[Senate Hearing 111-437]
[From the U.S. Government Publishing Office]
VA/DOD RESPONSE TO CERTAIN
MILITARY EXPOSURES
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
Together with
ADDITIONAL STATEMENTS SUBMITTED FOR THE RECORD
OCTOBER 8, 2009
----------
Printed for the use of the Committee on Veterans' Affairs
VA/DOD RESPONSE TO CERTAIN MILITARY EXPOSURES
S. Hrg. 111-437
VA/DOD RESPONSE TO CERTAIN
MILITARY EXPOSURES
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
OCTOBER 8, 2009
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
----------
October 8, 2009
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 2
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 4
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 6
Burris, Hon. Roland W., U.S. Senator from Illinois............... 6
Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia... 105
Prepared statement........................................... 105
Attachments.............................................. 107
WITNESSES
Hagan, Hon. Kay R., U.S. Senator from North Carolina............. 7
Wyden, Hon. Ron, U.S. Senator from Oregon........................ 8
Partain, Mike.................................................... 10
Prepared statement........................................... 12
Attachment............................................... 17
Response to post-hearing question submitted by Hon. Daniel K.
Akaka...................................................... 64
Enclosures............................................... 66
Nuckols, John R., Professor, Department of Environmental and
Radiological Health Sciences, Colorado State University........ 71
Prepared statement........................................... 72
Response to post-hearing questions submitted by Hon. Daniel
K. Akaka................................................... 75
Pennington, Stacy, Sister of SSG. Steven Gregory Ochs, Iraqi
Operation Freedom and Operation Enduring Freedom Veteran....... 75
Prepared statement........................................... 78
Miller, Robert F., M.D., Associate Professor of Pulmonary and
Critical Care Medicine, Vanderbilt University Medical Center... 80
Prepared statement........................................... 82
Paganelli, Laurie, Mother of Jordan Paganelli, Childhood Cancer
(Sarcoma) Warrior and Past President of U.S. Naval Air Facility
(NAF), Atsugi, Japan........................................... 83
Prepared statement........................................... 86
Feigley, Charles E., Ph.D., Professor, Environmental Health
Sciences, Public Health Research Center, Arnold School of
Public Health, University of South Carolina; Chair,
Subcommittee on the Atsugi Incinerator Committee on Toxicology
Board on Environmental Studies and Toxicology Division on Earth
and Life Studies, National Research Council, The National
Academies...................................................... 88
Prepared statement........................................... 90
Response to post-hearing questions submitted by Hon. Daniel
K. Akaka................................................... 92
Gibb, Herman, Ph.D., M.P.H....................................... 92
Prepared statement........................................... 95
Response to post-hearing questions submitted by Hon. Daniel
K. Akaka................................................... 96
Powell, Russell, Former U.S. Army Staff Sergeant................. 97
Prepared statement........................................... 99
Peterson, Michael, DVM, M.P.H., DRPH, Chief Consultant,
Environmental Health, Strategic Healthcare Group, Office of
Public Health & Environmental Hazards, Veterans Health
Administration, Department of Veterans Affairs................. 115
Prepared statement........................................... 116
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka....................................... 121
Hon. Richard Burr.......................................... 123
Postlewaite, R. Craig, DVM, M.P.H., Acting Director, Force Health
Protection and Readiness Programs, Office of the Assistant
Secretary of Defense (Health Affairs), U.S. Department of
Defense........................................................ 125
Prepared statement........................................... 126
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka....................................... 128
Hon. Richard Burr.......................................... 131
Gillooly, Paul B., Ph.D., CAPT, Medical Services Corps, U.S. Navy
(Ret.), Navy/Marine Corps Public Health Center................. 132
Prepared statement........................................... 134
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka....................................... 139
Hon. Richard Burr.......................................... 290
Payne, Eugene G., Jr., Major General, Assistant Deputy
Commandant, Installations and Logistics (Facilities),
Headquarters, U.S. Marine Corps................................ 291
Prepared statement........................................... 292
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka....................................... 296
Hon. Richard Burr.......................................... 298
Resta, John J., Scientific Advisor, U.S. Army Center for Health
Promotion and Preventative Medicine............................ 299
Prepared statement........................................... 301
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka....................................... 305
Hon. Richard Burr.......................................... 310
Response to request arising during the hearing by Hon.
Richard Burr............................................... 324
APPENDIX
Akers, Paul C., BS, MS, MD, Camp Lejeune, NC (1954-60); prepared
statement...................................................... 327
Agency for Toxic Substances and Disease Registry (ATSDR);
prepared statement............................................. 328
Camp Lejeune Community Assistance Panel (CAP); prepared statement 336
Aschengrau, Ann, Sc.D., Professor, Associate Chair of the
Department of Epidemiology, Boston University School of Public
Health; accompanied by four other signers; prepared statement.. 342
Briscoe, David A., U.S. Marine (Ret.); prepared statement........ 343
Little, Candy; prepared statement................................ 344
O'Dowd, Robert, Somerdale, NJ, Marine Veteran, Former Financial
Manager, Defense Logistics Agency; accompanied by nine other
signers; letter................................................ 345
Attachment............................................... 347
Parulis, Shelly, Jacksonville, NC; letter........................ 351
Sims, Sam; letter................................................ 355
VA/DOD RESPONSE TO CERTAIN
MILITARY EXPOSURES
----------
THURSDAY, OCTOBER 8, 2009
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:31 a.m., in
room 562, Dirksen Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Rockefeller, Brown, Burris, Hagan,
Wyden, Burr, and Isakson.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Senator Akaka. The Senate Committee on Veterans' Affairs
will come to order. Aloha and welcome to today's hearing where
we will focus on how the Departments of Veterans Affairs and
Defense respond to in-service exposures.
As the Committee charged with oversight of the Department
of Veterans Affairs, we must be certain that VA is providing
appropriate health care and compensation to those who are
harmed by exposures while serving in the military. In order for
VA to do that, DOD must first determine who was exposed, what
they were exposed to and the health consequences of such
exposures. The information must then be shared with VA.
Two of the matters we will look at today relate to claimed
exposure of members of the Armed Forces during the current
conflicts. The other two involve claimed exposures in the past
and relate not only to members of the Armed Forces, but also to
family members. These are very different issues and as such,
require different
approaches.
As to the question of who might have been exposed in the
present conflict, current DOD records should be available to
answer that question. If they are not, then the Committee must
know why not. For the earlier exposures, DOD must pull together
records to provide some estimation of potentially exposed
populations.
I believe that the overall issue of providing intervention
on exposures is vital. DOD should commit to ensuring that going
forward no one will leave active duty without a detailed record
of where the individual was stationed and a comprehensive
physical that might identify any health concerns related to
possible in-service exposures.
VA's role is to merge the information regarding potential
exposure and the scientific analysis so as to craft an
appropriate response. This effort must be carried out, giving
the benefit of the doubt to the veterans concerned. In some
cases, there has been an absence of reliable information on
exposures, including health consequences. In other cases, it is
not possible to achieve consensus on the science.
One thing is clear, those harmed by an in-service exposure
to environmental hazards should receive a timely and
appropriate response from the government. Because Congress is
not the ideal forum for seeking to resolve complex and often
emotional issues related to potential exposures, we must be
sure that DOD and VA are working together effectively on such
issues.
I look forward to the testimony of the many witnesses that
we have here this morning. I now turn to Senator Burr, for his
opening statement.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Aloha, Mr. Chairman.
Chairman Akaka. Aloha.
Senator Burr. And good morning. I want to thank you for
calling what I think is an extremely important hearing. I want
to welcome our witnesses and to recognize all of the veterans
and their family members who have joined us here today for this
hearing.
I also want to give a special welcome to two North
Carolinians, Jerry Ensminger and Shelly Parulis and to thank
them for their tireless leadership and advocacy on behalf of
veterans and their families. Your interest in this hearing only
serves to underscore the importance of the issues we are
discussing today.
Over the years, thousands of military personnel and their
families have been exposed to dangerous chemicals where they
were living and working while serving our country. Today we
will hear about some of those exposures, including: the plumes
from an incinerator near a base in Japan; smoke from burn pits
being used in Iraq and Afghanistan; dust from a facility in
Iraq coated with a known carcinogen; and contaminated drinking
water at a base in North Carolina.
I want to express my sincere appreciation to the veterans
and family members on our first panel for your willingness to
share with us your painful experiences about your exposure.
Your perspectives will help guide our efforts to find answers
for veterans across the country about how these exposures may
have affected their health or the health of their loved ones.
More importantly, your testimony will help us determine what
steps we need to take to protect and improve the lives of those
who have been harmed.
Mr. Chairman, my remarks will focus on one exposure issue
that is very personal to me, the contaminated drinking water at
Camp Lejeune in my home State of North Carolina. I know we will
hear from several witnesses about this issue, but I also would
like to acknowledge two former Marines, Jerry Ensminger, who is
here today, and David Briscoe, who could not be here today.
They both lived at Camp Lejeune during the years that the
water was contaminated and have their own painful stories.
David, who lived in Camp Lejeune in the 1980s, was later
diagnosed with cancer of the hard pallet and underwent
treatment that reduced his ability to eat, speak and work.
Jerry's daughter, who was born at Camp Lejeune in 1975, was
diagnosed with leukemia at age six and tragically died 3 years
later. Jerry, I commend you for your personal strength in the
face of such tragedy and appreciate you being here today.
Unfortunately, Jerry and David's heart-wrenching stories
are not unique for veterans who served on Camp Lejeune between
1957 and 1987. The residents of Camp Lejeune didn't know it at
the time, but the water they were drinking, cooking with, and
bathing in contained harmful chemicals, including TCE, PCEs,
benzene and vinyl chloride, which are known or probable human
carcinogens.
Some of them are now living with rare cancers, like one of
our witnesses today. Mark Partain is a son of a Marine, a
former resident of Camp Lejeune, and one of over 20 former
Lejeune residents diagnosed with a rare male breast cancer at
an unusually young age. He was just 39 years old. This
condition usually strikes less than 2,000 men each year and
most are over the age of 55.
Although a number of studies have suggested a possible link
between the water and Camp Lejeune and these types of
conditions, we still do not have the answers about what made
Jerry's daughter or Mike or David sick or what has caused our
former Lejeune residents to become ill. The government's role
in scientific discovery is clear; Camp Lejeune was designed by
the EPA as a national priority list site.
Under Title 42 of the U.S. Code, the Agency for Toxic
Substance and Disease Registry is conducting a number of
studies of the Camp Lejeune contamination. These studies
include sophisticated computer modeling and future mortality
and health surveys. It is unfortunate that ATSDR was not
invited to provide a witness for this hearing so that they
could respond to testimony being given by our witnesses and
answer questions from this Committee.
Mr. Chairman, I hope in order to strike a balance of the
scientific opinion on what I think is an important issue, I
would ask that ATSDR's official response to the National
Research Council's report on Camp Lejeune be included in the
record today.
Chairman Akaka. It will be included in the record.
[The information referred to appears in the Appendix.]
Senator Burr. I thank the chair for that. We have an
obligation to figure out how much of these dangerous chemicals
veterans and their families were exposed to at Camp Lejeune and
what impact these exposures had potentially on their health.
For these patriots who have endured unbearable heartache and
suffering, they deserve no less than our best effort to provide
them with the answers about why they are sick.
Also, we must always make sure that the claims these
families have pending are not prematurely denied by the
government before science has had the opportunity to provide
more answers. Let me stress, before science has had the
opportunity. While we wait for science, we must deal with the
fact that many of these exposed veterans and their families
continue to suffer from devastating conditions.
It is simply not right for us to continue to tell our
veterans and their families to just wait for another study.
They have already waited two decades. We owe them much more
than that. That is why I have introduced, along with my
colleague from North Carolina, Senator Hagan, legislation--the
Caring for Camp Lejeune Veterans Act, S. 1518--which would
allow veterans stationed at Camp Lejeune while the water was
contaminated to get medical care from the VA.
Perhaps more importantly, it would also allow the VA to
treat their families for conditions associated with exposure to
contaminated water. Providing health care to veterans and their
families would be one step toward meeting our moral obligation
to those who have put more at risk. As we will discuss today,
there are many other veterans and their families who may have
been exposed to dangerous chemicals in other places around the
world. For all of them, it is important that we have a
framework in place to determine in a fair and hassle free and
timely matter what benefits and services they need and deserve.
To that end, we will have a candid and productive
discussion today about what is currently working well and where
improvements are needed. Mr. Chairman, for veterans and their
families put at risk by exposure, whether in Japan,
Afghanistan, Iraq or North Carolina, we have a solemn duty to
take care of those who were put in harm's way while serving
this Nation. I hope we will work together, and I think we will,
to provide these veterans and their families with the answers
they deserve and more importantly, the help they need.
I thank the chair.
Chairman Akaka. Thank you very much, Senator Burr. Now we
will have the opening statement of Senator Brown.
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown. Thank you, Mr. Chairman, Ranking Member
Burr, and Senator Hagan, too, for your good work on this very
important issue.
Today's hearing is about toxic exposure, elusive science
and earned compensation. It is about our servicemembers and
their families and how we will resolve the difficult challenges
that exposure issues present. When there is doubt, we must take
the side of the servicemember.
Yesterday I met with Mary and Jeff Byron. Jeff is a former
Marine who served at Camp Lejeune from 1982 to 1985. Mary and
Jeff were at Camp Lejeune when their first baby was born and I
believe their second child was born. We discussed their family
and the impact that living at Camp Lejeune had on this family's
lives through that generation and even the next generation.
Jeff is one of more than 5,900 Ohio veterans whose families
are part of the Marine Corps Registry for potential exposure at
Camp Lejeune. Jeff and Mary are here today. At one point, Jeff,
in recalling what had transpired with his family during their
time at Camp Lejeune and soon after and the problems that his
family was facing, told me he turned to his wife and asked,
what is happening to our family?
Connecting the dots between service and exposure is a
complicated process. Helping these families should not be
complicated. In tough cases like this, we have to ask
ourselves, what is the greater sin? Do we refuse benefits to a
servicemember or a veteran or a servicemember's family or a
veteran's family who may be suffering from service-connected
exposure to cancerous toxins? Or do we provide benefits to a
servicemember or veteran or servicemember's family or veteran's
family whose health care challenges may not be service-
connected?
Do we save a few bucks or do we save a few lives?
Scientific certainty should not trump human decency. There is
another point here that cannot be overlooked. Our military now
is working to connect the dots, but private contractors are
not. From the exposures of Camp Lejeune to the burn pits in
Iraq, to the emissions at Atsugi Naval Air Station, we found
the military working to find the answers.
It has not been the smoothest journey to where we are
today. For too long, the Department of Defense fought and
denied exposure claims, but the military, again, finally now is
working with the VA to serve the best interests of our
servicemembers, our veterans and I hope their families.
I spoke this week with the Marine commandant, General James
Conway, who has pledged his cooperation and who has pledged
that the military will do much better at meeting its
obligations than it has in the past. This cooperation though,
has not been the case with the sodium dichromate exposure at
the Qarmat Ali Water Treatment Plant.
What is the difference? The difference is the water
treatment plant was run by a private contractor, KBR. In a
recent hearing, soldiers testified they were never offered any
kind of protective clothing or masks or other protections by
the company. They were never told about the presence of one of
the most hazardous carcinogens. Hexavalent chromium is a
general toxic carcinogen and inhalation leads to lung cancer,
yet the company either dismissed these concerns, or worse,
intentionally mislead our military personnel. It is a lousy way
to turn a profit.
So, while I am not happy at the speed and the progress of
the Department of Defense and the VA, I am outraged at the
behavior of private contractors, especially KBR. We should all
be outraged by the behavior of KBR and like-minded contractors
who take the money from our taxpayers, who take the money from
our military, but fail its members. That is not the focal point
of this hearing, but it is an issue Congress must confront.
As we consider how to ensure members of our military who
have been harmed by environmental hazards benefits they
deserve, we should learn from the rocky road former nuclear
workers have been forced to travel to prove they have been
harmed by their jobs.
The Department of Labor is charged with addressing work-
connected health care issues affecting our former nuclear
workers, many of whom are in my home State of Ohio. It has been
an unjustifiably steep, red-taped-ridden battle for these
workers and I welcome my colleagues' assistance and efforts to
improve that program. We must not repeat the mistakes of that
program as we address the concerns of servicemembers.
We must cut through the bureaucracy and focus on delivering
both help and hope to men and women and their families who
served our Nation and now are suffering because of it. That is
why the work of this Committee and the leadership of the
Chairman and the Ranking Member on this issue are so important.
That is why the testimony of our witnesses is so vital and
appreciated.
Thank you.
Chairman Akaka. Thank you very much, Senator Brown. Senator
Isakson, your opening statement.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Thank you very much, Mr. Chairman. In
deference to the witnesses, I will be very brief. I want to
thank you at the outset for calling what I consider to be a
most important hearing and I look forward to hearing the
testimony of each and every witness.
I would like to thank each of the witnesses for helping to
shed light on this very serious matter. I would particularly
like to thank the witnesses who will be sharing their deeply
personal stories. You not only put a face on the consequences
of these exposures, but also help us as we determine the
correct path for us to follow. I thank you for your service to
our country and I thank you for being here today to testify.
Chairman Akaka. Thank you very much, Senator Isakson.
Senator Burris, your opening statement.
STATEMENT OF HON. ROLAND W. BURRIS,
U.S. SENATOR FROM ILLINOIS
Senator Burris. Thank you, Mr. Chairman. I would like to
also thank you for holding this hearing on the important issue
of exposure to environmental hazards to our servicemembers.
When we ask the brave men and women of this country to risk
their lives in service to this country, the country in turn has
an obligation to protect them from exposure and environmental
hazards and provide information and treatment.
I am deeply concerned whether there have been adequate
studies and reporting of environmental hazards in places abroad
where we are fighting two wars and in other military bases both
abroad and here in the U.S. In addition, as this body debates
the reform and expansion of our Nation's health care system and
the quality of care that is provided for our citizens, we need
to ensure that our soldiers and veterans receive the care that
they need from health problems resulting from these exposures.
I want to thank our witnesses today, some of them who have
experienced or have loved ones who have experienced severe
problems that are caused by some of these hazards. So, I will
have a few questions, Mr. Chairman, after we finish our
statements. Thank you.
Chairman Akaka. Thank you very much, Senator Burris. I see
my distinguished colleague, who, like our Ranking Member,
represents the State of North Carolina. Senator Hagan has
joined us. I would like to invite her to share a statement at
this time.
STATEMENT OF HON. KAY R. HAGAN,
U.S. SENATOR FROM NORTH CAROLINA
Senator Hagan. Thank you very much, Mr. Chairman. I would
like to begin by thanking you for holding this important
hearing and for giving me the courtesy of allowing me to make a
brief statement concerning an issue that is so important to me
and many of my constituents.
I also want to thank the Ranking Member, Senator Burr, for
his leadership on this issue. He has been discussing this issue
of water contamination at Camp Lejeune for many years and since
I have been sworn in, he and I have worked very closely
together on this issue. I have greatly appreciated his guidance
and tenacity in pursuing closure for the affected families.
Mr. Chairman, between 1957 and 1987, Marines and their
families at Camp Lejeune drank and bathed in water that was
contaminated with toxins at concentrations up to 280 times what
is currently considered safe by the Environmental Protection
Agency. My heart certainly goes out to the Marines and their
families who were exposed and affected.
A compelling CNN piece just last month highlighted cases of
former Marines and their families who have been diagnosed with
male breast cancer. Today there are over 40 individual cases,
all of whom at one point or another served on base or lived at
Camp Lejeune during the contaminated years. These service men
and women, as well as so many, have spent their careers working
to successfully finish the mission that they started. I think
it should be our mission to get these families complete
answers.
Marines and their families who were exposed to dangerous
chemicals over several decades deserve to know if this exposure
had an effect on their health. They cannot get closure until
the remaining CDC studies, which are in progress, are complete;
and these CDC studies are to be done by the Agency for Toxic
Substances and Disease Registry, the ATSDR. I am looking
forward to working with the Navy and the Marine Corps to fully
fund these human health and water modeling studies, which will
hopefully give us answers. It has received a lot of attention.
I would like to address the conclusion of the National
Academy of Science literature review which was recently
completed. Well respected scientists from across the country,
including officials at the ATSDR, have openly challenged the
validity of this review. This review significantly downplayed
the level of exposure Camp Lejeune residents had to TCE and PCE
chemicals found in the Camp Lejeune's water--potable water--
system and it also did not take into account the EPA's draft
health risk assessments for these chemicals. It also
significantly downplayed the adverse health effects resulting
from such exposure and did not assess scientific associations
between benzene and vinyl chloride in adverse health effects.
Benzene, a chemical, was leaking into the water supply at
Camp Lejeune at a rate of 1,500 gallons per month. Furthermore,
we all understand that there were no specific Federal
regulatory standards regarding volatile organic compounds until
the late 1980s. However, I think it is important to note that
the Navy and Marine Corps had their own regulations regarding
the operation of drinking water systems and the disposal of
contaminants and hazardous waste.
It is impossible to know with 100 percent certainty what
happened over 25 years ago, but I think it is important that
the most comprehensive understanding possible of the actions
that were taken and not taken during the contamination period,
the origins of the contamination, as well as where the
contamination sites were located, be given. Even more
importantly, I believe that this information must be explained
to the public in an understandable fashion.
I believe that Congress, the Navy, and the Marine Corps
need to work together to develop an action plan to take care of
the victims that were exposed to this contaminated water. While
this is happening, I encourage the Chairman and the Committee
to consider legislation introduced by Senator Burr, which I co-
sponsored along with five other senators. It provides veterans
and their families who are suffering from adverse health
effects associated with Camp Lejeune's contaminated water to
obtain health care from the VA.
This issue is not just about North Carolina. These men and
women are living all over our country now. We cannot leave
these families with mounting medical problems and half answers.
Thank you, Chairman Akaka and Senator Burr for the
opportunity to speak today.
Chairman Akaka. Thank you very much, Senator Hagan. I am
delighted to have my friend from Oregon here, Senator Wyden.
STATEMENT OF HON. RON WYDEN,
U.S. SENATOR FROM OREGAN
Senator Wyden. Thank you very much, Mr. Chairman, for your
thoughtfulness, and Senator Burr, and for the opportunity to
spend a few minutes here. I would ask unanimous consent that my
full remarks go into your record and would just touch on a
couple of issues this morning.
Chairman Akaka. Without objection, it will be included in
the record.
Senator Wyden. Mr. Chairman and colleagues, I am very glad
that you are looking at this critically important issue.
National Guard soldiers from my home State have told me about
their exposure to hexavalent chromium at Qarmat Ali in Iraq.
The soldiers have told me about how their rooms were filled
with toxic smoke from open air burn pits and they have told me
about their struggles with the agency trying to secure benefits
and health care. I very much appreciate, Mr. Chairman, your
putting a spotlight on this issue, and particularly working to
make sure that the Department of Veterans Affairs gets our
veterans the benefits they need and that they are treated with
respect and attention.
Mr. Chairman and colleagues, I think we all understand that
nobody at the VA gets up in the morning and says, I want to
spend my day being rotten to veterans. They all mean well. They
care about our veterans deeply, yet, so often the system can be
inflexible and our veterans get caught in red tape.
On September 19, I received what I felt was a positive
letter from then Secretary of the Army, Pete Geren, who told
me, I quote, ``The VA is working internally to use the registry
and the list of possible medical issues from chromium exposure
to establish a service connection.''
Yet, because a service connection has not been established
by DOD and the VA, some of our veterans get caught in this
morass of red tape when they ought to be receiving treatment
for respiratory problems, skin and eye problems, and even
cancer that they picked up as a result of their exposure to
chromium.
One Oregon National Guard soldier was told, and I quote,
``Exposure is not a disability, nor does the VA pay
compensation for exposure.'' Then that soldier was told to go
out and produce 15 pieces of evidence if he hoped to receive
any kind of treatment for his illness. I think our colleagues,
whether you are a Democrat or Republican, would agree that
veterans should not be subjected to this kind of merry-go-round
approach.
It is not enough for the agencies to say they want to help
and then, when the soldiers have to find their way through the
bureaucracy, there is nobody there to get them their benefits.
They face enough when they go into combat; they should not have
to battle their government to get medical care when they return
home.
I know you are going to hear from a variety of very
thoughtful witnesses this morning who are going to talk about
what is needed to make sure our veterans are properly cared
for.
Mr. Chairman and colleagues, thank you very much for the
chance to come and offer the vantage point from some Oregon
National Guard members who have reported to me. We have one of
the highest levels of participation in the Guard in the
country. We feel very strongly in our State about ensuring that
they receive adequate medical care when they have been injured,
when in harm's way, and we thank you for your thoughtfulness to
be able to come and spend a few minutes and lay out their
concerns.
Chairman Akaka. Thank you very much, Senator Wyden, for
your statement.
I want to now welcome our first panel this morning. Our
first witness is Mike Partain, who is testifying in regard to
Camp Lejeune. We have Dr. John Nuckols, who is a professor at
Colorado State University and a member of the Committee on
Contaminated Drinking Water at Camp Lejeune.
Next we have Stacy Pennington, sister of SSG. Steve Ochs,
who was exposed to burn pits and died in 2008. She is followed
by Dr. Robert F. Miller, who is an associate professor of
pulmonary and critical care medicine at Vanderbilt University
Medical Center and has studied health effects of environmental
exposures like burn pits.
We also have Laurie Paganelli, who will testify in regard
to the Atsugi Naval Air Facility in Japan. She will be followed
by Dr. Charles Feigley, who is a professor at the University of
South Carolina and was also the chair of the subcommittee on
the Atsugi incinerator for the National Resource Council.
Our final witnesses are Dr. Herman Gibb, who will testify
in regard to health effects related to Qarmat Ali; and Russell
Powell, who will testify about his experiences at the same
facility. I want to thank the Veterans of Foreign Wars for
making it possible for Mr. Powell to share his story with the
Committee today.
I thank you all for being here this morning. Your full
testimony will, of course, appear in the record. Mr. Partain,
will you please begin?
STATEMENT OF MIKE PARTAIN
Mr. Partain. Good morning, Mr. Chairman.
Chairman Akaka. Good morning.
Mr. Partain. Good morning, Mr. Chairman. I would like to
thank you, the Ranking Member, and Members of the Veterans'
Affairs Committee for permitting me to testify this morning.
My name is Michael Partain and I am son and grandson of
U.S. Marine Corps officers. My parents were stationed at Marine
Corps Base Camp Lejeune shortly after my father graduated from
the U.S. Naval Academy. My father chose to live in base housing
because he trusted the Marine Corps would protect his family.
I was conceived and carried while my parents lived on the
base. During the time of my mother's pregnancy, we were exposed
to high levels of tetrachloroethylene, trichloroethylene,
dichloroethylene, benzene and vinyl chloride in the tap water
provided to my family by the Marine Corps.
I was born at the base naval hospital in January 1968. Two
years ago, I was diagnosed with male breast cancer at the age
of 39. It is rare for this disease to strike men, especially
young men such as myself. In fact, I am one of 40 men who share
the unique commonality of male breast cancer and exposure to
contaminated tap water aboard Camp Lejeune. Fortunately, I have
health insurance which provides treatment for my disease. Even
then, my battle with cancer has been a traumatic, emotional,
physical, and a financial ordeal for my family.
Over the past 2 years, I have been in contact with numerous
other families who are suffering from illnesses related to
their exposures at Camp Lejeune. Many of these people do not
have adequate health care or are now uninsurable because of
their diseases. These families supported their Marines in body
and spirit and now they have been left behind to suffer and die
by the very organization they trusted and served faithfully.
Beginning on 31 October 1980, Navy and Marine Corps
officials received what would later become a litany of warnings
that the base's drinking water supply was highly contaminated
with chlorinated hydrocarbons. The U.S. Army Environmental
Hygiene Laboratory was tasked to analyze the base's tap water
for trihalomethanes in preparation for a new EPA safe drinking
water regulation. The Army lab warnings were repeated three
more times between December 1980 and March 1981.
For some unknown reason, the Army lab further spelled out
the issue by placing the word ``solvents'' with an exclamation
point at the end of their March 1981 warning. Curiously, this
key word was omitted from the 2007 Government Accountability
Office review of the Camp Lejeune drinking water contamination.
There was no documented action taken to identify the source of
the contamination at that time.
On 6 May, 1982, Mike Hargett, co-owner of Grainger
Laboratory, phoned the base chemist, Elizabeth Betz, and
advised her that PCE and TCE contamination was found in the tap
water samples sent for TTHM analysis. Ms. Betz then notified
her immediate supervisors. A week later, Ms. Betz was summoned
to a briefing involving the base's facilities command staff.
That is documented in her memorandum for the record. ``It
appeared to me that they had not been informed about the
findings. I did not inform them.''
Further testing revealed continued contamination. Grainger
then wrote the commanding general of Camp Lejeune.
``Interferences which were thought to be chlorinated
hydrocarbons entered the quantization of certain
trihalomethanes. These appear to be at high levels and hence,
more important from a health standpoint than the total
trihalomethane content. For these reasons, we called the
situation to the attention of Camp Lejeune personnel.''
The Grainger memo documented in writing that the
contamination present in the potable water systems aboard the
base was a serious issue. Grainger's chemist correctly
concluded that the contaminants were located in the well fields
for both Tarawa Terrace and Hadnot Point. No further action was
taken by the Navy or Marine Corps officials.
Several months ago, I spoke to Mr. Hargett, former co-owner
of Grainger Lab. He indicated to me that he had secretly tipped
off the State of North Carolina that there was a problem with
the TTHM testing program at the base. Shortly after this
revelation, a State of North Carolina environmental engineer
wrote to the base's assistant chief of staff facilities
requesting the Grainger analytical data sheets which contained
their notations of the contamination.
This request was ignored and then denied. It was not until
30 November 1984, that the Marine Corps officials began to
finally close the contaminated wells at Camp Lejeune. Two weeks
later, an article appeared in the base's newspaper. The article
advised residents and personnel that four wells were removed
from service due to traces of organic compounds which were
unregulated by the Safe Drinking Water Act.
What the article failed to mention was that on 6 July 1984,
Hadnot Point Well HP-602 was sampled and found to be highly
contaminated with benzene. The base environmental engineer also
failed to disclose to the readers the presence of a 20,000- to
30,000-gallon unreported and unremediated fuel leak dating back
to 1979 which occurred on Hadnot Point. This fuel plume was in
the groundwater and was 15 feet thick.
The minimization and deception did not end there. On 30
April 1985, the commanding general of Camp Lejeune advised the
residents of Tarawa Terrace that two wells were taken offline
because of minute trace amounts of--several organic chemicals
were detected in the water. In September 1985, the base
environmental engineer, Robert Alexander, was directly quoted
in a newspaper that people had not been directly exposed to
pollutants.
In November 1985, base officials, including Robert
Alexander, informed the EPA that the contamination had not
reached the distribution plants. What the Marine Corps has
failed to disclose to Members of Congress, the media, and the
public was that the Marine Corps was in violation of their own
orders which date back to 1963. These orders, if followed,
would have prevented most of the human exposures of Camp
Lejeune.
One of these orders is the Bureau of Medicine and Surgery
instruction known as BUMED 6240.3B. The purpose of the BUMED
was to establish standards for water for drinking throughout
the naval establishment, including Camp Lejeune. ``Substances
which may have a deleterious physiological effect or for which
the physiological effect are not known shall not be introduced
into the system in a manner which would permit them to reach
the consumer.''
There is also a Marine Corps order that specifically
addresses safe disposal of chemicals on the base. In the
interest of time, I will not go into the details during my
opening statement. However, I am prepared to answer questions
on both these documents.
In closing, I note at the table is a former member of the
National Resource Council committee which produced the report
that downplayed the health effects resulting from our exposures
at Camp Lejeune. I also note with great concern, as Senator
Burr indicated, the ASTDR, the agency statutorily tasked by
Congress to assess health effects for national priority sites
such as Camp Lejeune, is not represented in this hearing.
The NRC's report contains numerous flaws, including the
committee's failure to assess our exposures to benzene and
vinyl chloride. I respectfully submit that the Senate Veterans'
Affairs Committee seek out the professional recommendations of
the project manager in charge of ATSDR's Camp Lejeune studies.
I thank you for your time.
[The prepared statement of follows:]
Prepared Statement of Michael Sean Partain
Good Morning Mr. Chairman. I would like to thank the Chairman,
Ranking member and members of the Veteran's Affairs Committee for
permitting me to testify this morning.
My Name is Michael Partain and I am the son and grandson of U.S.
Marine Corps Officers. My parents were stationed aboard Marine Corps
Base Camp Lejeune shortly after my father graduated from the United
States Naval Academy. I was conceived, carried and then born at the
base Naval Hospital while my parents lived in base housing. During the
time of my mother's pregnancy, we were exposed to high levels of
tetrachloroethylene (PCE), trichloroethylene (TCE), dichloroethylene
(DCE), benzene and vinyl chloride in the tap water provided to my
family by the Marine Corps. Two years ago, I was diagnosed with male
breast cancer at the age of thirty nine. In fact, I am one of about
forty men who share this unique commonality of male breast cancer and
exposure to contaminated tap water aboard Camp Lejeune.
Beginning on 31 October 1980, Navy and Marine Corps officials
received what would later become a litany of warnings that the base's
drinking water supply was highly contaminated with chlorinated
hydrocarbons (see chronology, Oct 30 1980). The United States Army
Environmental Hygiene Agency (USAEHA) laboratory located at Ft.
McPherson, Georgia was tasked to analyze the base's tap water for
trihalomethane's (TTHMs) in preparation for a new EPA Safe Drinking
Water regulation. As part of their analysis for Hadnot Point's tap
water, the laboratory stumbled across interferences caused by
chlorinated hydrocarbons which inhibited the laboratory's ability to
quantify the chemical they were testing for in the samples. The
laboratory's supervisor documented these findings upon the analytical
results sheet provided to Navy and Marine Corps officials. He advised
that the base's tap water samples from Hadnot Point were highly
contaminated with chlorinated hydrocarbons and they needed to test
their water by Gas chromatography-mass spectrometry. This machine is
used by scientist to identify specific compounds while in solution. The
Army lab's warnings were repeated three more times between December
1980 and March 1981. For some unknown reason, the Army lab further
spelled out the issue by placing the word (SOLVENTS!) at the end of
their March 1981 warning (see chronology, March 9, 1981). Curiously,
this key word was omitted from the 2007 Government Accountability
Office (GAO) review of the Camp Lejeune Drinking water contamination
when this document was cited on the GAO's timeline of events. Between
October 1980 and December 1981, no documented action was taken by Navy
or Marine Corps officials to identify the source of the contamination.
Later the following year, the Army lab reports were referred to in the
base's Initial Assessment Study (IAS) draft report being prepared for
the Navy's NACIP program. The Army lab's reliability was called into
question in the review comments submitted by the base's Assistant Chief
of Staff for Facilities, Colonel John T. Marshall,
``it is important to note that accuracy of data provided by the
U.S. Army laboratory is questionable. It is recommended that
the TTHM information be de-emphasized throughout the report.''
How could these reports be questionable if they were never investigated
or verified? Oddly enough, Colonel Marshall's review was written
fifteen days after the base received a written report from yet another
lab verifying the legitimacy of the Army lab warnings. The other lab's
data was not included in the final IAS report released in April 1983.
The IAS report concluded that none of the twenty sites aboard Camp
Lejeune slated for further study posed an immediate threat to human
health.
The Navy and Marine Corps' lack of action was not the case for the
entire base. Within weeks of the March 1981 USAEHA warning that
solvents were contaminating Hadnot Point's water, Navy and base
officials discovered organic contamination at the base's Rifle Range
water distribution system located near the base chemical dump. Between
March and May 1981, Navy and base officials sampled the Rifle Range's
tap water and the system's potable water wells for contamination. Then
on 31 July 1981, J.R. Bailey from the Navy's Facilities Engineering
Command wrote to the Commanding General of Camp Lejeune advising the
General that Rifle Range potable water well RR-97 contained organic
contamination and that two other wells should be used in preference
over this well due to lower levels of contamination found in those
wells. The Rifle Range water distribution system only served a handful
of permanent residents, unlike Hadnot Point's system which served
enlisted barracks, bachelor officer's quarters, the base Naval Hospital
and other facilities located on Hadnot Point. What is puzzling is why
the Navy and Marine Corps went through the trouble of testing specific
potable water wells for a remote potable water system on the base and
then failed to test the other systems serving the vast majority of
people on the base for another three and a half years. Why were the
USAEHA lab warnings to the base ignored?
In September 1981 the USAEHA Lab experienced equipment problems and
a back log of tests. As a result, the lab was unable to perform further
TTHM testing for Camp Lejeune. A replacement was needed. In April 1982,
Grainger laboratory was contracted to perform TTHM testing for Camp
Lejeune. At this time, the testing was expanded to include a new water
distribution system aboard the base. That distribution system was for
the Tarawa Terrace (TT) family housing area. The initial samples were
collected in April 1982 and analyzed by the laboratory. Then on 6 May
1982 Mike Hargett, co-owner of Grainger Laboratory, phoned the base
chemist, Elizabeth Betz and advised her that PCE and TCE contamination
was found in the tape water samples sent for TTHM analysis. Ms. Betz
then notified the Supervisory Ecologist, Danny Sharpe, of the Grainger
findings and these findings were then sent up the chain of command to
Billy Elston, Deputy Base Maintenance Officer and to the Utilities
Director, Fred Cone. A week later, on 14 May 1982, Betz was summoned to
a briefing involving the base's facilities command staff. The purpose
of the briefing was to explain April's TTHM analysis results to Colonel
Millice, the Assistant Chief of Staff, Facilities, and Lt Colonel
Fitzgerald, Deputy Base Maintenance officer. Betz documented in her
memorandum for the record that
``it appeared to me that they had not been informed about the
findings. I did not inform them.''
The findings mentioned in the memorandum were the existence of PCE and
TCE in the tap water for Hadnot Point and Tarawa Terrace's potable
water distribution systems.
Shortly after the briefing, a second round of TTHM sampling was
collected for Camp Lejeune. However, some of these samples had problems
with air bubbles and interfered with the testing performed by Grainger
Labs. A new round was collected and sent to Grainger. Nonetheless, Mike
Hargett and Grainger labs found that the solvent peaks discovered in
the April samples were still present but the comparison with the
duplicate samples indicated poor repeatability. Betz and Hargett agreed
to collect yet another sample for testing. This sample was taken at the
end of June. The Grainger Lab report indicated interference in one of
the samples but there is no explanation of what was causing the
interference. As a result of the continued interference, Betz
specifically collected samples from both the Tarawa Terrace and Hadnot
Point water treatment plants for special testing of these two systems.
One sample was taken from the raw water entering the plant which
represented the well fields providing untreated water to the plants and
the other from the treated water distributed from the plants to the
consumers. One can logically conclude that the ensuing test results
from these samples would clearly demonstrate whether the interference
problem was emanating at the water treatment plant(s) or in well(s)
supplying raw water to the treatment plants. The samples were collected
and packed in ice and then shipped to Grainger Labs in Raleigh North
Carolina.
Immediately following the sample shipment, Betz called the state of
North Carolina and spoke to Linda Sewall concerning TTHM reporting
requirements. At the end of the conversation, Betz asked Linda Sewall
which Safe Drinking Water Act secondary contaminants were required to
be reported. PCE and TCE were not listed among the SDWA secondary
contaminants. Betz did not inform Ms. Sewall that PCE and TCE were
found in the potable water aboard the base.
The Grainger report arrived at the base on August 10th 1982:
``Interferences which were thought to be chlorinated
hydrocarbons hindered the quantization of certain
trihalomethanes. These appeared to be at high levels and hence
more important from a health standpoint than the total
trihalomethane content. For these reasons we called the
situation to the attention of Camp Lejeune personnel.''
The Grainger Lab memo documented in writing that the contamination in
the potable water systems aboard the base was a serious issue.
Grainger's chemist, Bruce Babson, correctly concluded that the
contaminants were in the well fields for both Tarawa Terrace and Hadnot
Point. If the contamination was emanating from wells there could be but
one logical conclusion. The groundwater supplying the wells aboard the
base was contaminated! No further action was taken by Navy or Marine
Corps officials.
In her 19 August 1982 memorandum for the record, Betz incorrectly
states the presence of PCE in the base's potable water is linked to the
presence of vinyl lined asbestos coated pipes in the base's water
distribution system. This scenario was based on a 1980 Suggested Action
Guidance Report on Tetrachloroethylene issued by the EPA, that the
contamination could be a result of vinyl lined asbestos coated water
pipes. There was no documented action taken to test this theory. In
fact, according to base records dating back to 1983, vinyl lined
asbestos cement pipes were not used as construction materials for any
of the base's water distribution systems. The question remains, after
the 10 August 1982 warning from Grainger laboratory, why did Navy and
Maine Corps officials fail to go out and test the individual wells
supplying the water distribution systems for Hadnot Point and Tarawa
Terrace?
Then on 1 June 1983, Colonel Marshall compiled data for what was
supposed to be a routine report on the TTHM analysis for the State of
North Carolina. He sent the data in the form of a table contained in a
letter to Charles Rundgren of the State's Water Supply Branch. The
original analytical Grainger lab TTHM data sheets were not included in
this letter. These data sheets contained Grainger's findings for the
TTHM readings including notations that PCE and TCE were contaminating
the samples. Several months ago I spoke to Mr. Hargett, former co-owner
of Grainger Laboratory, and he indicated to me that he had secretly
tipped off the state of North Carolina that there was a problem with
the base's TTHM testing program. Colonel Marshall's letter was supposed
to be a routine communication to document base compliance with the new
TTHM regulations slated to take effect by November 1983. Later that
month, Colonel Marshall received a reply from the State's Environmental
Engineer, William Elmore. Mr. Elmore thanked Colonel Marshall for the
data compilation but informed him that the State required the raw
analytical data on the actual forms used by Grainger Laboratory. The
reports requested by Mr. Elmore were the very same reports upon which
Grainger Lab had documented the existence of tetrachloroethylene and
trichloroethylene within the potable water supply systems for Hadnot
Point and Tarawa Terrace beginning in 1982. Colonel Marshall stalled
and did nothing. His successor, Colonel Lilley then inherited the
problem of what to do with Mr. Elmore's request. On 30 November 1983,
Colonel Lilley called the North Carolina's water supply branch and
spoke with Dick Caspers. We do not know what was said in the
conversation with Mr. Caspers, but two weeks later, Col Lilley wrote
Mr. Elmore and advised him that per this conversation with Mr. Caspers,
Marine Corps Base Camp Lejeune was not required to provide the
requested Grainger Laboratory reports and thus they were not submitted
to the State.
It took another year before the drinking water contamination aboard
Camp Lejeune was ``officially discovered''. Today the Marine Corps
maintains that ``once the source of the chemicals was determined to be
the wells, the wells were immediately taken out of service.'' The
Marine Corps also now states that ``taking care of Marines, Sailors,
their families and civilian workers is our top priority.'' My previous
testimony belies the former statement and the following will cast
serious doubt on the latter.
Two weeks after the first well was removed on service on at Hadnot
Point, an article appeared in the base's newspaper. The article advised
the reader that as a result of samples taken on 3 December 1984, four
wells were removed from service due to traces of organic compounds. The
article also read that none of the organic compounds were listed under
the Safe Drinking Water Act. The article went on to quote the Base
Environmental Engineer, Robert Alexander:
``every effort will be made to maintain the excellent quality
water supply traditionally provided to residents of Camp
Lejeune.''
What the article failed to mention was that on 6 July 1984, Hadnot
Point well HP-602 was sampled and found to be highly contaminated with
benzene. This well remained operational until November 1984. The well
was situated down gradient from the Hadnot Point fuel farm and thus
exposed to the fuel leaking from the underground tanks. The Base
Environmental engineer also failed to disclose to the readers the
presence of a 20,000-30,000 unreported and un-remediated fuel leak
dating back to 1979. This fuel plume was in the ground water and was
fifteen feet thick! Environmental Engineering Company's report warned
the presence of benzene far exceeded the human health risk and
therefore the use of the well (HP-602) should be discontinued
immediately.
The deception did not end there. On 30 April 1985, the Commanding
General of Camp Lejeune advised that residents of Tarawa Terrace that
two wells had to be taken of line because minute (trace) amounts of
several organic chemicals were detected in the water. The General also
stated:
``There are no definitive State of Federal regulations
regarding a safe level of these compounds, but as a precaution,
I have ordered closure of these wells.''
Four months later, the Base Environmental Engineer, Robert Alexander,
was directly quoted in a newspaper article:
``people had not been directly exposed to the pollutants.''
The misrepresentation did not end with the public and the media, it
extended to the EPA. On 1 November 1985, there was a meeting at Camp
Lejeune between base officials and EPA Representatives. During this
meeting, base officials including Robert Alexander told the EPA that
the contamination had not reached the distribution plants. Three years
later another base official, Assistant Chief of Staff Facilities,
Colonel Thomas J Dalzell was quoted in the media that prior to 1983:
``At that time we were not aware of any of these particular
compounds that might have been in the ground water and we have
no information that anyone's health was in any danger at that
time.'' The Colonel also stated that the sources of the
contamination were the base's motor pools and that these
compounds were being dumped in the ground or in the sewers and
that they were not really aware of the effects on ground water
back in the 1960's and 1970's.
Beginning with the very first public announcement of the drinking
water contamination aboard Camp Lejeune, there has been a constant drum
beat by the Marine Corps that they did not violate any Federal Safe
Drinking Water Act standard or any State of North Carolina standards.
On September 24th 2009, Maj-General Jensen appeared on CNN's Campbell
Brown show and reiterated the Marine Corps official position. What the
Marine Corps has failed to disclose to Members of Congress, the media,
the public and prior investigations into the Camp Lejeune's drinking
water contamination was that the Marine Corps was in violation of their
own orders dating back to 1963. These orders if followed would have
prevented most of the human exposures at the base.
In September 1963, the Navy's Bureau of Medicine and Surgery issued
a set of instructions known as BUMED 6240.3B. These instructions were
revised in 1972 with version C and then replaced in 1988. The purpose
of BUMED 6240.3B was to establish standards for water for drinking
throughout the Naval establishment including Camp Lejeune. Contained
within the instructions were preventive measures, including the
requirement for frequent surveys to locate and identify health hazards
which might exist in the system. Health Hazards were specially defined
within the instructions as to be any conditions, devices, or practices
in the water supply system and its operation which create or may create
a danger to the health and well being of the water consumer. Supply
wells were also defined as part of the water supply system. Pollution
was defined as the presence of any foreign substance (organic,
inorganic, radiological or biological) which tended to degrade its
quality so as to constitute a hazard or impaired the usefulness of the
water. Perhaps the most disturbing part of the regulation is found
under the chemical characteristics limits. Paragraph 7 subparagraph C:
``Substances which may have deleterious physiological effect,
or for which the physiological effects are not known, shall not
be introduced into the system in a manner which would permit
them to reach the consumer.''
These standards have yet to be publicly addressed or explained by the
Navy. Instead the Navy and Marine Corps summarily dismisses this
potable water regulation as being to general to be a standard of care.
During our research of Navy and Marine Corps documents we
discovered another key document which undermines the Marine Corps and
Navy's official statements that they had little knowledge that these
chemicals could contaminate the ground water at Camp Lejeune. Base
Order 5100.13B was the third revision of an order from the Commanding
General of Camp Lejeune. The order dates back to June 1974 and may date
back to the creation of the base's chemical dump in 1959. We will not
know the actual beginning date of the order until the Marine Corps
produces the prior two versions of the order and the higher headquarter
guidance which created the order in the fist place. The purpose of Base
Order 5100.13B was for the safe disposal of contaminants or hazardous
wastes. The order identified organic solvents as hazardous materials
and ominously warned that improper disposal of contaminants and
hazardous materials created hazards such as contamination of drinking
water. As I read BUMED 6240.3B and Base Order 5100.13B a line from a
famous movie called ``A Few Good Men'' comes to mind. ``We follow
orders, or people die. It's that simple.'' At Camp Lejeune, orders were
not followed and people have died or were made sick due to the
negligence of the United States Marine Corps.
Submitted with this testimony is our copy of the historical time
line of events for the Camp Lejeune drinking water contamination. The
time line was painstakingly researched using authentic Navy and Marine
Corps documents. Each entry is referenced to an actual document. We
have also provided a copy of the document library for Members of the
Committee and their staff. The document library was provided to us by
the ATSDR.
______
Attachment: Historical Time Line of Events for the Camp Lejeune
Drinking Water Contamination
______
Response to Post-Hearing Question Submitted by Hon. Daniel K. Akaka to
Michael Sean Partain
Question 1. You stated during the hearing that you have found
approximately 40 men who were stationed or lived at Camp Lejeune who
have breast cancer. Have you shared this information with the Marine
Corps and the National Research Council, and if so, when?
Response. As of November 2009, we have identified a total of 53 men
with male breast cancer who either served aboard Camp Lejeune or were a
dependent living on the base during the time of the drinking water
contamination. The existence of this cluster was first revealed to the
National Research Council (NRC) in November 2007 when Mr. Kris Thomas,
a dependent exposed while living at Tarawa Terrace in the 1960's and
1970's, addressed the NRC's Camp Lejeune committee in Jacksonville
North Carolina. Mr. Thomas informed committee members that there were
at least two cases of male breast cancer in children from the base. The
next day, the Jacksonville Daily News printed a story with this
information, including the names of former residents with male breast
cancer.
In January 2009, I traveled to Washington, D.C., to speak before
another NRC committee reviewing the EPA's Draft Risk assessment for
tetrachloroethylene (PCE), one of the chemicals found in our water at
Camp Lejeune. My presentation included the revelation that our number
had increased from two to nine men with breast cancer from Camp
Lejeune. The project director for this Committee was Susan Martel. Ms.
Martel also concurrently served as the project director for the NRC's
Camp Lejeune committee during the time period when both committees were
empanelled. The Camp Lejeune male breast cancer issue then received
increased media attention following the retraction of the ATSDR's 1997
Public Health Assessment for Camp Lejeune. We identified a total of 20
cases of male breast cancer originating from the base during the time
between November 2007, the first announcement of the existence of the
male breast cancer cases, up until the end of June 2009.
Since the release of the NRC's Camp Lejeune report, we have
identified 33 additional cases for the total of 53 men. The NRC's final
report mentions male breast cancer at Camp Lejeune only in passing (See
Enclosure A, Public Summary and Context section, page 7, of the NRC
Report on Camp Lejeune) and the disease was summarily dismissed from
their conclusions and recommendations. The NRC report also failed to
recommend any future studies into this unusual and emerging cancer
cluster. On July 23, 2009, the National Resources Defense Council urged
ATSDR to disregard the NRC's inattention toward the male breast cancer
cases at Camp Lejeune and stated ``the prevalence of male breast cancer
among former and current Lejeune residents should be given particular
attention because of its rarity in the general population.'' (Enclosure
B)
The Agency for Toxic Substances and Disease Registry (ATSDR) was
also notified about the existence of male breast cancer at Camp
Lejeune. ATSDR is the government agency mandated by Congress under
Title 42 of the U.S. Code to conduct research into health effects due
to environmental exposures at National Priority List sites such as Camp
Lejeune. On October 14, 2009, the ATSDR Community Assistance Panel
(CAP) discussed the existence of the male breast cancer cluster aboard
the base. Unfortunately, the Marine Corps is unable or unwilling to
provide this agency with an accurate number of men stationed aboard the
base during the contamination period so that epidemiologists such as
Dr. Frank Bove (ATSDR), Dr. Richard Clapp (CAP Member) or Dr. Devra
Davis (CAP Member) can estimate the number of cases of male breast
cancer expected to occur in the population. Without these critical
data, it is difficult to precisely evaluate the significance of the
number of cases we have discovered over the past two years. According
to the National Cancer Institute's Surveillance, Epidemiology and End
Results (SEER) Program, the occurrence rate of male breast cancer in
the U.S. general population is about 1 in 100,000. Most of the cases
are diagnosed occur in men over 70 years in age. The median age of
diagnosis for breast cancer in men is about age 67. More than half of
the men identified from Camp Lejeune were diagnosed under the age 56,
and several cases were in men in their twenties and thirties.
The Marine Corps was first made aware of the existence of male
breast cancer at Camp Lejeune when I was nominated as a member to the
ATSDR CAP in December 2007. I am not aware of any action taken by the
Marine Corps concerning the existence or significance of the cluster
other than a series of communications from Headquarters Marine Corps
Public Affairs the day I testified before this Committee in October
2009.
It is my understanding that on this date, Major Dent from the
Public Affairs Office contacted news agencies to inform them that the
expected occurrence rate for male breast cancer was 1 in 1,000 and that
based on a population of 400,000 men from Camp Lejeune, there should be
approximately 400 cases of male breast cancer from the Camp Lejeune
population. The email went on to suggest that the media outlet was not
accurately reporting the story and that there was no significant male
breast cancer cluster at Camp Lejeune. I have attached a copy of this
email from Major Dent, with the recipient's name redacted for the
Committee as Enclosure B. Neither I nor the Marine Corps are certified
in epidemiology.
The significance of this rare cancer is best assessed by
epidemiologist familiar with drinking water contamination at Camp
Lejeune including those who work at Federal agencies such as ATSDR/CDC
or the EPA. Unfortunately, until the Marine Corps can provide an
accurate number of the men exposed, we may never know the significance
of all the cases of male breast cancer from Camp Lejeune we have
discovered so far. In fact, Drs. Davis and Clapp have since confirmed
that the statement that the expected rate of male breast cancer is 1 in
1,000 is incorrect. They advise that the lifetime risk of any man
developing breast cancer by the time he reaches age 85 is 1 in 1,000.
As a result this lifetime estimate is not relevant to the population
risk of the thousands of young men who lived at Camp Lejeune during
peak periods of contamination of the drinking water.
We continue to find men with the disease as time passes. Male
breast cancer is typically found in the later stages of the disease and
thus more fatal. It is unknown just how many men may have already
succumbed to their cancer. We have heard from a few families with
deceased servicemembers who succumbed to the disease. One ATSDR future
proposal for Camp Lejeune, is a mortality study for the servicemembers
exposed at the base. A mortality study would be a potential tool to
help us identify deceased victims of male breast cancer for future
studies. It is frightening to think of how many men could be out in the
general population who were at Camp Lejeune during the drinking water
contamination may still be unaware about their potential risk for this
deadly disease. Male breast cancer is also a clear indication that our
exposures aboard Camp Lejeune have affected our health. Otherwise, why
is there such an unusual number of men with the disease whose only
commonality is that we all, at one point in our lives, either lived or
served aboard Camp Lejeune during the contamination and we all have
male breast cancer?
Enclosures
______
Enclosure A: Excerpt from NRC Report on Camp Lejeune
______
Enclosure B: NRDC Letter to ATSDR July 23, 2009
______
Enclosure C: Email from USMC Public Affairs to Media Outlet (Redacted)
Chairman Akaka. Thank you very much, Mr. Partain, for your
testimony. Dr. Nuckols, will you please begin your testimony.
STATEMENT OF JOHN R. NUCKOLS, PROFESSOR, DEPARTMENT OF
ENVIRONMENTAL AND RADIOLOGICAL HEALTH SCIENCES, COLORADO STATE
UNIVERSITY
Mr. Nuckols. I believe a copy of my full testimony has been
submitted by the National Research Council and I have prepared
a summary in my own hand. I would be happy to share it with the
Committee if you would like a paper copy.
Chairman Akaka. Thank you.
Mr. Nuckols. In 1984, evidence of contamination of the
water distribution system serving the Tarawa Terrace area
within Camp Lejeune, NC, was discovered. It was one of six
water distribution systems serving different areas on the camp.
Since that time, contamination of another water
distribution system serving the Hadnot Point area and
contamination of the natural source for all water systems on
the base, the Castle-Hayne Aquifer, has been documented. Many
former residents and employees of the base have raised
questions about whether health problems they or members of
their families have experienced could be related to exposure to
the contaminated water.
At the request of Congress, the Navy sponsored a study by
committee of the National Research Council to review the
scientific evidence on associations between adverse health
effects and historical data on pre-natal, childhood and adult
exposures to contaminated drinking water at Camp Lejeune.
In September 2007, the NRC convened a committee of experts
in epidemiology, toxicology, exposure analysis, environmental
health, groundwater modeling, biostatistics, and risk
assessment for this purpose. In or about August 2009, the NRC
review document, Contaminated Water Supplies at Camp Lejeune,
Assessing Potential Health Effects, was published.
I served as one of the volunteers on the NRC committee,
primarily as the chair of a subcommittee that was responsible
for chapter two, Exposure to Contaminants in Water Supply at
Camp Lejeune. In that chapter, we described the scenarios of
exposure to contaminants in the water supply and identified
gaps in understanding of exposure to people who lived or worked
there.
There were three other working subcommittees, epidemiology,
toxicology and risk communication. The internal process used by
the committee was as follows: we gathered information on the
chemicals present in the Camp Lejeune water supply, including
magnitude of contamination, geographic extent and timing; we
ascertained reported health concerns from people who lived or
worked at Camp Lejeune.
Based on published toxicology and epidemiology studies, we
gathered scientific evidence of causation or association of
diseases with the predominant chemical contaminants that were
present in the water supply and compared these to health
outcomes reported by the affected population. We ascertained
whether conclusions could be drawn that any adverse health
outcomes could be attributed to the water contaminants at Camp
Lejeune and whether additional health studies would be more
likely to provide such a definitive conclusion. And finally, we
made recommendations as to further actions concerning studies
of adverse health effects and water contamination at Camp
Lejeune.
In short, these recommendations were that new health
effects studies of persons who lived or worked at Camp Lejeune
and their families should be undertaken only if their
feasibility and promise of providing substantial improved
knowledge are established in advance.
Second and foremost, the decisions regarding the
appropriate policy response to health concerns about exposure
to contaminated water at Camp Lejeune should not be delayed or
await the results of epidemiological studies that are in
progress or planned. My testimony today is derived strictly
from the content of the report by the NRC Committee on
Contaminated Drinking Water at Camp Lejeune, which I fully
support.
Thank you for your invitation and your attention.
[The prepared statement of Mr. Nuckols follows:]
Prepared Statement of John R. Nuckols, Ph.D., Professor, Department of
Environmental and Radiological Health Sciences, Colorado State
University, Fort Collins, CO
Good morning Mr. Chairman and Members of the Committee. My name is
John Nuckols. I am a professor in the Department of Environmental and
Radiological Health Sciences at Colorado State University. I was a
member of the Committee on Contaminated Drinking Water at Camp Lejeune,
a committee of the National Research Council. The Research Council is
the operating arm of the National Academy of Sciences and the National
Academy of Engineering. I'm pleased to appear before you today to
discuss our committee's recent report Contaminated Water Supplies at
Camp Lejeune--Assessing Potential Health Effects.
At the request of Congress, the Navy sponsored a study by a
committee of the Research Council to review the scientific evidence on
associations between adverse health effects and historical data on
prenatal, childhood, and adult exposures to contaminated drinking water
at Camp Lejeune. For each health effect reviewed, the Committee was
asked to evaluate the available scientific literature concerning
evidence of a statistical association between contaminants found or
likely to have been in the water supply at Camp Lejeune and adverse
health effects. The Committee was also asked to review whether there
was any evidence to suggest any causal relationships between the
exposures and health outcomes.
Let me begin with the Research Council study process. As you are
aware, the Research Council is a non-governmental institution
originally chartered by President Lincoln to provide independent
scientific advice to the Nation. That scientific advice is usually in
the form of consensus reports produced by expert, unpaid committees. In
the case of the Camp Lejeune study, the Committee was comprised of 13
members with expertise in epidemiology, toxicology, exposure
assessment, environmental engineering, clinical medicine,
biostatistics, and risk assessment. The Committee's report was
developed through an established study process designed to ensure the
Committee and the report were free from actual or potential conflicts
of interests, were balanced for any biases, and were independent of
oversight from the sponsoring agency.
Our committee reviewed the relevant scientific literature, heard
from experts, met with former residents and workers to hear their
concerns, and deliberated for two years. Once the Committee reached its
consensus, but prior to the report being released, the draft report was
subjected to a formal, peer-review process overseen by the National
Academies Report Review Committee. The report was released only after
the Review Committee was satisfied that all review comments had been
appropriately considered and addressed.
Copies of the final report were sent to the sponsor immediately
prior to public release. The sponsor was not provided an opportunity to
review the report or any portions of the report, or to suggest changes
to the NRC report prior to its release.
To address the specific charge of the Camp Lejeune study, our
committee divided the review into two major categories: (1) evaluating
the potential for exposure of former residents and workers to
contaminants in the water supply source and distribution systems at
Camp Lejeune, in particular the Tarawa Terrace and Hadnot Point water-
supply systems; and (2) evaluating the potential health effects
associated with these water contaminants based on epidemiological and
toxicological evidence. The two assessments were then considered
together to ascertain whether conclusions could be drawn about whether
any adverse health outcomes could be attributed to the water
contamination.
In reviewing the available exposure information, the Committee
agreed with previous assessments that the primary contaminant of the
Tarawa Terrace water system was perchloroethylene (PCE), a solvent that
was improperly disposed of by an off-base dry-cleaner. Other
contaminants were also identified as being of concern, including
trichloroethylene (TCE), dichloroethylene, benzene, toluene, and vinyl
chloride. Sophisticated computer modeling techniques were used by the
Agency for Toxic Substances and Disease Registry (ATSDR) to make
predictions about the monthly concentrations of PCE to which residents
of Tarawa Terrace were exposed. The Committee questioned the degree of
accuracy that could be achieved from the modeling because no
contaminant measurements were available for the first 30 years of the
contamination, so it was not possible to verify model predictions. In
addition, assumptions had to be made about how the water system was
operating over the potential exposure period, as no records were
available at the time of the development of the model reviewed by the
NRC committee. Given these uncertainties, the Committee concluded that
the Tarawa Terrace modeling predictions should only be used to provide
general estimates of the timeframe and magnitude of exposure.
The contamination of the Hadnot Point water system was more complex
than Tarawa Terrace. There were multiple sources of pollutants from on-
base activities, such as storage and disposal practices. To date, no
groundwater modeling has been performed for this water system. Based on
the records the Committee reviewed, trichloroethylene appeared to be
the primary contaminant of concern, but other contaminants were also
detected in the water supply, including dichloroethylene, methylene
chloride, and vinyl chloride. Because groundwater modeling of the
Hadnot Point system will be fraught with considerable difficulties and
uncertainties (similar to, but much more complex than those associated
with the Tarawa Terrace models), the Committee recommended that simpler
models be used to assess the extent of water supply contamination and
potential exposures. Simpler models will not reduce the uncertainty
associated with the estimates, but they have the advantage of providing
a broad picture of the timeframe and magnitude of exposure with less
resources than complex modeling exercises. More complex predictive
models for exposure assessment should be used only if justified by more
straightforward analytical methods.
To evaluate the potential health effects to exposed residents, the
Committee undertook four kinds of reviews to determine what kinds of
diseases or disorders have been found to result from exposure to TCE
and PCE. The first was a review of epidemiologic studies of solvents
and their effects, including studies in occupational and industrial
settings and community studies. The second was a review of
epidemiologic studies of other communities with solvent-contaminated
water supplies. The third was a review of toxicologic studies conducted
in animals and humans to test for health effects. And the fourth was a
review of studies conducted specifically on the Camp Lejeune
population.
For the first review of epidemiologic studies, we used a
categorization process established by the Institute of Medicine to
evaluate risks to veterans of the Vietnam War and Gulf War. The
Institute's approach is to evaluate the available epidemiologic
literature involving exposures to specific chemicals in any setting,
but mainly occupational settings, to determine whether a ``statistical
association'' exists between specific chemicals and diseases and
disorders. A statistical association means that people who are exposed
to the chemicals are more likely to have or develop the disease or
disorder than people who are not exposed. A statistical association,
however, does not establish that the chemicals cause the disease or
disorders. On the basis of the Committee's review, all the health
outcomes were placed into one of two categories. The strongest evidence
was in the category of limited/suggestive of an association, which
means there is some evidence that people who were exposed to TCE or PCE
were more likely to have the disease or disorder but that the studies
were either few in number or had important limitations. In many cases,
the study subjects were exposed to multiple chemicals, so it was not
possible to separate out the effects of individual chemicals. Fourteen
of the 59 outcomes reviewed by the Committee were placed in this
category. The other 35 health outcomes reviewed by the Committee were
placed in the category of inadequate/insufficient evidence to determine
whether an association exists, which means that the studies were too
few in number, limited in quality, inconsistent, or inclusive in
results to make an informed assessment. It also means that such an
association cannot be ruled out.
The Committee decided to consider the subset of epidemiologic
studies that were conducted in communities exposed to solvents in their
water supplies in more detail. We felt these studies involved
populations and exposure situations that more closely resemble those at
Camp Lejeune. Overall, the Committee found the evidence from this
subset of studies to be inconsistent and that there were a variety of
limitations with the studies that did not allow any conclusions to be
drawn about what effects might be related to the exposures. Some of the
limitations were a lack of data on the levels of contaminants in the
water, lack of adequate information about diseases and disorders in the
population, and relatively small populations. These factors limit the
capacity of such studies to detect associations.
In animal experiments, a variety of adverse health effects were
observed following relatively high exposures to TCE and PCE. It is
difficult to determine whether the health effects observed in
laboratory animals are predictive of effects in humans. There are
differences in how TCE and PCE are handled in the body by rodents and
humans that affect biological responses. However, it is clear that TCE
and PCE do have toxic effects in laboratory animals and that some of
them may be of concern to humans. Similar health effects found in
epidemiology and toxicologic studies were kidney cancer, liver and
kidney toxicity, neurotoxicity, and immunotoxicity.
Only a few studies have been conducted on the Camp Lejeune
population, and these have focused on health effects in people who were
exposed as children or while their mothers were pregnant with them. Two
studies performed by ATSDR did not find any clear associations between
birth outcomes (mean birth weight, preterm birth, or small for
gestation age). However, a comparison of subgroups within the Tarawa
Terrace population found a weak association between PCE exposure and
small for gestational age children of women over the age of 35 or who
had prior miscarriages. The findings from these evaluations are no
longer valid. After the evaluations were completed, ATSDR discovered
that a residential area it classified as unexposed received water from
the Hadnot Point system, so the study results must be reanalyzed to
correct for this mistake in classification. ATSDR also has a study
underway on prenatal exposure to water-supply contaminants and birth
defects and childhood cancer. The outcomes in the study are rare, and
given the number of study participants, it appears that the statistical
power of the study could limit its ability to detect associations.
The Committee also looked into the feasibility and utility of
future studies of the Camp Lejeune population, including a health
survey and epidemiologic studies of mortality and morbidity in the
population. The Committee noted many difficulties with performing the
studies, such as the difficulty with identifying, locating, and
recruiting the study participants and obtaining reliable health
information on them in an efficient manner. It is questionable whether
there will be enough participants to ensure there is adequate
statistical power to detect associations, and the Committee was
concerned about the possibility of bias in the survey and studies, as
people who have experienced disease or illness are more likely to
participate.
After reviewing the preliminary plans and feasibility assessments,
the Committee concluded that most questions about whether exposures at
Camp Lejeune resulted in adverse health effects cannot be answered
definitively with further scientific study. There are two reasons for
this. First, it would be extremely difficult, if not impossible, to
reliably estimate the historical exposures experienced by people at the
base. Second, it will be difficult to detect any increases in the rate
of diseases or disorders in the study population. Most of the health
effects of concern are relatively rare, which means that very large
numbers of people are needed to detect increased cases. Although the
total number of people who lived at Camp Lejeune while the Tarawa
Terrace and Hadnot Point water supplies were contaminated was sizable,
the population is still unlikely to be large enough to detect effects.
Another factor is that the people tended to live on the base for a
relatively short period of time, making it difficult to rule out other
exposures or factors that could have contributed to the disease or
illness. Most chronic diseases are thought to have a latency period of
years, if not decades, which means that exposure needs to be assessed
over this same time period. All these factors make it unlikely that the
proposed studies, even if the notable uncertainties about feasibility
are resolved favorably, will produce a result of sufficient certainty
to resolve the question of whether Camp Lejeune residents suffered
adverse health effects (especially chronic diseases) from exposure to
contaminated water at Camp Lejeune. Thus, our committee's conclusion
was that there is no scientific justification for the Navy and Marine
Corps to wait for the results of additional health studies before
making decisions about how to follow up on the evident solvent
exposures on the base and their possible health consequences. The
services should undertake the assessments they deem appropriate to
determine how to respond in light of the available information.
With that, I would once again like to thank you for inviting me to
testify before this Committee, and I look forward to your questions.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
John R. Nuckols, Ph.D., Professor, Colorado State University, Member,
Committee on Contaminated Drinking Water at Camp Lejeune
Question 1. You heard testimony from Michael Partain during the
hearing. He stated that he has identified 40 men from Camp Lejeune who
have breast cancer. Did the National Research Council consider that
when they wrote their report? Does that number by itself raise any red
flags with you? Is that something that you think merits further
investigation?
Question 2. You stated that ATSDR has a study underway on prenatal
exposure to water-supply contaminants and birth defects and childhood
cancer, but that the statistical power of the study could limit its
ability to detect associations. Is there a better way, or better study
to undertake, to determine a possible connection between water-supply
contaminants and birth defects and childhood cancer?
Question 3. What steps did the National Research Council and the
ATSDR take in determining prenatal exposure to water-supply
contaminants?
Question 4. What exactly was the charter of the National Research
Council when asked to conduct your study?
Question 5. How did the National Research Council select scientific
studies to review? How many of the studies did you review? How rigorous
was your review, and how did you review them (e.g. did everyone on the
Committee read the same studies, did one person read one and brief the
rest of the group, etc.)?
[The Committee had not received the requested information
by press time.]
Chairman Akaka. Thank you very much, Dr. Nuckols. Now we
will hear the testimony from Ms. Pennington.
STATEMENT OF STACY PENNINGTON, SISTER OF SSG. STEVEN GREGORY
OCHS, IRAQI OPERATION FREEDOM AND OPERATION ENDURING FREEDOM
VETERAN
Ms. Pennington. Aloha, Honorable Chairman Akaka.
Chairman Akaka. Aloha.
Ms. Pennington. And honorable Members of the Committee,
good morning. It is an honor to be sitting before the U.S.
Senate Committee on Veterans' Affairs. Thank you for your
leadership in acknowledging the exposures happening to our
troops.
I have been asked to speak to you from a victim's
standpoint of the effect of exposure to dangerous toxins
produced by burn pits that are used to dispose of such items as
medical waste, fuel, plastic, vehicles, trash and ammunition. I
sit here in front of you with a heavy heart to share the
stories of two families who know how it feels to have a burning
pit in our souls.
My brother, SSG. Steven Gregory Ochs chose the military as
his career, serving our country for 14 years. SSG. Matt Bumpus
served his country for 8 years and 9 months. Both were called
to fight in Operation Iraqi Freedom. Staff Sergeant Ochs served
three tours in 12- to 15-month intervals from 2003 to 2007, and
Staff Sergeant Bumpus served his tour onset of the war in 2003.
Both of these brave soldiers you see before you dodged bullets,
mortar attacks, roadside bombs, and suicide bombers, yet
eventually their tours would take their lives.
The ultimate sacrifice of a soldier for his country is
death. However, their deaths did not show up in the manner you
may assume. In Balad is the site of the infamous, enormous burn
pit that has been called by Darrin L. Curtis, lieutenant
colonel of the U.S. Air Force of Bioenvironmental Engineering
and Flight Commander, the worst environmental site he had ever
visited.
Staff Sergeant Ochs and Staff Sergeant Bumpus were both
stationed in Balad and war, as strategic as it is, followed
them home. Death lay dormant in their blood and waited for them
to return safely home and into the arms of their loved ones.
And like every silent ticking time bomb, it eventually
exploded.
On September 28, just months after Steve's return home from
his third tour, he was diagnosed with acute myeloid leukemia,
also known as AML. He spent the next 10 months as a patient,
more like a resident, at Duke University Hospital. Doctors at
Duke said his aggressive form of AML was definitely chemically
induced and like Steve, both agreed it was due to the exposures
he experienced while in Afghanistan and Iraq.
However, the doctors refused to go on record, citing as the
reason that they could not prove it. The aggressive AML that
Steve endured was similar to bullets ricocheting in the body,
causing tortuous pain. The graphic images embedded in my mind
are Steve's last screams for air as he was rushed into ICU.
Forgive me.
Steve waved goodbye to my husband. Steve, with very little
strength, his last words to me were, I love you, Sis. And my
mom kissed his forehead and said, we will see you when they get
you comfortable. Not 5 minutes later, while we were in ICU
waiting room, the nurse came in to tell us that Steve went into
cardiac arrest and they were working to revive him now. My mom
ran into ICU. She fell to her knees as she realized her son was
dying.
Screams filled the air as we begged God to keep Steve here
with us. We know Steve heard us as tears were in Steve's eyes.
Doctors and nurses pumped on Steve's chest trying to revive
him, but I knew immediately he was gone. His spirit that
surrounded my dear sweet little brother of 32 years old, was
gone.
We were left alone with Steve's body for hours as we were
all in pure shock. My mom looked upon my brother's face and
wiped away the tears puddled in his eyes. And at that very
moment, our lives were changed forever. Steve died on July 12,
2008.
Two weeks later on the opposite side of the coast, Staff
Sergeant Bumpus would succumb to the same fate. For Staff
Sergeant Bumpus, the ticking time bomb exploded with a
vengeance on July 31, 2006. Matt was rushed to the hospital by
ambulance with acute appendicitis. In Matt's own words, ``the
next thing I remember is hearing that I had been diagnosed with
AML.''
Doctors declared that there was chromosome damage due to
exposures he must have come in contact with while in Iraq. Matt
ended his prestigious service to the Army one short year before
the war zone--chemical warfare showed signs of its presence. As
if this was not enough suffering, Staff Sergeant Bumpus' family
was met by the VA with harsh claims of denial to benefits. This
battle continues to this day as Lisa, Staff Sergeant Bumpus'
wife, is left alone with two small children to raise with no
military or VA benefits for her family.
The aggressive assault of the AML in Matt's body was taking
claim. Jo, Matt's mother, recalls the haunted look in Matt's
eyes as he revealed to her the AML invasion was back. Matt's
mother never forgot the discouragement and sadness that
overwhelmed Matt as he realized that promises he made to his
wife and children--to provide for his family, to love and
protect them--that his sacred word was broken.
He knew now that the battle was over and he would be
leaving his family behind. Tuesday, July 29, 2008, Matt once
again entered the hospital with fever and septic infection that
discharged throughout his entire body. Doctors notified the
family that it would just be days before his demise.
Matt was heavily sedated as the pain and incubation was
unbearable. Nate, Matt's 10-year-old son, bravely entered his
father's room to lay on his daddy's chest to say his final
goodbye. Nate curled up by his dad and cried and cried and
despite Matt's heavy sedation, Matt too was crying. Matt being
a devoted Christian, appropriately passed away on a Sunday
morning surrounded by his wife, mother, father, sister as they
expressed to Matt their everlasting love.
They too were in shock and stayed with Matt's body as they
realized and were overwhelmed that Matt was not coming home.
Matt died on August 3, 2008. You have to know that while
serving in Iraq, both of these soldiers complained of ailments
such as colds, major fatigue, headaches, sinus problems, loss
of hearing, and Staff Sergeant Ochs contracted TB while in
Afghanistan due to the massive exposure to dead bodies.
Both men were of strong stature, standing over six feet
tall, weighing over 200 pounds and both men were the perfect
image of Army-strong soldiers. Two men, brave, who served their
country courageously and committed to the cause, dedicated to
our country and entrusted the military.
Grief, sadness, and depression have gripped our entire
families. Their wives are emotionally broken and incomplete,
their mothers are emotionally unstable and engulfed with grief
and their fathers are lost; and worst of all, their children
are fatherless.
Sadly, Steve and Matt are not alone. Laura Bumpus and I
have spoken to over hundreds of families suffering the same
fate. We are aware of hundreds more suffering similar ailments.
These men are casualties of war. They deserve the respect of
that fact to reflect on the Army records.
My family, the Ochs family, proudly display our gold pin
presented to us by Steve's commander at his funeral.
Unfortunately, the Bumpus' family does not have that same
privilege and this too must be rectified. We are proud military
families and we will continue to be in the future. And you have
to know, we both have members currently serving this country
now. We deserve to display the gold flag in homage of our
beloved. This too has been a benefit denied to both of our
families.
We would like to thank the Department of Defense for
recently installing the necessary incinerators at the Balad
base. However, we are concerned, as other toxic burn pits
continue burning 24/7 throughout Iraq and Afghanistan and we
ask the Committee for your support to correct the problem.
In conclusion, our families will continue to live with
emotional battle scars caused by the terminal injuries our
beloved ones suffered as a result of the exposures of burn
pits. I assure you it is a heavy cross to bear. Our wish is for
this Committee to begin the actions it takes to stop this
nightmare. You have the power to save our courageous heroes who
serve our country and who protect me and who protect you.
Thank you for your time in hearing our voices.
[The prepared statement of Ms. Pennington follows:]
Prepared Statement of Stacy Pennington, Sister of SSG Steven Gregory
Ochs, Iraqi Operation Freedom and Operation Enduring Freedom Veteran
and Representing SSG Matt Bumpus, Iraqi Operation Freedom Veteran
Honorable Chairman Akaka and Honorable Members of the Committee:
Good Morning. It is an honor to be sitting before the U.S. Senate
Committee on Veterans' Affairs. Thank you for your leadership
acknowledging the exposures happening to our troops. My name is Stacy
Pennington and I was asked to speak to you from a victim's standpoint
of the affects of exposure to dangerous toxins produced by burn pits
that are used to dispose of such items as medical waste, fuel, plastic,
vehicles, trash and ammunition. I sit here in front of you with heavy
heart to share the stories of two families who know how it feels to
have a ``burning pit'' in our souls.
My brother, SSG Steven Gregory Ochs, chose the military as his
career serving our country for 14 years. SSG Matt Bumpus served his
country for 8 years and 9 months. Both were called to fight in
Operation Iraqi Freedom. SSG Ochs served 3 tours in 12-15 month
intervals from 2003-2007 and SSG Bumpus served his tour onset of the
war in 2003.
Both of these brave soldiers you see before you dodged bullets,
mortar attacks, road side bombs and suicide bombers. Eventually their
tours of duty would take their lives. The ultimate sacrifice for a
soldier, for his country is death. However, their deaths did not show
up in the manner you may assume.
In Balad is the site of the infamous enormous burn pit that has
been called by Darrin L. Curtis, Lt. Col., USAF and Bioenvironmental
Engineering Flight Commander as ``the worst environmental site'' he had
ever visited. SSG Ochs and SSG Bumpus were both stationed in Balad and
war as strategic as it is followed them home. Death lay dormant in
their blood and waited for them to return safely home and into the arms
of their loved ones. Like every silent ticking time bomb, it eventually
exploded.
On September 28, 2007, just months after Steve's return home from
his 3rd tour, he was diagnosed with Acute Myeloid Leukemia, also known
as AML. He spent the next 10 months as a patient, more like a resident,
at Duke University Hospital. Doctors at Duke said his aggressive form
of AML was definitely chemically induced and like Steve both agreed it
was due to the exposures he experienced while in Iraq and Afghanistan.
However, the doctors refused to go on record citing as the reason that
they could not prove it.
The aggressive AML that Steve endured was similar to bullets
ricocheting in the body causing torturous pain. The graphic images
embedded in my mind are of Steve's last screams for air as he was
rushed into ICU. Steve waved goodbye to my husband. Steve with very
little strength said, ``I love you sis'' and my Mom kissed his forehead
and said we will see you when they get you comfortable. 5 minutes later
while in the ICU waiting room the nurse came in to tell us Steve went
into cardiac arrest and they were working on him now. My mom ran into
ICU; fell to her knees as she realized her son was dying. Screams
filled the air as we begged God to keep Steve here with us. We know
Steve heard us as tears were in Steve's eyes. Doctors and nurses pumped
on Steve's chest trying to revive him. But I knew immediately he was
gone. His spirit that surrounded my dear sweet brother was gone. We
were left alone with Steve's body for hours as we were all in pure
shock. My mom looked upon my brother's face and wiped away the tears
puddled in his eyes. And at that very moment our lives were changed
forever. Steve died on July 12, 2008. Two weeks later on the opposite
side of the coast SSG Bumpus would succumb to the same fate.
For SSG Bumpus, the ticking time bomb exploded with a vengeance on
July 31, 2006. Matt was rushed to the hospital by ambulance with acute
appendicitis. In Matt's own words I quote, ``the next thing I remember
is hearing that I had been diagnosed with AML.'' Doctors declared that
there was chromosome damage due to exposures he must have come in
contact with while in Iraq. Matt ended his prestigious service to the
Army one short year before the war zone chemical warfare showed signs
of its presence.
As if this was not enough suffering, SSG Bumpus' family was met by
the VA with harsh claims of denial to benefits. This battle continues
to this day as Lisa, SSG Bumpus' wife, is left alone with two small
children to raise with no VA or military benefits for her family.
The aggressive assault of the AML in Matt's body was taking claim.
Jo, Matt's mother recalls the haunted look in Matt's eyes as he
revealed to her that the AML invasion was back. Matt's mother will
never forget the discouragement and sadness that overwhelmed Matt as
the realization that promises he made to his wife and children to
provide for his family, to love and protect them and that his sacred
word would be broken. He knew now that the battle was over and he would
be leaving his family behind. Tuesday, July 29, 2008, Matt once again
entered the hospital with fever and septic infection that discharged
throughout his body. Doctors notified the family that it would just be
days before his demise.
Matt was heavily sedated as the pain and incubation was unbearable.
Nate, Matt's 10 year old son, bravely entered his father's hospital
room to lay on his Daddy's chest as he said his final goodbye. Nate
curled up by his Dad and cried and cried. Despite Matt's heavy
sedation, Matt too was crying. Matt being a devoted Christian
appropriately passed away on a Sunday morning surrounded by his wife,
mother, father and sister as they expressed to Matt their everlasting
love. They too, were in shock and stayed with Matt's body as the
realization overwhelmed them that Matt would not be going home. Matt
died on August 3, 2008.
While serving in Iraq both soldiers complained of ailments from
colds, major fatigue, headaches, sinus problems, loss of hearing, and
SSG Ochs contracted TB while is Afghanistan due to exposures to masses
of dead bodies. Steve and Matt were men of large strong stature,
standing over 6 feet tall, weighing over 200 pounds and both men were
the perfect image of Army strong soldiers. Two brave men, who served
their country courageously, committed to the cause, dedicated to our
country and entrusted the military.
Grief, sadness and depression have gripped our entire families.
Their wives are emotionally broken and incomplete. Their mother's are
emotionally unstable and engulfed with grief. Their father's are lost.
Their children are fatherless.
Sadly, Steve and Matt are not alone. Laura Bumpus and I have spoken
to over a hundred families suffering the same fate. We are aware of
hundreds more suffering similar ailments. These men are casualties of
war. They deserve the respect of this fact to reflect in their Army
records. My family, the Ochs family, proudly displays our Gold Star pin
presented to us during Steve's funeral by his Commander. Unfortunately,
SSG Bumpus' family does not have this same privilege. This must be
rectified. We are proud military families and will continue to be in
the future. We both have family members currently serving our country.
We deserve to display the gold flag in homage of our beloved. This too
has been a benefit that both of our families have been denied.
In conclusion, our families will continue to live with the
emotional battle scares caused by the terminal injuries our loved ones
suffered as a result of the exposures of the burn pits. I assure you it
is a heavy cross to bare. Our wish is for this Committee to begin the
actions it needs to take to stop this nightmare. You have the power to
save our courageous heroes who serve our country and who protect me and
who protect you.
Thank you for your time and for hearing our voices.
Chairman Akaka. Thank you very much, Ms. Pennington, for
your testimony. Dr. Miller, your testimony, please.
STATEMENT OF ROBERT F. MILLER, M.D., ASSOCIATE PROFESSOR OF
PULMONARY AND CRITICAL CARE MEDICINE, VANDERBILT UNIVERSITY
MEDICAL CENTER
Dr. Miller. Chairman Akaka, Ranking Member Burr, and
Members of the Committee, I thank you for the opportunity to
testify today. My comments will focus on a group of U.S.
soldiers with permanent respiratory impairment following
service in Iraq and Afghanistan.
In early 2003, 20,000 soldiers from the 101st Airborne out
of Fort Campbell, KY, were deployed to Northern Iraq as part of
Operation Iraqi Freedom. In June 2003, opposing forces set fire
to the Mishraq Sulfur Mine approximately 25 kilometers from
Camp Q West, a major military supply air strip and primary area
of deployment for the 101st Airborne.
At that time, the Mishraq Sulfur Mine was the largest
sulfur mine in the world. It burned for over 4 weeks and caused
the release of 42 million pounds of sulfur dioxide per day.
This represents the largest manmade release of sulfur dioxide
on record. Satellite imaging documented that the sulfur dioxide
plume extended north and south over the city of Mosul and Camp
Q West.
Sulfur dioxide is the gas that you and I associate with
striking a match. It is a potent lung toxin and has been shown
to cause lung injury at levels as low as .1 part per million.
Our soldiers were exposed to levels many times higher than
this. Skin, eye and airway irritation reported by soldiers in
the area suggests levels in excess of 50 parts per million.
Random sampling by the U.S. Army documented toxic levels of
over 100 parts per million.
Most of the 101st Airborne deployed in early 2003 returned
to Fort Campbell in 2004. This is when Vanderbilt University
began receiving referrals from providers at Fort Campbell
asking for assistance in evaluating soldiers complaining of
shortness of breath on exertion, soldiers who could no longer
pass physical training--physical fitness testing.
The typical soldier had been able to complete a two-mile
run in exemplary time within regulation. Now these soldiers had
to walk much of the course. In almost all cases, standard
respiratory evaluations had been normal. X-rays, chest CT
scans, and pulmonary function testing were all normal or nearly
normal.
None of these routine tests explained the cause for the
soldiers' limitation. Vanderbilt physicians ultimately referred
patients for surgical lung biopsy and I must emphasize that it
is very uncommon to perform a surgical biopsy to evaluate
shortness of breath when standard testing is normal. You just
do not send a patient to the operating room for a surgical lung
biopsy when pulmonary function tests and x-rays fail to
indicate some type of cause.
But the degree of exercise limitation and sulfur dioxide
exposure were compelling enough for us to apply this aggressive
approach. In almost every case, surgical biopsy showed
constrictive bronchiolitis, a condition associated with damage
or destruction affecting more than 50 percent of the small
airways of the lungs.
This abnormality causes pulmonary limitation, but is not
detectable on x-ray. Between 2004 and 2009, Vanderbilt
physicians performed surgical biopsies on 45 of 70 soldiers
referred for unexplained shortness of breath. All of the
biopsies except one demonstrated some form of bronchiolitis.
This condition has no known treatment and has resulted in Med
boards from almost all of those affected.
While the majority of patients diagnosed with constrictive
bronchiolitis were exposed to sulfur dioxide from the sulfur
mine fire, 25 percent of those biopsies served at a time or a
place incompatible with this exposure. They had similar
exercise limitation, test results and biopsies showing
bronchiolitis, but they did not report any extraordinary
exposures that would distinguish them from other soldiers.
However, almost all reported inhalational exposures that were
common to the Iraqi experience, including fumes from burn pits,
burning human waste, fires and dust from combat, burning oil
and diesel exhaust.
Consider the example of a 42-year-old physician who was
deployed to Northern Iraq in 2007. She had been an avid
marathon runner prior to deployment and ran regularly during 8
months--her 8 months tour of duty. Upon return, she was too
short of breadth to run a mile. Her x-rays, pulmonary function
tests were normal and her lung biopsy showed constrictive
bronchiolitis, the same abnormalities seen in the other
soldiers. She remains limited and now finds it difficult to
climb stairs and walk up inclines.
Up to this point, almost all of the soldiers diagnosed with
constrictive bronchiolitis have been referred from Fort
Campbell, but we have received a number of communications from
soldiers and providers throughout the country, leading us to
believe that this condition is present but not being diagnosed
at other facilities.
As noted previously, this diagnosis can only be established
by surgical lung biopsy and most clinicians would hesitate to
recommend this procedure. Military and VA officials have had a
difficult time rating disability in this population. In most
cases, the affected soldiers are comfortable at rest and are
able to perform their activities of daily living. They have
normal or near normal pulmonary function tests, but at the same
time, they cannot meet the physical training requirements and
are considered unfit for duty.
This unique circumstance has challenged those who want to
determine disability. Pulmonary function testing is the
standard for rating respiratory problems, but how does one rate
a soldier who is too short of breath to serve yet has a normal
pulmonary function test? Unfortunately, the ratings applied
thus far have not been standardized. We have seen many examples
of a soldier receiving a rating from the U.S. Army only to have
it downgraded by the VA.
More research is needed to understand the cause and
prevention of this disease. There is little doubt that the
cause of bronchiolitis and those exposed to the Mishraq Sulfur
Mine fire was due to inhalational toxin. There is also little
doubt that those not exposed to sulfur fires suffer from a
disease caused by toxic inhalation.
We must determine what these other toxins are to prevent
those serving from being exposed. We must also consider
baseline pulmonary function testing prior to deployment,
knowing that our soldiers too often encounter inhalational
toxins. And finally, I urge the development of standards for
evaluating this condition that I have described today.
Thank you for your attention.
[The prepared statement of Dr. Miller follows:]
Prepared Statement of Robert F. Miller, M.D., Associate Professor of
Pulmonary and Critical Care Medicine, Vanderbilt University Medical
Center
Chairman Akaka, Ranking Member Burr, and Members of the Committee,
I thank you for the opportunity to testify today. My comments will
focus on a group of United States soldiers with permanent respiratory
impairment following service in Iraq and Afghanistan.
BACKGROUND
In early 2003, 20,000 soldiers from the 101st Airborne from Ft.
Campbell, KY were deployed to northern Iraq as part of Operation Iraqi
Freedom. In June 2003, opposing forces set fire to the Mishraq Sulfur
Mine, approximately 25 miles north the Qayyarah Airfield West (Camp Q
West), a major military supply airstrip and the primary area of
deployment for the 101st Airborne.
At that time, the Mishraq Sulfur Mine was the largest sulfur mine
in the world. It burned for over 4 weeks and caused the release of 42
million pounds of sulfur dioxide (SO2) per day. This represents the
largest man-made release of SO2 on record. Satellite imaging documented
that the SO2 plume extended in a Southeast direction over the city of
Mosul and Camp Q West.
SO2 is the gas that you and I would associate with striking a
match. It is a potent lung toxin and has been shown to cause lung
injury at levels as low as 0.1 PPM. Our soldiers were exposed to levels
many times higher than this. The skin, eye and airway injury irritation
noted by almost everyone in the area suggests levels in excess of 50
PPM. Random sampling by the US Army documented toxic levels of SO2.
CLINICAL PRESENTATIONS
Most of the 101st Airborne deployed in early 2003 returned to Ft.
Campbell in early 2004. This is when Vanderbilt began to receive
referrals from providers at Fort Campbell, asking for assistance in
evaluating soldiers who complained of shortness of breath on exertion
and could no longer pass physical fitness testing. The typical soldier
previously had been able to complete a two mile run within regulation
time, but now had to walk much of the course. In almost all cases,
standard respiratory evaluations obtained at Fort Campbell had been
normal, including chest x-rays, chest CT scans and pulmonary function
testing. None of these routine tests could explain the cause for the
soldiers' limitations.
Vanderbilt physicians ultimately referred patients for surgical
lung biopsy. I must emphasize that it is very uncommon to obtain
surgical biopsies to evaluate shortness of breath with exertion when
standard testing is normal. But the degree of exercise limitation and
SO2 exposure were compelling enough for us to apply an aggressive
approach. In almost every case, surgical biopsy showed constrictive
bronchiolitis, a condition associated with damage or destruction
affecting more than 50% of small airways. This abnormality causes
pulmonary limitations, but is not detectable on x-ray.
Between 2004 and 2009 Vanderbilt physicians performed surgical
biopsies on 45 of 70 soldiers referred for unexplained shortness of
breath on exertion. All of the biopsies except one demonstrated some
form of bronchiolitis. This condition has no known treatment and has
resulted in medical boards for almost all of those affected.
While the majority of the patients diagnosed with constrictive
bronchiolitis were exposed to SO2 from the Mishraq sulfur mine fire,
25% of those biopsied served at a time or place incompatible with this
exposure. They had similar exercise limitations, test results, and
biopsies showing bronchiolitis, but they did not report any
extraordinary exposures that would distinguish them from other
soldiers. However, almost all reported inhalational exposures that were
common to the Iraqi combat experience. These include fumes from burn
pits burning human waste, fires and dust from combat, burning oil and
diesel exhaust.
Consider the example of a 42 year-old physician who was deployed to
northern Iraq in 2007. She had been an avid marathon runner prior to
deployment and ran regularly during her 8 months in Iraq. Upon return,
she was too short of breath to run a mile. Her X-rays and pulmonary
function testing were normal and she ultimately had a surgical lung
biopsy showing constrictive bronchiolitis, the same abnormality seen in
most of the other soldiers. She remains limited and now finds it
difficult to climb stairs and walk gentle inclines.
Up to this point, almost all of the soldiers diagnosed with
constrictive bronchiolitis have been referred from Ft Campbell.
However, we have begun to receive communications from soldiers and
providers throughout the country, leading us to believe that this
condition is present but not being diagnosed at other military
facilities. As noted previously, this diagnosis can only be established
by surgical lung biopsy and most clinicians would hesitate to recommend
biopsy when x-rays and pulmonary function tests are normal.
RATING DISABILITY FOR BRONCHIOLITIS
Military and VA officials have had a difficult time rating
disability in this population. In most cases, the affected soldiers are
comfortable at rest and are able to perform the activities of daily
living. They have normal or near normal pulmonary function tests, but
at the same time they cannot meet physical training requirements and
are considered unfit for deployment. This unique circumstance has
challenged those who must determine a disability rating. Pulmonary
function testing is the usual standard for rating respiratory
disabilities, but how does one rate the soldier who is too short of
breath to serve and yet has normal test results? Unfortunately, the
ratings applied thus far have not been standardized. Additionally, we
have seen many examples of soldiers who received one rating from the US
Army only to have it downgraded by the VA.
More research is needed to understand the cause(s) and prevention
of this disease. There is little doubt about the cause of bronchiolitis
in those who were exposed to the Mishraq Sulfur Mine fire. There is
also little doubt that those not exposed to the sulfur fires suffer
from a disease caused by toxic inhalation. We must determine what these
other toxins are so that preventive measures can be employed. We should
also consider baseline pulmonary function testing prior to deployment
knowing that our soldiers too often encounter inhalational toxins. And
finally, I urge the development of standards for evaluating the
condition that I have described today.
Thank you for your attention and I would be glad to answer any
questions.
Chairman Akaka. Thank you very much, Dr. Miller, for your
testimony. Now we will receive the testimony of Mrs. Paganelli.
STATEMENT OF LAURIE PAGANELLI, MOTHER OF JORDAN PAGANELLI,
CHILDHOOD CANCER (SARCOMA) WARRIOR AND PAST RESIDENT OF U.S.
NAVAL AIR FACILITY (NAF) ATSUGI, JAPAN
Mrs. Paganelli. Thank you. Good morning, Chairman and
Members of the Committee. Thank you for this opportunity to
present my testimony on behalf of my family and as a
representative for hundreds of sailors, Marines, and civilians
who were unknowingly exposed to and have been adversely
affected by contaminated air, soil, and water at U.S. Navy Air
Facility Atsugi, Japan.
My name is Laurie Paganelli and I am a former resident of
Atsugi. My husband was an active duty Navy servicemember and we
were given orders to report to Atsugi in 1997. Our tour of duty
was from 1997 to 2000. Our only son, Jordan, was 5 years old
when we arrived. While stationed at Atsugi, he attended Shirley
Lanham Elementary School, played soccer, T-ball, and attended
many sporting and cultural events throughout our time there.
On January 11--excuse me--2008, our lives changed forever.
Jordan, then 16 years old, was diagnosed with a rare, vicious
and highly aggressive form of cancer, so aggressive in fact
that by the time he displayed any symptoms, his cancer had
already progressed to Stage IV.
The name of his cancer is Alveolar Rhabdo-Myo-Sarcoma, as
known short, ARMS. ARMS is considered extremely rare and there
are only about 350 cases each year in the United States, and
because of its rarity there is a severe lack of funding for
this type of cancer. Only 3 percent of research money goes
toward childhood cancer research, making a 5-year survival rate
dismally low.
Jordan's protocol was an intensive multi-agent therapy,
including dose compressed cycles which had us calling Walter
Reed Army Medical Center home for most of the 15 months of
continuous treatment. Jordan also battled through 12 total
weeks of daily radiation, 7 weeks to his torso and lungs, and
then five more weeks to his entire head following the discovery
of additional cancerous lesions that had spread to his brain.
Additionally, due to cancer-based damage to his hips, he
spent 10 months on crutches and the rest with a cane. Quite the
contrast to the young boy who played at Atsugi base and the
high school cross country star he had been just months earlier.
During our stay at Atsugi, we were aware of the
incinerator. It smelled, burned our eyes and sometimes added a
greenish glow to the air around us. We certainly were not aware
of the effects it would have on our family years later. As most
military families do, I trusted that the Navy wouldn't let us
live somewhere that was a danger to our health. I was wrong.
From 1983 to 2001, sufficient and compelling evidence
showed that the blend of high toxic chemicals were released
from the Shinkampo Incinerator Complex, labeled SIC, at levels
that far exceeded the EPA's health risk-based guidelines. These
chemicals severely contaminated the residential area of Atsugi.
A partial list of chemicals include: volatile organic
compounds, poly-chlorinated bi-phenyls, pesticides,
polycyclic--excuse my pronunciations--aromatic hydro-carbons,
dioxins, furans, particulates, and heavy metals.
In 1990, U.S. Department of the Navy documents referred to
this plume of smoke as ``witch's brew of toxic chemicals.''
During the operation of SIC, the Navy spent approximately $18
million dollars, performing numerous ambient air and health
studies at Atsugi. The data repeatedly confirmed that Atsugi
was being polluted by carcinogenic and non-carcinogenic
chemicals, which are categorized by the EPA to have long
latency periods, meaning that the effects would be evident
years after exposure.
In 1997, the Navy began to communicate health risks to
Atsugi residents. However, during the initial 12 years of
incinerator operations, personnel had little to no knowledge of
the potential health risks in toxic exposures. A review of the
Navy's human risk assessment of Atsugi prepared in 2001 by the
Committee of Toxicology stated, ``there does not seem to have
been a coordinated strategy for risk communication.''
In 1997, risk communication efforts included instructions
for residents and school children to stay indoors while the
plume of toxins blew toward the base. A standard Form 600 was
added to personnel medical records stating that we were exposed
to 12 toxic chemicals and exceeded the maximum contamination
levels.
Although the Navy had no control over the missions of the
SIC, they did have the ability to avoid exposing thousands of
children to toxic chemicals. By 1990, the base residents were
being exposed to dioxin and other toxic chemicals. In 1997, the
Navy Inspector General reported that ``the Navy must act
decisively to reduce personnel exposure to incinerator
contaminants. A range of options to accomplish this include,
but not limited to, moving U.S. personnel to other locations,
must be examined.''
The 1999 study conducted by the government of Japan and the
U.S. Navy found dioxin levels in the air to be dangerously
high. By 2000, Defense Secretary William Cohen and chief of the
Japanese Defense Agency agreed that Japan would provide
temporary off-base housing and that Japan would not object to
the U.S. Government's efforts to sue SIC for violating
environmental laws.
In 2001, the U.S. Department of Justice brought suit
against a private incinerator in a Yokohoma court. A lawsuit
claimed that toxic chemicals severely polluted the air, soil
and groundwater and interfered with U.S. Government rights of
property and possession. The SIC was closed when the government
of Japan decided to pay the incinerator owner the equivalent of
$42 million to shut down and dismantle the incinerators.
The Navy had knowledge that Atsugi residents were being
exposed to dioxin in the SIC emissions in the early 1990s and
they knew what detrimental effects such exposure would have to
the human body. As you remember, dioxin is what made Agent
Orange so toxic. So, it is no surprise that by 1998, the Navy
recognized their liability and instituted a one-page waiver
that did not convey any information of known long-term risks
associated with the SIC.
We were required to sign the waiver. In 2007, after
complaints of former residents, the Navy provided a public Web
site with some study-based information. However, the Web site
has not been widely publicized and many former Atsugi residents
do not have knowledge of its existence.
Recently the Navy started--stated that the 2009 Atsugi
health study produced a registry. However, the study confirms
that approximately 75 percent of the Atsugi population in the
study was lost to follow-up, which adversely affects the
study's end result, specifically because of the documented
latency period of toxic exposure.
Over the last 3 years, an estimated 750 former residents,
including retired and former active duty personnel and their
families, have come together for support outside the realm of
the Navy. Within this group, at least 61 cancer cases have been
reported, all of which have been directly associated with
dioxin exposure. They include: brain, thyroid, cervical/
ovarian, colorectal, leukemia, lymphoma, and various other
cases of sarcoma, many of which involve innocent children, like
our son, Jordan, who lived at Atsugi while their mothers and
fathers faithfully served the United States of America while
stationed in Japan.
Besides cancer, many former residents suffer from
illnesses, including nervous system disorders, liver and kidney
damage, auto-immune diseases, neurological disorders, cardiac
irregularities, and other toxic-related diseases as defined by
the Agency of Toxic Substances and Disease Registry.
In closing, I would like to state that I had the basic
human right not to be exposed to the types of toxic chemicals
that were highly prevalent at Atsugi. Our military members are
proud to dedicate their lives in defense of this great country
and we support them in their mission every day. However, we
trusted the Navy to provide a safe environment for our family
members, but they failed to do so, knowingly housing our
families in a toxic waste zone.
We look to you, Committee Members, to rectify this gross
misconduct and to take action to ensure that the VA is provided
with an appropriate registry and an accurate risk of cancer and
non-cancerous illnesses associated with the SIC. We urge you to
ensure that all former residents are notified.
Finally, we urge you to introduce a bill to enact a new law
that allows former Atsugi residents and dependents to receive
appropriate VA benefits, to include medical care and disability
compensation. My son has been fighting for his life and the
journey so far I would not wish on any parent or family.
We will never know if this disease was caused or brought
about by the exposure of the toxic chemicals at Atsugi.
However, the risk imposed to him and my family and lack of
proactive risk mitigation is an absolute tragedy. I pray that
no other family has to endure the pain of watching their child
fight for it's life.
Thank you for allowing me to speak today.
[The prepared statement of Mrs. Paganelli follows:]
Prepared Statement of Laurie Paganelli, Mother of Jordan Paganelli,
Childhood Cancer (Sarcoma) Warrior and Past Resident of U.S. Naval Air
Facility (NAF) Atsugi, Japan
Good morning Mr. Chairman and Members of the Committee: Thank you
for this opportunity to present testimony on behalf of my family and as
a representative for hundreds of Sailors, Marines, and civilians who
were unknowingly exposed to and have been adversely affected by the
contaminated air, soil, and water at U.S. Navy Air Facility Atsugi,
Japan.
My name is Laurie Paganelli and I am a former resident of Atsugi.
My husband is an active-duty Navy servicemember and we were given
orders to report to Atsugi in 1997. Our tour of duty was from 1997-
2000. Our only son, Jordan, was 5 years old when we arrived. While
stationed at Atsugi, he attended Shirley Lanham Elementary School,
played soccer, t-ball, and attended many other sporting/cultural events
on the base throughout our time there.
On January 11, 2008 our lives changed forever. Jordan (then 16-
years old) was diagnosed with a rare, vicious, and highly aggressive
form of cancer--so aggressive in fact, that by the time he displayed
any symptoms, his cancer had already progressed to a STAGE 4 condition.
The name of his cancer is: Alveolar Rhabdo-Myo-Sarcoma (``ARMS'' for
short). ARMS is considered extremely rare because there are only about
350 cases diagnosed each year in the United States. And, because of its
rarity, there is a severe lack of awareness and funding for this type
of cancer. Only 3% of research money goes toward childhood cancer
research, making the 5-year survival rate dismally low. Jordan's
protocol was an Intensive Multi-Agent Therapy, including Dose-
Compressed Cycles which had us calling Walter Reed Army Medical Center
``home'' for most of the 15 months of continuous treatment. Jordan also
battled through 12 total weeks of DAILY radiation: 7 weeks to his torso
and lungs; and then 5 more weeks to his entire head following the
discovery of additional cancerous legions that had spread to his brain.
Additionally, due to cancer-based damage to his hips, he spent 10
months on crutches and the rest with a cane--quite a contrast to the
young boy who played at ``Atsugi Base'' and the high school cross
country star he had been just months prior to diagnosis. During our
stay at Atsugi we were aware of the incinerator. It smelled, burned
your eyes, and sometimes added a greenish glow to the air around us. We
certainly were not aware of the effects it would have on our family
years later. As most military families do, I trusted that the Navy
wouldn't let us live there if it was a danger to our health. I WAS
WRONG.
From 1983 until 2001, sufficient and compelling evidence showed
that a blend of highly toxic chemicals were released from the Shinkampo
Incineration Complex (labeled the ``SIC'') at levels that far exceeded
the EPA's health-risk-based guidelines. These chemicals severely
contaminated the residential area of Atsugi. A partial list of
chemicals included: volatile organic compounds, poly-chlorinated bi-
phenyls, pesticides, polycyclic aromatic hydro-carbons, dioxins,
furans, particulates, and heavy metals. In 1990, U.S. Department of the
Navy documents referred to this plume of smoke as a ``witch's brew of
toxic chemicals.''
During the operation of the SIC, the Navy spent approximately 18
million dollars performing numerous ambient air and health studies at
Atsugi. This data repeatedly confirmed that Atsugi was being polluted
with carcinogenic and non-carcinogenic chemicals, many of which have
been categorized by the EPA to have long-latency periods--meaning that
their affects would be evident years after the exposure.
In 1997, the Navy began to communicate health risks to Atsugi
residents. However, during the initial 12 years of incinerator
operations, personnel had little or no knowledge of the potential
health risks of their toxic exposure. In fact, a review of the Navy's
Human Health Risk Assessment of Atsugi (prepared in 2001 by the
Committee of Toxicology) stated: ``There does not seem to have been a
coordinated strategy for risk communication.''
In 1997, risk communication efforts included instructions for
residents and school children to stay indoors when the plume of toxins
blew toward the base. A ``Standard Form 600'' was added to personnel
medical records stating that we were exposed to 12 toxic chemicals that
exceeded Maximum Contamination Levels.
Although the NAVY had no control over the emissions of the SIC,
they did have the ability to avoid exposing thousands of children to
toxic chemicals. By early 1990, it was evident that base residents were
being exposed to Dioxin and other toxic chemicals. In 1997, the Navy
Inspector General reported that ``The Navy must act decisively to
reduce personnel exposure to incinerator contaminants. A range of
options for accomplishing this, including (but not limited to) moving
U.S. personnel to other locations, must be examined.''
The 1999 study conducted by the Government of Japan and the U.S.
Navy, found dioxin levels in the air to be dangerously high. By 2000,
Defense Secretary William Cohen and the Chief of the Japanese Defense
Agency agreed that Japan would provide temporary off-base housing and
that Japan would not object to the U.S. government's efforts to sue the
SIC for violating environmental laws.
In 2001, the United States Department of Justice brought suit
against the private incinerator in a Yokohoma Court. The lawsuit
claimed that toxic chemicals severely polluted the air, soil, and
ground water and interfered with the U.S. Government rights of property
use and possession. The SIC was closed when the Government of Japan
decided to pay the incinerator owner the equivalent of 42 million
dollars to shut down and dismantle the incinerators.
The NAVY had knowledge that Atsugi residents were being exposed to
Dioxin in the SIC's emissions by the early 1990's; and they knew what
detrimental affects such exposure would do to the human body. As you
remember, Dioxin is what made ``Agent Orange'' so toxic. So, it's no
surprise that by 1998, the NAVY recognized their liability and
instituted a one page waiver that did not convey information of the
known long-term risk associated with the SIC. We were all REQUIRED to
sign this waiver.
In 2007, after complaints of former residents, the NAVY provided a
public Web site with some study-based information. However, the Web
site has not been widely publicized and many former Atsugi residents
still do not have knowledge of its existence.
Recently, the NAVY has stated that the 2009 Atsugi Health Study
produced a registry. However, the study confirms that approximately 75%
of the Atsugi population in the study was lost to follow-up, which
adversely affected the study's end result--specifically because of the
documented latency period of the toxic exposure.
Over the last three years, an estimated 750 former residents
(including retired and former active duty personnel and their families)
have come together for support outside the realm of the NAVY. Within
just this group, at least 61 cancer cases have been reported--all of
which have been directly associated with Dioxin exposure. They include
Brain, Thyroid, Cervical/Ovarian, Colo-Rectal, Leukemia, Lymphoma and
various other cases of sarcoma--many of which involve innocent children
(like our son Jordan) who lived at Atsugi while their mothers and
fathers faithfully served the United States of America while stationed
in Japan.
Besides cancer, many former residents suffer from illnesses
including; nervous system disorders, liver and kidney damage, auto-
immune diseases, neurological disorders, cardiac irregularities, and
other toxic related diseases as defined by the Agency for Toxic
Substances and Disease Registry.
In closing, I would like to state that we had the basic human right
not to be exposed to the types of toxic chemicals that were highly
prevalent at Atsugi. Our military family members are proud to dedicate
their lives in defense of our great county; and, we support them and
their mission each and every day. However, we trusted the Navy to
provide a safe environment for our family members. But, they failed to
do so by knowingly housing our families in a toxic waste zone.
We look to you, committee members, to rectify this gross misconduct
and to take action to ensure that the VA is provided with an
appropriate registry and an accurate list of cancer and non-cancerous
illnesses associated with the SIC exposure. We urge you to ensure that
all former residents are notified. Finally, we urge you to introduce a
bill to enact a new law that allows former Atsugi residents and
dependents to receive the appropriate VA benefits to include medical
care and disability compensation.
My son has been fighting for his life; and his journey thus far is
one that NO parent should ever have to take with their child. We will
never know if his disease was caused (or brought about) by the exposure
of toxic chemicals at Atsugi. However, the risk imposed to him and my
family, and the lack of proactive risk mitigation, is an absolute
tragedy. I pray that no other family has to endure the pain of watching
their child fight for their lives.
Thank you for allowing me to speak to you today.
Chairman Akaka. Thank you very much, Mrs. Paganelli. Now we
will receive the testimony of Dr. Feigley.
STATEMENT OF CHARLES E. FEIGLEY, Ph.D., PROFESSOR,
ENVIRONMENTAL HEALTH SCIENCES, PUBLIC HEALTH RESEARCH CENTER,
ARNOLD SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF SOUTH CAROLINA;
CHAIR, SUBCOMMITTEE ON THE ATSUGI INCINERATOR COMMITTEE ON
TOXICOLOGY BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY
DIVISION ON EARTH AND LIFE STUDIES, NATIONAL RESEARCH COUNCIL,
THE NATIONAL ACADEMIES
Mr. Feigley. Good morning, Mr. Chairman and Members of the
Committee. Thank you for your concern about the health of
veterans.
My names is Charles Feigley. I am professor of
environmental health sciences at the University of South
Carolina, Arnold School of Public Health. I am also principal
investigator of a DOD-sponsored contract testing the use of
copper in air conditioning systems to improve air quality and
reduce illness in the military.
As well, I am principal investigator of the University of
South Carolina Center for Public Health Preparedness, which is
funded by the Centers for Disease Control and Prevention. We
assist State, local, and tribal health agencies and their
community partners to prepare for a wide range of public health
emergencies.
In addition, I have served on a number of committees of the
National Research Council, or NRC, including as chair of the
NRC subcommittee that prepared the report titled, ``Review of
the U.S. Navy's Health Risk Assessment of the Naval Air
Facility at Atsugi.''
The National Research Council is an operating arm of the
National Academy of Sciences, not part of the government, and
it is--it was established in 1863 by Congress and under
President Lincoln to advise the government on matters of
science and technology. I am here before you today because of
my experience as a volunteer serving on that NRC committee.
The NRC report titled, Review of the U.S. Navy's Health
Risk Assessment of the Naval Air Facility at Atsugi was
prepared in response to requests from the U.S. Navy for an
independent review of the final draft of the Navy Environmental
Health Center's report on the risk assessment at Atsugi which
was in 2000, the year 2000.
The NEHC, that is, the Naval Environmental Health Center,
that prepared the risk assessment report that we reviewed, had
conducted a risk assessment because of concerns that were
raised by residents of Atsugi, the U.S. Navy personnel, and
their families regarding health effects of what came to be
called Enviro-Tech Incinerator--the Enviro-Tech Incinerator,
formally called Shinkampo or Jinkanpo Incinerator Complex.
That complex was adjacent to the U.S. Naval Air Facility
which is located southwest of Tokyo, and when I say adjacent,
one of the critical things that really is not mentioned in my
written statement is that the incinerator is at a much lower
elevation than the base facility. The stacks from the
incinerator discharged just above the level of the naval air
facility so that when the air is--when the bin is blowing, as
it frequently is, from the incinerator to the base, they were
directly downwind and at really pretty much the same level of
discharge.
The concerns were related to the exposure to emissions from
the incinerator and to chemicals resulting from the storage
handling and disposal of waste material at the facility. The
risk assessment was conducted after a previous NRC committee
recommended that a comprehensive health study at NAF at Atsugi
be conducted.
The NRC subcommittee on Atsugi consisted of members
selected for their expertise in toxicology, epidemiology,
industrial hygiene, engineering, exposure assessment, and risk
assessment. We were specifically asked to do two things. This
is our charge: review the adequacy of the methods used to
assess risks, the uncertainty is identified, the risk to
susceptible subpopulations, such as pregnant women and young
children, and the scientific validity of the conclusions drawn.
Second, to recommend research to fill data gaps and options
for mitigating risks associated with exposure to the
incinerator emissions. It is important to note that you can see
from these specific tasks that the subcommittee was not asked
to determine the potential health effects from the incinerator,
but to review the assessment that was conducted by the Naval
Environmental Health Center.
In its review, the subcommittee identified a number of
aspects of the risk assessment that were exemplary and others
that needed improvement. The subcommittee noted that the NEHC
risk assessment included a rigorous quality assurance and
quality control program and the subcommittee, therefore, had
confidence in the accuracy of the data collected.
The subcommittee was pleased with a broad number of air
pollutants that were monitored and the collection of
meteorological data. It also commended the NEHC for calculating
risks of acute and chronic toxicity endpoints of the different
subpopulations.
The subcommittee was concerned however about
inconsistencies in the objectives of the risk assessment, some
technical aspects regarding how the collected data was used in
the risk assessment, and the interpretation of data and risk
assessment findings by the NEH. The subcommittee also commented
on the lack of analysis and characterization of uncertainty in
the risk assessment.
The subcommittee concluded that the NEH had collected a
large amount of sampling data at NAF Atsugi. If analyzed and
interpreted appropriately, the data might have been adequate to
determine whether the air pollution at NAF Atsugi poses a
health risk and how much the incinerator facility contributes
to that pollution.
However, the analyses of the data were inadequate to draw
conclusions about the health risks of the persons residing at
NAF Atsugi and about the contributions of the incinerator to
those risks. In addition, the NEHC had interpreted some of the
results of the risk assessment without taking into account the
meaning and limitations of the risk assessment process.
The subcommittee concluded that aspects of the analyses and
interpretation of the data, not the underlying data themselves,
constituted the main limitation of the risk assessment. The
committee provided recommendations to improve the NEH risk
assessment, including recommendations for the planning of the
risk assess--of risk assessments, determination of attributable
risk, analysis of air monitoring data, interpretation of risk
assessment, treatment of uncertainty and information gaps that
should be filled, and improvements in the presentation and
organization of the NEH draft summary report itself.
Given the aforementioned limitations of the Navy's risk
assessment draft summary report, the subcommittee found that
the analyses presented did not determine reliably whether
military personnel and their families incurred health risks by
living at NAF Atsugi, nor did the analyses represent reliably
the contribution of the incinerator to those health risks.
With that, I once again thank you for inviting me to
testify before this Committee. I appreciate the important work
that the Committee does for veterans' affairs and welcome any
questions you might have.
[The prepared statement of Mr. Feigley follows:]
Prepared Statement of Charles E. Feigley, Ph.D. Professor,
Environmental Health Sciences, Public Health Research Center, Arnold
School of Public Health, University of South Carolina
Good morning Mr. Chairman and Members of the Committee. Thanks to
Senator Akaka and Members of the Committee on Veterans' Affairs for
your concern about veteran's health.
My name is Charles Gene Feigley. I am a professor of environmental
health sciences at the University of South Carolina, Arnold School of
Public Health.. I am Principal Investigator of a DOD-sponsored project
testing the use of copper in air conditioning systems to improve air
quality and reduce illness in the military. I am also Principal
Investigator of the University of South Carolina's Center for Public
Health Preparedness funded by the Centers for Disease Control and
Prevention to assist State, local, and tribal health agencies and their
community partners prepare for response to a wide range of public
health emergencies. In addition, I have served on a number of
committees of the National Research Council (NRC), including as Chair
of the NRC Subcommittee that prepared the report Review of the U.S.
Navy's Health Risk Assessment of the Naval Air Facility at Atsugi. The
National Research Council is the operating arm of the National Academy
of Sciences, National Academy of Engineering, and the Institute of
Medicine of the National Academies, chartered by Congress in 1863 to
advise the government on matters of science and technology. I am here
before you today because of my experience as a volunteer serving on
that NRC Committee.
The NRC report, Review of the U.S. Navy's Health Risk Assessment of
the Naval Air Facility at Atsugi, was prepared in response to a request
from the US Navy for an independent review of the Navy Environmental
Health Center (NEHC) report NAF Atsugi, Japan Human Health Risk
Assessment Summary of Findings, Conclusions and Recommendations, Draft
Final, January 2000, as well as a number of supporting documents for
that risk assessment. The NEHC had conducted that risk assessment
because of concerns that had been raised by the residents of NAF
Atsugi--US Navy personnel and their families--regarding the health
effects of the Enviro-Tech incinerator facility (formerly called the
Shinkampo or Jinkanpo incinerator complex). That complex was adjacent
to the US Naval Air Facility (NAF) at Atsugi, Japan, southwest of
Tokyo. Enviro-Tech was a privately owned waste-combustion facility that
consists of three incinerators, a waste-staging area, and an ash-
holding area. The concerns were related to exposure to emissions from
the incinerators and to chemicals resulting from the storage, handling,
and disposal of waste material at the facility. The risk assessment was
conducted after a previous NRC subcommittee had recommended that a
comprehensive health risk assessment of NAF Atsugi be conducted.
The NRC Subcommittee on the Atsugi Incinerator--which consisted of
members selected for their expertise in toxicology, epidemiology,
industrial hygiene, engineering, exposure assessment, and risk
assessment--was specifically asked to:
1. Review the adequacy of the methods used to assess risk, the
uncertainties identified, the risks to susceptible subpopulations (such
as pregnant women and young children), and the scientific validity of
the conclusions drawn.
2. Recommend, depending on its evaluation, research to fill data
gaps and options for mitigating the risks associated with exposure to
the incinerator emissions.
It is important to note that, as you can see from those specific
tasks, the Subcommittee was not asked to determine the potential health
effects from the incinerator, but to review the assessment that was
conducted by the NEHC. In its review the Subcommittee identified a
number of aspects of the risk assessment that were exemplary and others
that needed improvement.
The Subcommittee noted that the NEHC risk assessment included a
rigorous quality-assurance and quality-control program, and the
Subcommittee therefore had confidence in the accuracy of data
collected. The Subcommittee was pleased with the broad number of air
pollutants that NEHC monitored and the collection of meteorological
data. It also commended the NEHC for calculating the risks of acute-
and chronic-toxicity end points for different subpopulations.
The Subcommittee was concerned, however, about inconsistencies in
the objectives of the risk assessment, some technical aspects regarding
how the collected data was used in the risk assessment, and the
interpretation of the data and risk assessment findings by the NEHC.
The Subcommittee also commented on the lack of uncertainty analysis or
characterization in the risk assessment.
The Subcommittee concluded that NEHC had collected a large amount
of sampling data at NAF Atsugi. If analyzed and interpreted
appropriately, those data might have been adequate to determine whether
air pollution at NAF Atsugi poses a health risk and how much the
incinerator facility contributes to that pollution. However, the
analyses of the data were inadequate to draw conclusions about the
health risks for persons residing at NAF Atsugi and about the
contribution of the incinerator to those risks. In addition, NEHC had
interpreted some of the results of the risk assessment without taking
into account the meaning and limitations of the risk-assessment
process. The Subcommittee concluded that aspects of the analyses and
interpretation of the data, not the underlying data themselves,
constituted the main limitation of the risk assessment. The
Subcommittee provided recommendations to improve the NEHC risk
assessment, including recommendations for the planning of risk
assessments, determination of attributable risk, analysis of air-
monitoring data, interpretation of the risk assessment, treatment of
uncertainty, information gaps that should be filled, and improvements
in the presentation and organization of the NEHC draft summary report
itself. Given the aforementioned limitations of the Navy's risk
assessment draft summary report, the Subcommittee found that the
analyses presented did not determine reliably whether military
personnel and their families incur increased health risks by living at
NAF Atsugi. Nor did the analyses presented reliably determine the
contribution of the incinerator facility to health risks.
With that, I would once again like to thank you for inviting me to
testify before this Committee. I appreciate the important work
conducted by the Committee on Veterans' Affairs and welcome any
questions you may have.
______
Post-hearing Questions Submitted by Hon. Daniel K. Akaka to Charles E.
Feigley, Ph.D., Professor, University of South Carolina, Chair,
Subcommittee on the Atsugi Incinerator
Question 1. Please provide the Committee with the best estimate of
the size of population that was at Atsugi between 1983 and 2001. Of
this population, how many were servicemembers and how many were
dependents, both adult and children? Please also provide the ages of
the children.
Question 2. Is there a study that can be done that will provide
more accurate data than those done in the past? What would that look
like?
[The Committee had not received the requested information
by press time.]
Chairman Akaka. Thank you, Dr. Feigley. Dr. Gibb, your
testimony, please.
STATEMENT OF HERMAN GIBB, Ph.D., M.P.H.
Mr. Gibb. Good morning. Thank you for the opportunity to
testify this morning. I will be testifying on the subject of
Qarmat Ali. I am testifying in my personal capacity and do not
in any way represent the interest, beliefs or opinions of my
employer.
I presented similar testimony to the Senate Democratic
Policy Committee hearing on August 3, 2009. The subject of that
hearing was, ``The Exposure at Qarmat Ali--Did the Army Fail to
Protect U.S. Soldiers Serving in Iraq?'' I have a Ph.D. in
epidemiology from the Johns Hopkins University and an MPH in
environmental health from the University of Pittsburgh.
I spent 29 years at the U.S. Environmental Protection
Agency. Most of my time at the EPA was spent at the National
Center for Environmental Assessment where I served in the
capacities of assistant center director and associate director
for health. Based on my experience working at EPA on risk
assessments of hexavalent chromium and my study of chromate
production workers, I can state that the symptoms reported by
the soldiers who served at Qarmat Ali are consistent with
significant exposure to sodium dichromate.
Sodium dichromate--and I may use the term hexavalent
chromium and sodium dichromate interchangeably--but sodium
dichromate is a hexavalent chromium compound. EPA maintains an
online database of risk assessments on over 500 substances,
including an evaluation of the potential of these substances to
cause cancer in humans. Hexavalent chromium is classified as a
human carcinogen.
Among those substances that the EPA has classified as
carcinogenic to humans, and it is estimated a cancer inhalation
unit risk, the highest risk is that for hexavalent chromium. In
other words, it is the most carcinogenic.
In 2000, while at the EPA, I was the senior author of two
publications on the health risks experienced by chromate
production workers at a facility in Baltimore, MD. The first
publication reported the results of a mortality study. The
second examined the risk of clinical irritation experienced by
the workers.
The hexavalent chromium exposure at the facility was
primarily from sodium dichromate, which is the same exposure
that the soldiers experienced at Qarmat Ali. From my work on
these studies, the EPA awarded me the Agency Scientific and
Technological Achievement Award. I became interested in
studying the group of workers in Baltimore because of the
considerable amount of exposure data available for the
facility. The group was relatively large, 2,357 workers. There
were 122 deaths from lung cancer.
Hexavalent chromium was found to be significantly
associated with an increased risk of lung cancer even after
controlling for smoking. Half of those who developed lung
cancer had worked at the facility for less than 10 months. And
I might add that one quarter of the lung cancer cases had
worked at the facility for 2 months or less.
In 2006, based in large measure on our study, the
Occupational Safety and Health Administration set a permissible
exposure limit for hexavalent chromium of 5 micrograms per
cubic meter for--as an 8-hour time weighted average. This new
OSHA PEL reduced the previous PEL by over 10-fold.
Clinically diagnosed symptoms of irritation were found to
occur in our study population within a relatively short time
period after beginning employment. The medium time to develop
an irritated nasal septum was only 20 days. That means that
half of the workers developed it in less than 20 days and half
developed it in more than 20 days: an ulcerated nasal septum,
22 days; a bleeding nasal septum, 92 days; a perforated nasal
septum 182 days.
We recorded 10 different types of clinically diagnosed
irritation. What was also remarkable was the higher percentage
of the group that was diagnosed with signs of irritation. For
example, 68 percent of the group was diagnosed at one time or
another with nasal irritation. The signs of irritation which
the soldiers and workers experienced at Qarmat Ali are
consistent with what we reported in our study.
The testimony by Russell Powell in the hearing today, by
the soldiers in the hearing held by the Democratic Policy
Committee on August 3, and by the civilian workforce in the
previous hearing held on this subject suggests that they are
experiencing signs of hexavalent chromium exposure.
A report from the Army Center for Health Promotion and
Preventive Medicine, CHPPM, indicated the blood samples were
collected from 137 potentially exposed soldiers and DOD
civilians. CHPPM's description of these results is confusing
and lacks sufficient detail. CHPPM suggests that the chromium
and the red blood cells of the vast majority of the individuals
in their study are within normal ranges. However, CHPPM notes
in italicized print that there are some other literature
references that have lower limits.
Unfortunately, CHPPM does not specify the literature
sources, nor do they indicate how low these lower limits are.
Where did CHPPM get their reference values and how good are
they? Although CHPPM reports that nearly all of the test
results were below the limit of detection, CHPPM also reports
that 98 percent of the samples showed chromium levels within
the range of four to five micrograms per liter. How is it
possible that 98 percent of the samples could be within the
range of four to five micrograms per liter when they report
that nearly all of the results were below the limit of
detection?
In 1987, an article cited by the National Institute for
Occupational Safety and Health, Dr. Angerer and others found
that exposures 10 times the current OSHA limit will result in a
concentration of chromium in red blood cells of .6 micrograms
per liter. Assuming Angerer and his coauthors are correct, and
accounting for at least the 40-day delay in CHPPM's collection
of blood samples, the air concentration which the Qarmat Ali
soldiers were exposed could be estimated to be approximately 80
to 200 times the current OSHA limit.
Why did CHPPM fail to explore inconsistencies in its data
with that of other literature? These limitations call for
greater scrutiny of the CHPPM results. The samples drawn from
some of the soldiers and workers at Qarmat Ali were reported by
CHPPM to have been taken approximately a month after
remediation measures were taken to limit the exposure.
At the Democratic Policy Committee meeting on August 3,
there were four soldiers attending. Only one of them had had
their blood drawn and I asked when it was drawn and he said it
was 60 days after exposures ended. In its draft, Toxicological
Profile on Chromium, the Agency for Toxic Substances and
Disease Registry reports that the half life of chromium in red
blood cells is 30 days. In other words, 30 days after the
exposure has ended, we expect to see only 50 percent of the
chromium in the volume of red blood cells that would have been
there initially.
The measurements of chromium in red blood cells is an
insensitive method of detecting hexavalent chromium exposure.
The measurement of chromium in the red blood cell only captures
the hexavalent chromium that makes its way into the cell. It
does not measure how much hexavalent chromium may have been
inhaled and remains in the nose or lung or was reduced in the
body to trivalent chromium, which is not getting to the red
blood cell; nor does it measure the chromium that was
eliminated from the body.
It should be noted that NIOSH in its draft update on
hexavalent chromium states the biomarkers, which would include
blood tests, are of uncertain value as early indicators of
potential hexavalent chromium-related health effects. ATSDR
reports that 90 percent of absorbed chromium is eliminated
within 24 hours. Nevertheless, CHPPM still put a great deal of
emphasis on the red blood cell analyses from samples taken at
least 4 weeks and maybe 2 months after possible exposure to
hexavalent chromium.
An analogy would be like giving a breathalyzer to a person
3 days after they were pulled over for erratic driving. The
toxin would have been eliminated from the body in the
intervening period. Given the limited usefulness of these red
blood cell tests, they should not be used as a bottom-line
indicator of the hexavalent chromium exposure that the soldiers
and workers experienced and they certainly should not be
extrapolated to other individuals who were exposed at Qarmat
Ali.
Nasal perforations, bloody noses and skin irritation would
be far more telling about the soldiers and workers' exposures
that measures the chromium and red blood cells taken 1 month or
maybe 2 months after remediation has taken place.
In summary, the symptoms that have been reported by the
soldiers and civilian workers are consistent with what has been
experienced by other workers exposed to hexavalent chromium.
Judgment on whether these soldiers and civilian employees were
exposed should not be based on measurements of red blood cells
taken 1-2 months after remediation measures were taken, nor
should such results be extrapolated to other individuals who
were present at the facility.
Again, I thank you, Mr. Chairman, for the opportunity to
testify today.
[The prepared statement of Mr. Gibb follows:]
Prepared Statement of Herman Gibb, Ph.D., M.P.H.
Good afternoon. I am Dr. Herman Gibb. Thank you for the opportunity
to testify before you today. I am testifying in my personal capacity
and do not in any way represent the interests, beliefs or opinions of
my employer. I presented similar testimony to the Senate Democratic
Policy Committee hearing on August 3, 2009. The subject of that hearing
was ``The Exposure at Qarmat Ali: Did the Army Fail to Protect U.S.
Soldiers Serving in Iraq?''
I have a Ph.D. in Epidemiology from the Johns Hopkins University
and an M.P.H. in Environmental Health from the University of
Pittsburgh. I spent 29 years at the U.S. Environmental Protection
Agency (EPA). Most of my time at the EPA was spent at the National
Center for Environmental Assessment where I served in the capacities of
Assistant Center Director and Associate Director for Health. Based on
my experience working at the EPA on risk assessments of hexavalent
chromium and my study of chromate production workers, the symptoms
reported by some of the soldiers who served at Qarmat Ali are
consistent with significant exposure to sodium dichromate.
EPA maintains an online database of risk assessments on over 500
substances, including an evaluation of the potential of these
substances to cause cancer in humans. Hexavalent chromium is classified
as a human carcinogen. Among those substances that the EPA has
classified as carcinogenic to humans and has estimated a cancer
inhalation unit risk, the highest risk is that for hexavalent chromium.
In 2000, while at the EPA, I was the senior author of two publications
on the health risks experienced by chromate production workers at a
facility in Baltimore, MD. The first publication reported the results
of a mortality study, the second examined the risk of clinical
irritation experienced by the workers. The hexavalent chromium exposure
at the facility was primarily from sodium dichromate. For my work on
these studies, the EPA awarded me the Agency's Scientific and
Technological Achievement Award.
I became interested in studying the group of workers in Baltimore
because of the considerable amount of exposure data available for the
facility. The group was relatively large--2,357 males; there were 122
deaths from lung cancer. Hexavalent chromium was found to be
significantly associated with an increased risk of lung cancer, even
after controlling for smoking. Half of those who developed lung cancer
had worked at the facility for less than ten months.
In 2006, based in large measure on our study, the Occupational
Safety and Health Administration (OSHA) set a Permissible Exposure
Limit (PEL) for hexavalent chromium of 5 micrograms per cubic meter
(mg/m3) as an 8-hour time-weighted average based on the carcinogenic
dose response. The new OSHA PEL reduced the previous PEL by over 10-
fold.
Clinically diagnosed symptoms of irritation were found to occur in
our study within a relatively short time period after beginning
employment. The median time to develop an irritated nasal septum was
only 20 days, an ulcerated nasal septum 22 days, a bleeding nasal
septum 92 days, a perforated nasal septum 182 days. We recorded 10
different types of clinically diagnosed irritation. What was also
remarkable was the high percentage of the group that was diagnosed with
signs of irritation. For example, sixty-eight percent of the group was
diagnosed at one time or another with nasal irritation.
The signs of irritation which the soldiers and workers experienced
at Qarmat Ali are consistent with what we reported in our study. The
testimony by Russell Powell in the hearing today, by the soldiers in
the hearing held by the Democratic Policy Committee on August 3, and by
the civilian workers in the previous hearing held on this subject
suggest that they are experiencing signs of hexavalent chromium
exposure.
A report from the Army's Center for Health Promotion and Preventive
Medicine (CHPPM) indicated that blood samples were collected from 137
potentially exposed soldiers and DOD civilians. CHPPM's description of
these results is confusing and lacks sufficient detail.
CHPPM suggests that the chromium in the red blood cells of
the vast majority of the individuals in their study are within normal
ranges. However, CHPPM notes, in italicized print, that ``there are
some other literature references that use lower limits.''
Unfortunately, CHPPM does not specify the literature sources nor do
they indicate how low these ``lower limits'' are. Where did CHPPM get
their reference values and how good are they?
Although CHPPM reports that nearly all of the test results
were below the limit of detection, CHPPM also reports that ninety-eight
percent of the samples showed chromium levels within the range of 4 to
5 micrograms per liter (mg/L). How is it possible that ninety-eight
percent of the samples could be within the range of 4 to 5 micrograms
per liter when they report that nearly all the results were below the
limit of detection?
In a 1987 article cited by the National Institute for
Occupational Safety and Health (NIOSH), Dr. Angerer and others found
that exposures 10X the current OSHA limit will result in a
concentration of chromium in red blood cells of 0.6 micrograms per
liter (mg/L). Assuming Angerer and his co-authors are correct and
accounting for at least a 40-day delay in CHHPM's collection of blood
samples, the air concentration to which the Qarmat Ali soldiers were
exposed could be estimated to be approximately 80-200 times the current
OSHA limit. Why did CHPPM fail to explore inconsistencies in its data
with that of other literature?
These limitations call for greater scrutiny of the CHPPM results.
The samples drawn from some of the soldiers and workers at Qarmat Ali
were taken a month after remediation measures were taken to limit the
exposure. In its draft Toxicological Profile on Chromium, the Agency
for Toxic Substances and Disease Registry (ATSDR) reports that the
half-life of chromium in red blood cells is 30 days. In other words, 30
days after the exposure has ended, we would expect to see only 50
percent of the chromium in the volume of red blood cells that would
have been there initially.
Furthermore, the measurement of chromium in red blood cells is an
insensitive method of detecting hexavalent chromium exposure. The
measurement of chromium in the red blood cell only captures the
hexavalent chromium that makes its way into the cell. It does not
measure how much hexavalent chromium may have been inhaled and remained
in the nose or lung or was reduced in the body to trivalent chromium
which does not get into the red blood cell.
It should be noted that NIOSH, in its draft update on hexavalent
chromium states that biomarkers, which would include blood tests, are
of uncertain value as early indicators of potential hexavalent
chromium-related health effects. Nevertheless, CHPPM still put a great
deal of emphasis on the red blood cell analyses from samples taken at
least four weeks after possible exposure to hexavalent chromium. An
analogy would be like giving a breathalyzer to a person three days
after they were pulled over for erratic driving. The toxin would have
been eliminated from the body in the intervening period.
Given the limited usefulness of these red blood cell tests, they
should not be used as a bottom line indicator of the hexavalent
chromium exposure that the soldiers and workers experienced. And they
certainly should not be extrapolated to other individuals who were
exposed at Qarmat Ali. Nasal perforations, bloody noses, and skin
irritation would be far more telling about the soldiers' and workers'
exposure than measures of chromium in red blood cells taken a month
after remediation has taken place.
In summary, the symptoms that have been reported by the soldiers
and civilian workers are consistent with what has been experienced by
other workers exposed to hexavalent chromium. Judgment on whether these
soldiers and civilian employees were exposed should not be based on
measurements of chromium in red blood cells taken 30 days after
remediation measures were taken, nor should such results be
extrapolated to other individuals who were present at the facility.
______
Post-hearing Questions Submitted by Hon. Daniel K. Akaka to
Herman Gibb, Ph.D., MPH
Question 1. In the Baltimore study, workers exhibited symptoms
between 20 and 182 days. One-fourth of the workers who had cancer had
worked at the facility for less than two months. The Army has stated
that even soldiers, such as Russell Powell, who were at Qarmat Ali for
extended periods of time, were not exposed for a long enough amount to
produce any adverse or long term health effects. Given the exposure
period of those in the Baltimore study and the symptoms and conditions
those individuals exhibited in that amount of time, do you agree with
the Army's assertion?
Question 2. Do you believe, given Russell Powell's length of time
at Qarmat Ali, that his symptoms can be attributed to his exposure?
Question 3. Given the similarities between the illnesses and the
symptoms exhibited by both the Baltimore workers and the Qarmat Ali
soldiers, and considering that both groups had a similar period of
exposure, is it reasonable that the same unique symptoms experienced by
so many Qarmat Ali soldiers could be attributed to other factors? What,
if any, environmental or otherwise, factors could be responsible for
such conditions, experienced by a number of servicemembers within the
same vicinity?
Question 4. In Mr. Resta's testimony, he stated that blood tests
alone were not the predominant indicators for exposure. Mr. Resta
stated that the Army primarily relied on physical exams when making the
final determination on exposure. Do you believe that a physical exam
would provide a more accurate indication if an individual was exposed
to sodium dichromate? What method of detection do you believe to be the
most accurate?
Question 5. In your research on sodium dichromate, have you ever
observed a latency period between the time an individual was exposed to
the chemical and the time it took symptoms or conditions to manifest
themselves?
[The Committee had not received the requested information
by press time.]
Chairman Akaka. Thank you very much, Dr. Gibb. Now we will
receive the testimony of Mr. Powell.
STATEMENT OF RUSSELL POWELL, FORMER U.S. ARMY
STAFF SERGEANT
Mr. Powell. Thank you, Mr. Chairman. I thank the Committee
Members for having me testify here today and also a special
thanks to the Veterans of Foreign Wars.
My name is Russell Powell. I live in Moundsville, West
Virginia. I started my military career in 1994, in the 1-505
Parachute Infantry Regiment as a medic. Later through my
military career, I became a flight medic in Panama and Fort
Bragg.
In 2001, I joined the West Virginia Army National Guard as
a medic. In April 2003--or excuse me--March 2003, the 1092nd
Engineer Battalion was deployed to Iraq. From April 2003 to
June 2004, the 1092nd was assigned as security for KBR workers.
When Charlie Company arrived at the plant, which was the Qarmat
Ali Water Treatment Plant, it had been seriously pillaged and
destroyed.
There was a coating of orange-colored dust throughout the
facility and at the time, no one knew or made any concerns of
what the powder was. The orange dust was located in large bags
that were ripped open throughout the facility. During my stay
at Qarmat Ali, there were at least 10 dust storms. They would
blow through the facility picking up dust and debris.
At no time were myself or other soldiers or KBR workers
offered any protective clothing, masks or respirators to keep
us from the elements. During these storms or shortly after
about 90 percent of the KBR workers and the soldiers would have
severe nose bleeds, cough up blood, have a hard time breathing
and experience nausea and burning sensations to their lungs and
throat.
After a week of being at the facility, several personnel
began getting skin lesions on their hands, arms, faces and
nostrils. Of course, we also had soldiers that developed
deviated--or excuse me--perforated septums, which cause holes
through their nose from one end of their nose to the other.
As a medic, I felt pretty concerned for the safety and
health of all the persons that were sitting at the Qarmat Ali
Treatment Plant. I talked to one of the KBR workers and I asked
him what is going on about everybody getting real sick, getting
bloody noses. And one of the KBR workers said their supervisor
said we are all allergic to the dust and sand.
Later on, there was another dust storm and I was eating an
MRE. The storm hit me when I started eating. My lungs started
burning. My throat started burning and I started being real
nauseated and sick. The same day they said Doc, you are not
going out to the water treatment plant tomorrow; you just stay
in and go to the infirmary and see one of the Navy doctors.
Well I went to one of the Navy doctors at Camp Commando in
Kuwait and he pretty much said oh, you are sick. You just got a
viral infection. But I went to a bomb shell bunker and tried to
give myself an I.V. because I knew I was--there was something
really wrong. After I went to that bomb shell shelter and tried
to administer an I.V., I do not really remember anything.
I woke up in the hospital, The Kuwaiti Soldiers Hospital.
There was a couple of Navy soldiers that found me and they
said, I was just coughing up blood and delirious. Well, I spent
a week at the Soldiers Hospital. My face and lips were burnt,
yet I was not out--exposed to any sun. It was pretty much from
the dust.
I got out of the hospital, but--excuse me--at the hospital,
the doctor said that they did not really know what caused my
face and lips to be burnt as bad as they were. They went ahead
and just gave me a bunch of antibiotics, sent me back to Qarmat
Ali.
When I got back to Qarmat Ali, there were a bunch of
soldiers, a bunch of my soldiers complaining of the same
symptoms that I had when I went to the Kuwaiti hospital. Of
course, I gave them antibiotics because we did not have
physician. We did not have a physician assistant, so I pretty
much became the doctor for the battalion.
In June 2003, Indiana National Guard soldiers relieved us
from our duties from Qarmat Ali. At no time did any of the
1092nd from the West Virginia National Guard get tested for any
exposure to chemicals, blood drawn or anything; or even told
about it. When I left Iraq in April 2004, I went to the VA
Clinic in Clarksburg, West Virginia, and talked to them about
my skin rashes, stomach problems, and nose bleeds. The doctors
were unable to determine what was the cause of these problems.
In 2009, I received a letter from the West Virginia
National Guard stating that we were possibly exposed to sodium
dichromate while serving at Qarmat Ali. The VA doctors believed
this could be the cause of our health issues, but because they
know little about sodium dichromate, they are still
researching, trying to figure out the effects of it on the
human body.
I would like to thank Senator Rockefeller and his staff,
and especially the VFW, for giving soldiers and veterans much
needed support through the VA system in West Virginia. Once
again, I thank all of you for having me here today.
[The prepared statement of Mr. Powell follows:]
Prepared Statement of Russell Powell, Former U.S. Army Staff Sergeant
I'd like to thank you for having me here at this Senate hearing. My
name is Russell Powell, I reside in Moundsville, West Virginia. I
started my military career in January 1994; I was assigned to the 82nd
Airborne Division as a paratrooper infantry medic. In 1997 I was
reassigned as a flight medic at Howard Air Force Base Panama City,
Panama. In 1999 I was again reassigned to 57th Dust off at Fort Bragg,
North Carolina. August 2000, I was discharged from the army and in
April 2001 I joined with 1092nd West Virginia Army National Guard as a
medic. The 1092nd was deployed to Iraq in March 2003. In April 2003 to
June 2004 1092nd Charlie Company was assigned as security for the KBR
Contractors, my duties consisted of battalion medic and supplied
defensive positions and cover fire if needed to protect KBR contractors
at Qarmat Ali Water treatment plant in Basra, Iraq.
When Charlie Company 2nd platoon arrived at the plant it was in
total disarray and had been severely pillaged and destroyed. There was
a coating of orange colored dust throughout the facility. At that time
no one knew or made any concerns of what the powder was. The orange
dust was located in large bags that were ripped open, causing the dust
to be spread all over the facility. At times the orange dust was so
thick there were at least two inches of dust on my boots. During my
stay at the QA there were at least ten dust storms, they were like
tornadoes blowing through the facility picking up the dust and other
debris. At no time were we offered any kind of protective clothing,
masks, or respirators to protect us from the elements. During these
storms or shortly there after soldiers in the company, KBR workers and
myself would have severe nose bleeds, coughing up blood, a hard time
breathing, nausea, and/ or a burning sensation the lungs and throat.
After a few weeks of being at the facility several personnel began
getting lesions on their hands, arms, faces and nostril area. As a
medic I felt very concerned for the safety and health of persons
exposed. I questioned one of the KBR workers (I have forgotten his
name), and he told me that his supervisors told him not to worry about
it, that we were allergic to sand and dust. Shortly there after, there
was another severe dust storm I ate an MRE (meals ready to eat) and my
throat and stomach began to burn like nothing I have felt before, my
nose began to bleed, and was nauseated. After this particular storm I
was severely sick to the point that when we returned to Kuwait City,
Kuwait (Camp Commando) I was told that I was not going out on the
mission the following day.
The following day I went to the Infirmary at Camp Commando, and was
seen by a Naval Doctor. After a brief examination he dismissed me as
being sick and prescribed me Motrin and Tylenol. Approximately thirty
minutes later I went to a bombshell bunker to give myself an IV, a
couple soldiers found me I was delirious and coughing up blood. I do
not remember anything until waking up the following day in the Kuwait
Soldiers Hospital. My face and lips were burnt and my throat was sore
to the point I couldn't swallow anything. I was there for almost a week
getting antibiotics intravenously. The doctors had no explanation why I
was sick or why my face and lips were burnt so badly. The day I was
released from the Hospital I returned to Qarmat Ali with Charlie
Company 2nd platoon. Upon my return to QA numerous soldiers were
complaining of the same symptoms I was experiencing. I prescribed those
soldiers antibiotics, however the symptoms persisted. At the end of
June 2003 the Indiana National Guard relieved us of our duties. Our
unit moved into northern Iraq. The nose bleeds subsided a little, but
the nausea was still present daily.
After leaving Iraq in April 2004 I went to the VA Clinic in
Clarksburg, WV to talk to the doctors about my skin rashes and lesions,
stomach problems, and nose bleeds. The doctors were unable to determine
what the cause is of these problems were. In 2009 I received a letter
from the WV national Guard stating we were possible exposed to Sodium
Dichromate while serving at QA, and the VA doctors believe that this
could be what's causing my health issues, but because they know little
about Sodium Dichromate they are researching and trying to figure out
the affects of it on the human body. I know for a fact that Sen.
Rockefeller is giving veterans and soldiers alike, much needed support
through the VA system in WV.
Once again I would like to thank you all of you for hearing my
testimony.
Chairman Akaka. Thank you very much, Mr. Powell, for your
testimony. I would like to say thank you again to our first
panel. Many of you have given heartfelt testimony regarding
some very, very personal issues that have affected your lives.
I know I speak for the entire Committee when I say that we
appreciate your presence here today. I would like to ask my
question to four of our witnesses, Mr. Partain, Mrs.
Pennington, Ms. Paganelli and Mr. Powell.
Are you satisfied with the military's response to each of
the exposures you or your family member was affected by,
including high-risk lists or high-risk health problems? Mr.
Partain?
Mr. Partain. As far as the military's response to my
exposures at Camp Lejeune, I would say no. I was diagnosed with
male breast cancer in April 2007. My wife found the disease
when she gave me a hug before bed one night. Two months later,
I discovered that I had been exposed in the womb while at Camp
Lejeune. I had no knowledge of my exposures until then. It just
happened that my father was watching a newscast and saw a
hearing about Camp Lejeune and that is how I became aware of
this.
Chairman Akaka. Ms. Pennington?
Ms. Pennington. Actually, we were disappointed with the
doctors at Duke University for orally citing the reasons for my
brother's aggressive AML. When pushed, again, they admitted it
was definitely due to chemical exposure, but they could not
prove it and there was some pushback that they received from
the military there at Fort Bragg. I do not know the details to
that. They would not elicit any further.
I can tell you the Bumpus family, no, has not received any
assistance from the VA or military because Matt ended his
service 1 year after--or the disease came to light--1 year
after his service. So, the VA has harshly denied the connection
between the AML, his service in Iraq, and where he was
stationed in Balad.
So no, they are not receiving any benefits from the VA or
military and are completely dissatisfied.
Chairman Akaka. Thank you. Mrs. Paganelli?
Mrs. Paganelli. Thank you. I would say on behalf of Atsugi
residents, or past Atsugi residents, no, because I really
strongly believe there needs to be an accurate registry and so
many families are not informed. I just really would like there
to be a registry for these families and benefits for those who,
further down the line, need them; some acknowledgement for
that. Thank you.
Chairman Akaka. Thank you. Mr. Powell?
Mr. Powell. I think the Army did, or the Department of
Defense did kind of lack an acknowledgement that we were even
exposed later--about 5 years later--after we returned home. It
was kind of an eye opener I will tell you. I guess we go to the
VA and the VA has no idea what is going on with us, and they
still are kind of timid on what to say, whether it was exposure
or anything like that. They just are just trying to back away
from it.
So, we are all pretty disappointed. We are on a registry,
but the registry to us still does not say that you guys were
exposed; and a lot of the soldiers who tried to put in claims
for the chemical exposure got denied.
Chairman Akaka. Dr. Gibb, how well do you think the Army
understood the scientific literature associated with the
exposure at Qarmat Ali?
Mr. Gibb. I do not think they understood it very well at
all. Their statements by CHPPM that--well, they put a great
deal of emphasis on the blood tests and the blood tests at that
period of time were essentially worthless.
As to how much exposure they could have had, they could
have had fairly high exposure that might not have even have
shown up in the blood test. They made a statement in their
report that some people exposed to very high exposures for more
than 2 years had developed lung cancer, but that is not--I
think at the time in 2003, the leading study, and I hope to say
this with modesty, was my study on chromium--sodium dichromate
exposure. That would have told them that we had people exposed
for less than 2 years that developed lung cancer.
And also the statement about that most of the--98 percent
of the samples were within or below the limit of detection, yet
they could tell you that the exposure was between 5 and 8
micrograms per liter. I do not know how they could say that. I
mean, I do not know what that means.
I have shown that to other Ph.Ds and M.D.s; they cannot
understand it. I mean, if M.D.s and Ph.Ds cannot understand
what they are telling you in their fact sheet, how is the
soldier who is not trained to understand these supposed to
understand it?
So, I think that the information--I mean, I have put
together these kinds of fact sheets at the Environmental
Protection Agency and press releases and it is important not to
scare people unduly. But, it is also important to put the
correct information out there and I do not think they did that.
Chairman Akaka. Thank you, Dr. Gibb. I now turn to Senator
Burr, for his questions and we will follow that with Senator
Rockefeller.
Senator Burr. Thank you, Mr. Chairman. Dr. Feigley, your
subcommittee was asked, number 1, to review the adequacy of the
methods used to assess risk, the uncertainties identified, the
risks to susceptible subpopulations such as pregnant women,
young children, the scientific validity of the conclusions
drawn. Number 2, recommend, depending on the evaluation,
research to fill data gaps and options for mitigating the risk
associated with exposure to incinerator emissions.
Was the NRC subcommittee asked to review the final NEHC
report?
Mr. Feigley. No, not to my knowledge. I will have to pass
that off to some other folks back here from the NRC, but our
committee was not asked, let me put it that way.
Senator Burr. So, the subcommittee's recommendations--you
do not know whether any or all of the recommendations were
taken into account from the draft report to the final report?
Mr. Feigley. I do not.
Senator Burr. OK. Let me ask you, if you contracted with
the NRC--if you were not on the subcommittee and you were going
to contract with the NRC for that particular site, would you
have limited the NRC review to the scope that the subcommittee
was limited to?
Mr. Feigley. No, and in fact, I think we say in the report
that we thought that the Navy should have used the NRC to
review their plans for doing their sampling. We recommended
they do a comprehensive sampling at the base, a comprehensive
risk assessment. However, I think they should have asked us
to--us being NRC, not--I am not part of NRC, but I am just a
volunteer. But I think they should have asked NRC to actually
review their plans for doing the sampling because then I think
a lot of things that we had--the negative things that we said
about their report would have been said before they did the
study and they could have corrected them.
Senator Burr. Therefore, it is pretty difficult to believe
that you could go back and reconstruct without reviewing in
total the risks?
Mr. Feigley. There are some bright spots in what we saw
that we thought perhaps further analysis might have revealed,
especially some of the air quality modeling and the correlation
between air quality modeling and the measurements that they did
on the facility that could have revealed some things.
Senator Burr. Let me get into thresholds and then Dr. Gibb,
I am going to turn to you for your prior work--the 26 years at
EPA.
Mr. Gibb. Twenty-nine.
Senator Burr. Twenty-nine, excuse me. Thank you for that
service. An observation question. Is the threshold for risk at
EPA different than the threshold for risk at the NRC?
Mr. Gibb. I do not have an answer to that question. I mean,
there is----
Senator Burr. Let me ask it in a different fashion. If it
were different, would you find that to be a flaw? Shouldn't the
threshold for risk at both--which both assess the risk on a
human population and U.S. population--shouldn't that be the
same?
Mr. Gibb. That is a rather tricky question.
Senator Burr. Well let me ask it in a more specific way.
Should the NRC look at benzene differently than the EPA does?
Mr. Gibb. I think the answer to that is no; I do not think
they should look at it differently.
Senator Burr. OK, I just wanted to clarify that. Now, Dr.
Nuckols, before I ask you a question, I would like to ask the
Chairman, after the NRC issued its report on Camp Lejeune
earlier this year, other experts--including Camp Lejeune
Community Assistance Panel, a group of five scientists, and the
National Resource Defense Council--released documents
criticizing the report. I would ask unanimous consent to
include copies of those documents in the hearing record.
Chairman Akaka. The documents will be included.
[The information referred to can be found in the Appendix.]
Senator Burr. In one of those documents I just mentioned,
Dr. Nuckols, it was noted that the National Research Council's
Hazard Evaluation in the Camp Lejeune report, and I quote,
``did not take into account that benzene and vinyl chloride
were contaminants in drinking water at Hadnot Point or Tarawa
Terrace.''
I guess I would ask you, is that accurate and can you
explain benzene and vinyl chloride; what they are and what NRC
sees as their hazard?
Mr. Nuckols. First of all, hazard evaluation, in my mind,
has a very specific definition and there is a portion of the
report in which a hazard evaluation was conducted. Is that--I
just want to make sure that is what you are referring to?
Senator Burr. Eventually where I am going to get to is that
the basis of what the NRC subcommittee found, and I am reading
out of your testimony, it says, ``to evaluate the potential
health effects to exposed residents, the committee undertook
four kinds of reviews to determine what kinds of disease and
disorders have been found to result from exposure to TCE and
PCE, not to benzene or vinyl chloride.''
So, the obvious thing is, did you take into account when
you were assessing the risk to individuals exposed on the base
to the groundwater contamination to the two chemicals of
benzene and vinyl chloride?
Mr. Nuckols. In the hazard evaluation that was conducted by
a subset of the committee, which I think was in the toxicology
subgroup that I mentioned, I do not think that benzene or vinyl
chloride were considered.
In the overall report, the charge, in my understanding and
I think the majority of the committee, was the underlying words
``a causative relationship.'' The process that we took toward
that was--in my group, which is in my summary, I pointed out--
was to try to make a determination of the extent of chemical
contamination, where it was, what chemicals, and so forth.
In the initial work of the committee, a lot of focus was
made on PCE and TCE because they had been the principal
contaminants, the primary contaminants that were the focus of
the ATSDR study and their risk assessment.
Senator Burr. So, can I conclude from what you are saying
that you did not assess in the same manner benzene and vinyl
chloride as you did TCE and PCE?
Mr. Nuckols. It was not included in the hazard evaluation.
I am fairly certain of that. Where I was going with my response
was that in the exposure assessment group we came across more
information about benzene being--occurring--in the aquifer;
that there were samples there that would lead us to believe
that there was exposure.
Our job, if you want to think of that group, that subgroup,
was to provide chemicals to the toxicologists and the
epidemiologists for their evaluation and we did, I think,
include those, although they were not as rigorously examined as
PCE and TCE.
Senator Burr. Listen, I am in full agreement with you. The
limitations that were on the NRC are prescribed in what you
have been asked to look at and I think Dr. Feigley just
confirmed that in another study. So, can I conclude that review
of toxicology studies, epidemiological studies, and conduct of
a hazard evaluation did not take place for benzene and vinyl
chloride in the same fashion, if at all, as TCE and PCE?
Mr. Nuckols. The procedure that was used by the
epidemiologists and the toxicologists was to review published
studies of whether there was causation between these chemicals
and disease. They left it open pretty much to what was out
there in terms of what we knew about the relationship.
To my knowledge, both benzene and vinyl chloride were
considered in that way. They were not considered in the hazard
evaluation that is published in the report.
Senator Burr. I would only point this out that--I think
this is at the root of part of the misunderstanding, was it or
wasn't it? I would even think that if it was, it would be in
your testimony. It would be stated clearly in the report. But
you only referenced TCE an PCE and there are these two other
chemicals that I think Dr. Gibb would agree, are known
carcinogens that under any study of the adverse health effects
of contamination you could not exclude. And if you came to a
conclusion that they play no part, it would be a need of the
report to explain why because the EPA's own scientific
information says that there is a direct cause to benzene and
vinyl chloride contamination.
Mr. Nuckols. Can I respond to that, sir? First of all, I
think that if you end the report, we do specifically list
benzene and vinyl chloride as being----
Senator Burr. Present.
Mr. Nuckols [continued]. Contaminant--well not just
present, but contaminants of concern, chapter two. Read the
conclusions of chapter two, Contaminants of Concern, and there
is, in my mind, no place in the report that says these should
not be studied; that they are not an issue. It is not there.
There is, in fact, information about what studies are out
there on benzene and vinyl chloride in--I think it is in the
appendix to the study and that was because--and I agree, it was
late coming on board in the time period that we were working on
the report as to whether or not it was an issue of concern.
ATSDR in their first risk analysis said that benzene was not of
concern.
But I think one of the important things that is overlooked
in this report is that we have identified contamination and
chemicals that were previously maybe not looked upon as being
primary contaminants of concern at Camp Lejeune.
Senator Burr. The Chairman has shown me great latitude and
if the Chairman would allow me to ask one more question, I will
not have to go to a second round. Unless the Chairman intends
to go to a second round, I will wait.
Chairman Akaka. I Intend to do a second round.
Senator Burr. You--no, go ahead, Jay.
Chairman Akaka. Go ahead. Continue with your question,
Senator Burr.
Senator Burr. I did not want to neglect Mike, since he is
directly affected by Camp Lejeune. Mike, let me just ask you,
what actions would you like to see Congress, the Department of
Defense, and/or Veterans Affairs do with regard to the
exposures you are faced with and others have been faced with at
Camp Lejeune?
Mr. Partain. Before I answer that, may I interject
something on the previous conversation you were having with Dr.
Nuckols?
Senator Burr. Yes, sir.
Mr. Partain. Dr. Nuckols was referring to ATSDR's work--
that they had relied on ATSDR, he started to say, I believe,
regarding the public health assessment. One thing I would like
to point out concerning both ATSDR's public health assessment
and the work that the National Resource Council did with Camp
Lejeune, was that they had incorrect data concerning the
benzene and vinyl chloride.
More importantly, ATSDR, in their public health assessment,
did not address benzene and that was one of the reasons why
that document was basically withdrawn from public view in April
of this year. So, they did not evaluate benzene with the
correct data and that data was not given to the NRC. They, even
in their tables, have the incorrect levels for the--they omit
the July 1984 readings.
To answer your question, we would like to see a full
disclosure of what transpired at the base relating to the
drinking water contamination. To accomplish that would mean the
full cooperation of the Department of the Navy and the U.S.
Marine Corps by disclosing all documents, plus full funding of
all ATSDR's initiatives concerning the Camp Lejeune studies.
With the existence of documented exposure levels, any
person who is now or was suffering from the effects of their
exposures at Camp Lejeune, they should be giving medical care
or compensation for their past suffering and disabilities. And
for those who have lost loved ones, they should be afforded
restitution.
Senator Burr. Mr. Chairman, I want to again thank you for
what I think has been a very insightful panel. I want to thank
the witnesses for their very personal testimonies, the experts
that we have, for their insight and knowledge, and the Chair
for his indulgence. I apologize to Senator Rockefeller.
Chairman Akaka. Thank you, Senator Burr, for your
questions. Now let me call on Senator Rockefeller for his
questions.
STATEMENT OF HON. JOHN D. ROCKEFELLER IV,
U.S. SENATOR FROM WEST VIRGINIA
Senator Rockefeller. Thank you, Mr. Chairman. I will submit
my statement for the record and go directly to questions.
[The prepared statement of Senator Rockefeller follows:]
Prepared Statement of Honorable John D. (Jay) Rockefeller IV,
U.S. Senator from West Virginia
I want to thank the Committee for convening this important hearing.
We have a responsibility to make clear to the DOD just how important it
is to prevent exposures when possible, and to work with the VA to
immediately notify and provide care for our veterans if they have been
exposed--as soon as possible, not years after the fact.
I am very proud that a former Staff Sergeant and medic in the West
Virginia Army National Guard, Russell Powell, is here today, willing to
step up and talk about his personal experiences as hard as that may be.
The fact that his West Virginia National Guard Unit was deployed to
Basra to provide security for contractors at the Qarmat Ali water
treatment plant is part of the tough job our troops face.
The fact that they were not warned of or protected from exposure to
Sodium Dichromate--a dangerous chemical--is an enormously serious
problem.
The exposure was not public in West Virginia until this year when I
learned of the problem. I wrote both the Secretary of Defense and the
Secretary of the Department of Veterans Affairs for information and a
report on what was being done to help exposed veterans.
We have been here before. In 1993, as Chairman of the Senate
Committee on Veterans' Affairs, we investigated the possible causes of
what was then referred to as ``Gulf War Syndrome.''
I was deeply disturbed by senior Pentagon officials' dismissal of
serious health concerns then, and I am enormously worried today, that
we may continue to get that same approach from the Pentagon. Even after
it evaluated the site at Qarmat Ali, the Department of Defense failed
to notify exposed National Guard members on time.
This much is clear: DOD and its contractors have failed to meet
their responsibility to our men in uniform. They have failed to be
honest and forthright about the risks. And they have failed to do
everything within their ability to reach those exposed.
Qarmat Ali took place in 2003: we still do not have all the answers
and we still have not reached all of the guardsmen. Six years is simply
unacceptable.
While DOD couldn't find and notify many West Virginia guardsmen, my
staff worked with a number of executive branch agencies in
collaboration with Secretary Shinseki to try to forward critical
information to exposed West Virginia Guard members they had on file.
But it should not require a U.S. Senator and his dogged staff to
get this information to the men and women who need it so urgently.
However, VA testimony suggests that the Department is taking the
Qarmat Ali exposure seriously and working to revise the testing in the
VA registry and considering how it will handle claims for benefits and
care. (See October 8, 2009, letter and Attachment from Secretary
Shinseki that follows.) This is promising, and my staff and I will
monitor each effort carefully to be sure the Russell Powells and their
colleagues get the care and support suggested and earned.
This has been a cornerstone of who I am as a person and as a
legislator throughout my career and I will never stop the fight for our
men and women who serve.
With so much at stake, we must share the truth as soon as possible.
Only then can we continue to track and learn about the illness to
provide our veterans the care they have earned and deserve, the best
care possible.
______
Attachments
Senator Rockefeller. I want to focus on you two, but I want
to do it in a different fashion. Senator Burr's questions were
so good because they were so specific--related to different
toxins and the effect and what was included in this study and
that study.
What fascinates me but angers me so much is that as I
said--and you will remember this, Russell, from our August
hearing--is there is such a direct comparison between this and
the Gulf War Syndrome: the denial on the part of the military,
their refusal to not only respond to soldiers whose lives are
being shredded, could not sleep, could not keep marriages,
could not get jobs, could not read newspapers because they were
being told to take a pill which had never been cleared by the
FDA for animal use much less for human use to protect them from
what they thought Saddam Hussein was going to do. And it turned
out actually that it was the wrong pill anyway. It was for the
chemical he did not have.
But that is another matter. But the refusal--I want to get
into the military culture. I know the military is in the next
panel. I am not going to be here on the next panel. But you are
a medic, Russell, and you are a good one. You have been through
this, you come, you testify, and you tell us what you are going
through; and you have seen the letter from Eric Shinseki that
he sent this morning.
Mr. Powell. Correct.
Senator Rockefeller. Which has some promise to it. He says
he is going to give full pulmonary tests, and in West Virginia
we have discovered all of those people who were not on the
registry or were not yet found. In Indiana, I am not sure they
have. They have a lot more of them, but I am not sure they have
discovered all of those.
But when you got into that situation with the orange dust
and being a medic with some stature, you went over to that
place to lie down and try and give yourself an I.V. and all the
rest of the story, it says something about a soldier's--well,
first of all, it says something about the military's inability
to deal with something that might either be embarrassing for
them or for which they cannot explain, perhaps because they are
busy fighting wars, which is a rather large task.
On the other hand, there are people who are doctors and who
have medical responsibilities in the military who are not
fighting wars; they are taking care of soldiers. There is
something which prevents--and I have heard this in other
sessions about other types of problems--soldiers taking on the
military even as they suffer.
I want to talk about that for a moment. From your point of
view--first of all, I understand the chain of command. I
understand that from my point of view this is kind of
redundant. You went through this in 2003?
Mr. Powell. Correct.
Senator Rockefeller. And nobody discovered what you had
until 2009. What is the culture problem we are dealing with
here?
Mr. Powell. I do not think the Army knew fully--was fully
aware of the chemicals being on the ground through KBR not
actually providing them with that information. But the Army
could have told us a little bit sooner whenever they did find
out, in August 2003, but they did not. They did not tell any of
the soldiers. There is a soldier that I talked to who is a
government employee who just found out recently that he was one
of the guys exposed to chemicals. He is a government employee
and they were saying they could not find this gentleman. This
is the Department of the Army saying they cannot find him.
Well, one of the high-ranking officers from West Virginia
was on an aircraft with him, this was a month or two ago, and
still that individual--because I cannot really tell you what he
does for the government, but he was talking to one of our
generals. He told the general that he was in the 1092nd Charlie
Company and the general did not say well maybe you might want
to look at this or look at that. He was just dumbfounded until
we linked up with that individual through e-mails while trying
to find all of our soldiers.
Because we are trying to do our best to find out where our
people went and give them the heads up on their actual medical
problems, assuming a lot of them are having medical problems
and just didn't know why. When you go to the VA or anything
like that, it is so horrible because you say you are a medic, a
flight medic, they kind of look down on you in a sense because
they say well, you already know everything Mr. Know-it-all.
That is how most of the physicians act.
We are not even trying to do that. We are saying hey, this
is what is wrong with me. I am pretty sick. I am not faking the
funk with you. I was doing medicine for a lot of years. I am
not trying to get over on you.
It is real frustrating because they are just kind of
brushing us off.
Now there are a few doctors that are really concerned and
are actually trying to figure out the problems relating to
those chemicals, but most of them at the VA just kind of brush
me off. It is really a hard obstacle to get through.
Senator Rockefeller. Dr. Gibb, do you have any thoughts
about that? Why is it that people, strong men like Russell,
cannot--they look down at a medic--some doctors are good, some
doctors are bad or whatever?
I mean, for heaven's sakes, they knew they were going to
send you to this camp, to Qarmat Ali, and therefore, they had
to have been there. Therefore, the fact of there being some
orange dust must not have escaped them unless they were color
blind. So, I do not understand that.
There is a lack of thoroughness or a lack of concern, a
lack of care. I mean, if you saw the orange dust, knowing what
you now know and knowing what the world now knows 6 years
later, it is not very complicated to me. They were entering
into a risky environment and chose not to know about it, not to
warn about it, not to take steps to clean it up or to do
whatever.
Now Dr. Gibb, do you have any thoughts on that?
Mr. Gibb. I think they had a significant exposure there. I
mean, some of the soldiers described it looking like orange
powered donuts and it was all over the ground. Statements of
the soldiers at the previous hearing indicated that it was
everywhere.
I think that--and the bags read sodium dichromate. It was
not like guessing. So, they should have known and it should
have been reported. Again, I do not think there was a good
understanding of what sodium dichromate was or what its effects
were. So, I think there was a significant exposure that should
have been addressed immediately, as soon as they learned what
it was.
I think that there was just--I feel like it was dealt with
irresponsibly. I cannot think of a better word.
Senator Rockefeller. Let me be a little tougher about it
then. Doesn't the military have a responsibility, particularly
when you are not in a huge situation which varies a lot like
the second world war or the first world war, you know, like
those, instead you have a particular type of territory where
there are certain factors which are common for all of that
territory--Basra, I guess, was where you were--and then there
is this orange dust. I do not understand that.
I do not understand why, if there are doctors who are in
charge of the health, are they not in the deployment decision
process in any way? Are they left out until somebody does get
sick? Is there anybody here who can answer that question?
Mr. Gibb. Again, I think that the knowledge of industrial
hygiene is critical. I mean, you could recommend pre-deployment
physicals and post-deployment physicals and all those kinds of
things, but if you do not understand what substances you are
dealing with, those kinds of physicals are not going to get the
kind of information that you need.
So, I think this was a lack of understanding of the
industrial hygiene, the environmental health, and then the
follow-up to that was, it was just sort of like do not worry
about it, it is OK. That, to me, is just--I do not want to say
unconscionable, but I think it is--this is a very serious
substance. This is a very potent carcinogen. This is a very
irritating substance. You do not have to look very far to find
information about the effects of sodium dichromate.
It is not some arcane chemical that we do not know about.
We have known about the carcinogenicity of sodium dichromate
since the early 1950s when the Public Health Service did a
study of all the chromium production plants in the United
States and reported huge lung cancer risks from the substance
and the irritation of it. So, it has been known for a long
period of time.
I think, first, not having the knowledge to say well, we
have soldiers in the facility and they are using this
particular chemical, it is called sodium dichromate. What is
sodium dichromate? Then you have to take steps to address that.
I mean, this particular situation with the thousands of bags
was that of 100-pound bags broken out, open and the dust
blowing all over the place and everybody reporting orange dust.
That should have been cause to say, this is a serious
situation; we need to do something right now.
And then to follow up to say, well, sodium dichromate is
not that bad. You have to be exposed for high concentrations
for about 2 years to get lung cancer. Do not worry too much
about it, the blood tests do not show anything. The blood tests
essentially were worthless at that point.
Blood tests might have even been worthless when they were
being exposed because it takes a fair amount--it takes a large
amount of hexavalent chromium to show concentrations in the
blood. So, I think that the follow-up, the organization going
into it, was inadequate. The follow-up was inappropriate. I
mean, the soldiers deserve better than that.
I think I would say what happened was a disservice to the
soldiers. Disservice is putting it mildly. It was wrong.
Senator Rockefeller. It is shocking. It is just shocking. I
have said before, maybe the last time, the very first Veterans'
Committee meeting I ever attended 25 years ago, there was a
soldier who had been sent into that part of the Pacific where
they were testing the atomic bomb. He described what it was to
be dying having served your Nation, having followed orders way
back then, when things were I guess a lot more primitive, but
maybe not. He said it is just an amazing feeling to have your
government say to you, well you cannot prove that your cancer
was caused by your being in at that time, when we all know--and
if you are a West Virginian like Russell Powell, you know if
you have been in a coal mine for 10 years you have Black Lung;
you just have it. You do not need proof of it, you have it.
There is a presumption of it.
But we make the soldier prove everything, and then along
comes Agent Orange. I was at that hearing when Admiral
Zumwalt--nobody was paying any attention to Agent Orange.
People were dying all over the place of the same thing, cancer.
But when Admiral Zumwalt came up there and testified and said
that his son had died or was in the process of dying from
cancer, oh, then everybody got really alert and we started
making good, so to speak, on people who had Agent Orange
exposure.
That is the wrong way to do things. The military is meant
to know that stuff. And then we had the Gulf War Syndrome,
which the military took I think something like 17 years to
admit that they were wrong. We did a lot of studies and a lot
of investigation on that when I was sitting in Dan Akaka's
seat. But they did not pay any attention.
That same infuriating indifference to soldiers, meaning
assuming that soldiers would be making excuses as opposed to
soldiers having real medical problems that they had not taken
the time to disclose because the order of battle may be
presumed to be more important. But on the other hand, these are
doctors and they are ignoring the symptoms. They are writing us
letters saying, take an aspirin and go home, or you have a
virus, go home, sleep, get some good sleep. It makes me mad.
What scares me is that I do not know that the culture has
changed. Now I get this letter from Shinseki, which you have
seen, Mr. Powell, and I think you and I both think it is pretty
good--that involved Guard members who have had an initial
examination will be recalled and will have a complete exposure
assessment as well as a more targeted physical examination and
ancillary testing looking for indications of health outcomes
that may be relevant to hexavalent chromium.
Those who have yet to enroll in the Gulf War Registry--I
like that part--will get this targeted examination, initially.
They will also receive a chest radiograph and pulmonary
function testing and that will be repeated every year and then
every 5 years.
So, I think the Veterans Administration--you know, I am a
fan of Shinseki. I have no problems saying that. But he is on
the receiving end of this. The doing in was with the military
and I do not get why they do not learn. Maybe I am wrong, but
until somebody shows me I am wrong, I am just mad.
Please.
Ms. Pennington. Senator Rockefeller, I would just like to
add what I neglected to mention when Chairman Akaka asked me if
we were satisfied with what the military and the VA did with
Sergeant Bumpus and my brother, Staff Sergeant Ochs. I need to
tell you that my brother, upon return from his third tour in
Iraq in the end of April 2007, suffered from flu-like symptoms
almost immediately.
He went to Womack Hospital at Fort Bragg, NC, three times.
The doctors did exactly what you just said. They said you have
some type of virus. They sent him home with 800 milligrams
Ibuprofen. So, it was not until September 2007 when he had to
get special permission to be seen by a private hospital where
the private hospital actually discovered that my brother had
AML.
I would also like to add that Sergeant Bumpus had a private
doctor, Dr. Tim Grennan, do a chromosome analysis on the
initial blood drawn before Matt underwent chemotherapy. He
discovered chromosome mutations that would only happen if he
was exposed to chemicals and this was something that you would
see only after one receives chemotherapy.
So, I just wanted to go on record and let you all know
that. Thank you.
Senator Rockefeller. Well, Mr. Chairman, I have over--well,
the timer has just gone flat to 0.00, so I guess I am in real
trouble. But those of us in Congress get military health care
and we go down a few flights from here to get it. There are a
lot of doctors and Bethesda Naval Hospital available to us for
whatever.
It would be sort of nice and sort of important if your
family and friends seeing your situation all felt like you
could get the same thing. I have no reason to think there is
anything that we are doing here more important than what your
loved ones were doing and what you were doing in terms of the
welfare of the Nation. Dr. Miller, please.
Dr. Miller. You know, I think when a soldier finds himself
in a combat situation, there are a lot of unknowns and some
things you cannot anticipate. But in the group that I have
taken care of, there was a clear danger after it was identified
and I thought that there was dissemination of inaccurate
information to downplay what happened.
For example, there was a memo sent out to the soldiers
exposed in the 101st Airborne that said sulfur dioxide is not a
problem. It has no known serious side effects and it is not a
carcinogen. They had measurements that the levels were toxic,
well above the military's baseline of 13 parts per million, and
they found them as high as 120 parts per million.
Then there was a second report out from the 62nd Medical
Brigade Preventative Medical staff that said that you would
only have problems if you were exposed to 400 to 500 parts per
million, which would do us all in. I think that there are
things that you cannot anticipate, but when you do identify
them, you have to make sure that the disseminated information
is accurate.
Senator Rockefeller. OK, well I have gone way over my time,
but I guess this letter, I do not know if it is available. I
mean, it came in today. Ordinarily, I would be cynical and say
well that is good timing, but I am not in this case because it
is from General Shinseki and I think he is trying to do the
right thing.
There has always been a lack of coordination between the
Department of Defense and the VA. One does everything on paper
and the other does everything on IT medical records. It is a
terrific health care system. I do not know how they coordinate.
I do not know what has changed.
Americans by nature react to episodes and then we sort of
forget them. It is like--a little bit like when we go to war.
We go to war, we win it, we tie, we lose it, or whatever; then
we come home and sort of let everything military deteriorate. I
just think in the case of the care of veterans, it would be
nice if we had more activity on the front end rather than
waiting to have the VA try to clean up what the military failed
to do, and that is just my point of view.
I thank the Chair and I thank all of you, a lot.
Mr. Partain. Mr. Chairman, if I may.
Chairman Akaka. Mr. Partain?
Mr. Partain. When Senator Rockefeller was discussing the
orange dust in Iraq at the facility out there and heard about
the Atsugi Air Station in Japan, it befuddles the mind. It is
almost like common sense: there is orange dust; someone should
look into it. I know in our case at Camp Lejeune, our issue was
solvents in our drinking water and in our research through the
documents we came across an order, a Marine Corps order from
the commanding general of the base, which identified organic
solvents as a hazardous material and further stated that
improper practices and disposal practices create hazards such
as contamination of drinking water.
From the very beginning, from the first public announcement
in 1984, to the residents and personnel aboard Camp Lejeune,
the Marine Corps has maintained that they were in violation of
Federal and State regulations. What they have failed to tell
the public and everybody was that they were in violation of
their own orders.
This order I am referring to dates back to 1974 and it is
the third order in a series. We have not found the other two.
They have not been produced, but we suspect they may go back to
the early 1960s. It just almost seems like common sense.
Organic solvents, they are listed in there as something that is
hazardous, and then if you dispose of them improperly, they are
going to end up being in the drinking water.
Well that is exactly what happened at Camp Lejeune. Where
is the common sense? Thank you.
Chairman Akaka. Thank you very much. I want to thank the
witnesses in the first panel for sharing your personal
experiences with us today. Again, this will be helpful to the
Committee and we look forward to dealing with these problems
that have been mentioned.
Thank you very much, again, and I will call up the second
panel.
[Pause.]
Chairman Akaka. This hearing will be in order. I want to
welcome our principal witness from VA, Dr. Michael Peterson,
who is the Chief Consultant on Environmental Health for the
Strategic Health Care Group at the Veterans Health
Administration. He is accompanied by Dr. Stephen C. Hunt, the
National Director for the Post-Deployment Integrated Care
Initiative at VHA, and Bradley G. Mayes, the Director of the
Compensation and Pension Service at the Veterans Benefits
Administration.
The next witness on the panel is Dr. Craig Postlewaite,
Acting Director, Force Health Protection and Readiness Programs
and Director, Force Readiness and Health Assurance at the
Department of Defense. Next we have Dr. Paul Gillooly, who is
the Public Health Assessor at Navy Marine Public Health Center.
We also have Maj. Gen. Eugene Payne, Jr., the Assistant
Deputy Commandant for Installations and Logistics for
Facilities with the Marine Corps. Our final witness on the
second panel is John Resta, Scientific Advisor, U.S. Army
Center for Health Promotion and Preventative Medicine.
I thank you all for being here this morning. Your full
testimony will of course appear in the record. Mr. Peterson,
will you please begin with your testimony?
STATEMENT OF MICHAEL PETERSON, DVM, M.P.H., DRPH, CHIEF
CONSULTANT, ENVIRONMENTAL HEALTH, STRATEGIC HEALTHCARE GROUP,
OFFICE OF PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS, VETERANS
HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Dr. Peterson. Good morning, Mr. Chairman, Ranking Member
and Committee Members. Thank you for this opportunity to
discuss what VA is doing to support veterans with environmental
exposures that occurred during military service. As you
indicated, I am accompanied by Dr. Hunt and Mr. Mayes this
morning.
VA recognizes that servicemembers sometimes face exposures
to toxicants or materials in the course of their military
service that can have deleterious health effects. We have
developed a robust program within the Office of Public Health
and Environmental Hazards to address this need by: identifying
potential sources of exposure in at-risk veterans; informing
veterans and health care providers; and offering treatment and
care for service-connected conditions.
My written testimony provides background information about
initiatives within VA to address these concerns, explains how
VA works with DOD to identify and respond to environmental
hazards and describes the four specific exposures cited earlier
and actions taken by VA in response.
I would like to spend the few minutes I have addressing how
VA and DOD collaborate on not just these exposures, but any
possible environmental hazard and how we help veterans receive
the health care and benefits they deserve. One of the many
lessons that VA has learned from experiences with Agent Orange
and Gulf War veterans illnesses is that information regarding
possible exposures to environmental agents and other toxicants
both within the combat theatre and other areas in which our
troops operate must be received and acted upon by VA as early
as possible.
Up-to-date information on these situations is invaluable to
VA's ability to identify veterans who may have been affected by
an exposure, evaluate their individual risk of exposure, and
for sequelae provide appropriate medial surveillance and
mitigate untoward health effects that are known to be caused by
these toxicants.
In addition, where the possible outcomes are not known, it
is important to perform epidemiological studies on exposed
troops. This will better provide information than performing
retrospective studies once it is determined that adverse health
outcomes are being ascribed to a potential exposure.
To this end, the joint DOD/VA Deployment Health Working
Group was established. This working group reports to the Joint
Executive Council through the Health Executive Council. The
objective of this group is to identify and foster opportunities
for sharing information and resources between VA and DOD in the
areas of deployment health surveillance, assessment, follow-up
care, health risk communication and research and development.
Each year this working group discusses deployment-related
concerns and develops strategies by which to address them. The
Deployment Health Work Group meets monthly to discuss a wide-
ranging array of exposure issues, including those dating to the
World War II era. The Deployment Health Work Group also
actively seeks to discuss and recommend coordinated action to
identify involved servicemembers, establish a determination of
risks for this population and develop methods of outreach, risk
communication, and where necessary, medical surveillance and
appropriate health care for veterans with any condition that
may have resulted from these exposures.
Mr. Chairman, VA understands these issues are very
important to you, all the Members of this Committee, and to
veterans and their families. I can assure you VA is equally
concerned and committed to working with DOD and other agencies
to identify potential hazards, inform veterans of any risks to
their health, develop appropriate responses, and deliver needed
care and benefits to veterans and their families. Only through
such cooperation will VA be prepared to deliver the proper
health care and disability compensation benefits to those
entitled.
Before I conclude, I would like to tell you about a new
study currently underway that VA is conducting to help assess
and identify the environmental exposure risks faced by this
latest generation of veterans. VA's National Health Study for a
New Generation of U.S. veterans begins with 30,000 veterans
deployed to OEF/OIF and 30,000 comparison veterans who were not
deployed.
This study includes veterans who served in each branch of
service representing active duty, National Guard and Reserve
members. Women are being over sampled to make sure they are
represented and comprise 20 percent of the study. The study
compares the deployed and non-deployed veterans in terms of
chronic medical conditions, TBI, PTSD, and other psychological
conditions, general health perceptions, reproductive health,
pregnancy outcomes, functional status, use of health care,
behavioral risk factors and VA disability compensation.
This research will help us identify what conditions are
disproportionally found within the deployed population, which
can help us then provide an evidence base for health care
treatment and possibly serve as presumption for benefits.
Thank you again for the opportunity to testify. My
colleagues and I are prepared to address any questions you or
the Committee Members might have.
[The prepared statement of Dr. Peterson follows:]
Prepared Statement of Michael R. Peterson, DVM, MPH, DRPH, Chief
Consultant, Environmental Health, Strategic Healthcare Group, Office of
Public Health and Environmental Hazards, Veterans Health
Administration, U.S. Department of Veterans Affairs
Good morning, Mr. Chairman, Ranking Member and committee members.
Thank you for this opportunity to discuss the work of the Department of
Veterans Affairs (VA) in responding to certain exposures that occurred
during military service, including respiratory exposures from an
incinerator near the Naval Air Facility Atsugi, water contamination at
Camp Lejeune, sodium dichromate at the Qarmat Ali Water Treatment
Plant, and exposures to burn pits during the current conflicts. I am
accompanied today by Dr. Stephen Hunt, National Director, Post-
Deployment Integrated Care Initiative, VA Puget Sound Health Care
System, and Mr. Bradley Mayes, Director of Compensation and Pension
Service, Veterans Benefits Administration.
VA recognizes that servicemembers sometimes face exposure to
toxicants or materials in the course of their military service that can
have deleterious health effects. We have developed a robust program
within the Office of Public Health and Environmental Hazards to address
this need by identifying potential sources of exposure and at-risk
Veterans, informing Veterans and health care providers, and offering
treatment and care for service-connected conditions. My testimony will
provide background information about initiatives within VA to address
these concerns, explain how VA works with the Department of Defense
(DOD) to identify and respond to environmental hazards, and describe
the four specific exposures cited earlier and actions taken by VA in
response.
va programs specifically targeting exposure-related disease
VA is very concerned about environmental health concerns of
Veterans and offers a range of programs including health registries,
special training for staff, and education materials including web-based
information, fact sheets, and brochures. VA actively monitors and
provides support to Veterans and their health care providers concerning
a range of potential environmental exposures and outcomes, including
Agent Orange, Gulf War Veterans' Illnesses, radiation, toxic embedded
fragments including depleted uranium, thermal injuries, mustard gas,
noise, vibration, and other physical exposures. More information about
these programs specifically tailored to Veterans and health care
providers can be found online at: http://www.publichealth.va.gov/
exposures/. VA notifies Veterans about these exposures through many
different avenues. First, every VA medical center is required to have
an environmental health clinician on staff. This person serves as a
local resource for Veterans and clinical providers. In addition, the
Transition Assistance Advisors (who work for the National Guard and
receive training from VA) and Post-Deployment Integrated Care Clinics
provide VA-wide expertise in a range of exposures and health outcomes
commonly seen in returning Veterans. VA regularly provides letters,
newsletters, brochures and other information to Veterans while
maintaining registries specifically designed to track and inform
Veterans with materials related to their unique health care needs.
VA trains its providers to prepare to respond to the specific
health care needs of all Veterans, which in turn helps providers inform
Veterans of these risks. This training includes specific Clinical
Practice Guidelines on post-combat deployment health and other issues.
VA operates three War Related Illness and Injury Study Centers
(WRIISCs) that provide specialized health care for combat Veterans from
all deployments who experience difficult-to-diagnose or undiagnosed but
disabling illnesses. Starting in 2002, the WRIISCs began serving as
referral centers for Veterans with undiagnosed or difficult-to-diagnose
complaints. Veterans referred to the WRIISCs are provided with a
complete exposure assessment, outpatient or inpatient evaluation
(including advanced neurological evaluations), and a detailed treatment
plan, which is provided to the Veterans' VA primary care providers.
Based on lessons learned from the Gulf War, VA realizes that concerns
about unexplained illnesses could also emerge after other deployments,
and we are building our understanding of such illnesses. Furthermore,
as we recognize that many unexplained illnesses or symptoms may be
related to exposure to toxicants during deployment, the WRIISCs now
provide extensive exposure assessments to patients referred to them.
Following the Gulf War, VA developed the Veterans Health Initiative
(VHI) Independent Study Guides (ISG) for health care providers as one
of many options to provide tailored care and support of Veterans. These
study guides were principally designed for the clinical care of
Veterans of the Gulf War era, but have proven highly relevant for
treating Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)
Veterans, since many of the hazardous deployment-related exposures are
likely to be the same. VA developed ISGs for health care providers to
deliver appropriate care to Veterans returning from Iraq and
Afghanistan that cover topics such as gender and health care,
infectious diseases of Southwest Asia, military sexual trauma, and
health effects from chemical, biological and radiological weapons.
Study Guides on Post Traumatic Stress Disorder (PTSD) and Traumatic
Brain Injury (TBI) were also developed and made available for primary
care physicians to increase understanding and awareness of these
conditions. VHI ISGs are currently undergoing a comprehensive update to
make them more relevant to busy providers and to modularize the content
so that it is more accessible. The Office of Public Health and
Environmental Hazards and the Employee Education System are working
together on this project. VA recently brought on board an American
Association for the Advancement of Science fellow with advanced degrees
in post-secondary education and computer technology to spearhead this
effort.
VA has also initiated a large, long-term study to look carefully at
a broad array of health issues that may affect OEF/OIF Veterans and
their counterparts who served during the same time period. VA's
``National Health Study for a New Generation of U.S. Veterans'' will
begin with 30,000 Veterans deployed to OEF/OIF and 30,000 comparison
Veterans who were not deployed.
The study includes Veterans who served in each branch of service,
representing active duty, Reserve, and National Guard members. Women
are being over-sampled to make sure they are represented and comprise
20 percent of the study, or 12,000 women. A combination of mail
surveys, online surveys, telephone interviews, and in-person physical
evaluations are used to collect data from Veterans.
The study compares the deployed and non-deployed Veterans in terms
of chronic medical conditions, Traumatic Brain Injury (TBI), Post
Traumatic Stress Disorder (PTSD) and other psychological conditions,
general health perceptions, reproductive health, pregnancy outcomes,
functional status, use of health care, behavioral risk factors and VA
disability compensation. VA has contracted with an independent Veteran-
owned research firm to collect the data.
Interaction and Information Exchange with DOD
One of the many lessons that VA has learned from experiences with
Agent Orange and Gulf War Veterans' Illnesses is that information
regarding possible exposures to environmental agents and other
toxicants, both within the combat theater and other areas in which our
troops operate, must be received and acted upon by VA as early as
possible. Up-to-date information on these situations is invaluable to
VA's ability to identify Veterans who may have been affected by an
exposure, evaluate their individual risk of exposure and for sequelae,
provide appropriate medical surveillance, and mitigate untoward health
effects that are known to be caused by these toxicants. In addition,
where the possible health outcomes are not known, it is important to
perform prospective epidemiological studies on exposed troops. This
will provide better information than performing retrospective studies
once it is determined that adverse health outcomes are being ascribed
to a potential exposure.
To this end, the Joint DOD/VA Deployment Health Working Group
(DHWG) was established. This working group reports to the Joint
Executive Council through the Health Executive Council (HEC). The
objective of this group is to identify and foster opportunities for
sharing information and resources between VA and DOD in the areas of
deployment health surveillance, assessment, follow-up care, health risk
communication, and research and development. Each year this working
group discusses deployment-related concerns and develops strategies by
which to address them. The DHWG meets monthly to discuss a wide-ranging
array of exposure issues, including those dating to the World War II
era. The DHWG also actively seeks to discuss and recommend coordinated
action to identify involved servicemembers, establish a determination
of risk for this population, and develop methods of outreach, risk
communication and, where necessary, medical surveillance and
appropriate health care for Veterans with any condition that may have
resulted from these exposures.
Now I will discuss in greater detail the four exposures about which
the Committee asked for specific information.
Incinerator at Naval Air Facility Atsugi
Naval Air Facility Atsugi, Japan is located about 25 miles from
Tokyo at the site of a Japanese Air Force base which the U.S. took
control of in 1945. In 1985, a private waste incinerator, Shinkampo
Incinerator Complex (SIC), began operations immediately southeast of
the community areas of the base. The incinerator burned a variety of
liquid and solid industrial waste, municipal solid waste, and
construction debris. The incinerator released a plume of smoke, ash,
particulate material, and fumes at ground level over the community area
of the base. Complaints by residents regarding air quality led to
multiple health risk assessments between 1988 and 1999. These
assessments demonstrated health risks related to the incinerator plume
which resulted in efforts by representatives of the U.S. Government to
close the incinerator. This was accomplished in 2001. It is estimated
that over the 15 years of operation, 18,000 adults and 8,000 children
could have been exposed, with a typical exposure duration of 3 years.
The non-cancer health effects of primary concern are impairment of
respiratory function from exposure to inhaled respiratory toxicants
particularly among the resident children at the base. Permanent
reduction in respiratory function can occur after several years of
exposure to respiratory toxicants especially if exposure occurred
before age 16. The final health risk assessment completed in 2002 by
DOD noted an increased risk of cancer, above the U.S. background rate,
among residents of Naval Air Facility Atsugi during incinerator
operations.
In 2007, Battelle Corporation was asked by the Department of the
Navy to conduct a review of the various health risk assessments and
recommend what, if any, population-based medical surveillance of
residents of Naval Air Facility Atsugi might be warranted, as well as
the parameters and expected outcomes from such screenings. Battelle
published its report in June 2008. The only recommendation from that
report was that a health registry be established for residents of Naval
Air Facility Atsugi. All medical surveillance recommendations were
limited to the juvenile population at the base.
Because all of the recommendations in this detailed report address
medical surveillance of a population not within VA's statutory
authority, VA has not requested information regarding this cohort. Any
Veteran who served at the Naval Air Facility Atsugi who may develop
either a respiratory condition or cancer that competent medical
authority ascribes to exposure at Naval Air Facility Atsugi would be
eligible to submit a claim for direct service connection for the
condition, provided they meet other eligibility criteria for benefits.
VA will inform regional offices of the Naval Air Facility Atsugi
situation and alert them to the possibility of disability claims from
Veterans who were stationed there. All such claims will be evaluated on
a case-by-case basis with evidentiary weight given to medical
examinations and opinions from both private and VA physicians. In all
cases, the benefit of doubt will be provided to the Veteran. VA's
assessment of issues related to Naval Air Facility Atsugi continues to
be coordinated through HEC and the Office of Public Health and
Environmental Hazards and we continue to monitor study outcomes that
could inform future policy decisions.
Water Contamination at Camp Lejeune
From the 1950s through the mid-1980s, some persons residing or
working at the U.S. Marine Corps Base Camp Lejeune were exposed to
drinking water contaminated with volatile organic compounds. Two of the
eight water treatment facilities supplying water to the base were
contaminated with either tricholoroethylene (TCE) or
tetrachloroethylene (perchloroethylene, or PCE). The Department of
Health and Human Services' Agency for Toxic Substances and Disease
Registry (ASTDR) estimated that PCE drinking water levels exceeded
current standards from 1957 to 1987 and represented a potential public
health hazard. The heavily contaminated wells were shut down in
February 1985, but it is estimated that more than one million
individuals may have been exposed.
An ATSDR study begun in 2005 is evaluating whether children of
mothers who were exposed while pregnant to contaminated drinking water
at Camp Lejeune are at an increased risk of spina bifida, anecephaly,
cleft lip or cleft palate, and childhood leukemia or non-Hodgkin's
lymphoma. The results of this report have not yet been released. In the
same year, a panel of independent scientists convened by ATSDR
recommended the agency identify cohorts of individuals with potential
exposure, including adults who lived or worked on the base and children
who lived on the base (including those that may have been exposed while
in utero), and conduct a feasibility assessment to address the issues
involved in planning future studies at the base.
In October 2008, the Department of the Navy issued a letter to
Veterans who were stationed at Camp Lejeune while in military service
between 1957 and 1987. This letter informed Veterans that the Navy had
established a health registry
and encouraged them to participate. Veterans who received the letter
from the Navy may visit the following Web sites for the most current
updates about Department o f N a v y a c t i o n s: h t t p : / /
w w w . a t s d r . c d c . g o v / s i t e s / l e j e u n e /
i n d e x . h t m l o r www.marines.mil/clsurvey/index.html. Veterans
may also call the Department of Navy toll-free at (877) 261-9782.
VA is providing Veterans with information about this issue and
offering contact information and referrals to the Navy registry. In
December 2008, VA issued a VA Health Care Fact Sheet on the
contamination of the ground water at Camp Lejeune. On June 13, 2009,
the National Research Council of the National Academies' Committee on
Contaminated Drinking Water at Camp Lejeune released a report that
indicated further research will unlikely provide definitive information
on whether exposure resulted in adverse health effects. However, the
report did find 14 conditions with limited or suggestive evidence of an
association with exposure to PCE, TCE, or solvent mixtures. VA is
convening a work group to evaluate the National Research Council's
report and any other relevant scientific studies. This will contribute
significantly to further policy decisions.
VA does not operate a registry for this population and does not
have special authority to enroll Veterans or their family members based
upon this exposure. Veterans who are a part of this cohort may apply
for enrollment if they are otherwise eligible, and are encouraged to
discuss any specific concerns they have about this issue with their
health care provider. Veterans are also encouraged to file a claim for
VA disability compensation for any injury or illness they believe is
related to their military service. VA environmental health clinicians
can provide these Veterans with information regarding the potential
health effects of exposure to volatile organic compounds and VA's
WRIISCs are also available as a resource to providers.
VA takes the Camp Lejeune matter very seriously and has informed
all regional offices of the situation. Disability claims based on
contaminated drinking water exposure at Camp Lejeune will be evaluated
on a case-by-case basis with evidentiary weight given to medical
examinations and opinions from both private and VA physicians. In all
cases, the benefit of doubt will be provided to the Veteran.
Sodium Dichromate at Qarmat Ali Water Treatment Plant
VA has been extremely proactive in its response to this exposure
event. As you are aware, there are approximately 600 National Guard
troops, primarily from four states (Oregon, South Carolina, West
Virginia and Indiana), who may have been exposed to sodium dichromate
(a source of hexavalent chromium) while serving at Qarmat Ali outside
Basrah, Iraq.
VA is obtaining the names and contact information of National Guard
troops present at Qarmat Ali. We are also verifying the numbers of
these Veterans who have either enrolled in care or received a Gulf War
registry exam. We have already augmented the Gulf War Registry (GWR) to
reflect service at Qarmat Ali. The involved Guard Members who have had
an initial exam will be recalled to have a complete exposure assessment
as well as a more targeted physical exam and ancillary testing to
detect indications of health outcomes that may be related to hexavalent
chromium. Those who have yet to enroll in the GWR will receive this
targeted examination initially. They will also receive a chest
radiograph and pulmonary function testing. This evaluation will be
repeated periodically (every year for an exam and every 5 years for a
chest radiograph). All of this testing can be done within the GWR's
existing authority.
Once we have made all the these modifications to the GWR, and have
established the appropriate process for the involved VA medical
centers, VA will send letters to each servicemember explaining the new
process and details regarding how to receive an examination. Because
this group of Veterans is relatively small and already identified, and
because the health risks of exposure to hexavalent chromium are well
established, VA believes this is the best cohort to develop its new
program of targeted medical surveillance. VA hopes that experience with
this program can be a model for other medical surveillance programs for
returning Veterans who may have been exposed to environmental
toxicants.
VA has begun analyzing the available list of identifiable
servicemembers to determine who has filed claims for disability
benefits for any condition potentially related to toxin exposure. It is
important to note that this analysis is still ongoing and is primarily
focused on, but not limited to, diseases of the skin and respiratory
system. On preliminary review, it appears that approximately 25 percent
of potentially exposed members have filed claims for such conditions.
This assessment takes into consideration all identifiable members of
the Guard who have previously filed disability claims for such
conditions and who have claims currently pending for such conditions.
It also assumes that such claims were filed after exposure and related
to exposure. This analysis has the potential to identify Veterans whose
claims are based on disabilities resulting from exposure at Qarmat Ali
and to provide regional office personnel with relevant historical
information to assist with evaluating these claims.
Many of these claims may have been adjudicated prior to VA's
learning of potential toxin exposure at Qarmat Ali. Therefore, we are
currently working on the best possible methods to educate our field-
station employees of the circumstances surrounding this incident,
ensure those stations have easy access to all identifiable data on the
potential exposure of National Guard members, and determine whether VA
must readjudicate any claims that were previously adjudicated without
such information.
Burn Pits and Other Environmental Exposures
During a May 14, 2009 Deployment Health Work Group meeting, VA was
apprised of 24 potential exposure incidents in OEF/OIF. This included
various open burn pits for waste disposal, sulfur fires, non-potable
water contamination, exposure to industrial waste, and others. DOD and
VA have made significant progress in sharing information and assessing
health risks. VA works diligently to obtain and interpret data from DOD
and formulate appropriate responses to better serve combat Veterans.
Exposure to open burn pits for solid waste disposal has created
significant concern among Veterans and their families. The most widely
publicized of these was the burn pit at Balad Air Base in Iraq.
According to a May 2008 report from the U.S. Army Center for Health
Promotion and Preventive Medicine (USA CHPPM), the amount of solid
waste being burned was estimated at about 2 tons of material per day in
the early stages of troop deployment and currently may be as much as
several hundred tons per day. This 2008 risk assessment concluded that
the overall risk estimate for 12 month exposure was low. It states that
the risk for both cancer and non-cancer outcomes did not exceed
Environmental Protection Agency guidelines for acceptable risk.
Affected troops did report upper respiratory irritation due to burn
pits. This outcome was expected. Because of uncertainty related to
specific exposures, as well as questions about methodology and
estimates, VA officials must rely on objective facts developed on a
case-by-case basis. VA understands DOD tested air samples at Balad in
2005, 2006, and 2007. USA CHPPM's May 2008 risk assessment was based on
the air samples performed in 2007.
VA anticipates that concerns about potential long-term health
effects from exposure to pollutants generated from open pit waste
burning used throughout the Iraq and Afghanistan theaters will be an
ongoing issue for affected Veterans. VA has learned many lessons from
previous conflicts wherein servicemembers were exposed to various
toxins on the battlefield. In many of those situations, too much time
lapsed between Veterans' exposure to such toxins and an easy path to
the many VA benefits they had earned. After VA learned of potential
exposure for servicemembers to burn pits, and to help address health
concerns of Veterans and their families, VA began initiating a contract
with the Institute of Medicine to provide a review of potential long-
term health effects from exposure to burn pit pollutants.
In addition to these efforts, VA has started presenting one-day
seminars to VA and non-VA providers on many of these exposures. These
seminars give information regarding the nature of the exposures, their
possible health outcomes, how to perform an exposure assessment for
Veterans, appropriate medical surveillance, treatment options, and risk
communication.
VA is analyzing data on the number of Veterans from the first Gulf
War, the Gulf War Era, and OEF/OIF, who have filed service connection
claims for a variety of conditions, including respiratory and skin
disabilities. This information will hopefully serve as a valuable tool
to help VA observe any early, discernable trends such as increased
disability claims for diseases potentially related to toxins. VA is
currently exploring the best information to include in communication
and how best to deliver such information to field employees responsible
for adjudicating disability claims, specifically those related to
toxins. This analysis is not yet complete.
CONCLUSION
Mr. Chairman VA understands these issues are very important to you,
all the Members of this Committee, and to Veterans and their families.
I can assure you VA is equally concerned and committed to working with
DOD and other agencies to identify potential hazards, inform Veterans
of any risks to their health, develop appropriate responses, and
deliver needed care and benefits to Veterans and their families. Only
through such cooperation will VA be prepared to deliver the proper
health care and disability compensation benefits to those entitled.
Sharing this information is important because many factors may
contribute to adverse, long-term health effects for servicemembers and
Veterans.
Thank you again for the opportunity to testify. My colleagues and I
are prepared to address any questions you or the other committee
members might have.
______
Responses to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka
to Michael Peterson, DVM, MPH, DRPH, Chief Consultant, Environmental
Health, Strategic Healthcare Group, Veterans Health Administration,
U.S. Department of Veterans Affairs
Question 1. What proactive measures is your Department taking to
notify the people on the Marine Corps' online health registry for Camp
Lejeune that they may be eligible for VA benefits due to exposures?
Response. VA and DOD have a Data Use Agreement (DUA) that permits
VA to obtain the names on the Camp Lejeune, N.C., registry. VA received
data from DOD in early March containing registry data as of February
12, 2010. Information in the registry identifies individuals self-
reporting by name, address, and telephone number. The registry also
contains a subset of approximately 45,000 names of the approximately
157,000 names in the registry that were identified by the Defense
Manpower Data Center (DMDC) as active duty members stationed at Camp
Lejeune from 1975 to 1985. (Electronic records at DMDC are available
only from 1975 forward) VA is developing recommendations for the
Secretary based on the 2009 National Research Council Report.
``Contaminated Water Supplies at Camp Lejeune, Assessing Potential
Health Effects.'' The Secretary will consider all available evidence
and recommendations in determining the content of any necessary future
notification of Veterans.
Question 2. Dr. Robert F. Miller testified concerning veterans who
had been exposed to fumes from burn pits and other sources in Iraq.
Veterans reporting shortness of breath had normal standard respiratory
evaluations including chest x-rays, chest CT scans and pulmonary
function testing. None of these routine tests could explain the cause
for the soldiers' limitations. When Vanderbilt physicians performed
surgical biopsies on 45 of 70 soldiers referred for unexplained
shortness of breath on exertion, all except one demonstrated some form
of bronchiolitis. Given these findings, what actions should be taken by
VHA and VBA, including specialized testing and evaluations, when a
veteran claims a disability due to shortness of breath after exposure
to environmental toxins?
Response. Any exposed Veteran who complains of shortness of breath,
that has persisted or gotten worse since an exposure while in the
military, should have a chest radiograph and complete pulmonary
functions, including pre-and post bronchodilators and what is known as
alveolar diffusion capacity (a lung function test). A high resolution
CAT Scan (CT) may also be useful. According to a recent scientific
symposium on this issue lung biopsy is only used after other diagnostic
modalities have been exhausted. VBA will instruct Regional Office (RO)
personnel that special methods must be followed when handling
disability claims involving various conditions, including shortness of
breath, from Veterans exposed to contaminants associated with hazardous
material in Iraq and Afghanistan. VBA will issue this instruction in
the form of a training letter, which is currently in concurrence. VA is
also in the process of requesting from DOD data containing all known
locations of burn pits in Iraq and Afghanistan so that VA can provide
such information to all field stations.
The exposure training letter will instruct RO personnel to specify
that a medical examiner must conduct any reasonably feasible testing
for a wide range of respiratory disabilities, including any form of
bronchiolitis that may be the result of toxicants. Results must be
provided in the examination report along with a medical opinion as to
whether it is; ``at least as likely as not'' that any diagnosed
respiratory system condition is related to such exposure.
Question 3. Will VA be contracting with the Institute of Medicine
to study the health effects of exposure to burn pits? If so, what is
the timeline for that report?
Response. The contract with the Institute of Medicine was signed on
October 29, 2009. The contract will end on April 30, 2011, with a
report due on that date.
Question 4. If a recently-separated veteran seeks health care at VA
and mentions that he was exposed to a burn pit or sodium dichromate,
what happens? Is the result the same if the veteran is more than five
years removed from active military service?
Response. Necessary care and/or treatment would be provided to all
eligible Veterans claiming exposure to a burn pit or sodium dichromate.
Combat Veterans (within their five years of post discharge) will be
enrolled upon application for enrollment/care and are eligible for
cost-free hospital and treatment for conditions associated with the
theater of operation. VA clinicians have wide latitude in determining
if a Veteran's condition is associated with Veteran's combat service
and thus, cost-free care. This decision does not require the same rigor
or standards used for adjudication of a service-connected claim.
Combat Veterans more than five years removed from their date of
discharge from the military/release from active duty must meet the
applicable eligibility and enrollment requirements that apply. Under
current rules, this means that Veterans without other special
eligibility factors whose income places them in Priority Group 8 above
the current enrollment income threshold could not be enrolled or
treated by VA. In such cases, VA would encourage the Veteran to file a
claim for service-connected disability rating. If service-connection
were granted, VA would offer enrollment and necessary treatment as
required.
If the Veteran served in Iraq (but not Afghanistan) even if they
were not otherwise eligible for care they would be eligible for a Gulf
War registry exam. Based upon the results of this exam, they would be
referred to VBA to file a claim for service connection. Once service
connection is established for any condition related to the exposure,
they are eligible for further care. VHA and VBA are working together to
establish a process for expedited service connection for these
conditions. We anticipate that our model exposure-related assessment
within the Gulf War registry will be available in spring 2010. The
conditions which will be expedited based upon this exposure have been
identified. If the model exposure-related assessment within the Gulf
War Registry is ready by spring, then it is feasible that VBA can
prepare rating-related training by summer 2010.
The Deployment Health Working Group, a joint DOD/VA work group, has
recently begun an effort to establish a permanent agreement between the
VA and DOD that will permit the transfer of information from DOD to the
VA whenever an exposure incident occurs. The outcome of this effort
will be a listing of Soldiers, Sailors, Airmen and Marines exposed in
any given incident.
Question 5. What occurs when a veteran claims service-connection
for a condition due to exposure to contaminated water at Camp Lejeune?
Response. VA RO personnel were alerted to the Camp Lejeune
contaminated water situation in the June 2009 C&P Service Bulletin and
instructed to adjudicate each related claim on a case-by-case basis,
with the benefit of any doubt provided to the Veteran. All available
evidence related to the claim will be obtained. Service connection may
be granted if the evidence shows: (1) a current chronic disability, (2)
military duty at Camp Lejeune during the period of water contamination
(as verified though Official Military Records), and (3) a medical nexus
or relationship between the current disability and the service at Camp
Lejeune. A statement of this medical nexus may be provided by a
competent VHA or private medical examiner.
______
Response to Post-hearing Questions Submitted by Hon. Richard Burr to
Michael Peterson, DVM, MPH, DRPH, Chief Consultant, Environmental
Health, Strategic Healthcare Group, Veterans Health Administration,
U.S. Department of Veterans Affairs
Question 1. At the hearing, I asked whether VA could create a
special enrollment category for Veterans potentially affected by the
contaminated drinking water at Camp Lejeune using the Secretary's
general authority to provide needed health care to categories of
Veterans not specified in the law and the question was to be taken back
to VA General Counsel. What is the VA General Counsel's opinion on that
question?
Response. VA is required to establish and operate a system of
annual patient enrollment, 38 U.S.C. 1705(a). The law requires that VA
manage the enrollment of patients in accordance with the priorities set
forth in section 1705(a)(1)-(8) but specifically authorizes VA to
establish subpriorities within each statutory priority group. In
accordance with the law, VA established an enrollment system by
regulation in 38 CFR 17.36. The system provides subpriorities within
the two lowest priority categories (7 and 8). VA currently enrolls all
Veterans in priority 1-7 and the highest subpriorities of priority 8.
VA could, in accordance with the regulatory process, revise its
enrollment regulations to establish in priority 8 an additional
subcategory for Veterans who are potentially affected by the
contaminated drinking water at Camp Lejeune.
Question 2. During the hearing, there was confusion about whether
VA had, in fact, received from the Marine Corps the registry of names
of former Camp Lejeune residents.
A. Has this list been shared with VA? If so, when?
Response. VA and DOD have a Data Use Agreement (DUA) that permits
VA to obtain the names on the Camp Lejeune, NC, registry. VA received
data from DOD in early March containing registry data as of February
12, 2010. Information in the registry identifies individuals self-
reporting by name, address, and telephone number. The registry also
contains a subset of approximately 45,000 names of the approximately
157,000 names in the registry that were identified by the Defense
Manpower Data Center (DMDC) as active duty members stationed at Camp
Lejeune from 1975 to 1985. (Electronic records at DMDC are available
only from 1975 forward.)
B. If not, will VA work with the Marine Corps to obtain the
registry so that VA can better identify the medical history of those
who are already receiving VA health care and proactively outreach to
those who are not?
Response. See response to A above.
Question 3. It is my understanding that there is an on-going
initiative funded by the Department of Energy (DOE) that provides
eligibility to former DOE workers to participate in a program that
provides examinations and specialized testing for health effects that
may be related to exposures they encountered during their time as
employees or contractors to DOE. In addition, if health effects that
could be linked to those exposures are identified, these former
employers may be provided health care and the opportunity to file for
compensation.
A. Has VA discussed this program with the Department of Energy? If
so, what have you learned from those discussions?
Response. Subject matter experts in the Environment Agents Service
in the Office of Public Health and Environmental Hazards, Veterans
Health Administration are familiar with this program. The Environmental
Health Strategic Healthcare Group has discussed this program with the
medical director of The Building Trades Program. This program is the
basis of the War Related Interactive Online Referral and Surveillance
(WARRIORS) program. It is an initiative which is funded by VA's Office
of Rural Health and will be utilized to assist rural physicians without
access to VA expertise on these issues to perform a conflict/exposure
specific evaluation to include history/examination, ancillary testing
and recommended follow-up and consultation. The contractor for
development of this program is in the process of being approved and an
award is expected to be made by the end of FY2010.
B. If no, are there lessons that VA could learn from further
examining this DOE program?
Response. See response to A above.
Question 4. At the hearing, a VA representative testified that
guidance to the field--in the form of a Fast Letter--would be sent
regarding how to handle disability claims from Veterans who were
stationed at Camp Lejeune during the period that the water was
contaminated.
A. Has that been done? Would you please provide a copy of the Fast
Letter when it has been sent out?
Response. VBA will instruct Regional Office (RO) personnel that
special methods must be followed when handling disability claims
arising from six separate exposure events including the Camp Lejeune
contaminated water incident. The other events include burn pits used
throughout Iraq, Afghanistan, and the Horn of Africa; high particulate
matter levels throughout Iraq, Afghanistan, and the Horn of Africa; the
2003 Iraqi sulfur fire incident; the 2003 sodium dichromate exposure
incident at Qarmat Ali, Iraq; and, the Atsugi, Japan incinerator
incident. VBA will issue this instruction in the form of a training
letter. VA will provide the Committee a copy as soon as it is complete.
The exposure training letter will consist of three elements. The
first section will serve as an educational tool on each specific
exposure, including the Camp Lejeune incident. The second section
contains claims processing instructions that are specific to these
exposures. Finally, the third section functions as an additional
educational tool that VA adjudicators will use to alert Compensation
and Pension (C&P) examiners to a Veteran's specific exposure
incident(s) so that any subsequent examinations and/or medical opinions
are fully informed.
Through this process, all VBA employees involved in adjudicating
claims, and C&P examiners, will become well aware of the details of
each of the six exposure incidents, including the water contamination
at Camp Lejeune.
B. With respect to the other three exposures discussed at the
hearing (Qarmat Ali, burn pits, Atsugi), has any guidance been sent to
the field on how to adjudicate claims from potentially exposed
veterans? If so, please provide copies of any such guidance and a
timeline for when the guidance was provided to the field.
Response. The October 2009 C&P Service Bulletin provided
information to RO personnel on the environmental contamination history
of Naval Air Facility (NAF) Atsugi, Japan and instructed them to handle
any related disability claims on a case-by-case basis, with the benefit
of any doubt provided to the Veteran. VBA is currently in the process
of developing instructions for the field on methods for handling
disability claims based on chromium exposure at Qarmat Ali, Iraq and
exposure to the toxic contaminants associated with burn pit sites, as
well as others in Iraq and Afghanistan.
The information needed to assess these sites and the contaminants
associated with them will require additional research and cooperation
from the Department of Defense. VA received the names of National Guard
members who were potentially exposed to toxins at Qarmat Ali, Iraq. We
are generating requests for information related to additional
exposures.
VA also contracted with the Institute of Medicine to investigate
the possible health outcomes of exposure to burn-pit emissions. When
this research is completed, a Fast Letter and/or training letter will
be released to the field. The November 2009 C&P Service Bulletin also
provided basic information.
C. If guidance has not been provided to the field with respect to
any of these exposures, would you please provided a timeline for when
you anticipate providing such guidance?
Response. Guidance on handling Veterans' claims based on exposure
at Camp Lejeune and NAF Atsugi has already been provided to the field
through the C&P Service Bulletin. When additional research is completed
in the next few months, Fast Letters and/or training letters will be
released to the field providing information on handling claims based on
all known exposure events in Iraq and Afghanistan.
Question 5. At the hearing, we also heard testimony about a sulfur
mine in Iraq that was set on fire in 2003. Would you please provide an
update on what steps VA has taken to date with regard to that exposure
incident?
Response. Please see post-hearing Question 2 from Senator Akaka and
VA's subsequent response. VA was made aware of this fire and potential
exposures in March 2009. DOD has determined that bronchiolitis in
Veterans with known exposure to the 2003 sulfur fire is ``plausibly''
related to such fire. The subject of the sulfur fire will be covered
extensively in VBA's forthcoming training letter on hazardous exposures
in Iraq and Afghanistan.
Chairman Akaka. Thank you very much, Mr. Peterson. The
chair calls for a slight recess and we will be right back.
[Recess.]
Chairman Akaka. The hearing will come to order. And now I
call for the testimony of Dr. Postlewaite.
STATEMENT OF R. CRAIG POSTLEWAITE, DVM, M.P.H., ACTING
DIRECTOR, FORCE HEALTH PROTECTION AND READINESS PROGRAMS,
OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE (HEALTH AFFAIRS),
U.S. DEPARTMENT OF DEFENSE
Mr. Postlewaite. Good afternoon, sir. Thank you very much.
Mr. Chairman, distinguished Members of the Committee, thank you
for the opportunity to discuss the Department of Defense
Occupational Environmental Health Program, our program to
assess health risks associated with the environment in our
workplaces.
I am Dr. Craig Postlewaite, Acting Director of Force Health
Protection and Readiness Programs for the Assistant Secretary
of Defense for Health Affairs. I am also a veteran with 26
years active duty service. Under my purview is the policy and
oversight for the deployments--or for the department's
Deployment Health Program. A key component of the Deployment
Health Program is our Occupational and Environmental Health
Program, or OEH, as I will refer to it.
Its goal is to protect our personnel from accidental death,
injury, or illness caused by hazardous, occupational, or
environmental exposures. This includes preventing or minimizing
short-term health effects, especially those severe enough to
interfere with mission accomplishment and also any long-term
effects that may affect our servicemembers' health and quality-
of-life in the years to follow.
To prevent or limit hazardous exposures, both in peace time
and in deployed settings, the Department applies a rigorous
risk management program. Mr. Chairman, the Department's many
fine OEH professionals take their responsibility seriously and
are fully dedicated to protecting and preserving the health of
our personnel by identifying hazards, ascertaining the
significance of those health hazards in terms of risk,
determining appropriate controls and communicating the risk
information to commanders and affected personnel.
Since 2001, our OEH professionals have collected over
17,500 individual environmental samples throughout the U.S.
Central Command Theatre of Operations, including nearly 10,000
in Iraq, more than 3,500 in Kuwait and over 3,300 in
Afghanistan. In the vast majority of cases, these samples
indicate that U.S. personnel are not experiencing any exposures
that would put their long-term health at risk.
However, with the current technology and under war time
conditions, it is not always possible to monitor the working
locations of all servicemembers for all hazards, especially for
those who operate outside of our base camps.
While our focus continues to remain on exposure prevention
and control, we realize that some hazardous exposures can and
will occur despite our best efforts. And unfortunately, some
individuals may develop short-term or long-term health effects
as a result.
First and foremost, we want to ensure that those affected
individuals get the very best care and treatment they are
entitled to through the Military Health System and the VA.
Second, these fine veterans have our profound sympathies for
the pain and suffering they and their families experience. They
have earned our sincere gratitude for their service.
Our Department of Defense Instruction, Occupational
Environmental Health, DODI 6055.05, requires DOD to share
hazard and exposure data with the VA to assist in the
adjudication of veterans' disability claims. Such records also
are valuable in establishing diagnosis and proper treatment.
To ensure that VA is aware of individual hazardous
exposures, all exposure-related information is to be entered
into each individual's medical record so it will be available
to the VA at time of treatment or claims adjudication.
Once the DOD electronic exposure record becomes a reality--
and I discuss that more in my written testimony, hopefully it
will be in the next few years--it will also be made available
to the VA. For a number of years, the DOD and VA have
collaborated through the DOD/VA Deployment Health Working
Group, as Dr. Peterson mentioned. We use that forum to share,
on a frequent basis, information related to exposures.
While the Department of Defense is in-garrison and
deployed, OEH programs have been quite effective in identifying
and controlling chemical, biological, and physical hazards
which our servicemembers or DOD civilians may encounter. We, of
course, are fully committed to improving those programs
wherever we can.
Mr. Chairman, thank you for the opportunity to discuss the
DOD's OEH program today. I appreciate it.
[The prepared statement of Mr. Postlewaite follows:]
Prepared Statement of R. Craig Postlewaite, DVM, MPH, Acting Director,
Force Health Protection and Readiness Programs, Office of the Assistant
Secretary of Defense (Health Affairs)
Mr. Chairman and distinguished Members of the Committee, thank you
for the opportunity to discuss the Department of Defense's (DOD's)
Occupational and Environmental Health (OEH) Program.
The OEH program is an important component of the Department's
efforts to enhance Force Health Protection. DOD understands the
importance of anticipating, recognizing, evaluating, and controlling
health hazards associated with exposure to chemical, physical, and
biological hazards. Our goal is to protect our personnel from
accidental death, injury, and illness caused by hazardous occupational
or environmental exposures. This goal includes preventing and/or
minimizing short-term health effects, especially those severe enough to
interfere with mission accomplishment and, any long-term effects that
may affect a Servicemember's health and quality of life in years to
come.
To prevent or limit hazardous exposures, both in peacetime and in
deployed settings, the Department applies a rigorous risk management
program. Mr. Chairman, the Department's many fine OEH professionals
take their responsibilities seriously, and are dedicated to protecting
and preserving the health of our personnel by identifying hazards,
ascertaining the significance of any health or safety risks associated
with the hazards, determining appropriate options to control the
hazards, and communicating risk information to commanders and affected
personnel.
In the peacetime setting, the policies and procedures governing our
OEH program are contained in DOD Instruction (DODI) 6055.05,
``Occupational and Environmental Health.'' Our OEH policies and
procedures for the deployed setting are established in three documents:
DODI 6055.05; the Joint Staff memorandum, MCM 0028-07, ``Procedures for
Deployment Health Surveillance''; and DODI 6490.03, ``Deployment
Health.''
Mr. Chairman, in August 2006, the Under Secretary of Defense for
Personnel and Readiness issued updated policy guidance for deployment
OEH in the revision to DODI 6490.03. This revision significantly
strengthened requirements for deployment OEH surveillance, including
OEH data reporting and archiving; medical record entries documenting
exposures; deployment health risk communications; and established a new
requirement to track and report once daily the locations for all
deployed Servicemembers so environmental hazards at a particular
location could be linked with the individuals who may have been exposed
to them during the time those hazards existed.
The deployment OEH program actually begins during our pre-
deployment preparation phase, when occupational and environmental
hazard assessments for the current theater of operations, and any other
theater of operation or deployed location as well, are conducted based
on medical intelligence provided by the National Center of Medical
Intelligence and other sources. Once in theater, we accomplish
baseline, periodic, and incident-driven OEH surveillance by monitoring
the air, water, soil, food, and disease-carrying vectors.
Since 2001, we have collected more than 17,500 individual
environmental samples throughout the U.S. Central Command Theater of
Operations, including nearly 10,000 in Iraq, more than 3,500 in Kuwait,
and more than 3,300 in Afghanistan. In the vast majority of cases,
these data indicate U.S. personnel are not experiencing any exposures
that would put their long-term health at risk. However, with the
current technology, it is not possible, in a wartime environment, to
monitor the working locations of all Servicemembers for all hazards,
especially for those who operate outside of base camps.
While our focus continues to remain on exposure prevention and
control, we realize that some exposures can, do, and will occur despite
our best efforts. In recognition of that reality, we revised DODI
6490.03 and the Joint Staff memorandum on Deployment Health
Surveillance to take steps to effectively address gaps that had
hindered the assembly of electronic individual deployed longitudinal
exposure records as called for by the President in August 1998 in
Presidential Review Directive 5, ``A National Obligation, Planning for
Health Preparedness for and Readjustment of the Military, Veterans, and
Their Families after Future Deployments.''
Today, the process of assembling individual longitudinal exposure
records is labor intensive, but it can be done with available data.
Over the next several years, we anticipate it will be possible to
extract the medical record entries of all personnel who have received
medical evaluation and care for confirmed exposures and also access an
individual Servicemember's assignment history (dates and locations),
including their peacetime, in-garrison assignments as well as their
recent deployments. Their deployment histories will be used to retrieve
archived OEH monitoring data for those deployment locations where
exposures may have occurred, or existed, during the time the individual
was deployed to that location. By merging deployment environmental
monitoring data with the in-garrison occupational monitoring data and
adding the medical record entries, we will be able to achieve the
vision established by the President.
In addition, the Department will be able to access population-at-
risk databases, such as the Personnel Blast and Contaminant Tracking
System that records the names and other identifiers of personnel who
have been involved in exposure incidents but may not have been affected
severely enough to result in medical evaluation or treatment.
Department of Defense Instruction 6055.05, ``Occupational and
Environmental Health,'' requires DOD to share hazard and exposure data
with the Department of Veterans Affairs (VA) to assist in adjudication
of veterans' disability claims. Such records also are valuable in
establishing diagnoses and treatment.
To ensure that VA is aware of individual hazardous exposures, all
individual exposure-related information is entered into each
individual's medical record so it will be available to VA at the time
of treatment or claims adjudication. Once electronic individual
exposure records become a reality, they will be made available to VA.
For several years, DOD and VA have collaborated through the DOD/VA
Deployment Health Working Group, to focus on issues related to the
post-deployment health of Servicemembers and veterans. Environmental
and occupational exposures are a major focus of the group and discussed
at nearly every monthly meeting.
To reduce hazardous exposures or the resulting health impacts from
potential exposures to deployed personnel, the Department provides all
deploying Servicemembers comprehensive pre-deployment health threat and
countermeasures briefings. Additionally, members also complete a pre-
deployment health assessment; provide serum samples; and obtain all
necessary immunizations, preventive medications, and personal
protective equipment they need prior to deployment.
Following deployment, members provide an additional serum sample
and complete a post-deployment health assessment within 60 days of
return from deployment, followed by a post-deployment health
reassessment within 90-180 days. In addition, personnel are referred to
healthcare providers as necessary for the evaluation of any self-
reported OEH exposures or for other health concerns.
For Operation Enduring Freedom and Operation Iraqi Freedom, we
estimate that, on average, approximately four percent of deployed
Servicemembers seek care for a non-battle related injury or illness
each week. This is the lowest rate of disease and non-battle injuries
ever recorded for a large operation in a time of war, and is a
reflection, in part, of the effectiveness of Force Health Protection
and OEH programs.
Overall, the Department is pleased with both in-garrison/peacetime
and deployed OEH programs that have been quite effective in identifying
and controlling chemical, biological, and physical hazards. Of course,
there is always room for improvement, and we are fully committed to
bringing about those improvements.
Mr. Chairman, thank you for the opportunity to discuss the DOD
Occupational and Environmental Health Program with you. I would be
pleased to answer any questions you may have.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Craig Postlewaite, DVM, M.P.H., Acting Director, Force Health
Protection and Readiness Programs, Office of the Assistant Secretary of
Defense (Health Affairs), U.S. Department of Defense
Question 1. What is the timeline for replacing burn pits with
incinerators? Will all burn pits be closed?
Response. U.S. Central Command (USCENTCOM) environmental
operational guidance to its Service components in Iraq and Afghanistan
is to eventually replace burn pits with incinerators. USCENTCOM
Regulation 200-2 directs that when establishing expeditionary bases,
``Develop a burn pit, landfill and/or incinerator operation to dispose
of non-reusable solid waste. If a burn pit is used, develop a plan to
transition to an incinerator as the camp matures and population
increases.'' The regulation goes on to say, ``This will be done as soon
as practical after the base is established.''
In Iraq, to date, we have procured large commercial incinerators
through Military Construction funding (MILCON) projects and, in most
cases, turned them over to Logistics Civil Augmentation Program for
daily operation. Because the MILCON process is slow, in Afghanistan, we
purchased smaller incinerators (below MILCON threshold) through the
Joint Acquisition Review Board process. Although procuring smaller
units has required us to purchase more units, this process has allowed
incinerators to arrive faster. More than 105 incinerators have been
purchased or established at bases in both Iraq and Afghanistan, and
have either replaced or significantly reduced the need for burn pits.
However, to prevent the development and spread of disease carried by
flies, rats, and other vermin, we will continue to require burn pits as
a healthy and safe means of disposing of solid waste where camps are
either immature or do not have the population to support an
incinerator. Where feasible, landfill options or local commercial
disposal are preferable alternatives to burn pits on U.S. bases but
neither of these options are viable in our current operational
environment. In Iraq, there are 23 solid waste incineration units in
operation at major camps with two units under construction (these are
separate and distinct from a similar number of medical waste
incinerators and two units for hazardous waste, also in operation). The
burn pit at Joint Base Balad was closed on October 1, 2009. United
States Forces will continue to use burn pits at selected locations in
Iraq until the final United States withdrawal of forces in 2011. In
Afghanistan, there are 82 solid waste incinerators in the works,
planned, or contracted for purchase and United States Forces--Army and
USCENTCOM are developing requirements for additional incinerators. As a
result of the drawdown in Iraq, USCENTCOM will transfer reusable
incinerator equipment from Iraq to Afghanistan as it becomes available.
Question 2. The number of servicemembers exposed to burn puts is
high. How can health effects be properly monitored given the number
affected?
Response. The health of personnel in-theater is monitored at
several levels:
At provider level, as individuals seek medical treatment
at our in-theater medical treatment facilities and by medics deployed
in the field. When a Servicemember is treated, the provider considers
the cause of the illness. When an environmental factor may be
responsible that is affecting several individuals, this information is
elevated through command channels.
Individual diagnoses and symptoms are entered into the
Servicemember's electronic medical record and sent to the Joint Medical
Workstation, where population-based trends at the installation and in
the theater can be identified to indicate if a problem requires
investigation.
A health assessment questionnaire is provided (to those
who deployed) at the conclusion of deployment and again at 90 to 180
days after returning. This questionnaire offers the Servicemember the
opportunity to identify any health concerns or problems experienced,
and to identify any occupational or environmental exposure experienced
or of concern. These questionnaires are reviewed by medical personnel
to identify Servicemembers who warrant further evaluation or medical
treatment.
Health outcome data, including any associated with the
inhalation of burn pit smoke, is reviewed by the Armed Force Health
Surveillance Center and the Department of Defense Deployment Health
Research Center. Both organizations are examining the data closely to
determine whether there may be any long-term health effects associated
with smoke inhalation. While they have generated some preliminary
assessments, it is too early to draw any conclusions until further
studies are completed.
We are aware that inhalation of the smoke from burn pits by our
Servicemembers is responsible for mild, short-term health effects in
some personnel to include red, watery eyes and irritation of the upper
respiratory system and, in some cases, a cough. We also believe that,
in a small number of people with either increased susceptibility to the
smoke (genetic/family history, preexisting medical conditions) or
combined burn pit smoke exposure with some other inhalation exposure,
such as tobacco smoke, may be affected by more serious long-term health
effects. The number of these people is quite small compared to the
numbers exposed, so it is difficult to establish statistically solid
relationships.
Question 3. The Committee understands that there were four National
Guard units--Indiana, West Virginia, Oregon and South Carolina--that
were present at Qarmat Ali for a period of time. Please provide
chronological data (timeline) on when each unit arrived, for what
amount of time the unit was present, and when each unit left. In
addition, please provide the approximate amount of personnel each unit
had, and how many members of each unit were stationed at Qarmat Ali.
Response. There were no U.S. Army units stationed at the Qarmat Ali
water treatment facility. The U.S. Soldiers were based either in Kuwait
or Basra, they provided individual protection details to KBR
contractors. During the time a unit performed this mission, some
soldiers may have been sent repeatedly to the Qarmat Ali facility,
while others may have never been sent to the facility.
The exact timelines for the mission support are not available, the
approximate dates of the missions were:
1st Battalion 162nd Infantry (Oregon Army National Guard)--
started the personal security mission in April 2003, when KBR
began to conduct site visits and repairs. They continued the
mission until replaced by the Indiana Army National Guard in
the middle of June. After an overlap with the Indiana ARNG
Soldiers, the Oregon ARNG Soldiers moved to new missions at the
end of June. The unit supported the mission from Kuwait. Since
the actual work began at the site in May, the Oregon ARNG
Soldiers supported the mission for approximately six weeks. The
Oregon ARNG reported 278 soldiers were involved in this
particular mission. In 2003, when the Army conducted site
testing and medical evaluations, the unit reported 48 Soldiers
having been at the site.
1092nd Engineer Battalion (West Virginia Army National
Guard)--From April until July 2003 the unit was assigned the
personal protection detail. The WV ARNG was based out of Kuwait
and chose to perform the mission by assigning the
responsibility to C Company for the entire period of the
mission. The WV ARNG period overlapped the Oregon and Indiana
ARNG mission change. In 2008, the unit reported having 124
Soldiers involved in the Project RIO mission.
1st Battalion 152nd Infantry (Indiana Army National Guard)-
started the personal security mission in June 2003 when they
replaced the Oregon ARNG Soldiers. While the unit was based in
Kuwait, they chose to perform the mission by assigning it to
their C Company for the entire time. The C Company was moved to
Basra to be closer to the mission site. The Indiana ARNG
Soldiers performed the mission from June 2003 until December
2003. The Indiana ARNG reported 128 Soldiers involved in
mission. In 2003, when the Army conducted site testing and
medical evaluations, the unit reported 128 Soldiers having been
at the site.
133rd Military Police Company (South Carolina Army National
Guard)--did not perform the personal protection mission. The SC
ARNG had a quick reaction force mission responsibility. Should
a unit in the area be engaged or need support, they would call
the 133rd and the 133rd would respond with rapid movement and
additional firepower. The SC ARNG Soldiers had this mission
from August 2003 until December 2003. The SC ARNG reported
having 142 Soldiers involved in the mission. In 2003, when the
Army conducted site testing and medical evaluations, the unit
reported 37 Soldiers having been at the site.
In 2008, during the Army review of the incident, the units reported
that soldiers not involved in the mission may have visited the site for
a variety of administrative reasons. The ARNG headquarters of each
state began a mission to contact each soldier to determine the exact
number of soldiers who visited the site at Qarmat Ali between April and
October 2003.
Question 4. There have been several references made to
correspondence between then-Secretary of Defense Cohen and then-
Ambassador Foley regarding the effects of the exposure from the
Shinkampo Incineration Complex (SIC) near NAF Atsugi and possible
courses of action by the Navy to protect the residents stationed there.
Please provide copies of all correspondence between these individuals
between 1985 and 2001 regarding NAF Atsugi.
Response. [The Committee had not received the requested information
by press time.]
Question 5. The Department of Defense has stated that it is in the
process of attaining the Social Security Numbers (SSNs) of soldiers
from the four separate units that rotated through Qarmat Ali so that
these individuals can be added to a database and their health effects
can be analyzed. When do you expect this process to be complete? What
will happen once this information is attained--who will it be shared
with?
Response. Gathering of information has been more difficult than
anticipated and is taking longer than expected. More than 1,100
Servicemembers were deployed to Iraq in the four units. Only about one
third of those were known to have been directly involved in the mission
that placed them at the Qarmat Ali facility (the site of the incident);
the number of Servicemembers who may have had an incidental contact
with the site (administrative visit, resupply effort, etc.) is unknown.
The Army will count all unit members as potentially exposed until it
confirms whether they were at the site. To complete this process, the
Army will have to contact each individual. The Army's biggest challenge
is to locate and contact those individuals who are no longer serving.
Some have moved and not left forwarding contact information, others
have not responded to attempts by the Army to contact them. Others are
still in the Army, but are now deployed again to Iraq or Afghanistan.
The Army continues to work this issue and will not stop until they have
confirmed every individual who spent even a single day at the Qarmat
Ali site. It is anticipated that there will be an initial transfer of
SSNs that will occur by December 15, 2009, with monthly updates
thereafter.
The SSNs will be shared with two agencies: the Office of the
Assistant Secretary of Defense for Health Affairs (OASD(HA)) and the
Department of Veterans Affairs (VA). The VA will use the information to
track the Servicemembers through a separate registry that they are
establishing for this incident. The individuals will receive an entry
level medical evaluation and regular medical evaluations to monitor
their health and any issues that may arise from the exposure. The
OASD(HA) will determine if any individuals were treated while in
theater or after returning, and if any of those treatments were for
conditions that may have been related to sodium dichromate exposure.
Question 6. When will you provide the Department of Veterans'
Affairs (VA) the data it has requested from you pertaining to veterans
potentially exposed to chemicals at Camp Lejeune, so that VA can better
determine care and compensation for these veterans?
Response. The Veterans' Benefits Administration requested access to
that data on October 21, 2009. The Deputy Commandant of the Marine
Corps for Installations and Logistics will provide access to the
requested data for the veterans possibly exposed to chemicals. The
Marine Corps has contacted the VA and projects that access will be
available in approximately three months (January 2010), depending on
privacy act requirements and necessary permissions.
______
Response to Post-Hearing Questions Submitted by Hon. Richard Burr to
Craig Postlewaite, DVM, MPH, Acting Director, Force Health Protection
and Readiness Programs and Director, Force Readiness and Health
Assurance
Question 1. At the hearing, Mr. John Resta indicated that the
Department of Defense (DOD) may be moving forward with additional air
sampling and studies regarding the potential health effects of burn
pits being used in Iraq and Afghanistan.
A. Please provide additional details regarding any ongoing or
planned air sampling related to burn pits.
B. Is ongoing sampling being done near the living quarters of
Servicemembers in Iraq?
C. Would you please provide a timeline of when additional studies
will be initiated and when we can expect the results?
Response. Air sampling for particulate matter is conducted across
Iraq and Afghanistan at locations with deployed preventive medicine
personnel, which includes most of the larger United States base camps.
Sampling for volatile organic compounds is also conducted. A multi-
Service group is developing a comprehensive air sampling strategy for
United States Central Command, focusing on sites with significant air
pollution sources such as burn pits. The group is considering potential
air hazards, methods to collect samples in a deployed area, and how
such data could be used to better characterize the air and estimate the
health risk to deployed Servicemembers. The group's members will travel
to six locations in Iraq and Afghanistan in early November 2009 to
brief on historical air sampling results, discuss the current situation
with medical personnel, and gain further understanding of the exposure
situation and concerns. Upon return, they will update the draft
strategy and present it to the Joint Environmental Surveillance Work
Group Executive Committee in late November 2009 and to the Defense
Health Board at the end of November 2009. Sampling is expected to begin
by early 2010, assuming operational security conditions allow it.
Air sampling locations are selected by deployed preventive medicine
personnel based on their assessments of air hazards and the possible
impact on the mission and potentially affected populations. These
sampling locations frequently include living areas.
Additional burn pit studies are expected to begin in early 2010.
The actual dates may be affected by: equipment purchase and shipping,
training, coordination of laboratory assistance, rotation schedules, or
the operational situations at the locations of interest. Results are
expected three to six months after the completion of field work.
Epidemiologic studies to examine health outcomes that may be
associated with smoke exposures have been initiated on behalf of the
Armed Force Health Surveillance Center and the DOD Deployment Research
Center, with two already completed. Each provided important data, but
neither can be considered definitive in terms of whether any long-term
health risks are present. A plan for additional studies to be
accomplished has been outlined and several additional studies are
underway. Some of these are hypothesis-generating studies that may
require further studies. At this time, it is not possible to provide a
firm date on when a determination can be made regarding the impact of
breathing burn pit smoke on the incidence of chronic health conditions,
but we should have a better idea by March 2010, when the planned
studies are complete.
Question 2. A February 2009 article in Inhalation Toxicology,
written by employees from the United States Army Center for Health
Promotion and Preventive Medicine, noted that authors of a 2005 journal
article had ``conducted a survey of 15,000 military personnel deployed
to [Operation Enduring Freedom/Operation Iraqi Freedom] and estimated
that 69.1% reported experiencing respiratory illnesses, of which 17%
required medical care,'' and that ``[t]he frequency of respiratory
conditions doubled from a pre-combat period to a period of combat
operations in this group.''
A. What steps are being taken to ensure that possible respiratory
illness is addressed in Post-Deployment Health Assessments?
B. To what extent does the smoke from burn pits potentially
contribute to respiratory health problems of deployed Servicemembers?
Response. Post-Deployment Health Assessments that are accomplished
within 30 days of returning to the Servicemember's home base or station
and have a number of questions pertaining to smoke exposure and
respiratory illness that each Servicemember is requested to answer:
Question #8, ``. . . cough lasting more than 3 weeks;
trouble breathing more than 3 weeks; chest pain or pressure, and
other'';
Question #16, ``Are you worried about your health because
of exposure to chlorine gas, fog oils (smoke screen), garbage,
industrial pollution, JP8 or other fuels, smoke from burning trash or
feces, and other?'';
Page 6, Question #10, ``Do you have any other concerns
about possible exposures or events?''; and
Question #11 (to be asked by a provider), ``Do you
currently have any questions or concerns about your health?''
Positive or ``yes'' answers to these questions are followed up by
the healthcare provider to determine if a medical referral is needed,
including for respiratory illness.
The increase in respiratory conditions in-theater noted in the
article was detected by analyzing the Post-Deployment Self Assessment
data. Individuals' self-reporting of symptoms on questionnaires seems
to increase from pre- to post-deployment, but the increase is not
reflected in more objective measures of health status, namely health
care encounters. The Army's Center for Health Promotion and Preventive
Medicine has assessed the frequency of post-deployment inpatient and
ambulatory care visits for respiratory conditions, and not found them
to be associated with deployment (i.e., number of deployments and
cumulative time deployed). The Department of Defense recognizes that
exposure to burn pits smoke can cause acute, short-term and, (most
often) mild respiratory health problems in Servicemembers. These
symptoms include red, watery eyes, and mild upper system symptoms,
(depending on the degree of smoke exposure) such as coughing and sinus
congestion. It is possible that some individuals who have preexisting
respiratory conditions may have those conditions aggravated by smoke
exposures, or because of special susceptibilities, unique medical
histories, or even as a result of combined exposures (such as use of
cigarettes or cigars), could develop some type of chronic health
effects. What is not known is what health conditions might fall into
this category and how frequently such conditions may develop. The
studies conducted to date have not demonstrated a significant increase
on a population-wide basis in respiratory health outcomes after
deployment. Additional epidemiologic studies are underway to identify
any associated health conditions and the extent of any risks toward the
development of long-term, chronic conditions.
Chairman Akaka. Thank you very much, Dr. Postlewaite. And
now we will receive the testimony of Dr. Gillooly.
STATEMENT OF PAUL B. GILLOOLY, Ph.D., CAPT., MEDICAL SERVICE
CORPS, U.S. NAVY (RET.), NAVY/MARINE CORPS PUBLIC HEALTH CENTER
Mr. Gillooly. Chairman Akaka, distinguished Members of the
Committee, I am Dr. Paul Gillooly, representing Navy Medicine.
I am here to discuss Navy Medicine's efforts in evaluating the
potential health risks for U.S. Navy personnel and their
families living and working at Naval Air Facility Atsugi,
Japan, from the operation of the adjacent privately-owned
Shinkampo Incineration Complex referred to as the SIC.
It is important to make clear our role in Navy Medicine is
to conduct such studies when tasked and to act as advisors to
Navy Line Officers, who as risk managers, make the final
decisions with regard to implementing new policies or visions
to existing policies in response to potential health threats in
these situations.
The incinerators were installed first in the early 1980s
and burned municipal waste. Navy health concerns first arose
around 1985 when the incinerator applied for and was granted a
license to burn industrial waste. Navy Medicine's involvement
began in 1994 and continued through the closing of the
incinerator in 2001.
Following the closure of the incinerator, we completed a
comprehensive health risk assessment report in 2002. Navy
Medicine conducted or sponsored three human health risk
assessments, three epidemiological studies, and a medical
screening study, all of which underwent high level external
peer review. In addition, we coordinated the execution of a
robust health and environmental risk communication plan.
The first two screening health risk assessments conducted
in 1994 and 1997 raised concerns for both cancer and non-cancer
effects from exposure to the incinerator. In October 1997, the
Bureau of Medicine and Surgery was tasked by Commander-in-
Chief, U.S. Pacific Fleet to conduct a comprehensive health
risk assessment. The most significant results of the
comprehensive risk assessment were as follows:
The cancer risk for children under the age of six living on
base for a 3-year tour of duty suggested that a child's
exposure to contaminants from air and soil could potentially
result in an additional lifetime cancer risk of 1.1 per 10,000.
The calculated cancer risk for adults living or working on base
for a 3- or 6-year tour of duty suggested that an adult's
exposure to contaminants from air and soil falls within the
EPA's acceptable cancer risk range of 1 in 10,000 to 1 in
1,000,000.
We worked closely with EPA throughout the life of this
project, and EPA procedures and guidance were used in the
development of the sampling plan, collection of the air quality
data, quality assurance audits and procedures, and execution of
the entire risk assessment methodology. This is an important
point in that due to the absence of equivalent regulatory
oversight by the Government of Japan, the U.S. Navy assumed
that role. To ensure that equivalent standard of environmental
protection we were committed to using the accepted and legal
risk assessment methodology of the EPA.
To respond to NAF Atsugi community concerns, Navy Medicine
was given permission to conduct three health studies: a
children's respiratory health study in 1998; a pregnancy loss
or miscarriage study for women at NAF Atsugi, also in 1998; and
a retrospective cohort study of disease just completed in 2009.
There were no significant findings in either the children's
respiratory study or the pregnancy loss study. The recently
completed retrospective cohort study of disease was designed to
determine if the incidence of disease associated with exposure
to the emissions from the incinerator significantly differ for
residents of NAF Atsugi from 1985 to 2001 when compared to a
similar population in Yokosuka over that same time period.
The study included over 5,600 active duty and over 11,000
family members at NAF Atsugi former-resident cohort and found a
significantly higher risk for dermal complaints, a non-cancer
health effect, in the Atsugi population when compared to the
Yokosuka population. No other area of analysis found
significant differences in disease and illness incidence or
health complaints.
Navy Medicine then requested Battelle Memorial Institute,
an external independent private agency, to review all available
Navy Atsugi health risk assessment data and make
recommendations for possible additional medical screening.
Battelle stated: ``The conclusion of all previous evaluations
are remarkable for their consistency. Residents of NAF Atsugi
were exposed to ambient air and soil contaminants due primarily
to emissions from the Shinkampo Incinerator Complex that were
sufficient to produce an incremental increase in lifetime risk
of cancer and increase the risk of respiratory non-cancer
effects. However, since the incremental risk was relatively
small, it would not be scientifically meaningful to provide
broad medical screening for all potential exposed personnel.''
In April 1998, at the direction of the Assistant Secretary
of the Navy for Manpower and Reserve Affairs, Navy Medicine
developed a comprehensive risk communication and health
consultation plan. This plan addressed the means for providing
information to the community, establish procedures for
providing formal risk communication to everyone onboard NAF
Atsugi and personnel negotiating orders to Atsugi, and
implemented health consultations and documentation describing
the potential exposure conditions at NAF Atsugi.
In coordinating with the VA, the primary process followed
by DOD and Navy Medicine is to ensure the VA is aware of
individual hazards exposures and that the information is
entered into the medical records of those affected, so it is
available to the VA at the time of treatment or claims
adjudication.
This process was initiated for NAF Atsugi base residents
beginning around 1995 to 1998 timeframe and continued until the
incinerator closed in 2002. In June 2009, following a brief by
Navy Medicine, the DOD/VA Deployment Health Working Group
agreed the VA would receive a list of all affected active duty
personnel stationed at NAF Atsugi from 1985 to 2001. This
collection of information will aid in any future outreach or
surveillance activities for this population as indicated.
Presently, Navy Medicine, through the Navy and Marine Corps
Public Health Center, has developed a Web site that provides
all publicly available documents related to NAF Atsugi and a
frequently asked questions section as a means of providing
information to former Atsugi residents, their health care
providers, and the VA. This Web site also has a link allowing
any VA medical care provider the opportunity to contact a Navy
physician directly for any additional information on health
issues related to the NAF Atsugi exposures.
Mr. Chairman, distinguished Members of the Committee, thank
you for the opportunity to share with you Navy Medicine's
efforts in evaluating exposures from the incinerator at NAF
Atsugi.
[The prepared statement of Mr. Gillooly follows:]
Prepared Statement of Paul Gillooly, Ph.D., Captain, Medical Services
Corps, U.S. Navy (Retired) Navy/Marine Corps Public Health Center
Chairman Akaka, Senator Burr, distinguished Members of the
Committee: I am Dr. Paul Gillooly, representing Navy Medicine, to
address Navy Medicine's efforts in relation to potential health risks
for U.S. Navy personnel and their families living and working on Naval
Air Facility (NAF) Atsugi, Japan, from the operation of the adjacent,
privately owned, Japanese Shinkampo Incineration Complex (SIC).
Navy Medicine conducted or sponsored three human health risk
assessments, three epidemiological studies and a medical screening
study.
HEALTH RISK ASSESSMENTS
At the request of the Commanding Officer (CO), NAF Atsugi, in 1994,
the Navy Environmental Health Center (NEHC) conducted a screening human
health risk assessment (HRA) with data collected in July, August and
September 1994 by Naval Facilities Engineering Services Center (NFESC).
The assessment was considered to be a screening assessment because the
air quality data collected by NFESC was not intended for human health
risk assessment purposes but for compliance purposes, as it was
collected over a limited period of time, of short duration and air was
the only medium sampled. Groups of chemicals sampled included Volatile
Organic Compounds (VOCs); Polycyclic Aromatic Hydrocarbons (PAHs);
Organochlorine pesticides and Polychlorinated Biphenyls (PCB); Dioxins
and Furans; and metals and particulates. The screening assessment was
released in October 1995 and can be found at http://www-
nmcphc.med.navy.mil/downloads/ep/Atsugi/NAF%20ATSUGI%
20SCREENING%20RISK%2095%20image.pdf. This screening HRA indicated that
the air quality at NAF Atsugi could raise the additional lifetime
cancer risk to levels higher than the U.S. Environmental Protection
Agency's (USEPA's) acceptable lifetime cancer risk range (i.e., 1 in
10,000 to 1 in 1,000,000 additional cases of cancer) for children
(under the age of six) spending a normal three-year tour of duty at NAF
Atsugi. This risk assessment is based on the interpretation of the
National Contingency Plan 40 CFR Part 300 (2003) Subpart E--Hazardous
Substance Response Section 300.430 Remedial Investigation/Feasibility
Study (d) Feasibility Study (2)(i)(a)(2). Current EPA regulatory risk
assessment procedures estimate cancer risks as additional lifetime
incidence. The screening risk assessment also indicated concerns for
non-cancer health effects, related to trimethyl benzenes and chromium.
The Commander in Chief, U. S., Pacific Fleet (CINCPACFLT) requested
NEHC to conduct another screening HRA with 1997 air quality data
collected by Earth Tech under contract to Naval Facilities Engineering
Command Pacific. The data was collected to address compliance issues,
as a result of the SIC owner's request to the Government of Japan to
modify the operating permit to allow for an increase in operating hours
and throughput. The second screening HRA supported the first with
regard to indicating a similar level of concern for calculated cancer
risk and concern for non-cancer health effects in the exposed
population. It can be found at http://www.nmcphc.med.navy.mil/
downloads/ep/Atsugi / SCREENING % 2 0 LEVEL % 2 0 AIR_
TECHNICAL%20MEMO%20NOV%2098.pdf.
In October 1997, the Bureau of Medicine and Surgery (BUMED) was
tasked by Commander in Chief U.S. Pacific Fleet, to conduct a
comprehensive HRA. Sampling for the assessment was conducted from March
1998 until July 2000. Eight groups of air pollutants were monitored,
including: acid gases; aldehydes and ketones; dioxins; PCBs and
pesticides; particulate matter (PM10 and PM2.5) and heavy metals,
mercury, VOCs, and semi-volatile organic compounds (SVOCs). In soil,
sampling was conducted for metals; pesticides and PCBs; SVOCs; and
dioxins. Sampling was conducted to collect representative data that is
spatially and temporally distributed over various seasons and various
weather and incinerator operating conditions. The results of the
comprehensive health risk assessment were as follows: http://www.
nmcphc.med.navy.mil/downloads/ep/Atsugi/
Complete_Health_Risk_Assessment.PDF.
The cancer risk for children (under the age of 6) living
on base for a 3-year tour of duty suggested that a child's exposure to
contaminants from air and soil during a 3-year tour of duty could
potentially result in an additional lifetime cancer risk of 1.1 per
10,000.
The calculated cancer risk for adults living or working on
base for a 3 or 6-year tour of duty suggested that an adult's exposure
to contaminants from air and soil falls within the cancer risk range of
1 in 10,000 and 1 in 1,000,000.
Eight groups of air pollutants were monitored, including:
acid gases; aldehydes and ketones; dioxins; PCBs and pesticides;
particulate matter (PM10 and PM2.5) and heavy metals, mercury, VOCs,
and semi-volatile organic compounds (SVOCs). In soil, sampling was
conducted for metals; pesticides and PCBs; SVOCs; and dioxins
Potential adverse non-cancer health effects that may be
related to concentrations of chemicals in the air such as irritation of
the eyes and upper respiratory system, headaches, and skin rash are
short lived and directly related to exposure. Health effects related to
some of the individual chemicals that cause respiratory effects may be
reversible when an individual leaves NAF Atsugi. However, there is some
concern that repeated long-term exposure to chemicals, in combination
with others, might result in long-term, non-cancer health effects.
Because risk assessments use many assumptions and
estimates, the final risk numbers always contain some uncertainty.
Because of this, the numbers need to be interpreted with caution. The
true risk numbers may be higher or lower; however, they are likely
lower because there were many conservative assumptions and estimates
used in the risk assessment to be health protective, as it was based on
an upper bound risk. In the U.S., risk assessment results similar to
those found at NAF Atsugi may, in some contexts, result in additional
USEPA regulatory action. Legal and political action initiated by the U.
S. Department of Justice eventually resulted in the closure of the
Shinkampo Incinerator Complex in 2001.
EPIDEMIOLOGICAL HEALTH STUDIES
To respond to NAF Atsugi community concerns, NEHC conducted three
health studies, a Children's Respiratory Health Study (children at
Yokosuka, Japan, and those on and off-base at Atsugi), a Pregnancy Loss
Study for Women at NAF Atsugi, and a Retrospective Cohort Study of
Disease.
Children's Respiratory Study
The Children's Respiratory Study was designed to determine if air
pollutants from the Shinkampo incinerator were affecting the
respiratory health of children. Between 7 May 1998 and 5 June 1998, 127
fifth and sixth grade children who attended Atsugi or Yokosuka DOD
schools volunteers participated in a health study. The study can be
found at: http://www-nmcphc.med.navy.mil/downloads/ep/Atsugi/
Complete_Health_Risk_Assessment.PDF.
There were two primary goals of this study. The first was to
determine if there were differences in respiratory health between
children who live or go to school at NAF Atsugi and similar children
who live at Yokosuka. The second goal was to identify whether the
children who live or go to school at Atsugi have more respiratory
symptoms on days when they were exposed to higher levels of pollutants
from the SIC.
Given the limits of this study, we were not able to document
differences in the respiratory health of children living on or off base
at NAF Atsugi versus those at Yokosuka.
Pregnancy Loss Study
The Pregnancy Loss Study, designed to describe the rate of
miscarriage at NAF Atsugi and other naval facilities in Japan, was
conducted in the summer of 1998. The researchers examined hospital and
clinic records for Navy personnel or their dependents who were pregnant
and living in Japan at some point between June 1995 and May 1998.
Information used to calculate the miscarriage rates came from three
different sources, Delivery Logs at Naval Hospital Yokosuka (NHY),
Pathology records at NHY and the Prenatal Log at the Atsugi Branch
Medical Clinic. The study can be found at: http://www-
nmcphc.med.navy.mil/downloads/ep/Atsugi/
Complete_Health_Risk_Assessment.PDF.
A total of 1862 pregnancies with known outcomes from NHY (including
Atsugi, Yokosuka, Sasebo and Iwakuni) were examined. There were 1701
live births and 130 miscarriages between June 1995 and May 1998. The
corresponding miscarriage rate for this period was 7.1%. The rate at
NAF Atsugi, determined from review of the prenatal log during the same
period, was 8.8%. Statistically, there is no difference between the
overall NH Yokosuka rate and the Atsugi rate. This rate was based on
the examination of 353 total pregnancies, with 322 live births and 31
miscarriages.
Within study constraints, the results of the study indicated that
the risk of miscarriage at NAF Atsugi was comparable to Yokosuka,
Retrospective Cohort Study of Disease
In March 2007, Navy and Marine Corps Public Health Center (NMCPHC),
formerly NEHC, was requested by the Navy Bureau of Medicine and Surgery
(BUMED) to investigate the long-term health effects that might be
associated with exposure to SIC emissions. NMCPHC reviewed the HRA to
determine the appropriate diseases to study based on chemicals
identified in the environmental sampling results. Target organs and
illnesses were selected based on published environmental exposure
literature from USEPA and peer reviewed literature. Using this
information, the Atsugi Health Study was designed to determine if
incidence of disease associated with exposure to the emissions of the
SIC significantly differ for residents of NAF Atsugi from 1985 to 2001
when compared to a similar population over the same time period. The
study can be found at: http://www-nmcphc.med.
navy.mil/downloads/ep/Atsugi/Complete_Health_Risk_Assessment.PDF.
The study included over 5,600 active duty and over 11,000 family
members in NAF Atsugi former-resident cohort. Current medical
information was available for 24% of active duty and 28% of dependents
compared to 19% and 25% for comparison population. Outcomes were
studied for 11 cancer types and non-cancer outcomes for ocular, dermal,
and respiratory disorders.
The results of the study found a significantly higher risk for
dermal complaints, a non-cancer health effect, in the Atsugi population
when compared to the Yokosuka population. No other area of analysis
found significant differences in disease and illness incidence or
health complaints. None of the types of cancer considered as possible
associated with exposure to SIC pollution had significantly different
risk ratios between the populations.
Medical Screening Study
Navy Medicine, via the Navy and Marine Corps Public Health Center,
requested Battelle Memorial Institute, an external private agency,
independent from the Navy, to review the health risk assessment data
and make recommendations for possible additional medical screening.
Battelle Memorial Institute was requested to answer a specific question
with supporting evidence: ``For those who lived aboard NAF Atsugi
during the time of incinerator operation, what, if any, additional
population-based medical screening might be indicated? Provide the
medically supported basis for that determination.'' Furthermore, if
additional population-based medical screening is indicated, recommend
screening parameters, include the standard used and the expected
outcome such screening would have on the population's health.
As background for those not familiar with population-based medical
screening, the U.S. Preventive Services Task Force (USPSTF),
established in 1984 under the U.S. Department of Health and Human
Services, has routinely published recommendations for primary care
practitioners on what medical screening or testing should be provided
to apparently healthy persons based on age, sex and risk factors for
disease. These are general medical screening recommendations that are
appropriate for any and all members of the U.S. population that are in
the recommended screening group. These provide early detection of
diseases ranging from cancer to mental health conditions. The
recommendations can be accessed at: http://www.ahrq.gov/clinic/
prevenix.htm.
From the Battelle report's Executive Summary: ``The conclusion of
all previous evaluations are remarkable for their consistency:
residents of NAF Atsugi were exposed to ambient air and soil
contaminants [based on chemicals analyzed for the 2002 human health
risk assessment], due primarily to emissions from the SIC, that were
sufficient to produce an incremental increase in lifetime risk of
cancer and increase the risk of respiratory non-cancer health effects.
However, since the incremental risk was relatively small, it would not
be scientifically meaningful to provide broad medical screening for all
potentially exposed personnel.'' Because of the authors' opinion that
there is no epidemiologic study protocol, with or without medical
testing, capable of detecting the small number of cancers that could
possibly have been caused by an environmental exposure from the
incinerator against the normal background of cancer incidence in the
human population, no additional screening or testing is recommended for
disease that is not already evident.
COMMUNICATIONS
Communication with NAF Atsugi Population
In April 1998, at the direction of Assistant Secretary of the Navy
for Manpower and Reserve Affairs (ASN(M&RA)), NEHC developed a
comprehensive risk communication and health consultation program. This
was coordinated with the Bureau of Medicine and Surgery, NAF Atsugi,
Branch Medical Clinic Atsugi, Commander Naval Forces Japan, Bureau of
Naval Personnel and Commander in Chief, U.S. Pacific Fleet. The plan
established procedures for providing formal risk communication to
everyone onboard NAF Atsugi and personnel with orders to Atsugi. One-
on-one health consultations were conducted for all adults extending for
more than six years on station, all adults who had children under the
age of six, those with chronic respiratory conditions and pregnant or
nursing women. A standard entry was made in medical records that
described potential exposure conditions at NAF Atsugi.
The program required that Navy Detailers mention the air quality
issue and refer military members to medical and base points of contact
for further information. It required overseas medical screeners discuss
the health risks and provide a focused health consultation for
individuals with orders to NAF Atsugi and a provide a fact sheet
addressing potential risks of living and working at NAF Atsugi. A
phased approach was established to inform individuals of potential
risks to adults and children living or working at NAF Atsugi.
A Health and Environmental Risk Communication Plan addressed the
means for providing information to the community (e.g., base newspaper
articles, public availability sessions, fact sheets, web sites, library
repositories).
Several different medical record forms were used at NAF Atsugi to
respond to concerns from NAF Atsugi military personnel and their
families about medical documentation and full disclosure of their
potential exposure and possible health effects. All forms were placed
in personnel and family permanent health records. Branch Medical Clinic
Atsugi, with Bureau of Medicine and Surgery's approval, developed a
medical record form that listed the maximum sampling concentrations
measured in 1994 for 12 chemicals exceeding USEPA or New York State
ambient air quality standards during the air quality study. These
chemicals included: sulfur dioxide, nitrogen dioxide, hydrochloric
acid, carbon tetrachloride, benzene, dioxins, cadmium, mercury, nickel,
chromium, arsenic and respirable particulates. (http://www-nmcphc.
med.navy.mil/downloads/ep/Atsugi/Appendix_A_appendices.pdf) Cancer
risks were also provided on this form. Beginning 1 March 1996, this
form was inserted in medical records of all individuals that requested
the documentation.
During health risk communication and consultation at NAF Atsugi,
which began in June 1998, a revised form was completed for every
individual at NAF Atsugi and those with orders to NAF Atsugi. This new
form documented full disclosure of potential exposures and possible
health effects, related to environmental conditions, for each military
member and family member based upon their medical history. The new form
was signed by each adult family member (18 years and older) to
acknowledge receipt of risk communication. The sponsor or spouse signed
the new form for children under the age of 18. Additionally, all
servicemembers and family members over the age of 17 indicated that
they received a risk communication briefing by signing an
``Administrative Remarks NAVPERS 1070/613 (Rev. 10-81),'' commonly
referred to as a ``Page 13'' entry to be retained in their military
record. Prior to detachment from NAF Atsugi, another medical form was
completed to document arrival and departure dates and locations of
residence, schools attended and employment, while assigned to NAF
Atsugi.
Communication with the Department of Veterans Affairs (VA)
The primary process followed by the DOD and Navy Medicine to ensure
the VA is aware of individual hazardous exposures is to ensure all
individual exposure-related information is entered into individual
medical records of those affected so it is available to the VA at the
time of treatment or claims adjudication. This process was initiated
for NAF Atsugi base residents beginning in the 1995-1998 timeframe and
continued until the incinerator closed in 2001. Navy Medicine follows
the DODI 6055.05, ``Occupational and Environmental Health,'' Paragraph
2.c., ``Data Sharing,'' which requires DOD to share hazard and exposure
data with the VA to assist in adjudication of veterans' disability
claims. However, there is no specific policy that identifies the
conditions or circumstances that require notification to the VA of
possibly harmful exposures.
Presently, Navy Medicine, through the Navy and Marine Corps Public
Health Center (NMCPHC) has developed a Web site that provides all
publicly available documents related to NAF Atsugi and a Frequently
Asked Questions (FAQ) section as means of providing information to
former Atsugi residents, their health care providers, and the VA. These
documents include the two health risk assessments from 1995 and 1998
and the final comprehensive health risk assessment from 2002, which
along with other studies and reviews, provides the necessary
information from which the VA can adjudicate filed claims from military
members stationed at NAF Atsugi. The Web site also has a link allowing
any VA medical care provider the opportunity to contact a Navy
physician directly for any additional information on health issues
related to the NAF Atsugi exposures.
For several years, DOD and VA have collaborated in the DOD/VA
Deployment Health Working Group, which focuses on post-deployment
health of Servicemembers and veterans. This working group has a major
focus on environmental and occupational exposures, and it discusses
these issues at nearly every monthly meeting. These issues have
specifically included the Atsugi incinerator. In the case of the
personnel who were stationed at Atsugi, Japan, the DOD/VA Deployment
Health Work group received a briefing on the incinerator-generated
exposures in June 2009 by the BUMED Occupational Medicine Program Head.
In June 2009, following a brief by Navy Medicine, the DOD/VA
Deployment Health Working Group agreed the VA would receive a list of
all affected Active Duty personnel stationed at NAF Atsugi from 1985-
2001. These data come to the Navy and Marine Corps Public Health Center
from the NAF Atsugi Retrospective Cohort Study of Disease, a cohort
epidemiology investigation that utilized personnel records from the
Defense Manpower Data Center to assemble the two cohorts for analysis.
There were 5,635 Active Duty servicemembers identified from the Defense
Manpower Data Center personnel records as being stationed at NAF Atsugi
from 1985-2001. This collection of information will aid in any future
outreach or surveillance activities for this population as indicated.
MEDICAL SURVEILLANCE
After the Shinkampo Incinerator Complex shut down in 2001, outreach
and health consultation activities centered on the specific
environmental health exposures for the NAF Atsugi base population, were
discontinued. The final health risk assessment performed by the Navy
Environmental Health Center (NEHC), forwarded for release in 2002, did
not reveal any major changes in the types of materials that posed risk
to base residents nor the potential consequences to their health as
determined in the 1995 and 1998 health risk assessments. Excess cancer
risk was considered to be one new cancer above baseline per 10,000
individuals who as adults stayed more than 6 years at NAF Atsugi or as
child under six years of age stayed longer than 3 years. For
perspective, this excess cancer risk is approximately the same for
adults who live in Denver as opposed to another city at sea level due
to increased exposure to naturally occurring ionizing radiation at the
higher altitudes.
Mr. Chairman, distinguished Members of the Committee, thank you for
the opportunity to share with you Navy Medicine's efforts in relation
to exposures at NAF Atsugi.
______
Response to Post-Hearing Questions Submitted by Daniel K. Akaka to Paul
B. Gillooly, Ph.D., CAPT, Medical Services Corps, U.S. Navy (Ret.),
Navy/Marine Corps Public Health Center
Question 1. Please provide the best estimate of the size of the
population that was at Atsugi between 1983 and 2001. Of this
population, how many were servicemembers and how many were dependents,
both adult and children? Please also provide the ages of the children.
Response. Due to past Navy initiatives at paperwork reduction,
archive/disposal rules and available storage space, there is limited
data available. Review of NAF Atsugi's primary mission reflected no
major operational revisions during this time period and therefore the
number of personnel on base would have remained fairly constant.
Snapshot reviews of Command History, Housing Department files, and
School records reflect the estimated population averages and
demographics as follows:
Officers Authorized........................................... 373
Enlisted Authorized........................................... 2,532
U.S. Civilians Authorized (U.S.C.S.).......................... 273
NAFI Assigned................................................. 271
Japanese Nationals (Master Labor Contract).................... 1,298
Dependents on base............................................ 1,866
Dependents off base........................................... 610
Total servicemembers.......................................... 2,905
Dependents on/off base........................................ 2,476
NAF Atsugi only maintains an Elementary School. Junior and Senior
Schools are offsite. School attendance records are not available
between the years of 1993-2001. Children ages are not available, but
school grades are provided (from which approximate ages can be
extrapolated). Based on attendance files from 2006 to 2009 the
following average enrollments numbers are:
Pre-School.................................................... 18
Kindergarten.................................................. 85
1st Grade..................................................... 88
2nd........................................................... 85
3rd........................................................... 78
4th........................................................... 66
5th........................................................... 70
6th........................................................... 51
Question 2. Is there a study that can be done that will provide
more accurate data than those done in the past? What would that look
like?
Response. The safety and health of our personnel deployed overseas
is our number one priority. Therefore, a comprehensive human health
risk assessment was conducted which included accurate and extensive
ambient air, indoor air, and soil sampling in areas where our military
and civilian members and their families lived, worked, and played.
The June 2002, comprehensive ambient air samples were conducted
approximately once every 6 days between April 1998 and June 1999. Five
different ambient air locations and seven indoor air locations were
sampled. A total of 344 ambient air samples and 67 indoor air samples
were collected. During each sampling event, wind speeds and directions
were also taken in order to correlate this data with ambient air
findings. In March 1998, extensive soil samples were collected across
the base.
To ensure that the best science was used in the health risk
assessment, Navy Medicine requested that the US Environmental
Protection Agency (USEPA) and the National Academies of Science (NAS)
review and comment on the draft comprehensive health risk assessment.
USEPA scientists reviewing this health risk assessment generally
concurred with the study design, methodologies, and conclusions. The
NAS made positive comments regarding their confidence in the sampling
techniques, data collected, and meteorological monitoring. Both made
recommendations for the final report.
Consequently, Navy Medicine made changes to the draft comprehensive
health risk assessment report in response to USEPA and NAS comments and
recommendations. The final comprehensive risk assessment report, dated
June 2002, includes additional information and revisions in response to
their comments and recommendations. The final report includes Navy
Medicine responses to comments received from USEPA (Appendix B--51
pages) and the NAS (Appendix C--98 pages), which follows this response.
Navy Medicine expended approximately an additional nine months,
responding to these recommendations and incorporating changes to the
comprehensive health risk assessment, to ensure the best science
possible was used in support of our Navy community.
Last, the Agency for Toxic Substances and Disease Registry (ATSDR)
reviewed the health risk assessment and provided the following
statement: ``Based on the level of detail presented in the Navy's
assessments and the reviews of those documents, especially those
performed by the National Research Council [NAS], we concluded that
additional public health assessment activities by ATSDR are not
necessary as they would not provide an evaluation that is any more
definitive than those that have already been conducted.''
Attachment B
Attachment C
Question 3. Why did the Navy wait so many years before acting
against the SIC operation?
Response. The incinerator operation was located outside the fence
line of NAF Atsugi on the sovereign territory of the host Nation. The
operation began as a small burn pit and grew to a full scale
incinerator over the years. The Navy was very proactive and began
monitoring plant operations and air sampling as early as September
1988, followed by the conduct of the Navy Medicine Comprehensive Health
Risk Assessment . The Navy shared the data with the GoJ via USFJ, and
pursued solutions through the Host government at the highest levels of
DOD, the State Department, and other official channels [Justice
Department] until the GoJ finally took action on the issue and the
operation was subsequently closed in 2001.
Question 4. On what date did the Navy require SF600s to be placed
in servicemembers' medical records?
Response. Beginning in March 1996 and ending sometime after the
incinerator was shut down in May 2001, several different SF600s were
developed for inclusion in medical records of individuals assigned to
Naval Air Facility Atsugi.
The first SF 600 developed, listed the maximum sampling
concentrations measured in 1994 for 12 chemicals exceeding USEPA or New
York State ambient air quality standards during the air quality study
conducted by Naval Facility Engineering Services Center. Cancer risks
were also provided on this SF600. Beginning 1 March 1996, this SF 600
was inserted in medical records of all individuals that requested the
documentation.
In February 1998, BUMED sent an Administrative Message
regarding overseas screening for NAF Atsugi Japan indicating
``Effective immediately, for all family members being screened for
overseas assignment for NAF Atsugi, place an overprinted SF600
articulating the situation in the individuals health records text for
the SF600 follows: ``To be retained permanently in the health record.
This SF600 is to document full disclosure of potential environmental
exposures for all personnel and their families who are assigned to NAF
Atsugi. Authority: Chief BUMED 262200ZFebruary 98.
In May 1998, Commander in Chief, U.S. Pacific Fleet sent
an Administrative Message regarding ``Risk Communication and Health
Consultation Plan for Naval Activities Onboard Naval Air Facility
Atsugi Japan.'' The message addressed the implementation of a
Comprehensive Risk Communication and Health Consultation Plan.
In July 1998, BUMED sent an updated Administrative Message
regarding overseas screening for NAF Atsugi Japan to address this
``Detailed Comprehensive Risk Communication and Health Consultation
Plan for NAF Atsugi.''
The comprehensive health risk communication and consultation at NAF
Atsugi began in June 1998. A revised SF 600 was developed to be
permanently retained in the medical records for every individual at NAF
Atsugi and those with orders to NAF Atsugi. The purpose of the SF600
was to document potential exposures and possible health effects,
related to environmental conditions, for each military member and/or
family member based upon their medical history. An SF600 overprint was
to be completed at the time of the member's Departure Health
Consultation to document the history on where servicemembers and family
members lived, worked, or attended school or day care while at NAF
Atsugi.
______
Response to Post-Hearing Questions Submitted by Hon. Richard Burr to
Paul B. Gillooly, Ph.D., CAPT, MSC, USN (Ret.), Public Health Assessor,
Navy Marine Corps Public Health Center
Question 1. The Shinkampo Incineration Complex operated near Naval
Air Facility (NAF) Atsugi from 1985 to 2001.
A. During that time, were there any recommendations made within the
Navy to relocate military families stationed at Atsugi?
B. If any such recommendation was made, where did the
recommendation originate in the Navy and what was the final disposition
of the recommendation?
Response. Relocation of families was considered, but was regarded
as a significant morale issue for a forward-deployed air wing. At a
point during the time period, families were provided notice of the
concerns surrounding the Shinkampo Incineration Complex prior to moving
to Atsugi NAF and had the option of curtailing their tour. USFJ was
fully engaged in the Shinkampo issue, and consistently raised the
Shinkampo problem at Joint Committee meetings with the Government of
Japan.
Question 2. In June 2009, the Navy and Marine Corps Public Health
Center released an ``Executive Summary for NAF Atsugi Health Study,''
which compared health outcomes experienced by NAF Atsugi residents with
health outcomes of individuals stationed at another base in Japan.
According to that summary, ``[c]entral nervous system, liver and kidney
damage were not included [in the study] for their non-cancer effects
because the available literature was felt to be inadequate regarding
the very low levels reported'' in the Navy's 2002 Human Health Risk
Assessment. However, the medical records of former NAF Atsugi residents
contain a form explaining that they were exposed to 12 emissions that
exceeded the Environmental Protection Agency's ambient air quality
standards.
A. Is the Navy aware that the Agency for Toxic Substances and
Disease Registry has found that exposure to some of those chemicals,
such as carbon tetrachloride, may cause liver, kidney, and central
nervous system damage?
Response. Yes, the Navy is aware that the Agency for Toxic
Substances and Disease Registry (ATSDR) publishes a list of reported
health effects from studies that include some of the chemicals that
were also found in the NAF Atsugi Health Study. These documents were
reviewed when determining the health effects to include in the NAF
Atsugi Study. ATSDR also reported levels of exposure at which these
effects might be observed in humans, but these levels were much greater
than those reported in the Navy's 2002 Human Health Risk Assessment.
The presence of a chemical is not sufficient to associate it as the
cause of disease. The studies cited by ATSDR were mostly occupational
and had exposures much higher than those measured, during the NAF
Atsugi, Japan Human Health Risk Assessment, dated June 2002.
As stated in the full report of the NAF Atsugi Health Study
(Paragraph V.A.2), the ambient air concentrations measured in Atsugi
were primarily compared to the concentrations reported by the US
Environmental Protection Agency (USEPA). If the USEPA did not have a
current risk assessment, other sources were used for the health effects
comparison. As an example, the mean ambient air concentration for
carbon tetrachloride was reported to be 0.616 micrograms per cubic
meter of air (ug/m3). For comparison to the levels reported by USEPA
and in the literature, the mean value had to be converted to parts per
million (PPM). Based on the atomic mass of carbon tetrachloride, 0.616
ug/m3 converts to 0.1 PPM (at 20 degrees centigrade and 1 atmosphere of
pressure). When this level is compared to the studies cited in the
ATSDR Toxicological Profile for Carbon Tetrachloride, no non-cancer
health effects were observed in humans.
B. What steps does the Navy intend to take to ensure that these or
other relevant health effects are considered in investigating the long-
term health effects that might be associated with the exposures at NAF
Atsugi?
Response. Navy Medicine has not been tasked to investigate the
long-term effects for residents of Atsugi when the incinerator was
operating. Navy Medicine does not have full access to the medical
information for persons once they leave active service.
Question 3. The Navy testified that a Department of Defense and
Department of Veterans Affairs working group ``agreed the VA would
receive a list of all affected Active Duty personnel stationed at NAF
Atsugi from 1985-2001'' and that this information ``will aid in any
future outreach or surveillance activities for this population.''
A. In addition to maintaining a Web site with information related
to NAF Atsugi, what future outreach activities and public
communications does the Navy intend to use to ensure that former NAF
Atsugi residents are aware of the environmental exposures related to
the Shinkampo incinerator?
Response. The Navy Marine Corps Public Health Center (NMCPHC) web
page is BUMED's primary means of communicating the information to those
with questions and concerns.
The maintenance and updating NMCPHC's Web site is Navy Medicines
primary means of communicating this information. Further communication
plans fall outside of Navy Medicine's purview.
B. Has the Navy already shared with VA the names of individuals who
were stationed at NAF Atsugi between 1985 and 2001? If not, when will
those names be provided to VA?
Response. As mentioned during the hearing, Navy Medicine has
presented the pertinent information before the DOD/VA Deployment Health
Working Group focusing on environmental exposures on 11 June 2009. The
VA is aware of the type of information Navy Medicine has available, but
to date no official request from the VA has been received by Navy
Medicine.
Chairman Akaka. Thank you very much, Dr. Gillooly, for your
testimony, and now we will receive the testimony of General
Payne.
STATEMENT OF MAJOR GENERAL EUGENE G. PAYNE, JR., ASSISTANT
DEPUTY COMMANDANT, INSTALLATIONS AND LOGISTICS (FACILITIES),
HEADQUARTERS, U.S. MARINE CORPS.
General Payne. Senator Akaka, Senator Burr, thank you for
the opportunity to appear before you and participate in this
hearing regarding past drinking water exposures at Marine Corps
Base Camp Lejeune.
My name is Major General Gray Payne and I am the Assistant
Deputy Commandant for Installations and Logistics for
Facilities. In that regard, I am responsible for Marine Corps
facilities and services issues on all of our installations, to
include environmental protection.
The health and welfare of our Marines, sailors, their
families, and our civilian workers are a top priority for the
Marine Corps. The Marine Corps is and always has been a very
large family and we all know people, including myself, who are
stationed or worked at Marine Corps Base Camp Lejeune during
their military careers.
The Marine Corps is deeply concerned with all the military
and civilian families who are experiencing or have experienced
any health issues. We understand that there are those who
believe their health concerns may be a result of time spent at
Camp Lejeune. The Marine Corps consists of war fighters and
those who directly support war fighters. We have no public
health experts.
Accordingly, we rely on the expertise of the scientific
organizations like the Agency for Toxic Substances and Disease
Registry, or ATSDR, and the National Academies National
Research Council, or NRC, to inform our understanding of this
issue. We have provided over $14.5 million in funding and have
exhausted countless man hours and direct support of research
initiatives. Unfortunately, the studies completed to date have
not determined whether or not there is an association between
the past contamination and adverse health effects.
We would like nothing more than to have those hard
questions answered. So, we will continue to support and
cooperate with the Department of Veterans Affairs, the ATSDR,
and the NRC in an effort to get answers for those of our Marine
Corps family who may have been exposed to volatile organic
compounds in drinking water at Camp Lejeune in the past.
Sir, you have my written statement, so in the interest of
time, I will conclude my remarks, and I am certainly available
to answer any questions you may have.
[The prepared statement of General Payne follows:]
Prepared Statement of Major General Eugene G. Payne, Jr., Assistant
Deputy Commandant for Installations and Logistics (Facilities),
Headquarters, U.S. Marine Corps.
Senator Akaka, Senator Burr, distinguished Members of the
Committee; thank you for the opportunity to appear before you and
participate in this hearing regarding past drinking water exposures at
Marine Corps Base Camp Lejeune. My name is Major General Gray Payne and
I am the Assistant Deputy Commandant for Installations and Logistics
for Facilities. I am responsible for Marine Corps facilities and
services issues on our installations, to include environmental
protection.
The health and welfare of our Marines, Sailors, their families, and
civilian workers are a top priority for the Marine Corps. The Marine
Corps is and always has been a large family, and we all know people,
including myself, who were stationed or worked at Marine Corps Base,
Camp Lejeune during their military careers. The Marine Corps is deeply
concerned with all the military and civilian families who are
experiencing or have experienced any health issues and we understand
that there are those who believe their health concerns may be a result
of time spent at Camp Lejeune. The Marine Corps consists of war-
fighters, and those who directly support war-fighters. We have no
epidemiological experts, and accordingly we rely on the expertise of
scientific organizations like the Agency for Toxic Substances and
Disease Registry (ATSDR) and the National Academies, National Research
Council (NRC) to inform our understanding of this issue. We have
provided over $14.5 million in funding and have exhausted countless
man-hours in direct support of research initiatives. We will continue
to support and cooperate with the Veterans Administration, the ATSDR
and the NRC in an effort to get answers for those of our Marine Corps
family who may have been exposed to volatile organic compounds (VOC) in
drinking water at Camp Lejeune.
HISTORY OF DISCOVERY
It is important to keep in mind that the
events surrounding this situation occurred over 25 years ago.
Environmental standards and regulations have changed dramatically over
the intervening years as a result of advances in scientific knowledge
and increased public awareness. The events at Camp Lejeune must be
considered in light of the scientific knowledge, regulatory framework,
and accepted industry practices that existed at the time, rather than
in the context of today's standards.
Trichloroethylene [TCE] and tetrachloroethylene [PCE] were
discovered in the Camp Lejeune drinking water in the early 1980's. The
circumstances that led up to the discovery are as follows. In 1981,
Camp Lejeune officials became aware that VOCs were interfering with the
analysis of potable water samples that were being collected in
preparation for the implementation of future drinking water standards
for Total Trihalomethanes (TTHM). Sampling conducted by a Navy
contractor revealed that another chemical present in the water sample
was interfering with the analysis; however, the type of chemical and
source were unknown. Base personnel continued to sample the water for
TTHMs over the next several years using various laboratories with
varying results. Through targeted sampling in 1982, two of Camp
Lejeune's eight public drinking water systems were determined to be
contaminated by two chemicals--TCE and PCE. TCE and PCE are chemicals
commonly found in degreasing agents and dry cleaning solvents
respectively. It is important to note that there were no drinking water
regulations in place for TCE, PCE, benzene, or vinyl chloride at the
time of discovery. In the early 1980's, the Naval Assessment and
Control of Installation Pollutants (NACIP) program, a precursor to the
Department of the Navy (DON) Installation Restoration Program, was
already in the process of identifying contaminated sites on Base for
further sampling and investigation. Plans were in place to sample
potable wells near the identified contaminated sites. It was these
sampling events that identified, between late 1984 and early 1985,
individual wells that contained groundwater impacted with TCE and PCE
and other VOC's such as benzene. As the Base received sampling data on
impacted wells, the wells were promptly removed from service. A
separate investigation by the State of North Carolina in 1985 revealed
leaks from an off-base dry cleaner had contaminated the wells near the
Tarawa Terrace housing area. The Hadnot Point water system was
contaminated by on-base sources. As referenced above, no drinking water
standards for TCE or PCE were in place at the time of discovery, and
all impacted wells were voluntarily removed from service promptly by
Base direction in late 1984/early 1985. Initial regulation of these
volatile organic compounds under the Safe Drinking Water Act did not
begin until 1987. Final regulations on the chemicals were in force in
1989 and 1992, respectively.
NOTIFICATION
Camp Lejeune first notified military personnel and family members
about the impacted drinking water on December 13, 1984, through an
article appearing in Camp Lejeune's newspaper, The Globe. Camp Lejeune
also distributed a public notice to residents of Tarawa Terrace on
April 30, 1985. In May 1985, Camp Lejeune issued a press release
announcing the water contamination problem and explaining the steps
being taken to restore water services to the affected base residents.
Jacksonville Daily News and Wilmington Morning Star printed stories on
the situation on May 11 and 12, 1985.
In 2000, ATSDR requested assistance from the Marine Corps to reach
additional participants for a survey they were conducting. At the time,
the number of participants was approximately 6,500. ATSDR needed over
12,000 for a statistically valid study. The Marine Corps played an
active role in assisting ATSDR in identifying participants eligible for
the survey through both targeted and global notifications. In January
2000, Camp Lejeune held an ``open house'' with base residents and the
Jacksonville community to discuss issues about the drinking water
previously discovered to contain VOCs. In August 2000, Headquarters
Marine Corps sent a message to all Marines worldwide in an effort to
reach potential ATSDR survey participants. In addition, articles were
published in numerous base newspapers including the Quantico Sentry,
Camp Lejeune Globe, and Camp Pendleton Scout, which have a large
readership of both active duty and retired military members. Camp
Lejeune also solicited participants for the ATSDR survey by sending a
press release to other military base publications. In November 2000,
Headquarters Marine Corps held a press brief at the Pentagon asking
media to assist in helping to reach survey participants. On January 25,
2001, Headquarters Marine Corps sent a second message to all Marines
worldwide in an effort to reach potential ATSDR survey participants. In
February 2001, regional media outreach efforts began, and outlets
reached included:
(A) TV Stations--1027 outlets
(B) Daily Newspapers--1373 outlets
(C) Weekly Newspapers--1171 outlets
Total: 3571 media outlets contacted.
In 2001, Headquarters Marine Corps requested approval from the
Department of Defense to release to the ATSDR the Social Security
numbers of potential survey participants. In July 2001, Headquarters
Marine Corps received approval from DOD for a limited release of Social
Security Number information covered by the Privacy Act to the ATSDR in
order to support the ATSDR's survey participant location efforts. Based
on extensive data searches by Headquarters Marine Corps, contact
information for the names of potential survey participants was
identified and forwarded to the ATSDR.
The FY08 National Defense Authorization Act mandated that the
Secretary of the Navy attempt to directly notify former residents of
Camp Lejeune of their potential exposure to the chemicals. The Act also
required that ATSDR develop a health survey to be included with the
notification letter. On Sept. 14, 2007, the Marine Corps posted a link
to the registration database on its Web site (www.marines.mil/clsurvey)
so that former Camp Lejeune residents and workers as well as interested
parties can be placed on a contact list to receive notification and
information regarding this important issue. The call center became
operational September 17, 2007 and is used as another tool to locate
former residents and workers and register them to receive additional
updates to the ongoing studies. In addition to direct notifications,
the Marine Corps continues to use various general communication venues
to reach former base residents and workers to encourage them to
register. This general notification has included articles and/or
advertisements in: newspapers such as USA Today; periodicals such as
Time and Newsweek; internet advertisements on general consumer Web
sites such as WebMD and Weather.com.; military related Web sites such
as the Leatherneck, U.S. Navy Institute, and the Vietnam Veterans
Association; internet search engines such as Yahoo! and Google; and
radio broadcasts. As of September 28, 2009, more than 140,000
individuals have been registered with the Marine Corps.
ATSDR HEALTH INITIATIVES
All military installations on the National Priorities List of
hazardous waste sites, including Camp Lejeune which was listed in 1989,
undergo a Public Health Assessment conducted by the ATSDR to determine
if there are any current or past health concerns resulting from past
practices.
In 1992, the Agency for Toxic Substances and Disease Registry
(ATSDR) made its first of many site visits to Camp Lejeune as part of
its statutory duty to conduct a public health assessment (PHA). In
1997, the ATSDR published its PHA for Camp Lejeune. In the PHA, the
ATSDR stated that the Volatile Organic Compound-impacted water would
not likely harm adults. (Earlier this year ATSDR withdrew the PHA from
their Web site in part because it believes that the statement was
overly reassuring.). The ATSDR recommended, however, an epidemiological
study of former Camp Lejeune residents to determine what effect, if
any, the VOCs may have had on the health of prenatal children. This
population was considered by the ATSDR to be the most susceptible
population to health impacts from VOCs. In support of this
recommendation, a health study began in 1999 as a survey to determine
whether or not a statistically significant study population could be
reached for a case control study. In January 2002, the ATSDR closed its
survey with 12,598 eligible participants, and began its analysis of
survey results. In July 2003, the ATSDR released a progress report of
the survey and concluded that a follow-on case control/epidemiological
study was warranted. The Marine Corps actively participated in
publicizing this report through a press release, a Web cast by the
Deputy Commandant for Installations and Logistics, and by posting
survey information on the Marine Corps Camp Lejeune drinking water web
page. ATSDR also determined in 2003 that extensive water modeling would
be needed at Camp Lejeune in support of the case control study. That
water modeling continues today and is currently projected to be
complete in September 2011. The case control study will be completed
sometime thereafter.
In 2005, the Marine Corps hired a contractor to perform a
comprehensive search of Camp Lejeune to provide a better confidence
level that all potentially relevant documents had been found. ATSDR and
other interested parties have been provided access to all documents
that were found. In addition, we have been working with agencies
outside of the Marine Corps to ask them to provide information that may
be under their control.
INDEPENDENT REVIEWS AND INVESTIGATIONS
Three independent reviews have been conducted of the actions taken
by Marine Corps personnel on this matter: an Independent Drinking Water
Fact-Finding Panel chartered by the Commandant of the Marine Corps, an
EPA Criminal Investigation Division investigation, and a Government
Accountability Office review.
In 2004 the Fact-Finding Panel determined that Camp Lejeune
provided drinking water at a level of quality consistent with general
water industry practices in light of the evolving regulatory
requirements at the time.
In 2005 the EPA concluded that there had been no violations of the
Safe Drinking Water Act, no conspiracy to withhold information, falsify
data, or conceal evidence.
In 2007 the GAO issued a report that describes efforts to identify
and address the past contamination, activities resulting from concerns
about possible adverse health effects and government actions related to
the past contamination. The report had no findings or recommendations
for the Marine Corps.
In accordance with the 2007 National Defense Authorization Act, the
Marine Corps contracted with the National Academy of Sciences--NRC to
review the evidence regarding potential associations between exposure
to contaminated drinking water at Camp Lejeune and adverse health
effects in prenatal children, children, and adults. The NRC review
report concluded that while former Camp Lejeune residents and workers
were exposed to unregulated solvents, there are no conclusive
associations between adverse health effects and exposure to the
impacted water at the base. The report opined that further study was
unlikely to provide definitive information about the health effects of
such exposure. The report noted that the highest levels of either TCE
or PCE measured in the mixed-water samples at Camp Lejeune were much
lower than the lowest dose that caused adverse effects in the most
sensitive strains of species of laboratory animals. The review
concluded, however, that even though adverse effects were unlikely,
they could not be ruled out completely and that the DON (and other
policymakers) should move forward with responses they deem appropriate
based on available information.
We are aware of ongoing assessment activities currently being
undertaken by the US EPA and remain interested in that process.
COORDINATION WITH DEPARTMENT OF VETERANS AFFAIRS
As part of the Marine Corps robust outreach and notification
campaign we have worked extensively with various Veterans Affairs
offices. In 2007 and 2008 we sent notification and registry posters to
a total of 210 VA centers in all 50 states as well as the US
Territories and Washington, DC . We also sent copies of posters in 2007
and 2008 to VFW District Offices and Military Treatment Facilities in
all fifty states, US Territories and Washington, DC. In addition, in
March of this year, we worked with VA public affairs to alert VA
program directors and other executives of new information about the
water contamination issue via an email release. In particular, this
email release provided information on the pending release of the
National Research Council research. VA personnel were asked to directly
contact HQ USMC public affairs for additional information and
assistance.
CONCLUSION
I have received letters from, and have personally spoken with
individuals who feel that they have been harmed by Camp Lejeune water.
Their stories are very sad, and my heart goes out to them. The Marine
Corps has done and is doing everything it can for them, recognizing
that we are not scientists or health care professionals, and neither
can we address claims for compensation. What we can do, have done, and
commit to continuing to do is to cooperate with the Veterans
Administration, the ATSDR, the NAS, and other appropriate agencies and
scientific organizations as they address the scientific and medical
issues, and keep our Marine family informed of any progress.
______
Response to Post-Hearing Question Submitted by Hon. Daniel K. Akaka to
Major General Eugene G. Payne, Jr., Assistant Deputy Commandant for
Installations and Logistics (Facilities), Headquarters, U.S. Marine
Corps.
Question 1. Please provide us with a detailed breakdown of the
number of servicemembers and family members who lived or worked on Camp
Lejeune between 1957 and 1987. Specifically, please detail the number
of active duty servicemembers, spouses, children, and number of babies
born to servicemembers during that time period.
Response. Unfortunately, detailed data for servicemembers and
family members who lived or worked on Camp Lejeune between 1957 and
1987 does not exist. The Marine Corps can only make crude estimations
extrapolated from the limited available data using assumptions that
will likely produce conservatively high estimations. We estimate that
at Camp Lejeune between 1957 and 1987 there were:
As many as 630,000 servicemembers.
As many as 60,000 spouses.
As many as 60,000 dependent children.
As many as 30,000 births.
Total population estimate = 500,000-800,000
Note: These estimates do not include Marine Corps Air Station New
River. Data from the Defense Manpower Data Center (DMDC), Camp Lejeune
housing, Camp Lejeune schools, and Agency for Toxic Substances and
Disease Registry (ATSDR) studies were used to produce these estimates.
Question 2. How many servicemembers who were on active duty between
1957 and 1987 at Camp Lejeune are still on active duty?
Response. The Marine Corps does not maintain such data. We have
contacted the Defense Manpower Data Center to see if an estimate is
possible.
Question 3. When did the Marine Corps know about TCE and PCE
contaminants in the water at Camp Lejeune, and what did the Marine
Corps do about it?
Response. Volatile organic compounds (TCE, PCE, benzene and others)
were discovered in the drinking water at Camp Lejeune in the early
1980's.
In 1981, Camp Lejeune officials first became aware that VOCs were
interfering with the analysis of potable water samples that were being
collected in preparation for the implementation of future drinking
water standards.
In 1982 and 1983, continued testing identified two VOCs of primary
concern--trichloroethylene (TCE), a metal degreaser, and
tetrachloroethylene (PCE), a dry cleaning solvent--in two water systems
that served base housing areas, Hadnot Point and Tarawa Terrace.
Notably, TCE and PCE were not regulated under the Safe Drinking Water
Act until 1989 and 1992 respectively. Additional testing at the same
sources, but later in time, resulted in variances on the level of
contaminants discovered within the water. Navy Assessment and Control
of Installation Pollutants (NACIP) program plans were already in place
to identify contamination sites and to sample potable wells near such
sites.
In 1984, the source of contamination was found when the NACIP
program identified VOCs in some of the individual wells serving the
Hadnot Point and Tarawa Terrace water systems. As impacted wells were
identified, they were promptly removed from service.
Following the initial discovery of contamination in the wells in
1984, the Base Commanding General sent a notification letter to
residents, and the Public Affairs Office ran an article in the Base
newspaper and held a press event with local media.
As more information became available through further studies the
Marine Corps' outreach efforts broadened to the national population.
The Marine Corps has collaborated with the ATSDR from the beginning
of its studies to determine the extent of the contamination, and
whether adverse health effects may have resulted from it. For example,
in 1999, the Marine Corps conducted an outreach/mass media campaign to
assist the ATSDR in locating potential participants for the scientific
study. This study population included parents that were pregnant while
living in on-base housing from 1968-1985. To assist ATSDR with its
recruiting efforts for the study, the Marine Corps distributed
announcements to more than 3,500 media outlets (TV, daily & weekly
newspapers), as well as releasing two (2) separate worldwide Marine
Messages. The USMC has and will continue to actively help with outreach
for ATSDR's studies. Collaboration with ATSDR continues to the present
day.
Additionally, the Congress at Public Law 109-364, Section 318
directed the Navy to request a review by the National Academies'
National Research Council (NRC) to address the scientific evidence on
whether reported adverse health effects can be associated with past
contamination of the water supply at Camp Lejeune. This recently
published study (released June 13, 2009) by the NRC, an independent
Council of scientific experts, addressed TCE and PCE as the primary
contaminants of concern. A copy of the report can be obtained at http:/
/nationalacademies.org/morenews/20090613.html.
Among other things, the NRC report stated that it ``cannot be
determined reliably whether diseases and disorders experienced by
former residents and workers at Camp Lejeune are associated with their
exposure to past contaminants in the water supply because of data
shortcomings and methodological limitations, and these limitations
cannot be overcome with additional study.'' In addition, the report
states that the results of their comparison of the lowest dose of TCE
and PCE at which adverse effects were observed in animal studies
against approximated doses to former residents measured in mixed water
``suggest that the highest levels of either TCE or PCE measured in the
mixed-water samples at Camp Lejeune were much lower than the lowest
dose that caused adverse effects in the most sensitive strains and
species of laboratory animals.''
Three independent reviews have been conducted of the actions taken
by the Marine Corps at the time (2004 Drinking Water Fact-Finding
Panel, an EPA Criminal Investigation Division investigation, and the
2005 Government Accountability Office review).
The Fact-Finding Panel determined that Camp Lejeune provided
drinking water at a level of quality consistent with general water
industry practices in light of the evolving regulatory requirements at
the time.
The EPA Criminal Investigation Division concluded that there had
been no violations of the Safe Drinking Water Act, no conspiracy to
withhold information, falsify data, or conceal evidence regarding
violation of any law.
The GAO report describes efforts to identify and address the past
contamination, activities resulting from concerns about possible
adverse health effects and government actions related to the past
contamination, and the design of the current ATSDR study, including the
study's population, timeframe, selected health effects, and the
reasonableness of the projected completion date.
Additional information on the Fact-Finding Panel, the EPA
investigation, and the GAO report are available at: www.marines.mil/
clwater.
Finally, the Marine Corps is working to notify anyone who lived or
worked at Camp Lejeune prior to 1987 of the historic drinking water
issue. To identify and inform these individuals, the Marine Corps
developed an outreach response using multiple forms of communication
and media.
Distributed print articles to more than 10,000 newspapers
nationwide
Created radio spots distributed to more than 6,500 radio
stations
Developed online advertising for consumer- and military-
related Web sites, including Yahoo, Google, WebMD, Vietnam Veterans of
America and Leatherneck and Gazette Web site
Placed advertising in national publications, including USA
Today, Time and Newsweek
Placed advertising in military-related publications, such
as Leatherneck, Gazette and Semper Fi.
Provided posters and print announcements distributed to VA
facilities nationwide
Distributed posters to all US-based commissaries
Conducted interviews with newspaper and broadcast
journalists
Created a Web site providing a compilation of information
on the historic drinking water issue and links to other sites with
related information
In addition, the Marine Corps has worked with the Internal Revenue
Service to locate former Marines who have lived or worked on Camp
Lejeune 1987 and before. The IRS used its database to mail an estimated
150,000 letters from August 1 to October 1, 2008.
Currently, approximately 145,000 former residents are registered,
and the Marine Corps encourages anyone who has not registered to do so
by calling 877-261-9782 or online at https://clnr.hqi.usmc.mil/clwater/
index.html.
Question 4. When did the Marine Corps notify residents of Camp
Lejeune about the water contamination, and in what form did that
notification occur?
Response. Following the initial discovery of contamination in the
wells in 1984, the Base Commanding General sent a notification letter
to residents, and the Public Affairs Office ran an article in the Base
newspaper and held a press event with local media.
As more information became available through further studies the
Marine Corps' outreach efforts broadened to the national population.
The Marine Corps has collaborated with the ATSDR from the beginning
of its studies to determine the extent of the contamination, and
whether adverse health effects may have resulted from it. For example,
in 1999, the Marine Corps conducted an outreach/mass media campaign to
assist the ATSDR in locating potential participants for the scientific
study. This study population included parents that were pregnant while
living in on-base housing from 1968-1985. To assist ATSDR with its
recruiting efforts for the study, the Marine Corps distributed
announcements to more than 3,500 media outlets (TV, daily & weekly
newspapers), as well as releasing two (2) separate worldwide Marine
Messages. The USMC has and will continue to actively help with outreach
for ATSDR's studies. Collaboration with ATSDR continues to the present
day.
Finally, the Marine Corps is working to notify anyone who lived or
worked at Camp Lejeune prior to 1987 of the historic drinking water
issue. To identify and inform these individuals, the Marine Corps
developed an outreach response using multiple forms of communication
and media.
Distributed print articles to more than 10,000 newspapers
nationwide
Created radio spots distributed to more than 6,500 radio
stations
Developed online advertising for consumer- and military-
related Web sites, including Yahoo, Google, WebMD, Vietnam Veterans of
America and Leatherneck and Gazette Web site
Placed advertising in national publications, including USA
Today, Time and Newsweek
Placed advertising in military-related publications, such
as Leatherneck, Gazette and Semper Fi.
Provided posters and print announcements distributed to VA
facilities nationwide
Distributed posters to all US-based commissaries
Conducted interviews with newspaper and broadcast
journalists
Created a Web site providing a compilation of information
on the historic drinking water issue and links to other sites with
related information
In addition, the Marine Corps has worked with the Internal Revenue
Service to locate former Marines who have lived or worked on Camp
Lejeune 1987 and before. The IRS used its database to mail an estimated
150,000 letters from August 1 to October 1, 2008.
______
Response to Post-Hearing Questions Submitted by Hon. Richard Burr to
Major General Eugene G. Payne, Jr., Assistant Deputy Commandant for
Installations and Logistics (Facilities), Headquarters, U.S. Marine
Corps.
Question 1. The term ``organic solvents'' has been used since the
1970s to reference organic liquids, such as Volatile Organic Compounds.
When Major General Payne was asked at the hearing whether he knew if
the specific term ``organic solvents'' in Camp Lejeune Base Order
5100.13B had changed over the years since the order was published,
Major General Payne indicated that he was not knowledgeable on that
issue.
A. Was Major General Payne stating that, in his official capacity,
he should not be expected to know the purpose or relevant details of
Camp Lejeune Base Order 5100.13B, a Marine Corps order that has been
referenced in formal requests for information to the Marine Corps by
Members of Congress and an order that was cited during Senator Burr's
recent meeting with the Commandant of the Marine Corps regarding the
Camp Lejeune water contamination?
B. Was Major General Payne stating that the Marine Corps does not
know and understand the formal definition of the term ``organic
solvents'' or have access to environmental experts who know and
understand the formal definition of the term ``organic solvents'' as it
appears in Camp Lejeune Base Order 5100.13B, an order that detailed the
procedures for the proper disposal of chemicals and hazardous waste on
Camp Lejeune?
C. Does the Marine Corps agree that the term ``organic solvents''
includes Volatile Organic Compounds (see the definition from National
Institute of Occupational Safety and Health)? If the Marine Corps does
not agree that ``organic solvents'' include Volatile Organic Compounds,
what types of chemicals was the Marine Corps referencing when using the
specific term ``organic solvents''?
Response. Major General Payne was asked to speculate on the
accepted definition of the term ``organic solvent'' circa 1974, how the
authors of Camp Lejeune Base Order 5100.13B defined that term when they
wrote the Order in 1974, and whether the definition of that term had
changed over the years since the order was published. Major General
Payne is neither a scientist, nor a subject matter expert on ``organic
solvents,'' nor a historian. Accordingly, he properly declined to
answer the questions. To the more specific question: today, does the
term ``organic solvents'' include VOCs; as we understand the definition
today, we believe that VOCs are properly categorized as organic
solvents.
Question 2. The Marine Corps maintains a Camp Lejeune Water Study
database for the former residents of Camp Lejeune. The registry now
contains over 144,000 registrants.
A. How many of the registrants are military veterans who once
served on Camp Lejeune?
Response. The Marine Corps does not put any stipulations on who is
allowed to register with the Camp Lejeune Historic Drinking Water
Registry; therefore, anyone interested in receiving additional
information and notifications may request to be placed in the registry.
The registry does not require registrants to identify if they are
Military veterans. Using several assumptions, the Marine Corps
estimates that as of October 29, 2009; approximately 87,000 registrants
may be Military veterans who once served at Camp Lejeune, NC.
B. How many of the registrants are former dependents or family
members of veterans who once served on Camp Lejeune?
Response. The Marine Corps again uses several assumptions in
estimating the number of registrants who may be former dependents or
family members of veterans who once served at Camp Lejeune, NC. We
estimate that approximately 58,000 individuals in the registry fall
into this category.
C. Does the Marine Corps plan to share the names of those
individuals with VA so that it may use that information to better treat
veterans already enrolled in VA's health care system or proactively
outreach to those not yet enrolled?
Response. The Marine Corps has contacted the VA and has begun the
process to transfer information from our database to the VA.
1. The Marine Corps has established contacts that will make the
official request for the data.
2. The Marine Corps has provided the VA with a data dictionary in
order for them to determine what available information they need to
accomplish their task.
3. The Marine Corps will follow the Federal statute that requires
placing a notice in the Federal Register to update the System of
Records Notice (SORN) associated with the Camp Lejeune database in
order to share the data with the VA.
The Marine Corps will continue to collaborate with the VA in order
to identify the most appropriate manner in which to transfer the data.
Chairman Akaka. Thank you very much, General Payne. Mr.
Resta, your testimony, please.
STATEMENT OF JOHN J. RESTA, SCIENTIFIC ADVISOR, U.S. ARMY
CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE
Mr. Resta. Good afternoon, Senator Akaka, Senator Burr.
Thanks for the opportunity for me to speak today about the
occupational environmental health exposures in military
operations.
My name is John Resta. I serve as Scientific Advisor for
the U.S. Army Center for Health Promotion and Preventive
Medicine, also known as the CHPPM. Our workforce at the CHPPM
is dedicated to keeping soldiers healthy. One of our primary
responsibilities is to provide deployed commanders assistance
in identifying, assessing, and countering occupational and
environmental health hazards.
During military operations, soldiers, sailors, airmen,
Marines, and civilian employees who also deploy may encounter
numerous occupational and environmental health hazards that
have the potential to cause illness and injury. In our written
statement, we provided the Committee specific details on what
actions we have taken to address these hazards at the Qarmat
Ali Water Treatment Plant and the Joint Base Balad Burn Pit
with an emphasis on the results of the medical evaluations and
health risk assessments we have conducted to date.
These risk assessments have relied on numerous medical
examinations, clinical lab tests, exposure questionnaires, and
thousands of occupational and environmental samples. At Qarmat
Ali, we concluded from the medical evaluations conducted on the
soldiers and Department of Army civilians who served at the
site during the assessment period that no significant exposure
to sodium dichromate had occurred. These results, coupled with
the occupational environmental samples that were collected,
indicate that all soldiers and Department of Army civilians who
served at the site at any time are unlikely to experience
future adverse health effects.
This conclusion was validated by the Defense Health Board
following their review of the health risk assessment. The
Defense Health Board is an independent advisory panel made up
of nationally recognized medical and scientific experts from
academia and industries. Our burn pit health risk assessments
have concluded that smoke exposures could lead to short-term,
reversible irritant health effects.
Smoke from burning trash and other wastes, especially in
combination with hot, dry, dusty conditions, cause temporary
irritation of the eyes, nose and throat in most people,
regardless of their health condition. However, no environmental
monitoring to date collected at Joint Base Balad has identified
a risk for future adverse health effects.
It is possible that combinations of some exposures, such as
smoke from the burn pits, high levels of airborne dust, and
cigarette smoking, may increase the risk of chronic health
conditions in a small number of people. We have no direct
evidence of this at this present time. We will be monitoring
the air quality at Joint Base Balad in concert with the Air
Force and the Navy over the next year, even though municipal
solid waste incinerators have largely replaced open burning
there.
We are continuing to communicate the findings and
limitations of these risk assessments to our soldiers and other
servicemembers in an understandable form. We have challenges in
this endeavor. For example, it is often difficult to answer the
fundamental question, will I get sick?
Current health risk assessment science does not adequately
address the health risks from combined exposures like burn pit
smoke, nor can it determine whether a disease that has multiple
causes and develops over a long period of time in an individual
was caused by a specific exposure. We continue to seek more
innovative methods to assess health risks and are working with
both the National Academy of Sciences and the Defense Health
Board.
We continue to address our soldiers' health concerns and
are working to ensure that they and their health care providers
are informed about these incidents.
Mr. Chairman, thank you for the opportunity to be here
today and discuss our role in these important actions. I look
forward to answering any questions you or the Committee might
have. Thank you.
[The prepared statement of Mr. Resta follows:]
Prepared Statement of John J. Resta, Scientific Advisor, U.S. Army
Center for Health Promotion and Preventive Medicine
Chairman Akaka and distinguished Members of the Committee, thank
you for inviting me here today to speak about occupational and
environmental health exposures in military operations and the efforts
of my organization, U.S. Army Center for Health Promotion and
Preventive Medicine (USACHPPM), in preventing disease and non-battle
injuries to our Soldiers and deployed civilian employees.
The USACHPPM is a subordinate command of the U.S. Army Medical
Command. USACHPPM's military and civilian personnel are experts in more
than 50 public health disciplines. They include occupational and
environmental medicine physicians, public health and occupational
health nurses, epidemiologists, industrial hygienists, environmental
engineers, health risk assessors, chemists, toxicologists and many
others. We provide consultative services in these disciplines through a
worldwide network, with our headquarters at Aberdeen Proving Ground,
Maryland, and five subordinate commands at Landstuhl, Germany; Camp
Zama, Japan; Fort George G. Meade, Maryland; Fort Sam Houston, Texas;
and Fort Lewis, Washington. Since Operation Desert Storm in 1991, the
USACHPPM has been providing technical assistance and support to
deployed preventive medicine units and personnel who conduct
occupational and environmental health surveillance activities. This
continues through our current efforts in support of Operations Iraqi
Freedom and Enduring Freedom.
Today, I'd like to speak with you about two specific occupational
and environmental health exposures, the potential exposures to sodium
dichromate at the Qarmat Ali Water Injection Facility in Iraq and the
exposures to smoke from the open burning of solid waste in Iraq,
Afghanistan and the Horn of Africa.
QARMAT ALI WATER INJECTION FACILITY
On September 15, 2003, the 1st Battalion, 152nd Infantry from the
Indiana National Guard notified the Combined Forces Land Component
Command-Surgeon (CFLCC-Surgeon) of its concerns regarding the site
contamination at the Qarmat Ali Water Injection Facility. The Qarmat
Ali facility was being repaired as part of Task Force Restore Iraqi Oil
(TF-RIO) by an Army Corps of Engineers contractor. Within a day of
notification, the site was placed off-limits and the CFLCC-Surgeon
requested assistance from the USACHPPM in assessing the health risks
associated with potential exposures to sodium dichromate. By this time,
the contractor had started encapsulating the contaminated areas on the
site. The DOD Inspector General is currently conducting a review of
Army actions regarding the exposure of personnel to sodium dichromate
at Qarmat Ali.
On September 30, 2003, a USACHPPM team comprised of an
occupational-environmental medicine physician, environmental
scientists, engineers, and industrial hygienists arrived at Qarmat Ali
and started an Occupational and Environmental Health Survey and Risk
Assessment, which they completed on October 24, 2003. This assessment
included environmental samples from the soil, air, and living and
working areas as well as medical examinations of the Soldiers and
Department of Army civilians assigned to the site. No medical exams
were provided to civilian contractors because occupational health for
contractor employees is the employing contractor's responsibility.
The USACHPPM team conducted environmental soil, air and surface-
wipe sampling, to include ambient air monitoring of the location and
breathing-zone monitoring of USACHPPM team and military security team
members. Soil sample results were below the Military Exposure
Guidelines for hexavalent chromium and total chromium in all onsite
areas, but were over the guidelines in one offsite area where exposure
was not expected. The USACHPPM team recommended that the contractor
perform further containment to encapsulate those areas. The average
concentrations for hexavalent chromium and total chromium in the air
were below the one-year Military Exposure Guidelines. In fact, no
hexavalent chromium was detected in any breathing-zone air sample. The
survey's surface-wipe sample results for hexavalent chromium dust
indicated that the interior of the contractor trailer located at the
Qarmat Ali Water Injection Facility compound was contaminated with
hexavalent chromium dust. The USACHPPM team recommended moving the
trailer to the boundary of the compound and completely decontaminating
it.
Medical examinations were administered to 137 of the 161
potentially exposed Soldiers and DOD civilians in the 1st Battalion,
152nd Infantry from the Indiana National Guard and TF-RIO from the U.S.
Army Corps of Engineers. There were 14 members who were not available
for evaluation and 10 who declined all or part of the testing. The
exams were conducted within 30 days of the last potential exposure at
the site and within 120 days of site encapsulation. They included
administering exposure (i.e., how long, how often a person would have
been onsite) and symptom questionnaires as well as specific clinical
medical tests tailored to assess chromium exposure. The people who were
examined were the people who, according to their answers to the
questionnaire, had the most potential for exposure in terms of time
frequency and locations visited at the water treatment plant. The
Soldiers were there before encapsulation (arriving in June 2003) as
well as after encapsulation.
The comprehensive medical exams provided consisted of a medical
history, a general physical exam, blood and urine testing (including
red blood cell and serum chromium levels, complete blood counts, serum
chemistries, liver and renal function tests, and routine urine
analysis). Ancillary testing included chest x-rays and spirometry
testing. Previously published information that the Soldiers and DOD
civilians only received serum and urine analysis for chromium is
incorrect.
Less than 30 percent of the people examined reported symptoms, and
the symptoms that were reported were symptoms that could have a variety
of causes. Eye or throat irritation was the most common symptom
reported. None of those examined exhibited symptoms of over-exposure to
chromium. All of the people tested had normal blood levels; more than
half of the chromium blood tests were actually below the detection
limit of the test. If a significant inhalation exposure to hexavalent
chromium (the element of sodium dichromate that has been shown to be a
lung carcinogen in studies of industrial workers exposed to high levels
for more than two years) had occurred, elevated levels of chromium
would have remained in the red blood cells for at least 120 days
following exposure. Red-blood-cell testing of potentially exposed
people occurred within 30 days of their last expected exposure and
within 120 days of site encapsulation. Analysis of the blood testing
for chromium was done at the Armed Forces Institute of Pathology in
Washington, DC. Whole blood testing was chosen because other medical
tests (serum, urine) weren't sensitive enough to detect chromium
exposures beyond 30 days. The recent disclosures of severe symptoms by
Soldiers (i.e., coughing up blood, chrome holes, etc.) were not
reported to the risk assessment team in October 2003. The extent of
these concerns cannot be determined with any objective data at this
point, though we are attempting to locate medical records of
servicemembers present at the site prior to the USACHPPM's arrival to
determine if any specific medical conditions may have been linked to
these Soldiers' service at the site.
The USACHPPM concluded that these medical results indicated that no
significant exposure to sodium dichromate had occurred, and that the
symptoms reported could be related to existing personal medical
conditions and desert environment-related exposures, such as heat,
sand, dust and wind. Based on the medical team's evaluation of medical
and exposure assessment results, specific long-term follow-up
surveillance of these people as a group was not recommended because the
potential for long-term health effects caused by assignment to duty at
the site was unlikely.
The Soldiers and DOD civilians located at the site were provided
fact sheets about the potential exposures during the assessment and at
a town hall meeting (open forum) with a question-and-answer session.
Town halls were sponsored by unit leadership for all interested
Soldiers and DOD civilians. The results of each person's medical exams,
to include the whole blood test results were placed in the individual,
hard-copy deployment medical records, along with a description of the
potential exposure on a Standard Form 600 (Chronological Record of
Medical Care Medical Record). The Army confirmed that the test results
did in fact reach the Soldiers' hard-copy records. Potentially exposed
Soldiers and DOD civilians were also instructed to direct healthcare
providers to this information in their medical records and to raise any
remaining concerns about this incident during their post-deployment
health assessments. Medical follow-up for those Soldiers who have
health concerns is available through the military medical system or the
Department of Veterans Affairs, depending on the military status of the
Soldier.
Based on the limited adverse health findings of the assessment, the
survey team felt that there was limited benefit to conducting a medical
evaluation on Soldiers that had relocated from the site prior to the
arrival of the USACHPPM assessment team. The assessment team determined
that units from the 1st Battalion, 162nd Infantry from the Oregon Army
National Guard and 133d Military Police Company of the South Carolina
Army National Guard were present at the site prior to the team's
arrival. Soldiers from these units were asked to complete an exposure
and symptom survey, either directly through unit town hall meetings or
through medical providers at their new locations if they had relocated
to another area. For these past-exposed Soldiers, there were no unit
records available to document who served at the site and for how long.
The completed surveys, along with a fact sheet for medical providers,
was to be placed in Soldier medical records by the unit as
documentation of potential exposure to sodium dichromate and for
reference in case of future health concerns.
Throughout the assessment, the USACHPPM team ensured that the
operational commanders were kept apprised of the assessment findings
and conclusions, to include daily situational reports to the CFLCC
medical cell and briefings to the commanders of the four deployed and
potentially exposed units/groups (1st Battalion, 152nd Infantry, of the
Indiana Army National Guard; 133rd Military Police Company of the South
Carolina Army National Guard; 1st Battalion of the 162nd Infantry of
the Oregon Army National Guard; and Task Force Restore Iraq Oil of the
U.S. Army Corps of Engineers). A formal Occupational and Environmental
Health Survey and Risk Assessment report containing all of the results
and recommendations was submitted to CFLCC on January 15, 2004.
This report was initially classified in accordance with U.S.
Central Command guidance; an unclassified report was published on
January 10, 2009. At the time, DOD, Army, Joint Staff and U.S. Central
Command Force Health Protection policy did not include a procedure for
reporting deployment exposures or other operational public health
information to non-deployed, rear area units such as the Indiana
National Guard State Adjutant General or the U.S. Army Forces Command.
This policy is being reevaluated at this time.
In addition to medical record information that is available to
Department of Veterans Affairs (DVA) providers, the Deputy Assistant
Secretary of Defense, Force Health Protection and Readiness has
facilitated our collaboration with the DVA. In December 2008, DVA
personnel reviewed a copy of the classified Occupational and
Environmental Health Survey and Risk Assessment report. A copy of the
declassified report was provided to the DVA in January 2009, and a
presentation was made to the DOD/VA Deployment Health Working Group in
May 2009.
The medical response to this incident was exemplary. The site was
placed off-limits within a day of notification to the Combined Forces
Land Component Command Surgeon. The USACHPPM deployed a team to theater
within two weeks of request. The methodology and results of the
USACHPPM assessment were reviewed, validated and cited as exemplary by
the Defense Health Board, an independent review entity made up of
medical and scientific professionals from academia and industry.
BURN PITS
As far back as Operation Joint Endeavor in Bosnia in 1996, military
preventive medicine personnel recognized that while open burning of
solid waste is sometimes an operational necessity during combat
operations, it should be used to the minimum extent possible based on
the operational situation. When open burning operations are necessary,
they should be located as far downwind of personnel as possible.
In 2004, the USACHPPM deployed a response team to Camp Lemonier in
Djibouti to assess the potential health risks from the burn pit smoke
from an off-post burn pit located about 1.5 miles south of Camp
Lemonier. At this location, the local population open-burned all of the
solid waste from the surrounding area, to include the U.S. operations
on Camp Lemonier. There was a solid waste incinerator present, but it
was not in use at the time. The assessment consisted of advanced air
sampling from volatile organic compounds, polyaromatic hydrocarbons,
dioxins/furans and particulate matter less than 10 microns in diameter.
The assessment concluded that the operational health risk estimate was
moderate due to the elevated presence of acrolein and aluminum.
Deployed preventive medicine teams have conducted several rounds of
additional sampling at this location since. The operational health risk
from acrolein was found to be low and was only detected above Military
Exposure Guidelines sporadically.
In 2005, the burn pit operations at the Joint Base Balad were
initially sampled by deployed preventive medicine teams. From their
results, the USACHPPM concluded that additional sampling was needed to
fully characterize the site. The USACHPPM and the U.S. Air Force School
of Aerospace Medicine jointly performed both an operational health risk
assessment and a long-term health risk assessment based on large-scale
sampling events at Joint Base Balad in 2007. The sampling plan focused
on burn pit emissions. Other potential and/or known sources of air
emissions including airfield operations, diesel generators, ground
vehicle operations, and naturally blowing sand and dust were also
collected in the samples. The long-term health risk assessment was
conducted using the U.S. Environmental Protection Agency (USEPA)
standard health risk assessment methodology. The USEPA method is
specifically designed to focus on people who may be the most sensitive
to the effects of a particular exposure; therefore, it is considered to
be very protective.
Using the USEPA method, the potential for short-term, reversible,
irritant health effects to U.S. personnel was identified. Smoke from
burning trash and other waste, especially in combination with hot, dry,
dusty conditions, can cause temporary irritation of the eyes, nose and
throat in some people, regardless of their health condition. However,
no environmental monitoring data collected at Joint Base Balad to date
have identified an increased risk for long-term health conditions. It
is possible, however, that combinations of some exposures, such as
smoke from burn pits, the high levels of airborne dust, and/or tobacco
smoke in smokers, may increase the risk of chronic health conditions in
a small number of people, although we have no direct evidence of this
at the present time. Due to anecdotal concerns raised about possible
dioxin exposures at Joint Base Balad, the USACHPPM conducted a pilot
study in cooperation with the Centers for Disease Control and
Prevention, National Center for Environmental Health Laboratory (CDC-
NCEH). Serum samples of Balad veterans from the DOD's Serum Repository
were randomly selected for dioxin analysis at the CDC-NCEH. Both pre-
and post-deployment samples were selected from the sera of personnel
who had been deployed to Joint Base Balad at least twice for at least
one year per deployment. The analyses did not find elevated levels of
dioxin in the sera, as would be expected if personnel had been
breathing elevated concentrations of dioxin during their deployments.
The USACHPPM and U.S. Air Force School of Aerospace Medicine have
authored various risk communication products, including fact sheets and
briefing slides, so that Service Members are aware of the results of
sampling and health risk assessments as they are completed. The fact
sheets can be found on both the USACHPPM Web site and in Department of
Defense Deployment Health and Family Readiness Library.
To improve on the lessons we've learned from this situation, we
authored guidance on the use, operation and location of burn pits that
was published in Headquarters, Department of the Army, Technical
Bulletin, Medical 593, Guidelines for Field Waste Management, September
2006. This guidance is straightforward. The preferred method of solid
waste disposal is incineration. Open burning should only be used in
emergency situations until approved incinerators can be obtained. The
potential use of improper burning methods can lead to significant
occupational and environmental health exposures to deployed troops. We
recommend that burn pit operations be conducted as far downwind as
possible (at least 450 feet) from troop locations and living areas.
Hazardous waste, batteries and medical waste should not be burned.
The USACHPPM and U.S. Air Force School of Aerospace Medicine
briefed the Department of Defense/Department of Veterans Affairs
Deployment Health Working Group in March 2009 on the burn pit health
risk assessments at Joint Base Balad. The meeting focused on the air
quality surveillance efforts at Joint Base Balad, Iraq, which included
sampling for a range of toxic chemicals potentially produced by open
burning of solid waste. We discussed the short- and long-term health
effects expected based on the analyzed chemicals, data gaps, and
possible future efforts to better characterize potential burn pit smoke
exposures. We also addressed the DVA's questions arising from various
misleading media accounts of burn pits and burn pit exposures. Since
that time we have been consulting with the DVA on their inquiries into
the extent of burn pit operations and the results of air sampling at
other burn pit locations in the U.S. Central Command area of
responsibility.
The USACHPPM, U.S. Air Force School of Aerospace Medicine, and the
Navy and Marine Corps Public Health Center are jointly developing an
air surveillance program for contingency operations, with a focus on
locations with burn pits. The sampling plan will be coordinated with
the Defense Health Board with the goal of identifying a field-expedient
sampling strategy that is considered representative and defensible. The
USACHPPM also is collaborating with the U.S. Army Engineer School
Directorate of Environmental Integration to update Army deployment
environmental management doctrine.
As a result of its assessments at Balad and Qarmat Ali, the
USACHPPM continues to modify, update and expand deployment occupational
and environmental health surveillance and preventive medicine
activities from our experiences and lessons learned. Specific
surveillance lessons learned from the Qarmat Ali Water Injection
Facility and Joint Base Balad incidents include:
Producing, disseminating and archiving both classified and
redacted deployment occupational and environmental health surveillance
reports on both classified and unclassified networks.
Ensuring that our military and civilian personnel who
deploy to active theaters of operation for deployment occupational and
environmental health incidents are continually trained and up to date
on personal deployment requirements.
Mr. Chairman and distinguished committee members, my thanks for
inviting me to speak with you about the U.S. Army Center for Health
Promotion & Preventive Medicine's role in environmental surveillance
and health assessment of potential sodium dichromate exposures and
open-pit burning in overseas contingency operations. Thank you for
holding this hearing and for your enduring support of servicemembers
serving across the globe. I look forward to your questions.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
John J. Resta, Scientific Advisor, U.S. Army Center for Health
Promotion and Preventative Medicine
Question 1. The Army has stated that there is no evidence that
exposure to sodium dichromate at Qarmat Ali will cause adverse or long
term health effects, and that symptoms can be attributed to other
factors. What other, environmental or otherwise, factors could be
responsible for such conditions?
Response. During the CHPPM evaluation in 2003, Soldiers from the 1-
152nd IN BN (INARNG) and DA Civilian employees from Task Force Rio were
questioned regarding symptoms (symptoms are complaints) and observed
for signs (signs are visible findings on examination). In the desert
environment of Iraq and Kuwait, the symptoms reported by the Soldiers
were a common experience for Soldiers in the country. Of the total
population, about 77% did not report symptoms and 23% reported
symptoms. The symptoms that they complained of were irritative or
inflammatory in nature, and included irritation of the nose (9%),
throat (7%), eyes (6%), lungs (4%), skin (1.4%), sinuses (1.4%), and
general/other (3%). Overall, there was a low incidence of each
individual symptom, with nasal symptoms being the most common.
These symptoms are non-specific, meaning that they are not specific
to a single etiology or cause. As stated in the report, irritation of
the eyes, nose and throat are not uncommon in a dry and dusty desert
environment, due to heat, sand, dust, and wind. In a survey performed
by Roop, et al on the prevalence of symptoms during deployment, 50% of
non-asthmatics reported cough, and 55% reported allergy symptoms while
deployed. (See ``Military Medicine Volume 172 Number 12 Dec 2007'') In
addition to these environmental factors, the differential diagnosis (or
list of other possible medical conditions to consider) for these
symptoms are myriad.
Common causes of irritation and inflammation symptoms of the upper
and lower airways are many, and include asthma, allergic rhinitis
(``hay fever''), chronic bronchitis (tobacco), emphysema,
bronchiectasis, and infections (such as the common cold, influenza,
pneumonia, tuberculosis, or whooping cough).
With irritation of the eyes, possible medical conditions to
consider would include conjunctivitis, which is inflammation and
irritation of the conjunctiva, the mucous membrane that lines the
eyelids. Conjunctivitis can be caused by many things, such as allergy,
viral infections or bacterial infections, sicca (dry eye), irritation
from excessive heat or cold or chemical solutions, or exposure to
ultraviolet rays or foreign bodies.
Skin irritation and inflammation can be caused by allergies (drugs,
foods), common scaling disorders such as atopic dermatitis (eczema,
allergic component), psoriasis (genetic basis), seborrheic dermatitis
and dandruff (may be reaction to yeasts), fungal infections of the skin
(ringworm, jock itch, athlete's foot), and intertrigo (caused by effect
of heat, moisture and friction). Other common causes are allergic
contact dermatitis (due to irritants such as soap or detergents or an
allergen such as poison ivy) and folliculitis due to infection,
irritants, perspiration, and rubbing of fabrics on the skin.
Question 2. The Committee is aware that following notification by
the Commander of the Indiana National Guard in late September 2003, an
Army team arrived at Qarmat Ali to assess contamination of the site, to
conduct an exposure assessment and to evaluate any potential health
effects. Please comment on the methodology used to determine any
potential risk associated with exposure, the amount of testing that was
conducted and for what period of time the testing occurred.
Response. Soil sampling, ambient air monitoring (including
breathing zone monitoring), and surface wipe sampling were conducted by
the USACHPPM Team as part of the Deployment Occupational and
Environmental Health Survey and Occupational Health Risk Assessment
from 30 Sep-2 Nov 2003. Samples were collected by trained personnel
that included certified industrial hygienists, environmental scientists
with over two decades of contamination site assessment experience and
enlisted preventive medicine technicians. Sampling and laboratory
analytical methods were derived from those used during contaminated
site and workplace assessments developed by the Environmental
Protection Agency (EPA) and National Institute for Occupational Safety
and Health. Sample results were compared to the one-year Military
Exposure Guidelines (MEGs) for air and soil. MEGs are concentrations
for chemicals in air, water and soil that are used to assess the
significance of an exposure to a contaminant. They represent a
concentration above which certain types of health effects may begin to
occur in a population after an exposure of a specified duration. They
are guidelines and not health standards. When these guidelines are
exceeded, they serve as an action level for additional investigation/
study. They have been derived from existing regulatory guidance
published by the EPA, Occupational Safety and Health Administration and
other Federal agencies. Additional information can be found in USACHPPM
Technical Guide 230, Chemical Exposure Guidelines for Deployed Military
Personnel available at http://chppm-ww.apgea.army.mil/documents/TG/
TECHGUID/TG230.pdf and the Reference Document (RD) 230 Chemical
Exposure Guidelines for Deployed Military Personnel available at http:/
/chppm-www.apgea.army.mil/documents/TG/TECHGUID/TG230RD.pdf. Risks were
estimated by determining the hazard severity and exposure potential in
accordance with Army Composite or Operational Risk Management Guidance.
Additional information can be found in USACHPPM Technical guide 248,
Guide to Deployed Preventive Medicine Personnel on Health Risk
Management available at http://chppm-www.apgea.army.mil/documents/TG/
TECHGUID/TG248.pdf. These were reviewed by the National Academy of
Sciences Committee on Toxicology in 2004. This review is available at
http://www.nap.edu/catalog.php?record_id=10974#toc.
Soil Sample Results. A total of 60 soil samples were collected in
different areas of the Qarmat Ali site from 7-12 Oct 2003. Only one
offsite area tested above the One-Year MEG for Total Chromium or
Hexavalent Chromium [Cr VI] in soil. However, four areas of the site
tested above the MEG for polychlorinated biphenyls (PCBs). The severity
of this exposure was estimated to be Negligible due to the short
exposure durations.
Air Sample Results. Eighty three breathing zone samples were
collected 7-12 October 2003, 43 were analyzed for Cr VI and 40 for
Arsenic, Chromium (Total), Lead and Selenium. Twenty eight area air
samples were collected between 8-11 October 2003 and analyzed for
Antimony, Arsenic, Beryllium, Cadmium, Chromium (Total), Lead,
Manganese, Nickel, Vanadium, Zinc and Particulate Matter Less than 10
microns (PM10).
The survey's breathing zone and general area air sample results for
heavy metals, to include Cr VI were well below the Cr VI MEG.
The majority of the sample results for PM10 exceeded the 1-year MEG
of 70 micrograms/cubic meter. Although these results indicate that on-
site personnel may have been exposed to concentrations greater than the
MEG, they are consistent with PM10 concentrations experienced in and
around US base camps located throughout Southwest Asia.
However, these sample results only estimated exposure conditions at
the time of the survey (i.e., some post-containment of sodium
dichromate-contaminated grounds had occurred, light winds blowing in an
easterly direction, and limited oil well water injection operations)
rather than past conditions (i.e., pre-containment of sodium
dichromate-contaminated grounds and potentially high winds) and future
conditions (i.e., potentially high winds blowing in a westerly
direction and full-scale oil well water injection operations). Air
concentrations prior to encapsulation were modeled using the EPA's
Particulate Emission Factors model used in hazardous waste site
restoration. This model indicated that Soldiers present at the site
prior to encapsulation could have been exposed to Cr VI at
concentrations greater than the MEG but lower than the OSHA Permissible
Exposure Limit. The one year-MEG for Cr VI was much lower than the OSHA
Permissible Exposure Limit in place at the time.
Surface Wipe Sampling. The survey's surface wipe sample results for
Cr VI dust indicated that the interior of the contractor trailer
located on the site was contaminated with Cr VI dust. These results
also indicated a lesser degree of Cr VI dust cross-contamination from
the Qarmat Ali Water Injection Facility (WIF) compound to the TF RIO
work trailer (located in contractor's Pioneer Camp near the Basra
International Airport). Although no occupational and/or environmental
exposure limits currently exist for Cr VI dust, personnel living and
working in the contractor trailer may have been overexposed to Cr VI
dust unless properly protected. Recommendations were made to relocate
the Qarmat Ali Industrial WIF's KBR trailer nearer to the western
boundary of the compound, and thoroughly decontaminate the trailer with
soap and water prior to reoccupation. The study also recommended that
the work and living areas of personnel known to have been on the Qarmat
Ali WIF compound be cleaned with soap and water to remove any cross-
contamination residue.
Medical Evaluations. The comprehensive medical exams provided by
the USACHPPM SMART-PM team consisted of a medical history, a general
physical exam, blood and urine testing (including red blood cell and
serum chromium levels, complete blood counts, serum chemistries, liver
and renal function tests, and routine urine analysis). Ancillary
testing included chest x-rays and spirometry (pulmonary function)
testing.
No nasal perforations or ulcerations were noted in any of the
individuals examined. To evaluate exposure above the permissible levels
in workplace settings, urine is tested before and at the end of the
shift, or the end of the workweek, and increases are noted. This is
because individuals can have different levels in their urine based on
age, sex, smoking, and diet. As stated above, for these individuals,
urine measurement would not have been sufficient to assess their
exposure, and there were no available pre-exposure urines for
comparison. The decision to test whole blood (plasma, serum and red
blood cells) was made with this understanding, and reference values
were obtained from the literature and the laboratory at the Armed
Forces Institute of Pathology for comparison purposes. Most of these
blood tests were below the detection limit of the laboratory test, and
100% of the tests were within ``normal'' reference ranges identified in
the literature. Based on the collected information, there did not
appear to be a concern that overexposure had occurred. Individuals were
therefore at negligible risk for any long-term health effects from
chromium exposure.
The medical evaluations supported the low to negligible overall
long-term health risk, with only sporadic potentially-related minor
health effects being observed.
Question 3. The Army has stated that a number of soldiers who were
present at Qarmat Ali had the opportunity to be given a medical exam
and have blood work tested for any abnormal levels of chromium. Results
of this testing showed that blood chemistry for chromium was average.
Given the Army has stated that it did not know National Guard Units
from West Virginia, Oregon and South Carolina were present at the time
of this testing and only tested those in the Indiana National Guard
Unit, how can testing of the Qarmat Ali population be conclusive if a
number of the Qarmat Ali population were not surveyed or tested?
Response. The Army assessment team provided comprehensive medical
testing to those Soldiers and DA Civilian employees who were present at
the site during the assessment. The Army knew of the presence of the
South Carolina and Oregon Army National Guard at the site. The West
Virginia Army National Guard unit (1092nd Engineer Battalion) was the
only unit whose presence at the site was not known during the site and
medical evaluation in 2003.
The Soldiers from the 1-152nd IN BN (INARNG) and DA Civilian
employees from Task Force Rio reported the highest average time on the
site. Soldiers that had served at the site prior to the assessment
team's arrival from the 1-162nd IN BN (ORARNG) and the 133d MP (SCARNG)
and had already departed were provided an exposure survey to estimate
their overall exposure duration and frequency. These units were asked
about the period of time that they spent at the site and they reported
an average time on site of approximately 8.6 hours. Soldiers from the
1-152nd IN BN (INARNG) reported that they had spent on average147 hours
on site. They did not show any specific signs of overexposure to
chromium and the medical evaluations and site testing determined that
they were not at an increased risk for future health effects. Since the
1-162nd IN BN (ORARNG) and the 133d MP (SCARNG) spent significantly
less time on site than the IN NG units, the assessment team concluded
that their exposure was considerably less than that experienced by the
1-152nd IN BN (INARNG) and any risk of future health effects was also
minimal. This conclusion was validated by the Defense Health Board in
their October 2008 review of the risk assessment
There was no official record of the presence of the 1092nd Engineer
Co (WVARNG) provided to the assessment team. The presence of the 1092nd
Engineers was identified during site visits to the 1-152nd IN BN and 1-
162nd IN BN. Interviews with Soldiers from the 1092nd Engineers by a
team from the office of the Assistant Secretary of the Army for
Manpower and Reserve Affairs suggests that these soldiers were exposed
for a similar duration and at a similar level to the 1-152nd IN BN
(INARNG) Soldiers. Unfortunately, there is no testing that can be
administered this long after exposure to determine the risk of future
health effects for these Soldiers.
Question 4. The Army has stated that on average, soldiers spent 147
hours at Qarmat Ali. Given that any information in the surveys was
self-reported, how can the Army guarantee the accuracy of these
statements, in regard to the amount of time that was spent at Qarmat
Ali? Were official unit records used to validate information that was
given in soldiers' statements?
Response. There was no official system of records in place at the
time of the incident that would independently document the amount of
time a Soldier is present at a site. Current policy now requires
recording a Soldier's duty location during a deployment once daily.
Exposure duration and frequency for Soldiers of the 1-152nd IN BN
(INARNG) were determined from exposure questionnaires completed by
individual Soldiers. This is a common technique used in the field of
Industrial Hygiene. Only the Soldiers of the 1-152 IN BN (INARNG)
reported the average exposure of 147 hours. The Soldiers of the South
Carolina and Oregon Army National Guard units reported considerably
less average exposure (8.6 hours).
Question 5. The Army has stated that all results of the
aforementioned testing were included in the medical records of soldiers
who participated. In addition, the Army has said that these soldiers
were encouraged to discuss their results along with any health
concerns, on their post-deployment health assessments and with their
health care providers. Have these soldiers' medical records, in regard
to any testing done in relation to potential exposure to sodium
dichromate, been shared with any other organization or been added to
any exposure database? Has any additional testing for sodium dichromate
exposure been conducted on these individuals? Are these individuals
currently being monitored?
Response. All occupational and environmental sample results from
the site assessment have been provided to the Department of Veterans
Affairs (VA) to include a by-name list of whole-blood chromium
monitoring results for those Soldiers eligible for VA medical care.
Since early 2009, the DOD Deputy Assistant Secretary of Defense, Force
Health Protection and Readiness, has assisted in facilitating the
USACHPPM attending and participating at quarterly scheduled DOD/VA
Deployment Health Working Group meetings. On 14 May 2009, the USACHPPM
presented a briefing to the Working Group entitled ``Operation Enduring
Freedom and Operation Iraqi Freedom Deployment OEH Incidents.'' This
briefing contained a section on the Qarmat Ali Water Injection Plant
incident.
The Assistant Secretary of the Army, Manpower and Reserve Affairs,
in coordination with the National Guard Bureau has conducted extensive
outreach to Army National Guard units who were at the site but were not
evaluated. As of late September 2009, 1164 Soldiers were estimated to
have deployed with the units who served at the site, 863 of these
Soldiers have been contacted by their State Joint Force Headquarters,
informed about the incident, and encouraged to enroll in the VA
registry; 258 had enrolled in the registry; and 154 were reported to
have had completed medical examinations provided by the VA.
The VA has established a separate registry for this incident. All
of the Soldiers from this incident currently enrolled in the VA's Gulf
War Registry will be added to this registry. As part of this
enrollment, the VA will provide routine follow up examinations, to
include x-rays, to monitor the Soldiers involved in the incident. The
ARNG Joint Force Headquarters in each state will retain the medical
records of the Soldiers to ensure that a second record of the exposure
is maintained and available to the Soldiers.
There has not been additional testing done for sodium dichromate
exposure. There are no medical tests that can detect exposure this long
after the incident.
Question 6. The Committee is aware that in 2004, a report was
issued by the Army with findings and recommendations in regard to the
situation at Qarmat Ali and that report was subsequently sent to the
Defense Health Board. Other than commenting that ``the standard of care
was exceeded'' what other recommendations, comments or concerns did the
Defense Health Board express with respect to this report? Was the
report shared or critiqued by any other independent medical or
scientific body, such as the Institute of Medicine?
Response. The Defense Health Board (DHB) provided 14 specific and
general observations and recommendations on the study. These included
such observations that while environmental contamination was present at
the site, all available evidence indicates a low level of personal
exposure and no expectation of future health effects. They also
observed that Soldiers who were similarly exposed but not studied
should be reassured that this finding applies to them as well. They
also recommended that information about the incident be conveyed to
medical providers and included in the involved Soldiers' permanent
record and that this incident be used to train personnel in the best
practices to address future similar incidents.
We did not seek additional outside review due to the time available
and the fact that the chair of the DHB review also serves as the
Chairman of the National Academy of Sciences Committee on Toxicology.
Detailed information on the DHB review is available at: http://
www.health.mil/dhb/recommendations/2008/
DHB%20Review%20of%20USACHPPM%20Assessment%
20at%20Qarmat%20Ali%20Final%20Report.pdf.
Question 7. In Dr. Gibb's testimony, he noted that there were
several data inconsistencies in CHHPM's report. Specifically, CHHPM's
report cited test results that showed that 98 percent of blood samples
showed chromium levels within a range of 4 to 5 micrograms per liter in
one area of the report, then CHHPM stated that nearly all results were
below the limit of detection in another area of the report. How do you
account for these inconsistencies in data in CHHPM's report?
Response. Dr. Gibbs's testimony contained a factual error. The
CHPPM report states on page 15 that ``The majority of test results were
below the detection limit of the test method'' and ``All the results,
to include the earlier tests done by KBR, were within the first
reference range (0.2 to 10.0 mg/L) and 98% of the results were within
the second reference range (4 to 5 mg/L).'' Of the 135 tests done, 73
were below the level of detection of 0.5 mg mg/L, with the remaining
ranging from 0.5 mg/L to a maximum of 8.7 mg mg/L. All were below 10
mg/L, meaning all were within the first range. Only two results (7 mg/L
and 8.7 mg/L) were above 5 mg/L. It is common within the field of
occupational medicine for results to be called ``within normal limits''
or within the normal range as long as they are not above the upper
limit of the range. Dr. Gibbs incorrectly concluded that CHPPM had
claimed that the results were between 4 to 5 mg/L.
Question 8. What type of surveillance, medical and otherwise, does
the Army provide in areas where burn pits currently exist?
Response. Army preventive medicine personnel conduct initial
occupational and environmental health surveillance to determine what
potential environmental hazards may exist at a given location. These
may include: toxic industrial chemicals and toxic industrial materials
from local sources that may be in the air, water, or soil; ionizing
radiation; non-ionizing radiation; physical hazards such as extreme
noise, heat and cold, and altitude; food-, water-, vector-, and
arthropod-borne threats; endemic diseases; and any by-products of US
forces activities (noise, smoke from burn pits, exhaust, etc.). The
results are documented in a site-specific Occupational and
Environmental Health Site Assessment. Identified hazards are assessed
for potential impact on the mission and for long-term health concerns.
The hazards are eliminated, reduced or otherwise controlled as feasible
within mission constraints. Surveillance is conducted when hazards
cannot be eliminated and a decision is made by commanders to accept the
health risks associated with the exposure situation. Surveillance
relating to burn pits can include ambient air sampling, surface soil
sampling, and reviewing medical encounter data.
Soldiers (and other Servicemembers) are asked to discuss any
concerns that they have about burn pits or other environmental
exposures with a health care provider as part of their mandatory post-
deployment health assessment process. This assessment is a two-step
process that occurs within 30 days of their return from a deployment
and again within 6 months after their return from deployment. Specific
information on this program and the survey forms is available at http:/
/afhsc.army.mil/Documents/DOD_PDFs/DODI_6490_03.pdf
Question 9. When will additional environmental assessments from
burn pit sites, in addition to the one already done at Balad, be
conducted?
Response. A tri-service group is developing an air sampling
strategy for the CENTCOM AOR, focusing on sites with significant air
pollution sources such as burn pits. The group is considering potential
air hazards, methods to collect samples in a deployed area, and how
such data could be used to better characterize the air and the health
risk to deployed Service Members. Personnel from the group are
traveling to 6 locations in Iraq and Afghanistan in early November 2009
to brief command personnel on historical air sampling results, discuss
the current situation with medical personnel, and gain further
understanding of the exposure situation and concerns. Upon return, the
draft sampling strategy will be updated and presented to the Joint
Environmental Surveillance Work Group Executive Committee in late
November 2009. It will then be reviewed by the Defense Health Board at
the end of November 2009. Sampling is expected to begin in early 2010,
assuming that operational security considerations are sufficient to
allow this to occur safely.
Question 10. What other environmental exposures is the Army
currently monitoring?
Response. Currently, Army preventive medicine personnel are
conducting occupational and environmental health surveillance to
determine what potential environmental hazards and risks exist at all
large US Base Camps in Iraq and Afghanistan. Surveillance includes
periodic sampling of ambient air quality, potable and non-potable water
sources, and contaminated soil. The results are documented in a site-
specific Occupational and Environmental Health Site Assessment. Since
2001, more than 17,000 environmental samples have been collected
throughout the CENTCOM Area of Operations with almost 10,000 in Iraq,
more than 3,500 in Kuwait, and 3,300 in Afghanistan.
Question 11. What preventative measures are taken by the Army
before it sends soldiers into areas where there are potential
environmental hazards?
Response. The preventive measures undertaken by the Army prior to
deployment are addressed in Army Regulation (AR) 11-35, Deployment
Occupational and Environmental Health Risk Management, Headquarters
Department of the Army, 16 May 2007. These include an assessment of
occupational and environmental health hazards such as industrial
chemicals, hazardous noise levels, or radiation or other hazard present
or being generated by local national agricultural, industrial, or
commercial activities. Ideally, these assessments are completed pre-
deployment as part of an Occupational and Environmental Health Site
Assessment or an Environmental Baseline Study prior to the
establishment of a forward operating base or other deployment location.
These considerations are included in the Army composite risk management
process to balance mission risks when developing contingency and
operational plans. Operational planners attempt to identify these
hazards as part of the overall intelligence preparation of the
battlefield but they are often unable to obtain the needed data prior
to US Forces occupation of a site. As a result, a primary component of
the DOD/Army Deployment Occupational and Environmental Health Risk
Management program is the principle of hazard recognition and
avoidance. Commanders at all levels are required, by DOD, Joint Staff
and Army Policies, to ensure that Occupational and Environmental Health
hazards are identified and assessed during periodic monitoring as part
of their overall composite risk management plan for the operation,
similar to the risks from combat, CBRN attacks, and physical safety
hazards.
______
Response to Post-Hearing Questions by Hon. Richard Burr to John J.
Resta, PE, MS, Scientific Advisor, U.S. Army Center for Health
Promotion and Preventive Medicine
Question 1. At the hearing, Mr. John Resta indicated that the
Department of Defense may be moving forward with additional air
sampling and studies regarding the potential health effects of burn
pits being used in Iraq and Afghanistan.
A. Please provide additional details regarding any on-going or
planned air sampling related to burn pits.
Response. Air sampling for Particulate Matter is being conducted
across Iraq and Afghanistan at locations with deployed preventive
medicine personnel which includes most of the larger US base camps.
Sampling for volatile organic compounds (VOCs) is also being performed
because of burn pits and other sources of VOCs at the base camps such
as generator and vehicle exhaust.
A tri-service group is developing a comprehensive air sampling
strategy for the CENTCOM Area of Responsibility, focusing on sites with
significant air pollution sources such as burn pits. The group is
considering potential air hazards, methods to collect samples in a
deployed area, and how such data could be used to better characterize
the air and estimate the health risk to deployed Service Members.
Personnel from the group are traveling to 6 locations in Iraq and
Afghanistan in early November 2009 to brief command personnel on
historical air sampling results, discuss the current situation with
medical personnel, and gain further understanding of the exposure
situation and concerns. Upon return, the draft strategy will be updated
and presented to the Joint Environmental Surveillance Work Group
Executive Committee in late November 2009. It will then be presented to
the Defense Health Board at the end of November 2009 for their review
and comment. Sampling is expected to commence by early 2010 assuming
operational security conditions are adequate to allow this to occur
safely.
B. Is on-going sampling being done near the living quarters of
servicemembers in Iraq?
Response. Air sampling locations associated with burn pit smoke are
selected by deployed preventive medicine personnel based on their
assessment of air hazards and their impact on the mission and
potentially affected populations. These sampling locations frequently
include living areas.
C. Would you please provide a timeline of when additional studies
will be initiated and when we can expect the results?
Response. As discussed above, additional burn pit studies would be
expected to begin in early 2010. The actual dates may be affected by:
equipment purchase and shipping, training, coordination of laboratory
assistance, personnel rotation schedules, and/or the operational
situation at the locations of interest. Results would be anticipated 3-
6 months after the completion of field work.
Question 2. A February 2009 article in ``Inhalation Toxicology''
written by employees from the U.S. Army Center for Health Promotion and
Preventive Medicine noted that authors of a 2005 journal article had
``conducted a survey of 15,000 military personnel deployed to
[Operation Enduring Freedom/Operation Iraqi Freedom] and estimated that
69.1% reported experiencing respiratory illnesses, of which 17%
required medical care,'' and that ``[t]he frequency of respiratory
conditions doubled from a pre-combat period to a period of combat
operations in this group.''
A. What steps are being taken to ensure that possible respiratory
illness is addressed in post-deployment health assessments?
Response. Soldiers (and other Servicemembers) are asked to discuss
any health concerns that they have about burn pits or other
environmental exposures with a health care provider as part of their
mandatory post-deployment health assessment process which is a two-step
process that occurs within 30 days of their return from a deployment
and again within 6 months after their return from deployment. Specific
information on this program and the survey forms is available at http:/
/afhsc.army.mil/Documents/DOD_PDFs/DODI_6490_03.pdf.
The increase in respiratory conditions in theatre noted in the
article occurred during deployment by analyzing these post-deployment
self assessment data. Soldiers' self-reporting of symptoms on
questionnaires seems to increase from pre-to-post-deployment, but the
increase is not reflected in more objective measures of health status,
namely health care encounters. CHPPM has assessed the frequency of
post-deployment inpatient and ambulatory care visits for respiratory
conditions, and not found them to be associated with deployment (i.e.
number of deployments and cumulative time deployed).
B. To what extent does the smoke from burn pits potentially
contribute to respiratory health problems of deployed servicemembers?
Response. It is not possible to state to what extent any one
exposure contributes to ``respiratory health problems of deployed
servicemembers.'' It is recognized that exposure to burn pits smoke can
cause acute, short-term and, most often, mild respiratory health
problems in servicemembers such as red, watery, and mild upper system
symptoms, depending on the degree of smoke exposure, such as coughing
and sinus congestion. It is also suspected that a fairly small number
of personnel who may have preexisting respiratory conditions may have
those conditions aggravated by smoke exposures, or because of special
susceptibilities, unique medical histories, or possibly even as a
result of combined exposures (such as use of open burning and smoking
cigarettes or cigars, etc.) could develop some type of chronic health
effects. What are not known is what conditions might fall into this
category and how frequent such conditions may develop. Epidemiologic
studies are underway to identify any associated conditions and the
extent of any risks toward the development of long-term, chronic
conditions. The studies conducted to date have not demonstrated a
significant increase in respiratory health outcomes post-deployment.
Additional epidemiologic studies are underway to identify any
associated health conditions and the extent of any risks toward the
development of long-term, chronic conditions.
Question 3. In his testimony, Mr. Resta indicated that the U.S.
Army Center for Health Promotion and Preventive Medicine and the U.S.
Air Force School of Aerospace Medicine ``performed both an operational
health risk assessment and a long-term health risk assessment based on
large-scale sampling events at Joint Base Balad'' and that ``no
environmental monitoring data collected at Joint Base Balad to date
have identified an increased risk for long-term health conditions.''
A. Can you explain the extent to which the presence of particulate
matter was considered in reaching that conclusion about long-term
health conditions?
Response. The risk assessment conclusions for the burn pit health
risk assessments were based on the chemical test results and did not
consider particulate matter (PM) exposures primarily because a CENTCOM-
wide PM characterization study was in progress during the time of the
risk assessments and the potential health effects of PM exposures are
not well understood. USACHPPM has requested that the National Academy
of Sciences evaluate the existing PM data set and provide
recommendations on assessing the health risks from exposures to PM.
This evaluation is ongoing and expected to be completed in 2010.
B. What impact do open burn pits potentially have on particulate
matter levels?
Response. Products of combustion include particulate matter, which
is a broad term for particles which can be inhaled and include acid
aerosols, metals and other compounds. Thus, burn pits add particulate
matter to the surrounding air and potentially raise particulate matter
levels. However, PM levels at Balad and across the region are naturally
much higher than those found in the US. The year-long sampling effort
for the CENTCOM-wide PM characterization study showed PM levels at
Balad were similar to other locations in the region, some of which had
burn pits and some that did not.
C. Would you explain the findings that were published in
``Inhalation Toxicology'' in February 2009 with regard to the health
effects of exposure to particulate matter (article entitled ``Potential
Health Implications Associated with Particulate Matter Exposure in
Deployed Settings in Southwest Asia'') and what impact those findings
may have on your conclusions regarding the long-term health risks
associated with open burn pits?
Response. The article was a review of some of the health effects
associated with particulate matter, and specifically, what has been
published regarding potential relationship of particulate matter in
military populations. Based on the literature to date, no clear
consensus regarding long-term health risks associated with particulate
matter in deployed settings has emerged. Thus, the article discusses
potential health risks. The article identifies burn pits as a potential
source of particulate matter, and notes that burning and products of
combustion may contribute to long-term health effects.
Chairman Akaka. Thank you very much, Mr. Resta.
My first question is for all of the DOD witnesses. I am
really interested in the timeline for each of the exposures.
So, General Payne, tell me about Camp Lejeune. When did the
Marine Corps first learn about some potential problems there
and when were your VA partners and servicemembers first
notified about that?
General Payne. Sir, there was an indication, I am told, in
approximately 1979 that there were VOCs that were interfering
with the testing of the water. But our ability to determine the
specific chemicals involved took several years.
Once we found out the specific chemicals, the specific
wells, we began shutting down those wells in late 1984. The
first notification was through the base newspaper and I have no
idea, sir, why that route was chosen. Looking back from 2009,
it seems to me to be a very inadequate response and an
inadequate notification, quite frankly. I cannot speak for why
the decision was made at that time in late 1984 and again in
1985 to use that means of notification of the potentially
affected residents.
Chairman Akaka. The same question I would like to ask of
Dr. Gillooly. Can you share the timeframe for Atsugi?
Mr. Gillooly. Yes sir. As mentioned in my introductory
remarks, the incinerators were constructed in the early 1980s.
They were burning municipal waste. They applied for a permit to
burn industrial waste in 1985. I think that was when the first
concerns arose. There were some studies done by other
organizations within the Navy, not Navy Medicine, in the late
80s and early 1990s. We were not involved in those studies.
We were tasked, or asked rather, in 1994 to come in and
look at what had been done and at that point, we had done a
screening risk assessment. So, that is when we first became
aware of the air emission problems, then wrote a fact sheet and
began some risk communication on base at that time.
We followed that up in 1997 with another screening risk
assessment using data that was primarily collected, not by us,
but for compliance purposes, and each time we recommended that
we go to a full comprehensive risk assessment study that would
involve a year-long study of the air pollutants. In other
words, we would sample for the whole year.
As you are aware, the Department of Justice filed suit, I
believe, in 1999-2000, against the incinerator complex and it
was closed in 2001.
Chairman Akaka. When were your VA partners notified about
this or the other servicemembers?
Mr. Gillooly. Pardon? Could you repeat that, please? I did
not hear that. When was----
Chairman Akaka. Yes. When was this information passed on to
VA?
Mr. Gillooly. Well, to my understanding, this year. In
fact, there was a formal presentation to the VA about the
Atsugi retrospective cohort epidemiological studies. So, I
think, to my knowledge, that is the first formal presentation
to the VA.
Chairman Akaka. Mr. Resta, your timeline in Qarmat Ali and
the burn pits, when did the problems come to light and when
were your servicemembers and VA notified?
Mr. Resta. For Qarmat Ali, my organization became aware of
it on 15 September 2003, when we were contacted by the
Coalition Forces Land Component Command, also known as CFLCC.
CFLCC, on about the same day, also put the site off limits for
all U.S. military personnel.
We deployed and arrived on 30 September, started our field
work, completed our study in November 2003, and published a
report in January 2004, which was classified at the time in
accordance with CENTCOM classification guidance. Between 2005
and 2007 there were several informal contacts between members
of my organization and various physicians within the VA asking
questions about the incident.
The first formal data transfer was of the classified report
in December 2008, and then we subsequently prepared an
unclassified report that was provided to them in January 2009.
In terms of burn pits, our first involvement with burn pits
occurred in 2004 at Camp Lemonier in Djibouti on the Horn of
Africa, where we conducted our first study.
We identified the risks at Balad as part of an occupational
and environmental health site assessment in the 2006 timeframe,
we started conducting environmental sampling there in 2007.
That environmental sampling continues with certain periodicity
today, and we started providing informal--at the technical
level between physicians--information on that to the VA
probably as early as 2007.
We provided formal information to the VA in May of this
year. They have gotten all the data to date that we have--all
the sampling data that we have on Joint Base Balad to date.
Chairman Akaka. Thank you. Let me ask Dr. Postlewaite if
you have any further comments on this.
Mr. Postlewaite. I think the timelines are accurate, sir. I
have nothing to add to that.
Chairman Akaka. Dr. Peterson, what happens when information
about exposures arrives at VA's doorsteps; and Dr. Hunt, do you
begin to assess the health of a veteran who has served in an
area where exposure is known to have occurred?
Dr. Peterson. Mr. Chairman, I would reference my opening
statement about the DOD/VA Deployment Health Work Group. As
other witnesses have explained on the DOD side, that has become
the venue in the last few years of both discussions related to
exposures and a venue for the transfer of information to
include things like lists of potential people exposed.
When through that working group the VA is notified, we have
a discussion with others at the Health Work Group, and
internally to VA, concerning the appropriate course of action.
What do we feel based on work done by DOD up to that particular
period of time in terms of exposure, how much of a risk is
there?
We identify methods by which to communicate with both
veterans and providers that the exposure has occurred and what
they need to be concerned about from a provider's perspective;
from the prospective of care and where necessary, we begin to
conduct medical surveillance and provide appropriate health
care as authorized under statutory authority.
I think Dr. Hunt can provide us a very interesting
perspective in terms of what you have asked him to do and also
to kind of balance out what I said in terms of when that
information is provided to our providers in the field, when
veterans become aware and start asking questions, how those
questions are addressed, and how the care is handled at that
point.
So, I will ask Dr. Hunt to address that.
Chairman Akaka. Dr. Hunt?
Dr. Hunt. First, I would like to thank the Chairman and
Ranking Member for the invitation to come speak with you today,
as well as the staffers. I commend you on the work that you are
doing.
I feel like I am sitting here with 3,000-3,500 veterans
that I have seen over the years. I am a primary care physician,
occupational environmental medicine trained, and have done many
hundreds of Gulf War registry exams, Agent Orange exams,
Project SHAD exams, and ionizing radiation exams. I have sat
with many of these veterans and feel like I will try to
represent today their needs and their experiences.
I cannot get the stories out of my head that Stacy told
today and Laurie and Russell. I think of Senator Burr's
friends, Jerry and David. Day in and day out, I sit with these
individuals that have concerns about environmental agent
exposures. I feel like there are two very important kind of
paths that these situations take.
If we have a situation like Qarmat Ali, Camp Lejeune, where
we have what seemed to be fairly clear exposure incidents, I
feel like we are putting in place both through the work in the
DOD and CHPPM and the Office of Public Health Environmental
Hazards with our risk centers, a very nice approach that--I
wish Senator Rockefeller was still here because it is still not
where we want it to be. But we are really moving in the
direction of being able to take care of these incidents in a
way that more quickly provides relief for these veterans and
their families.
Many of the people that we see--I think of Senator Burr's
comments--have situations where we still do not have the
answer, or situations where we are waiting for science.
Tuesday, going to clinic, I ran into a Gulf War veteran that I
had not seen for 6 or 7 years. I had done his initial Gulf War
registry exam back in 1994 or 1995. Hadn't seen him for a long
time. He was doing great. He had been down to Florida. He was
being seen in a VA down there.
We had a short chance to talk and I thought, he is really
doing well, this fellow. When he first came in, he had
medically unexplained symptoms, as 20 percent of the veterans
from the first Gulf War did. We still do not know exactly what
that is about. We still do not fully understand it.
But what we do know is that there are many things we can do
to help these veterans before we fully understand everything
that is going on in terms of direct associations between
exposures and health problems.
So I guess to answer your question, what we try to do when
a veteran comes in is to first of all acknowledge their
service, acknowledge their sacrifice, take a step back from the
chief concern about the exposure and the health concerns and
reassure them that we will be spending time on that, but to
take a step back and look at the greater context of their needs
and their situation, particularly combat veterans.
These exposures in combat particularly are a part of a very
complex matrix of exposures that have to do with environmental
agents, psychological traumas, sleep deprivation, and all the
other potentially deleterious experiences a person has in
combat.
So, we try to assess kind of the full spectrum of risks
that this person has been exposed to. We try to put the
assessment of their environmental exposures in the context of
that overall risk. We try to get the services set up that they
need, including getting them service connected, getting them
benefits, getting them the support that they need so that even
before we know the answers to is this particular symptom
related to this particular exposure, there are a lot of things
we can do to help them get back on track and get back on their
feet, particularly combat veterans.
Chairman Akaka. Thank you very much, Dr. Hunt. Senator
Burr, your questions.
Senator Burr. Thank you, Mr. Chairman. I apologize to the
witnesses that I was not here to hear the testimony, but I have
tried to go over it as best I could.
Let me go to you, Dr. Peterson, and to any of your
colleagues from the VA that feel appropriate to potentially
answer. The Navy sent out letters to veterans stationed at Camp
Lejeune between 1957 and 1987, encouraged them to participate
in the health registry. To date, roughly 140,000 individuals
have responded and it is reasonable to conclude that many
responded because they are in fact suffering from health
problems and are worried they could be linked to the service at
Camp Lejeune.
Has the Navy or the Marine Corps volunteered to share the
names, addresses of those individuals with the VA potentially
so the VA could let them know whether they are eligible for VA
care? In other words, have they provided the registry to the
VA?
Dr. Peterson. Yes, in fact, the VA is providing veterans
with information about this issue and offering contact
information and referrals to a registry that the Navy has
established in the past. So we have--the Navy has been
proactive in----
Senator Burr. The 140,000-plus name registry has been
provided to the VA?
Dr. Peterson. Yes.
Senator Burr. OK. Has the VA proactively gone after those
140,000 individuals to counsel them relative to their potential
benefits within the VA system?
Dr. Peterson. We make the benefits aware to all of our
veterans in a variety of ways. We have not specifically
targeted that group. What has happened, coincidentally, with
working issues like informing our veterans and going after them
and indicating what benefits there are available to them, we
have also----
Senator Burr. They have responded to a Navy/Corps
notification that they were at Camp Lejeune over a period of
time where they potentially were exposed to toxic substances in
the water. That list of people who responded and said, I
acknowledge I was there, I might have a concern, has been
supplied to the VA, but we do not do anything proactive from a
standpoint of the VA to reach out to those individuals?
Dr. Peterson. No, we do reach out proactively. I guess the
point I am trying to make is while we are in the process of
beginning to do that, we are also finding out that the National
Research Council has produced a document, as was talked about
earlier on the first panel, that indicates from their findings
that we need to move forward in terms of research. Having been
accomplished, there is no more research that indicates any more
studies need to be done. This is a finding of the commission.
Senator Burr. Dr. Peterson, seriously, I do not want to get
into the NRC results with the Veterans Administration. I look
at the VA from the standpoint of the agency mandated to provide
service, health care service specifically, and you have thrown
me a curve ball because the VA says and the Marine Corps says
they have never--the Marine Corps says they have never given
the VA registry the registry, and the VA says they have never
gotten the registry.
For you to tell me that you have the registry is something
new.
Dr. Peterson. OK. Brad, did you want to answer that?
Senator Burr. Mr. Mayes, would you like to clarify that?
Mr. Mayes. Senator--I think I turned it off there. I am not
aware and I can speak for what we have done in the Benefits
Administration, that we specifically have the names to conduct
the outreach. We have been made aware of the situation at
Lejeune.
What we have done on the benefits side of the house is we
have gone out and tried to make our field personnel sensitive
that you are going to start seeing veterans coming into our
regional offices----
Senator Burr. Let me ask a real specific question.
Mr. Mayes. Yes, sir.
Senator Burr. To whoever would like to take it. Have you
taken whatever list you think has been provided for you and
compared it to the veterans that are enrolled within the VA
system to see who might already be enrolled, receiving services
from the Veterans Administration, where it would be extremely
beneficial to that veteran for their doctor to know that they
were potentially exposed to toxic substances at Camp Lejeune in
their treatment?
Mr. Mayes. Sir, the short answer is I do not think we have
the registry with all of the names. So to my knowledge, we have
not matched that up.
Senator Burr. Well, let me go to the logical next question.
Mr. Mayes. I know what it is.
Senator Burr. Isn't that essential to the performance of
your job, the delivery of health care to individuals, just if
we limit it for a second to the ones who qualify for VA
benefits? I mean, Dr. Hunt, I know exactly what you were saying
earlier. Having as much information about the individual you
are treating gives you specific insight as to the treatment
therapies that you might pursue, knowing where they were
exposed to the same thing if it is two--if it is one place
versus the other might give you insight.
Based upon others you have seen, to me, it seems like an
issue that the VA would actually be proactive with the Corps
and the Navy, saying, we need this to do our job. The more
information we get, the more effective we can be at the
treatment of these individuals.
Let's forget the ones that do not know whether they qualify
today. Does that--am I right there?
Dr. Hunt. [Nodding affirmatively.]
Senator Burr. I take the shaking of the head in the
affirmative--OK. Dr. Peterson, in your testimony, you state
that the VA does not have special authority to enroll Camp
Lejeune veterans and their family members in the VA health care
system.
As you know, I have introduced legislation that would
explicitly authorize the VA to care for veterans and family
members that show illnesses that might be the result of their
time at Camp Lejeune. It appears to me that the VA could create
a special enrollment category for those affected veterans using
the Secretary's general authority to provide needed health care
to categories of veterans not specified in law.
Does the VA have such legal authority?
Dr. Peterson. I can't answer that question without asking
general counsel. I do not know. I do not know.
Senator Burr. Could I ask you to take that to the general
counsel?
Dr. Peterson. I would be happy to, sir.
[See Question 1 in post-hearing questions by Senator Burr.]
Senator Burr. I think you will find out the answer to that
is affirmative.
Dr. Peterson. OK.
Senator Burr. And if that is the case, and I will not pose
this in the form of a question, I will pose it in the form of a
statement. Why would we rather wait to see if I pass
legislation versus initiate the authority of the Secretary to
create through that general authority the coverage for
individuals that we fear might have a condition which is the
result of having served at Camp Lejeune during a period that
the groundwater was contaminated to a degree yet to be
determined, OK?
Mr. Mayes, I cut you off earlier and this question might go
to the heart of it, and I will let you answer in a complete
statement. If veterans who were stationed at Camp Lejeune, have
evidence that they have one of the diseases that might be the
result of that contaminated water, how does VA evaluate a
disability claim for an individual who might fall into that
matrix?
Mr. Mayes. Yes sir, I think I understand the question. At
the present time, we need evidence, of course, that they have a
disease and then we would put them at Camp Lejeune, which we
would certainly not question if they were at Camp Lejeune
during the affected period, that they were clearly exposed to
whatever was in the water--they would be drinking and bathing
and using the water.
And then we would be looking for a medical nexus opinion
between the disease and exposure to some toxic substance that
might have been in the water. At the present time, that is
required for service connection in those particular cases.
Senator Burr. If I happen to visit any VA facility in the
country, how familiar would that person who sees that veteran
coming in--that doc in that facility--be about Camp Lejeune
potential contamination if in fact they found somebody that met
that criteria; would the average person out there even know
anything about it?
Mr. Mayes. The average adjudicator out there should know
about it, Senator. We have a monthly call with all of our field
managers that manage those veteran service centers that
adjudicate those claims. It was in June that we made all of
those managers aware that this was an issue.
We had anecdotal evidence that people were coming in and
filing claims, that they needed to be sensitive to this and
then, in fact, they had to sympathetically view those claims,
order an exam if it is necessary, but at the end, they would
still need the disease exposure at Lejeune and then that nexus
opinion.
Senator Burr. I take for granted somewhere there exists a
memorandum stating that information to them?
Mr. Mayes. Sir, we have not put it in a formal, what we
call a fast letter, which would be guidance. We do document--we
do document what we say on those calls.
Senator Burr. I feel fairly confident you will after this
hearing.
Mr. Mayes. Yes, sir.
Senator Burr. Therefore, I would like you to send me a copy
of it when you do.
Mr. Mayes. Will do, Senator.
Senator Burr. For the purposes of the Committee.
Mr. Mayes. Yes, sir.
Dr. Hunt. Senator?
Senator Burr. Yes, sir?
Dr. Hunt. On the clinical side, we--that information is
being disseminated. Two weeks ago we had a conference on post-
combat care in the VA. There were 3,000 people that attended
from around the country. It is the biggest conference the VA
has ever had.
There were several sessions at the conference that were
done by the Office of Public Health Environmental Hazards,
including one talking about Camp Lejeune and these other four
exposure incidents as well. Also, we have monthly conference
calls for this post-deployment in-grade care initiative and the
one next month is done by the War-Related Illness and Injury
Study Centers to further disseminate information to clinicians
in the field about Camp Lejeune and these other exposure
incidents.
There is also a monthly conference call through the
Environmental Hazards Group where they discuss this too. So,
clinicians certainly are getting the word about these veterans.
So, if they come in, at least clinicians are increasingly aware
of.
Senator Burr. Thank you for that, Dr. Hunt, and thank you
for noticing that I blurred the line between disability back to
medical care, unintentionally, but I am glad that I did so that
you could sort of fill me in on that.
Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Burr. This
question to Dr. Hunt builds on what Senator Burr was asking
about.
VA has said that records are shared between DOD and VA for
purposes of adjudicating claims, but what about for the purpose
of providing health care? The bottom line is, can a VA doctor
look at a veteran's health record and tell what environmental
hazards they were exposed to during their deployment?
Dr. Hunt. One of the advantages of having been in the
system for a period of time is knowing how absolutely absent
that sort of communication was in the past. There is no
question that we are moving forward with bidirectional health
information exchange, with remote data access.
I confirm the chart when I am seeing a patient. I can click
on remote data. I can get data from Fort Lewis or from military
treatment facilities and among those data are information from
the Post-Deployment Health Reassessment, PDHRA, which has
information on exposure, and that is very useful for sure.
So we are increasingly gaining access to those sorts of
records that are very helpful.
Chairman Akaka. On the question of Qarmat Ali, Dr.
Postlewaite, in your written testimony you called DOD's
response to the exposures at Qarmat Ali exemplary. How would
you characterize DOD's efforts to prevent exposures there?
Specifically, how did your program help soldiers and workers at
the water treatment plant?
Mr. Postlewaite. Thank you, Senator. Actually, that
testimony you quoted is Mr. Resta's, but I would like to take
an opportunity to address your question, if I may. The word
``exemplary'' that was used in that testimony was a quote from
the Defense Health Board when they reviewed the Army medical
response to Qarmat Ali. They found it to be timely based on the
minimal time since notification.
The Army was able to put together a team of experts,
including occupational health physicians, get them into
theater. This was in 2003. This is a very difficult time
because we were very much engaged in hostilities at that time.
This is out away from the base camp, where there wasn't lots of
protection.
But nevertheless, the leadership said go for it and they
were pulled in very, very quickly. The environmental assessment
was done very quickly, as well as the medical assessment. We
felt that under very extraordinary circumstances it was a very
timely response.
Chairman Akaka. Dr. Postlewaite and Mr. Resta, Dr. Gibb
stated that the symptoms that have been reported by soldiers
and civilian workers at Qarmat Ali are consistent with what has
been experienced by other workers similarly exposed. He also
said that blood samples were not taken until 1 month after
remediation measures were taken to limit the exposure and that
kind of delay does not allow for an accurate measure of
exposure.
How confident are each of you that you have properly
identified servicemembers' risk of exposure at Qarmat Ali?
Mr. Postlewaite. This is a very complex situation with
Qarmat Ali, Senator Akaka. Again, in 2003 when this occurred,
the Army came in very quickly, did the assessments on the
individuals that were currently assigned there at Qarmat Ali,
became aware of some units that had been there previously, felt
after the environmental assessment was done, taking a look
around the area, interviewing the troops and during that time,
I think as is in the reports that you all have read, there were
some symptoms noted primarily related to dried nasal membranes
and upper respiratory kinds of symptoms that would be very
consistent with the desert environment.
At that point in time, the team had no knowledge at all of
these severe effects that have been coming out in the media
over the last year since KBR raised these issues. That was not
brought up at the time. So, based on the information that was
available when those assessments were done, including the blood
chromium, which we felt was the correct test because it
measured the chromium in the red blood cells (which stays
around longer), the hexavalent chromium that you would find in
the serum, based on symptoms and based on the physical exams
that were given, and based upon the blood samples that were
drawn at the time, we felt very confident that we had fully
assessed the situation and that there were no reasons to
suggest long-term health effects.
As I said, we now have additional information and we are
certainly reopening our book on this to take a closer look and
we are very interested in what the VA physical exams will show
for these individuals to see whether those health symptoms that
they were experiencing may be consistent with these exposures.
This caught us very much by surprise because we did not
have all that information. We had an individual this morning,
the medic that spoke to us, who indicated that he took care of
treatment for a number of the people in his unit, which was
very valiant of him, but it may have prevented some of that
information related to health effects from actually getting
back to the medical facility where people could start putting
two and two together to identify a real problem.
So, there are a lot of complex issues to this that are not
easily navigated.
Chairman Akaka. Mr. Resta?
Mr. Resta. If I could just add a few things, sir, is that
the physician that ran this response is a board-certified
occupational medicine physician who works in industrial
situations for the Army and is well versed in occupational
medicine.
Through his physical examinations and ancillary testing--
not solely blood chrome levels, but including pulmonary
function tests, chest x-rays and things like blood and urine
and liver functions and the like that are outside of my area of
expertise--he concluded that the symptoms that veterans or
soldiers at that point were complaining about, the signs that
he observed, were not consistent with hexavalent chromium
exposure.
Dr. Gibb's testimony had a few factual errors in it, which
makes me believe we need to share some information with him.
The blood chemistries that we did for chromium, 73 of 135, were
less than the level of detection, which was 0.5 micrograms per
liter, not 5 to 6 micrograms per liter, as he testified.
Twenty-one of 135 were in excess of 1.0 micrograms per
liter with a maximum detected of 8.7 micrograms per liter. And
these are well within U.S. national averages. At the time we
were using a national average range of 0.1 to 10 micrograms per
liter. But the blood tests alone--just to clear up potential
confusion--the blood test alone was not the sole determination
of whether or not a significant exposure had occurred. It was
predominately the physical examination by the occupational
medicine physician. And so I just wanted to clear that up.
Chairman Akaka. Before I yield to Senator Burr, I would
like to ask this question on burn pit exposures. Dr.
Postlewaite----
Mr. Postlewaite. Yes, sir.
Chairman Akaka. We have heard stories about servicemembers
experiencing medical difficulties due to service near burn pits
in Iraq and Afghanistan. For several years now we have known
this. What active measures does your office take to ensure the
environmental safety of our servicemembers around the areas of
these burn pits?
Mr. Postlewaite. Yes, sir. Burn pits, as you probably know,
were utilized at a number of camps within Iraq and also
Afghanistan for an expedient means to dispose of waste that was
generated at those camps, so that the waste itself would not
generate a health hazard.
Unfortunately, some of these burn pits were located quite
close to the camps, in some cases, upwind of the camps. Some of
that was due to the fact with hostilities in the area the
commanders did not feel like they could locate them very far
away from the installations without putting their people at
risk.
In other cases, the burn pits were located in the
periphery, but as the base grew in size, the population
expanded around it. As a result, we have a number of situations
like this in-theater. The largest burn pit in theater, Balad
Air Base, at the time was the one that was most easily studied.
We could study it without putting people out in the far reaches
of the territory where their protection would have been an
issue.
We felt that, because it was the largest burn pit, this one
would be a good one to study in depth because we felt it would
be representative of the others. There were over 400 air
samples that were taken at Balad Air Base in 2007, constituted
the data necessary for a risk assessment as well as an
addendum.
Both the addendum and the risk assessment looking at all
the substances that were analyzed did not indicate a health
risk. We took that information, that risk assessment, and had
it reviewed by the Defense Health Board because we wanted
third-party validation that our interpretation was correct.
Nevertheless, we do feel like some people probably have
suffered some untoward health effects as a result of it. We do
not feel like the numbers are large based on the total numbers
of people that probably were exposed to smoke throughout the
theater. In fact, the Post-Deployment Health Assessments that
were mentioned earlier, I believe the figure that I saw last
was about 56 percent of all the individuals deployed actually
checked that square on the Post-Deployment Heath Assessment.
So, it was a very wide exposure. We have looked at our
health outcome data from our returning veterans. We just are
not seeing any significant elevations of the kinds of
conditions that we would expect as a result of exposure to the
smoke. But with that said, we are continuing to peel back the
layers of the onion, if you will. We are doing site-specific
studies on just the troops who were at Balad, for example, to
see if their health experience was any different.
Right now we do not have any strong evidence to suggest
that this smoke affected large numbers of people, but we really
do feel like some people probably had increased
susceptibilities. They may have had combined exposures. They
may have had previous health conditions which would place them
at greater risk.
So, we will not say that nobody is suffering from these
exposures.
Chairman Akaka. Let me follow up with Mr. Resta. According
to your testimony, the risks of burn pits were recognized as
far back in Bosnia in 1996. Were the soldiers located near burn
pits in Iraq and Afghanistan issued any protective gear or
warned in any way of the potential harms associated with burn
pits?
Mr. Resta. I am not aware that there was any specific
personal protective equipment that was ever issued to any
soldiers. I have heard anecdotes, stories of soldiers who were
immediately downwind pulling guard duty wearing dust masks and
things like that to essentially try to reduce the smell per se.
But I am not aware that we have ever issued anything there.
In terms of notification, once we got the results of the
first risk assessment, we tried, again, to communicate those
risks to the people present at Balad via various town hall
meetings, fact sheets, and the like. The challenge of doing
that in such a large operational setting is that a lot of the
people who had previously been there were no longer there, new
people were there, and the situation and conditions had
actually changed.
That is one of the reasons that we embarked on additional
sampling and continue to do that today even while we are
operating incinerators, which in the last report I received has
reduced the amount of open burning by over 90 percent.
Chairman Akaka. Thank you. Senator Burr.
Senator Burr. Thank you, Mr. Chairman. General Payne,
welcome, and let me say for the record upfront, when this
controversy at Camp Lejeune existed you were not in your
capacity today.
Now, I have in my hand, as do probably numerous people,
Base Order 5100.13B which is entitled, ``Safe Disposal of
Contaminants and Hazardous Waste,'' specifically prohibiting
the improper disposal of, and I quote, ``organic solvents'' and
defined improper practices as those, and again I quote,
``create hazards such as contamination of drinking water.''
Now in your testimony, I interpreted what you said to mean
the Marine Corps did not violate any regulations. I guess I
have to ask, is not complying--how does not complying with the
base order square with that?
General Payne. Sir, again, looking back with the lens of
2009, you look at that and one just shakes their head as to how
this happened based on the timeframes. I think that you have to
start with understanding that even in 1984, when we started
closing the wells in early 1985, when we concluded, that was
still long before these chemicals were regulated.
TCE and PCE were not even regulated until 1989 and 1992,
respectively. I can only surmise, sir, because I was not
involved in the decisionmaking at that time, I can only surmise
that we simply did not understand the ramifications of that
contamination.
Senator Burr. But would you agree with me pertinent words
here are ``organic solvent?'' I mean, there is a little room
for poisonous chemical waste or other unsuitable compounds;
either organic solvents or compounds, the definition of organic
solvent has not changed. Would you agree with me on that?
General Payne. Sir, I am not a scientist. I am a war
fighter, so I really cannot answer that.
Senator Burr. OK.
General Payne. Whether it has changed, whether we knew what
that meant at the time, and whether that definition has
changed, I'm sorry, sir.
Senator Burr. Well, we both cannot reconstruct the
personnel or the decisions that were made at the time and I
think in an effort to try to provide a fresh start, my hope is
that we can identify that we have done some things wrong in the
past and that now it is time to make the commitment to get the
information we need to know how to go forward.
Let me, if I could, turn over to Dr. Gillooly.
General Payne. And we concur with that, sir.
Senator Burr. Thank you, sir. Why was the--I take for
granted, you are the Public Health Center?
Mr. Gillooly. Yes, sir, Navy-Marine Corps Public Health
Center.
Senator Burr. Did that used to be called the Navy
Environmental Health Center?
Mr. Gillooly. Yes, sir.
Senator Burr. So, you have changed your name?
Mr. Gillooly. Yes, sir.
Senator Burr. OK, I just wanted to make sure I asked the
right person the right question. Why was NRC not asked to
review a broader set of risks?
Mr. Gillooly. We had the NRC review our previous two
screening health risk assessments in 1995 and 1997. They more
or less agreed with our findings and conclusions for those.
Senator Burr. The 2000 draft that they reviewed, they
found--they raised several questions. How did you incorporate
into the final rule what they raised?
Mr. Gillooly. Sir, we took their recommendations seriously.
We worked approximately 6 more months just working those
issues, incorporating where we could their primary issues about
reducing the uncertainty and better characterization of the
health risks. We provided to them a 100-page report that listed
point-by-point which of those items we could actually do that
were practicable at that point in time and they were included
in the final report.
Senator Burr. But several of the issues were structural
problems with the way you conducted your analysis throughout
the thing. I am not sure how you could go back and remediate
that unless it was to guess.
Mr. Gillooly. Well, I think I should back up. Number 1 is,
when we first asked the National Resource Council to look at
the report, typically you have an opportunity to discuss with
them what you intend to do onsite and we were not able to
because the Department of Justice had litigation ongoing.
So, issues such as challenges and limitations of trying to
do a risk assessment overseas from a source that was privately
owned outside the fence were very real. For example, the gold
standard would be to get on that stack, that incinerator stack
and measure the pollution coming out of the stack. We did not
do that.
Senator Burr. Adopting that rationale would tell me that
you would lean heavier on a contractor versus a DOD arm to
actually conduct more of the study.
Mr. Gillooly. Well, it is a team approach. We had both
contractors and----
Senator Burr. OK. Why would the NRC not be asked to look at
the final report before it was published?
Mr. Gillooly. All I can tell you is the Navy Bureau of
Medicine and Surgery forwarded the final draft report to the
Commander in Chief, U.S. Pacific Fleet, for release. What
happened after that I cannot comment on. In fact, I was
surprised today when Dr. Feigley indicated he had not seen
that.
Senator Burr. Mr. Resta, in your testimony, first
paragraph, excuse me, first paragraph of burn pits, you said it
should be used to minimum extent possible based on the
operational situation. When open burning operations are
necessary, they should be located as far downwind of personnel
as possible.
That would suggest that there is a human risk to those burn
pits. Am I making the right assumption?
Mr. Resta. Yes sir, you are. Breathing smoke is not
healthy.
Senator Burr. Then share with me this. Earlier this year,
in the Defense Authorization Bill, I offered an amendment to
study the issue of burn pits. The Committee rejected my
amendment and said, due to objections from the Department of
Defense.
Share with me any rational reason why the Department of
Defense would not want to know whether burn pits had more than
just smoke inhalation problems for our troops.
Mr. Resta. I certainly cannot speak for the Department of
Defense given where I am located, the Department of Army. I can
hypothesize that perhaps our objections were that we are
already working with the National Academy of Sciences on that
very issue.
I would have to really take that for the record to find out
what exactly we forwarded up there.
Senator Burr. Take that back for the record.
Mr. Resta. Yes, sir.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Richard Burr to
John J. Resta, PE, MS, Scientific Advisor, U.S. Army Center for Health
Promotion and Preventive Medicine
The Department of Defense (DOD) concurred in principle with the
amendment, but due to the short timeline and lack of specificity, the
amendment was not implementable. It is not possible to accomplish all
the environmental monitoring indicated, have all the samples analyzed,
and perform the necessary risk assessments, nor determine all health
effects from burn pits within 180 days. Further hindering compliance,
the 15 military installations or facilities required to be included in
the report were not specified. These gaps caused the DOD to object to
the proposed amendment.
Senator Burr. I think even though you are in a very
specialized area, I would think that you would be consulted on
a decision like that.
Mr. Chairman, I have a ton more questions. I would like
unanimous consent to be able to provide written questions and
to get answers because one, we have been here a long time and I
know you have things to do. These witnesses have been here for
a long time. But I do want to make one observation.
Chairman Akaka. Yes, Senator Burr. I have some questions
too. We will certainly----
Senator Burr. OK, may I make one observation?
Chairman Akaka [continuing]. Send them for the record.
Senator Burr. This Committee has struggled to try to make
seamless the handoff of active duty troops to our Veterans
Administration from the standpoint of the health care needs of
our veterans.
Today I have come to the conclusion that our problem is far
worse than just working with DOD on the electronic medical
records making this is a seamless process where when you go
into a new health care system they know exactly what you have
been exposed to, they know exactly where you have been, they
can assess what your health needs are based upon where you have
served and what you might have been exposed to.
Today I found that it is much worse because even where we
identify things that potentially could cause long-term health
conditions to our active duty Reserve and called-up Guard,
there is not an attempt to download that information to where
we know these individuals will be, at some point, receiving
their health care.
I sort of paint everybody on one side and I also paint
everybody on the VA side for not screaming about the need to
get this information. We have made tremendous progress between
VA and DOD to try to get electronic medical records that are
seamless.
If, in fact, exposure to burn pits has some potential
downstream effects, then I want to make sure a VA doctor knows
exactly where that person was so that they can see them and
treat them based upon what their exposure might be. If they
were at Camp Lejeune for those years, that information is
absolutely essential to the VA side to take care of them.
If they were exposed to an incinerator--and it really does
not matter what the conclusion of the report was, that is
pertinent information to a medical doctor who is making a
decision about an individual based upon what he sees and what
he reads. And if he only has what he sees, the care cannot be
as complete as if he matches that with what he reads.
So, I would hope on both sides of this table that the VA
would become proactive in asking for the information that is
pertinent to delivering care to these warriors on the active
duty side, that we understand this is not about minimizing the
potential effects of what we are in charge of. It is about
making sure that we get the most pertinent information to all
the people that can affect the best long-term quality-of-life
for the individuals that may or may not have been affected.
Again, I thank all of you for your testimony. Thank you,
Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Burr. This has
been a great hearing. In closing, I again want to thank all of
our witnesses for appearing today and for your responses as
well.
To the veterans and family members of veterans affected by
the exposures discussed today, I truly appreciate your
willingness to share your stories with the Committee. I
understand that these deeply personal matters are sensitive and
are not always easy to speak so freely about.
As Chairman, I am committed to ensuring that VA continues
to study the health effects related to these exposures and that
VA adapts to meet the treatment needs of individuals affected
by toxin exposures.
As I mentioned in my opening statement, in order for VA to
do this DOD must first determine who was exposed and what they
were exposed to and the health consequences of such exposure.
The information must then be shared with VA. This Committee is
not charged with direct oversight of DOD. That falls to the
Armed Services Committee. However, this Committee shares the
responsibility for oversight where the roles of DOD and VA
intersect and we share several members, including me and
Senator Burr.
To quote President Obama, ``We cannot let burn pits and
other exposures be this generation's Agent Orange.'' We have a
responsibility to ensure that the newest era of veterans
receive the highest quality of care and prevent the tragic
stories we have heard today from happening again.
I thank you again for sharing your comments and thoughts
and without question, it is going to be helpful to what we are
trying to do to help the veterans of our country.
This hearing is now adjourned.
[Applause.]
[Whereupon, at 1:37 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Paul C. Akers, BS, MS, MD,
Camp Lejeune, NC (1954-60)
My name is Paul C. Akers, M.D., and as you know from my preliminary
information, I am a Marine Corps dependent, the son of MSgt. Paul A.
Akers (deceased). I was born on August 3, 1945, at Miramar (Marine
Corps Air Station). My family was stationed at Quantico, VA; El Toro,
CA; Cherry Point, NC; and at Santa Ana, CA, prior to being stationed at
Camp Lejeune, NC.
While we were stationed at Camp Lejeune, we lived in Tarawa Terrace
II at 2505 Bougainville Drive (1954-59) and at 3040 Saipan Drive (1959-
60). My sister and I attended base schools on Brewster Avenue, all
schools being on one campus and encompassing grades one through twelve.
My father was head of the meat department at the commissary and he was
also assigned to Camp Geiger, ITR and other locations during our stay
at Camp Lejeune. My mother was a housewife, and volunteered as a Grey
Lady in the library of the Camp Lejeune Naval Hospital. The
neighborhood students rode to school and to extracurricular
destinations on USMC buses driven by enlisted Marine personnel. We
played little-league baseball at a field adjacent to Tarawa Terrace I
and little-league football on a field at Camp Geiger. Camp Lejeune High
School teams practiced at the school but held their games in the
outfield of the base baseball field or at the base football field, and
they played basketball games at the base field house. Baseball games
were played at the high school. Children played in the woods around
Tarawa Terrace; the neighborhood boys played pick-up games on a make-
shift diamond beneath a water tower in the complex.
Families drank, bathed in, cooked with, and ate food prepared with
this water. In addition, families watered the flowers and lawns, washed
their clothes, and children played in wading pools filled with this
water. There were swimming pools on base, but I do not know the source
of the water used to fill them. They were closed periodically during
the summers due to polio outbreaks. Not only was Hospital Point the
location for the base hospital, but it was also the site for social
events, such as oyster roasts, birthday parties, etc. In the early
1950's, my family was stationed at Cherry Point MCAS, and I was sent to
Camp Lejeune Naval Hospital to have my tonsils taken out. My mother was
diagnosed with metastatic breast cancer in the mid-1950's; she had
found a lump in her breast about a week or two before her diagnosis.
Adm. Joseph L. Yon, M.D. was her surgeon. She had positive lymph node
biopsies and underwent a radical mastectomy and subsequent radiation
therapy. I was in the third or fourth grade at the time of her
diagnosis. My mother died May 27, 1960 in the Naval Hospital in
Quantico, Virginia. She and my father are both buried in Arlington
National Cemetery. At the time of my mother's death, I was fourteen,
and my sister was twelve.
My sister died with metastatic malignant melanoma on June 2, 2009,
after having been diagnosed in early May, 2009. She was sixty-two years
old at the time and had previously had some Gyn atypia as well. I was
diagnosed with stage 4, non-Hodgkins lymphoma on April 29, 2009, and am
currently undergoing treatment. Except for my mother, my sister, and
myself, there is no history of malignancy on either side of our family.
As a physician and as a scientist, I am concerned on both a
personal and professional level. Three of the major contaminants in the
Camp Lejeune Water Study are classified as carcinogens and capable of
causing the cancers that have been reported in my family. As a
practicing physician, I would be highly concerned for my patients and
would monitor their health statuses closely immediately after becoming
aware of their exposure to the above-mentioned carcinogens. Believing
the exposure was related to their duty stations--Camp Lejeune, El Toro,
and other sites--I feel that the U.S. Government should assume the
responsibility for monitoring these people's health statuses and their
associated medical. Since the exposure occurred during their service to
the military (Marines, Navy, civilian base employees and dependants),
the logical location for such monitoring and any subsequent related
health care would be at a local VA hospital with all related expenses
covered by the Veterans Administration. Validation of exposure
potential may be obtained by review of the service or employee records.
I regret that I will be unable to deliver this testimony in person;
however, as I mentioned earlier, I am still undergoing treatment and
have an intrathecal methotrefate treatment scheduled for October 7,
2009. If I may provide any additional information, either in person or
in writing, please do not hesitate to contact me.
______
Prepared Statement of The Agency for Toxic Substances and
Disease Registry (ATSDR)
CONTAMINATED DRINKING WATER AND HEALTH EFFECTS AT MARINE BASE CAMP
LEJEUNE: FINAL PLANS OF THE AGENCY FOR TOXIC SUBSTANCES AND DISEASE
REGISTRY
AUGUST 2009
Executive Summary
ATSDR has been assessing the human health risks from hazardous
substances at U.S. Marine Corps Base Camp Lejeune since the late 1980s.
The agency conducted public health assessments, initiated a variety of
epidemiological studies, and employed state-of-the-art computational
tools (modeling) to reconstruct exposures to volatile organic compounds
(VOCs) from drinking water systems. In 1997, ATSDR characterized the
VOC drinking water pollutants as a ``past public health hazard,'' a
position ATSDR continues to maintain. Since then, ATSDR has focused on
epidemiological studies designed to measure the occurrence of illness
and death among the service men and women and their families exposed to
the contaminated drinking water.
Several documents or reviews of ATSDR's work have been completed
during the past 14 months. ATSDR finalized An Assessment of the
Feasibility of Conducting Future Epidemiologic Studies at USMC Base
Camp Lejeune in June, 2008. ATSDR later held an April, 2009 Expert
Panel to assess ATSDR's plans for historical reconstruction of drinking
water contamination at Hadnot Point and Holcomb Boulevard. In June,
2009 the National Research Council (NRC) issued a report, Contaminated
Water Supplies at Camp Lejeune--Assessing Potential Health Effects.
This document considers this information and defines ATSDR's plans for
completing our research activities at Camp Lejeune.
Tarawa Terrace exposure modeling: ATSDR will use its modeling to
generate semi-quantitative exposure estimates for the planned
epidemiologic studies rather than limit the use of the historic
reconstruction to exposed/unexposed. ATSDR believes that the models
provide a reliable means for assigning individuals to multiple exposure
categories useful in epidemiologic studies. ATSDR's approach is
supported by two previous expert panels that focused on exposure
reconstruction efforts.
Hadnot Point exposure modeling: ATSDR will apply simpler modeling
techniques for Hadnot Point and Holcomb Boulevard then those used for
Tarawa Terrace. The Hadnot Point area is significantly larger than the
Tarawa Terrace area and contains multiple contaminant source locations.
Applying the complex numerical models used at Tarawa Terrace to the
entire Hadnot Point area would be time consuming, costly, and add
another level of uncertainty to the water modeling analysis. This
approach is supported by both the NRC report and the ATSDR 2009 expert
panel.
Reanalysis of birth outcomes study: ATSDR will proceed with its
planned reanalysis of the birth outcomes study to correct for errors in
exposure classification. To avoid further exposure misclassification,
ATSDR will await the completion of the historic exposure reconstruction
of the Hadnot Point drinking water system.
Birth defects and childhood cancer studies: ATSDR will complete its
case-control study of birth defects and childhood cancers. The analysis
will proceed expeditiously once the historic exposure reconstruction of
the Hadnot Point drinking water system is completed.
Further epidemiological studies: ATSDR has proposed mortality and
morbidity studies. The morbidity study will be based upon a ``health
survey'' that would solicit information about diagnosed illnesses
(e.g., cancer) from former service men and women and their families.
ATSDR plans to move forward as quickly as possible to conduct the
mortality study which has adequate study power and can be completed in
a relatively short time period. ATSDR recognizes that a scientifically
valid morbidity study based upon a health survey is time consuming and
costly. The utility of the health survey depends upon high
participation rates and the ability to secure objective confirmation of
reported medical conditions. ATSDR will alter its plans for the health
survey by using a phased approach, evaluating participation rates and
diagnosis verifiability in advance of a complete survey of all eligible
participants. ATSDR will define scientifically sound criteria for
evaluating the results of the first phase, and for deciding upon the
feasibility of a complete survey.
ATSDR concludes that the portfolio of epidemiologic studies is not
only scientifically useful, but also a service to the community of
service men and women and their families exposed to contaminated
drinking water at USMC Base Camp Lejeune.
Table of Contents
Executive Summary..................................................... 1
Table of Contents..................................................... 4
I. History and Purpose................................................ 5
II. Science and Service............................................... 6
III. Partnerships and Oversight....................................... 7
IV. ATSDR Camp Lejeune Portfolio...................................... 8
V. The NRC Recommendations............................................12
VI. Implementation and Timeline.......................................21
VII. References.......................................................22
I. HISTORY AND PURPOSE
ATSDR has been assessing the human health risks from hazardous
substances at U.S. Marine Corps Base Camp Lejeune since the late
1980's. The agency conducted public health assessments, initiated a
variety of epidemiological studies, and employed state-of-the-art
computational tools (modeling) to reconstruct exposures to volatile
organic compounds (VOCs) from drinking water systems. In 1997, ATSDR
characterized the VOC drinking water pollutants as a past public health
hazard, a position ATSDR continues to maintain. Since then, ATSDR has
focused on epidemiological studies designed to measure the occurrence
of illness and death among the service men and women exposed to the
contaminated drinking water. ATSDR has enlisted four different Expert
Panels and a Community Assistance Panel to help guide the development
of this work.
Several documents or reviews of ATSDR's work have been completed
during the past 14 months. ATSDR finalized An Assessment of the
Feasibility of Conducting Future Epidemiologic Studies at USMC Base
Camp Lejeune in June, 2008. ATSDR later held an April, 2009 Expert
Panel to assess ATSDR's plans for historical reconstruction of drinking
water contamination at Hadnot Point and Holcomb Boulevard. In June,
2009 the National Research Council (NRC) issued a report, Contaminated
Water Supplies at Camp Lejeune--Assessing Potential Health Effects.
ATSDR has carefully evaluated these reports, comments from the Camp
Lejeune Community Assistance Panel, and comments from additional
scientists and an environmental non-governmental organization. ATSDR's
plans take into consideration the underlying science, our commitment to
serving communities exposed to hazardous substances, and address the
comments and concerns of the reviewers.
II. SCIENCE AND SERVICE
ATSDR has a unique mandate to conduct human health research related
to community exposures to hazardous substances. Although our knowledge
of the relationships between chemical exposures and human health is
often based upon studies of highly exposed workers or animal toxicology
testing, there remains a pressing need to know whether lower level
exposures, away from the workplace, cause human illness. ATSDR
identified the drinking water contamination at Marine Base Camp Lejeune
as an opportunity for conducting this type of research.
ATSDR recognizes the importance of setting appropriate expectations
for our research. Our research studies must be of high quality. ATSDR
research should contribute to the understanding of the human health
effects of hazardous exposures such as VOCs in drinking water. While no
single study can be conclusive, our research should add information to
the overall weight-of-evidence regarding associations between hazardous
exposures and human health outcomes.
Our science serves a secondary, service-related, function: the
right to know. At Camp Lejeune, hundreds of thousand of men and women
lived and worked providing service to their country. Many were
unknowingly exposed to VOCs in their drinking water. Beyond
contributing to our general knowledge about these hazardous substances,
ATSDR research studies will provide information that former service men
and women of Camp Lejeune want to know about the health risks from
these past exposures.
ATSDR believes conditions are appropriate to continue research at
Camp Lejeune. ATSDR's research should help inform policy decisions that
respond to the health concerns of the service men and women exposed to
contaminated drinking water. However, the development of these policies
need not await the results of ATSDR research. The policy decisions
should be based a weight-of evidence assessment of all relevant human
and animal studies and consider authoritative assessments that have
previously been published. Policies should be flexible enough to
incorporate new information, such as the results from the ATSDR
studies.
III. PARTNERSHIPS AND OVERSIGHT
ATSDR serves the men and women who lived at Camp Lejeune while the
drinking water was contaminated. Our work at Camp Lejeune would not be
possible without the support and partnership of multiple people and
organizations. Although no single person or group represents this
diversity of people, many former marines have become active partners by
serving on our Community Assistance Panel (CAP). The Department of Navy
and United States Marine Corps have dedicated significant resources and
efforts to assist ATSDR. Both groups have been instrumental in helping
us understand the complexity and history of Camp Lejeune's drinking
water systems. The quality of our efforts would have suffered without
the dedicated interest and help from these people.
ATSDR recognizes the value of objective scientific review. Over the
years ATSDR has assembled four separate expert panels as we developed
our epidemiological studies and computer-based models of drinking water
contamination. Two panels have addressed the historic reconstruction of
contaminated drinking water at Camp Lejeune: first the Tarawa Terrace
system and second the Hadnot Point and Holcomb Boulevard systems. A
third expert panel focused on whether or not ATSDR should conduct
epidemiologic studies of the Camp Lejeune population beyond studies of
birth outcomes, birth defects, and childhood cancers. The fourth expert
panel provided advice to ATSDR on scientific approaches to a
congressionally mandated health survey. The NRC report provides an
additional opportunity for objective external review. In addition,
protocols and reports of ATSDR's work have routinely been peer-reviewed
by experts outside the Agency.
IV. ATSDR CAMP LEJEUNE PORTFOLIO
ATSDR's work at Camp Lejeune is briefly described below for
background purposes.