Veterans' Benefits

Some of the 200,000 active-duty military personnel who participated in atmospheric nuclear tests between 1945 and 1962 were exposed to potentially harmful doses of radiation. During the last 20 years, veterans with diseases that they attribute to radiation exposure have filed claims for monetary compensation with the Department of Veterans Affairs (VA). Veterans can receive compensation for 16 types of cancer without documenting the radiation dose because VA presumes these cancers to be directly linked to the veterans' exposures. For other cancers and some nonmalignant ailments, the Defense Department (DOD) estimates, or "reconstructs," the radiation dose using such information as the duties and locations of veterans and their units during the atmospheric testing, the type and the quantity of radiation released from the explosives, and readings from the film badges worn by veterans and from other devices use to measure radiation doses in the vicinity. VA uses the results of these dose reconstructions to decide compensation claims. This report (1) reviews studies that assess the validity of dose reconstructions for estimating veterans' radiation exposures and discusses the issue with experts and other knowledgeable individuals, (2) determines what activities are in place to oversee the dose reconstruction process, and (3) examines alternatives for deciding veterans' claims for compensation related to radiation exposures.

GAO noted that: (1) some veterans, veterans' organizations, and experts GAO talked with do not have confidence in the Department of Defense's (DOD) dose reconstruction program; (2) they question the completeness of DOD's data and methodology and believe the DOD's involvement in estimating radiation doses from exposure to tests for which it was responsible presents a conflict of interest; (3) however, independent studies by the National Research Council and the Institute of Medicine have validated the dose reconstruction process that DOD uses for deciding radiation claims; (4) these studies point out that DOD's reconstruction process tends to overestimate both external and internal does--an outcome that would increase the likelihood that a claim would be decided in a veteran's favor; (5) DOD conducted separate studies to determine the accuracy of dose reconstruction and found that the external radiation dose estimates obtained through reconstruction methods were about the same as the readings directly measured by film badges worn by other participants at the same tests; (6) some experts interviewed, including Health Physics Society representatives, also support the use of dose reconstruction for claims decisions; (7) although studies appear to validate DOD's dose reconstruction program for deciding claims, the agency is not providing for independent oversight of the program; (8) the Institute of Medicine has been critical of the program's lack of quality control, including the lack of a peer review process; (9) the National Research Council has also suggested that dose reconstruction be reviewed, or subjected to peer review, by outside independent scientists; (10) a VA official told GAO it was not VA's responsibility to establish a process to oversee a DOD program; (11) a DOD official explained that there had been no direct recommendation to DOD for a peer review process and the program did not include one when it was designed; (12) GAO did not identify any better alternatives available for deciding claims than dose reconstruction; (13) some suggest expanding the list of presumptive diseases as an alternative to dose reconstruction; and (14) others favor adding all human cancers to the list, but some experts, including officials at the National Cancer Institute, find little or no evidence that would link many cancers to relatively low levels of radiation, such as those levels to which most veterans were exposed.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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