Appendix D
Responses to Committee’s Questions



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Appendix D Responses to Committee’s Questions

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Defense Threat Reduction Agency 8725 John J Kingman Road MS 6201 Ft Belvoir, VA 22060-6201 SEP 2 8 2001 John Till, Ph.D. Chairman, Committee to Review DTRA Dose Reconstruction Program National Academy of Sciences Board on Radiation Effects Research 2101 Constitution Avenue, NW Washington, DC 20418 Dear Dr. Till: This is in reply to your letter dated September 6, 2001. The following responses are provided with respect to the questions posed by the National Research Council Committee to Review the Dose Reconstruction Program of the Defense Threat Reduction Agency and the Board on Radiation Effects Research. Per our conversation with NAS’ Dr. Al-Nabulsi on 7 September 2001, we indicated it would be appropriate for DTRA to respond to questions 5, 6, 8, 9, 10, 11, 12, 13, 14, and 16 and provide comments on the flow chart pertaining to DTRA responsibilities. We recommended questions 1 through 4 should be referred to Department of Veterans Affairs (VA), Office of the Undersecretary for Benefits and questions 7, 8, 10, and 15 to VA, Office of the Undersecretary for Health. Question 5. When a claimant is referred to JAYCOR, is the dose of record then sent to VA and DTRA or only to DTRA? Reply: When a dose is provided for a claim referred to JAYCOR, the dose information is given to DTRA for review and approval. DTRA then sends the dose information to both the VA and the claimant. In cases where the claimant’s address is not known, DTRA requests the VA to forward a copy to the claimant. Question 6. Under what circumstances is the file referred to SAIC for a dose and in what circumstances is this not done? Reply: Claimant files not referred to SAIC are under the following circumstances: 1997 non-participant cases (these cases are not verified participants); 1998 presumptive cases (these cases do not require dose information); and

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1999 most Hiroshima/Nagasaki cases (these cases receive a generic reconstructed total dose, upper bound less than 1 rem). All other cases are referred to SAIC. Question 8. Explain the use of the “dose screen.” At what point in the process is the CIRRPC screen applied? Which of the confidence limits are used, 90%, 95%, or 99%? Are different screens applied at different stages in the process? Reply: The CIRRPC dose screen is not, and has never been used by DTRA’s Nuclear Test Personnel Review (NTPR) program. Question 9. Provide a history of the dosimetry process. How has it changed over the years since its beginning? Also, provide history on the use of the PC tables. Reply: The history of the dosimetry process and its significant changes are enumerated below: 1978  External gamma dose from film badge dosimetry applied by service NTPR teams 1979   1980 Neutron dose reconstruction added to film badge doses and bounding estimates for major troop units performed, i.e. generic doses applied to military units performing common activities 1981   1982 Internal dose reconstruction (50-year) committed dose equivalent to target organ introduced 1983   1984 Statistical application of military unit film badge readings in lieu of missing film badge readings introduced 1985 Standardized NTPR guidance for dose assessment published in the Federal Register (32 CFR 218) FIIDOS computer code applied to internal dose methods 1986 Generic internal dose screen developed - no impact on individual organ doses from intake of fallout for VA claims 1987 Defense Nuclear Agency consolidates service NTPR teams into a centralized DNA program 1988 Dose reconstruction applied to periods of incomplete film badge coverage 1989 Upper-bound dose from individual film badge readings applied Doses extended to VA-defined operational test periods as published in

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  the Federal Register under implementing guidelines for Public Law 100-321 1990   Deep dose equivalent factor applied as defined in 1989 NAS Film Badge Dosimetry publication Readings from verified damaged film superseded by dose reconstruction, primarily applicable to Operations REDWING and DOMINIC film badges 1991   1992 Deep dose equivalent factor application rescinded Total upper-bound dose, coupling uncertainties for film badge and reconstructed doses, introduced for application to some VA claims 1993   1994 1995 Single contract for Jaycor and SAIC team introduced by DTRA Coordination of records research and reporting of dose information improved Reduction of data inconsistencies and improved internal (contractor) QA introduced as a result of collecting data for NAS mortality study 1996 Upper-bound dose included for all VA claims Doses accrued past the VA-defined operational period assigned vs. truncated at end of period included in reconstructions 1997 Standard operating procedures (SOP) for radiation exposure assessment introduced Case by case limited-scope guidance from previous decade rationalized in SOP Mean and upper-bound (95%) dose reporting emphasized NAS Five Series Study Dose Methodology Report details applied to specific test series 1997 Skin dose reconstruction added in response to VA review of scientific literature 1998 Limited one-time plutonium urine bioassay conducted - no impact on internal doses 2000   2001   PC tables are not, and has never been used by DTRA’s Nuclear Test Personnel Review (NTPR) program. Question 10. Who has the authority to communicate with the veteran and/or the veteran’s family? Reply: The DTRA Program Manager has authorized the Jaycor/SAIC Program Management team to designate hotline operators and analysts to communicate

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with veterans and family members. I am not aware of any restriction on any DTRA employees communicating with veterans or family members. Question 11. Are there any written procedures guiding the conduct of dose reconstructions other than those already provided to the committee? If so, please send us a copy of them. We assume the Standard Operating Procedure drafted in March 1997 is the basic procedure for assigning doses. Reply: The SOP and 32CFR Part 218 standard serve as the Program’s written dose reconstruction guidelines and procedures. Question 12. Are there any written procedures guiding the quality assurance measures applied during the dose reconstructions other than those already provided to the committee? If so, please identify them. Currently the primary document describing the dose reconstruction process is “NTPR Standard Operating Procedures: Radiation Exposure Assessment” dated 8 March 1997; is this the current guidance for quality control as well? Reply: There are no additional quality assurance written procedures other than those provided to the committee. The SOP indicates what constitutes a quality dose reconstruction and directs review for conformity with the SOP’s procedures, and appropriateness and responsiveness to the correspondence or request received by the NTPR program. The DTRA Program Manager conducts the final review/approval. Question 13. Is the master file still in use in Las Vegas and updated by JAYCOR/DTRA? Does the JAYCOR/SAIC database have different data from the master file? Reply: The Reynolds Electrical and Engineering Company (REECo), in Las Vegas, Nevada, was a prime support contractor to the Department of Energy (DOE), formerly the Atomic Energy Commission, throughout most of the U.S. nuclear testing program. As a result, the company maintained an archive of dose records, historical source documents, and original film badges for DOE and DoD participants in both atmospheric and underground nuclear testing. In 1978, DTRA (then DNA) began funding REECo (now Bechtel Nevada) for a dosimetry project to establish a database of all U.S. DoD-affiliated atmospheric nuclear testing records. NTPR dosimetry research and dose reconstruction results were added to the master file as they became available, primarily through routine data exchanges. As a result of DTRA’s database upgrade project, which resulted in the Nuclear Test Review Information System (NuTRIS), DTRA assumed full responsibility for maintaining dosimetry data

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for all U.S. DoD-affiliated U.S. atmospheric nuclear test participants. DOE continues to provide DTRA dosimetry documents and extant film badge analysis support. Also, when DOE receives a direct request for dosimetry information from a DoD-affiliated individual, Bechtel Nevada (formerly REECo) contacts DTRA to request available dose data from the NTPR database. This case-by-case exchange of data ensures consistency when doses for DoD-affiliated individuals are reported by Bechtel for DOE. Question 14. Is file A separate from the JAYCOR/DNA database? Reply: File “A” was a satellite database of DTRA’s retired legacy system database. It contained anecdotal and unverified information collected from callers and correspondents. The File “A” database has been integrated into DTRA’s newer, upgraded NuTRIS database system. Question 16. What is the policy for contacting veterans during the dose assignment process? Does SAIC often check with the veteran or references he may have provided by phone to verify information? Please explain the frequency of this occurrence during the past. Reply: Contact with the veterans (and/or their representatives or references) is an integral part of the dose reconstruction process. There is some form of pertinent participation statement regardless of the method by which they contact the program (personal inquiry, VA claim, FOIA, Congressional inquiry, etc.). The participation statements are contained within the responses to an NTPR program questionnaire, a statement in support of claim, or simply within the text of a letter the veteran wrote, or transcribed from conversation notes from when he called to request information through the NTPR hotline regarding his dose. An analyst can, at his/her discretion, contact the veteran or review any references they may have been provided by telephone (if contact information is available) in the absence of veteran-supplied statements, if the information in the statements leaves large uncertainties in the assessment which might be reduced by follow-up, or if there are inconsistencies in the statements that need to be resolved. The most effective and expedient way to obtain this information is by direct contact between the analyst and the veteran. Even after the assessment is complete and the veteran is informed of the resulting dose(s), he is free to contact the program if he feels that the events described in the assessment do not properly reflect the scope or circumstances of participation. If new and pertinent event information is proffered and after review is deemed to be within the credible range of possible activities, documented by record sources, in which the veteran could have

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participated, then the analysis is revisited and, if necessary, a new assessment is performed. While written statements and correspondence have always been a part of the dose reconstruction process, contact by telephone has, until recent years, been relatively rare, due in large part to the inherent public relations risk when contacting a veteran. However, the increased complexity of the reconstructions, due to both the incorporation of additional historical information as well as new tasks into the scope of the program (internal doses, skin doses, etc.) has resulted in a need for increased levels of detail in the veteran’s participation statements. While direct contact is not always necessary, the veterans can often provide invaluable information, sometime even beyond what was expected, that has a direct impact on their dose assessment. Enclosed is a copy of the flow chart with our corrections as they pertain to the DTRA responsibilities in the process. I recommend that you contact VA, Office of the Undersecretary for Benefits, to obtain specific information for the VA parts of the process. Regarding the input numbers for the DTRA part of the process, DTRA receives typically about 600 VA claim-related inquiries a year. The outcomes of these claims are: about 150 are found to be non-participants, about 90 are presumptive, participation only responses, and about 360 are responses for which participation and dose information is provided to VA. I hope these comments will be of assistance to your committee and board. Please feel free to contact me at 703-325-2407 or by e-mail at dennis.schaeffer@dtra.mil if there are additional questions. Sincerely, D. M. Schaeffer Program Manager Nuclear Test Personnel Review Technology Development Directorate Copy to: NAS BRER (Attn: Dr. Evan Douple) NAS BRER (Attn: Dr. Isaf AI-Nabulsi)

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Defense Threat Reduction Agency 8725 John J. Kingman Road MSC 6201 Ft Belvoir, VA 22060-6201 3 NOV 2001 Department of Veterans Affairs Central Office Compensation and Pension Service ATTN: Mr. Bradley Flohr 810 Vermont Avenue, NW Washington, DC 20420 Dear Mr. Flohr: The National Academy of Sciences has requested the Defense Threat Reduction Agency (DTRA) to provide the VA with identifing information for 99 case files the Academy is sampling as part of its dose reconstruction review. The Academy would like to investigate actions VA may have taken in processing claims on the 99 individuals. A review of our files indicates that the Nuclear Test Personnel Review Program has received VA claim inquiries for only 62 of the 99 sample cases. Attached is a spreadsheet containing pertinent identifying information for these 62 cases; a second spreadsheet contains identifying data for the 37 cases for which we have no record of a VA contact. It is possible that for these 37 cases, some individuals may not have submitted claims to the VA, and others may have involved VA action but without referral to DTRA. The Academy has requested that you indicate only key number and adjudication outcome in your response. Sincerely, D. M. Schaeffer Nuclear Test Personnel Review Technology Development Directorate Enclosures as stated cc: I. Al-Nabulsi (w/o encls) E. Douple (w/o encls)

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DEPARTMENT OF VETERANS AFFAIRS Veterans Benefits Administration Washington DC 20420 October 31, 2001 John E. Till, Ph.D Chairman, Committee to Review the Dose Reconstruction Program of DTRA National Academy of Sciences Board on Radiation Effects Research 2101 Constitution Ave., NW Washington, DC 20418 Attn: Ms. Isaf AI-Nabulsi, Ph.D. Study Director Dear Dr. Till: I am responding to your request of September 7, 2001, seeking answers to certain questions from the NRC committee to review the dose reconstruction program of the Defense Threat Reduction Agency. Please excuse the delay in responding to your request. I have been asked to respond to questions 1, 2, 3, 4, 7, and 10. Question #1: Clarify and resolve the number of claims awarded on the basis of non-presumptive, atmospheric testing and Hiroshima and Nagasaki, “radiogenic” diseases, especially the issue of the number 50. Reply: According to the information contained in our special issues database, non-presumptive service connection has been awarded in 1,260 claims based on atmospheric nuclear testing, and in 357 claims on the basis of the occupation of Hiroshima or Nagasaki. As we discussed during your information gathering session earlier this year, the number “50”, which has been used, unfortunately, to represent the number of claims for which service connection has been granted under the provisions of 38 CFR § 3.311(b), has no basis in fact. Question #2: Can you provide us a list of names/ID numbers for veterans who filed a claim under “non-presumptive” law? Reply: The information you are requesting is protected by the Privacy Act (5 USC § 552a (b)) and 38 USC § 5701. We may release names of veterans and addresses, but not identifying claim numbers, to DoD, but not to NRC.

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Question #3: When did the VA’s claims database get started and what information is available in the database? Reply: VA began tracking special issue cases, of which radiation-related cases is a category, in 1982. In November 1998, the initial tracking system was migrated into the Veterans Issue Tracking Adjudication Log (VITAL). VITAL tracks information input into it on a number of special issue claims, e.g., Agent Orange, post-traumatic stress disorder, and radiation. Information can be extracted concerning the number of granted and denied claims in different categories, such as grants and denials of claims based on atmospheric nuclear testing on a non-presumptive basis and grants and denials of claims on the basis of the presumptive provisions of Pub. L. 100-321. Question #4: Clarify the VA’s policy on handling claims retroactively that would have been different due to changes in policy (such as the change in the list of presumptive cancers). Reply: When a cancer is added to the list of presumptive diseases contained at 38 CFR § 3.309(d), benefits which had previously been denied may be granted upon request of a claimant, or on VA’s own review, but no earlier than the date of the legislation. This is not a matter of VA policy, but a matter of a legislative change with a resulting amendment to the regulation. Question #7: Is a compensation decision for a “radiogenic” disease ever made without a SAIC reconstruction? Reply: There are two categories of claims where determinations of entitlement to benefits based on a radiation-related illness are made without an SAIC reconstruction. (1) Claims based on the presumptive provisions of Pub. L. 100-321 and (2) claims based on occupational or therapeutic exposure to radiation while in the active military service. Question #10: Who has the authority to communicate with the veteran and/or the veteran’s family? Reply: Under the general delegation of authority provided by 38 U.S.C. § 512(a), any employee of the Department of Veterans Affairs, in the performance of their duty, has the authority to communicate with the veteran and/or the veteran’s family. I hope this satisfactorily responds to your questions. Should you require further information, please do not hesitate to contact me. Bradley Flohr, Chief Judicial/Advisory Review

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Defense Threat Reduction Agency 8725 John J. Kingman Road MSC 6201 Ft Belvoir, VA 22000-6201 April 1, 2002 Dr. Isaf Al-Nabulsi Board on Radiation Effects Research National Academy of Sciences 2001 Wisconsin Avenue, NW Washington, DC 20007 Dear Dr. Al-Nabulsi: In response to your 26 February 2002 letter, we provide an explanation of the calculations in the computer printouts for cases 344921 and 201699. We are including the documented method for performing the calculations, its basis, and policy memorandum implementing the method’s use (see enclosed). The documented method is contained in the attached computer code printout. The codes are what produce the computer printouts contained in your February 2002 letter. The basis for the codes is the National Academy of Sciences (NAS) report of “Film Badge Dosimetry in Atmospheric Nuclear Tests” (1989) (see excerpts enclosed). We implemented the performance of combined uncertainty analysis on multiple film badges in July 1992 (see policy memorandum enclosed). This memorandum implements the combined uncertainty analysis as prescribed in the 1989 NAS film badge study, except for the application of the deep-dose equivalence conversion and the use of 95% confidence intervals. We use the uncorrected film badge readings (factor of 1.0) for determining the total dose vice the deep-dose factor. We do this to preserve a one-to one correlation to the film badge record for the veteran to see evidence that original records are being used in the dose reconstruction and avoid the perception that we are lowering recorded doses. We use a 90% confidence interval vice 95% so that we have a consistent basis for combining the overall film badge reading uncertainty with reconstructed dose uncertainties, compiled and published in historical records at the 90% level. The code computes the individual entries by selecting the applicable test series by inclusive operation dates. It then selects the bias factors (B) and uncertainty factors (K) for the applicable test series (see computer code printout as annotated). The Band K factors originate from pages 136, 143, and 152 of the 1989 NAS report (excerpts enclosed). They correspond to Operations CASTLE,

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Question 4 -Date Pair/Upper Bound Meaning: Date pair request means reconstructing a dose for periods for which film badge readings do not exist or for which a film badge reading is not valid. Upper bound request means computing a 95% percentile total external dose which was not calculated previously and also computing a internal dose to a target organ, skin dose, or eye dose for a radiogenic disease specified in a VA claim. Question 5 - Use of 20 Micron Particle Sizes: To the best of our knowledge, we instituted the practice of using 20 micron particle sizes to maximize internal organ doses sometime in the late 1980s. Question 6 - Top Level Quality Assurance Guidance: Quality Assurance has always been a key element in our management and direction of the NTPR program. Specifically, the DTRA solicitation for NTPR Program Support, Statement of Work (June of 2000), contained a program management requirement for quality assurance monitoring in the program areas of database management, dose assessment and veteran assistance. Additionally, the solicitation designated quality assurance process as one of the contract evaluation factors for award. In response to the solicitation, Jaycor/SAIC submitted a technical proposal that specified quality assurance measures in the program task areas of database management, radiation exposure assessment, and veteran assistance. Our approach is consistent with many of the key elements of both ASME NQA-l and ANSI/ASQC E4-1994. Key elements of NTPR quality assurance include: Designated senior management responsibilities Designated responsibilities and roles by program task area Integrated and interdisciplinary work processes established IAW technical and administrative standards Approved work processes incorporated into standard operating procedures Comprehensive case tracking / monitoring system, records management system, and records back up system The key feature of NTPR Program Support’s quality assurance is the use of standard operating procedures (SOPs) in all program areas, to include dose reconstruction. As part of an earlier response to NAS, we provided a copy of the SOPs. As noted in the EPA Quality Assurance guidelines (EPA QA/G-6, March 2001): “The development and use of SOPs are an integral part of a successful quality system as it provides individuals with the information to perform the job properly, and facilitates consistency in the quality and integrity

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of a product or end result.” The NTPR SOPs were developed by Jaycor/SAIC as standard procedures and guidelines for company proprietary work in support of the NTPR program and were reviewed and approved by us to ensure consistency with federal guidelines and standards applicable to the program. The fully integrated Jaycor/SAIC NTPR team, under our direction, uses an interdisciplinary approach to ensure the work in all task areas meets Government-established performance standards. The following summary illustrates the comprehensive quality assurance actions implemented in the program’s three key task areas. Database Management Application Development Requirements review by working groups, team leader, program manager Application testing by selected users and team leaders Major modifications review by team leaders LAN Administration Standard procedures review by team leader Enhancements review by team leader, corporate LAN engineers, program manager Database Administration / Analysis Data entry review by Quality Assurance Specialist and team leader Data structure modifications review by programmers, team leader, program manager Dose data accuracy and database integrity review by data analyst and database administrator Documentation / Training Training materials review by selected users and team leader Training procedures review by team leader and program manager Radiation Dose Assessment Dose Triage Correspondence case review by health physicist Radiation Exposure Data Film badge review by health physicist Film badge versus reconstructed dose analysis/review by dose analysts Test series operational detail knowledge by dose analysts Technical Documentation Assessments and technical documents review by senior scientist and senior historian/editor

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Radiation Environment Scenario development review by senior scientist Scenario refinement and enhancement by senior scientist Methodology application consistency and accuracy IAW dose SOP review by senior scientist Veteran Assistance Research documentation: Correspondence actions review by deputy team leader, team, leader, health physicist (if dose info provided), admin supervisor, operations director (selected actions), program manager Outreach Admin: Outreach data collection review by team leader Word processing review by team leader Administrative action review by team leader St. Louis operation: Records retrieval and review cross-checks by team leader and researchers Special Projects Data abstraction review by deputy team leader and team leader Library maintenance review by team leader Special taskings review by operations director, program manager, health physicist (if dose related) Question 7 - Generic Dose Assignment vs. Dose Assessment Statistic: We are unable to sort out the information in our NTPR database according to these parameters to provide you a reply. We would have to hand sort NTPR files in order to make a meaningful reply. We would prefer to discuss alternatives with the Committee for obtaining the needed data. I trust that the above answers provide the groundwork for the reply to your questions at the August Committee meeting. Please contact me if you have questions or need additional information. I can be reached at (703) 325-2407 or at dennis.schaeffer@dtra.mil. Sincerely, D. Michael Schaeffer Program Manager Nuclear Test Personnel Review Program Technology Development Directorate Enclosure as stated

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Defense Threat Reduction Agency 8725 John J. Kingman Road MSC 6201 Ft Belvoir, VA 22060-6201 August 30, 2002 Dr. Isaf Al-Nabulsi Board on Radiation Effects Research National Academy of Sciences 500 5th Street, NW Washington, DC 20001 Dear Dr. Al-Nabulsi: In response to your 13 August 2002 letter, we provide responses to your six questions, concerning report SAIC - 0012024 “Methods and Applications for Dose Assessments of Beta Particle Radiation”. Question 1: P3, second bullet. Please elaborate on how adding the gamma dose to the beta dose leads to an upper bound of the skin dose. What method is used to provide a central estimate of skin dose? Response: We do not provide a central estimate for the skin dose. For the purposes of beta dose calculations, the nominally uniform external whole body gamma dose (including its upper bound) is considered to be applicable at 70 μm. A more central estimate of skin dose can be given by using the mean whole body gamma dose (i.e., in lieu of the terms annotated by Dγ/ub/fallout and Dγ/ub/total in Equation 7 on page 17). In addition, because the assumed retention of fallout on surfaces tends to high-side the beta component of the skin dose, we do not have a means of providing a central tendency value for the beta skin dose component. Question 2: PI5, table 10. What is the meaning of the numbers in parentheses in the column identified as “βdose4 (CEPXS)”? Response: The dose conversion factor in parentheses was based on an air density of 1.189 mg/cc, whereas the other value was based on an air density of 1.293 mg/cc. Question 3: Please help us understand the apparent contradiction between the statement on pg.13 “Figure 5 depicts…and illustrates reasonable justification to use U-235 based generic spectra for all shots during the testing era,” and the

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statement on pg.17 , “the determination of what constitutes the appropriate beta/gamma (β/γ) ratio must include evaluations such as the type of weapon used….” Response: Fission byproduct radionuclides predominated both fission and thermonuclear-type detonations. Figure 5 indicates that in the worst known deviation from a pure fission product inventory based on pure U-235 (i.e., CASTLE Bravo being thermonuclear) the difference in β/γ ratios is modest. Given that the majority of shots are much closer to a pure fission product inventory than were the CASTLE shots, the solid-line relationship in Figure-5 is typically representative. However, the deviation for CASTLE shots (similar to BRAVO) is enough to warrant applying the dashed-line relationship in Figure-5 for these shots. The statement made on page 17 regarding type of weapon is applied only in this context. Question 4: Page 28, last paragraph. What is the basis for using “l/r” estimation for an infinite plane source geometry factor? Response: There is none. The l/r estimate was not meant to indicate a mathematical functional relationship between gamma intensity and height from a plane source, but rather to indicate that there is an inverse proportional relationship with height. Note that the sentence could be clarified to indicate that an linear interpolation of the (β/γ) ratio between a height of 1 and 20 centimeters (to obtain an estimate of the ratio at 10 cm from Table-7) would result in an expected beta dose about 9 times greater than that at a height of 120 cm (rather than the stated factor of 12). Question 5: P44. It is implied in the second complete paragraph that an uncertainty factor of 2 in the beta dose component is reasonable. Should this be interpreted as the entire uncertainty of the beta dose or the uncertainty in the beta/gamma ratio? Response: Neither should be implied. This statement was an interpretation relative to the ratio of the beta dose to gamma dose cited in Reference 1 and does not pertain to current skin dose methodology. The ratio cited was 8 to 16 (i.e., a factor-of-2 range for this ratio). Note that while this range for the ratio may be representative (and generally corresponds to SAIC values at 1 meter from a surface), it does not address dependence on distance from surface and radionuclide inventory (e.g., with time for mixed-fission products). Question 6: What procedures were used for assessing beta dose prior to publication of SAIC-001/2024?

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Response: Prior to 1998, skin doses were not performed in the NTPR program, except on a case-by-case basis. Prior to the publication of SAIC-001/ 2024, beta doses were computed by applying the references therein directly -principally (and as cited in the radiation dose assessments) the user’s manual for the CEPXS radiation transport code and the SAI report that specified the beta and gamma energy spectra as a function of time after a detonation. I trust that the above answers provide a complete and comprehensive treatment of your questions. Please contact me if you have questions or need additional information. I can be reached at (703) 325-2407 or at dennis.schaeffer@dtra.mil. Sincerely, D. Michael Schaeffer Program Manager Nuclear Test Personnel Review Program Technology Development Directorate

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Defense Threat Reduction Agency 8725 John J. Kingman Road MSC 6201 Ft Belvoir, VA 22060-6201 SEP - 5 2002 Department of Veterans Affairs Central Office Compensation and Pension Service ATTN: Mr. Bradley Flohr 810 Vermont Avenue, NW Washington, DC 20420 Dear Mr Flohr: The National Academy of Sciences has requested the Defense Threat Reduction Agency (DTRA) to provide the VA with identifying information for 200 case files the Academy is sampling as part of its dose reconstruction review. The Academy would like to investigate actions VA may have taken in processing claims on the 200 individuals A review of our files indicates that the Nuclear Test Personnel Review (NTPR) Program reported radiation exposure information for 141 of the 200 sample cases. The remaining 59 cases did not require the NTPR Program to furnish dose information to the VA. Enclosed is a spreadsheet containing pertinent identifying information for all 200 cases. The first worksheet of this spreadsheet includes the dose information reported by the NTPR Program to the VA for 141 cases. The second worksheet provides pertinent information for the remaining 59 cases. As can be seen from this enclosure, some VA claim data, i.e., claim number and/or Regional Office information, is available from the NTPR case files for some of these 59 cases. This claim data was obtained from various sources, e.g., service medical records, reviewed by the NTPR Program during the course of researching individual inquiries. The available data is being provided to assist you with your response to the NAS. Sincerely, D. M. Schaeffer Nuclear Test Personnel Review Technology Development Directorate Enclosures as stated cc: ✓ I. Al-Nabulsi (w/o encls) E. Douple (w/o encls)

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Defense Threat Reduction Agency 8725 John J. Kingman Road MSC 6201 Ft Belvoir, VA 22060-6201 OCT 10 2002 Dr. Isaf Al-Nabulsi Board on Radiation Effects Research National Academy of Sciences 500 5th Street, NW Washington DC 2000 Dear Dr. Al-Nabulsi: In response to your early September request, we are providing an update to our dose reconstruction summary which extends to 30 September 2002 (copy attached). Please contact me if you have questions or need additional information. I can be reached at (703) 325-2407 or at dennis.schaeffer@dtra.mil. Sincerely, D. Michael Schaeffer Program Manager Nuclear Test Personnel Review Program Technology Development Directorate

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Defense Threat Reduction Agency 8725 John J. Kingman Road MSC 6201 Ft Belvoir, VA 22060-6201 December 03, 2002 Dr. Isaf Al-Nabulsi Board on Radiation Effects Research National Academy of Sciences 500 5th Street, NW Washington, DC 20001 Dear Dr. Al-Nabulsi: In response to your November 5, 2002 letter, we will clarify the dose reconstruction process when unit dose reconstructions form the basis for an individual’s dose assessment. Current DTRA policy requires that SAIC provide all doses prepared in support of VA claims. At one point in the NTPR Program before the current policy, there were cases where Jaycor applied available SAIC-prepared generic external dose reconstructions if the participation scenario for that reconstruction was applicable to the veteran’s participation scenario and if SAIC had previously determined the internal dose to a particular organ. As noted in your letter, the assigned doses then went to DTRA for review, approval, and release to the VA. Please contact me if you have questions or need additional information. I can be reached at (703) 325-2407 or at dennis.schaeffer@dtra.mil. Sincerely, D. Michael Schaeffer Program Manager Nuclear Test Personnel Review Program Technology Development Directorate

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DEPARTMENT OF VETERANS AFFAIRS Veterans Health Administration Washington DC 20420 In Reply Refer To: September 17, 2001 13 Isaf AI-Nabulsi, Ph.D. Study Director National Academies 2101 Constitution Avenue, N.W. Washington, DC 20418 Dear Dr. AI-Nabulsi: This is in reply to your letter dated September 7, 2001. As we discussed, I am responding to question numbers 8, 10, and 14 as they pertain to responsibilities of our office. Question 8. Explain the use of the “dose screen”. At what point in the process is the CIRRPC screen applied? Which of the confidence limits are used, 90%, 95%, or 99%? Are different screens applied at different stages in the process? Reply: Screening doses are used when a compensation claim requires a medical opinion on the likelihood that radiation exposure in service was responsible and when the CIRRPC report provides screening doses relevant to the veteran’s disease. The CIRRPC screening doses are applied after the case has been sent to the Office of Public Health and Environmental Hazards for a medical opinion. The screening doses based on the 99% confidence limits are used. The same screening doses based on 99% confidence limits are used for medical opinions provided at all stages of the adjudication process. Question 10. Who has the authority to communicate with the veteran and/or the veteran’s family? Reply: I am not aware of any restriction on any VA employees communicating with veterans or family members. Question 14. Are the CIRRPC screening doses used in actual compensation decisions? If not, what PC labels are used?

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Reply: The CIRRPC screening doses when applicable are used in formulating a medical opinion but other factors are considered as well. I hope these comments will be of assistance. Please feel free to contact me at 202-273-8452 or by e-mail at neil.otchin@hq.med.va.gov if there are additional questions. Sincerely, Neil S. Otchin, M.D. Program Chief for Clinical Matters Office of Public Health and Environmental Hazards