kentucky, and I'm hesitant to speak, but after 

setting in this meeting, I feel I'd be doing my people, 

my coworkers, a disjust-- a injustice if I didn't say 

something. 

We -- I have serious concerns with the dose 

reconstruction because what placed Paducah in the 

Special Exposure Cohort in the first place was that the 

data -- there's a lot of data available. Mark's gone 

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through a lot of data at Paducah. But it was shown 

that it was questionable, at best. And if I understand 

correctly, when you do a dose reconstruction, you're 

going to get this data from Paducah. Well, it's the 

same data that placed us in a Special Exposure Cohort. 

Just one -- I guess a for-instance. We had -- we've 

had some risk mapping sessions. We'd asked the 

gentlemen that were in releases, have you -- did they 

do urine samples? Say yes. Well, how soon? Twenty 

to 30 minutes after the release. So there's tons of 

data, but it was taken at the wrong time. So you know, 

you can look at this data and it will show that well, 

they -- they weren't exposed. But that's because it 

was taken too early. 

There's a lot of things that you're not going to find 

out -- I personally spent three weeks with an air hose 

on top of a crane blowing all the dust and paint scale 

and everything out of the 400 building, which is a 

cleaning building, where they had a compressor shop, 

they had a spray booth, I think they had a -- we found 

out since, probably a neptunium trap, many things that 

they had in this building. You know, these are the 

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kind of things these people are up against. 

I saw the same letter, their questionnaire, that Denise 

was talking about, and this gentlemen called me, was 

about a 55-year-old retiree from our plant, and he was 

upset. He was concerned because this page that listed 

all these isotopes, said have you ever been exposed to 

these. Well, you know, when I hired in in 1975 -- and 

I'm sure -- I know long before that, when we asked 

questions -- as an electrician, when I asked a 

question, they said you don't need to know. You know, 

this is national security. You don't have a need to 

know. So we didn't know what was going on. 

Now since, in the last three years working in the 

worker health program, I've heard stories of these 

gentlemen, when they brought the spent reactor fuel 

from Hanford, stored it outside the control room in 

barrels. They didn't know what was out there. Some of 

them knew it was spent reactor fuel, but they didn't 

know what was -- you know, it was just setting out in 

the building. We had barrels of green salt all over 

our buildings. There's a lot of exposures that people 

probably weren't even tested for. 

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And I guess what I'm -- what my concern is, you know, 

we've been called cold war veterans. I've heard us 

called that and I've made this statement in a 

Congressional hearing for Senator Bunting and also in a 

DOE public meeting. You know, we're called cold war 

veterans, and all we're asking is just don't leave us 

out in the cold. You know, don't -- don't make us go 

through some of the things like Denise was talking 

about. We've got the 70, 80-year-old people. You 

know, they don't know -- if you do a phone interview 

with them, some of them that I talked with, you know, 

they don't have -- their attention span is not very 

long. They're not going to -- they're not going to be 

able to set and go through this phone interview. I set 

in on this gentleman with a phone interview and the 

interviewer did a fine job. He didn't ask leading 

questions. He listened to the guy. But I don't know 

what he reported. And all I'm asking is just don't 

leave us out in the cold. Help these people out. 

DR. ZIEMER: Thank you, Philip. That concludes all the 

names I have on the public comment list. Are there any 

other individuals that were missed that I don't... 

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Okay, if not, let's quickly turn attention to 

tomorrow's schedule. The Board will be reconvening at 

8:00 o'clock in the morning. We actually start our 

formal session at 8:30. There will be a session for --

basically for the Board. This is an ethics training 

session that we're required to go through. 

We will have a working session where Mark Griffon will 

lead us through the next steps on the dose 

reconstruction process that we're preparing for the 

Board's quality assurance program, if I can use that 

terminology. 

There will be additional opportunities for public 

comment tomorrow morning, as well. 

Oh, and I'm sorry, I did miss -- we are going to have a 

report on the epidemiological research program of the 

DOE workers, so we will get a status report on that. 

Thank you. 

Also, tomorrow afternoon after the formal session, some 

of the Board members will be touring the Oak Ridge 

facilities. This will not be a formal Board meeting. 

There will be no business conducted, but an opportunity 

for some of the Board members to see some of the 

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facilities here in the Oak Ridge area. 

I'm going to ask Cori if we have any additional 

housekeeping items that we need to take care of today. 

MS. HOMER: Just don't leave anything in the room. 

DR. ZIEMER: Yes, do not leave things in the room 

overnight. 

So we'll now go into recess until 8:00 o'clock tomorrow 

morning. Thank you very much. 

 (Meeting adjourned) 

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2 C E R T I F I C 

3 A T E
 

STATE OF GEORGIA ) 

) 

COUNTY OF FULTON ) 

I, STEVEN RAY GREEN, being a Certified Merit Court 

Reporter in and for the State of Georgia, do hereby certify 

that the foregoing transcript was reduced to typewriting by 

me personally or under my direct supervision, and is a true, 

complete, and correct transcript of the aforesaid 

proceedings reported by me. 

I further certify that I am not related to, employed 

by, counsel to, or attorney for any parties, attorneys, or 

counsel involved herein; nor am I financially interested in 

this matter. 

WITNESS MY HAND AND OFFICIAL SEAL this _____ day of 

June, 2003. 

___________________________ 

 STEVEN RAY GREEN, CVR-CM 

 GA CCR No. A-2102 

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