Health Care for Exposure to Military Environmental Hazards

Part I: Camp Lejeune and Atsugi Naval Air Facility

Salem-News.com

(WASHINGTON D.C.) - Senate bill (S3378) authorizes health care for individuals exposed to environmental hazards at Camp Lejeune and the Atsugi Naval Air Facility and establishes an advisory board to examine exposures to environmental hazards during military service.

This story is not about a few rusting drums of chemicals sitting in an open field. The sad truth is that the widespread use of chemicals needed to support the military mission (e.g., jet fuels and degreasers like TCE), unsafe disposal practices, and failure to use personal protective clothing and equipment have lead to environmental contamination and unnecessary human suffering.

This article is Part I of a two part series addressing an original bill sponsored by Senator Daniel Akaka, (D, HI), Chairman, Senate Veterans Affairs Committee, posted on the Senate Legislative Calendar last week as S.3378, “Examination of Exposures to Environmental Hazards During Military Service and Health Care for Camp Lejeune and Atsugi Naval Air Facility Veterans and Families Act of 2010.” Part II of this series will address the impact of S.3378 on other military bases, including the establishment of an Advisory Board on Military Exposures to “consider and study” current military personnel, veterans and their family’s exposure to potential environmental hazards at bases other than Lejeune and Atsugi.

The original bill was introduced by Senator Akaka, Chairman of the Senate Committee on Veterans Affairs, on January 28th. The Committee voted 9 to 5 along party lines in favor of the bill. DOD as Health Care Provider in S.3378 The Defense Department is the final decision maker on who receives health care benefits under S.3378.

DOD’s long standing policy with regard to Marine Corps Base Camp Lejeune is that there’s no scientific evidence to support that organic solvents in Lejeune’s wells caused particular diseases. The Marine Corps and DOD cite a June 2009 National Research Council (NRC) report to support their position. However, there are problems with the NRC report. Senator Richard Burr (R, NC), the Ranking Member on the Committee, voted against the bill on January 28th, noting DOD’s hostility to providing health care benefits for Camp Lejeune veterans and dependents.

Senator Burr commented: “The committee’s vote today [January 28th] supposes that somehow by immaculate conception health care will appear for these veterans and their families.” Senator Burr provided written comments in the Committee Report, dated May 17th.

He noted that the bill, “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 [my emphasis].”

Senator Akaka in January acknowledged the reluctance of DOD to accept responsibility for health effects of environmental hazards: “Based on what I have seen, it appears clear that elements in the Department of Defense have been less than forthcoming in addressing these concerns [potential exposures to toxic substances at Camp Lejeune.] That failure does not relieve the Defense Department of its responsibility, nor mean that the burden should be placed on the Veterans Affairs Department.”

No one disagrees with Senator Akaka’s position that DOD should not be relieved of its responsibilities. However, whether DOD’s TRICARE program is the appropriate vehicle is questionable.

Senator Burr in the Committee Report noted that the TRICARE network is not set up to handle exposure-related illnesses while the VA health care system has extensive experiences with illnesses related to various exposures, including radiation, Agent Orange, and others.

The VA’s official position is that TRICARE is better suited to handle the treatment of dependents. According to Senator Burr, this ignores the fact that the VA’s CHAMPVA health care program is devoted to the treatment of dependents. This may have more to do with the cost of health care than anything else.

In regard to the estimated costs of S.1518, “Caring for Camp Lejeune Veterans Act of 2009,” the VA estimated the cost of legislation at $299.7 million in FY 2010, $319.5 million in FY 2011, $1.71 billion over the next 5 years and $4.16 billion over 10 years. Senator Burr sponsored S.1518, but the approval of an original bill (now S.3378) on January 28th effectively removed S.1518 from consideration.

Although not considered in the mark-up for S.3378, the costs of the program are a major factor.

One possibility for DOD to bear its responsibilities as suggested by Senator Akaka would be to require DOD to fund the costs of health care. That doesn’t mean that DOD has to provide the services under TRICARE or be the decider of who is eligible for health care.

This would require a major re-write of S.3378 and other than Senator Burr, I doubt if there’s any interest in doing this. From my perspective, the most important features of S.3378 are the review of environmental hazard claims by scientists with experience in environmental exposure, environmental exposure assessments, health monitoring or other relevant fields, the evaluation of military exposure claims for most military bases with few exceptions, and the submission of claims from active duty personnel, veterans, veterans advocacy groups, and officials of DOD and the VA.

The two other bills sponsored in the Senate (S.1518) or House (H.R. 4555) address the need for health care from the VA for Camp Lejeune veterans and dependents.

Atsugi NAF No one assigned to Naval Air Facility (NAF) Atsugi, the home of Carrier Air Wing 5, would have suspected that duty in Japan could exposed them to toxic chemicals, including deadly dioxin, the carcinogen infamously associated with Agent Orange.

In fact, prior to the closure of Atsugi’s privately owned Envirotech (formerly Shinkampo) incinerators in 2001, that is exactly what happened to military, dependents, and civilian workers stationed at NAF Atsugi during the period 1985 to 2001.

NAF Atsugi is located on Honshu, the main island of Japan. The base, about 20 miles from Tokyo, was originally built in 1938 by the Japanese Imperial Navy as Emperor Hirohito's Naval Air Base to address the threat posed by foreseen American bombing raids of the Japanese mainland.

Shelly Parulis, a spouse of a retired Marine Master Sergeant who was stationed at Atsugi from 1995 to 1998, and her family suffered the results of toxic exposure and leads the effort to obtain compensation and health benefits for Atsugi veterans, dependents ad civilian workers. The Navy has funded a number of engineering and technical reviews on NAF Atsugi. Four air quality studies conducted from 1989 to 1997 found chemicals in the incinerator complex’s smoke and ash known or suspected by the EPA “to cause cancer and/or upper respiratory injury and disease.” (See: srp.usmc.googlepages.com/USDOJPetitionSummaryofPreviousAmbien.pdf)

Despite the risks of serious disease, the Navy continued to assign personnel and their families to NAF Atsugi while the privately owned incinerator complex spewed its smoke and ash over the base from 1985 until 2001.

The immune systems of children are especially vulnerable to toxins.

There’s no evidence that limiting assignments to military only was under consideration by the Navy once the data on increased risk of cancer and upper respiratory injury and disease was known.

There is currently no Navy initiative to fund compensation and/or health benefits for any Atsugi veterans and dependents. Funding for this would have to be appropriated by Congress.

In 2001, the United States Justice Department sued Envirotech, the private owner of the incinerators, in a Yokohoma court, but before any judgment was made, the Japanese bought out the company and the closed the facility by year end.

At the end of the day, the polluter walked away with $40 million while the Japanese government “saved face” by closing the complex.

According to the Committee report, there is no current registry for individuals at Atsugi during the years of the incinerator’s operation. The Navy claims there’s no need for any registry since they determined the long-term health risks be very “very small.”

Under S.3378, DOD is required to compile a list of individuals exposed to environmental hazards from the incinerator at Atsugi within 90 days after the enactment of the Act.

There are no bills under than S.3378 that address the needs of Atsugi NAF veterans and dependents VA Health Care Provider in Other Bills Two other bills include the VA as the health care provider for both veterans and dependents and only address the environmental hazards from the contamination of Camp Lejeune water wells.

Senator Richard Burr in July 2009 introduced S-1518, “Caring for Camp Lejeune Veterans Act of 2009.”

The Department of Veterans Affairs is the designated health care provider in S-1518. However, Senator Burr’s bill could not clear the Senate Committee on Veterans Affairs. Senator Burr vowed to continue the fight and to attach his bill to any bill on the Senate floor, whenever the occasion arose.

A companion bill to S-1518 was introduced in the House on February 2nd. Representative Brad Miller (D, NC) introduced H.R. 4555, “The Janey Ensminger Act,” which requires the Department of Veterans Affairs to provide health care to veterans and their family members who have experienced adverse health effects as a result of exposure to contaminated well water at Camp Lejeune.

The bill is named after Janey Ensminger, age 9, daughter of retired Marine Master Sergeant Jerry Ensminger who died from leukemia after exposure to contaminated drinking water at Camp Lejeune.

Camp Lejeune NRC Study The National Research Council Report on Camp Lejeune of June 2009 stated that, "...strong scientific evidence is not available to determine whether health problems among those exposed are due to the contaminants." Among these health conditions are birth defects, childhood leukemia, liver damage, and male breast cancer.

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 quarterly to ensure water is not impacted.

Other scientists disagree with the NRC report’s findings, expressing disappointment that the NRC report which took two years in the preparation “reached puzzling and in some cases erroneous conclusions.”[1]

DOD’s resistance to accepting responsibility for health care for individuals affected by Camp Lejeune’s wells has left many veterans and dependents weary of any Congressional bill which requires the Defense Department to provide health care services. Putting DOD in the role of a decision maker who gets health benefits is questioned by many veterans. For many, DOD is figuratively the fox in the chicken house.

Section 6 and 7 of S.3378 gives DOD authority to compile a list of individuals who are eligible for health care at Camp Lejeune and Atsugi NAF.

DOD is required to ‘coordinate’ with the VA and in the case of Camp Lejeune to consult with the Agency for Toxic Substances and Disease Registry (ATSDR).

ATSDR was not involved in assessing the public health effects of exposure to the smoke from Atsugi so there’s no requirement for DOD to consult with ATSDR on this overseas base.

Despite the requirement to coordinate and consult with other agencies, DOD is clearly in charge of complying lists of individuals eligible for health care. DOD has real cost incentives to compile a short list of eligible veterans and dependents.

Could this happen? I don’t know but the reality is that Congressional oversight would likely prevent any blatant abuse by DOD.

It’s unlikely that DOD would refuse TRICARE to dependents and veterans who choose this option, but for veterans and their dependents who feel they have been ‘thrown under the bus,’ their reaction to a reluctant DOD providing health care is understandable.

Eligible dependents would receive health care through TRICARE, which offers three choices for health care: • TRICARE Prime, where military treatment facilities are the main source of health care.

• TRICARE Extra, a preferred provider option that saves money.

• TRICARE Standard, a fee-for-service option (the old CHAMPUS program).

The well water at Lejeune was contaminated with trichloroethylene (TCE) and other organic solvents over several decades. Congress estimated that as many as 500,000 veterans and their dependents may have been exposed to the contaminated drinking water at Lejeune.

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 quarterly to ensure water is not impacted. 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.

Other scientists disagree with the NRC report’s findings, expressing disappointment that the NRC report which took two years in the preparation “reached puzzling and in some cases erroneous conclusions.”[1] The bill provides a “Sunset” provision, which states that individuals may not be added by DOD to the eligible lists for health care for Lejeune and Atsugi five years after enactment of the bill. Over the next several months, we’ll know whether S.3378 becomes law or dies on the vine. In the immortal words of Yogi Berra, “It ain’t over till it’s over.” [1] tceblog.com/2009/06/18/scientists-speak-out-on-cl-report-disappointed-dismayed-disagree-should-not-stand-as-final-word-nc/.