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Spedai exposure Cohort Petition wxfer EneIgy the ~ ~~.,.tional
I8nessCon1p8n88tion~
U.s. Department of Health and Ruman SerVf;CeS CenIBr8 t:M&ea&e and~ Ix~
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OMS Number:
1x-0000.IpetionaISafe(y ~
Expif98:
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SDeCiai ExDOSure Cohort Petition - Fonn 8
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0920.{)639
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Labor Organization Information:
'NMie of Organization POsitionof Contad. Person
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Name of Petition Representative:
Address of Petition Representative:
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Telephone Number of Petition Representative: Email Address of Petition Re~ntatJve:
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by this petition
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Period during which labor organization represented employees cove.-
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Identity of other labor organizations that may represent or have representedthis clas of employees [If known): .
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List job titles and/or job duties of employeesIncluded in the class. In addition, you can list by name any ind"lvidualsother than petitioners identified on this form who you believeshould be Included in this cJ~:
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Employment Dates relevant to this petition:
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Is the petition based on one or more unmonitored,unrecorded,or Inadequatelymonitored or recorded exposure inCidents?: ... Yes a No If yes, provide the date(s) of the incident(s) and a complete description (attach additionalpages
as n~~ry):
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Nameor Social SeaJrityNumberof Rrst Petilioner:L~=
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Special Exposure Cohort Petition ~ the En8gy ~ ~1patiQIa1 IBriess CcJ."1Ip6I-~~Ad
§~ial Exposure Cohort P~n
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u.s. Department 01 Health and Human' SelVices Cer8s tK Disease' Cor*d and~ ~ k1SDJte ~ b' Safety ~-tfeaIIh OMBN"umber: '. 0920.()639 ExpIres:P..-5Gf7 05t31QOO1 '. -
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3t !east one of the foUowing e~
In this sectionbycheckingthe appropriate ~ 00x
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t\7qujiOO infOffilation related to the seleCtion.You are not required to complete more than one entry.
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., l/We have attached either documents or statements ~ded
by affidavit that indicate that radiation expQSW'8S radiation doses potentially incurred by members of the proposed class, and that refate to thiS petition, were not monitored, either through pelSCnalmonitoringor through area monitoring. (Attach documents and/or affidavits to the bad( of the petition form.)
Describe as completely as possible, to the extent it might be unclear, how the attaa'led documentation and/or affidaYit(s)indicate that potential radiation exposures were not monitored.
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W II We have attached either documents or statements provided by affidavit that indicate that
radiation monitoring records for members of the proposed class have been lost, falsified, or destroyed; or that there is no infonnation regarding monitoring, source, source tenn, or process from the site where the employees worked.
. DescnDe CO~ly .as
(Attachdocuments and/oraffidavits the backof the petitionform.) to
. '" ,.. how ., , as'PosSibie,~ extent mi~ be unclear. theattached io It
doalmentation and/or affidavlt(s) indicate that radiation monitoring records for members of tl)e proposed class have been lost, altered illegany. or destroyed.
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Name or Social Security Number of FII'st Petitioner:
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All Petition~rs shouldsign and~
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of threepersonsmaysignthe petition.
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Signature
Signature Notice:
Date
Date
Any person who knowinglymakes any false statement.misrepresentation. oonceaIment of fact or any other ad of fraud to obtain compensation' provided under EEOICPAor wOO. as -knowingly aa'.eP1s (X)n1pensation which that person is not entitled is subject to civil or to admnistJative remediesas well as felony aiminal proseaJtion and may, under appropriate criminal provisions. be punished a fineor imprisoM1ent both. I affinnthatthe information: by or
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provided on this form is aca1rateand true. -. '--- _0'- Offirs of CompensationAnalysisarKi Support ~~~ ___"00 ~~. _._, o.._,
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NIOSH 4676 ColumbiaParkway. Ms.c.-47 Cincinnati.OH 45226
Name or Social Security Number of First Petitioner:
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Special
Expos!..,.
Cohort
Petition
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u.s. Department of Healthand H~ ServiC88 c.1I8fsb' DI8-.e COf*oI ~ .,.,
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SafetyarxS H88IthI 05/31fZOO7
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:Spedai Expoeure Cohort ~on
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Public Burden Statement
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Public reporting burden for this ooIIedion of informatk)n is estimated to average 300 minutes per fe&pa1Se, indOOingtime for reviewing instructions, gathering the 1nfonnatkx1 needed. and completing the fonn. If you have any comments regattling the burden estimate or any other asped of this ~ of infot .~ -.. Iindl.Kflng suggestionsfor redudng this burden, send them to roc ReportsClearance Ofticer. 1600Clifton Road, Ms.e.11 , Atlanta GA, 30333; AnN:PRA 0920-xxxx. Do 00\ seOO1he competed petition form to ~is address..are not requiredto respondto the infom1ation PeIsons Completed petitions are to be submitted to NIOSH at the address providedit displaysa aJrTentIy ~ on this form unlessin these instructions. valid OMB number.
Privacy Act Advisement
in aaxxdance with the Privacy Act of 1974, as amended (5 U.S.C. § 552a), you are hereby notified of the Ifollowing:
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Illness Compensation Program Act (42 U.S.C. §§ 7384-7385) (EEOfCPA) authorizes the President to designate additlonaJclasses of employees k>be fnduded m the Special Exposure Cohort (SEC). EEOICPA authorizes HHS to implement Its responsibilities with the assisbK'a of the NationaIlnstiblte for ~paOOnal Safety (NIOSH), an Institute of the.Centers for Disease .: Coofn)I aoo Preventk>n. Infonnation OOCained NIOSH in OOMectionwith petitions for Including additional by
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The Enefgy Employees~patiCK\8J
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of employeesin the SEC wi11 usedto evaluatethe petitionand reportfindingsto the Advisory be
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Board on Radiation and Wofi(er Health and HHS.
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!Reoords contairnng identifiable infonnation beoome part of an existing NIOSH system of recorda under the Privacy Act, 09-20-147 -OCaJpationaJ,HeaIth Epidemiological Studiesand EEOICPA ProgramRecords.
HHS/COCINIOSH.- These records are tJeated in a confidential manner, unless otheIWise compelled by law. Dfsdosures ' that NIOSH may" need to make for the processing of your petition or other purposes are isted , belaN. .
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N/OSH may need to disclose personal identifying information to: (a) the Department of Energy, other federal agenaee. o~er government or private entities and to private sedor 8ffip(oyers to pennit these entities to retrieve records required by NIOSH; (b) identified witnesses as designated by NIOSH so that these irxfividuals can provkie information to assist with 1he evaluation of SEC petitions; (c) (X)ntJ'adoISassisting NIOSH; (d) colla:borating-researchef's,under certain limited circumstances to conduct further investigatio,.; (e) Federal, state and local agencies for law enforcement purJX)Ses; and (f) a Member of Congress or a Congressional staff member in response to a verified inquiry. I
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This notice applies to aUfonns and infommtional requests that you may receive fnxn NtOSH in oonnedion wIU'I evaluation of an SEC petition. the Use of the NIOSH petition fonns (A 8fKf B) is voluntary but yoor provlsk)n of Information required by these forms is mandatory for the oonsideration of B petition, 8S specified under 42 CFR Part 83. Petitions that fail to provkie required infom1ation may not be (X)nSfderedby HHS.
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Nameor Social SecurityNumberof Pm Petitioner:
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SPECIAL EXPOSURE COHORT PEnnON ~LEMENTAL INFORMA nON
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Sedion E.!: The name of the DOE Facility is Sandia National Laboratoryy Livermore. CaIiftJrnia. SectionE2: The location at the Facility relevant t.Qthis petition is the X-Ray DiffiactiODand Fluorescence Laboratory, B - --. _.easesee enclosedaffidavit ftom . -Section E.3: The job titlM J!nd duties were as follows. This x-ray lab only ~1oyed people. M ( MI-.
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was the lead engineerand I was the supportingteChnician.We both saiPpO[tC(! opa"ationof the the laboratory and sharedresponSibilities. Our job duties required being in the vicinity of the X-I1.y ~.bines while they were eoel"gize4. However, my every day respoDSl'bi1ities includedsample preparation, sample analyses. x-ray diffractometer and IX>wder camera cah"brati~ and maintenance the X-ray fluOreSCalce of units and the x-ray generators. Performing these Wks required being very near the ionizing radiation source and having physical contact with the Jaboratoryequipment, again while the radiationexpo~were :fullymy tenure. CoDseq\JeDtly,I was thf!!'eforesubjectto greater amountsof x-ray ma~.hJnes during energized. - -. :d o!1tinLtM operatethe x-ray lab after my deparmre, on a limited scale. to but Seajon E.4: Employment.dates relevantto.this petition are ftom t ). 1971to. 1978.. SectionE.S: This petition is basedon unmonitor~ unrecorded,and inadequately monitored exposures. The X-Ray Diffiaction and FluorescenceLaboratory utilized io~ radiation producedby Norelco X-Ray generatorsto characterizea multitude of weaponsgrade elements and compounds, which were radioactive.toxic, and classified. My employmentrequired a "Q" level of clearance many of the componentsofwbich we worked on were "ClaSsified". All of the work, as ~~I~ air ventilation, a lab coat, ana.a dosimeterworn behindmY -- in Clearance S3D!ple p'rep~.on and x-ray analyses, were performed the laboratory with just did room badge. Sanaiathe not provide any permanently mounted instrwnentation fur continuous recording of the ionizing radiation that was being emitted about the laboratory on a daily basis. A portable Geiger deteCtor was often used to check for abnorma1circumstanceswhere there were significant radiation leakages. Shieldjn,gdevices were utilized whenever possible. however they did not conform to today's standa.. j I bad to fabricateour own custom-made x-ray shieldingdevices to compensatefur classified components. Consequently. io~ radiation exposures were inevjtab]eand pretty muclJ an eveIY day incidei]t. as some scatteredradiation 'Wouldbe emitted. even under the very best ciralmstances. Exposures were even greater during diffi"actometer alignment.speci~~. and oversizedsamplepreparationand analyses. In summary,due to the Jack of monitors and poor perromJing dosimeters radiation exposures and radiation doses were unmonitoTed,unrecorded. and inadequatelymonitored. Dosimeters are discussedin detail in
paragraph F .1.
The Norelco x-ray generatorswere normally energiz«l daily at 40 Kilovolts and 20 miIliamps. X-ray analyses would typically take the entire day and fr~ extendedinto the eveninghours. as data collection took numeroushours and even days. I often returned to work in the eveningto continueanalyses monitor the x-ray equipment. and
~ F.I: This petition is further mpplanaJtedby'an Iffidavit that indicates, m*nown that radiationexposmes and radiationdoseswere mcmiecl In additionto-tht;-fact that there Wa'e g any room ars monitors, "-.has si1M a couple of diff~aIi. exampJes his affidavit in regarding dosimeter badges 00w they Wa'ei!:Iad-~iate lIK1nitoringthe type' of ioDi7ing and in radiationthat we were exposed to. His di..CQ~~~ SUPIK>rts ongoing debateof how the data the co~ from -d1ese dommetm sIxmIdm:t be relied'IipOO determine to ones' radiatioIi exPoSUl'e IIMi dosereconstnlctioo. &~, the lack of room &rQ UKmitorsand the Imsatisfactoryuse'of ~~ ]eft the workerwith radiationexpOStU'es wa-enot monitored. that Section F.2: The basis for proposing that radiation,.mOiJitoring records have beeIl kJst or possiIiy destJ'Oyed furtbtI- be ~~-ffied can by citing an expoSJre~-~ that cx:amed in February 1978. While calibratinga diffi'actomaerI received ~d~v of an elevatedexpoue of ionimg radiationto my fingersof my right hand,right 81'ID, bead,and the upper trunk of my body wha1~ x-ray beamsafetyinterlock shmoff failm ~ expoSD'e was receiving~ I tmooticed lmt11 1aterstep in the procedurecalledfor a ftuof'escalt~ a to be placedin the x -ray beamto vezify alignment. The x-ray generatorwas energized 40 Kilovolts and 20 miDiamps at during the exposw-e.The geDefmor was immediatelyde-~'giz.ed and ~~ report was filed. Sandia's H~J!h aId Safety DepartDDlt ~~ the iDcidait. As I was wearing ~ ~ appuYai dosimetry device, safety fepressltaUvesattemptedto reconsb'Uct iDcideot with tmespOsed the dosimeta'sto doaJmeDt potential x-ray expoaJreand an estimatedradiation dose. In the 1 2004,I req~ JJ,1Y do~ records:from Sandia. I was Salt doSmetryrecordsfor only a six ~ pmiod - -. -- After makinga ~ request, wastold that 00 other dosimdIy I datarecordsor even documalta1ion regardingthe accidentreport could be recova-edand that all av~ of ISieving the ~ havebeeneJ:~Jsted Unfort1m8tely, aucial time period from the are no longeravaiJab1 I attempted third ~ a after being
. ~
iufu&-med dosimeterrecordswere now avaiJabte.Again,I was sent dosimetry~-di that fix' the same six-yearperiod. Incidalt report recordswere not available either. I haveEIldosedmy Record of ()(nJPatianal~1l Dose u.t I ~~ from SaOOia National Laboratories,LiVerlJK)fe, California OD . Years of exposure and doserecordsare apparentlymissing. In
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summary,this incidmt fintber indicatesthat ramation exposures and the md-..iation dose that I ioom"edare unknown due to lost dommetery recordsandmissiug~ deot reports. In COIx:k&on.
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inadequate monitoringandrecording io~ at the
radiationexposures I received. that