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Background, Policy Context, and Statement of Task

The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act (PACT Act) of 2022 (PL 117-168) statutorily recognizes the long-term cost of war by adding several presumptive conditions, establishing requirements for how conditions for presumption are considered, and calling for new studies to examine the relationships between specified exposures and health outcomes in military and veteran populations. Its breadth and financial impact are large; it obligates the federal government to spend trillions of dollars for service-connected disabilities and research initiatives.

One section of the PACT Act pertains specifically to Manhattan Project–era veterans. Section 506 calls for the Department of Veterans Affairs (VA) to contract with the National Academies of Sciences, Engineering, and Medicine (the National Academies) to conduct a study on health outcomes in active-duty military veterans who participated in activities related to the Manhattan Project, including activities related to toxic exposures of covered waste, or who resided at or near at least one of 13 locations as specified by the legislation or added by VA.

This chapter provides a brief introduction to the Manhattan Project, the origin of the legislative language requiring this assessment and the statement of task derived from it, the formation and activities of committee appointed to address the statement of task, and organization of the report.

BRIEF HISTORY OF THE MANHATTAN PROJECT

The Manhattan Project was a top-secret program of the U.S. federal government, officially spanning January 12, 1942, to August 15, 1947, and involving complex work in, between, and among numerous locations around the United States (NPS, 2024). Its primary sites were Oak Ridge, Tennessee; Hanford, Washington; and Los Alamos, New Mexico, and it employed thousands of civilians and military service members who contributed their experience and expertise to develop and deliver the world’s first nuclear weapons. On August 6 and August 9, 1945, the United States detonated these weapons above Hiroshima and Nagasaki, Japan, respectively, resulting in a catastrophic event with estimated immediate casualties on the order of hundreds of thousands and many additional late adverse health outcomes among the survivors (Atomic Archive, n.d.; Grant et al., 2017; Radiation Effects Research Foundation, n.d.). The use of these weapons marked one of the most impactful historical events of the 20th century. It ushered in the nuclear age and paved the way for enduring scientific, political, environmental, social, cultural, and public health legacies. While the Manhattan Project gave rise to landmark scientific accomplishments, it also generated a wide array of health, safety, and environmental concerns.

With the end of the war, many of the military personnel and civilians who contributed to the Manhattan Project moved on with their lives, while the project waste physically remained at or near the wartime work sites. Responsibility for these sites has changed hands and involved multiple federal and state agencies and private contractors, resulting in fragmented records. Furthermore, changes in site management brought shifts in priorities with regard to how waste management and environmental contamination should be addressed. Each site has its own history and legacy that may continue to affect the health of its workers and surrounding communities.

ORIGIN OF THE REQUEST

Researchers from numerous disciplines have examined the Manhattan Project and its legacy from a variety of perspectives: environmental, scientific, technical, political, social, and cultural. Most of the historiography has focused on the three primary sites of Oak Ridge, Hanford, and Los Alamos, but given that some historians have estimated that more than 200 separate sites (including research and academic institutions, military and government institutions, and private companies and contractors) existed across the United States (Wellerstein, 2015), such a focus is only part of the story. The Manhattan Project’s vast and varied reach, including ongoing individual and community experiences of its legacy, contributed in part

to the passage of section 506 of PL 117-168 via amendment.¹ Concerns of St. Louis, Missouri, city and county citizens about radioactive environmental contamination arising from Manhattan Project–related activities that occurred in the area led to the legislative directive.

During the committee’s first meeting, where VA officially charged it with its task, the Honorable Cori Bush, U.S. representative from Missouri and author of the amendment language, provided brief remarks describing her motivations for including this study in the PACT Act and her hopes for what would be gained from it. She stated that decades after the radioactive waste was generated as part of Manhattan Project activities, it continues to contaminate and impact the St. Louis region and community and other areas and communities where such waste was generated. In particular, improperly stored waste that leaked or leached into Coldwater Creek, which runs north of St. Louis between the Missouri River and just south of the St. Louis Lambert International Airport, continues to contaminate residential gardens, yards, and public-school playgrounds with radioactive water during creek overflows. Moreover, legacy contamination and adverse health outcomes continue to disproportionately impact underserved communities. Representative Bush added that including VA as a sponsor of a study of veterans exposed to this waste in St. Louis and other specified areas was intended to bring attention to the ongoing effects of such exposures in addition to the existing involvement of other federal agencies, including the Army Corps of Engineers, Department of Energy, Environmental Protection Agency, and Government Accountability Office. She spoke of the legacy of Manhattan Project contamination and waste, her belief that this is also an issue of environmental and social justice, and her desire that these sources and areas of contamination be mitigated (Bush, 2024).

While this feasibility assessment focuses on military veterans, as required in its formal charge, it also acknowledges the varied and long-term potential health impacts on civilian populations and communities. Understanding and contextualizing historical releases and exposures can not only advance knowledge but provide insight into modern environmental challenges. By registering Representative Bush’s motivations, this feasibility assessment becomes a potential resource for greater public knowledge and can inform present-day health concerns for not only military veterans who experienced the Manhattan Project firsthand but also countless individuals in broader communities who continue to face its legacies. This report focuses on the adverse health outcomes experienced by military veterans who supported developing the first nuclear weapons and thus had complex exposures to radiological, chemical, and other hazards.

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¹ The full legislative language for section 506 appears in Appendix A.

STATEMENT OF TASK

The National Academies has long provided scientific advice on exposures, health outcomes, and research priorities on persistent environmental concerns and contaminants at the primary Manhattan Project locations (NASEM, 2020a, 2022a,b, 2023; NRC 1985, 1996, 2000, 2001, 2006, 2007). It has also studied “atomic veterans” who served in those areas or participated in the nuclear weapons testing that stemmed from that work (IOM, 2000; Johnson et al., 1986, 1996) and prepared feasibility assessments of epidemiologic studies on them (IOM, 1995; NRC, 2003). Moreover, it has conducted numerous comprehensive reviews on relationships between exposures during military service and health outcomes for populations of U.S. service members and veterans of all conflict eras (NASEM, 2018, 2022a) and offered conclusions and recommendations on epidemiologic and other study designs, frameworks for conducting research, and prioritization of research portfolios (IOM, 1999, 2003, 2008, 2011; NASEM, 2015, 2020b). However, the relationship between exposures from Manhattan Project–related activities and the health of military veterans specifically has not been examined.

Before the National Academies began its work in response to the PACT Act, VA determined a feasibility assessment was necessary to determine if the legislation could be addressed given the period of the Manhattan Project (January 12, 1942–August 15, 1947) and uncertainties regarding what records or data exist on individual veterans involved in it (including their health records before, during, and after this time frame and their quantifiable Manhattan Project-related exposures), and where those records are located. VA initiated the agreement with the National Academies and provided the statement of task (see Box 1-1), which is based on the legislative language but does not duplicate it. The elements in the feasibility assessment are derived from the legislation, such as quantifying and characterizing the veteran population at the specified sites, including demographic and military information; period and location of exposure to waste; and cause of death and any type of cancer or other illnesses associated with the exposures.

Although the legislative language specifies that the study be on “veterans who while serving in the active military, naval, air, or space service” and those who resided at or near specific locations, the statement of task is restricted to veterans who would primarily have served in the Army (and a very few in the Navy). The Air Force did not become its own branch until September 18, 1947, and the Space Force was not established until December 20, 2019. Beyond the five sites specified in the legislation, VA included an additional eight sites of interest (see Box 1-1).

The legislative language “participated in activities relating to the Manhattan Project (including activities relating to covered waste) in

connection with such service; or who resided at or near 13 specified locations” is nonspecific because “activities” is not defined. However, “covered waste” is defined in (e)(2) as “any waste arising from activities carried out in connection with the Manhattan Project.” For the feasibility assessment, the committee examines the possibility of identifying and quantifying any exposure to a recognized toxic substance.

The feasibility assessment includes identifying and characterizing available records on exposures and health outcomes of military personnel who served on the Manhattan Project and were potentially exposed to radioactive or other wastes related to that work. Several specific data elements are included in the statement of task that, if available, would inform exposures, health outcomes, and potential confounders or effect modifiers of an epidemiologic study. The National Academies committee characterized available records, information, or data and delineated the process for requesting or obtaining access to them that includes time frames and human and financial resources (to the extent known). Based on the characterization and

availability of the identified data and its expert assessment, the committee provides conclusions regarding the ability to conduct the study as written in PL 117-168 section 506; no recommendations are made.

COMMITTEE COMPOSITION AND DELIBERATION PERIOD

The National Academies convened a committee comprising 10 members with expertise in radiation and environmental epidemiology, cancer epidemiology, occupational health, health physics, dose reconstruction from radiation exposure, reconstruction of military chemical exposures, radiation exposure and risk assessment, radiobiology, military and veterans’ health, the history of the Manhattan Project, and historical research of archives and other historical databases and documents (see Appendix C for biographical sketches of the committee members). The committee held nine full meetings and several shorter planning and working group meetings between January 2024 and April 2025 to consider evidence and write its report. It held eight public information-gathering sessions during its deliberations, four of these near several Manhattan Project locations, to identify, understand, and characterize available records and information (see Appendix B for the locations, agendas, and speakers for these sessions).

ORGANIZATION OF THE REPORT

Chapter 2 describes the committee’s general approach for responding to its statement of task, including its interpretation of the task and defining specific terms used throughout this report. In Chapter 3, the committee presents an overview of each of the 13 specified sites, including a brief history and summary of known military presence in 1942–1947, processes that would have resulted in exposures and waste, and epidemiologic studies conducted at each site. Chapter 4 describes the types of military personnel who served at the sites, the sources of military and non-military records, and the process that would be needed to quantify these personnel and create a complete roster of those for whom additional records on health and exposure information might be identified and requested. Chapter 5 outlines how exposures may occur and how an exposure assessment could be performed for both radiological and chemical exposures based on the type and availability of data for each one. The chapter considers relevant sources that would need to be examined carefully to inform a study, including databases and contemporary historical records and addresses the nuances of using data from the Manhattan Project era to perform dose reconstructions. Chapter 6 describes potential sources of cause of death and health outcome data and the strengths and limitations of each source. Key findings and conclusions are provided in Chapters 4, 5, and 6. Chapter 7 provides a

synthesis of the committee’s findings regarding the availability and characterization of data and records and offers its overall conclusion regarding its assessment of the ability to conduct a full study as requested in PL 117-168 section 506. This report includes four appendixes: Appendix A presents the legislative language for PL 117-168 section 506; Appendix B contains the information-gathering session agendas and presenters; Appendix C provides the committee and staff biographical sketches; and Appendix D presents a summary of datasets that have been used to examine radiological exposures and health outcomes at the sites.

REFERENCES

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