1. More effective approaches should be established to communicate the meaning of doses to veterans in terms of their risk of disease and the probability that their disease was caused by radiation exposure from atomic testing.

  2. A comprehensive manual of standard operating procedures for the conduct of dose reconstructions is needed. The lack of a procedures manual may have led to inconsistencies in dose reconstructions.

  3. There was little evidence of quality control in dose reconstructions the committee reviewed. For example, many calculations are illegible or not explained. A comprehensive program of quality assurance and quality control of dose reconstructions is needed.

  4. If the dose reconstruction program continues, the committee believes there should be an independent oversight system. For example, an advisory board could be established to include experts in the various parts of the program and at least one atomic veteran. Broad oversight would be desirable, including the roles of both DTRA and VA. The board should be able to conduct random audits, review methods and recommend changes, and meet with atomic veterans regularly and help DTRA and VA communicate with them.

About 70% of all dose reconstructions have been done in response to veterans’ claims for compensation, but many of their diseases are now included in the presumptive category. Except for beta exposures and skin cancer, it appears to the committee that most future claims for nonpresumptive diseases would not qualify for compensation, even with revised upper-bound dose estimates.

The committee appreciates the sacrifices made by the veterans in the service of their country and their frustrations in dealing with the bureaucracy to obtain the compensation that they believe they are entitled to. Perhaps a few more veterans who filed claims in the past would have been compensated if the upper-bound dose estimates had been more credible. It is evident that only a very small number of awards have been granted for claims under the nonpresumptive regulation out of many thousand that have been filed. The exact number of successful claims is difficult to determine, but the committee has concluded that the number is probably on the order of 50, as has been previously reported. Obviously it is very unlikely that a claim will be granted when a veteran files under the nonpresumptive regulation.

Yet there are good reasons for the low rate of successful claims for nonpresumptive diseases. There is an extensive amount of information from radiation studies in humans which indicates that ionizing radiation is not a potent cause of cancer. Thus, although the committee believes that in many cases the veterans have legitimate complaints about their dose reconstructions, veterans also need to understand that in most cases their radiation exposure probably did not cause their cancer. Even if reasonable changes are made in the dose reconstruction program, it is not likely that the chance of a successful claim will increase very much when a dose reconstruction is needed, except possibly in cases of skin cancer.

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