Blake, Paul K.*; Komp, Gregory R.†
THE U.S. military consists of five armed services: the Army, Navy, Marine Corps, Air Force, and Coast Guard. It is the world’s second largest military, after China’s People’s Liberation Army. As of 31 December 2012, it employs 1.4 million active duty military, 1.3 million National Guard and reserve military, and 700,000 civilian individuals (USDOD 2013a). There are also a large number of contract personnel working alongside military and civilian employees. In non-U.S. territories, the U.S. military may provide U.S. Department of Defense (DOD) schools, medical and dental care, and other services for deployed family members. All of these individuals may be referred to collectively as the U.S. military affiliated population. This entire population has the potential for radiation exposure.
The U.S. military employs or encounters numerous ionizing and nonionizing radiation sources. Many of the radiation sources are similar to those found in industry, hospitals, nuclear power plants, and research centers. U.S. military individuals may also be exposed to radiation during military operations. These exposures could be received as a result of nuclear weapons, dirty bombs, or other sources. Military planners are concerned about radiation effects on people, equipment, and structures, including effects in space, on land, and on the sea. Accordingly, the U.S. military employs numerous military, civilian, and contract personnel to address these concerns. The U.S. military annually monitors 70,000 individuals, which is ∼2% of its workforce, for occupational ionizing radiation exposure.
The U.S. military has frequently been at the forefront of adopting and using new technologies. The use of ionizing radiation and the development of radiation safety guidelines is an excellent example. Within 3 y of the discovery of x-rays, the U.S. military was using x-rays, or roentgen rays as they were referred to then, to provide medical treatment to soldiers and sailors. The drastic decrease in the number of fatalities from gunshot fractures from up to 50% in the American Civil War to near 0% in the Spanish-American War may in part be attributed to the use of x-rays and the ability to either not treat or to localize and remove the bullet (Cirillo 2000). In 1900, Captain Borden, an Army physician, published, The Use of the Roentgen Ray by the Medical Department of the U.S. Army in the War with Spain (1898) (Borden 1900). In this publication, Captain Borden describes the types of roentgen ray apparatus and provides instruction on their safe use. These were some of the earliest guidelines to protect patients from radiation. He himself had three basic guidelines:
* exposure should never exceed 30 min;
* the x-ray tube should never be closer than 10 in (25.4 cm) from the body; and
* repeated exposures should never be made within 3 d of the previous exposure (Borden 1900).
However, it was not until World War I that x-ray technology had improved sufficiently to allow its use in field hospitals near the front lines (Warren 1966).
The Manhattan Project was a research and development project that produced the first atomic bombs during World War II. From 1942 through 1946, the project was under the direction of Major General Leslie Groves of the Army Corps of Engineers. The medical section of the Manhattan Project was established in 1943, and Dr. Stafford L. Warren, a radiologist at the University of Rochester, School of Medicine, was appointed medical director and commissioned a Colonel of the Army Medical Corps. The medical section was concerned with three main responsibilities:
* coordinating the biomedical research programs in universities;
* development of industrial safety procedures required for individual on- and off-site contractors; and
* medical care and public health protection of populations at the secret sites (Warren 1966).
Safety and health were a major concern during the Manhattan Project. Many of the early health physics and industrial hygiene practices were developed at the various laboratories involved in the project. Instruments to detect radioactive contamination, personal dosimeters, safety and health protection standards, toxicity research, and shielding design were some of the many contributions by the health physics group. By 1945, the film badge and Lauritsen pencil electroscope were standard equipment in all areas where there was any exposure to radiation (Warren 1966). Colonel Warren and his team were also responsible for health and safety at the detonation of the first nuclear weapon at the Trinity Site. He later led the team to assess the effects on Hiroshima and Nagasaki and directed the radiation safety operations for the Operation Crossroads nuclear test detonations.
U.S. MILITARY GUIDANCE
The U.S. military provides guidance for conducting operations in all types of situations from operating in a wartime nuclear environment to the routine peacetime use of radioactive materials. This guidance is used to preserve and maintain the health of military affiliated personnel while they accomplish necessary and purposeful work in areas where they are exposed to ionizing radiation. It was first formally established during the Manhattan Project and subsequent nuclear testing (CNO 1947). The radiological environment that the U.S. military must be capable of operating in includes radiological accidents, radiological dispersal devices, and the use of nuclear weapons. Joint Publication 3–11, Operations in Chemical, Biological, Radiological, and Nuclear (CBRN) Environments, provides doctrine to assist commanders and their staff in planning, preparing for, conducting, and assessing operations in which their forces may encounter chemical, biological, radiological, and nuclear threats and hazards (USDOD 2008). In non-CBRN environments, the U.S. military also uses radioactive materials in much the same way as nonmilitary groups. DOD Instruction 6055.8, Occupational Ionizing Radiation Protection Program, implements Occupational Safety and Health Administration, U.S. Environmental Protection Agency, and U.S. Nuclear Regulatory Commission (NRC) radiation protection guidance (USDOD 2009). This guidance does not apply to:
* patients undergoing diagnostic or therapeutic exposure in medical facilities;
* personnel exposed to ionizing radiation as a result of nuclear war;
* personnel exposed to ionizing radiation as a result of combat, peacekeeping, or peacemaking operations for which an alternate ionizing radiation protection standard is implemented in accordance with the North Atlantic Treaty Organization or military service doctrine;
* personnel exposed to cosmic ionizing radiation, such as aircrew, who are covered under Federal Aviation Administration guidelines; and
* personnel engaged in activities associated with nuclear reactor programs including the Naval Propulsion Program, nuclear weapon systems, and fuel and other material controlled under Section 2121 of Title 42, U.S Code of Federal Regulations (USC 2011).
The U.S. military services implement these programs in slightly different ways depending on their structure and mission. The Department of the Navy (including the Marine Corps) and the Air Force maintain Master Material Licenses with the NRC. They then issue operating permits for the use of radioactive material. The Armed Forces Radiobiology Research Institute (AFRRI), the Defense Logistics Agency (DLA), the Defense Threat Reduction Agency (DTRA), the Uniformed Services University of Health Sciences (USUHS), and various Army facilities have individual NRC licenses for each use of radioactive material. All military and civilian personnel occupationally exposed to NRC regulated sources must comply with Title 10 Code of Federal Regulations (USNRC 2013). Even though the NRC regulations do not apply outside the United States, the U.S. military extends its regulations to those areas to ensure consistent application regardless of location.
In addition to the NRC regulated environment, the U.S. military also has the authority for the Military Application of Atomic Energy (USC 2011). This is commonly referred to as 91b material, since 91b is the section of the U.S. Code providing this authorization. The authorization includes special nuclear material, byproduct, and source material. Examples of this include Naval Reactor sources, nuclear weapon warheads, and Army test and deactivated power reactors. Each military service maintains rigorous radiological control programs for these radiation sources. Personnel exposure limits are similar to Title 10 Code of Federal Regulations Part 20 (USNRC 2013) or may be more restrictive.
The U.S. military also regulates the use of x-ray exposure regardless of location. Each service has its own regulations for exposure from x-ray producing devices. For example, Coast Guard guidance (USCG 2013) has provided regulations for its 30 health clinics and x-ray exposure from high voltage vacuum tube transmitter units that powered Coast Guard Long Range Navigation (LORAN) systems from 1942–2010 (Blake et al. 2011). The U.S. military has 59 hospitals and 360 health clinics with numerous diagnostic and therapeutic x-ray sources. Fluoroscopy (cardiology) typically produces the highest annual occupational individual dose across the U.S. military. There are also industrial sources for radiography or nondestructive testing, accelerators, and analytical sources, among others.
Environmental conditions also contribute to the overall exposure received by the U.S. military personnel. U.S. military personnel participated in the atomic testing program and the cleanup of the Pacific Proving Ground; specifically, Bikini Atoll in 1969 and Enewetak Atoll a few years later (DNA 1981; DTRA 2002). More recently, they received exposure from being deployed near the Al Tuwaitha Nuclear Research Center in Iraq and providing assistance to Japan during the response to the Fukushima Daiichi Nuclear Power Station (FDNPS) disaster. Combat operations and training for combat operations are another source of potential exposure. Many of the items used by military personnel contain radioactive material and could contribute additional radiation exposure if broken or damaged. Military personnel also receive radiation exposure from remediation activities conducted under the Defense Environmental Restoration Program (USC 2013).
U.S. MILITARY EXPOSURE COHORTS
Table 1 indicates the number of unique military individuals per exposure cohort. Each individual may have numerous radiation exposure records. The sheer number of individuals monitored provides an excellent database for epidemiology studies. The collective effective dose has remained fairly consistent over the last several years. The Navy (including the Marine Corps), Army, and Air Force all have a low collective dose that remains close to 1 person-Sv annually. As with the nuclear industry as a whole, the Naval Reactors program has a higher collective dose than the remainder of the U.S. military (NCRP 2009).
The U.S. military activities responsible for measuring an individual’s radiation exposure are the Army, Naval, and Air Force Dosimetry Centers, and various Naval Reactor sites comprising >50% of the National Voluntary Laboratory Accreditation Program accredited radiation dosimeter processors (NIST 2013). These sites process whole body and extremity dosimeters, which include thermoluminescent and optically stimulated luminescent dosimeters, and electronic pocket dosimeters. Similarly, Army, Navy, Air Force, and Naval Reactors sites offer a variety of internal monitoring to include in vivo and in vitro bioassays. Only a few Coast Guard individuals are now monitored routinely for radiation exposure, and as a consequence, the U.S. military collective dose measured by these activities during 2006 is shown in Table 2.
Due to the operational requirements of the U.S. military, emergent, forward deployed dosimetry support may be required. An example of this occurred during the FDNPS radiological release, when operational commanders requested radiation internal monitoring of military affiliated individuals to assess intakes of radioactive materials. Both fixed and portable scanners were employed to perform over 8,000 measurements on over 7,000 individuals from 16 March through 31 August 2011. About 3% of those measurements had a measured activity greater than the minimum detectable activity. Those individuals with measured activities greater than the minimum detectable activity had a maximum committed effective dose of 0.4 mSv and a maximum thyroid committed equivalent dose of 6.5 mSv. This monitoring was performed at 44 unique locations, consisting of 18 ships and 26 shore facilities, using a rigorous quality assurance and control program (Cassata et al. 2013).
The U.S. military maintains occupational radiation exposure records on two million individuals from 1945 to the present in five centralized repositories. These repositories consist of searchable computer databases that include personal privacy information associated with radiation exposure. Older hardcopy records are also maintained on a limited basis. In accordance with Privacy Act of 1974, the Defense Privacy and Civil Liberties Office provides current, online System of Records and Notices for each repository listing their name, location, categories of individuals and associated records, the authorities for collection of this information, and assorted other items of interest to the public (USDOD 2013b).
Army records are maintained at the Army Dosimetry Center located at Redstone Arsenal, Alabama. Navy, Marine Corps, and Naval Reactor records are maintained at the Naval Dosimetry Center at Bethesda, Maryland. Air Force records are maintained at the Air Force Dosimetry Center at Wright-Patterson Air Force Base, Ohio. These three dosimetry centers also provide occupational radiation monitoring services for AFRRI, DLA, DTRA, USUHS, the Coast Guard, and certain federal entities and consequently maintain associated records for these military and federal entities.
Two nonservice specific military data repositories are also maintained. DTRA maintains records of atomic veterans, who are defined as military personnel involved in 210 U.S. atmospheric nuclear tests from 1945–1962; Japanese-held prisoners of war; or occupation force members located in proximity to Hiroshima and Nagasaki during the period September 1945 through 30 June 1946 (VA 2013a). The largest occupational force doses were ∼0.01 Sv. DTRA also maintains records of military personnel involved in 815 U.S. underground nuclear tests from 1951–1992 and military individuals involved in cleanup of U.S. nuclear test sites.
The most recent military radiation repository, the Operation Tomodachi Registry, is part of the DOD Environmental Health Surveillance Registries. The U.S. military may establish an environmental health surveillance registry when (1) occupational and environmental health exposures could cause illness or (2) when the exposure is not expected to cause illness, but individuals need access to exposure data. The Operation Tomodachi Registry is unique in that it also includes radiation exposure records for children affiliated with the U.S. military.
Following the devastating 11 March 2011 earthquake and tsunami in Japan, the U.S. military launched Operation Tomodachi, a humanitarian assistance and disaster relief operation involving 24,000 U.S. service members, 189 aircraft, 24 naval ships, and costing $90 million. The radiological release from the FDNPS potentially impacted 53,000 U.S. military-affiliated individuals on shore and 17,000 individuals on ships. The U.S. military instituted extensive environmental monitoring and both external and internal monitoring of individuals. It issued over 3,000 personnel dosimeters, of which over 99% measured 0.25 mSv or less per individual (Cassata et al. 2012). The Operation Tomodachi dose assessment process involved the collection and review of external radiation exposure rate information and radionuclide activity concentration results in air, water, and soil that were collected by various agencies of the U.S. military, the U.S. Department of Energy, the Government of Japan, and others. Data were either used as reported or estimated using scientifically-sound techniques for periods of time for which data were not available or when data were judged unreliable (Dunavant et al. 2013). These results were combined with conservative or high-sided values of exposure parameters, such as breathing rate, water ingestion rate, uncertainties in dose coefficients for internal radionuclides, and others to produce location-based doses that are considered to be higher than the dose received by any member of the population of interest (Cassata et al. 2012; Chehata 2012; Chehata et al. 2013). Table 3 provides ranges of estimated doses during Operation Tomodachi.
The U.S. military supports numerous epidemiology studies of its military affiliated populations. Not surprisingly, it has supported a number of studies of its radiation-exposed individuals. Although a few U.S. military affiliated individuals received lethal doses of radiation during criticality accidents during the Manhattan Project and the SL-1 accident (McLaughlin et al. 2000), the largest survivable radiation exposure occurred during U.S. atmospheric nuclear testing to 28 military individuals stationed on Rongerik Atoll, Marshall Islands, who were exposed to radioactive fallout on 1–2 March 1954 from Shot Bravo of Operation Castle. These 28 individuals received external whole body doses of ∼0.4 Sv and thyroid committed doses of ∼2.3 Sv (Goetz et al. 1987). A number of radioepidemiology studies have been performed and are ongoing for this cohort (Johnson et al. 1996; Thaul et al. 2000; Boice 2012).
Another military population of interest includes individuals who have received radiation exposure from Naval Reactor sources. The Navy has 104 operational reactors (including 71 submarines and 11 aircraft carriers) and has successfully steamed over 243 million kilometers on nuclear power. The responsible organization, Naval Reactors, is consistently recognized for its record of excellence (Harvey 2012). These reactors have unique design aspects. Nimitz Class carriers operate for 20 y without refueling with an expected service life of 50 y. Virginia Class submarines have life-of-ship reactor cores that will last 33 y. The USS Enterprise (CVN-65), inactivated at the end of 2012, had a 51-y lifetime (Polmar 2013). Naval Reactors has accumulated over 6,500 reactor-y of safe operation involving 526 nuclear reactor cores, without a single reactor accident, over a period of >50 y. No individual in the Naval Reactors Program has exceeded the federal annual limit in effect at the time. In recent years, the average annual radiation exposure for vessel operators has dropped to about one-tenth of the average annual exposure a member of the American public receives from natural background radiation and medical sources. The majority of radiation exposure occurs at four Navy public shipyards that maintain nuclear powered vessels (Mueller et al. 2012).
For more than a decade, Naval Reactor personnel, including those at shipyards and in the fleet, have been included among populations of occupationally exposed groups being studied. A study of the Portsmouth Naval Shipyard workers found that the health of shipyard workers had not been adversely affected by low levels of occupational radiation exposure incidental to work on nuclear powered ships. The study showed no statistically significant cancer risks linked to radiation exposure when compared to the general U.S. population (Silver et al. 2004). In addition, a more comprehensive epidemiological study of the health of workers at six naval public shipyards and two private shipyards that serviced U.S. naval nuclear-powered ships evaluated a population of over 70,000 workers from 1957 through 1981. This study did not show any cancer risks linked to radiation exposure. Furthermore, the overall death rate among radiation-exposed shipyard workers was actually less than the death rate for the general U.S. population (Matanoski 1991).
There have also been mortality studies on U.S. nuclear submariners. For example, a study of the health of sailors assigned to nuclear submarine duty from 1969–1981 concluded that submarine duty has not adversely impacted the health of crewmembers. Furthermore, the study indicated there was no correlation between cancer mortality and radiation exposure (Charpentier et al. 1993).
A smaller cohort, comprised of veterans who were victims of depleted uranium (DU) friendly fire, has been followed by the U.S. Department of Veterans Affairs (VA) in a biennial health surveillance program. A subset of this cohort is veterans who contain embedded DU metal fragments who have shown continuously elevated urine DU concentrations. This cohort remains under surveillance (McDiarmid et al. 2013).
Radiogenic Disease Compensation PROGRAMS
Federal radiogenic disease compensation programs for U.S. military radiation exposed individuals includes the VA, the U.S. Department of Justice (DOJ), and the U.S. Department of Labor (DOL). These programs are designed to serve as an expeditious, low-cost alternative to litigation. The VA’s compensation program is predicated on the fact that radiation exposure during military service may not manifest itself as a radiogenic disease until years later. A service member may have departed the military service and become a veteran before the disease appears. The VA provides two types of radiogenic compensation: presumptive compensation (VA 2013a) and nonpresumptive compensation (VA 2013b). VA presumptive compensation has been reserved for a unique exposure cohort—atomic veterans. To achieve this compensation, the veteran or his dependent must file a VA claim, provide documentation of 1–21 diseases specific to radiation-exposed veterans, and have participated in a defined radiation risk activity (VA 2013a). For atomic veterans who do not qualify for presumptive compensation, and all other veterans who may have become ill due to radiation exposure during their military service, nonpresumptive compensation is an option. In this case, the veteran or his dependent must file a VA claim, provide documentation of a potential radiogenic disease, and explain how they may have been exposed to radiation during their military service. The VA typically requests a radiation dose assessment for the veteran from the military organization responsible for maintaining radiation records for the specific veteran. Upon obtaining this information, the Veterans Health Administration will generate a medical opinion on the likelihood that radiation was responsible for the disease. The Veterans Benefits Administration will review this medical opinion, provide an advisory opinion, and return the case to the originating VA regional office. The VA regional office makes a compensation decision and informs the veteran and/or his dependent. Approximately 1,000 VA veteran radiogenic disease compensation claims are filed annually. Approximately 30% of the atomic veteran nonpresumptive claims are deemed service-connected. The percentage of service connection for nonatomic veterans is typically smaller.
Atomic veterans may also file for radiogenic disease compensation through DOJ’s Radiation Exposure Compensation Act program, under the onsite participant category (USDOJ 2013). This is a presumptive program that has similar qualifications to the VA presumptive compensation program. However, payment is provided in a lump sum compensation award of $75,000. Although atomic veteran onsite participants may file for either VA or DOJ compensation, they typically are only paid through one program. An interagency radiation compensation network exists which allows federal agencies to have knowledge of individual compensation payouts. Consequently, in cases where an atomic veteran or his/her dependent may have qualified for compensation through both programs, the secondary compensation program would not begin payments until they would have exceeded the primary compensation program payout. In 2012, ∼500 onsite participant claims were filed by atomic veterans or his/her dependents.
U.S. military civilian employees who may have developed a radiogenic disease may file for compensation via DOL’s Federal Employees Compensation Act (USDOL 2012). This is a lump sum, nonpresumptive compensation program. Similar to the VA nonpresumptive compensation program, a radiation dose assessment is required in order to determine the likelihood that radiation was responsible for the disease. Typically, only a few compensation claims are filed annually by military civilian employees under this program. There is a similar compensation program for contract workers employed at private shipyards performing work on nuclear powered ships. Private shipyard workers may file for radiogenic disease compensation via DOL’s Longshore and Harbor Workers’ Compensation Act (USDOT 1984). Typically, the number of claims filed via this program is less than the comparable number filed via the Federal Employees Compensation Act.
The authors are grateful to radiation health experts from the office of the Secretary of Defense, Army, Navy, Marine Corps, Air Force, Coast Guard, Naval Reactors, and DTRA who reviewed the original NCRP presentation for accuracy.
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