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NIOSH Dose Reconstruction Program

Categories: Chemicals, Exposure, Manufacturing

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

Welder with torchThe 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.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. January 22, 2008 at 9:07 pm ET  -   Rose Marie Waterman

    Fine idea, however, we workers who found that our actual uranalysis bioassays were sent to Las Alamos and buried in the soil can never prove our cases up to the 50% or above status needed for compensation. I worked at Fernald, received back a denial from DOE initially although it was obvious that much of the information that was contained in my file was never looked at during their determination (i.e., such comments as “prostate cancer”, “office worker”, “no information on number of pregnancies or live births”, etc.)when that information was shown on my intake documents. I am a woman (no prostate, although an “office clerk” by paygrade status, worked in every production facility on site at one time or another because of the scope of my job, and never had any births as I was unable to have children. This joke was continued through the DOL process. I finally requested that my case be held and not further considered until I could obtain the records that were missing from my file for 17 uranalysis bioassays from April of 1984 thru September of 1984 when I left Fernald’s employ. These records show “N/A”. When I inquired as to why the results of these tests which were done immediately after the last one that indicated I was inhaling and ingesting uranium and radon at a fairly high level, I was told that these records were sent to DOL for “their eyes only”. Later, when I requested these records be released to me under the Freedom of Information Act and other such viable release documents, I was informed that these records were now in the soil at Las Alamos and because of the levels of contamination in that soil, the records could never been dug up. So this is what I am left with: no way to prove my claim! If DOE admits that there is a 23 to 29% chance that I got cancer from the work I did at the facility because of my exposure, then simple logic says that I should be compensated. Even one test that revealed contamination in my system in April of 1984 and continuation on the same job on the dirty side should be proof enough that the carcinogens were not only a contributing factor but largely the causation for the cancer and subsequent other illnesses that I now have, those being, peripheral neuropathy (loss of use of my lower legs spreading into my spine), and emphysema. No one is making a determination beyond a shadow of a doubt in a positive determination on my claim as stated above. We at Fernald have no way of reconstructing our records thanks to DOL. Anyone care to look into this? Can’t disprove it so err on the side of the worker!

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  2. January 22, 2008 at 11:19 pm ET  -   Terrie Barrie

    On May 2, 2007, a professor, whose name was redacted from the transcrips, offered public comments to the Advisory Board on Radiation and Worker Health (pages 144-154 of the transcripts) objecting to the scientific validity of NIOSH’s methodology in reconstructing dose under EEOICPA.

    What steps has NIOSH taken to continue the dialog with this professor? If no follow up contact has been made to date, when do you anticipate a call or meeting with him to discuss his comments?

    I also understand that the data from the late Dr. Ruttenber has been offered to you for the Rocky Flats site profile and SEC petition. Has NIOSH formally requested this data from Margaret Ruttenber? If not, when do you expect this request to be sent? If the data has been requested, what was the response?

    Thank you for your kind consideration. I look forward to your reply.

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    • AUTHOR COMMENT March 6, 2008 at 4:00 pm ET  -   Larry Elliot

      NIOSH has had no further contact with the individual who offered comments during the public comment session on May 2, 2007. In general, the comments detailed the individual’s concerns with the manner in which radiation risks are estimated. These concerns have already been considered by the National Cancer Institute, who developed the risk models upon which NIOSH relies, and by NIOSH as we applied the risk models to an occupational exposure. No new technical information was presented, nor were issues raised that required clarification or follow-up communications with the commenter.

      The raw data upon which Dr. James Ruttenber relied are the same data used in the Rocky Flats Neutron Dose Reconstruction Project. NIOSH already has this data in hand, and it has been considered both in the dose reconstructions for Rocky Flats workers, and in the evaluation of the Rocky Flats SEC petition. Nonetheless, NIOSH is currently working to obtain Dr. Ruttenber’s files and data.

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  3. January 23, 2008 at 12:25 am ET  -   Ione Smith

    Dear Mr. Elliott,
    Thank you for the opportunity to ask you a question that has bothered me for many years. My question is this:

    Why are the rarer types of cancers compensated at such a low rate? For example, multiple myeloma seems to have less than .02% of the claims found favorable under PoC, yet MM is one of the kinds of cancers that is most often linked to radiation exposure. This does not make sense to me. Thank you in advance for your feedback.

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    • AUTHOR COMMENT March 6, 2008 at 4:00 pm ET  -   Larry Elliot

      Under the scientific methods we use, the rarity of a cancer per se does not influence the dose reconstruction. The risk models that are applied to dose reconstructions, however, attempt to provide fairness in assessing whether it was more likely than not that a rare cancer was caused by work-related exposure to radiation. Our models were adopted—as required under the Energy Employees Occupational Illness Compensation Program Act—from those originally developed by the National Cancer Institute for estimating risks of different types of cancers from exposures to radiation. These NCI models were based on cancers observed in the Japanese survivors of the Hiroshima atomic bomb explosion. In regard to multiple myeloma, relatively few cases were found among the Hiroshima survivors, therefore, NCI combined multiple myeloma cases with lymphoma cases to create a combined risk model for lymphoma and multiple myeloma. In this way, an association between the exposure to radiation and a rare cancer would be statistically strengthened. That being said, our methods also incorporate several other factors that must be considered in a scientifically rigorous dose reconstruction, such as the target organ or tissue for a given cancer or the time from first exposure until diagnosis of the cancer. In the case of multiple myeloma, the target is the red bone marrow. Because many radionuclides do not concentrate in this tissue, the dose of radiation received by red bone marrow is often times relatively low.

      NIOSH cannot specifically address your estimate of a 0.02 percent compensation rate for multiple myeloma because we do not know the source of where you obtained this information. Our analysis of claimant data indicates that as of September 2007, the compensation rate for multiple myeloma under Part B of EEOICPA was approximately 6%.

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  4. January 23, 2008 at 10:52 am ET  -   Charles D. Saunders

    Niosh, I would like to know how you can only give me a 22.57% Causation when you stated you couldn’t determine as to my work location at Rocky Flats Plant for those 16 Years? Why did you not use any of the documentation I referred to on paper and in Phone interview? With it coming out in the news that a CT scan can even cause Cancer then any Causation Percentage would be a reason for granting a claim? Where are your calculations for the years for witch I was in 881 being bombarded by Plutonium in the DUCT work and Concrete in the building that was enough to reclaim before tear down? Why is the building not completely tore down, because the concrete was to highly contaminated that Contractors just buried the Building 881 along with 771 Building which during the whole time I was getting radiation that didn’t show up on the Cold side badge which checked for other types of radiation and I think one of my good friend was given the wrong badge and he turned up Real Hot and they wanted to know where he got hot? He Didn’t know! No mention of this was mentioned in my D/R report you all sent me at my request and all the other information I gave you to be able to do a correct D/R on me?

    I would like to know why you did my D/R when you are still updating your NIOSH-IREP Computer program. I think the last was in late 2007, is this a fact? When you had my hearing June 30 2005 I believe the 15th of May that year you came out with Multipliers for correcting the figures on all D/R’s did that not tell me that you had an incorrect program that you gave me only 22.57% Causation? This Scientific Program is continually having to be up dated, then will, What Year, will you have it up to running correctly 2050? Personally I can’t wait around, that would make me 113 in age don’t think I’ll be here that long for I will be in the ground close to my Dad, Harpeth Hills Cemetery!! Why don’t you admit that and tell DOL to use the SEC Cohort for all Sick Nuclear Workers and keep updating the list that is in that? I have one simple question and my Thyroid Cancer you or DOL pays some and others like me are turned down, why do you discriminate against Part of the Sick Nuclear Workers like Me as an example? I see that my cancer is on the list of being caused by Radiation yet you turn me down? Had no CT before Rocky Flats, had three since the cancer I would think that any Causation would qualify any Individual? You can email me the answers for all the Sick Workers. Thanks and GOD BLESS

    Don’t loose my email address, will be waiting ASAP

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  5. January 23, 2008 at 12:11 pm ET  -   Donna Cederwall

    It is amazing how much time and money is spent on proving these cases of dying and dead workes their evidence is not valid. When I went to work at Lawrence Livermore National Laboratory (LLNL) in 1980, I asked why there were so many cases of cancer. Their comment to me was this is like a large city. I had been told by a chemist not to drink the water and to push for bottled water in my building. He said there was a lot of hazardous problems in many of the buildings, the pipes and at Site 300 that the lab was keeping under wraps. My husband died nearly 20 years later of pancreatic cancer. He worked at Site 300 as a Hazards Material Driver. In the information put together by my children and myself, we gave many instances of what he handled and the sites he delivered. No great surprise, the information was either never enough, or the records couldn’t be found or had been destroyed. Point – he’s still dead! I am married to a retired scientist from LLNL. Some of his work included the study of Site 300 after experiments. The findings were usually the same. They didn’t know the long term problems of the fine dust that dropped on the equipment, buildings, or the workers. My first husband worked daily in that dust. He ran at lunch in the fine dust. He had to clean his truck daily before he drove it because it was covered in fine dust. Give us all a break. Instead of paying your staff the money to prove our cases are not valid, just pay us what you owe us. As far as the dosemiters, the only true reading one could get would be if they were worn on your feet. How many times do we need to read that those readings were not accurate. It’s time to do what is right by all the workers and their families. If you poll most of the claimants, you will learn that we believe you are waiting for all of us to die off, then you can say your program at least tried, yet more importantly, you all were given our money as paychecks while proving we were all wrong.

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  6. January 25, 2008 at 2:36 am ET  -   Donna Hand

    How does the dose reconstruction work with the PoC? The dose reconstruction is in “rems” while the PoC is in kev and distributions of lognormal, constant, triangular etc.

    Where does the DOL Case examiner obtain the info to put into the PoC for a claiment? For example the technical basis document for Pinellas Plant states that the energies to be used for unmonitored claiments is 250 kev. But I have seen some PoCs with <15 kev. I was also told (and it is backed up in your guidelines,) that a unmonitored claiment's PoC will be ran at acute and lognormal or constant, (not triangular). Can you please clarify this?

    Can you please address why the DOL has listed several cancers non-radiogenic cancers and your CFR lists only CLL as non-radiogenic? For example, Prostate cancer will not be paid by DOL because it is not a radiogenic cancer. BUT the BEIR VII report states that prostate cancer can come from exposure to 5 radioactive substances, ( tritium, krypton, cobalt, etc.)

    Why does the DOL deny claims that are cancer in situ, when your regulation states that the DOL shall run the cancer in situ as a malignant cancer?

    Why does your ToxNet state illnesses and diseases more accuarately than haz-map, but haz-map is used by the DOL?

    Why does beryllium sensitivity claiments only get monitored, when the Part E says ANY illness from toxic substances? This is not claiment friendly as per Congressional intent.

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    • AUTHOR COMMENT March 6, 2008 at 4:00 pm ET  -   Larry Elliot

      You have raised several questions and comments in your blog. Let me attempt to answer them separately:

      1. How does the dose reconstruction work with the PoC? The dose reconstruction is in “rems” while the PoC is in kev and distributions of lognormal, constant, triangular etc.
      Response: This is a very broad question that is difficult to answer in an e-mail exchange. The best place to find explanations for these types of questions is on the Office of Compensation Analysis and Support (OCAS) Web site. Specifically, a detailed explanation of the Probability of Causation (PoC) models can be found at http://www.cdc.gov/niosh/ocas/pdfs/irep/irepfnl.pdf.

      Additionally, the implementation guides for internal and external dosimetry contain discussions on the use of various types of distributions in dose reconstruction.

      2. Where does the DOL Case examiner obtain the info to put into the PoC for a claiment? For example the technical basis document for Pinellas Plant states that the energies to be used for unmonitored claiments is 250 kev. But I have seen some PoCs with <15 kev. I was also told (and it is backed up in your guidelines,) that a unmonitored claiment's PoC will be ran at acute and lognormal or constant, (not triangular). Can you please clarify this?
      Response: The inputs to the NIOSH Interactive Radioepidemiology Program (NIOSH-IREP), which computes the probability of causation values, are contained in the NIOSH-IREP spreadsheet that is attached to all dose reconstruction reports. This is the source of the information that the Department of Labor (DOL) uses to perform their calculations. The bases behind the various distributions that are listed on the input sheet are discussed in either the implementation guides discussed above or in the individual site profiles, which are available on the OCAS website at http://www.cdc.gov/niosh/ocas/ocastbds.html.

      3. Can you please address why the DOL has listed several cancers non-radiogenic cancers and your CFR lists only CLL as non-radiogenic? For example, Prostate cancer will not be paid by DOL because it is not a radiogenic cancer. BUT the BEIR VII report states that prostate cancer can come from exposure to 5 radioactive substances, ( tritium, krypton, cobalt, etc.)
      Response: Under Part B of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), all cancers, with the exception of chronic lymphocytic leukemia (CLL), are eligible to be considered for compensation. We are unaware of the discrepancy you describe and recommend that you contact DOL with questions related to the example you provided.

      4. Why does the DOL deny claims that are cancer in situ, when your regulation states that the DOL shall run the cancer in situ as a malignant cancer? Why does your ToxNet state illnesses and diseases more accurately than haz-map, but haz-map is used by the DOL? Why does beryllium sensitivity claimants only get monitored, when the Part E says ANY illness from toxic substances? This is not claimant friendly as per Congressional intent.
      Response: NIOSH can not comment on these questions because they are all related to responsibilities assigned to DOL as defined under EEOIPCA. Contact for DOL can be found at http://www.dol.gov/esa/regs/compliance/owcp/eeoicp/main.htm.

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  7. January 25, 2008 at 6:52 pm ET  -   Anonymous

    Can you tell me if there is any consideration for persons diagnosed with CLL Leukemia for benefits?

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    • AUTHOR COMMENT February 25, 2008 at 2:27 pm ET  -   Larry Elliot

      NIOSH would like to thank Ms. Barrie for responding to your question. It is important to note that under the Health and Human Services’ Guidelines for Determining the Probability of Causation (42 C.F.R. Part 81), which are used under Part B of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), chronic lymphocytic leukemia (CLL) is not considered to be caused by exposure to radiation. Therefore, NIOSH does not complete dose reconstructions for CLL and in cases where CLL is involved; DOL will assign a probability of causation of zero for this cancer.

      Ms. Barrie’s response to your blog mentions that CLL may be covered under Part E of EEOICPA. NIOSH is not involved with Part E of EEOICPA and cannot comment on this statement. DOL is responsible for overseeing claims filed under Part E of EEOICPA. If you are interested in filing a Part E claim or need information regarding possible coverage for CLL under Part E, please contact DOL for clarification.

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  8. January 28, 2008 at 12:18 pm ET  -   Terrie Barrie

    Mr. Satina,
    CLL is not recognized as being a radiogenic cancer and not a cancer that is covered under an SEC facility. I do belive, and I may be wrong, that NIOSH would still construct dose for it. However, it MAY be possible to receive benefits under Part E of EEOICPA. DOL has determined that benzene could be responsible for CLL. You can find more information about DOL’s bulletin at

    [http://www.dol.gov/esa/regs/compliance/owcp/eeoicp/PolicyandProcedures/finalbulletinshtml/Bulletin06-08EstablishingCausationforSpecificMedical.htm]

    The attachment lists the ICD code for CLL.

    However, it is not as easy as it seems. You would still need to prove you were exposed to benzene and it would be helpful if a specialist wrote a detailed rationalized letter on your behalf, tying the exposure to the disease.

    This blog will not allow email addresses in the comments, but if you google me, I’m sure you can find it, if you have anymore questions.

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  9. January 30, 2008 at 12:44 pm ET  -   Ron Simon

    Have exposure matrices been made for any chemicals or hazardous substances other than asbestos and radiation exposures? If a claimant were to claim he had for example liver disease or leukemia from benzene or another solvent how would the decision be made as to what exposures the person had if they were not measured? Has this work been done for any substances and plants?

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    • AUTHOR COMMENT February 25, 2008 at 3:05 pm ET  -   Larry Elliot

      The Department of Labor (DOL) has developed Site Exposure Matrices (SEM) to assist in their adjudication of claims involving illnesses potentially related to exposures to toxic substances and chemicals incurred at a Department of Energy (DOE) or Radiation Exposure Compensation Act (RECA) facility covered under Part E of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).

      Please note that NIOSH is not involved in Part E claims. More information on SEMs can be found at the following DOL web site: http://www.dol.gov/esa/owcp/energy/regs/compliance/main.htm. This Web site includes a link that can be used to view the SEMs that have been developed for various facilities covered under Part E.

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  10. January 31, 2008 at 10:00 am ET  -   Judy Padilla

    As a former nuclear worker at Rocky Flats, I was denied compensation by NIOSH even tho I worked HANDS-ON with weapons grade Plutonium, in a glove-box atmosphere, for 15 yrs. before my cancer was diagnosed. I was given a dose estimation of 42.19% when most of my dosemetry records for the 1980′s had been lost or destroyed. (This was when the production of weapons for the Cold War was at it’s peak.) I am not only victimized, but also betrayed by the Government which I, and many others, fought for. It took NIOSH 5 years to come up with this falsified and bogus number. They have the brazen gall to admit to “an educated guess” and play with the lives of the people who protected theirs. I am still alive and will continue to fight for the rights of all nuclear workers as long as I can! Woe to the workers of the new Nuclear Power Push. If the government continues to “protect” it’s workers in this same fashion, it is openly murdering them! Take Heed you future nuclear workers-

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  11. March 4, 2008 at 2:55 am ET  -   Carsece

    Hi
    Your site really helps me
    Good

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  12. April 6, 2008 at 1:45 am ET  -   Ione Smith

    I am writing in response to your reply about the low compensation for Multiple Myeloma cases. You said that NIOSH could not address this specifically, but I quote a CDC NIOSH Source: [http://www.dosimetryresources.com/2005%20PDF%20Files/2-9.pdf]. Although this is now outdated, it is clear to see the trend which continued to play out within the overall status of cases within the system presently. Also, how do you consider the old AEC studies caried out by Mancuso, Kneale etc. from 1970′s? These particular studies have been discussed, but have not be refuted by Epidemiologists. There is an increased level of MM cases of Nuclear workers at Hanford over the normal population using mortality studies. You say you have used a variety of sources to make your dose reconstructions, which is great. But to the average person who sees 15 years of acute doses listed on the DR, but zero neutrons, and then does not meet the 50% PoC, you can understand why someone might research the internet, see the many studies carried out by NIOSH/OCAS etc and wonder why the DR does not address these areas.

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    • AUTHOR COMMENT April 29, 2008 at 1:16 pm ET  -   Larry Elliot

      On February 13, 2008 we responded to your initial comment concerning the low compensation rate for Multiple Myeloma (MM). We were unable at that time to specifically address your estimate of a compensation rate as you did not provide a source for the estimate.

      As you indicate, the source mentioned in your latest comment was posted in 2005 and the information is out of date. The compensation rate for lymphoma and MM was 23.8% as of September 2007 (6% for MM alone), although it was 0.7% in the 2005 report mentioned above. In the 2005 report, the compensation rate for lymphoma and MM ranked 21st among all types of cancers compensated; however, by September 2007, this group of cancers was among the 10 types of cancers most frequently compensated. A good part of this shift in compensation rate for multiple myeloma can be explained by a change in the types of cases being processed. Early in the program, NIOSH reviewed several cases with extremely low potential for exposure to radiation. As would be expected for cases with extremely low exposure potential, a number of the early reconstructions resulted in a probability of causation (POC) of less than 50%. As NIOSH started moving through the more difficult cases with higher levels of exposure, the number of cases awarded compensation increased.

      At present, the NIOSH Interactive Radioepidemiological Program (IREP) for lymphoma and MM is based on scientific findings obtained from the data most widely accepted by the scientific community for assessing risks for cancer from exposure to radiation, namely the effects found among the survivors of the Hiroshima and Nagasaki atomic bombings. Information derived from worker studies is not currently used in NIOSH-IREP, because the findings from these occupational studies have been judged by the scientific community to be inconclusive. There are several reasons for this, including: 1) there is a high degree of uncertainty in individual dosimetry; 2) the studies are usually focused on mortality, not disease incidence; and 3) many studies suffer from relatively short follow-up times and are thus lacking in statistical power. That is why the findings of Hanford workers by Mancuso, Stewart & Kneale in 1977 were widely contested by other scientists. Marks, Gilbert & Breitstein re-examined the Hanford data a year later, but found the standardized mortality ratio (SMR) for cancer was 86, well below average (reference: Marks S, Gilbert ES & Breitstein BD. Cancer mortality in Hanford workers. In: Late biological effects of ionizing radiation. Vol. I. Vienna: International Atomic Energy Authority. 1978;369-84).

      In your comments you also mention a particular exposure scenario, in which you question why a dose reconstruction for a worker who received 15 years of acute exposure could result in a probability of causation of less than 50%. As we stated in our response to your original inquiry, the likelihood of compensation under Part B of EEOICPA is related not only to the cancer model used, but also to the dose received by the organ or tissue that developed cancer. In the case of multiple myeloma, the target organ is the red bone marrow. For many exposure scenarios that are reconstructed by NIOSH, the dose received by the red bone marrow is relatively low.

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  13. May 19, 2008 at 7:06 pm ET  -   Donna Hand

    Could you please explain to me “carcinoma in situ” and how that is not a pre-cancer when the medical evidence that was used in the 42 CFR 81 commentary stated that it was a pre-cancer. The carcinoma in situ is an early satge tumor. carcinoma means a cancer that begins in the skin or in the tissues that line or cover the body organs. it can arise in the breast, colon, liver, lung, prostate, and stomach. The term “in situ” means in the natural or normal place and in the case of cancer, it means that the tumor cells are still confined to the site where they originated and they have neither invaded neighboring tissues nor metastasized afar. The technical bulletin also establishes that carcinoma in situ are ICD9 codes of 230 etc. The medical experts have stated that colon polyphs are carcinoma in situ, yet NIOSH and DOL refuses to establish or use this in the dose reconstruction. Please verify by the HHS authorities and CDC if colon polyphs are carcinoma in situ of the colon, or colon cancer. Also lymph noules that are removed from the breast, or thyriod are they carcinoma in situ also?

    Cancer is an abnormal growth of cells which tend to proliferate in an uncontrolled way. Pre-cancerous pertains to something that is not yet overtly cancerous, but it appears to be on its way to becoming a cancer.

    Under this definition and under the federal regulations, then are you required to include precancerous carcinoma in situ?

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    • AUTHOR COMMENT May 28, 2008 at 3:44 pm ET  -   Larry Elliot

      Regarding your question as to how NIOSH’s regulations deal with carcinoma in situ (CIS), we refer you to section F of our Final Rule on Guidelines for Determining Probability of Causation (42 C.F.R. Part 81), which states: “HHS requires that CIS be treated as a malignant neoplasm of the specified site.” This means that, for purposes of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), all cases that have established medical diagnoses of CIS are considered to be cancer. Because of this, NIOSH performs dose reconstructions for any claim with a CIS diagnosis that has been forwarded to us by the Department of Labor (DOL).

      Your second question concerns whether colon polyps are considered to be CIS. Whether a polyp has become cancerous is primarily based on the results of lab tests that involve microscopic examination of the individual cells that make up the polyp. A diagnosis for colon cancer, including CIS of colon, will be given to polyps that have shown the growth of malignant tissues or cells. For a case to be considered CIS of the colon, it would have to be designated as such in a medical report. This, along with other information, would be used by the Department of Labor in determining the eligibility of an individual case for consideration under EEOICPA.

      You asked about whether lymph nodules that are removed from the breast or thyroid are considered to be CIS. As in the case of colon polyps, a CIS diagnosis is established based on extensive medical information. As the review of this medical information is the responsibility of the DOL, it is very important to contact them and provide them with the available medical information so DOL will be able to determine whether such a condition is a CIS.

      We thank you for your interest in our program and hope that we have clearly addressed the questions that you raised.

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  14. August 1, 2008 at 2:32 am ET  -   Deborah Hill

    Regarding claims for Multiple Myeloma is radiation exposure the only causation considered? Are toxins,chemicals found in herbicides and pesticides, and cleaning solutions not considered, as well? If not then why not? How often do 33 year olds deemed healthy by pre-employment physicals die at such a young age when every medical standard regards this to be a disease for men age 65 and up? Based upon what medical evidence was it decided that for this disease to be compensatable one had to acquire it after 5 years of employment? For Janitors/GroundsKeepers who worked all over the Y-12 plant in Oak Ridge, TN during the early 1970′s both inside and outside God only knows what all they were exposed to. I do mean only God knows as it would be next to impossible for anyone to trace those footsteps during that time period. Would you not agree? Considering components of agent orange were used as a means to kill out weeds liberally all over the complex these factors MUST be taken seriously into consideration,as well as the 29.988 rems of radiation exposure. Agent orange has been proven and accepted by the VA to cause Multiple Myeloma.

    Look it up, I did! I would appreciate answers to my questions ASAP. Are there any Janitors/GroundsKeepers out there from 1970-1972 who can post here what they were exposed to? I would love to read any comments. NIOSH how would you have explained to your nine and four year old boys why their Daddy died in 1973 so very young from a disease associated with much older men? I’m betting you have no comment on that, right? Waiting to hear from you, D. Hill

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    • AUTHOR COMMENT August 6, 2008 at 7:53 am ET  -   James W. Neton

      Dear Ms. Hill, thank you for submitting your question regarding claims of multiple myeloma (MM).

      Under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA), chemical exposures are not taken into account in the NIOSH dose reconstruction because EEOICPA specifies that dose reconstruction determinations must be based on the radiation dose received by the employee at the atomic employer facility. However, both EEOICPA and the NIOSH-authored Probability of Causation Guidelines (42 U.S.C. pt. 81) allow for modification of NIOSH’s Interactive RadioEpidemiology Program (NIOSH-IREP) risk models to incorporate potential interaction between occupational exposures to chemical carcinogens and radiation in cancer risks. Despite this ability to update risk models, the scientific information currently available regarding the risks associated with combined radiation and chemical exposure is insufficient to allow for quantitative adjustments to NIOSH-IREP.

      Although NIOSH-IREP does not include the cancer risk associated with chemical exposures, Part E of EEOICPA is available to assist nuclear weapons workers with illnesses that might have resulted from toxic occupational exposures. The web link to this program, which is administered by the Department of Labor (DOL), can be found at: http://www.dol.gov/esa/owcp/energy/regs/compliance/PARTE.htm. If you haven’t done so yet, we strongly recommend you to contact DOL regarding your case.

      Regarding your question as to why there is a requirement under EEOICPA that multiple myeloma be diagnosed at least five years after first exposure, we would like to point out that this requirement is only applicable to cases that are being considered for addition to the Special Exposure Cohort. The basis for this requirement lies in the fact that EEOICPA adopted the presumptive cancer list that was included in the Radiation Exposure Compensation Act (RECA). Under RECA, there is a minimum five year latency requirement for a number of cancers, including multiple myeloma. This five year latency requirement does not apply to cases that undergo dose reconstruction under Part B of EEOICPA.

      We hope that the above responses address your questions. If you need additional information, please feel free to contact our program directly via e-mail at: ocas@cdc.gov.

      Dr. Neton is the Associate Director for Science for the Office of Compensation Analysis and Support.

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  15. August 27, 2008 at 5:37 am ET  -   hooka

    This is my first time visiting your blog and i must say i like it alot. Your post was an educational read. I will definetly check back here more often!

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  16. September 9, 2008 at 8:02 pm ET  -   Jane Bruner

    My mother died from cancer 11 years ago after working at the Pinellas Plant from 1958 to 1990. Of course my father’s claim has been denied as have most of the claims. I believe and have proof of conspiracy to defraud these workers. It is odd when our dose reconstruction was completed she had a 37% rating that her cancer was caused by working at the plant. When 2 more cancers she had were added her original cancer went from 37% to 7% to keep this claim under 50%. Everyone involved in this program, 1) is probably not qualified to make determinations. 2) none of the claims people I have encountered are licensed to adjust claims in the state of Florida. How are you people getting around that? I have been a claims manager for 7 years and have never seen anything like this.

    The handling of these claims are in very bad faith. Something needs to be done regarding this entire program. I hear people at the Dept of labor are getting monetary bonuses based on the number of claims that are denied. Most of these people should be sitting in jail. Best of luck to everyone as we will all need it.

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    • AUTHOR COMMENT October 13, 2008 at 2:28 pm ET  -   Larry Elliot

      We understand your concern. It may seem obvious that when additional cancers are added to a dose reconstruction it would increase the probability that radiation caused the multiple cancers. However, in some cases, the NIOSH dose reconstruction will result in a lower probability of causation when additional cancers are added. Let me explain how and why this can happen.

      First, please recognize that it takes a lot of time and effort to accurately estimate the exposure a worker received while working at a covered facility. In order to complete dose reconstructions in as timely and efficient a manner as possible, NIOSH may make simplifying assumptions that are favorable to the claimant.

      Instead of completing a dose reconstruction which precisely estimates the worker’s exposure for cases that would most likely result in a probability of causation well below the 50% necessary for the claim to be compensable by the Department of Labor, NIOSH will significantly over-estimate the exposure based on the highest levels of exposure observed or possible for the facility. If the claim will not be compensable even when using these significantly over-estimated exposure estimates, then no further refinement is required.

      This manner of dose reconstruction is called an “efficiency measure” because it allows NIOSH to issue a timely dose reconstruction where attempts to refine the exposure estimate would not result in a compensable claim (i.e., a full dose reconstruction would in all likelihood produce a much lower probability of causation than the over-estimated exposure values used).

      Anytime a new cancer is reported to NIOSH by the Department of Labor, NIOSH is required to reassess the exposure estimates. If the new cancer creates a potentially compensable case, NIOSH must refine the dose reconstruction using more probable exposure estimates. These new, more accurate exposure estimates will be lower than the original estimate because we no longer use the simplifying assumptions which overestimated the exposure for the initial cancer case. This revised exposure estimate may result in a probability of causation for the two cancers that is lower than the non-compensable estimate that was obtained for the first cancer using the over-estimated radiation exposure. That is why the addition of a new cancer may result in a probability of causation that is lower than the probability found for the single original cancer. However, it is possible for additional cancer(s) to produce a full dose reconstruction that will be determined to be compensable by the Department of Labor.

      The use of “efficiency measures” and procedures for dose reconstructions are described in detail in the Federal Regulations that NIOSH follows under the Energy Employees Occupational Illness Compensation Program Act. These regulations are available on the NIOSH Office of Compensation Analysis and Support website.

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  17. September 16, 2008 at 8:57 pm ET  -   Jena Williams

    I am a graduate student at Old Dominion University and am currently taking a Risk Assessment course. I find the topic of dose response reconstruction to be very interesting due to the fact that risk from radiation exposure must be estimated using a retrospective method. Since the OSH Act of 1970 there has been a greater effort to prevent harmful exposure of workers to a given substance by constant monitoring and regulation, thereby reducing the risk of chronic illness. According to the information provided in the overview, the Energy Employees Occupational Illness Compensation Program allows workers or their survivors who may have been exposed to radiation, beryllium, silica, and other toxic substances to claim for compensation for the harmful exposure that may have led to illnesses such as cancer.

    NIOSH developed the methods for dose reconstruction. The above information lists several methods that NIOSH may use to construct dose reconstruction which includes passive monitor readings, biological samples, x-rays, employment history, etc. It is stated that “the collection of radiation exposure data can be time consuming because exposure records may not exist or may be difficult to retrieve.” With the current regulations regarding occupational exposure and the industrial hygienist’s responsibility to monitor and report exposures in the workplace, would it be beneficial to use recent exposure data for workers who are currently working in similar environments as those requesting compensation in order to more accurately estimate exposure? For example, if a current worker was monitored for an exposure and the engineering, administrative, and PPE controls were factored out of the situation as needed, would this information be adequate to fill in the gaps of missing data? Before the OSH Act of 1970, occupational safety and health as it relates to risk prevention and documentation of exposure was not as efficient as it is today. Although industrial methods and technology have changed over time, it seems like this data may at least help in filling in the missing information needed to more accurately compile dose reconstruction data.

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    • AUTHOR COMMENT October 7, 2008 at 10:37 pm ET  -   Larry Elliot

      Thank you for your e-mail concerning ways in which NIOSH could fill in data gaps in historical monitoring information using contemporaneous exposure data. In principle, what you suggest is a technically valid approach. In practice, however, NIOSH has found that back-extrapolating exposure conditions based on current exposure levels is extremely difficult. This is primarily due to the changes in engineering controls (e.g., ventilation, containment) that have been instituted over the last 50 years. Even if these parameters were constant, there were often differences in the quantity and composition of the material being processed, which further complicates the evaluation. For these reasons, we typically prefer to rely on bioassay monitoring data or air sample data that are independent of engineering controls.

      There are a few instances where a back-extrapolation approach might be applicable. For instance, the levels of radon gas in a building are entirely driven by the size of the building, the number of air changes per unit time, and the emanation rate of the radon. If contemporary levels of radon are known, and the ventilation rates are either unchanged or known, NIOSH believes that it would be possible to back-extrapolate radon levels in buildings.

      Thanks again for your interest in our program.

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  18. September 17, 2008 at 4:18 pm ET  -   Donna Hand

    Could you please explain the effect of metastic lesions and the dose reconstruction. Example: NIOSH does a dose reconstruction for breast cancer and it is less than PoC 50%. The claimant then finds out that the cancer has now metastise to the liver, bone, and lung. Would this make the dose different or do you run these models as if they are primary cancer, secondary cancer, or run a “other ill defined site” model?

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    • AUTHOR COMMENT October 2, 2008 at 4:51 pm ET  -   Larry Elliot

      Thank you for your inquiry regarding the effect of metastatic lesions on the dose reconstruction. When a cancer has metastasized into new cancers, the new cancers are considered secondary cancers “by the Department of Labor (DOL) for the purposes of EEOICPA.” Because this claimant already has a known primary cancer of the breast, the breast cancer model will be used for the calculation of probability of causation (PC). There will be no further dose reconstruction for any secondary cancers. Therefore, the PC would remain the same. Because the DOL determines whether a secondary cancer has a known primary cancer, we recommend that you contact DOL for additional information on this topic.

      I hope this has answered your questions. Please contact us if you have further questions.

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  19. October 15, 2008 at 8:01 pm ET  -   Nicole Ange

    I am taking a risk assessment course as a graduate student at Old Dominion University. As you have stated in your article, every case is different which is why you must handle each on an individual basis. Everyone is biologically and socially different, resulting in them experiencing their environments differently. Two individuals in the same concentration-time field may experience different rates of exposure and the results of the exposure can vary greatly among them. Also, if there are multiple Medias or pathways of exposure, each media/pathway may impact the individuals differently when the individuals are exposed to them either singly or in multiple variations. With the various results of exposure to the individuals, what particular methods did you use to determine the standards for your Probability of Causation procedure that allowed your decisions to be fair and equivalent among the various cases?

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    • AUTHOR COMMENT October 31, 2008 at 1:19 pm ET  -   Larry Elliot

      Thank you for your inquiry. You have raised an important question related to the variability in exposures among individuals in a given radiation environment and the variability in cancer risks from a given exposure. In the compensation program for energy workers, these issues are considered in two separate pieces.

      The first piece considers the possible variability in dose among individuals due to exposure to radiation or radionuclides. This variability is taken into account in one of two ways. One way is to estimate the uncertainty (variability) in the models and parameters used to estimate dose from the various exposure pathways and use those uncertainties to estimate an uncertainty in dose. The possibility of multiple media and multiple exposure pathways does not present any difficulties, because the total dose is simply the sum of the doses from all pathways. So, all that is required is to estimate the dose and its uncertainty from each pathway and add them appropriately. The other way to account for uncertainty (variability) is to use assumptions about conditions of exposure and doses from a given exposure that almost certainly overestimate the true dose to any individual. Use of bounding assumptions is common in dose assessments for energy workers, and it gives claimants the benefit of the doubt in estimating their doses.

      The second piece of a calculation of probability of causation (PC) is to convert an estimate of dose and its uncertainty to an estimate of cancer risk, from which PC for a diagnosed cancer is calculated. This calculation can use either a central estimate of dose and its uncertainty or a bounding point estimate of dose, as described above. The calculation of PC associated with a given dose is performed using a computer program, called the Interactive RadioEpidemiological Program (IREP), which takes into account many sources of uncertainty in estimating cancer risk associated with a given dose. An important uncertainty that is taken into account in all calculations using IREP is an uncertainty in the cancer risk associated with a given dose that is intended to represent the variability in risks among different individuals in a population who receive the same dose.

      Within the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), the U.S. Department of Labor grants compensation when the Department determines that the individual’s cancer at least as likely as not was caused by past exposure to radiation in the workplace. This situation is met when the value of the PC is 50% or greater. When the value of the PC is at 50%, the baseline risk of the specific case of cancer (in an otherwise unexposed population composed of individuals with attributes of age and gender that are similar to those of the claimant) is doubled.

      To ensure that, scientifically, energy workers are treated fairly and given the benefit of the doubt where uncertainties about past exposures exist, decisions by the Department of Labor about awarding compensation are based on the upper 99% credibility limit of an uncertain PC calculated using IREP. Because of the presence of uncertainty in the estimate of exposure, dose and risk, many different values of PC are calculated for a given claimant using the IREP computer model. Compensation is awarded if the upper 99% credibility limit of the uncertain PC is at or exceeds a value of 50%. When the upper 99% credibility limit of PC equals a value of 50%, this is similar to saying that there is at least a one percent chance that the baseline risk of a specific case of cancer has been doubled.

      The approach of using uncertain doses or bounding estimates of dose and upper 99% credibility limits of an uncertain PC assures that, despite inter-individual variability in exposure, dose and risk, that determinations about eligibility for compensation are made with scientific fairness.

      I hope this information is helpful. Please let us know if you have any questions.

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