89–010 

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 


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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 


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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 the 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, 


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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 


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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 


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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 entiVerDate Mar 15 2010 04:04 May 18, 2010 Jkt 089010 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\SR189.XXX SR189

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tled, ‘‘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 orderof-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 


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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 


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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. 


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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 


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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 


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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 UnVerDate Mar 15 2010 04:04 May 18, 2010 Jkt 089010 PO 00000 Frm 00012 Fmt 6659 Sfmt 6602 E:\HR\OC\SR189.XXX SR189

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1Different 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. 

funded 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. 


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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, beVerDate Mar 15 2010 04:04 May 18, 2010 Jkt 089010 PO 00000 Frm 00014 Fmt 6659 Sfmt 6602 E:\HR\OC\SR189.XXX SR189

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cause 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 in- crease 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 


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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 takeup 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. 

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. 

In total, CBO estimates the number of people that would be approved for benefits because of environmental exposures under this 


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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 di- rect 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 


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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 


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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 laborintensive 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 payas-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 deVerDate Mar 15 2010 04:04 May 18, 2010 Jkt 089010 PO 00000 Frm 00019 Fmt 6659 Sfmt 6602 E:\HR\OC\SR189.XXX SR189

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fined 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 RamirezBranum. 

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: 


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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 DeVerDate Mar 15 2010 04:04 May 18, 2010 Jkt 089010 PO 00000 Frm 00021 Fmt 6604 Sfmt 6604 E:\HR\OC\SR189.XXX SR189

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partment 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 halfcentury old may not be available, and the legislation leaves openended 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. 


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VA estimates the legislation, as written, would cost $299.7 mil- lion 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. 

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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. 


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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 


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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. 

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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. 

Æ 


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