Introduction

John Howard, M.D.
Director, NIOSH

By virtue of our mandate to conduct research and make recommendations for the prevention of work-related injury and illness, NIOSH work touches a wide array of workplaces and occupations. Knowing this, many may still be surprised to learn that NIOSH provides scientific support to a Congressionally-mandated program that dispenses compensation and medical benefits for nuclear weapons workers who may have developed certain work-related illnesses. As you will read in this blog post, the NIOSH Office of Compensation Analysis and Support (OCAS) assists with implementing a program created by the Energy Employees Occupational Illness Compensation Program Act of 2000 by completing dose reconstructions and other technical activities.

While somewhat different from our typical research and prevention activities, the NIOSH role in this program speaks to our credibility as a scientific institution. When developing the program, Congress needed to ensure that an organization with the appropriate scientific skills and expertise could objectively evaluate the radiation exposure faced by former nuclear weapons workers. Our experience with risk assessment combined with our previous work with uranium miners and the research conducted by the Health Effects Research Branch made NIOSH the logical choice. Additionally, NIOSH’s reputation as a good steward of the scientific process ensured an unbiased evaluation of the amount of radiation likely received by the energy workers.

As you will read in this blog, dose reconstruction is a scientifically complex process. In fact, the entire Compensation Program involves many challenging issues—many of them outside the realm of science. The NIOSH process has always been an open one. And, as always, we welcome comments and questions. The blog provides yet another tool for this open dialog.

Overview

The National Institute for Occupational Safety and Health (NIOSH) established its Office of Compensation Analysis and Support (OCAS) in 2001 after Congress passed the Energy Employees Occupational Illness Compensation Program Act of 2000 (the Act). Under the Act, the Department of Labor (DOL), the Department of Energy (DOE), the Department of Justice (DOJ), and the Department of Health and Human Services (HHS) were each tasked with certain responsibilities. DOL was tasked with administering the compensation program, DOE with providing employment and exposure records, and DOJ with handling claims involving the Radiation Exposure Compensation Act. HHS was tasked with providing scientific support and expertise by completing radiation dose reconstructions, overseeing the Special Exposure Cohort petitioning process, and conducting other technical activities; tasks which were to be carried out by NIOSH. More information about these tasks follows below.

The Act allows energy workers who were involved in nuclear weapons production activities (or their survivors) to file claims with DOL to seek compensation for illnesses caused by workplace exposure to radiation, beryllium, silica, or other toxic substances. If DOL determines that the energy worker (1) had the potential for workplace radiation exposure and (2) had developed cancer, then the claim is forwarded to NIOSH for a dose reconstruction before DOL makes its final compensation decision. All other claims involving beryllium, silica, and other toxic substances are handled solely by DOL and not forwarded to NIOSH for dose reconstruction. Under the Act, dose reconstruction is an accepted scientific method used by NIOSH to determine the amount of radiation a worker likely received while employed at a DOE facility or an Atomic Weapons Employer (AWE) facility.

DOL uses the results of the dose reconstruction to assist in determining the Probability of Causation (POC)—that is, the likelihood that the worker’s cancer was caused by his/her workplace exposure to radiation. If the POC is 50% or greater then the energy worker (or his/her survivors) is eligible for compensation; $150,000, plus medical benefits for surviving energy workers for their cancer treatment.

Between October 2001 and December 2007, NIOSH received more than 26,000 claims for dose reconstruction. NIOSH has completed more than 73% of these claims and returned them to DOL for a compensation decision. In 2007, NIOSH completed more than 400 dose reconstructions per month on average.

Dose Reconstruction

Under the Act, NIOSH was responsible for developing the methods for conducting dose reconstruction. When conducting a dose reconstruction, NIOSH may use personal radiation exposure data such as film badge readings, urine sample data, incident reports, medical x-rays, and employment history, as well as other information such as co-worker data, environmental exposure records, and process records. In addition, program participants have the opportunity to provide additional information to NIOSH during a voluntary telephone interview.

The dose reconstruction process is complex. It utilizes many sciences including physics, chemistry, biology, and statistics. Each claim is unique and must be handled on an individual basis. The collection of radiation exposure data can be time consuming because exposure records may not exist or may be difficult to retrieve. Additionally, it may be necessary to investigate inconsistencies between radiation exposure records and the input received from workers and their survivors during the interview process. NIOSH makes every attempt to ensure that all possible radiation exposure the worker may have received is accounted for in the dose reconstruction.

Probability of Causation

NIOSH was also tasked to develop the guidelines used by DOL for determining a worker’s POC. Under these guidelines, NIOSH supplies DOL with the dose reconstruction results, which includes the worker’s radiation dose estimates for each year he/she received an exposure, the type of exposure, and any uncertainty distributions associated with each estimate. In addition, personal and medical information such as birth date, cancer diagnosis, date of diagnosis, gender, race/ethnicity, and smoking history may be required when determining a worker’s POC. DOL uses this information to calculate the worker’s POC and determine whether his/her cancer was “at least as likely as not” (50% or greater) related to workplace radiation exposure. The Act requires these determinations be based on the upper 99% confidence interval to ensure each worker is given the benefit of the doubt before a final compensation decision is made. In other words, there is only 1 chance in 100 where the true POC value could be greater than the value used by DOL to determine compensation. This favorable approach ensures that NIOSH does not under-estimate the worker’s radiation dose in any case.

Special Exposure Cohort

Under certain circumstances, the Act permits program participants to by-pass the dose reconstruction process and receive compensation as part of the Special Exposure Cohort provided the worker meets all eligibility requirements. To date, the Cohort currently includes 29 different groups of workers and more than 1,000 workers and their survivors. The Act itself designated 4 of these groups as members of the Cohort and allows petitions to be filed for adding other groups of workers. NIOSH is responsible for evaluating each petition that is filed and determining whether it is feasible to conduct dose reconstructions with sufficient accuracy for the identified group of workers.

For more information about the Special Exposure Cohort, the NIOSH dose reconstruction program, the Act, or any of its guidelines/procedures, visit OCAS on the NIOSH Web site.

—Larry Elliott

Mr. Elliott is the Director of the NIOSH Office of Compensation Analysis and Support.