U.S. Marine Corps Base Camp Lejeune, located in eastern North Carolina, is a large installation that covers 156,000 acres and is home at any given time to a population of about 170,000 active-duty personnel, family members, retirees, and civilian employees living on base or in the surrounding community. Between 1957 and 1987, the ground water at Camp Lejeune was inadvertently contaminated with chemicals, primarily industrial solvents that are now known to cause cancer and other health problems. In 1980, drinking water contaminants, primarily trichloroethylene (TCE) and perchloroethylene (PCE), as well as other solvents, were first detected at Camp Lejeune in treated drinking water. The contaminated wells were closed in 1987. In 1989, the U.S. Environmental Protection Agency placed Camp Lejeune on the National Priorities List, also known as Superfund. It is estimated that between 500,000 and 1,000,000 people may have used the contaminated water and many of them continue to have concerns about the long-term effects that might result from that exposure.

In 2012 Congress passed the Honoring America's Veterans and Caring for Camp Lejeune Families Act. The law provides health benefits to veterans and family members who have any of 15 health outcomes associated with exposure to TCE, PCE, or solvent mixtures. At the request of the Veteran's Administration, Review of the VA Guidance for the Health Conditions Identified by the Camp Lejeune Legislation reviews the latest scientific literature to ensure that the clinical guidance provided for the 15 covered medical conditions is scientifically sound. This report also describes the medical conditions that result from renal toxicity due to solvent exposures and characterizes neurobehavioral effects as mandated for coverage in the law.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE REVIEW OF CLINICAL GUIDANCE FOR THE CARE OF HEALTH CONDITIONS IDENTIFIED BY THE CAMP LEJEUNE LEGISLATION
• Reviewers
• Acronyms and Abbreviations
• Summary
  • STUDIES ON THE CAMP LEJEUNE POPULATION
  • COMMITTEE'S STATEMENT OF TASK AND APPROACH
  • RENAL TOXICITY
  • NEUROBEHAVIORAL EFFECTS
  • OTHER HEALTH OUTCOMES
  • USE OF THE GUIDANCE
• 1. Introduction
  • A BRIEF HISTORY OF CAMP LEJEUNE WATER CONTAMINATION
  • AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY RESPONSE TO CONTAMINATION
  • NATIONAL RESEARCH COUNCIL REPORT
  • HONORING AMERICA'S VETERANS AND CARING FOR CAMP LEJEUNE VETERANS ACT OF 2012
  • DEPARTMENT OF VETERANS AFFAIRS CAMP LEJEUNE PROGRAM
  • COMMITTEE'S CHARGE
  • APPROACH
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Characterization of Renal Toxicity
  • PREVIOUS ASSESSMENTS
  • REVIEW OF RECENT ANIMAL STUDIES
  • REVIEW OF RECENT EPIDEMIOLOGICAL STUDIES
  • CONCLUSIONS FROM ANIMAL AND HUMAN STUDIES
  • DISCUSSION OF GUIDANCE AND ALGORITHM
  • REFERENCES
• 3. Characterization of Neurobehavioral Effects
  • NEUROBEHAVIORAL AND RELATED EFFECTS
  • IN UTERO AND CHILDHOOD EXPOSURES
  • 2009 NRC REPORT
  • ADDITIONAL ENDPOINTS
  • DISCUSSION OF THE GUIDANCE AND ALGORITHM
  • REFERENCES
• 4. Other Health Outcomes
  • CANCER AND RELATED CONDITIONS
  • SCLERODERMA (SYSTEMIC SCLEROSIS)
  • MISCARRIAGE AND INFERTILITY
  • HEPATIC STEATOSIS
  • REFERENCES
• 5. Use of the Guidance
  • PURPOSE OF THE GUIDANCE AND ALGORITHMS
  • DECISION POINTS
  • FUTURE CONSIDERATIONS
  • REFERENCES
• APPENDIXES
  • Appendix A Committee Biographies
  • Appendix B Guidance for VHA Staff Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Section 102, Covered Clinical Conditions
  • Appendix C Excerpt from the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012 (P.L. 112-154)

This study was supported by Contract/Grant No. VA241-P-2024 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2015. Review of VA clinical guidance for the health conditions identified by the Camp Lejeune legislation. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.