[Senate Report 111-189]
[From the U.S. Government Publishing Office]
Calendar No. 377
111th Congress Report
SENATE
2d Session 111-189
======================================================================
EXAMINATION OF EXPOSURES TO ENVIRONMENTAL HAZARDS DURING MILITARY
SERVICE AND HEALTH CARE FOR CAMP LEJEUNE AND ATSUGI NAVAL AIR FACILITY
VETERANS AND THEIR FAMILIES ACT OF 2010
_______
May 17, 2010.--Ordered to be printed
_______
Mr. Akaka, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
together with
SUPPLEMENTAL VIEWS
[To accompany S. 3378]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee'') unanimously reports favorably, without amendment,
an original bill to authorize health care for certain
individuals exposed to environmental hazards at Camp Lejeune
and the Atsugi Naval Air Facility, to establish an advisory
board to examine exposures to environmental hazards during
military service, and for other purposes, and recommends that
the bill do pass.
INTRODUCTION
On January 28, 2010, the Committee met in open session to
consider a number of measures pending before the Committee,
including an original measure proposed by Chairman Daniel K.
Akaka to authorize health care for certain individuals exposed
to environmental hazards at Camp Lejeune, North Carolina, and
the Atsugi Naval Air Facility (hereinafter, ``NAF Atsugi'') in
Japan, to establish an advisory board to examine exposures to
environmental hazards during military service, and for other
purposes.
Earlier, on July 27, 2009, Committee Ranking Member Richard
Burr introduced S. 1518, the proposed ``Caring for Camp Lejeune
Veterans Act of 2009.'' Later Senators Begich, Burris, Byrd,
Feingold, Graham, Grassley, Hagan, Harkin, Isakson, Johanns,
LeMieux, Lincoln, Nelson (FL), Stabenow, and Wicker were added
as cosponsors. S. 1518 would amend title 38, United States
Code, to authorize the Department of Veterans Affairs
(hereinafter, ``VA'') to furnish hospital care, medical
services, and nursing home care to veterans who were stationed
at Camp Lejeune, North Carolina, while the water was
contaminated at Camp Lejeune.
On October 21, 2009, the Committee held a hearing on the
above-mentioned bill and other veterans-related legislation.
Testimony was offered on S. 1518 by: Gerald M. Cross, MD,
FAAFP, Acting Under Secretary for Health, Veterans Health
Administration, Department of Veterans Affairs; Robert Jackson,
Assistant Director, National Legislative Service, Veterans of
Foreign Wars of the United States; and Ian de Planque,
Assistant Director for Claims Service, The American Legion.
COMMITTEE MEETING
After carefully reviewing the testimony from the foregoing
hearing, the Committee met in open session on January 28, 2010,
to consider, among other legislation, the original bill,
consisting of provisions from S. 1518, and several freestanding
provisions. The Committee voted, without dissent, to report
favorably the original bill.
SUMMARY OF THE ORIGINAL BILL AS REPORTED
The original bill as reported (hereinafter, ``the Committee
bill''), would authorize health care for certain individuals
exposed to environmental hazards at Camp Lejeune and the Atsugi
Naval Air Facility and establish an advisory board to examine
exposures to environmental hazards during military service.
BACKGROUND AND DISCUSSION
In a few specific instances, Congress has acted to provide
benefits and health care to veterans who may have been exposed
to environmental hazards during their military service.
Generally, these benefits and health care services have been
provided after Congress determined that there was sufficient
evidence to link certain disabilities to an environmental
hazard or hazards. On a few other occasions, Congress has
extended health care and benefits to the children of
servicemembers and veterans based on a concern that they were
born more susceptible to certain diseases or conditions because
of a parent's exposure to an in-service environmental
hazard.
What has emerged from this process is a largely piecemeal
approach to addressing environmental exposures--with Congress,
VA, and the National Academy of Sciences (hereinafter, ``NAS'')
each playing a role.
Not addressed in Congress' prior actions on environmental
exposures are those exposures that have occurred only on
military installations and that may affect not only
servicemembers and veterans, but also their dependents who
reside with them on or near a particular installation.
Background. Since Congress began legislating on
environmental hazards, it has taken a piecemeal approach to
addressing military exposures. It became apparent at the
Committee's October 8, 2009, hearing on VA and DOD's Response
to Certain Military Exposures that such an approach to
allegations of exposure during military service was not the
most effective or appropriate approach. One point that was
clear in that hearing was that Congress has historically not
been an effective forum for resolving scientific questions of
environmental exposures or the consequences of such exposures.
Four exposures were specifically addressed during the
hearing: exposure to smoke from an incinerator at the Naval Air
Facility Atsugi in Japan; water contamination at Camp Lejeune;
exposure to sodium dichromate at the Qarmat Ali Water Treatment
Plant in Iraq; and burn pit exposures during the current
conflicts in Iraq and Afghanistan. The exposures at NAF Atsugi
and Camp Lejeune presented questions that were both significant
and unprecedented because of alleged exposures to the
dependents of active duty military personnel.
Camp Lejeune: Marine Corps base Camp Lejeune is an active
military base located on 236 square miles of land in Onslow
County, North Carolina, adjacent to the southern side of the
City of Jacksonville. It was commissioned in 1942 as a training
area to prepare Marines for combat. It is the major East Coast
base of the U.S. Marine Corps.
As explained by the Government Accountability Office
(hereinafter, ``GAO''), the drinking water at Camp Lejeune is
obtained from groundwater pumped from a freshwater aquifer
located approximately 180 feet below the ground. Groundwater is
pumped through wells located near the water-treatment plant.
After the water is treated, it is stored in ground and elevated
storage reservoirs. When needed, treated water is pumped from
the reservoirs
and tanks to facilities such as offices, schools, or houses on t
he base.
According to the U.S. Marine Corps, Camp Lejeune officials
first became aware of volatile organic compounds (hereinafter,
``VOCs'') in drinking water samples in 1981 that were collected
to comply with future drinking water standards. In January
1982, the Naval Assessment and Control of Installation
Pollutants (hereinafter, ``NACIP'') Program at Camp Lejeune
began to identify potentially contaminated sites on the base.
In 1982 and 1983, additional testing identified two VOCs--
trichloroethylene (hereinafter, ``TCE''), a metal degreaser,
and tetrachloroethylene (hereinafter, ``PCE''), a dry cleaning
solvent--in two water systems that served Camp Lejeune base
housing areas: Hadnot Point and Tarawa Terrace. Base officials
did not know the source of VOCs; water treatment plants and
piping infrastructure were investigated as the possible
sources. In 1983, the NACIP initial assessment study was
published. This study led to the subsequent sampling of
individual water supply wells in 1984. A direct association
between VOCs in Hadnot Point and Tarawa Terrace drinking water
and VOCs in the wells and groundwater was established when the
water supply wells were sampled (beginning in 1984). Officials
at Camp Lejeune confirmed the wells impacted by VOCs and shut
them down in late 1984 and early 1985.
Measurements of mixed water samples suggest that supply
wells TT-23 and TT-26 were major contributors to contamination
of the Tarawa Terrace water supply. The Agency for Toxic
Substances and Disease Registry (hereinafter, ``ATSDR'') lists
16 wells that served the Tarawa Terrace water-supply system.
According to GAO, two wells, TT-23 and TT-26, were shut down on
February 8, 1985, because of PCE contamination. However, well
TT-23 was used briefly after that date--at least on March 11-
12, 1985, and on April 22, 23, and 29, 1985. The ATSDR
indicates that TT-23 was removed from service in May 1985.
According to the National Research Council (hereinafter,
``NRC''), which functions under the auspices of the NAS, there
were multiple sources of potential pollutants, including an
industrial area, a drum dump, a transformer storage lot, an
industrial fly ash dump, an open storage pit, a former fire
training area, a site of a former on-base dry cleaner, a
liquids disposal area, a former burn dump, a fuel-tank sludge
area, and the site of the original base dump. The NRC stated
that the contamination appears to have begun in the middle
1950s and continued until the middle 1980s, when contaminated
supply wells were shut down. According to the Marine Corps,
nine of ten wells taken out of service have been permanently
demolished (piping removed and holes filled in). One well was
returned to service in 1993 following multiple clean samples.
This well is in service today. Currently, drinking water is
checked for VOCs quarterly to ensure water is not impacted.
Camp Lejeune was placed on the Environmental Protection
Agency (hereinafter, ``EPA'') National Priorities List in 1989.
The National Priorities List is part of the Superfund cleanup
process, and lists the most hazardous environmental sites
across the United States and its territories. It serves
primarily for informational purposes, identifying for the
States and the public those sites that appear to warrant
remedial actions. Today, Camp Lejeune is still on that list, as
are approximately 130 other military installations.
From 1991 to 1997, the ATSDR conducted a public health
assessment at Camp Lejeune that was required by law because of
the installation's listing on the National Priorities List. The
ATSDR was particularly interested in routine drinking water
tests, conducted in the 1980s, that found VOCs at detectable
levels in some on-base drinking water supply wells. The ATSDR's
1998 health study, ``Volatile Organic Compounds in Drinking
Water and Adverse Pregnancy Outcomes,'' found a link between
PCE-contaminated drinking water and lower birth weights for
infants of older mothers and mothers with histories of fetal
loss. PCE-contaminated drinking water was also linked with
small-for-gestational-age infants for older mothers and mothers
with two or more fetal losses. However, the findings from these
analyses are no longer valid. After the study was completed,
the ATSDR discovered that a residential area it classified as
unexposed, Holcomb Boulevard, received water from the Hadnot
Point system for the first 4 years of the study period, and the
study results must be reanalyzed to correct for this mistake in
classification. The ATSDR has indicated that it will reanalyze
the results of the study using exposure estimates from its
groundwater modeling of the Tarawa Terrace and Hadnot Point
systems.
In response to concerns from many Marines and their
families who had been present at Camp Lejeune and to supplement
the few studies that had been undertaken and to help inform
decisions about addressing health claims, Congress mandated in
Public Law 109-364, the John Warner National Defense
Authorization Act for Fiscal Year 2007, that the Secretary of
the Navy enter into an agreement with the NAS to examine
whether adverse health effects are associated with past
contamination of the water supply at Camp Lejeune. The NRC
published its report on June 13, 2009, listing possible health
consequences of exposure to the contaminated water at Camp
Lejeune during the period from 1957-1985. All the health
outcomes listed in its report were placed into one of two
categories: limited/suggestive evidence of an association or
inadequate/insufficient evidence to determine whether an
association exists.
The strongest evidence was in the category of limited/
suggestive evidence of an association, which means there is
some evidence that people who were exposed to TCE or PCE were
more likely to have a certain disease or disorder but that the
studies were either few in number or had limitations. However,
associations between exposures and diseases or disorders placed
in the limited/suggestive evidence of an association category
cannot be ruled out. The other health outcomes reviewed 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 inconclusive in results to make an informed
assessment. Fourteen of the 59 health outcomes reviewed by the
NRC were placed in the limited/suggestive evidence of an
association category, and 45 were placed in the inadequate/
insufficient evidence of an association category. According to
the NRC, in many cases the study subjects were exposed to
multiple chemicals, making it impossible to separate the
effects of individual chemicals.
In 2007, the GAO reported that former residents and
employees of Camp Lejeune had filed more than 750 claims
against the federal government related to the contamination.
Adjudication of these claims and similar claims filed since
then has been postponed until completion of an ongoing study
being performed by the ATSDR. This study on specific birth
defects and childhood cancers includes children born from 1968
through 1985 to mothers who, for some time during their
pregnancy, were exposed to drinking water contaminated with
VOCs at Camp Lejeune. It is scheduled to be completed in 2011.
However, Dr. John R. Nuckols, a member of the NRC's Committee
on Contaminated Drinking Water at Camp Lejeune, testified at
the October 8 hearing that, because further research was
unlikely to provide definitive information, his committee had
concluded that there was 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.
Also at the October 8 hearing, Michael Partain, the son of
a Marine Corps officer, testified that he was conceived,
carried and born at Camp Lejeune in 1968. He stated that at age
39 he was diagnosed with male breast cancer and that he is one
of approximately 40 men who were exposed to Camp Lejeune tap
water and who have breast cancer. VA's Michael R. Peterson,
Chief Consultant, Environmental Health Strategic Health care
Group, Office of Public Health and Environmental Hazards,
Veterans Health Administration, testified that more than one
million people may have been exposed to hazardous chemicals in
the Camp Lejeune well water.
Naval Air Facility Atsugi: The NAF Atsugi is located in the
Kanto Plain area on the island of Honshu, Japan. The Japanese
Navy constructed the base in 1941 and it was commissioned in
1950 as U.S. Air Station Atsugi. In 1971, the name of the base
was changed to NAF Atsugi and the official joint use of the
base with the Japanese Maritime Self Defense Force began.
In 1985, a private waste incinerator--owned and operated by
Shinkampo Incineration Complex (hereinafter, ``SIC'')--was
built and began operations approximately 150 meters south of
the NAF Atsugi fence line. This complex was approximately five
acres in size and was comprised of three incinerators, a waste
staging area, and an ash holding area. The discharge heights of
the incinerator stacks were only slightly higher than the
ground surface of the plateau on which NAF Atsugi is located.
Due to the complex topography and short incinerator stack
heights relative to the plateau, emissions from the
incineration complex were regularly carried parallel to the
stack height downwind towards the base resulting in a
fumigation condition.
Complaints by the residents on NAF Atsugi about air quality
due to the incinerator plume led to a series of evaluations and
attempts to quantify pollution levels emitted from the
incinerator. The first of these evaluations was conducted in
1988 by the U.S. Navy Aircraft Environmental Support Activity.
Subsequent environmental testing was conducted in 1989, 1995,
1998, and 2002. Health risk communication activities began in
1995 based on the 1994 air quality studies and the 1995 Health
Risk Assessment. A formal program of Health Risk Communication
and Medical Consultation was initiated in 1998 to give
individuals necessary and appropriate
information and to involve them in making decisions that affect
them.
Demonstration of the potential health risks related to poor
air quality at Atsugi led to efforts by representatives of the
United States Government to close the incinerator. After a
number of years, these efforts resulted in a financial payment
by the Japanese government to the incinerator operator to close
the facility in May 2001.
After the SIC 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, forwarded for release in
2002, did not find 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.
In June 2009, 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 to 2001.
This collection of information will aid in any future outreach
or surveillance activities for this population as indicated.
However, that number is drastically different than another
estimate provided in a report by the Battelle Memorial
Institute entitled, ``Review of NAF Atsugi Health Risk
Assessments and Related Environmental Data to Determine if
Additional Population-Based Medical Screening is Indicated,''
dated June 3, 2008, illustrating the need for an accurate
measurement. According to this report:
No estimates of the exposed population during the
years of the incinerator operation (1985-2001) are
available in any of the documentation. In order to
arrive at an order-of-magnitude estimate,
extrapolations were made from the description of the
on-base population during 1998. At that time, NAF
Atsugi had a population of about 3,500 active duty
personnel and 1,700 dependents, of which about 1,100
were children. Assuming a typical residence time of
three years, annual turnover in the base population
would be estimated to be about 1,700 of which 400 would
be children. If this was characteristic of the
population dynamic for the entire exposure period, then
about 18,000 adults and 8,000 children would have
possibly been exposed to the contaminated environmental
conditions during on-station assignments of one to
three years. In the case of dependents, a typical
duration of exposure would have been three years.
There is currently no registry for individuals who were
present at NAF Atsugi during the years of the incinerator's
operation. Voluntary enrollment into such a database was
offered to residents stationed at NAF Atsugi but according to
the U.S. Navy, there was so little interest that the effort was
discontinued. The Navy also claims there has been no need for
such a database because the long-term health risks were
determined to be very small.
Committee Bill. The Committee bill would establish a new
mechanism for responding to issues related to exposures that
occur at military installations. Rather than have Congress
provide health care, benefits, and other services to
servicemembers, veterans, and their dependents in a piecemeal
fashion, the Committee bill would create an Advisory Board that
would be tasked with reviewing and making recommendations on
how to respond to concerns about possible exposure to hazards
on military installations. It is the Committee's intent that
the process will streamline the overall consideration of
environmental hazard exposures. It is the Committee's
expectation that, by ensuring that scientific experts analyze
potential exposure issues on a global level, later outcomes on
claims for benefits and assistance will be both fairer and
justifiable to potentially exposed individuals.
Because issues relating to the exposures at Camp Lejeune
and NAF Atsugi have already been heard by the Committee, the
Committee bill would provide access to immediate health care
relief to those servicemembers, veterans, and dependents who
were potentially exposed to contaminated water at Camp Lejeune
and polluted air at NAF Atsugi.
Section 2 of the Committee bill would define ``military
exposure'' for the purposes of the new Advisory Board as an
exposure to an environmental hazard on a military installation.
``Military exposure claim'' would be defined as a formal claim
of a military exposure submitted by or on behalf of an
individual. This section would exclude individuals whose
exposure occurred at a military installation during a period in
which imminent danger pay is authorized because circumstances
surrounding military exposures in war or conflict zones are
often fluid and difficult to review appropriately while events
are ongoing.
It is the Committee's intent that the new Advisory Board
will consider the exposure of a specific cohort of people at a
military installation, not adjudicate individual claims of
exposure. The goal would be for the Board to investigate the
various elements related to a claimed exposure at a given
location so as to help frame any subsequent action on
individual claims. It is the Committee's expectation that the
process for reviewing overall claims of exposures not supplant
VA's current process of adjudicating an individual's claim for
service-connected disability.
Section 3 of the Committee bill would establish the
Advisory Board on Military Exposures, which would provide
advice to the Department of Defense (hereinafter, ``DOD'') and
VA regarding matters relating to exposures of current and
former members of the Armed Forces and their dependents to
environmental hazards on military installations.
It is the Committee's intent that the Advisory Board,
through a non-political, scientific analysis, will make
recommendations to DOD and VA on matters relating to claimed
exposures on military installations. The Committee's
expectation is that this process will give an appropriate body
of scientific experts and veterans an opportunity to review
matters relating to claimed exposures thoroughly and that this
approach will result in a more consistent approach to military
exposures than Congress or the Committee has taken in the past.
The seven-member Board would be appointed by the President,
and would consist of two members from military service
organizations or veterans service organizations; two members
from federal agencies (other than DOD and VA) with backgrounds
in environmental exposure or environmental exposure
assessments, health monitoring, or other relevant fields; and
three members with backgrounds in environmental exposure or
environmental exposure assessments, health monitoring, or other
relevant fields, none of whom may be federal officials or
employees. This section would also outline terms of office,
compensation, and staffing for the Board.
Section 4 of the Committee bill would set forth the purpose
of the new Advisory Board on Military Exposures. The Board
would consider and study the matters relating to claims of
exposure of current and former members of the Armed Forces and
their dependents to potential environmental hazards at military
installations. It is the Committee's expectation that, while
DOD and VA would collaborate in this endeavor, DOD would take
the lead role in this initiative because DOD is better
positioned to provide information on particular hazards on
military installations.
This section would also specify the parties who may submit
material relating to claimed exposures to the Advisory Board:
members of the Armed Forces, veterans, dependents of members of
the Armed Forces and veterans; veterans advocacy groups; and
DOD and VA officials. It also includes a 180-day deadline for
the Board to consider the initial claim and what recommended
actions may include. Again, it is the Committee's expectation
that the Board consider an exposure of a specific cohort of
people at a military installation rather than any individual's
claim of exposure.
Section 4 would also authorize the Board to convene a
science advisory panel to assist with exposure claims and it
outlines the membership of the science advisory panel. It would
require a 180-day deadline for the science advisory panel to
review the overall exposure claim and take action, and would
outline what those recommended actions may include. The
Committee intends this to be a settled, scientifically-sound,
non-political process that will be duplicated for all military
exposure claims. This section includes subpoena authority for
both the Advisory Board and the science advisory panels in
order to ensure attendance and testimony of witnesses to
consider military exposure matters. It is the Committee's
expectation that relevant federal agencies, including the EPA,
will work cooperatively with the Advisory Board and science
advisory panels.
Finally, this section would specify that the Advisory
Board's first cases shall be exposure matters related to Camp
Lejeune and NAF Atsugi.
Section 5 of the Committee bill would authorize DOD to
provide servicemembers, veterans, and dependents who were
exposed to environmental hazards at military installations the
health care benefits recommended by the Advisory Board. Under
current law, there is no authority for DOD to provide health
care for these individuals.
Section 6 of the Committee bill would require DOD, in
coordination with VA and after consultation with the ATSDR, to
assemble a list of individuals, which may include those who
were fetuses in utero, exposed to environmental hazards at Camp
Lejeune during the period which DOD and VA determine that water
was contaminated with volatile organic compounds. The Committee
believes that DOD should take the lead role in compiling this
list because DOD is in a better position to identify which
servicemembers and dependents were at a particular military
installation during a particular time. Individuals on this list
would be immediately eligible for health care in the following
manner: servicemembers and veterans would be eligible for
health care from or through VA or DOD; dependents would be
eligible for care from or through DOD for conditions that are
associated with exposure to contaminated water at Camp Lejeune.
This approach reflects the Committee's view that dependents'
health care should be provided by DOD. In a letter dated
January 26, 2010, VA Secretary Eric K. Shinseki stated, ``. . .
VA suggests that dependents' health care would be better placed
under TRICARE, a health system much better suited to treatment
of dependents,'' thereby endorsing the Committee's approach to
dependent care.
This section would also require that the Secretary of
Defense, in consultation with the Secretary of Veterans
Affairs, report to Congress within 30 days of assembling the
list of individuals who were exposed on the evidence and
criteria used to compile the list in order to make the process
as transparent as possible. After five years, no additional
names would be able to be added to the list. It is the
Committee's expectation that the Advisory Board will have made
recommendations regarding the exposure at Camp Lejeune within
that five-year window.
Section 7 of the Committee bill is comparable to section 6
except that it relates to exposures at NAF Atsugi. This section
would require DOD, in coordination with VA, to assemble a list
of individuals, which may include those who were fetuses in
utero, exposed to environmental hazards at NAF Atsugi during
the period which they determine that the air was contaminated
due to the operation of an incinerator. Consistent with the
Committee's approach of assembling a list for those potentially
exposed to contaminated water at Camp Lejeune, it is the
Committee's intent that DOD take the lead role in compiling
this list because DOD is in a better position identify which
servicemembers and dependents were at a particular military
installation during a particular time. After five years, no
additional names would be able to be added to the list. It is
the Committee's expectation that the Advisory Board will have
made recommendations regarding the exposure at NAF Atsugi
within that five-year window.
Just as is proposed for those exposed at Camp Lejeune,
individuals on this list shall be immediately eligible for
health care. As is the case with dependents of servicemembers
who were stationed at Camp Lejeune, the Committee believes that
DOD is the more appropriate agency to provide health care to
dependents of servicemembers. This section would also require
that the Secretary of Defense, in consultation with the
Secretary of Veterans Affairs, report to Congress within 30
days of assembling the list of individuals who were exposed on
the evidence and criteria used in compiling the list.
Section 8 of the Committee bill would require DOD, in
consultation with VA, to submit annual reports to the
Committees on Armed Services and Veterans' Affairs in the House
of Representatives and the Senate. The section also outlines
required content for these reports, including a description of
the classes of individuals who have received health care and
other benefits as a result of this bill, a description of the
health care benefits that have been provided to individuals,
and recommendations for any necessary additional legislation.
Section 9 of the Committee bill would require DOD and VA to
prescribe joint regulations to carry out the provisions of this
Act.
Section 10 of the Committee bill would authorize the
necessary appropriations to carry out the Act.
Concerns with Cost Estimate
The Congressional Budget Office (CBO) estimates that the
Committee bill would increase direct spending by about $2.7
billion over the 2012-2020 period and increase spending subject
to appropriation, discretionary spending, by about $4 billion
over the same period. While the Committee is not satisfied with
the accuracy of the discretionary cost estimate, it understands
that it is appropriate to allocate such costs to this
legislation. Indeed, Congress should be prepared to appropriate
the necessary funds to cover the discretionary costs of this
bill so that the health care needs of those exposed to
environmental hazards while at a military installations can be
satisfied.
However, it is the Committee's view that the portion of the
CBO estimate relating to mandatory costs is wholly without
merit or basis. It is the Committee's view that the narrative
accompanying the estimate betrays a fundamental
misunderstanding of the intention of the bill and makes many
assumptions that are simply not supported by the plain language
of the legislation.
In its estimate, CBO clearly misconstrues the role and
purpose of the Advisory Board. The Advisory Board has no power
to provide benefits--health care or monetary--to any
individual. Its function is simply to review information--
including data on the number of individuals who might have been
at a particular military installation at a given time, and on
any environmental hazards that might have been present on that
installation--and then make recommendations. With the possible
assistance of a scientific review panel, the Advisory Board
also would be expected to review the available science on both
potential exposures to environmental hazards and the possible
consequences of those exposures. After reviewing and discussing
such information, the Advisory Board would be expected to
submit recommendations to DOD and VA, not take any action with
respect to individual claims.
To take such an information gathering process and project a
specific increase in the number of veterans receiving
compensation from VA, as CBO does in its estimate, is to pile
speculation--what the Advisory Board might find with reference
to a specific installation--on speculation--what the Advisory
Board might recommend based on such findings--on speculation--
what VA would do in response to such recommendations.
Based on the cost estimate, it appears that CBO believes
that there are populations of servicemembers, veterans, and
their dependents who were exposed to environmental hazards to
such a degree that there are present health consequences. The
Committee does not start with that assumption and certainly
does not expect that the Advisory Board will do so.
The Committee is aware of no other instance in which
possible actions by Executive Branch agencies or departments,
in response to an advisory body's work product, was assigned a
mandatory score by CBO. A mandatory score would more
appropriately be assigned when Congress directs an agency to
provide some specific benefit to a specified beneficiary or
group of beneficiaries. In this instance, this is neither the
intention nor the expectation. If the Advisory Board determines
that servicemembers, veterans, and their dependents were
exposed to a sufficient level of environmental hazards to
warrant health care or a monetary benefit, the Advisory Board
must submit recommendations to DOD and VA on health care or
compensation that such individuals should receive. The
discretion to provide those benefits remains with DOD and VA.
CBO fails to distinguish this difference throughout its cost
estimate.
CBO also sets up a false comparison between the Advisory
Board in the Committee bill and two existing programs under
which certain individuals receive compensation from the federal
government. As discussed above, the Advisory Board that would
be established by the Committee bill is mandated to simply
study and evaluate information and make recommendations. Under
the two programs referenced by CBO in its estimate--the
Radiation Exposure Compensation Program (RECA) and the Energy
Employees Occupational Illness Compensation Program (EEOICP)--
both of which represent final Congressional resolution on
specific, difficult issues relating to claims for exposures,
specified populations are made entitled to specified
compensation for defined and described exposures. Under RECA,
an apology and monetary compensation are provided to
individuals who contracted certain cancers and other diseases
following exposure to radiation released during atmospheric
nuclear weapons tests or occupational exposure while employed
in the uranium industry during the Cold War. Under EEOICP,
lump-sum compensation and health benefits are provided to
eligible Department of Energy nuclear weapons workers,
contractors, or subcontractors, and atomic weapons employees
with radiation-induced cancer. Lump-sum compensation is also
provided to certain survivors if the worker is deceased. There
is simply no basis for the suggested comparison between those
two programs and the work of the Advisory Board in the
Committee bill.
As explained earlier in this report, the Advisory Board
would be comprised of two members of military service
organizations or veterans service organizations; two members
who are officials of government agencies (other than DOD and
VA) with backgrounds in environmental exposure or environmental
exposure assessments, health monitoring, or other relevant
fields; and three members with backgrounds in environmental
exposure or environmental exposure assessments, health
monitoring, or other relevant fields who are not federal
employees. CBO's cost estimate refers to this group as ``the
government''--an incorrect characterization. The Advisory Board
is purely an advisory body that makes recommendations to DOD
and VA--who, in turn must make an affirmative decision to
provide health care and benefits to the affected populations.
CBO appears to rest its basis for the mandatory cost
estimate on ``determinations by the government'' that the
affected population has suffered health effects from exposure
to environmental contamination that will, in turn, increase the
likelihood that veterans submitting disability compensation
claims would be deemed service-connected by VA. This
understanding is also flawed. The claims submitted to VA would
still require the same rigorous adjudication that all others
undergo. The individual must be a veteran impacted by an in-
service event that caused or aggravated a named condition.
Also troublesome is CBO's estimate that half of all
military installations could be studied in the first ten years
of enactment of this bill. The order of magnitude for the
number of affected installations is unknown. However, as
discussed earlier in the report, approximately 130
installations are on the EPA's National Priorities List. Given
that number of sites alone, it would be ambitious for half of
all military installations to be reviewed in a ten-year period.
COMMITTEE BILL COST ESTIMATE
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by CBO, estimates that enactment of the
Committee bill would, relative to current law, not increase
direct spending in 2011, and would increase direct spending by
about 2.7 billion over the 2012-2020 period. In addition, CBO
estimates that implementing the bill would increase spending
subject to appropriation by $40 million in 2011; $558 million
over the 2011-2015 period; and about $4 billion over the 2011-
2020 period. According to CBO, the Committee bill would impose
an intergovernmental mandate as defined by the Unfunded Mandate
Reform Act (hereinafter, ``UMRA'') by authorizing subpoena
authority. However, CBO estimates that the cost of complying
with the authority would be small and well below the thresholds
established in UMRA.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:
Congressional Budget Office,
Washington, DC, May 4, 2010.
Hon. Daniel K. Akaka,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for the Examination of
Exposures to Environmental Hazards During Military Service and
Health Care for Camp Lejeune and Atsugi Naval Air Facility
Veterans and their Families Act of 2010.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Matthew
Schmit and Dwayne Wright.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
Examination of Exposures to Environmental Hazards During Military
Service and Health Care for Camp Lejeune and Atsugi Naval Air
Facility Veterans and their Families Act of 2010
Summary: This bill would authorize a new federal health
benefit for former military members and their dependents whose
health was affected by exposure to environmental contaminants
at Camp Lejeune, North Carolina, or at the Atsugi Naval Air
Facility in Japan. The bill also would establish a new advisory
board to study environmental contamination at other military
facilities and would authorize health benefits for former
military personnel and their dependents who were present at
sites identified by the board as having environmental hazards.
CBO expects that the determination that individuals were
exposed to environmental contaminants on military installations
would increase the likelihood that certain disability
compensation claims submitted to the Department of Veterans
Affairs (VA) would be deemed ``service-connected.'' Those
additional claims would increase VA compensation payments and
CBO estimates that direct spending would increase by about $2.7
billion over the 2012-2020 period.\1\ In addition, CBO
estimates that implementing the bill would increase spending
subject to appropriation by about $4 billion over the 2011-2020
period, mainly to cover the cost of the new health benefits and
the administration of claims.
---------------------------------------------------------------------------
\1\Different time periods are relevant for enforcing the current
pay-as-you-go rules in the Senate and the House of Representatives. CBO
estimates that enacting the bill would increase direct spending by $80
million over the 2010-2014 period and $1,655 million over the 2010-2019
period.
---------------------------------------------------------------------------
Pay-as-you-go procedures apply because enacting the
legislation would affect direct spending. Pursuant to section
311 of the Concurrent Resolution on the Budget for Fiscal Year
2009 (S. Con. Res. 70), CBO estimates this bill would increase
projected deficits by more than $5 billion in at least one of
the four consecutive 10-year periods starting in 2020.
The bill includes new subpoena authority that would impose
an intergovernmental and private-sector mandate as defined in
the Unfunded Mandates Reform Act (UMRA), but CBO estimates the
cost of complying with the mandate would be small and well
below the thresholds established in UMRA ($70 million for
intergovernmental mandates and $141 million for private-sector
mandates in 2010, adjusted annually for inflation).
Estimated cost to the Federal Government: The estimated
budgetary impact of this bill is shown in the following table.
The costs of this legislation fall within budget functions 050
(national defense) and 700 (veterans benefits and services).
This estimate assumes that the bill will be enacted near the
beginning of fiscal year 2011.
Table 1.
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------------------------------------------------------
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2011-2015 2011-2020
--------------------------------------------------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Veterans Compensation
Estimated Budget Authority............................ 0 5 25 50 75 100 225 450 725 1,075 155 2,730
Estimated Outlays..................................... 0 5 25 50 75 100 225 450 725 1,075 155 2,730
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Health Care Benefits
Estimated Authorization Level......................... 0 5 25 50 75 125 275 525 875 1,325 155 3,280
Estimated Outlays..................................... 0 4 21 44 68 113 241 466 788 1,210 137 2,955
Administrative Costs
Estimated Authorization Level......................... 50 100 100 100 100 100 100 125 125 150 450 1,050
Estimated Outlays..................................... 40 88 97 98 99 99 99 119 123 143 421 1,004
---------------------------------------------------------------------------------------------
Total Changes in Spending Subject to Appropriation
Estimated Authorization Level..................... 50 105 125 150 175 225 375 650 1,000 1,475 605 4,330
Estimated Outlays................................. 40 92 117 142 167 212 340 585 911 1,353 558 3,958
--------------------------------------------------------------------------------------------------------------------------------------------------------
Basis of estimate: This bill would authorize a new federal
health benefit for former military members and their dependents
whose health was affected by environmental contamination at
Camp Lejeune, North Carolina, or at the Atsugi Naval Air
Facility in Japan. It is alleged that the drinking water at
Camp Lejeune was contaminated from 1957 through 1987 and that
the air around the Atsugi Naval Air Facility was contaminated
by a nearby trash incinerator from 1985 through 2001, causing
higher incidence rates of cancer, birth defects, and other
physical ailments associated with exposure to toxic substances.
The bill also would establish a new advisory board to study
environmental contamination at other military facilities and
would authorize health benefits for former military personnel
and their dependents who would be determined to have been
exposed at those facilities.
Veterans can currently receive compensation from VA for
disabilities incurred as a result of their time in the service.
However, because studies of contamination at Camp Lejeune,
Atsugi Naval Air Facility, and other military bases are not yet
complete, VA compensation for ailments allegedly caused by
environmental contamination at those facilities is generally
approved only after overwhelming evidence is submitted. CBO
expects that the determination by the government that the
affected population has suffered health effects from exposure
to environmental contamination on military bases would increase
the likelihood that disability compensation claims submitted to
the VA by such veterans would be deemed ``service-connected,''
causing an increase in VA compensation payments relative to the
expected payments under current law. CBO estimates those
additional payments would increase direct spending by about
$2.7 billion over the 2012-2020 period.
In addition, CBO estimates that implementing this bill
would increase spending subject to appropriation by about $4
billion over the 2011-2020 period, mainly to cover the cost of
the new health benefits and the costs to administer claims.
This bill also would create a new federal advisory board to
study and make recommendations on benefits to individuals
affected by environmental contamination at military facilities
and would require the Secretary of Defense to compile lists of
all individuals exposed to contamination at Camp Lejeune and
Atsugi.
Estimating the Number of Potential Claims
To estimate the number of people who would eventually be
approved for government benefits under this bill, CBO divided
the potential population into two groups: the first group
consists of those potentially affected by contamination at Camp
Lejeune and Atsugi; and the second population consists of
potential claims from other military facilities that would be
identified by the new advisory board. CBO then used observed
take-up rates from other government programs for occupational
illnesses to estimate the number of individuals who would
eventually receive benefits.
Camp Lejeune and Atsugi Naval Air Facility. Based on
information from the Department of Defense (DOD), CBO estimates
about 675,000 military personnel and dependents lived or worked
at Camp Lejeune and the Atsugi Naval Air Facility during the
periods of alleged contamination. In the first 10 years after
enactment of this bill, CBO estimates that about 20,000 of
those former members and dependents would be approved for
benefits. That estimate is based on take-up rates for two other
government programs that provide compensation for occupational
illnesses: the Radiation Exposure Compensation Program (RECA)
and the Energy Employees Occupational Illness Compensation
Program (EEOICP). The number of people approved for benefits
would be significantly smaller than the population potentially
exposed because many of those potential claimants would have
long since died, would not have adequate proof of a compensable
ailment, or would not be able to be located.
Of those approved for benefits in the first 10 years, CBO
estimates just under 75 percent would be former military
members, while the rest would be spouses and children of former
servicemembers. CBO derived this breakdown by looking at
marriage rates as well as prevalence rates for some of the
ailments connected with environmental contamination. Disease
prevalence rates are typically higher for older males (most of
the veterans affected by this legislation would be over the age
of 65). CBO assumes that no cases would be approved for
benefits prior to fiscal year 2012, because it would take time
to establish regulations and train adjudication officials.
Other Military Facilities. The bill also would create a new
advisory board that would examine environmental contamination
at other military facilities and make recommendations as to
whether personnel exposed to contamination at those facilities
should receive health benefits or other compensation. DOD would
be authorized to provide any health benefits recommended by the
advisory board.
A review of information from the Environmental Protection
Agency and other sources reveals that environmental
contamination at current and former military facilities is a
widespread problem. Combined with the fact that military
personnel frequently work with hazardous chemicals and other
dangerous substances, such as jet fuel and cleaning agents, it
is possible that anyone who has ever lived or worked on a
military facility was exposed to a variety of contaminants.
Depending on how the new advisory board chooses to conduct its
work, the number of additional claims that would be approved
for benefits could be quite large.
Based on information from VA on the number of living
veterans and adjusting that number to account for spouses and
children, CBO estimates that as many as 50 million former
members and dependents have lived or worked on military
installations and are still living. (This figure does not
include any civilian employees who may have worked at military
installations. Benefits for those individuals are not addressed
by this bill.) Because of time and resource constraints, it
would take many years for the new advisory board to review all
reported instances of environmental contamination. For this
estimate, CBO assumes that about half of all military
installations could be studied in the first 10 years after
enactment of this bill.
To estimate the number of people who would eventually be
approved for benefits, CBO applied take-up rates derived from
the RECA and EEOICP programs, with adjustments to take into
account the higher probability of exposures in those
programs.\2\ Using this methodology, CBO estimates that an
additional 100,000 claims would be approved for federal
benefits by 2020. However, CBO assumes no claims, with the
exception of those for Camp Lejeune and Atsugi Naval Air
Facility, would be approved prior to 2016, because of the time
needed to establish the new advisory board and the time needed
by the board to conduct studies and establish benefit
procedures for the additional sites identified as having
contamination.
---------------------------------------------------------------------------
\2\RECA and EEOICP provide compensation and health benefits to
people who worked in the production and testing of nuclear weapons. The
exposures that occurred in the nuclear program were widespread,
affecting entire factories (in the case of weapons production) or large
geographic areas (in the case of testing). While CBO considers it
appropriate to apply benefit take-up rates from those programs to the
allegedly large-scale exposures at Camp Lejeune and Atsugi, many of the
incidents of contamination examined by the new advisory board would be
limited to certain sections of military bases, limiting the probability
of exposure for the general base populations. Therefore, CBO reduced
the estimated take-up rates for the additional sites that would be
identified by the board.
---------------------------------------------------------------------------
In total, CBO estimates the number of people that would be
approved for benefits because of environmental exposures under
this legislation would total about 700 in 2012 and expand to
almost 120,000 by 2020. Of those approved for benefits, just
under 75 percent would be veterans and the rest would be
dependents of former military personnel.
Direct Spending
VA pays compensation to veterans for disabilities that
result from their military service. While VA compensates
veterans for various forms of cancer because of exposure to
contaminants--Agent Orange, for example--disability
compensation related to exposure at Camp Lejeune has only been
granted under very limited circumstances. Implementing this
bill would result in additional individuals being certified as
needing health care because of exposure to contaminants on
military facilities. CBO expects that such certification would
increase the likelihood that VA would determine that such
veterans had compensable, service-connected disabilities. The
resulting increase in disability compensation payments would
represent an increase in direct spending.
In total, CBO estimates that enacting this bill would
increase direct spending by $2.7 billion over the 2012-2020
period, including costs for new accessions (newly approved
beneficiaries), veterans currently on the rolls, and surviving
spouses.
New Accessions. Based on the population information
described above, CBO estimates that about 75 percent of the
newly eligible pool of veterans are not currently receiving
veterans disability compensation. Therefore, in 2012--the first
year CBO expects veterans to begin receiving disability
compensation under this bill--we estimate that about 350 newly
eligible veterans would apply for and be granted benefits,
increasing to about 60,000 by 2020 as other facilities are
identified by the advisory board. VA rates veterans with
service-connected disabilities from zero to 100 percent,
according to their degree of disability. CBO assumes that the
newly eligible veterans would enter the disability compensation
rolls at the average disability rating of 40 percent.
In 2009, the average annual benefit payment for a
disability rated at 40 percent was $7,262 (or $605 monthly).
Adjusting for cost-of-living increases, the annual payment for
a veteran rated at 40 percent in 2012 would be $7,356 (or $613
monthly). After accounting for mortality and cost-of-living
adjustments, CBO estimates that, under the bill, direct
spending for new accessions would increase by about $1.3
billion over the 2012-2020 period.
Veterans Currently on the Rolls. The bill also would make
some veterans who are currently receiving disability
compensation for other disabilities eligible to have their
compensation increased because of ailments associated with
service-connected, environmental contamination. Many veterans
who are receiving a disability compensation payment are rated
for more than one disability. The average rating for veterans
on the disability compensation rolls in 2009 was 40 percent and
the average increased rating--the rate for which a veteran was
compensated after receiving an additional compensation rating--
was 70 percent.
About 15 percent of the current veterans population (23
million) receives disability compensation from VA. However, CBO
assumes that the eligible population under this bill would be
more likely to have applied for disability compensation due to
the information about environmental contamination available and
would thus be more likely to have received a disability rating
for some other disability. Therefore, CBO assumes that of the
eligible population discussed above, 25 percent would already
be receiving disability compensation and would receive an
increased rating. In 2012, CBO estimates about 120 veterans
would become eligible for and receive an increased rating
increasing to about 20,000 by 2020.
In 2009, the average annual disability payment for a
veteran rated at 40 percent was $7,262 and the average payment
for a veteran rated at 70 percent was $23,760--a difference of
$16,498. After adjusting for cost-of-living, CBO estimates that
enacting the bill would increase direct spending for existing
recipients by about $1 billion over the 2012-2020 period.
Surviving Spouses. VA provides dependency and indemnity
compensation (DIC) payments to the surviving spouses of certain
deceased veterans. CBO expects that some of the spouses of
veterans who died because of ailments related to exposure to
environmental contamination would become eligible for DIC
payments under this bill. Based on the population figures
derived above, CBO estimates that about 50 spouses would become
eligible for and receive DIC payments in 2012 increasing to
about 8,500 by 2020. The average annual DIC benefit payment in
2009 was $14,683. After adjusting for cost-of-living increases,
CBO estimates that enacting the bill would increase direct
spending for DIC by about $440 million over the 2012-2020
period.
Other Direct Spending. In addition to the direct spending
for VA compensation, this bill could increase mandatory outlays
from the Medicare-Eligible Retiree Health Care Fund (MERHCF).
Some of the people approved for health benefits (see below)
would be military retirees or retiree dependents. While they
are already eligible for health care from DOD, it is possible
that they could become eligible for treatments not currently
available through the regular DOD health programs. In some
instances, DOD might seek reimbursement of those expenses from
the MERHCF, although CBO estimates those additional expenses
would not be significant.
Spending Subject to Appropriation
In addition to the direct spending discussed above, the
bill would increase spending subject to appropriation. Those
costs would be primarily for the health benefits authorized by
the bill as well as for various administrative costs incurred
by DOD and, to a lesser extent, VA.
This bill would authorize DOD and VA to provide health care
to individuals exposed to environmental contamination at Camp
Lejeune, Atsugi, and other military facilities identified by
the new advisory board. Based on the cost of health benefits
provided by EEOICP and the Federal Black Lung Program, CBO
estimates that the annual cost of the new health benefit would
be about $7,700 (in 2010 dollars) for each approved claim.
Costs would be lower than the average annual medical costs for
persons in those age groups because not everyone would use the
new health benefit and the bill specifies that only diseases
and conditions directly related to the exposures in question
would be covered. CBO estimates that per capita costs would
increase by about 6 percent each year, based on national per
capita health expenditure projections published by the Centers
for Medicare and Medicaid Services. In total, CBO estimates the
new health benefit would cost about $3 billion over the 2012-
2020 period, subject to appropriation of the necessary amounts.
This bill also has several requirements that would increase
administrative costs for DOD and VA. In addition to the cost of
adjudicating and administering claims, appropriations would be
needed to fund the activities of the new advisory board. CBO
estimates the cost of administering claims and the activities
of the advisory board would average about $65 million per year,
or about $650 million over the 2010-2020 period, subject to
appropriation of the necessary amounts. That estimate is based
on the administrative costs for the Federal Black Lung Program
and the EEOICP, government compensation programs that require
complex determinations for health benefits. Administrative
costs would increase as the advisory board identifies
additional sites and more people seek benefits.
In addition, DOD would be required to compile lists of
individuals exposed to contamination. Because older base
housing reports are often incomplete or nonexistent, compiling
lists of individuals who served at various military
installations would be a very labor-intensive process requiring
the review of millions of individual service records. Based on
information from DOD, CBO estimates that DOD would spend about
$35 million a year for this purpose, subject to appropriation
of the necessary amounts.
In total, CBO estimates the administrative costs of this
bill would total about $1 billion over the 2011-2020 period.
When combined with the cost of providing the new health
benefits, CBO estimates that this bill would have a
discretionary cost of about $4 billion over the 2011-2020
period.
Pay-As-You-Go Considerations
The Statutory Pay-As-You-Go Act of 2010 establishes budget
reporting and enforcement procedures for legislation affecting
direct spending. The net changes in outlays that are subject to
those pay-as-you-go procedures are shown in the following
table.
Table 2.--CBO Estimate of Pay-As-You-Go Effects for the Examination of Exposures to Environmental Hazards During Military Service and Health Care for
Camp Lejeune and Atsugi Naval Air Facility Veterans and their Families Act of 2010, as ordered reported by the Senate Committee on Veterans' Affairs on
January 28, 2010
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------------------------------------------------------------
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010-2015 2010-2020
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact 0 0 5 25 50 75 100 225 450 725 1,075 155 2,730
--------------------------------------------------------------------------------------------------------------------------------------------------------
Impact on long-term deficits: Pursuant to section 311 of
the Concurrent Resolution on the Budget for Fiscal Year 2009
(S. Con. Res. 70), CBO estimates this bill would increase
projected deficits by more than $5 billion in at least one of
the four consecutive 10-year periods starting in 2020.
Intergovernmental and private-sector impact: The bill would
impose both intergovernmental and private-sector mandates as
defined in the Unfunded Mandates Reform Act because it would
establish an advisory board with the authority to subpoena
information. State, local, and tribal governments, as well as
private-sector entities, if subpoenaed by the board, would be
required to provide testimony, documents, or other evidence.
CBO expects that the advisory board would likely exercise this
authority sparingly, and the costs to comply with subpoenas
would not be significant. Thus, we estimate that the costs to
comply with the mandates would be small and well below the
annual thresholds established in UMRA ($70 million for
intergovernmental mandates and $141 million for private-sector
mandates in 2010, adjusted annually for inflation).
Estimate prepared by: Federal Costs: Veterans'
Compensation--Dwayne Wright; Health Benefits and
Administration--Matthew Schmit and Sunita D'Monte.
Impact on state, local, and tribal governments: Lisa
Ramirez-Branum.
Impact on the private sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
REGULATORY IMPACT STATEMENT
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans'
Affairs has made an evaluation of the regulatory impact that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses and that the paperwork
resulting from enactment would be minimal. Finally, the
Committee finds that the only impact on personal privacy would
be in the context of providing access to health care services
and compiling lists of names of individuals who were present
during the time exposures occurred at Camp Lejeune, North
Carolina, or at the Naval Air Facility in Atsugi, Japan. It is
the Committee's expectation that any individual would be able
to have his/her name removed from any such list if the
individual did not wish to receive health care services
specified in the legislation.
TABULATION OF VOTES CAST IN COMMITTEE
In compliance with paragraph 7 of rule XXVI of the Standing
Rules of the Senate, the following is a tabulation of votes
cast in person or by proxy by members of the Committee on
Veterans' Affairs at its January 28, 2010, meeting. The
Committee, by voice vote, ordered the original bill reported
favorably to the Senate, subject to amendment.
AGENCY REPORT
On October 21, 2009, Gerald M. Cross, MD, FAAFP, Acting
Under Secretary for Health, Veterans Health Administration,
Department of Veterans Affairs, appeared before the Committee
and submitted testimony of the Department's views of the bills.
Excerpts from this statement are reprinted below:
STATEMENT OF GERALD M. CROSS, MD, FAAFP, ACTING UNDER SECRETARY FOR
HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS
Good Morning Mr. Chairman and Members of the Committee:
Thank you for inviting me here today to present views on
several bills that would affect Department of Veterans Affairs
(VA) benefits and services. Joining me today are Mr. Brad
Mayes, Director of the Compensation and Pension Service, Mr.
Richard Hipolit, Assistant General Counsel, and Mr. Walter
Hall, Assistant General Counsel. Unfortunately, we do not have
views and estimates on several bills including S. 1109,
S. 1467, S. 1556, S. 1753, and a draft bill regarding exposure
to chemical hazards referred to in the list of bills provided
in the Committee's witness letter of October 8. We will forward
those as soon as they are available. We appreciate the
opportunity to address these bills that would affect the
Department's health care and benefits programs.
* * * * * * *
S. 1518--``CARING FOR CAMP LEJEUNE VETERANS ACT OF 2009''
S. 1518 would amend title 38 to extend eligibility for
hospital care, medical services and nursing home care for
certain Veterans stationed at Camp Lejeune during a period in
which well water was contaminated notwithstanding that there is
insufficient medical evidence to conclude that a particular
illness is attributable to such contamination. It would also
make family members of those Veterans who resided at Camp
Lejeune eligible for the same services, but only for those
conditions or disabilities associated with exposure to the
contaminants in the water at Camp Lejeune, as determined by the
Secretary.
VA takes the Camp Lejeune matter very seriously but has
concerns with the legislation as written. S. 1518 would provide
a very broad enrollment and treatment authority for
servicemembers and their families. As the legislation is
written, any condition that cannot be specifically eliminated
as related to the contaminated water at Camp Lejeune would
require VA to provide treatment. We note this authority is
broader than that conferred on radiation-exposed Veterans.
Moreover, the legislation would also require VA to provide
medical services and nursing home care to those family members
who either consumed contaminated water or were in utero at the
time of consumption if the condition or disability can be
associated with exposure to contaminated water at Camp Lejeune.
From the 1950s through the mid-1980s, persons residing or
working at the U.S. Marine Corps Base Camp Lejeune were
potentially 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 the level of PCE in drinking water
exceeded current standards from 1957 to 1987 (when the
contaminated wells were shut down) and represented a potential
public health hazard.
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 the 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. VA currently provides Veterans
with information about this issue and referrals to the Navy
registry. Veterans who are a part of this cohort may also 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 War-
Related Illness and Injury Study Centers are also available as
a resource to providers.
It is unclear exactly how many people were potentially
affected, but some estimates place the number at one million
Veterans and family members. Though the Department of the Navy
has attempted to contact all servicemembers who were stationed
at Camp Lejeune during the three decades of potential exposure,
it is possible not everyone was reached or identified. Records
over a half-century old may not be available, and the
legislation leaves open-ended what ``resided'' or ``stationed''
means because there is no limitation such as a minimum time
requirement on the base. Consequently, a broad definition of
these terms may mean VA's estimates of 500,000 Veterans and
500,000 family members are too conservative.
Because of these concerns, VA recommends that if any
enhanced Veteran care is authorized, it should be modeled upon
the authority providing for benefits and services for
radiation-exposed Veterans and limited to conditions that can
be associated with consumption of contaminated water. VA also
would recommend that any care for potentially eligible family
members be provided by DOD as the exposure is directly related
to service at Camp Lejeune.
VA estimates the legislation, as written, would cost $299.7
million in FY 2010, $319.5 million in FY 2011, $1.71 billion
over 5 years and $4.16 billion over 10 years.
* * * * * * *
This concludes my prepared statement. I would be pleased to
answer any questions you or any of the Members of the Committee
may have.
------
The Secretary of Veterans Affairs,
Washington, DC, January 26, 2010.
Hon. Daniel K. Akaka,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Department of Veterans Affairs (VA)
understands that the Committee will be considering S. 1518
during the mark-up scheduled for January 28, 2009. 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 take this issue
very seriously; however, VA would like to reiterate several
concerns with the bill that were previously discussed in our
October 21, 2009, testimony. In particular, we would like to
emphasize the following:
Should it be enacted, S. 1518 would provide new
and unprecedented eligibility for VA health care to certain
dependents who resided at Camp Lejeune over a more than thirty-
year period.
VA estimated that the legislation could apply to
500,000 dependents, although this number could be conservative.
VA recommends that if any enhanced Veteran care is authorized,
it should be modeled upon the authority providing benefits and
services to radiation-exposed Veterans and limited to
conditions that can be associated with consumption of
contaminated water.
If enacted, VA suggests that dependents' health
care would be better placed under TRICARE, a health system much
better suited to treatment of dependents.
VA estimated that the legislation, as written,
would cost $299.7 million in FY 2010, $319.5 million in FY
2011, $1.71 billion over 5 years, and $4.16 billion over 10
years.
VA very much appreciates your leadership and support of
programs to assist our Nation's Veterans. Should your staff
need additional information, please have them contact David
Ballenger in the Office of Congressional and Legislative
Affairs.
Sincerely,
Eric K. Shinseki.
* * * * * * *
SUPPLEMENTAL VIEWS OF MR. RICHARD M. BURR
Although I appreciate the Committee's effort to provide a
mechanism through which veterans, servicemembers, and
dependents exposed to water contaminants at Camp Lejeune can
receive necessary medical treatment based on their exposure, I
believe the approach taken in the Committee bill is flawed.
Furthermore, I believe this report does not fully account for
the contentious debate within the scientific community
regarding the extent of water contamination at Camp Lejeune,
the revelations about additional contaminants (most
prominently, benzene) that have recently come to light, and the
erosion of confidence that many affected individuals have in
the Department of Defense because of its slow and, often,
adversarial role in bringing facts of the contamination into
full public view.
As mentioned in the report above, in June 2009, the NRC
issued a report entitled ``Contaminated Water Supplies at Camp
Lejeune--Assessing Potential Health Effects.'' Not mentioned,
however, is the fact that this congressionally-mandated report
has been criticized by certain members of the scientific
community, including one of the peer reviewers who provided the
NRC with input on the report, primarily because it failed to
conduct a hazard assessment of the two known carcinogens
present in the base water system, benzene and vinyl chloride.
The most significant of these is benzene, an ingredient in
gasoline that is known to cause childhood and adult leukemia.
The absence of a comprehensive analysis of the presence and
harmful effects of benzene in the NRC report has become a
significant issue, particularly since it was disclosed in March
2010 that the ATSDR, the Federal agency statutorily tasked with
studying the contamination at Camp Lejeune, discovered
documents from Navy contractors working at Camp Lejeune
indicating the fuel losses from underground storage tanks at
the base may have reached 800,000 to 1,000,000 gallons and
spanned the period 1957 to 1987. It is the regularity of new
information surfacing regarding the water contamination that is
disturbing, and it calls into question whether DOD is fully
committed to resolving this matter in a way that fulfills its
stated concern for the health and welfare of the affected
Marines, sailors, civilian employees, and their families who
lived and worked at Camp Lejeune.
For this primary reason, the Committee bill fails to
recognize the distinct distrust of the Navy, Marine Corps, and
DOD that is felt by Camp Lejeune Marines, sailors, and their
families. Those personally affected by the contamination on the
base find it objectionable that the organizations they hold
responsible for their medical conditions would become
responsible for their health care, especially when those same
organizations have yet to accept responsibility for the
contamination that occurred.
Furthermore, I take issue with this report's reference to
Secretary Shinseki's letter which states that ``dependents'
health care would be better placed under TRICARE, a health
system much better suited to treatment of dependents.'' That
letter, and this report, makes no mention of exactly why that
would be the case. First, all of the affected ``dependents''
from the Camp Lejeune water contamination are now adults. So,
if it is a question of lacking pediatric providers that the
Secretary was referring to, that is not an issue here.
Secondly, VA has an entire health care program (CHAMPVA)
devoted to the treatment needs of certain dependents of
veterans; it has a specific program of health care for children
of Vietnam veterans born with certain birth defects; and it
provides health care to veterans who have conditions related to
myriad exposures, including radiation exposure, Agent Orange
exposure, exposure to contaminants present during Project
Shipboard Hazard and Defense tests, and others. The assertion
that somehow TRICARE is ``better suited'' to provide care to
affected individuals is contradicted by these facts.
In addition, from a functional perspective, the DOD TRICARE
program is comprised of hundreds of independent providers of
medical care loosely organized in three regional networks,
whereas VA is an integrated health care delivery system.
TRICARE is not structured to identify and effectively treat
individuals who are eligible for care only associated with
exposure-related illnesses or conditions. In contrast, VA has a
history of delivering health care to those specific
populations, to include affected family members. I am highly
skeptical that the TRICARE network would be able to care for
such a unique group without significant complications and
inefficiencies. At the very least, the Committee should have
explored this question before acting. That is why the bill I
introduced (S. 1518), and the amendment I offered at the
Committee's markup, follows existing precedent and recognizes
VA as the sole government agency with resident expertise in
such specific treatment and care.
I would like to make one additional point about my bill
before I continue. At the Committee's October 21, 2009,
legislative hearing the Administration offered its views on
S. 1518, the Caring for Camp Lejeune Veterans Act of 2009. The
Administration testified that an estimate of 500,000 dependents
would be eligible for VA health care under my bill, a number it
later called as potentially ``too conservative.'' The
Administration then recommended an approach ultimately adopted
in the Committee bill, i.e., that DOD be the provider of health
care for affected Lejeune family members. To the extent the
majority relied on VA's estimates to inform its policy on this
matter, I would like to point out that the Congressional Budget
Office provided preliminary views on S. 1518 in which it
estimated fewer than 10,000 affected Lejeune family members
would receive VA health care between 2011 and 2015. Thus, there
is reason to believe that VA's estimates are significantly off
the mark. It is regrettable if those estimates, or a misreading
of them, led to the policy contained in the Committee bill.
I am also concerned with the aspect of the Committee bill
that would establish a Science Advisory Panel to support an
Advisory Board tasked with making benefit recommendations to
both VA and DOD. The members of the Science Advisory Panel
would have the responsibility to review exposure claims at
military installations and recommend action, but the Committee
bill does not address whether this panel would duplicate or
influence the current Title 42, United States Code,
responsibilities vested in the ATSDR to conduct scientific
inquiries of military installations where environmental
contamination and human exposure has occurred and has been
verified by the Environmental Protection Agency.
Further, the Committee bill would task DOD with the lead
role in providing information to the Advisory Board, but there
is no requirement in the Committee bill that DOD do so, or that
DOD collaborate in good faith with the VA or the Advisory
Panel. As I discussed above, there is a tremendous suspicion of
the military's involvement in these matters. The Committee bill
would only serve to amplify that distrust.
And finally, a glaring procedural problem with the
Committee bill is that it was advanced without the support of
the Armed Services Committee, the Senate Committee which has
sole jurisdiction over the TRICARE program. Veterans and family
members have waited too long for action by the Congress on
their exposure claims. By reporting a bill that arguably is
within another Committee's jurisdiction, I fear the only thing
the Committee has advanced on their behalf is more delay and
frustration.
* * * * * * *
CHANGES IN EXISTING LAW
In compliance with paragraph 12 of rule XXVI of the
Standing Rules of the Senate, the Committee notes that no
changes in existing law are made by the original bill as
ordered reported.