VA/DOD RESPONSE TO CERTAIN 

MILITARY EXPOSURES 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

TOGETHER WITH

ADDITIONAL STATEMENTS SUBMITTED FOR THE RECORD 

( 

OCTOBER 8, 2009 

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VA/DOD RESPONSE TO CERTAIN 

MILITARY EXPOSURES 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

OCTOBER 8, 2009 

Printed for the use of the Committee on Veterans’ Affairs 

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(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

ROLAND W. BURRIS, Illinois 

ARLEN SPECTER, Pennsylvania 

RICHARD BURR, North Carolina, Ranking 

Member 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

OCTOBER 8, 2009 

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 2 

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 4 

Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 6 

Burris, Hon. Roland W., U.S. Senator from Illinois ............................................. 6 

Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia ........................ 105 

Prepared statement .......................................................................................... 105 

Attachments ............................................................................................... 107 

WITNESSES 

Hagan, Hon. Kay R., U.S. Senator from North Carolina ..................................... 7 

Wyden, Hon. Ron, U.S. Senator from Oregon ....................................................... 8 

Partain, Mike ........................................................................................................... 10 

Prepared statement .......................................................................................... 12 

Attachment ................................................................................................ 17 

Response to post-hearing question submitted by Hon. Daniel K. Akaka .... 64 

Enclosures .................................................................................................. 66 

Nuckols, John R., Professor, Department of Environmental and Radiological 

Health Sciences, Colorado State University ...................................................... 71 

Prepared statement .......................................................................................... 72 

Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 75 

Pennington, Stacy, Sister of SSG. Steven Gregory Ochs, Iraqi Operation Freedom and Operation Enduring Freedom Veteran ............................................... 75 

Prepared statement .......................................................................................... 78 

Miller, Robert F., M.D., Associate Professor of Pulmonary and Critical Care 

Medicine, Vanderbilt University Medical Center .............................................. 80 

Prepared statement .......................................................................................... 82 

Paganelli, Laurie, Mother of Jordan Paganelli, Childhood Cancer (Sarcoma) 

Warrior and Past President of U.S. Naval Air Facility (NAF), Atsugi, 

Japan ..................................................................................................................... 83 

Prepared statement .......................................................................................... 86 

Feigley, Charles E., Ph.D., Professor, Environmental Health Sciences, Public 

Health Research Center, Arnold School of Public Health, University of 

South Carolina; Chair, Subcommittee on the Atsugi Incinerator Committee 

on Toxicology Board on Environmental Studies and Toxicology Division 

on Earth and Life Studies, National Research Council, The National Academies ..................................................................................................................... 88 

Prepared statement .......................................................................................... 90 

Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 92 

Gibb, Herman, Ph.D., M.P.H. ................................................................................. 92 

Prepared statement .......................................................................................... 95 

Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 96 

Powell, Russell, Former U.S. Army Staff Sergeant .............................................. 97 

Prepared statement .......................................................................................... 99 

Peterson, Michael, DVM, M.P.H., DRPH, Chief Consultant, Environmental 

Health, Strategic Healthcare Group, Office of Public Health & Environmental Hazards, Veterans Health Administration, Department of Veterans 

Affairs .................................................................................................................... 115

Prepared statement .......................................................................................... 116 

Page

IV 

Peterson, Michael, DVM, M.P.H., DRPH, Chief Consultant, Environmental 

Health, Strategic Healthcare Group, Office of Public Health & Environmental Hazards, Veterans Health Administration, Department of Veterans 

Affairs—Continued 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 121 

Hon. Richard Burr ........................................................................................ 123 

Postlewaite, R. Craig, DVM, M.P.H., Acting Director, Force Health Protection 

and Readiness Programs, Office of the Assistant Secretary of Defense 

(Health Affairs), U.S. Department of Defense ................................................... 125 

Prepared statement .......................................................................................... 126 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 128 

Hon. Richard Burr ........................................................................................ 131 

Gillooly, Paul B., Ph.D., CAPT, Medical Services Corps, U.S. Navy (Ret.), 

Navy/Marine Corps Public Health Center ......................................................... 132 

Prepared statement .......................................................................................... 134 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 139 

Hon. Richard Burr ........................................................................................ 290 

Payne, Eugene G., Jr., Major General, Assistant Deputy Commandant, Installations and Logistics (Facilities), Headquarters, U.S. Marine Corps. ............. 291 

Prepared statement .......................................................................................... 292 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 296 

Hon. Richard Burr ........................................................................................ 298 

Resta, John J., Scientific Advisor, U.S. Army Center for Health Promotion 

and Preventative Medicine .................................................................................. 299 

Prepared statement .......................................................................................... 301 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 305 

Hon. Richard Burr ........................................................................................ 310 

Response to request arising during the hearing by Hon. Richard Burr ...... 324 

APPENDIX 

Akers, Paul C., BS, MS, MD, Camp Lejeune, NC (1954–60); prepared statement ...................................................................................................................... 327 

Agency for Toxic Substances and Disease Registry (ATSDR); prepared statement ...................................................................................................................... 328 

Camp Lejeune Community Assistance Panel (CAP); prepared statement ......... 336 

Aschengrau, Ann, Sc.D., Professor, Associate Chair of the Department of 

Epidemiology, Boston University School of Public Health; accompanied by 

four other signers; prepared statement .............................................................. 342 

Briscoe, David A., U.S. Marine (Ret.); prepared statement ................................. 343 

Little, Candy; prepared statement ......................................................................... 344 

O’Dowd, Robert, Somerdale, NJ, Marine Veteran, Former Financial Manager, 

Defense Logistics Agency; accompanied by nine other signers; letter ............. 345 

Attachment ................................................................................................ 347 

Parulis, Shelly, Jacksonville, NC; letter ................................................................ 351 

Sims, Sam; letter ..................................................................................................... 355 

(1) 

VA/DOD RESPONSE TO CERTAIN 

MILITARY EXPOSURES 

THURSDAY, OCTOBER 8, 2009 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 9:31 a.m., in room 

562, Dirksen Senate Office Building, Hon. Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senators Akaka, Rockefeller, Brown, Burris, Hagan, 

Wyden, Burr, and Isakson. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Senator AKAKA. The Senate Committee on Veterans’ Affairs will 

come to order. Aloha and welcome to today’s hearing where we will 

focus on how the Departments of Veterans Affairs and Defense respond to in-service exposures. 

As the Committee charged with oversight of the Department of 

Veterans Affairs, we must be certain that VA is providing appropriate health care and compensation to those who are harmed by 

exposures while serving in the military. In order for VA to do that, 

DOD must first determine who was exposed, what they were exposed to and the health consequences of such exposures. The information must then be shared with VA. 

Two of the matters we will look at today relate to claimed exposure of members of the Armed Forces during the current conflicts. 

The other two involve claimed exposures in the past and relate not 

only to members of the Armed Forces, but also to family members. 

These are very different issues and as such, require different 

approaches. 

As to the question of who might have been exposed in the 

present conflict, current DOD records should be available to answer 

that question. If they are not, then the Committee must know why 

not. For the earlier exposures, DOD must pull together records to 

provide some estimation of potentially exposed populations. 

I believe that the overall issue of providing intervention on exposures is vital. DOD should commit to ensuring that going forward 

no one will leave active duty without a detailed record of where the 

individual was stationed and a comprehensive physical that might 

identify any health concerns related to possible in-service exposures. 

VA’s role is to merge the information regarding potential exposure and the scientific analysis so as to craft an appropriate reVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
2 

sponse. This effort must be carried out, giving the benefit of the 

doubt to the veterans concerned. In some cases, there has been an 

absence of reliable information on exposures, including health consequences. In other cases, it is not possible to achieve consensus on 

the science. 

One thing is clear, those harmed by an in-service exposure to environmental hazards should receive a timely and appropriate response from the government. Because Congress is not the ideal 

forum for seeking to resolve complex and often emotional issues related to potential exposures, we must be sure that DOD and VA 

are working together effectively on such issues. 

I look forward to the testimony of the many witnesses that we 

have here this morning. I now turn to Senator Burr, for his opening statement. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Aloha, Mr. Chairman. 

Chairman AKAKA. Aloha. 

Senator BURR. And good morning. I want to thank you for calling 

what I think is an extremely important hearing. I want to welcome 

our witnesses and to recognize all of the veterans and their family 

members who have joined us here today for this hearing. 

I also want to give a special welcome to two North Carolinians, 

Jerry Ensminger and Shelly Parulis and to thank them for their 

tireless leadership and advocacy on behalf of veterans and their 

families. Your interest in this hearing only serves to underscore the 

importance of the issues we are discussing today. 

Over the years, thousands of military personnel and their families have been exposed to dangerous chemicals where they were living and working while serving our country. Today we will hear 

about some of those exposures, including: the plumes from an incinerator near a base in Japan; smoke from burn pits being used 

in Iraq and Afghanistan; dust from a facility in Iraq coated with 

a known carcinogen; and contaminated drinking water at a base in 

North Carolina. 

I want to express my sincere appreciation to the veterans and 

family members on our first panel for your willingness to share 

with us your painful experiences about your exposure. Your perspectives will help guide our efforts to find answers for veterans 

across the country about how these exposures may have affected 

their health or the health of their loved ones. More importantly, 

your testimony will help us determine what steps we need to take 

to protect and improve the lives of those who have been harmed. 

Mr. Chairman, my remarks will focus on one exposure issue that 

is very personal to me, the contaminated drinking water at Camp 

Lejeune in my home State of North Carolina. I know we will hear 

from several witnesses about this issue, but I also would like to acknowledge two former Marines, Jerry Ensminger, who is here 

today, and David Briscoe, who could not be here today. 

They both lived at Camp Lejeune during the years that the 

water was contaminated and have their own painful stories. David, 

who lived in Camp Lejeune in the 1980s, was later diagnosed with 

cancer of the hard pallet and underwent treatment that reduced 

3 

his ability to eat, speak and work. Jerry’s daughter, who was born 

at Camp Lejeune in 1975, was diagnosed with leukemia at age six 

and tragically died 3 years later. Jerry, I commend you for your 

personal strength in the face of such tragedy and appreciate you 

being here today. 

Unfortunately, Jerry and David’s heart-wrenching stories are not 

unique for veterans who served on Camp Lejeune between 1957 

and 1987. The residents of Camp Lejeune didn’t know it at the 

time, but the water they were drinking, cooking with, and bathing 

in contained harmful chemicals, including TCE, PCEs, benzene and 

vinyl chloride, which are known or probable human carcinogens. 

Some of them are now living with rare cancers, like one of our 

witnesses today. Mark Partain is a son of a Marine, a former resident of Camp Lejeune, and one of over 20 former Lejeune residents 

diagnosed with a rare male breast cancer at an unusually young 

age. He was just 39 years old. This condition usually strikes less 

than 2,000 men each year and most are over the age of 55. 

Although a number of studies have suggested a possible link between the water and Camp Lejeune and these types of conditions, 

we still do not have the answers about what made Jerry’s daughter 

or Mike or David sick or what has caused our former Lejeune residents to become ill. The government’s role in scientific discovery is 

clear; Camp Lejeune was designed by the EPA as a national priority list site. 

Under Title 42 of the U.S. Code, the Agency for Toxic Substance 

and Disease Registry is conducting a number of studies of the 

Camp Lejeune contamination. These studies include sophisticated 

computer modeling and future mortality and health surveys. It is 

unfortunate that ATSDR was not invited to provide a witness for 

this hearing so that they could respond to testimony being given 

by our witnesses and answer questions from this Committee. 

Mr. Chairman, I hope in order to strike a balance of the scientific 

opinion on what I think is an important issue, I would ask that 

ATSDR’s official response to the National Research Council’s report 

on Camp Lejeune be included in the record today. 

Chairman AKAKA. It will be included in the record. 

[The information referred to appears in the Appendix.] 

Senator BURR. I thank the chair for that. We have an obligation 

to figure out how much of these dangerous chemicals veterans and 

their families were exposed to at Camp Lejeune and what impact 

these exposures had potentially on their health. For these patriots 

who have endured unbearable heartache and suffering, they deserve no less than our best effort to provide them with the answers 

about why they are sick. 

Also, we must always make sure that the claims these families 

have pending are not prematurely denied by the government before 

science has had the opportunity to provide more answers. Let me 

stress, before science has had the opportunity. While we wait for 

science, we must deal with the fact that many of these exposed veterans and their families continue to suffer from devastating 

conditions. 

It is simply not right for us to continue to tell our veterans and 

their families to just wait for another study. They have already 

waited two decades. We owe them much more than that. That is 

4 

why I have introduced, along with my colleague from North Carolina, Senator Hagan, legislation—the Caring for Camp Lejeune 

Veterans Act, S. 1518—which would allow veterans stationed at 

Camp Lejeune while the water was contaminated to get medical 

care from the VA. 

Perhaps more importantly, it would also allow the VA to treat 

their families for conditions associated with exposure to contaminated water. Providing health care to veterans and their families 

would be one step toward meeting our moral obligation to those 

who have put more at risk. As we will discuss today, there are 

many other veterans and their families who may have been exposed to dangerous chemicals in other places around the world. For 

all of them, it is important that we have a framework in place to 

determine in a fair and hassle free and timely matter what benefits 

and services they need and deserve. 

To that end, we will have a candid and productive discussion 

today about what is currently working well and where improvements are needed. Mr. Chairman, for veterans and their families 

put at risk by exposure, whether in Japan, Afghanistan, Iraq or 

North Carolina, we have a solemn duty to take care of those who 

were put in harm’s way while serving this Nation. I hope we will 

work together, and I think we will, to provide these veterans and 

their families with the answers they deserve and more importantly, 

the help they need. 

I thank the chair. 

Chairman AKAKA. Thank you very much, Senator Burr. Now we 

will have the opening statement of Senator Brown. 

STATEMENT OF HON. SHERROD BROWN, 

U.S. SENATOR FROM OHIO 

Senator BROWN. Thank you, Mr. Chairman, Ranking Member 

Burr, and Senator Hagan, too, for your good work on this very important issue. 

Today’s hearing is about toxic exposure, elusive science and 

earned compensation. It is about our servicemembers and their 

families and how we will resolve the difficult challenges that exposure issues present. When there is doubt, we must take the side 

of the servicemember. 

Yesterday I met with Mary and Jeff Byron. Jeff is a former Marine who served at Camp Lejeune from 1982 to 1985. Mary and 

Jeff were at Camp Lejeune when their first baby was born and I 

believe their second child was born. We discussed their family and 

the impact that living at Camp Lejeune had on this family’s lives 

through that generation and even the next generation. 

Jeff is one of more than 5,900 Ohio veterans whose families are 

part of the Marine Corps Registry for potential exposure at Camp 

Lejeune. Jeff and Mary are here today. At one point, Jeff, in recalling what had transpired with his family during their time at Camp 

Lejeune and soon after and the problems that his family was facing, told me he turned to his wife and asked, what is happening 

to our family? 

Connecting the dots between service and exposure is a complicated process. Helping these families should not be complicated. 

In tough cases like this, we have to ask ourselves, what is the 

5 

greater sin? Do we refuse benefits to a servicemember or a veteran 

or a servicemember’s family or a veteran’s family who may be suffering from service-connected exposure to cancerous toxins? Or do 

we provide benefits to a servicemember or veteran or servicemember’s family or veteran’s family whose health care challenges 

may not be service-connected? 

Do we save a few bucks or do we save a few lives? Scientific certainty should not trump human decency. There is another point 

here that cannot be overlooked. Our military now is working to 

connect the dots, but private contractors are not. From the exposures of Camp Lejeune to the burn pits in Iraq, to the emissions 

at Atsugi Naval Air Station, we found the military working to find 

the answers. 

It has not been the smoothest journey to where we are today. For 

too long, the Department of Defense fought and denied exposure 

claims, but the military, again, finally now is working with the VA 

to serve the best interests of our servicemembers, our veterans and 

I hope their families. 

I spoke this week with the Marine commandant, General James 

Conway, who has pledged his cooperation and who has pledged 

that the military will do much better at meeting its obligations 

than it has in the past. This cooperation though, has not been the 

case with the sodium dichromate exposure at the Qarmat Ali 

Water Treatment Plant. 

What is the difference? The difference is the water treatment 

plant was run by a private contractor, KBR. In a recent hearing, 

soldiers testified they were never offered any kind of protective 

clothing or masks or other protections by the company. They were 

never told about the presence of one of the most hazardous carcinogens. Hexavalent chromium is a general toxic carcinogen and inhalation leads to lung cancer, yet the company either dismissed these 

concerns, or worse, intentionally mislead our military personnel. It 

is a lousy way to turn a profit. 

So, while I am not happy at the speed and the progress of the 

Department of Defense and the VA, I am outraged at the behavior 

of private contractors, especially KBR. We should all be outraged 

by the behavior of KBR and like-minded contractors who take the 

money from our taxpayers, who take the money from our military, 

but fail its members. That is not the focal point of this hearing, but 

it is an issue Congress must confront. 

As we consider how to ensure members of our military who have 

been harmed by environmental hazards benefits they deserve, we 

should learn from the rocky road former nuclear workers have been 

forced to travel to prove they have been harmed by their jobs. 

The Department of Labor is charged with addressing work-connected health care issues affecting our former nuclear workers, 

many of whom are in my home State of Ohio. It has been an 

unjustifiably steep, red-taped-ridden battle for these workers and I 

welcome my colleagues’ assistance and efforts to improve that program. We must not repeat the mistakes of that program as we address the concerns of servicemembers. 

We must cut through the bureaucracy and focus on delivering 

both help and hope to men and women and their families who 

served our Nation and now are suffering because of it. That is why 

6 

the work of this Committee and the leadership of the Chairman 

and the Ranking Member on this issue are so important. That is 

why the testimony of our witnesses is so vital and appreciated. 

Thank you. 

Chairman AKAKA. Thank you very much, Senator Brown. Senator Isakson, your opening statement. 

STATEMENT OF HON. JOHNNY ISAKSON, 

U.S. SENATOR FROM GEORGIA 

Senator ISAKSON. Thank you very much, Mr. Chairman. In deference to the witnesses, I will be very brief. I want to thank you 

at the outset for calling what I consider to be a most important 

hearing and I look forward to hearing the testimony of each and 

every witness. 

I would like to thank each of the witnesses for helping to shed 

light on this very serious matter. I would particularly like to thank 

the witnesses who will be sharing their deeply personal stories. 

You not only put a face on the consequences of these exposures, but 

also help us as we determine the correct path for us to follow. I 

thank you for your service to our country and I thank you for being 

here today to testify. 

Chairman AKAKA. Thank you very much, Senator Isakson. Senator Burris, your opening statement. 

STATEMENT OF HON. ROLAND W. BURRIS, 

U.S. SENATOR FROM ILLINOIS 

Senator BURRIS. Thank you, Mr. Chairman. I would like to also 

thank you for holding this hearing on the important issue of exposure to environmental hazards to our servicemembers. When we 

ask the brave men and women of this country to risk their lives 

in service to this country, the country in turn has an obligation to 

protect them from exposure and environmental hazards and provide information and treatment. 

I am deeply concerned whether there have been adequate studies 

and reporting of environmental hazards in places abroad where we 

are fighting two wars and in other military bases both abroad and 

here in the U.S. In addition, as this body debates the reform and 

expansion of our Nation’s health care system and the quality of 

care that is provided for our citizens, we need to ensure that our 

soldiers and veterans receive the care that they need from health 

problems resulting from these exposures. 

I want to thank our witnesses today, some of them who have experienced or have loved ones who have experienced severe problems that are caused by some of these hazards. So, I will have a 

few questions, Mr. Chairman, after we finish our statements. 

Thank you. 

Chairman AKAKA. Thank you very much, Senator Burris. I see 

my distinguished colleague, who, like our Ranking Member, represents the State of North Carolina. Senator Hagan has joined us. 

I would like to invite her to share a statement at this time. 

7 

STATEMENT OF HON. KAY R. HAGAN, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator HAGAN. Thank you very much, Mr. Chairman. I would 

like to begin by thanking you for holding this important hearing 

and for giving me the courtesy of allowing me to make a brief 

statement concerning an issue that is so important to me and 

many of my constituents. 

I also want to thank the Ranking Member, Senator Burr, for his 

leadership on this issue. He has been discussing this issue of water 

contamination at Camp Lejeune for many years and since I have 

been sworn in, he and I have worked very closely together on this 

issue. I have greatly appreciated his guidance and tenacity in pursuing closure for the affected families. 

Mr. Chairman, between 1957 and 1987, Marines and their families at Camp Lejeune drank and bathed in water that was contaminated with toxins at concentrations up to 280 times what is currently considered safe by the Environmental Protection Agency. My 

heart certainly goes out to the Marines and their families who were 

exposed and affected. 

A compelling CNN piece just last month highlighted cases of 

former Marines and their families who have been diagnosed with 

male breast cancer. Today there are over 40 individual cases, all 

of whom at one point or another served on base or lived at Camp 

Lejeune during the contaminated years. These service men and 

women, as well as so many, have spent their careers working to 

successfully finish the mission that they started. I think it should 

be our mission to get these families complete answers. 

Marines and their families who were exposed to dangerous 

chemicals over several decades deserve to know if this exposure 

had an effect on their health. They cannot get closure until the remaining CDC studies, which are in progress, are complete; and 

these CDC studies are to be done by the Agency for Toxic Substances and Disease Registry, the ATSDR. I am looking forward to 

working with the Navy and the Marine Corps to fully fund these 

human health and water modeling studies, which will hopefully 

give us answers. It has received a lot of attention. 

I would like to address the conclusion of the National Academy 

of Science literature review which was recently completed. Well respected scientists from across the country, including officials at the 

ATSDR, have openly challenged the validity of this review. This review significantly downplayed the level of exposure Camp Lejeune 

residents had to TCE and PCE chemicals found in the Camp Lejeune’s water—potable water—system and it also did not take into 

account the EPA’s draft health risk assessments for these chemicals. It also significantly downplayed the adverse health effects resulting from such exposure and did not assess scientific associations between benzene and vinyl chloride in adverse health effects. 

Benzene, a chemical, was leaking into the water supply at Camp 

Lejeune at a rate of 1,500 gallons per month. Furthermore, we all 

understand that there were no specific Federal regulatory standards regarding volatile organic compounds until the late 1980s. 

However, I think it is important to note that the Navy and Marine 

Corps had their own regulations regarding the operation of drinkVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
8 

ing water systems and the disposal of contaminants and hazardous 

waste. 

It is impossible to know with 100 percent certainty what happened over 25 years ago, but I think it is important that the most 

comprehensive understanding possible of the actions that were 

taken and not taken during the contamination period, the origins 

of the contamination, as well as where the contamination sites 

were located, be given. Even more importantly, I believe that this 

information must be explained to the public in an understandable 

fashion. 

I believe that Congress, the Navy, and the Marine Corps need to 

work together to develop an action plan to take care of the victims 

that were exposed to this contaminated water. While this is happening, I encourage the Chairman and the Committee to consider 

legislation introduced by Senator Burr, which I co-sponsored along 

with five other senators. It provides veterans and their families 

who are suffering from adverse health effects associated with Camp 

Lejeune’s contaminated water to obtain health care from the VA. 

This issue is not just about North Carolina. These men and 

women are living all over our country now. We cannot leave these 

families with mounting medical problems and half answers. 

Thank you, Chairman Akaka and Senator Burr for the opportunity to speak today. 

Chairman AKAKA. Thank you very much, Senator Hagan. I am 

delighted to have my friend from Oregon here, Senator Wyden. 

STATEMENT OF HON. RON WYDEN, 

U.S. SENATOR FROM OREGAN 

Senator WYDEN. Thank you very much, Mr. Chairman, for your 

thoughtfulness, and Senator Burr, and for the opportunity to spend 

a few minutes here. I would ask unanimous consent that my full 

remarks go into your record and would just touch on a couple of 

issues this morning. 

Chairman AKAKA. Without objection, it will be included in the 

record. 

Senator WYDEN. Mr. Chairman and colleagues, I am very glad 

that you are looking at this critically important issue. National 

Guard soldiers from my home State have told me about their exposure to hexavalent chromium at Qarmat Ali in Iraq. The soldiers 

have told me about how their rooms were filled with toxic smoke 

from open air burn pits and they have told me about their struggles with the agency trying to secure benefits and health care. I 

very much appreciate, Mr. Chairman, your putting a spotlight on 

this issue, and particularly working to make sure that the Department of Veterans Affairs gets our veterans the benefits they need 

and that they are treated with respect and attention. 

Mr. Chairman and colleagues, I think we all understand that nobody at the VA gets up in the morning and says, I want to spend 

my day being rotten to veterans. They all mean well. They care 

about our veterans deeply, yet, so often the system can be inflexible 

and our veterans get caught in red tape. 

On September 19, I received what I felt was a positive letter 

from then Secretary of the Army, Pete Geren, who told me, I quote, 

‘‘The VA is working internally to use the registry and the list of 

9 

possible medical issues from chromium exposure to establish a 

service connection.’’ 

Yet, because a service connection has not been established by 

DOD and the VA, some of our veterans get caught in this morass 

of red tape when they ought to be receiving treatment for respiratory problems, skin and eye problems, and even cancer that 

they picked up as a result of their exposure to chromium. 

One Oregon National Guard soldier was told, and I quote, ‘‘Exposure is not a disability, nor does the VA pay compensation for exposure.’’ Then that soldier was told to go out and produce 15 pieces 

of evidence if he hoped to receive any kind of treatment for his illness. I think our colleagues, whether you are a Democrat or Republican, would agree that veterans should not be subjected to this 

kind of merry-go-round approach. 

It is not enough for the agencies to say they want to help and 

then, when the soldiers have to find their way through the bureaucracy, there is nobody there to get them their benefits. They 

face enough when they go into combat; they should not have to battle their government to get medical care when they return home. 

I know you are going to hear from a variety of very thoughtful 

witnesses this morning who are going to talk about what is needed 

to make sure our veterans are properly cared for. 

Mr. Chairman and colleagues, thank you very much for the 

chance to come and offer the vantage point from some Oregon National Guard members who have reported to me. We have one of 

the highest levels of participation in the Guard in the country. We 

feel very strongly in our State about ensuring that they receive 

adequate medical care when they have been injured, when in 

harm’s way, and we thank you for your thoughtfulness to be able 

to come and spend a few minutes and lay out their concerns. 

Chairman AKAKA. Thank you very much, Senator Wyden, for 

your statement. 

I want to now welcome our first panel this morning. Our first 

witness is Mike Partain, who is testifying in regard to Camp Lejeune. We have Dr. John Nuckols, who is a professor at Colorado 

State University and a member of the Committee on Contaminated 

Drinking Water at Camp Lejeune. 

Next we have Stacy Pennington, sister of SSG. Steve Ochs, who 

was exposed to burn pits and died in 2008. She is followed by Dr. 

Robert F. Miller, who is an associate professor of pulmonary and 

critical care medicine at Vanderbilt University Medical Center and 

has studied health effects of environmental exposures like burn 

pits. 

We also have Laurie Paganelli, who will testify in regard to the 

Atsugi Naval Air Facility in Japan. She will be followed by Dr. 

Charles Feigley, who is a professor at the University of South 

Carolina and was also the chair of the subcommittee on the Atsugi 

incinerator for the National Resource Council. 

Our final witnesses are Dr. Herman Gibb, who will testify in regard to health effects related to Qarmat Ali; and Russell Powell, 

who will testify about his experiences at the same facility. I want 

to thank the Veterans of Foreign Wars for making it possible for 

Mr. Powell to share his story with the Committee today. 

10 

I thank you all for being here this morning. Your full testimony 

will, of course, appear in the record. Mr. Partain, will you please 

begin? 

STATEMENT OF MIKE PARTAIN 

Mr. PARTAIN. Good morning, Mr. Chairman. 

Chairman AKAKA. Good morning. 

Mr. PARTAIN. Good morning, Mr. Chairman. I would like to 

thank you, the Ranking Member, and Members of the Veterans’ Affairs Committee for permitting me to testify this morning. 

My name is Michael Partain and I am son and grandson of U.S. 

Marine Corps officers. My parents were stationed at Marine Corps 

Base Camp Lejeune shortly after my father graduated from the 

U.S. Naval Academy. My father chose to live in base housing because he trusted the Marine Corps would protect his family. 

I was conceived and carried while my parents lived on the base. 

During the time of my mother’s pregnancy, we were exposed to 

high levels of tetrachloroethylene, trichloroethylene, dichloroethylene, benzene and vinyl chloride in the tap water provided to my 

family by the Marine Corps. 

I was born at the base naval hospital in January 1968. Two 

years ago, I was diagnosed with male breast cancer at the age of 

39. It is rare for this disease to strike men, especially young men 

such as myself. In fact, I am one of 40 men who share the unique 

commonality of male breast cancer and exposure to contaminated 

tap water aboard Camp Lejeune. Fortunately, I have health insurance which provides treatment for my disease. Even then, my battle with cancer has been a traumatic, emotional, physical, and a financial ordeal for my family. 

Over the past 2 years, I have been in contact with numerous 

other families who are suffering from illnesses related to their exposures at Camp Lejeune. Many of these people do not have adequate health care or are now uninsurable because of their diseases. 

These families supported their Marines in body and spirit and now 

they have been left behind to suffer and die by the very organization they trusted and served faithfully. 

Beginning on 31 October 1980, Navy and Marine Corps officials 

received what would later become a litany of warnings that the 

base’s drinking water supply was highly contaminated with chlorinated hydrocarbons. The U.S. Army Environmental Hygiene Laboratory was tasked to analyze the base’s tap water for trihalomethanes in preparation for a new EPA safe drinking water regulation. 

The Army lab warnings were repeated three more times between 

December 1980 and March 1981. 

For some unknown reason, the Army lab further spelled out the 

issue by placing the word ‘‘solvents’’ with an exclamation point at 

the end of their March 1981 warning. Curiously, this key word was 

omitted from the 2007 Government Accountability Office review of 

the Camp Lejeune drinking water contamination. There was no 

documented action taken to identify the source of the contamination at that time. 

On 6 May, 1982, Mike Hargett, co-owner of Grainger Laboratory, 

phoned the base chemist, Elizabeth Betz, and advised her that 

PCE and TCE contamination was found in the tap water samples 

11 

sent for TTHM analysis. Ms. Betz then notified her immediate supervisors. A week later, Ms. Betz was summoned to a briefing involving the base’s facilities command staff. That is documented in 

her memorandum for the record. ‘‘It appeared to me that they had 

not been informed about the findings. I did not inform them.’’ 

Further testing revealed continued contamination. Grainger then 

wrote the commanding general of Camp Lejeune. ‘‘Interferences 

which were thought to be chlorinated hydrocarbons entered the 

quantization of certain trihalomethanes. These appear to be at high 

levels and hence, more important from a health standpoint than 

the total trihalomethane content. For these reasons, we called the 

situation to the attention of Camp Lejeune personnel.’’ 

The Grainger memo documented in writing that the contamination present in the potable water systems aboard the base was a 

serious issue. Grainger’s chemist correctly concluded that the contaminants were located in the well fields for both Tarawa Terrace 

and Hadnot Point. No further action was taken by the Navy or Marine Corps officials. 

Several months ago, I spoke to Mr. Hargett, former co-owner of 

Grainger Lab. He indicated to me that he had secretly tipped off 

the State of North Carolina that there was a problem with the 

TTHM testing program at the base. Shortly after this revelation, 

a State of North Carolina environmental engineer wrote to the 

base’s assistant chief of staff facilities requesting the Grainger analytical data sheets which contained their notations of the contamination. 

This request was ignored and then denied. It was not until 30 

November 1984, that the Marine Corps officials began to finally 

close the contaminated wells at Camp Lejeune. Two weeks later, an 

article appeared in the base’s newspaper. The article advised residents and personnel that four wells were removed from service due 

to traces of organic compounds which were unregulated by the Safe 

Drinking Water Act. 

What the article failed to mention was that on 6 July 1984, 

Hadnot Point Well HP–602 was sampled and found to be highly 

contaminated with benzene. The base environmental engineer also 

failed to disclose to the readers the presence of a 20,000- to 30,000- 

gallon unreported and unremediated fuel leak dating back to 1979 

which occurred on Hadnot Point. This fuel plume was in the 

groundwater and was 15 feet thick. 

The minimization and deception did not end there. On 30 April 

1985, the commanding general of Camp Lejeune advised the residents of Tarawa Terrace that two wells were taken offline because 

of minute trace amounts of—several organic chemicals were detected in the water. In September 1985, the base environmental engineer, Robert Alexander, was directly quoted in a newspaper that 

people had not been directly exposed to pollutants. 

In November 1985, base officials, including Robert Alexander, informed the EPA that the contamination had not reached the distribution plants. What the Marine Corps has failed to disclose to 

Members of Congress, the media, and the public was that the Marine Corps was in violation of their own orders which date back to 

1963. These orders, if followed, would have prevented most of the 

human exposures of Camp Lejeune. 

12 

One of these orders is the Bureau of Medicine and Surgery instruction known as BUMED 6240.3B. The purpose of the BUMED 

was to establish standards for water for drinking throughout the 

naval establishment, including Camp Lejeune. ‘‘Substances which 

may have a deleterious physiological effect or for which the physiological effect are not known shall not be introduced into the system 

in a manner which would permit them to reach the consumer.’’ 

There is also a Marine Corps order that specifically addresses 

safe disposal of chemicals on the base. In the interest of time, I will 

not go into the details during my opening statement. However, I 

am prepared to answer questions on both these documents. 

In closing, I note at the table is a former member of the National 

Resource Council committee which produced the report that 

downplayed the health effects resulting from our exposures at 

Camp Lejeune. I also note with great concern, as Senator Burr indicated, the ASTDR, the agency statutorily tasked by Congress to 

assess health effects for national priority sites such as Camp Lejeune, is not represented in this hearing. 

The NRC’s report contains numerous flaws, including the committee’s failure to assess our exposures to benzene and vinyl chloride. I respectfully submit that the Senate Veterans’ Affairs Committee seek out the professional recommendations of the project 

manager in charge of ATSDR’s Camp Lejeune studies. 

I thank you for your time. 

[The prepared statement of follows:] 

PREPARED STATEMENT OF MICHAEL SEAN PARTAIN

Good Morning Mr. Chairman. I would like to thank the Chairman, Ranking member and members of the Veteran’s Affairs Committee for permitting me to testify 

this morning. 

My Name is Michael Partain and I am the son and grandson of U.S. Marine 

Corps Officers. My parents were stationed aboard Marine Corps Base Camp Lejeune 

shortly after my father graduated from the United States Naval Academy. I was 

conceived, carried and then born at the base Naval Hospital while my parents lived 

in base housing. During the time of my mother’s pregnancy, we were exposed to 

high levels of tetrachloroethylene (PCE), trichloroethylene (TCE), dichloroethylene 

(DCE), benzene and vinyl chloride in the tap water provided to my family by the 

Marine Corps. Two years ago, I was diagnosed with male breast cancer at the age 

of thirty nine. In fact, I am one of about forty men who share this unique commonality of male breast cancer and exposure to contaminated tap water aboard 

Camp Lejeune. 

Beginning on 31 October 1980, Navy and Marine Corps officials received what 

would later become a litany of warnings that the base’s drinking water supply was 

highly contaminated with chlorinated hydrocarbons (see chronology, Oct 30 1980). 

The United States Army Environmental Hygiene Agency (USAEHA) laboratory located at Ft. McPherson, Georgia was tasked to analyze the base’s tap water for 

trihalomethane’s (TTHMs) in preparation for a new EPA Safe Drinking Water regulation. As part of their analysis for Hadnot Point’s tap water, the laboratory stumbled across interferences caused by chlorinated hydrocarbons which inhibited the 

laboratory’s ability to quantify the chemical they were testing for in the samples. 

The laboratory’s supervisor documented these findings upon the analytical results 

sheet provided to Navy and Marine Corps officials. He advised that the base’s tap 

water samples from Hadnot Point were highly contaminated with chlorinated hydrocarbons and they needed to test their water by Gas chromatography-mass spectrometry. This machine is used by scientist to identify specific compounds while in solution. The Army lab’s warnings were repeated three more times between December 

1980 and March 1981. For some unknown reason, the Army lab further spelled out 

the issue by placing the word (SOLVENTS!) at the end of their March 1981 warning 

(see chronology, March 9, 1981). Curiously, this key word was omitted from the 

2007 Government Accountability Office (GAO) review of the Camp Lejeune Drinking 

water contamination when this document was cited on the GAO’s timeline of events. 

13 

Between October 1980 and December 1981, no documented action was taken by 

Navy or Marine Corps officials to identify the source of the contamination. Later the 

following year, the Army lab reports were referred to in the base’s Initial Assessment Study (IAS) draft report being prepared for the Navy’s NACIP program. The 

Army lab’s reliability was called into question in the review comments submitted 

by the base’s Assistant Chief of Staff for Facilities, Colonel John T. Marshall, 

‘‘it is important to note that accuracy of data provided by the U.S. Army 

laboratory is questionable. It is recommended that the TTHM information 

be de-emphasized throughout the report.’’ 

How could these reports be questionable if they were never investigated or verified? 

Oddly enough, Colonel Marshall’s review was written fifteen days after the base received a written report from yet another lab verifying the legitimacy of the Army 

lab warnings. The other lab’s data was not included in the final IAS report released 

in April 1983. The IAS report concluded that none of the twenty sites aboard Camp 

Lejeune slated for further study posed an immediate threat to human health. 

The Navy and Marine Corps’ lack of action was not the case for the entire base. 

Within weeks of the March 1981 USAEHA warning that solvents were contaminating Hadnot Point’s water, Navy and base officials discovered organic contamination at the base’s Rifle Range water distribution system located near the base chemical dump. Between March and May 1981, Navy and base officials sampled the Rifle 

Range’s tap water and the system’s potable water wells for contamination. Then on 

31 July 1981, J.R. Bailey from the Navy’s Facilities Engineering Command wrote 

to the Commanding General of Camp Lejeune advising the General that Rifle Range 

potable water well RR–97 contained organic contamination and that two other wells 

should be used in preference over this well due to lower levels of contamination 

found in those wells. The Rifle Range water distribution system only served a handful of permanent residents, unlike Hadnot Point’s system which served enlisted barracks, bachelor officer’s quarters, the base Naval Hospital and other facilities located on Hadnot Point. What is puzzling is why the Navy and Marine Corps went 

through the trouble of testing specific potable water wells for a remote potable 

water system on the base and then failed to test the other systems serving the vast 

majority of people on the base for another three and a half years. Why were the 

USAEHA lab warnings to the base ignored? 

In September 1981 the USAEHA Lab experienced equipment problems and a back 

log of tests. As a result, the lab was unable to perform further TTHM testing for 

Camp Lejeune. A replacement was needed. In April 1982, Grainger laboratory was 

contracted to perform TTHM testing for Camp Lejeune. At this time, the testing 

was expanded to include a new water distribution system aboard the base. That distribution system was for the Tarawa Terrace (TT) family housing area. The initial 

samples were collected in April 1982 and analyzed by the laboratory. Then on 6 May 

1982 Mike Hargett, co-owner of Grainger Laboratory, phoned the base chemist, Elizabeth Betz and advised her that PCE and TCE contamination was found in the tape 

water samples sent for TTHM analysis. Ms. Betz then notified the Supervisory 

Ecologist, Danny Sharpe, of the Grainger findings and these findings were then sent 

up the chain of command to Billy Elston, Deputy Base Maintenance Officer and to 

the Utilities Director, Fred Cone. A week later, on 14 May 1982, Betz was summoned to a briefing involving the base’s facilities command staff. The purpose of the 

briefing was to explain April’s TTHM analysis results to Colonel Millice, the Assistant Chief of Staff, Facilities, and Lt Colonel Fitzgerald, Deputy Base Maintenance 

officer. Betz documented in her memorandum for the record that 

‘‘it appeared to me that they had not been informed about the findings. I 

did not inform them.’’ 

The findings mentioned in the memorandum were the existence of PCE and TCE 

in the tap water for Hadnot Point and Tarawa Terrace’s potable water distribution 

systems. 

Shortly after the briefing, a second round of TTHM sampling was collected for 

Camp Lejeune. However, some of these samples had problems with air bubbles and 

interfered with the testing performed by Grainger Labs. A new round was collected 

and sent to Grainger. Nonetheless, Mike Hargett and Grainger labs found that the 

solvent peaks discovered in the April samples were still present but the comparison 

with the duplicate samples indicated poor repeatability. Betz and Hargett agreed to 

collect yet another sample for testing. This sample was taken at the end of June. 

The Grainger Lab report indicated interference in one of the samples but there is 

no explanation of what was causing the interference. As a result of the continued 

interference, Betz specifically collected samples from both the Tarawa Terrace and 

Hadnot Point water treatment plants for special testing of these two systems. One 

sample was taken from the raw water entering the plant which represented the well 

14 

fields providing untreated water to the plants and the other from the treated water 

distributed from the plants to the consumers. One can logically conclude that the 

ensuing test results from these samples would clearly demonstrate whether the interference problem was emanating at the water treatment plant(s) or in well(s) supplying raw water to the treatment plants. The samples were collected and packed 

in ice and then shipped to Grainger Labs in Raleigh North Carolina. 

Immediately following the sample shipment, Betz called the state of North Carolina and spoke to Linda Sewall concerning TTHM reporting requirements. At the 

end of the conversation, Betz asked Linda Sewall which Safe Drinking Water Act 

secondary contaminants were required to be reported. PCE and TCE were not listed 

among the SDWA secondary contaminants. Betz did not inform Ms. Sewall that 

PCE and TCE were found in the potable water aboard the base. 

The Grainger report arrived at the base on August 10th 1982: 

‘‘Interferences which were thought to be chlorinated hydrocarbons hindered 

the quantization of certain trihalomethanes. These appeared to be at high 

levels and hence more important from a health standpoint than the total 

trihalomethane content. For these reasons we called the situation to the attention of Camp Lejeune personnel.’’ 

The Grainger Lab memo documented in writing that the contamination in the potable water systems aboard the base was a serious issue. Grainger’s chemist, Bruce 

Babson, correctly concluded that the contaminants were in the well fields for both 

Tarawa Terrace and Hadnot Point. If the contamination was emanating from wells 

there could be but one logical conclusion. The groundwater supplying the wells 

aboard the base was contaminated! No further action was taken by Navy or Marine 

Corps officials. 

In her 19 August 1982 memorandum for the record, Betz incorrectly states the 

presence of PCE in the base’s potable water is linked to the presence of vinyl lined 

asbestos coated pipes in the base’s water distribution system. This scenario was 

based on a 1980 Suggested Action Guidance Report on Tetrachloroethylene issued 

by the EPA, that the contamination could be a result of vinyl lined asbestos coated 

water pipes. There was no documented action taken to test this theory. In fact, according to base records dating back to 1983, vinyl lined asbestos cement pipes were 

not used as construction materials for any of the base’s water distribution systems. 

The question remains, after the 10 August 1982 warning from Grainger laboratory, 

why did Navy and Maine Corps officials fail to go out and test the individual wells 

supplying the water distribution systems for Hadnot Point and Tarawa Terrace? 

Then on 1 June 1983, Colonel Marshall compiled data for what was supposed to 

be a routine report on the TTHM analysis for the State of North Carolina. He sent 

the data in the form of a table contained in a letter to Charles Rundgren of the 

State’s Water Supply Branch. The original analytical Grainger lab TTHM data 

sheets were not included in this letter. These data sheets contained Grainger’s findings for the TTHM readings including notations that PCE and TCE were contaminating the samples. Several months ago I spoke to Mr. Hargett, former co-owner 

of Grainger Laboratory, and he indicated to me that he had secretly tipped off the 

state of North Carolina that there was a problem with the base’s TTHM testing program. Colonel Marshall’s letter was supposed to be a routine communication to document base compliance with the new TTHM regulations slated to take effect by November 1983. Later that month, Colonel Marshall received a reply from the State’s 

Environmental Engineer, William Elmore. Mr. Elmore thanked Colonel Marshall for 

the data compilation but informed him that the State required the raw analytical 

data on the actual forms used by Grainger Laboratory. The reports requested by Mr. 

Elmore were the very same reports upon which Grainger Lab had documented the 

existence of tetrachloroethylene and trichloroethylene within the potable water supply systems for Hadnot Point and Tarawa Terrace beginning in 1982. Colonel Marshall stalled and did nothing. His successor, Colonel Lilley then inherited the problem of what to do with Mr. Elmore’s request. On 30 November 1983, Colonel Lilley 

called the North Carolina’s water supply branch and spoke with Dick Caspers. We 

do not know what was said in the conversation with Mr. Caspers, but two weeks 

later, Col Lilley wrote Mr. Elmore and advised him that per this conversation with 

Mr. Caspers, Marine Corps Base Camp Lejeune was not required to provide the requested Grainger Laboratory reports and thus they were not submitted to the State. 

It took another year before the drinking water contamination aboard Camp Lejeune was ‘‘officially discovered’’. Today the Marine Corps maintains that ‘‘once the 

source of the chemicals was determined to be the wells, the wells were immediately 

taken out of service.’’ The Marine Corps also now states that ‘‘taking care of Marines, Sailors, their families and civilian workers is our top priority.’’ My previous 

15 

testimony belies the former statement and the following will cast serious doubt on 

the latter. 

Two weeks after the first well was removed on service on at Hadnot Point, an 

article appeared in the base’s newspaper. The article advised the reader that as a 

result of samples taken on 3 December 1984, four wells were removed from service 

due to traces of organic compounds. The article also read that none of the organic 

compounds were listed under the Safe Drinking Water Act. The article went on to 

quote the Base Environmental Engineer, Robert Alexander: 

‘‘every effort will be made to maintain the excellent quality water supply 

traditionally provided to residents of Camp Lejeune.’’ 

What the article failed to mention was that on 6 July 1984, Hadnot Point well HP– 

602 was sampled and found to be highly contaminated with benzene. This well remained operational until November 1984. The well was situated down gradient from 

the Hadnot Point fuel farm and thus exposed to the fuel leaking from the underground tanks. The Base Environmental engineer also failed to disclose to the readers the presence of a 20,000–30,000 unreported and un-remediated fuel leak dating 

back to 1979. This fuel plume was in the ground water and was fifteen feet thick! 

Environmental Engineering Company’s report warned the presence of benzene far 

exceeded the human health risk and therefore the use of the well (HP–602) should 

be discontinued immediately. 

The deception did not end there. On 30 April 1985, the Commanding General of 

Camp Lejeune advised that residents of Tarawa Terrace that two wells had to be 

taken of line because minute (trace) amounts of several organic chemicals were detected in the water. The General also stated: 

‘‘There are no definitive State of Federal regulations regarding a safe level 

of these compounds, but as a precaution, I have ordered closure of these 

wells.’’ 

Four months later, the Base Environmental Engineer, Robert Alexander, was directly quoted in a newspaper article: 

‘‘people had not been directly exposed to the pollutants.’’ 

The misrepresentation did not end with the public and the media, it extended to 

the EPA. On 1 November 1985, there was a meeting at Camp Lejeune between base 

officials and EPA Representatives. During this meeting, base officials including Robert Alexander told the EPA that the contamination had not reached the distribution 

plants. Three years later another base official, Assistant Chief of Staff Facilities, 

Colonel Thomas J Dalzell was quoted in the media that prior to 1983: 

‘‘At that time we were not aware of any of these particular compounds that 

might have been in the ground water and we have no information that anyone’s health was in any danger at that time.’’ The Colonel also stated that 

the sources of the contamination were the base’s motor pools and that these 

compounds were being dumped in the ground or in the sewers and that 

they were not really aware of the effects on ground water back in the 1960’s 

and 1970’s. 

Beginning with the very first public announcement of the drinking water contamination aboard Camp Lejeune, there has been a constant drum beat by the Marine 

Corps that they did not violate any Federal Safe Drinking Water Act standard or 

any State of North Carolina standards. On September 24th 2009, Maj-General Jensen appeared on CNN’s Campbell Brown show and reiterated the Marine Corps official position. What the Marine Corps has failed to disclose to Members of Congress, 

the media, the public and prior investigations into the Camp Lejeune’s drinking 

water contamination was that the Marine Corps was in violation of their own orders 

dating back to 1963. These orders if followed would have prevented most of the 

human exposures at the base. 

In September 1963, the Navy’s Bureau of Medicine and Surgery issued a set of 

instructions known as BUMED 6240.3B. These instructions were revised in 1972 

with version C and then replaced in 1988. The purpose of BUMED 6240.3B was to 

establish standards for water for drinking throughout the Naval establishment including Camp Lejeune. Contained within the instructions were preventive measures, including the requirement for frequent surveys to locate and identify health 

hazards which might exist in the system. Health Hazards were specially defined 

within the instructions as to be any conditions, devices, or practices in the water 

supply system and its operation which create or may create a danger to the health 

and well being of the water consumer. Supply wells were also defined as part of the 

water supply system. Pollution was defined as the presence of any foreign substance 

(organic, inorganic, radiological or biological) which tended to degrade its quality so 

as to constitute a hazard or impaired the usefulness of the water. Perhaps the most 

16 

disturbing part of the regulation is found under the chemical characteristics limits. 

Paragraph 7 subparagraph C: 

‘‘Substances which may have deleterious physiological effect, or for which 

the physiological effects are not known, shall not be introduced into the system in a manner which would permit them to reach the consumer.’’ 

These standards have yet to be publicly addressed or explained by the Navy. Instead the Navy and Marine Corps summarily dismisses this potable water regulation as being to general to be a standard of care. 

During our research of Navy and Marine Corps documents we discovered another 

key document which undermines the Marine Corps and Navy’s official statements 

that they had little knowledge that these chemicals could contaminate the ground 

water at Camp Lejeune. Base Order 5100.13B was the third revision of an order 

from the Commanding General of Camp Lejeune. The order dates back to June 1974 

and may date back to the creation of the base’s chemical dump in 1959. We will 

not know the actual beginning date of the order until the Marine Corps produces 

the prior two versions of the order and the higher headquarter guidance which created the order in the fist place. The purpose of Base Order 5100.13B was for the 

safe disposal of contaminants or hazardous wastes. The order identified organic solvents as hazardous materials and ominously warned that improper disposal of contaminants and hazardous materials created hazards such as contamination of drinking water. As I read BUMED 6240.3B and Base Order 5100.13B a line from a famous movie called ‘‘A Few Good Men’’ comes to mind. ‘‘We follow orders, or people 

die. It’s that simple.’’ At Camp Lejeune, orders were not followed and people have 

died or were made sick due to the negligence of the United States Marine Corps. 

Submitted with this testimony is our copy of the historical time line of events for 

the Camp Lejeune drinking water contamination. The time line was painstakingly 

researched using authentic Navy and Marine Corps documents. Each entry is referenced to an actual document. We have also provided a copy of the document library for Members of the Committee and their staff. The document library was provided to us by the ATSDR. 

17 

ATTACHMENT: HISTORICAL TIME LINE OF EVENTS FOR THE CAMP LEJEUNE DRINKING

WATER CONTAMINATION


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RESPONSE TO POST-HEARING QUESTION SUBMITTED BY HON. DANIEL K. AKAKA TO

MICHAEL SEAN PARTAIN

Question 1. You stated during the hearing that you have found approximately 40 

men who were stationed or lived at Camp Lejeune who have breast cancer. Have 

you shared this information with the Marine Corps and the National Research 

Council, and if so, when? 

Response. As of November 2009, we have identified a total of 53 men with male 

breast cancer who either served aboard Camp Lejeune or were a dependent living 

on the base during the time of the drinking water contamination. The existence of 

this cluster was first revealed to the National Research Council (NRC) in November 

2007 when Mr. Kris Thomas, a dependent exposed while living at Tarawa Terrace 

in the 1960’s and 1970’s, addressed the NRC’s Camp Lejeune committee in Jacksonville North Carolina. Mr. Thomas informed committee members that there were at 

least two cases of male breast cancer in children from the base. The next day, the 

Jacksonville Daily News printed a story with this information, including the names 

of former residents with male breast cancer. 

In January 2009, I traveled to Washington, D.C., to speak before another NRC 

committee reviewing the EPA’s Draft Risk assessment for tetrachloroethylene 

(PCE), one of the chemicals found in our water at Camp Lejeune. My presentation 

included the revelation that our number had increased from two to nine men with 

breast cancer from Camp Lejeune. The project director for this Committee was 

Susan Martel. Ms. Martel also concurrently served as the project director for the 

NRC’s Camp Lejeune committee during the time period when both committees were 

empanelled. The Camp Lejeune male breast cancer issue then received increased 

media attention following the retraction of the ATSDR’s 1997 Public Health Assessment for Camp Lejeune. We identified a total of 20 cases of male breast cancer originating from the base during the time between November 2007, the first announcement of the existence of the male breast cancer cases, up until the end of June 2009. 

Since the release of the NRC’s Camp Lejeune report, we have identified 33 additional cases for the total of 53 men. The NRC’s final report mentions male breast 

cancer at Camp Lejeune only in passing (See Enclosure A, Public Summary and 

Context section, page 7, of the NRC Report on Camp Lejeune) and the disease was 

summarily dismissed from their conclusions and recommendations. The NRC report 

also failed to recommend any future studies into this unusual and emerging cancer 

cluster. On July 23, 2009, the National Resources Defense Council urged ATSDR 

to disregard the NRC’s inattention toward the male breast cancer cases at Camp 

Lejeune and stated ‘‘the prevalence of male breast cancer among former and current 


Qr3Part48.eps
65 

Lejeune residents should be given particular attention because of its rarity in the 

general population.’’ (Enclosure B) 

The Agency for Toxic Substances and Disease Registry (ATSDR) was also notified 

about the existence of male breast cancer at Camp Lejeune. ATSDR is the government agency mandated by Congress under Title 42 of the U.S. Code to conduct research into health effects due to environmental exposures at National Priority List 

sites such as Camp Lejeune. On October 14, 2009, the ATSDR Community Assistance Panel (CAP) discussed the existence of the male breast cancer cluster aboard 

the base. Unfortunately, the Marine Corps is unable or unwilling to provide this 

agency with an accurate number of men stationed aboard the base during the contamination period so that epidemiologists such as Dr. Frank Bove (ATSDR), Dr. 

Richard Clapp (CAP Member) or Dr. Devra Davis (CAP Member) can estimate the 

number of cases of male breast cancer expected to occur in the population. Without 

these critical data, it is difficult to precisely evaluate the significance of the number 

of cases we have discovered over the past two years. According to the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program, the occurrence rate of male breast cancer in the U.S. general population is about 1 in 

100,000. Most of the cases are diagnosed occur in men over 70 years in age. The 

median age of diagnosis for breast cancer in men is about age 67. More than half 

of the men identified from Camp Lejeune were diagnosed under the age 56, and several cases were in men in their twenties and thirties. 

The Marine Corps was first made aware of the existence of male breast cancer 

at Camp Lejeune when I was nominated as a member to the ATSDR CAP in December 2007. I am not aware of any action taken by the Marine Corps concerning the 

existence or significance of the cluster other than a series of communications from 

Headquarters Marine Corps Public Affairs the day I testified before this Committee 

in October 2009. 

It is my understanding that on this date, Major Dent from the Public Affairs Office contacted news agencies to inform them that the expected occurrence rate for 

male breast cancer was 1 in 1,000 and that based on a population of 400,000 men 

from Camp Lejeune, there should be approximately 400 cases of male breast cancer 

from the Camp Lejeune population. The email went on to suggest that the media 

outlet was not accurately reporting the story and that there was no significant male 

breast cancer cluster at Camp Lejeune. I have attached a copy of this email from 

Major Dent, with the recipient’s name redacted for the Committee as Enclosure B. 

Neither I nor the Marine Corps are certified in epidemiology. 

The significance of this rare cancer is best assessed by epidemiologist familiar 

with drinking water contamination at Camp Lejeune including those who work at 

Federal agencies such as ATSDR/CDC or the EPA. Unfortunately, until the Marine 

Corps can provide an accurate number of the men exposed, we may never know the 

significance of all the cases of male breast cancer from Camp Lejeune we have discovered so far. In fact, Drs. Davis and Clapp have since confirmed that the statement that the expected rate of male breast cancer is 1 in 1,000 is incorrect. They 

advise that the lifetime risk of any man developing breast cancer by the time he 

reaches age 85 is 1 in 1,000. As a result this lifetime estimate is not relevant to 

the population risk of the thousands of young men who lived at Camp Lejeune during peak periods of contamination of the drinking water. 

We continue to find men with the disease as time passes. Male breast cancer is 

typically found in the later stages of the disease and thus more fatal. It is unknown 

just how many men may have already succumbed to their cancer. We have heard 

from a few families with deceased servicemembers who succumbed to the disease. 

One ATSDR future proposal for Camp Lejeune, is a mortality study for the servicemembers exposed at the base. A mortality study would be a potential tool to help 

us identify deceased victims of male breast cancer for future studies. It is frightening to think of how many men could be out in the general population who were 

at Camp Lejeune during the drinking water contamination may still be unaware 

about their potential risk for this deadly disease. Male breast cancer is also a clear 

indication that our exposures aboard Camp Lejeune have affected our health. Otherwise, why is there such an unusual number of men with the disease whose only 

commonality is that we all, at one point in our lives, either lived or served aboard 

Camp Lejeune during the contamination and we all have male breast cancer? 

Enclosures 

66 

ENCLOSURE A: EXCERPT FROM NRC REPORT ON CAMP LEJEUNE


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ENCLOSURE B: NRDC LETTER TO ATSDR JULY 23, 2009 


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108PAREncB2.eps
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108PAREncB3.eps
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108PAREncB4.eps
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ENCLOSURE C: EMAIL FROM USMC PUBLIC AFFAIRS TO MEDIA OUTLET (REDACTED) 

Chairman AKAKA. Thank you very much, Mr. Partain, for your 

testimony. Dr. Nuckols, will you please begin your testimony. 

STATEMENT OF JOHN R. NUCKOLS, PROFESSOR, DEPARTMENT OF ENVIRONMENTAL AND RADIOLOGICAL HEALTH 

SCIENCES, COLORADO STATE UNIVERSITY 

Mr. NUCKOLS. I believe a copy of my full testimony has been submitted by the National Research Council and I have prepared a 

summary in my own hand. I would be happy to share it with the 

Committee if you would like a paper copy. 

Chairman AKAKA. Thank you. 

Mr. NUCKOLS. In 1984, evidence of contamination of the water 

distribution system serving the Tarawa Terrace area within Camp 

Lejeune, NC, was discovered. It was one of six water distribution 

systems serving different areas on the camp. 

Since that time, contamination of another water distribution system serving the Hadnot Point area and contamination of the natural source for all water systems on the base, the Castle-Hayne Aquifer, has been documented. Many former residents and employees 

of the base have raised questions about whether health problems 

they or members of their families have experienced could be related 

to exposure to the contaminated water. 

At the request of Congress, the Navy sponsored a study by committee of the National Research Council to review the scientific evidence on associations between adverse health effects and historical 

data on pre-natal, childhood and adult exposures to contaminated 

drinking water at Camp Lejeune. 

In September 2007, the NRC convened a committee of experts in 

epidemiology, toxicology, exposure analysis, environmental health, 


108PartainC.eps
72 

groundwater modeling, biostatistics, and risk assessment for this 

purpose. In or about August 2009, the NRC review document, Contaminated Water Supplies at Camp Lejeune, Assessing Potential 

Health Effects, was published. 

I served as one of the volunteers on the NRC committee, primarily as the chair of a subcommittee that was responsible for 

chapter two, Exposure to Contaminants in Water Supply at Camp 

Lejeune. In that chapter, we described the scenarios of exposure to 

contaminants in the water supply and identified gaps in understanding of exposure to people who lived or worked there. 

There were three other working subcommittees, epidemiology, 

toxicology and risk communication. The internal process used by 

the committee was as follows: we gathered information on the 

chemicals present in the Camp Lejeune water supply, including 

magnitude of contamination, geographic extent and timing; we 

ascertained reported health concerns from people who lived or 

worked at Camp Lejeune. 

Based on published toxicology and epidemiology studies, we gathered scientific evidence of causation or association of diseases with 

the predominant chemical contaminants that were present in the 

water supply and compared these to health outcomes reported by 

the affected population. We ascertained whether conclusions could 

be drawn that any adverse health outcomes could be attributed to 

the water contaminants at Camp Lejeune and whether additional 

health studies would be more likely to provide such a definitive 

conclusion. And finally, we made recommendations as to further actions concerning studies of adverse health effects and water contamination at Camp Lejeune. 

In short, these recommendations were that new health effects 

studies of persons who lived or worked at Camp Lejeune and their 

families should be undertaken only if their feasibility and promise 

of providing substantial improved knowledge are established in advance. 

Second and foremost, the decisions regarding the appropriate policy response to health concerns about exposure to contaminated 

water at Camp Lejeune should not be delayed or await the results 

of epidemiological studies that are in progress or planned. My testimony today is derived strictly from the content of the report by the 

NRC Committee on Contaminated Drinking Water at Camp Lejeune, which I fully support. 

Thank you for your invitation and your attention. 

[The prepared statement of Mr. Nuckols follows:] 

PREPARED STATEMENT OF JOHN R. NUCKOLS, PH.D., PROFESSOR, DEPARTMENT OF

ENVIRONMENTAL AND RADIOLOGICAL HEALTH SCIENCES, COLORADO STATE UNIVER- SITY, FORT COLLINS, CO 

Good morning Mr. Chairman and Members of the Committee. My name is John 

Nuckols. I am a professor in the Department of Environmental and Radiological 

Health Sciences at Colorado State University. I was a member of the Committee on 

Contaminated Drinking Water at Camp Lejeune, a committee of the National Research Council. The Research Council is the operating arm of the National Academy 

of Sciences and the National Academy of Engineering. I’m pleased to appear before 

you today to discuss our committee’s recent report Contaminated Water Supplies at 

Camp Lejeune—Assessing Potential Health Effects. 

At the request of Congress, the Navy sponsored a study by a committee of the 

Research Council to review the scientific evidence on associations between adverse 

health effects and historical data on prenatal, childhood, and adult exposures to conVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00078 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
73 

taminated drinking water at Camp Lejeune. For each health effect reviewed, the 

Committee was asked to evaluate the available scientific literature concerning evidence of a statistical association between contaminants found or likely to have been 

in the water supply at Camp Lejeune and adverse health effects. The Committee 

was also asked to review whether there was any evidence to suggest any causal relationships between the exposures and health outcomes. 

Let me begin with the Research Council study process. As you are aware, the Research Council is a non-governmental institution originally chartered by President 

Lincoln to provide independent scientific advice to the Nation. That scientific advice 

is usually in the form of consensus reports produced by expert, unpaid committees. 

In the case of the Camp Lejeune study, the Committee was comprised of 13 members with expertise in epidemiology, toxicology, exposure assessment, environmental 

engineering, clinical medicine, biostatistics, and risk assessment. The Committee’s 

report was developed through an established study process designed to ensure the 

Committee and the report were free from actual or potential conflicts of interests, 

were balanced for any biases, and were independent of oversight from the sponsoring agency. 

Our committee reviewed the relevant scientific literature, heard from experts, met 

with former residents and workers to hear their concerns, and deliberated for two 

years. Once the Committee reached its consensus, but prior to the report being released, the draft report was subjected to a formal, peer-review process overseen by 

the National Academies Report Review Committee. The report was released only 

after the Review Committee was satisfied that all review comments had been appropriately considered and addressed. 

Copies of the final report were sent to the sponsor immediately prior to public release. The sponsor was not provided an opportunity to review the report or any portions of the report, or to suggest changes to the NRC report prior to its release. 

To address the specific charge of the Camp Lejeune study, our committee divided 

the review into two major categories: (1) evaluating the potential for exposure of 

former residents and workers to contaminants in the water supply source and distribution systems at Camp Lejeune, in particular the Tarawa Terrace and Hadnot 

Point water-supply systems; and (2) evaluating the potential health effects associated with these water contaminants based on epidemiological and toxicological evidence. The two assessments were then considered together to ascertain whether conclusions could be drawn about whether any adverse health outcomes could be attributed to the water contamination. 

In reviewing the available exposure information, the Committee agreed with previous assessments that the primary contaminant of the Tarawa Terrace water system was perchloroethylene (PCE), a solvent that was improperly disposed of by an 

off-base dry-cleaner. Other contaminants were also identified as being of concern, 

including trichloroethylene (TCE), dichloroethylene, benzene, toluene, and vinyl 

chloride. Sophisticated computer modeling techniques were used by the Agency for 

Toxic Substances and Disease Registry (ATSDR) to make predictions about the 

monthly concentrations of PCE to which residents of Tarawa Terrace were exposed. 

The Committee questioned the degree of accuracy that could be achieved from the 

modeling because no contaminant measurements were available for the first 30 

years of the contamination, so it was not possible to verify model predictions. In addition, assumptions had to be made about how the water system was operating over 

the potential exposure period, as no records were available at the time of the development of the model reviewed by the NRC committee. Given these uncertainties, the 

Committee concluded that the Tarawa Terrace modeling predictions should only be 

used to provide general estimates of the timeframe and magnitude of exposure. 

The contamination of the Hadnot Point water system was more complex than 

Tarawa Terrace. There were multiple sources of pollutants from on-base activities, 

such as storage and disposal practices. To date, no groundwater modeling has been 

performed for this water system. Based on the records the Committee reviewed, trichloroethylene appeared to be the primary contaminant of concern, but other contaminants were also detected in the water supply, including dichloroethylene, methylene chloride, and vinyl chloride. Because groundwater modeling of the Hadnot 

Point system will be fraught with considerable difficulties and uncertainties (similar 

to, but much more complex than those associated with the Tarawa Terrace models), 

the Committee recommended that simpler models be used to assess the extent of 

water supply contamination and potential exposures. Simpler models will not reduce 

the uncertainty associated with the estimates, but they have the advantage of providing a broad picture of the timeframe and magnitude of exposure with less resources than complex modeling exercises. More complex predictive models for exposure assessment should be used only if justified by more straightforward analytical 

methods. 

74 

To evaluate the potential health effects to exposed residents, the Committee undertook four kinds of reviews to determine what kinds of diseases or disorders have 

been found to result from exposure to TCE and PCE. The first was a review of epidemiologic studies of solvents and their effects, including studies in occupational 

and industrial settings and community studies. The second was a review of epidemiologic studies of other communities with solvent-contaminated water supplies. 

The third was a review of toxicologic studies conducted in animals and humans to 

test for health effects. And the fourth was a review of studies conducted specifically 

on the Camp Lejeune population. 

For the first review of epidemiologic studies, we used a categorization process established by the Institute of Medicine to evaluate risks to veterans of the Vietnam 

War and Gulf War. The Institute’s approach is to evaluate the available epidemiologic literature involving exposures to specific chemicals in any setting, but mainly 

occupational settings, to determine whether a ‘‘statistical association’’ exists between 

specific chemicals and diseases and disorders. A statistical association means that 

people who are exposed to the chemicals are more likely to have or develop the disease or disorder than people who are not exposed. A statistical association, however, 

does not establish that the chemicals cause the disease or disorders. On the basis 

of the Committee’s review, all the health outcomes were placed into one of two categories. The strongest evidence was in the category of limited/suggestive of an association, which means there is some evidence that people who were exposed to TCE 

or PCE were more likely to have the disease or disorder but that the studies were 

either few in number or had important limitations. In many cases, the study subjects were exposed to multiple chemicals, so it was not possible to separate out the 

effects of individual chemicals. Fourteen of the 59 outcomes reviewed by the Committee were placed in this category. The other 35 health outcomes reviewed by the 

Committee were placed in the category of inadequate/insufficient evidence to determine whether an association exists, which means that the studies were too few in 

number, limited in quality, inconsistent, or inclusive in results to make an informed 

assessment. It also means that such an association cannot be ruled out. 

The Committee decided to consider the subset of epidemiologic studies that were 

conducted in communities exposed to solvents in their water supplies in more detail. 

We felt these studies involved populations and exposure situations that more closely 

resemble those at Camp Lejeune. Overall, the Committee found the evidence from 

this subset of studies to be inconsistent and that there were a variety of limitations 

with the studies that did not allow any conclusions to be drawn about what effects 

might be related to the exposures. Some of the limitations were a lack of data on 

the levels of contaminants in the water, lack of adequate information about diseases 

and disorders in the population, and relatively small populations. These factors 

limit the capacity of such studies to detect associations. 

In animal experiments, a variety of adverse health effects were observed following 

relatively high exposures to TCE and PCE. It is difficult to determine whether the 

health effects observed in laboratory animals are predictive of effects in humans. 

There are differences in how TCE and PCE are handled in the body by rodents and 

humans that affect biological responses. However, it is clear that TCE and PCE do 

have toxic effects in laboratory animals and that some of them may be of concern 

to humans. Similar health effects found in epidemiology and toxicologic studies were 

kidney cancer, liver and kidney toxicity, neurotoxicity, and immunotoxicity. 

Only a few studies have been conducted on the Camp Lejeune population, and 

these have focused on health effects in people who were exposed as children or while 

their mothers were pregnant with them. Two studies performed by ATSDR did not 

find any clear associations between birth outcomes (mean birth weight, preterm 

birth, or small for gestation age). However, a comparison of subgroups within the 

Tarawa Terrace population found a weak association between PCE exposure and 

small for gestational age children of women over the age of 35 or who had prior miscarriages. The findings from these evaluations are no longer valid. After the evaluations were completed, ATSDR discovered that a residential area it classified as unexposed received water from the Hadnot Point system, so the study results must 

be reanalyzed to correct for this mistake in classification. ATSDR also has a study 

underway on prenatal exposure to water-supply contaminants and birth defects and 

childhood cancer. The outcomes in the study are rare, and given the number of 

study participants, it appears that the statistical power of the study could limit its 

ability to detect associations. 

The Committee also looked into the feasibility and utility of future studies of the 

Camp Lejeune population, including a health survey and epidemiologic studies of 

mortality and morbidity in the population. The Committee noted many difficulties 

with performing the studies, such as the difficulty with identifying, locating, and recruiting the study participants and obtaining reliable health information on them 

75 

in an efficient manner. It is questionable whether there will be enough participants 

to ensure there is adequate statistical power to detect associations, and the Committee was concerned about the possibility of bias in the survey and studies, as people who have experienced disease or illness are more likely to participate. 

After reviewing the preliminary plans and feasibility assessments, the Committee 

concluded that most questions about whether exposures at Camp Lejeune resulted 

in adverse health effects cannot be answered definitively with further scientific 

study. There are two reasons for this. First, it would be extremely difficult, if not 

impossible, to reliably estimate the historical exposures experienced by people at the 

base. Second, it will be difficult to detect any increases in the rate of diseases or 

disorders in the study population. Most of the health effects of concern are relatively 

rare, which means that very large numbers of people are needed to detect increased 

cases. Although the total number of people who lived at Camp Lejeune while the 

Tarawa Terrace and Hadnot Point water supplies were contaminated was sizable, 

the population is still unlikely to be large enough to detect effects. Another factor 

is that the people tended to live on the base for a relatively short period of time, 

making it difficult to rule out other exposures or factors that could have contributed 

to the disease or illness. Most chronic diseases are thought to have a latency period 

of years, if not decades, which means that exposure needs to be assessed over this 

same time period. All these factors make it unlikely that the proposed studies, even 

if the notable uncertainties about feasibility are resolved favorably, will produce a 

result of sufficient certainty to resolve the question of whether Camp Lejeune residents suffered adverse health effects (especially chronic diseases) from exposure to 

contaminated water at Camp Lejeune. Thus, our committee’s conclusion was that 

there is no scientific justification for the Navy and Marine Corps to wait for the results of additional health studies before making decisions about how to follow up 

on the evident solvent exposures on the base and their possible health consequences. 

The services should undertake the assessments they deem appropriate to determine 

how to respond in light of the available information. 

With that, I would once again like to thank you for inviting me to testify before 

this Committee, and I look forward to your questions. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

JOHN R. NUCKOLS, PH.D., PROFESSOR, COLORADO STATE UNIVERSITY, MEMBER, 

COMMITTEE ON CONTAMINATED DRINKING WATER AT CAMP LEJEUNE

Question 1. You heard testimony from Michael Partain during the hearing. He 

stated that he has identified 40 men from Camp Lejeune who have breast cancer. 

Did the National Research Council consider that when they wrote their report? Does 

that number by itself raise any red flags with you? Is that something that you think 

merits further investigation? 

Question 2. You stated that ATSDR has a study underway on prenatal exposure 

to water-supply contaminants and birth defects and childhood cancer, but that the 

statistical power of the study could limit its ability to detect associations. Is there 

a better way, or better study to undertake, to determine a possible connection between water-supply contaminants and birth defects and childhood cancer? 

Question 3. What steps did the National Research Council and the ATSDR take 

in determining prenatal exposure to water-supply contaminants? 

Question 4. What exactly was the charter of the National Research Council when 

asked to conduct your study? 

Question 5. How did the National Research Council select scientific studies to review? How many of the studies did you review? How rigorous was your review, and 

how did you review them (e.g. did everyone on the Committee read the same studies, did one person read one and brief the rest of the group, etc.)? 

[The Committee had not received the requested information by 

press time.] 

Chairman AKAKA. Thank you very much, Dr. Nuckols. Now we 

will hear the testimony from Ms. Pennington. 

STATEMENT OF STACY PENNINGTON, SISTER OF SSG. STEVEN 

GREGORY OCHS, IRAQI OPERATION FREEDOM AND OPERATION ENDURING FREEDOM VETERAN 

Ms. PENNINGTON. Aloha, Honorable Chairman Akaka. 

76 

Chairman AKAKA. Aloha. 

Ms. PENNINGTON. And honorable Members of the Committee, 

good morning. It is an honor to be sitting before the U.S. Senate 

Committee on Veterans’ Affairs. Thank you for your leadership in 

acknowledging the exposures happening to our troops. 

I have been asked to speak to you from a victim’s standpoint of 

the effect of exposure to dangerous toxins produced by burn pits 

that are used to dispose of such items as medical waste, fuel, plastic, vehicles, trash and ammunition. I sit here in front of you with 

a heavy heart to share the stories of two families who know how 

it feels to have a burning pit in our souls. 

My brother, SSG. Steven Gregory Ochs chose the military as his 

career, serving our country for 14 years. SSG. Matt Bumpus served 

his country for 8 years and 9 months. Both were called to fight in 

Operation Iraqi Freedom. Staff Sergeant Ochs served three tours 

in 12- to 15-month intervals from 2003 to 2007, and Staff Sergeant 

Bumpus served his tour onset of the war in 2003. Both of these 

brave soldiers you see before you dodged bullets, mortar attacks, 

roadside bombs, and suicide bombers, yet eventually their tours 

would take their lives. 

The ultimate sacrifice of a soldier for his country is death. However, their deaths did not show up in the manner you may assume. 

In Balad is the site of the infamous, enormous burn pit that has 

been called by Darrin L. Curtis, lieutenant colonel of the U.S. Air 

Force of Bioenvironmental Engineering and Flight Commander, the 

worst environmental site he had ever visited. 

Staff Sergeant Ochs and Staff Sergeant Bumpus were both stationed in Balad and war, as strategic as it is, followed them home. 

Death lay dormant in their blood and waited for them to return 

safely home and into the arms of their loved ones. And like every 

silent ticking time bomb, it eventually exploded. 

On September 28, just months after Steve’s return home from his 

third tour, he was diagnosed with acute myeloid leukemia, also 

known as AML. He spent the next 10 months as a patient, more 

like a resident, at Duke University Hospital. Doctors at Duke said 

his aggressive form of AML was definitely chemically induced and 

like Steve, both agreed it was due to the exposures he experienced 

while in Afghanistan and Iraq. 

However, the doctors refused to go on record, citing as the reason 

that they could not prove it. The aggressive AML that Steve endured was similar to bullets ricocheting in the body, causing tortuous pain. The graphic images embedded in my mind are Steve’s 

last screams for air as he was rushed into ICU. Forgive me. 

Steve waved goodbye to my husband. Steve, with very little 

strength, his last words to me were, I love you, Sis. And my mom 

kissed his forehead and said, we will see you when they get you 

comfortable. Not 5 minutes later, while we were in ICU waiting 

room, the nurse came in to tell us that Steve went into cardiac arrest and they were working to revive him now. My mom ran into 

ICU. She fell to her knees as she realized her son was dying. 

Screams filled the air as we begged God to keep Steve here with 

us. We know Steve heard us as tears were in Steve’s eyes. Doctors 

and nurses pumped on Steve’s chest trying to revive him, but I 

77 

knew immediately he was gone. His spirit that surrounded my dear 

sweet little brother of 32 years old, was gone. 

We were left alone with Steve’s body for hours as we were all in 

pure shock. My mom looked upon my brother’s face and wiped 

away the tears puddled in his eyes. And at that very moment, our 

lives were changed forever. Steve died on July 12, 2008. 

Two weeks later on the opposite side of the coast, Staff Sergeant 

Bumpus would succumb to the same fate. For Staff Sergeant 

Bumpus, the ticking time bomb exploded with a vengeance on July 

31, 2006. Matt was rushed to the hospital by ambulance with acute 

appendicitis. In Matt’s own words, ‘‘the next thing I remember is 

hearing that I had been diagnosed with AML.’’ 

Doctors declared that there was chromosome damage due to exposures he must have come in contact with while in Iraq. Matt 

ended his prestigious service to the Army one short year before the 

war zone—chemical warfare showed signs of its presence. As if this 

was not enough suffering, Staff Sergeant Bumpus’ family was met 

by the VA with harsh claims of denial to benefits. This battle continues to this day as Lisa, Staff Sergeant Bumpus’ wife, is left 

alone with two small children to raise with no military or VA benefits for her family. 

The aggressive assault of the AML in Matt’s body was taking 

claim. Jo, Matt’s mother, recalls the haunted look in Matt’s eyes as 

he revealed to her the AML invasion was back. Matt’s mother 

never forgot the discouragement and sadness that overwhelmed 

Matt as he realized that promises he made to his wife and children—to provide for his family, to love and protect them—that his 

sacred word was broken. 

He knew now that the battle was over and he would be leaving 

his family behind. Tuesday, July 29, 2008, Matt once again entered 

the hospital with fever and septic infection that discharged 

throughout his entire body. Doctors notified the family that it 

would just be days before his demise. 

Matt was heavily sedated as the pain and incubation was unbearable. Nate, Matt’s 10-year-old son, bravely entered his father’s 

room to lay on his daddy’s chest to say his final goodbye. Nate 

curled up by his dad and cried and cried and despite Matt’s heavy 

sedation, Matt too was crying. Matt being a devoted Christian, appropriately passed away on a Sunday morning surrounded by his 

wife, mother, father, sister as they expressed to Matt their everlasting love. 

They too were in shock and stayed with Matt’s body as they realized and were overwhelmed that Matt was not coming home. Matt 

died on August 3, 2008. You have to know that while serving in 

Iraq, both of these soldiers complained of ailments such as colds, 

major fatigue, headaches, sinus problems, loss of hearing, and Staff 

Sergeant Ochs contracted TB while in Afghanistan due to the massive exposure to dead bodies. 

Both men were of strong stature, standing over six feet tall, 

weighing over 200 pounds and both men were the perfect image of 

Army-strong soldiers. Two men, brave, who served their country 

courageously and committed to the cause, dedicated to our country 

and entrusted the military. 

78 

Grief, sadness, and depression have gripped our entire families. 

Their wives are emotionally broken and incomplete, their mothers 

are emotionally unstable and engulfed with grief and their fathers 

are lost; and worst of all, their children are fatherless. 

Sadly, Steve and Matt are not alone. Laura Bumpus and I have 

spoken to over hundreds of families suffering the same fate. We are 

aware of hundreds more suffering similar ailments. These men are 

casualties of war. They deserve the respect of that fact to reflect 

on the Army records. 

My family, the Ochs family, proudly display our gold pin presented to us by Steve’s commander at his funeral. Unfortunately, 

the Bumpus’ family does not have that same privilege and this too 

must be rectified. We are proud military families and we will continue to be in the future. And you have to know, we both have 

members currently serving this country now. We deserve to display 

the gold flag in homage of our beloved. This too has been a benefit 

denied to both of our families. 

We would like to thank the Department of Defense for recently 

installing the necessary incinerators at the Balad base. However, 

we are concerned, as other toxic burn pits continue burning 24/7 

throughout Iraq and Afghanistan and we ask the Committee for 

your support to correct the problem. 

In conclusion, our families will continue to live with emotional 

battle scars caused by the terminal injuries our beloved ones suffered as a result of the exposures of burn pits. I assure you it is 

a heavy cross to bear. Our wish is for this Committee to begin the 

actions it takes to stop this nightmare. You have the power to save 

our courageous heroes who serve our country and who protect me 

and who protect you. 

Thank you for your time in hearing our voices. 

[The prepared statement of Ms. Pennington follows:] 

PREPARED STATEMENT OF STACY PENNINGTON, SISTER OF SSG STEVEN GREGORY

OCHS, IRAQI OPERATION FREEDOM AND OPERATION ENDURING FREEDOM VETERAN

AND REPRESENTING SSG MATT BUMPUS, IRAQI OPERATION FREEDOM VETERAN

Honorable Chairman Akaka and Honorable Members of the Committee: Good 

Morning. It is an honor to be sitting before the U.S. Senate Committee on Veterans’ 

Affairs. Thank you for your leadership acknowledging the exposures happening to 

our troops. My name is Stacy Pennington and I was asked to speak to you from a 

victim’s standpoint of the affects of exposure to dangerous toxins produced by burn 

pits that are used to dispose of such items as medical waste, fuel, plastic, vehicles, 

trash and ammunition. I sit here in front of you with heavy heart to share the stories of two families who know how it feels to have a ‘‘burning pit’’ in our souls. 

My brother, SSG Steven Gregory Ochs, chose the military as his career serving 

our country for 14 years. SSG Matt Bumpus served his country for 8 years and 9 

months. Both were called to fight in Operation Iraqi Freedom. SSG Ochs served 3 

tours in 12–15 month intervals from 2003–2007 and SSG Bumpus served his tour 

onset of the war in 2003. 

Both of these brave soldiers you see before you dodged bullets, mortar attacks, 

road side bombs and suicide bombers. Eventually their tours of duty would take 

their lives. The ultimate sacrifice for a soldier, for his country is death. However, 

their deaths did not show up in the manner you may assume. 

In Balad is the site of the infamous enormous burn pit that has been called by 

Darrin L. Curtis, Lt. Col., USAF and Bioenvironmental Engineering Flight Commander as ‘‘the worst environmental site’’ he had ever visited. SSG Ochs and SSG 

Bumpus were both stationed in Balad and war as strategic as it is followed them 

home. Death lay dormant in their blood and waited for them to return safely home 

and into the arms of their loved ones. Like every silent ticking time bomb, it eventually exploded. 

79 

On September 28, 2007, just months after Steve’s return home from his 3rd tour, 

he was diagnosed with Acute Myeloid Leukemia, also known as AML. He spent the 

next 10 months as a patient, more like a resident, at Duke University Hospital. Doctors at Duke said his aggressive form of AML was definitely chemically induced and 

like Steve both agreed it was due to the exposures he experienced while in Iraq and 

Afghanistan. However, the doctors refused to go on record citing as the reason that 

they could not prove it. 

The aggressive AML that Steve endured was similar to bullets ricocheting in the 

body causing torturous pain. The graphic images embedded in my mind are of 

Steve’s last screams for air as he was rushed into ICU. Steve waved goodbye to my 

husband. Steve with very little strength said, ‘‘I love you sis’’ and my Mom kissed 

his forehead and said we will see you when they get you comfortable. 5 minutes 

later while in the ICU waiting room the nurse came in to tell us Steve went into 

cardiac arrest and they were working on him now. My mom ran into ICU; fell to 

her knees as she realized her son was dying. Screams filled the air as we begged 

God to keep Steve here with us. We know Steve heard us as tears were in Steve’s 

eyes. Doctors and nurses pumped on Steve’s chest trying to revive him. But I knew 

immediately he was gone. His spirit that surrounded my dear sweet brother was 

gone. We were left alone with Steve’s body for hours as we were all in pure shock. 

My mom looked upon my brother’s face and wiped away the tears puddled in his 

eyes. And at that very moment our lives were changed forever. Steve died on July 

12, 2008. Two weeks later on the opposite side of the coast SSG Bumpus would succumb to the same fate. 

For SSG Bumpus, the ticking time bomb exploded with a vengeance on July 31, 

2006. Matt was rushed to the hospital by ambulance with acute appendicitis. In 

Matt’s own words I quote, ‘‘the next thing I remember is hearing that I had been 

diagnosed with AML.’’ Doctors declared that there was chromosome damage due to 

exposures he must have come in contact with while in Iraq. Matt ended his prestigious service to the Army one short year before the war zone chemical warfare 

showed signs of its presence. 

As if this was not enough suffering, SSG Bumpus’ family was met by the VA with 

harsh claims of denial to benefits. This battle continues to this day as Lisa, SSG 

Bumpus’ wife, is left alone with two small children to raise with no VA or military 

benefits for her family. 

The aggressive assault of the AML in Matt’s body was taking claim. Jo, Matt’s 

mother recalls the haunted look in Matt’s eyes as he revealed to her that the AML 

invasion was back. Matt’s mother will never forget the discouragement and sadness 

that overwhelmed Matt as the realization that promises he made to his wife and 

children to provide for his family, to love and protect them and that his sacred word 

would be broken. He knew now that the battle was over and he would be leaving 

his family behind. Tuesday, July 29, 2008, Matt once again entered the hospital 

with fever and septic infection that discharged throughout his body. Doctors notified 

the family that it would just be days before his demise. 

Matt was heavily sedated as the pain and incubation was unbearable. Nate, 

Matt’s 10 year old son, bravely entered his father’s hospital room to lay on his Daddy’s chest as he said his final goodbye. Nate curled up by his Dad and cried and 

cried. Despite Matt’s heavy sedation, Matt too was crying. Matt being a devoted 

Christian appropriately passed away on a Sunday morning surrounded by his wife, 

mother, father and sister as they expressed to Matt their everlasting love. They too, 

were in shock and stayed with Matt’s body as the realization overwhelmed them 

that Matt would not be going home. Matt died on August 3, 2008. 

While serving in Iraq both soldiers complained of ailments from colds, major fatigue, headaches, sinus problems, loss of hearing, and SSG Ochs contracted TB 

while is Afghanistan due to exposures to masses of dead bodies. Steve and Matt 

were men of large strong stature, standing over 6 feet tall, weighing over 200 

pounds and both men were the perfect image of Army strong soldiers. Two brave 

men, who served their country courageously, committed to the cause, dedicated to 

our country and entrusted the military. 

Grief, sadness and depression have gripped our entire families. Their wives are 

emotionally broken and incomplete. Their mother’s are emotionally unstable and engulfed with grief. Their father’s are lost. Their children are fatherless. 

Sadly, Steve and Matt are not alone. Laura Bumpus and I have spoken to over 

a hundred families suffering the same fate. We are aware of hundreds more suffering similar ailments. These men are casualties of war. They deserve the respect 

of this fact to reflect in their Army records. My family, the Ochs family, proudly 

displays our Gold Star pin presented to us during Steve’s funeral by his Commander. Unfortunately, SSG Bumpus’ family does not have this same privilege. This 

must be rectified. We are proud military families and will continue to be in the fuVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00085 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
80 

ture. We both have family members currently serving our country. We deserve to 

display the gold flag in homage of our beloved. This too has been a benefit that both 

of our families have been denied. 

In conclusion, our families will continue to live with the emotional battle scares 

caused by the terminal injuries our loved ones suffered as a result of the exposures 

of the burn pits. I assure you it is a heavy cross to bare. Our wish is for this Committee to begin the actions it needs to take to stop this nightmare. You have the 

power to save our courageous heroes who serve our country and who protect me and 

who protect you. 

Thank you for your time and for hearing our voices. 

Chairman AKAKA. Thank you very much, Ms. Pennington, for 

your testimony. Dr. Miller, your testimony, please. 

STATEMENT OF ROBERT F. MILLER, M.D., ASSOCIATE PROFESSOR OF PULMONARY AND CRITICAL CARE MEDICINE, 

VANDERBILT UNIVERSITY MEDICAL CENTER 

Dr. MILLER. Chairman Akaka, Ranking Member Burr, and Members of the Committee, I thank you for the opportunity to testify 

today. My comments will focus on a group of U.S. soldiers with permanent respiratory impairment following service in Iraq and Afghanistan. 

In early 2003, 20,000 soldiers from the 101st Airborne out of Fort 

Campbell, KY, were deployed to Northern Iraq as part of Operation 

Iraqi Freedom. In June 2003, opposing forces set fire to the 

Mishraq Sulfur Mine approximately 25 kilometers from Camp Q 

West, a major military supply air strip and primary area of deployment for the 101st Airborne. 

At that time, the Mishraq Sulfur Mine was the largest sulfur 

mine in the world. It burned for over 4 weeks and caused the release of 42 million pounds of sulfur dioxide per day. This represents the largest manmade release of sulfur dioxide on record. 

Satellite imaging documented that the sulfur dioxide plume extended north and south over the city of Mosul and Camp Q West. 

Sulfur dioxide is the gas that you and I associate with striking 

a match. It is a potent lung toxin and has been shown to cause 

lung injury at levels as low as .1 part per million. Our soldiers 

were exposed to levels many times higher than this. Skin, eye and 

airway irritation reported by soldiers in the area suggests levels in 

excess of 50 parts per million. Random sampling by the U.S. Army 

documented toxic levels of over 100 parts per million. 

Most of the 101st Airborne deployed in early 2003 returned to 

Fort Campbell in 2004. This is when Vanderbilt University began 

receiving referrals from providers at Fort Campbell asking for assistance in evaluating soldiers complaining of shortness of breath 

on exertion, soldiers who could no longer pass physical training— 

physical fitness testing. 

The typical soldier had been able to complete a two-mile run in 

exemplary time within regulation. Now these soldiers had to walk 

much of the course. In almost all cases, standard respiratory evaluations had been normal. X-rays, chest CT scans, and pulmonary 

function testing were all normal or nearly normal. 

None of these routine tests explained the cause for the soldiers’ 

limitation. Vanderbilt physicians ultimately referred patients for 

surgical lung biopsy and I must emphasize that it is very uncommon to perform a surgical biopsy to evaluate shortness of breath 

81 

when standard testing is normal. You just do not send a patient 

to the operating room for a surgical lung biopsy when pulmonary 

function tests and x-rays fail to indicate some type of cause. 

But the degree of exercise limitation and sulfur dioxide exposure 

were compelling enough for us to apply this aggressive approach. 

In almost every case, surgical biopsy showed constrictive bronchiolitis, a condition associated with damage or destruction affecting 

more than 50 percent of the small airways of the lungs. 

This abnormality causes pulmonary limitation, but is not detectable on x-ray. Between 2004 and 2009, Vanderbilt physicians performed surgical biopsies on 45 of 70 soldiers referred for unexplained shortness of breath. All of the biopsies except one demonstrated some form of bronchiolitis. This condition has no known 

treatment and has resulted in Med boards from almost all of those 

affected. 

While the majority of patients diagnosed with constrictive bronchiolitis were exposed to sulfur dioxide from the sulfur mine fire, 

25 percent of those biopsies served at a time or a place incompatible with this exposure. They had similar exercise limitation, test 

results and biopsies showing bronchiolitis, but they did not report 

any extraordinary exposures that would distinguish them from 

other soldiers. However, almost all reported inhalational exposures 

that were common to the Iraqi experience, including fumes from 

burn pits, burning human waste, fires and dust from combat, burning oil and diesel exhaust. 

Consider the example of a 42-year-old physician who was deployed to Northern Iraq in 2007. She had been an avid marathon 

runner prior to deployment and ran regularly during 8 months— 

her 8 months tour of duty. Upon return, she was too short of 

breadth to run a mile. Her x-rays, pulmonary function tests were 

normal and her lung biopsy showed constrictive bronchiolitis, the 

same abnormalities seen in the other soldiers. She remains limited 

and now finds it difficult to climb stairs and walk up inclines. 

Up to this point, almost all of the soldiers diagnosed with constrictive bronchiolitis have been referred from Fort Campbell, but 

we have received a number of communications from soldiers and 

providers throughout the country, leading us to believe that this 

condition is present but not being diagnosed at other facilities. 

As noted previously, this diagnosis can only be established by 

surgical lung biopsy and most clinicians would hesitate to recommend this procedure. Military and VA officials have had a difficult time rating disability in this population. In most cases, the 

affected soldiers are comfortable at rest and are able to perform 

their activities of daily living. They have normal or near normal 

pulmonary function tests, but at the same time, they cannot meet 

the physical training requirements and are considered unfit for 

duty. 

This unique circumstance has challenged those who want to determine disability. Pulmonary function testing is the standard for 

rating respiratory problems, but how does one rate a soldier who 

is too short of breath to serve yet has a normal pulmonary function 

test? Unfortunately, the ratings applied thus far have not been 

standardized. We have seen many examples of a soldier receiving 

a rating from the U.S. Army only to have it downgraded by the VA. 

82 

More research is needed to understand the cause and prevention 

of this disease. There is little doubt that the cause of bronchiolitis 

and those exposed to the Mishraq Sulfur Mine fire was due to inhalational toxin. There is also little doubt that those not exposed to 

sulfur fires suffer from a disease caused by toxic inhalation. 

We must determine what these other toxins are to prevent those 

serving from being exposed. We must also consider baseline pulmonary function testing prior to deployment, knowing that our soldiers too often encounter inhalational toxins. And finally, I urge 

the development of standards for evaluating this condition that I 

have described today. 

Thank you for your attention. 

[The prepared statement of Dr. Miller follows:] 

PREPARED STATEMENT OF ROBERT F. MILLER, M.D., ASSOCIATE PROFESSOR OF PULMONARY AND CRITICAL CARE MEDICINE, VANDERBILT UNIVERSITY MEDICAL CENTER

Chairman Akaka, Ranking Member Burr, and Members of the Committee, I 

thank you for the opportunity to testify today. My comments will focus on a group 

of United States soldiers with permanent respiratory impairment following service 

in Iraq and Afghanistan. 

BACKGROUND

In early 2003, 20,000 soldiers from the 101st Airborne from Ft. Campbell, KY 

were deployed to northern Iraq as part of Operation Iraqi Freedom. In June 2003, 

opposing forces set fire to the Mishraq Sulfur Mine, approximately 25 miles north 

the Qayyarah Airfield West (Camp Q West), a major military supply airstrip and 

the primary area of deployment for the 101st Airborne. 

At that time, the Mishraq Sulfur Mine was the largest sulfur mine in the world. 

It burned for over 4 weeks and caused the release of 42 million pounds of sulfur 

dioxide (SO2) per day. This represents the largest man-made release of SO2 on 

record. Satellite imaging documented that the SO2 plume extended in a Southeast 

direction over the city of Mosul and Camp Q West. 

SO2 is the gas that you and I would associate with striking a match. It is a potent 

lung toxin and has been shown to cause lung injury at levels as low as 0.1 PPM. 

Our soldiers were exposed to levels many times higher than this. The skin, eye and 

airway injury irritation noted by almost everyone in the area suggests levels in excess of 50 PPM. Random sampling by the US Army documented toxic levels of SO2. 

CLINICAL PRESENTATIONS

Most of the 101st Airborne deployed in early 2003 returned to Ft. Campbell in 

early 2004. This is when Vanderbilt began to receive referrals from providers at 

Fort Campbell, asking for assistance in evaluating soldiers who complained of shortness of breath on exertion and could no longer pass physical fitness testing. The typical soldier previously had been able to complete a two mile run within regulation 

time, but now had to walk much of the course. In almost all cases, standard respiratory evaluations obtained at Fort Campbell had been normal, including chest xrays, chest CT scans and pulmonary function testing. None of these routine tests 

could explain the cause for the soldiers’ limitations. 

Vanderbilt physicians ultimately referred patients for surgical lung biopsy. I must 

emphasize that it is very uncommon to obtain surgical biopsies to evaluate shortness of breath with exertion when standard testing is normal. But the degree of exercise limitation and SO2 exposure were compelling enough for us to apply an aggressive approach. In almost every case, surgical biopsy showed constrictive bronchiolitis, a condition associated with damage or destruction affecting more than 50% 

of small airways. This abnormality causes pulmonary limitations, but is not detectable on x-ray. 

Between 2004 and 2009 Vanderbilt physicians performed surgical biopsies on 45 

of 70 soldiers referred for unexplained shortness of breath on exertion. All of the 

biopsies except one demonstrated some form of bronchiolitis. This condition has no 

known treatment and has resulted in medical boards for almost all of those affected. 

While the majority of the patients diagnosed with constrictive bronchiolitis were 

exposed to SO2 from the Mishraq sulfur mine fire, 25% of those biopsied served at 

a time or place incompatible with this exposure. They had similar exercise limitaVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00088 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
83 

tions, test results, and biopsies showing bronchiolitis, but they did not report any 

extraordinary exposures that would distinguish them from other soldiers. However, 

almost all reported inhalational exposures that were common to the Iraqi combat 

experience. These include fumes from burn pits burning human waste, fires and 

dust from combat, burning oil and diesel exhaust. 

Consider the example of a 42 year-old physician who was deployed to northern 

Iraq in 2007. She had been an avid marathon runner prior to deployment and ran 

regularly during her 8 months in Iraq. Upon return, she was too short of breath 

to run a mile. Her X-rays and pulmonary function testing were normal and she ultimately had a surgical lung biopsy showing constrictive bronchiolitis, the same abnormality seen in most of the other soldiers. She remains limited and now finds it 

difficult to climb stairs and walk gentle inclines. 

Up to this point, almost all of the soldiers diagnosed with constrictive bronchiolitis 

have been referred from Ft Campbell. However, we have begun to receive communications from soldiers and providers throughout the country, leading us to believe 

that this condition is present but not being diagnosed at other military facilities. 

As noted previously, this diagnosis can only be established by surgical lung biopsy 

and most clinicians would hesitate to recommend biopsy when x-rays and pulmonary function tests are normal. 

RATING DISABILITY FOR BRONCHIOLITIS

Military and VA officials have had a difficult time rating disability in this population. In most cases, the affected soldiers are comfortable at rest and are able to 

perform the activities of daily living. They have normal or near normal pulmonary 

function tests, but at the same time they cannot meet physical training requirements and are considered unfit for deployment. This unique circumstance has challenged those who must determine a disability rating. Pulmonary function testing is 

the usual standard for rating respiratory disabilities, but how does one rate the soldier who is too short of breath to serve and yet has normal test results? Unfortunately, the ratings applied thus far have not been standardized. Additionally, we 

have seen many examples of soldiers who received one rating from the US Army 

only to have it downgraded by the VA. 

More research is needed to understand the cause(s) and prevention of this disease. 

There is little doubt about the cause of bronchiolitis in those who were exposed to 

the Mishraq Sulfur Mine fire. There is also little doubt that those not exposed to 

the sulfur fires suffer from a disease caused by toxic inhalation. We must determine 

what these other toxins are so that preventive measures can be employed. We 

should also consider baseline pulmonary function testing prior to deployment knowing that our soldiers too often encounter inhalational toxins. And finally, I urge the 

development of standards for evaluating the condition that I have described today. 

Thank you for your attention and I would be glad to answer any questions. 

Chairman AKAKA. Thank you very much, Dr. Miller, for your testimony. Now we will receive the testimony of Mrs. Paganelli. 

STATEMENT OF LAURIE PAGANELLI, MOTHER OF JORDAN 

PAGANELLI, CHILDHOOD CANCER (SARCOMA) WARRIOR 

AND PAST RESIDENT OF U.S. NAVAL AIR FACILITY (NAF) 

ATSUGI, JAPAN 

Mrs. PAGANELLI. Thank you. Good morning, Chairman and Members of the Committee. Thank you for this opportunity to present 

my testimony on behalf of my family and as a representative for 

hundreds of sailors, Marines, and civilians who were unknowingly 

exposed to and have been adversely affected by contaminated air, 

soil, and water at U.S. Navy Air Facility Atsugi, Japan. 

My name is Laurie Paganelli and I am a former resident of 

Atsugi. My husband was an active duty Navy servicemember and 

we were given orders to report to Atsugi in 1997. Our tour of duty 

was from 1997 to 2000. Our only son, Jordan, was 5 years old when 

we arrived. While stationed at Atsugi, he attended Shirley Lanham 

Elementary School, played soccer, T-ball, and attended many sporting and cultural events throughout our time there. 

84 

On January 11—excuse me—2008, our lives changed forever. 

Jordan, then 16 years old, was diagnosed with a rare, vicious and 

highly aggressive form of cancer, so aggressive in fact that by the 

time he displayed any symptoms, his cancer had already progressed to Stage IV. 

The name of his cancer is Alveolar Rhabdo-Myo-Sarcoma, as 

known short, ARMS. ARMS is considered extremely rare and there 

are only about 350 cases each year in the United States, and because of its rarity there is a severe lack of funding for this type of 

cancer. Only 3 percent of research money goes toward childhood 

cancer research, making a 5-year survival rate dismally low. 

Jordan’s protocol was an intensive multi-agent therapy, including 

dose compressed cycles which had us calling Walter Reed Army 

Medical Center home for most of the 15 months of continuous 

treatment. Jordan also battled through 12 total weeks of daily radiation, 7 weeks to his torso and lungs, and then five more weeks to 

his entire head following the discovery of additional cancerous lesions that had spread to his brain. 

Additionally, due to cancer-based damage to his hips, he spent 10 

months on crutches and the rest with a cane. Quite the contrast 

to the young boy who played at Atsugi base and the high school 

cross country star he had been just months earlier. 

During our stay at Atsugi, we were aware of the incinerator. It 

smelled, burned our eyes and sometimes added a greenish glow to 

the air around us. We certainly were not aware of the effects it 

would have on our family years later. As most military families do, 

I trusted that the Navy wouldn’t let us live somewhere that was 

a danger to our health. I was wrong. 

From 1983 to 2001, sufficient and compelling evidence showed 

that the blend of high toxic chemicals were released from the 

Shinkampo Incinerator Complex, labeled SIC, at levels that far exceeded the EPA’s health risk-based guidelines. These chemicals severely contaminated the residential area of Atsugi. A partial list of 

chemicals include: volatile organic compounds, poly-chlorinated biphenyls, pesticides, polycyclic—excuse my pronunciations—aromatic hydro-carbons, dioxins, furans, particulates, and heavy metals. 

In 1990, U.S. Department of the Navy documents referred to this 

plume of smoke as ‘‘witch’s brew of toxic chemicals.’’ During the operation of SIC, the Navy spent approximately $18 million dollars, 

performing numerous ambient air and health studies at Atsugi. 

The data repeatedly confirmed that Atsugi was being polluted by 

carcinogenic and non-carcinogenic chemicals, which are categorized 

by the EPA to have long latency periods, meaning that the effects 

would be evident years after exposure. 

In 1997, the Navy began to communicate health risks to Atsugi 

residents. However, during the initial 12 years of incinerator operations, personnel had little to no knowledge of the potential health 

risks in toxic exposures. A review of the Navy’s human risk assessment of Atsugi prepared in 2001 by the Committee of Toxicology 

stated, ‘‘there does not seem to have been a coordinated strategy 

for risk communication.’’ 

In 1997, risk communication efforts included instructions for 

residents and school children to stay indoors while the plume of 

85 

toxins blew toward the base. A standard Form 600 was added to 

personnel medical records stating that we were exposed to 12 toxic 

chemicals and exceeded the maximum contamination levels. 

Although the Navy had no control over the missions of the SIC, 

they did have the ability to avoid exposing thousands of children 

to toxic chemicals. By 1990, the base residents were being exposed 

to dioxin and other toxic chemicals. In 1997, the Navy Inspector 

General reported that ‘‘the Navy must act decisively to reduce personnel exposure to incinerator contaminants. A range of options to 

accomplish this include, but not limited to, moving U.S. personnel 

to other locations, must be examined.’’ 

The 1999 study conducted by the government of Japan and the 

U.S. Navy found dioxin levels in the air to be dangerously high. By 

2000, Defense Secretary William Cohen and chief of the Japanese 

Defense Agency agreed that Japan would provide temporary offbase housing and that Japan would not object to the U.S. Government’s efforts to sue SIC for violating environmental laws. 

In 2001, the U.S. Department of Justice brought suit against a 

private incinerator in a Yokohoma court. A lawsuit claimed that 

toxic chemicals severely polluted the air, soil and groundwater and 

interfered with U.S. Government rights of property and possession. 

The SIC was closed when the government of Japan decided to pay 

the incinerator owner the equivalent of $42 million to shut down 

and dismantle the incinerators. 

The Navy had knowledge that Atsugi residents were being exposed to dioxin in the SIC emissions in the early 1990s and they 

knew what detrimental effects such exposure would have to the 

human body. As you remember, dioxin is what made Agent Orange 

so toxic. So, it is no surprise that by 1998, the Navy recognized 

their liability and instituted a one-page waiver that did not convey 

any information of known long-term risks associated with the SIC. 

We were required to sign the waiver. In 2007, after complaints 

of former residents, the Navy provided a public Web site with some 

study-based information. However, the Web site has not been widely publicized and many former Atsugi residents do not have knowledge of its existence. 

Recently the Navy started—stated that the 2009 Atsugi health 

study produced a registry. However, the study confirms that approximately 75 percent of the Atsugi population in the study was 

lost to follow-up, which adversely affects the study’s end result, 

specifically because of the documented latency period of toxic exposure. 

Over the last 3 years, an estimated 750 former residents, including retired and former active duty personnel and their families, 

have come together for support outside the realm of the Navy. 

Within this group, at least 61 cancer cases have been reported, all 

of which have been directly associated with dioxin exposure. They 

include: brain, thyroid, cervical/ovarian, colorectal, leukemia, 

lymphoma, and various other cases of sarcoma, many of which involve innocent children, like our son, Jordan, who lived at Atsugi 

while their mothers and fathers faithfully served the United States 

of America while stationed in Japan. 

Besides cancer, many former residents suffer from illnesses, including nervous system disorders, liver and kidney damage, autoVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00091 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
86 

immune diseases, neurological disorders, cardiac irregularities, and 

other toxic-related diseases as defined by the Agency of Toxic Substances and Disease Registry. 

In closing, I would like to state that I had the basic human right 

not to be exposed to the types of toxic chemicals that were highly 

prevalent at Atsugi. Our military members are proud to dedicate 

their lives in defense of this great country and we support them in 

their mission every day. However, we trusted the Navy to provide 

a safe environment for our family members, but they failed to do 

so, knowingly housing our families in a toxic waste zone. 

We look to you, Committee Members, to rectify this gross misconduct and to take action to ensure that the VA is provided with 

an appropriate registry and an accurate risk of cancer and non-cancerous illnesses associated with the SIC. We urge you to ensure 

that all former residents are notified. 

Finally, we urge you to introduce a bill to enact a new law that 

allows former Atsugi residents and dependents to receive appropriate VA benefits, to include medical care and disability compensation. My son has been fighting for his life and the journey so 

far I would not wish on any parent or family. 

We will never know if this disease was caused or brought about 

by the exposure of the toxic chemicals at Atsugi. However, the risk 

imposed to him and my family and lack of proactive risk mitigation 

is an absolute tragedy. I pray that no other family has to endure 

the pain of watching their child fight for it’s life. 

Thank you for allowing me to speak today. 

[The prepared statement of Mrs. Paganelli follows:] 

PREPARED STATEMENT OF LAURIE PAGANELLI, MOTHER OF JORDAN PAGANELLI, 

CHILDHOOD CANCER (SARCOMA) WARRIOR AND PAST RESIDENT OF U.S. NAVAL AIR

FACILITY (NAF) ATSUGI, JAPAN

Good morning Mr. Chairman and Members of the Committee: Thank you for this 

opportunity to present testimony on behalf of my family and as a representative for 

hundreds of Sailors, Marines, and civilians who were unknowingly exposed to and 

have been adversely affected by the contaminated air, soil, and water at U.S. Navy 

Air Facility Atsugi, Japan. 

My name is Laurie Paganelli and I am a former resident of Atsugi. My husband 

is an active-duty Navy servicemember and we were given orders to report to Atsugi 

in 1997. Our tour of duty was from 1997–2000. Our only son, Jordan, was 5 years 

old when we arrived. While stationed at Atsugi, he attended Shirley Lanham Elementary School, played soccer, t-ball, and attended many other sporting/cultural 

events on the base throughout our time there. 

On January 11, 2008 our lives changed forever. Jordan (then 16-years old) was 

diagnosed with a rare, vicious, and highly aggressive form of cancer—so aggressive 

in fact, that by the time he displayed any symptoms, his cancer had already progressed to a STAGE 4 condition. The name of his cancer is: Alveolar Rhabdo-MyoSarcoma (‘‘ARMS’’ for short). ARMS is considered extremely rare because there are 

only about 350 cases diagnosed each year in the United States. And, because of its 

rarity, there is a severe lack of awareness and funding for this type of cancer. Only 

3% of research money goes toward childhood cancer research, making the 5-year 

survival rate dismally low. Jordan’s protocol was an Intensive Multi-Agent Therapy, 

including Dose-Compressed Cycles which had us calling Walter Reed Army Medical 

Center ‘‘home’’ for most of the 15 months of continuous treatment. Jordan also battled through 12 total weeks of DAILY radiation: 7 weeks to his torso and lungs; and 

then 5 more weeks to his entire head following the discovery of additional cancerous 

legions that had spread to his brain. Additionally, due to cancer-based damage to 

his hips, he spent 10 months on crutches and the rest with a cane—quite a contrast 

to the young boy who played at ‘‘Atsugi Base’’ and the high school cross country star 

he had been just months prior to diagnosis. During our stay at Atsugi we were 

aware of the incinerator. It smelled, burned your eyes, and sometimes added a 

87 

greenish glow to the air around us. We certainly were not aware of the effects it 

would have on our family years later. As most military families do, I trusted that 

the Navy wouldn’t let us live there if it was a danger to our health. I WAS WRONG. 

From 1983 until 2001, sufficient and compelling evidence showed that a blend of 

highly toxic chemicals were released from the Shinkampo Incineration Complex (labeled the ‘‘SIC’’) at levels that far exceeded the EPA’s health-risk-based guidelines. 

These chemicals severely contaminated the residential area of Atsugi. A partial list 

of chemicals included: volatile organic compounds, poly-chlorinated bi-phenyls, pesticides, polycyclic aromatic hydro-carbons, dioxins, furans, particulates, and heavy 

metals. In 1990, U.S. Department of the Navy documents referred to this plume of 

smoke as a ‘‘witch’s brew of toxic chemicals.’’ 

During the operation of the SIC, the Navy spent approximately 18 million dollars 

performing numerous ambient air and health studies at Atsugi. This data repeatedly confirmed that Atsugi was being polluted with carcinogenic and non-carcinogenic chemicals, many of which have been categorized by the EPA to have long-latency periods—meaning that their affects would be evident years after the exposure. 

In 1997, the Navy began to communicate health risks to Atsugi residents. However, during the initial 12 years of incinerator operations, personnel had little or no 

knowledge of the potential health risks of their toxic exposure. In fact, a review of 

the Navy’s Human Health Risk Assessment of Atsugi (prepared in 2001 by the Committee of Toxicology) stated: ‘‘There does not seem to have been a coordinated strategy for risk communication.’’ 

In 1997, risk communication efforts included instructions for residents and school 

children to stay indoors when the plume of toxins blew toward the base. A ‘‘Standard Form 600’’ was added to personnel medical records stating that we were exposed 

to 12 toxic chemicals that exceeded Maximum Contamination Levels. 

Although the NAVY had no control over the emissions of the SIC, they did have 

the ability to avoid exposing thousands of children to toxic chemicals. By early 1990, 

it was evident that base residents were being exposed to Dioxin and other toxic 

chemicals. In 1997, the Navy Inspector General reported that ‘‘The Navy must act 

decisively to reduce personnel exposure to incinerator contaminants. A range of options for accomplishing this, including (but not limited to) moving U.S. personnel 

to other locations, must be examined.’’ 

The 1999 study conducted by the Government of Japan and the U.S. Navy, found 

dioxin levels in the air to be dangerously high. By 2000, Defense Secretary William 

Cohen and the Chief of the Japanese Defense Agency agreed that Japan would provide temporary off-base housing and that Japan would not object to the U.S. government’s efforts to sue the SIC for violating environmental laws. 

In 2001, the United States Department of Justice brought suit against the private 

incinerator in a Yokohoma Court. The lawsuit claimed that toxic chemicals severely 

polluted the air, soil, and ground water and interfered with the U.S. Government 

rights of property use and possession. The SIC was closed when the Government 

of Japan decided to pay the incinerator owner the equivalent of 42 million dollars 

to shut down and dismantle the incinerators. 

The NAVY had knowledge that Atsugi residents were being exposed to Dioxin in 

the SIC’s emissions by the early 1990’s; and they knew what detrimental affects 

such exposure would do to the human body. As you remember, Dioxin is what made 

‘‘Agent Orange’’ so toxic. So, it’s no surprise that by 1998, the NAVY recognized 

their liability and instituted a one page waiver that did not convey information of 

the known long-term risk associated with the SIC. We were all REQUIRED to sign 

this waiver. 

In 2007, after complaints of former residents, the NAVY provided a public Web 

site with some study-based information. However, the Web site has not been widely 

publicized and many former Atsugi residents still do not have knowledge of its 

existence. 

Recently, the NAVY has stated that the 2009 Atsugi Health Study produced a 

registry. However, the study confirms that approximately 75% of the Atsugi population in the study was lost to follow-up, which adversely affected the study’s end 

result—specifically because of the documented latency period of the toxic exposure. 

Over the last three years, an estimated 750 former residents (including retired 

and former active duty personnel and their families) have come together for support 

outside the realm of the NAVY. Within just this group, at least 61 cancer cases have 

been reported—all of which have been directly associated with Dioxin exposure. 

They include Brain, Thyroid, Cervical/Ovarian, Colo-Rectal, Leukemia, Lymphoma 

and various other cases of sarcoma—many of which involve innocent children (like 

our son Jordan) who lived at Atsugi while their mothers and fathers faithfully 

served the United States of America while stationed in Japan. 

88 

Besides cancer, many former residents suffer from illnesses including; nervous 

system disorders, liver and kidney damage, auto-immune diseases, neurological disorders, cardiac irregularities, and other toxic related diseases as defined by the 

Agency for Toxic Substances and Disease Registry. 

In closing, I would like to state that we had the basic human right not to be exposed to the types of toxic chemicals that were highly prevalent at Atsugi. Our military family members are proud to dedicate their lives in defense of our great county; 

and, we support them and their mission each and every day. However, we trusted 

the Navy to provide a safe environment for our family members. But, they failed 

to do so by knowingly housing our families in a toxic waste zone. 

We look to you, committee members, to rectify this gross misconduct and to take 

action to ensure that the VA is provided with an appropriate registry and an accurate list of cancer and non-cancerous illnesses associated with the SIC exposure. We 

urge you to ensure that all former residents are notified. Finally, we urge you to 

introduce a bill to enact a new law that allows former Atsugi residents and dependents to receive the appropriate VA benefits to include medical care and disability 

compensation. 

My son has been fighting for his life; and his journey thus far is one that NO 

parent should ever have to take with their child. We will never know if his disease 

was caused (or brought about) by the exposure of toxic chemicals at Atsugi. However, the risk imposed to him and my family, and the lack of proactive risk mitigation, is an absolute tragedy. I pray that no other family has to endure the pain of 

watching their child fight for their lives. 

Thank you for allowing me to speak to you today. 

Chairman AKAKA. Thank you very much, Mrs. Paganelli. Now we 

will receive the testimony of Dr. Feigley. 

STATEMENT OF CHARLES E. FEIGLEY, Ph.D., PROFESSOR, ENVIRONMENTAL HEALTH SCIENCES, PUBLIC HEALTH RESEARCH CENTER, ARNOLD SCHOOL OF PUBLIC HEALTH, 

UNIVERSITY OF SOUTH CAROLINA; CHAIR, SUBCOMMITTEE 

ON THE ATSUGI INCINERATOR COMMITTEE ON TOXICOLOGY BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY DIVISION ON EARTH AND LIFE STUDIES, NATIONAL 

RESEARCH COUNCIL, THE NATIONAL ACADEMIES 

Mr. FEIGLEY. Good morning, Mr. Chairman and Members of the 

Committee. Thank you for your concern about the health of veterans. 

My names is Charles Feigley. I am professor of environmental 

health sciences at the University of South Carolina, Arnold School 

of Public Health. I am also principal investigator of a DOD-sponsored contract testing the use of copper in air conditioning systems 

to improve air quality and reduce illness in the military. 

As well, I am principal investigator of the University of South 

Carolina Center for Public Health Preparedness, which is funded 

by the Centers for Disease Control and Prevention. We assist 

State, local, and tribal health agencies and their community partners to prepare for a wide range of public health emergencies. 

In addition, I have served on a number of committees of the National Research Council, or NRC, including as chair of the NRC 

subcommittee that prepared the report titled, ‘‘Review of the U.S. 

Navy’s Health Risk Assessment of the Naval Air Facility at 

Atsugi.’’ 

The National Research Council is an operating arm of the National Academy of Sciences, not part of the government, and it is— 

it was established in 1863 by Congress and under President Lincoln to advise the government on matters of science and techVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00094 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
89 

nology. I am here before you today because of my experience as a 

volunteer serving on that NRC committee. 

The NRC report titled, Review of the U.S. Navy’s Health Risk 

Assessment of the Naval Air Facility at Atsugi was prepared in response to requests from the U.S. Navy for an independent review 

of the final draft of the Navy Environmental Health Center’s report 

on the risk assessment at Atsugi which was in 2000, the year 2000. 

The NEHC, that is, the Naval Environmental Health Center, 

that prepared the risk assessment report that we reviewed, had 

conducted a risk assessment because of concerns that were raised 

by residents of Atsugi, the U.S. Navy personnel, and their families 

regarding health effects of what came to be called Enviro-Tech Incinerator—the Enviro-Tech Incinerator, formally called Shinkampo 

or Jinkanpo Incinerator Complex. 

That complex was adjacent to the U.S. Naval Air Facility which 

is located southwest of Tokyo, and when I say adjacent, one of the 

critical things that really is not mentioned in my written statement 

is that the incinerator is at a much lower elevation than the base 

facility. The stacks from the incinerator discharged just above the 

level of the naval air facility so that when the air is—when the bin 

is blowing, as it frequently is, from the incinerator to the base, they 

were directly downwind and at really pretty much the same level 

of discharge. 

The concerns were related to the exposure to emissions from the 

incinerator and to chemicals resulting from the storage handling 

and disposal of waste material at the facility. The risk assessment 

was conducted after a previous NRC committee recommended that 

a comprehensive health study at NAF at Atsugi be conducted. 

The NRC subcommittee on Atsugi consisted of members selected 

for their expertise in toxicology, epidemiology, industrial hygiene, 

engineering, exposure assessment, and risk assessment. We were 

specifically asked to do two things. This is our charge: review the 

adequacy of the methods used to assess risks, the uncertainty is 

identified, the risk to susceptible subpopulations, such as pregnant 

women and young children, and the scientific validity of the conclusions drawn. 

Second, to recommend research to fill data gaps and options for 

mitigating risks associated with exposure to the incinerator emissions. It is important to note that you can see from these specific 

tasks that the subcommittee was not asked to determine the potential health effects from the incinerator, but to review the assessment that was conducted by the Naval Environmental Health Center. 

In its review, the subcommittee identified a number of aspects of 

the risk assessment that were exemplary and others that needed 

improvement. The subcommittee noted that the NEHC risk assessment included a rigorous quality assurance and quality control program and the subcommittee, therefore, had confidence in the accuracy of the data collected. 

The subcommittee was pleased with a broad number of air pollutants that were monitored and the collection of meteorological 

data. It also commended the NEHC for calculating risks of acute 

and chronic toxicity endpoints of the different subpopulations. 

90 

The subcommittee was concerned however about inconsistencies 

in the objectives of the risk assessment, some technical aspects regarding how the collected data was used in the risk assessment, 

and the interpretation of data and risk assessment findings by the 

NEH. The subcommittee also commented on the lack of analysis 

and characterization of uncertainty in the risk assessment. 

The subcommittee concluded that the NEH had collected a large 

amount of sampling data at NAF Atsugi. If analyzed and interpreted appropriately, the data might have been adequate to determine whether the air pollution at NAF Atsugi poses a health risk 

and how much the incinerator facility contributes to that pollution. 

However, the analyses of the data were inadequate to draw conclusions about the health risks of the persons residing at NAF 

Atsugi and about the contributions of the incinerator to those risks. 

In addition, the NEHC had interpreted some of the results of the 

risk assessment without taking into account the meaning and limitations of the risk assessment process. 

The subcommittee concluded that aspects of the analyses and interpretation of the data, not the underlying data themselves, constituted the main limitation of the risk assessment. The committee 

provided recommendations to improve the NEH risk assessment, 

including recommendations for the planning of the risk assess—of 

risk assessments, determination of attributable risk, analysis of air 

monitoring data, interpretation of risk assessment, treatment of 

uncertainty and information gaps that should be filled, and improvements in the presentation and organization of the NEH draft 

summary report itself. 

Given the aforementioned limitations of the Navy’s risk assessment draft summary report, the subcommittee found that the analyses presented did not determine reliably whether military personnel and their families incurred health risks by living at NAF 

Atsugi, nor did the analyses represent reliably the contribution of 

the incinerator to those health risks. 

With that, I once again thank you for inviting me to testify before this Committee. I appreciate the important work that the 

Committee does for veterans’ affairs and welcome any questions 

you might have. 

[The prepared statement of Mr. Feigley follows:] 

PREPARED STATEMENT OF CHARLES E. FEIGLEY, PH.D. PROFESSOR, ENVIRONMENTAL

HEALTH SCIENCES, PUBLIC HEALTH RESEARCH CENTER, ARNOLD SCHOOL OF PUB- LIC HEALTH, UNIVERSITY OF SOUTH CAROLINA

Good morning Mr. Chairman and Members of the Committee. Thanks to Senator 

Akaka and Members of the Committee on Veterans’ Affairs for your concern about 

veteran’s health. 

My name is Charles Gene Feigley. I am a professor of environmental health 

sciences at the University of South Carolina, Arnold School of Public Health.. I am 

Principal Investigator of a DOD-sponsored project testing the use of copper in air 

conditioning systems to improve air quality and reduce illness in the military. I am 

also Principal Investigator of the University of South Carolina’s Center for Public 

Health Preparedness funded by the Centers for Disease Control and Prevention to 

assist State, local, and tribal health agencies and their community partners prepare 

for response to a wide range of public health emergencies. In addition, I have served 

on a number of committees of the National Research Council (NRC), including as 

Chair of the NRC Subcommittee that prepared the report Review of the U.S. Navy’s 

Health Risk Assessment of the Naval Air Facility at Atsugi. The National Research 

Council is the operating arm of the National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine of the National Academies, charVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00096 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
91 

tered by Congress in 1863 to advise the government on matters of science and technology. I am here before you today because of my experience as a volunteer serving 

on that NRC Committee. 

The NRC report, Review of the U.S. Navy’s Health Risk Assessment of the Naval 

Air Facility at Atsugi, was prepared in response to a request from the US Navy for 

an independent review of the Navy Environmental Health Center (NEHC) report 

NAF Atsugi, Japan Human Health Risk Assessment Summary of Findings, Conclusions and Recommendations, Draft Final, January 2000, as well as a number of supporting documents for that risk assessment. The NEHC had conducted that risk assessment because of concerns that had been raised by the residents of NAF Atsugi— 

US Navy personnel and their families—regarding the health effects of the EnviroTech incinerator facility (formerly called the Shinkampo or Jinkanpo incinerator 

complex). That complex was adjacent to the US Naval Air Facility (NAF) at Atsugi, 

Japan, southwest of Tokyo. Enviro-Tech was a privately owned waste-combustion facility that consists of three incinerators, a waste-staging area, and an ash-holding 

area. The concerns were related to exposure to emissions from the incinerators and 

to chemicals resulting from the storage, handling, and disposal of waste material 

at the facility. The risk assessment was conducted after a previous NRC subcommittee had recommended that a comprehensive health risk assessment of NAF 

Atsugi be conducted. 

The NRC Subcommittee on the Atsugi Incinerator—which consisted of members 

selected for their expertise in toxicology, epidemiology, industrial hygiene, engineering, exposure assessment, and risk assessment—was specifically asked to: 

1. Review the adequacy of the methods used to assess risk, the uncertainties identified, the risks to susceptible subpopulations (such as pregnant women and young 

children), and the scientific validity of the conclusions drawn. 

2. Recommend, depending on its evaluation, research to fill data gaps and options 

for mitigating the risks associated with exposure to the incinerator emissions. 

It is important to note that, as you can see from those specific tasks, the Subcommittee was not asked to determine the potential health effects from the incinerator, but to review the assessment that was conducted by the NEHC. In its review 

the Subcommittee identified a number of aspects of the risk assessment that were 

exemplary and others that needed improvement. 

The Subcommittee noted that the NEHC risk assessment included a rigorous 

quality-assurance and quality-control program, and the Subcommittee therefore had 

confidence in the accuracy of data collected. The Subcommittee was pleased with the 

broad number of air pollutants that NEHC monitored and the collection of meteorological data. It also commended the NEHC for calculating the risks of acute- and 

chronic-toxicity end points for different subpopulations. 

The Subcommittee was concerned, however, about inconsistencies in the objectives 

of the risk assessment, some technical aspects regarding how the collected data was 

used in the risk assessment, and the interpretation of the data and risk assessment 

findings by the NEHC. The Subcommittee also commented on the lack of uncertainty analysis or characterization in the risk assessment. 

The Subcommittee concluded that NEHC had collected a large amount of sampling data at NAF Atsugi. If analyzed and interpreted appropriately, those data 

might have been adequate to determine whether air pollution at NAF Atsugi poses 

a health risk and how much the incinerator facility contributes to that pollution. 

However, the analyses of the data were inadequate to draw conclusions about the 

health risks for persons residing at NAF Atsugi and about the contribution of the 

incinerator to those risks. In addition, NEHC had interpreted some of the results 

of the risk assessment without taking into account the meaning and limitations of 

the risk-assessment process. The Subcommittee concluded that aspects of the analyses and interpretation of the data, not the underlying data themselves, constituted 

the main limitation of the risk assessment. The Subcommittee provided recommendations to improve the NEHC risk assessment, including recommendations 

for the planning of risk assessments, determination of attributable risk, analysis of 

air-monitoring data, interpretation of the risk assessment, treatment of uncertainty, 

information gaps that should be filled, and improvements in the presentation and 

organization of the NEHC draft summary report itself. Given the aforementioned 

limitations of the Navy’s risk assessment draft summary report, the Subcommittee 

found that the analyses presented did not determine reliably whether military personnel and their families incur increased health risks by living at NAF Atsugi. Nor 

did the analyses presented reliably determine the contribution of the incinerator facility to health risks. 

92 

With that, I would once again like to thank you for inviting me to testify before 

this Committee. I appreciate the important work conducted by the Committee on 

Veterans’ Affairs and welcome any questions you may have. 

POST-HEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO CHARLES E. 

FEIGLEY, PH.D., PROFESSOR, UNIVERSITY OF SOUTH CAROLINA, CHAIR, SUBCOMMITTEE ON THE ATSUGI INCINERATOR

Question 1. Please provide the Committee with the best estimate of the size of 

population that was at Atsugi between 1983 and 2001. Of this population, how 

many were servicemembers and how many were dependents, both adult and children? Please also provide the ages of the children. 

Question 2. Is there a study that can be done that will provide more accurate data 

than those done in the past? What would that look like? 

[The Committee had not received the requested information by 

press time.] 

Chairman AKAKA. Thank you, Dr. Feigley. Dr. Gibb, your testimony, please. 

STATEMENT OF HERMAN GIBB, Ph.D., M.P.H. 

Mr. GIBB. Good morning. Thank you for the opportunity to testify 

this morning. I will be testifying on the subject of Qarmat Ali. I 

am testifying in my personal capacity and do not in any way represent the interest, beliefs or opinions of my employer. 

I presented similar testimony to the Senate Democratic Policy 

Committee hearing on August 3, 2009. The subject of that hearing 

was, ‘‘The Exposure at Qarmat Ali—Did the Army Fail to Protect 

U.S. Soldiers Serving in Iraq?’’ I have a Ph.D. in epidemiology from 

the Johns Hopkins University and an MPH in environmental 

health from the University of Pittsburgh. 

I spent 29 years at the U.S. Environmental Protection Agency. 

Most of my time at the EPA was spent at the National Center for 

Environmental Assessment where I served in the capacities of assistant center director and associate director for health. Based on 

my experience working at EPA on risk assessments of hexavalent 

chromium and my study of chromate production workers, I can 

state that the symptoms reported by the soldiers who served at 

Qarmat Ali are consistent with significant exposure to sodium dichromate. 

Sodium dichromate—and I may use the term hexavalent chromium and sodium dichromate interchangeably—but sodium dichromate is a hexavalent chromium compound. EPA maintains an online database of risk assessments on over 500 substances, including 

an evaluation of the potential of these substances to cause cancer 

in humans. Hexavalent chromium is classified as a human 

carcinogen. 

Among those substances that the EPA has classified as carcinogenic to humans, and it is estimated a cancer inhalation unit risk, 

the highest risk is that for hexavalent chromium. In other words, 

it is the most carcinogenic. 

In 2000, while at the EPA, I was the senior author of two publications on the health risks experienced by chromate production 

workers at a facility in Baltimore, MD. The first publication reported the results of a mortality study. The second examined the 

risk of clinical irritation experienced by the workers. 

93 

The hexavalent chromium exposure at the facility was primarily 

from sodium dichromate, which is the same exposure that the soldiers experienced at Qarmat Ali. From my work on these studies, 

the EPA awarded me the Agency Scientific and Technological 

Achievement Award. I became interested in studying the group of 

workers in Baltimore because of the considerable amount of exposure data available for the facility. The group was relatively large, 

2,357 workers. There were 122 deaths from lung cancer. 

Hexavalent chromium was found to be significantly associated 

with an increased risk of lung cancer even after controlling for 

smoking. Half of those who developed lung cancer had worked at 

the facility for less than 10 months. And I might add that one 

quarter of the lung cancer cases had worked at the facility for 2 

months or less. 

In 2006, based in large measure on our study, the Occupational 

Safety and Health Administration set a permissible exposure limit 

for hexavalent chromium of 5 micrograms per cubic meter for—as 

an 8-hour time weighted average. This new OSHA PEL reduced 

the previous PEL by over 10-fold. 

Clinically diagnosed symptoms of irritation were found to occur 

in our study population within a relatively short time period after 

beginning employment. The medium time to develop an irritated 

nasal septum was only 20 days. That means that half of the workers developed it in less than 20 days and half developed it in more 

than 20 days: an ulcerated nasal septum, 22 days; a bleeding nasal 

septum, 92 days; a perforated nasal septum 182 days. 

We recorded 10 different types of clinically diagnosed irritation. 

What was also remarkable was the higher percentage of the group 

that was diagnosed with signs of irritation. For example, 68 percent of the group was diagnosed at one time or another with nasal 

irritation. The signs of irritation which the soldiers and workers experienced at Qarmat Ali are consistent with what we reported in 

our study. 

The testimony by Russell Powell in the hearing today, by the soldiers in the hearing held by the Democratic Policy Committee on 

August 3, and by the civilian workforce in the previous hearing 

held on this subject suggests that they are experiencing signs of 

hexavalent chromium exposure. 

A report from the Army Center for Health Promotion and Preventive Medicine, CHPPM, indicated the blood samples were collected from 137 potentially exposed soldiers and DOD civilians. 

CHPPM’s description of these results is confusing and lacks sufficient detail. CHPPM suggests that the chromium and the red blood 

cells of the vast majority of the individuals in their study are within normal ranges. However, CHPPM notes in italicized print that 

there are some other literature references that have lower limits. 

Unfortunately, CHPPM does not specify the literature sources, 

nor do they indicate how low these lower limits are. Where did 

CHPPM get their reference values and how good are they? Although CHPPM reports that nearly all of the test results were 

below the limit of detection, CHPPM also reports that 98 percent 

of the samples showed chromium levels within the range of four to 

five micrograms per liter. How is it possible that 98 percent of the 

samples could be within the range of four to five micrograms per 

94 

liter when they report that nearly all of the results were below the 

limit of detection? 

In 1987, an article cited by the National Institute for Occupational Safety and Health, Dr. Angerer and others found that exposures 10 times the current OSHA limit will result in a concentration of chromium in red blood cells of .6 micrograms per liter. Assuming Angerer and his coauthors are correct, and accounting for 

at least the 40-day delay in CHPPM’s collection of blood samples, 

the air concentration which the Qarmat Ali soldiers were exposed 

could be estimated to be approximately 80 to 200 times the current 

OSHA limit. 

Why did CHPPM fail to explore inconsistencies in its data with 

that of other literature? These limitations call for greater scrutiny 

of the CHPPM results. The samples drawn from some of the soldiers and workers at Qarmat Ali were reported by CHPPM to have 

been taken approximately a month after remediation measures 

were taken to limit the exposure. 

At the Democratic Policy Committee meeting on August 3, there 

were four soldiers attending. Only one of them had had their blood 

drawn and I asked when it was drawn and he said it was 60 days 

after exposures ended. In its draft, Toxicological Profile on Chromium, the Agency for Toxic Substances and Disease Registry reports that the half life of chromium in red blood cells is 30 days. 

In other words, 30 days after the exposure has ended, we expect 

to see only 50 percent of the chromium in the volume of red blood 

cells that would have been there initially. 

The measurements of chromium in red blood cells is an insensitive method of detecting hexavalent chromium exposure. The measurement of chromium in the red blood cell only captures the 

hexavalent chromium that makes its way into the cell. It does not 

measure how much hexavalent chromium may have been inhaled 

and remains in the nose or lung or was reduced in the body to trivalent chromium, which is not getting to the red blood cell; nor 

does it measure the chromium that was eliminated from the body. 

It should be noted that NIOSH in its draft update on hexavalent 

chromium states the biomarkers, which would include blood tests, 

are of uncertain value as early indicators of potential hexavalent 

chromium-related health effects. ATSDR reports that 90 percent of 

absorbed chromium is eliminated within 24 hours. Nevertheless, 

CHPPM still put a great deal of emphasis on the red blood cell 

analyses from samples taken at least 4 weeks and maybe 2 months 

after possible exposure to hexavalent chromium. 

An analogy would be like giving a breathalyzer to a person 3 

days after they were pulled over for erratic driving. The toxin 

would have been eliminated from the body in the intervening period. Given the limited usefulness of these red blood cell tests, they 

should not be used as a bottom-line indicator of the hexavalent 

chromium exposure that the soldiers and workers experienced and 

they certainly should not be extrapolated to other individuals who 

were exposed at Qarmat Ali. 

Nasal perforations, bloody noses and skin irritation would be far 

more telling about the soldiers and workers’ exposures that measures the chromium and red blood cells taken 1 month or maybe 2 

months after remediation has taken place. 

95 

In summary, the symptoms that have been reported by the soldiers and civilian workers are consistent with what has been experienced by other workers exposed to hexavalent chromium. Judgment on whether these soldiers and civilian employees were exposed should not be based on measurements of red blood cells 

taken 1–2 months after remediation measures were taken, nor 

should such results be extrapolated to other individuals who were 

present at the facility. 

Again, I thank you, Mr. Chairman, for the opportunity to testify 

today. 

[The prepared statement of Mr. Gibb follows:] 

PREPARED STATEMENT OF HERMAN GIBB, PH.D., M.P.H. 

Good afternoon. I am Dr. Herman Gibb. Thank you for the opportunity to testify 

before you today. I am testifying in my personal capacity and do not in any way 

represent the interests, beliefs or opinions of my employer. I presented similar testimony to the Senate Democratic Policy Committee hearing on August 3, 2009. The 

subject of that hearing was ‘‘The Exposure at Qarmat Ali: Did the Army Fail to Protect U.S. Soldiers Serving in Iraq?’’ 

I have a Ph.D. in Epidemiology from the Johns Hopkins University and an M.P.H. 

in Environmental Health from the University of Pittsburgh. I spent 29 years at the 

U.S. Environmental Protection Agency (EPA). Most of my time at the EPA was 

spent at the National Center for Environmental Assessment where I served in the 

capacities of Assistant Center Director and Associate Director for Health. Based on 

my experience working at the EPA on risk assessments of hexavalent chromium and 

my study of chromate production workers, the symptoms reported by some of the 

soldiers who served at Qarmat Ali are consistent with significant exposure to sodium dichromate. 

EPA maintains an online database of risk assessments on over 500 substances, 

including an evaluation of the potential of these substances to cause cancer in humans. Hexavalent chromium is classified as a human carcinogen. Among those substances that the EPA has classified as carcinogenic to humans and has estimated 

a cancer inhalation unit risk, the highest risk is that for hexavalent chromium. In 

2000, while at the EPA, I was the senior author of two publications on the health 

risks experienced by chromate production workers at a facility in Baltimore, MD. 

The first publication reported the results of a mortality study, the second examined 

the risk of clinical irritation experienced by the workers. The hexavalent chromium 

exposure at the facility was primarily from sodium dichromate. For my work on 

these studies, the EPA awarded me the Agency’s Scientific and Technological 

Achievement Award. 

I became interested in studying the group of workers in Baltimore because of the 

considerable amount of exposure data available for the facility. The group was relatively large—2,357 males; there were 122 deaths from lung cancer. Hexavalent 

chromium was found to be significantly associated with an increased risk of lung 

cancer, even after controlling for smoking. Half of those who developed lung cancer 

had worked at the facility for less than ten months. 

In 2006, based in large measure on our study, the Occupational Safety and Health 

Administration (OSHA) set a Permissible Exposure Limit (PEL) for hexavalent chromium of 5 micrograms per cubic meter (μg/m3) as an 8-hour time-weighted average 

based on the carcinogenic dose response. The new OSHA PEL reduced the previous 

PEL by over 10-fold. 

Clinically diagnosed symptoms of irritation were found to occur in our study within a relatively short time period after beginning employment. The median time to 

develop an irritated nasal septum was only 20 days, an ulcerated nasal septum 22 

days, a bleeding nasal septum 92 days, a perforated nasal septum 182 days. We recorded 10 different types of clinically diagnosed irritation. What was also remarkable was the high percentage of the group that was diagnosed with signs of irritation. For example, sixty-eight percent of the group was diagnosed at one time or another with nasal irritation. 

The signs of irritation which the soldiers and workers experienced at Qarmat Ali 

are consistent with what we reported in our study. The testimony by Russell Powell 

in the hearing today, by the soldiers in the hearing held by the Democratic Policy 

Committee on August 3, and by the civilian workers in the previous hearing held 

96 

on this subject suggest that they are experiencing signs of hexavalent chromium exposure. 

A report from the Army’s Center for Health Promotion and Preventive Medicine 

(CHPPM) indicated that blood samples were collected from 137 potentially exposed 

soldiers and DOD civilians. CHPPM’s description of these results is confusing and 

lacks sufficient detail. 

• CHPPM suggests that the chromium in the red blood cells of the vast majority 

of the individuals in their study are within normal ranges. However, CHPPM notes, 

in italicized print, that ‘‘there are some other literature references that use lower 

limits.’’ Unfortunately, CHPPM does not specify the literature sources nor do they 

indicate how low these ‘‘lower limits’’ are. Where did CHPPM get their reference 

values and how good are they? • Although CHPPM reports that nearly all of the test results were below the limit 

of detection, CHPPM also reports that ninety-eight percent of the samples showed 

chromium levels within the range of 4 to 5 micrograms per liter (μg/L). How is it 

possible that ninety-eight percent of the samples could be within the range of 4 to 

5 micrograms per liter when they report that nearly all the results were below the 

limit of detection? • In a 1987 article cited by the National Institute for Occupational Safety and 

Health (NIOSH), Dr. Angerer and others found that exposures 10X the current 

OSHA limit will result in a concentration of chromium in red blood cells of 0.6 

micrograms per liter (μg/L). Assuming Angerer and his co-authors are correct and 

accounting for at least a 40-day delay in CHHPM’s collection of blood samples, the 

air concentration to which the Qarmat Ali soldiers were exposed could be estimated 

to be approximately 80–200 times the current OSHA limit. Why did CHPPM fail 

to explore inconsistencies in its data with that of other literature? 

These limitations call for greater scrutiny of the CHPPM results. The samples 

drawn from some of the soldiers and workers at Qarmat Ali were taken a month 

after remediation measures were taken to limit the exposure. In its draft Toxicological Profile on Chromium, the Agency for Toxic Substances and Disease Registry (ATSDR) reports that the half-life of chromium in red blood cells is 30 days. 

In other words, 30 days after the exposure has ended, we would expect to see only 

50 percent of the chromium in the volume of red blood cells that would have been 

there initially. 

Furthermore, the measurement of chromium in red blood cells is an insensitive 

method of detecting hexavalent chromium exposure. The measurement of chromium 

in the red blood cell only captures the hexavalent chromium that makes its way into 

the cell. It does not measure how much hexavalent chromium may have been inhaled and remained in the nose or lung or was reduced in the body to trivalent chromium which does not get into the red blood cell. 

It should be noted that NIOSH, in its draft update on hexavalent chromium states 

that biomarkers, which would include blood tests, are of uncertain value as early 

indicators of potential hexavalent chromium-related health effects. Nevertheless, 

CHPPM still put a great deal of emphasis on the red blood cell analyses from samples taken at least four weeks after possible exposure to hexavalent chromium. An 

analogy would be like giving a breathalyzer to a person three days after they were 

pulled over for erratic driving. The toxin would have been eliminated from the body 

in the intervening period. 

Given the limited usefulness of these red blood cell tests, they should not be used 

as a bottom line indicator of the hexavalent chromium exposure that the soldiers 

and workers experienced. And they certainly should not be extrapolated to other individuals who were exposed at Qarmat Ali. Nasal perforations, bloody noses, and 

skin irritation would be far more telling about the soldiers’ and workers’ exposure 

than measures of chromium in red blood cells taken a month after remediation has 

taken place. 

In summary, the symptoms that have been reported by the soldiers and civilian 

workers are consistent with what has been experienced by other workers exposed 

to hexavalent chromium. Judgment on whether these soldiers and civilian employees were exposed should not be based on measurements of chromium in red blood 

cells taken 30 days after remediation measures were taken, nor should such results 

be extrapolated to other individuals who were present at the facility. 

POST-HEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

HERMAN GIBB, PH.D., MPH 

Question 1. In the Baltimore study, workers exhibited symptoms between 20 and 

182 days. One-fourth of the workers who had cancer had worked at the facility for 

97 

less than two months. The Army has stated that even soldiers, such as Russell Powell, who were at Qarmat Ali for extended periods of time, were not exposed for a 

long enough amount to produce any adverse or long term health effects. Given the 

exposure period of those in the Baltimore study and the symptoms and conditions 

those individuals exhibited in that amount of time, do you agree with the Army’s 

assertion? 

Question 2. Do you believe, given Russell Powell’s length of time at Qarmat Ali, 

that his symptoms can be attributed to his exposure? 

Question 3. Given the similarities between the illnesses and the symptoms exhibited by both the Baltimore workers and the Qarmat Ali soldiers, and considering 

that both groups had a similar period of exposure, is it reasonable that the same 

unique symptoms experienced by so many Qarmat Ali soldiers could be attributed 

to other factors? What, if any, environmental or otherwise, factors could be responsible for such conditions, experienced by a number of servicemembers within the 

same vicinity? 

Question 4. In Mr. Resta’s testimony, he stated that blood tests alone were not 

the predominant indicators for exposure. Mr. Resta stated that the Army primarily 

relied on physical exams when making the final determination on exposure. Do you 

believe that a physical exam would provide a more accurate indication if an individual was exposed to sodium dichromate? What method of detection do you believe 

to be the most accurate? 

Question 5. In your research on sodium dichromate, have you ever observed a latency period between the time an individual was exposed to the chemical and the 

time it took symptoms or conditions to manifest themselves? 

[The Committee had not received the requested information by 

press time.] 

Chairman AKAKA. Thank you very much, Dr. Gibb. Now we will 

receive the testimony of Mr. Powell. 

STATEMENT OF RUSSELL POWELL, FORMER U.S. ARMY 

STAFF SERGEANT 

Mr. POWELL. Thank you, Mr. Chairman. I thank the Committee 

Members for having me testify here today and also a special 

thanks to the Veterans of Foreign Wars. 

My name is Russell Powell. I live in Moundsville, West Virginia. 

I started my military career in 1994, in the 1–505 Parachute Infantry Regiment as a medic. Later through my military career, I became a flight medic in Panama and Fort Bragg. 

In 2001, I joined the West Virginia Army National Guard as a 

medic. In April 2003—or excuse me—March 2003, the 1092nd Engineer Battalion was deployed to Iraq. From April 2003 to June 

2004, the 1092nd was assigned as security for KBR workers. When 

Charlie Company arrived at the plant, which was the Qarmat Ali 

Water Treatment Plant, it had been seriously pillaged and destroyed. 

There was a coating of orange-colored dust throughout the facility and at the time, no one knew or made any concerns of what the 

powder was. The orange dust was located in large bags that were 

ripped open throughout the facility. During my stay at Qarmat Ali, 

there were at least 10 dust storms. They would blow through the 

facility picking up dust and debris. 

At no time were myself or other soldiers or KBR workers offered 

any protective clothing, masks or respirators to keep us from the 

elements. During these storms or shortly after about 90 percent of 

the KBR workers and the soldiers would have severe nose bleeds, 

cough up blood, have a hard time breathing and experience nausea 

and burning sensations to their lungs and throat. 

98 

After a week of being at the facility, several personnel began getting skin lesions on their hands, arms, faces and nostrils. Of 

course, we also had soldiers that developed deviated—or excuse 

me—perforated septums, which cause holes through their nose 

from one end of their nose to the other. 

As a medic, I felt pretty concerned for the safety and health of 

all the persons that were sitting at the Qarmat Ali Treatment 

Plant. I talked to one of the KBR workers and I asked him what 

is going on about everybody getting real sick, getting bloody noses. 

And one of the KBR workers said their supervisor said we are all 

allergic to the dust and sand. 

Later on, there was another dust storm and I was eating an 

MRE. The storm hit me when I started eating. My lungs started 

burning. My throat started burning and I started being real nauseated and sick. The same day they said Doc, you are not going out 

to the water treatment plant tomorrow; you just stay in and go to 

the infirmary and see one of the Navy doctors. 

Well I went to one of the Navy doctors at Camp Commando in 

Kuwait and he pretty much said oh, you are sick. You just got a 

viral infection. But I went to a bomb shell bunker and tried to give 

myself an I.V. because I knew I was—there was something really 

wrong. After I went to that bomb shell shelter and tried to administer an I.V., I do not really remember anything. 

I woke up in the hospital, The Kuwaiti Soldiers Hospital. There 

was a couple of Navy soldiers that found me and they said, I was 

just coughing up blood and delirious. Well, I spent a week at the 

Soldiers Hospital. My face and lips were burnt, yet I was not out— 

exposed to any sun. It was pretty much from the dust. 

I got out of the hospital, but—excuse me—at the hospital, the 

doctor said that they did not really know what caused my face and 

lips to be burnt as bad as they were. They went ahead and just 

gave me a bunch of antibiotics, sent me back to Qarmat Ali. 

When I got back to Qarmat Ali, there were a bunch of soldiers, 

a bunch of my soldiers complaining of the same symptoms that I 

had when I went to the Kuwaiti hospital. Of course, I gave them 

antibiotics because we did not have physician. We did not have a 

physician assistant, so I pretty much became the doctor for the battalion. 

In June 2003, Indiana National Guard soldiers relieved us from 

our duties from Qarmat Ali. At no time did any of the 1092nd from 

the West Virginia National Guard get tested for any exposure to 

chemicals, blood drawn or anything; or even told about it. When I 

left Iraq in April 2004, I went to the VA Clinic in Clarksburg, West 

Virginia, and talked to them about my skin rashes, stomach problems, and nose bleeds. The doctors were unable to determine what 

was the cause of these problems. 

In 2009, I received a letter from the West Virginia National 

Guard stating that we were possibly exposed to sodium dichromate 

while serving at Qarmat Ali. The VA doctors believed this could be 

the cause of our health issues, but because they know little about 

sodium dichromate, they are still researching, trying to figure out 

the effects of it on the human body. 

I would like to thank Senator Rockefeller and his staff, and especially the VFW, for giving soldiers and veterans much needed supVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00104 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
99 

port through the VA system in West Virginia. Once again, I thank 

all of you for having me here today. 

[The prepared statement of Mr. Powell follows:] 

PREPARED STATEMENT OF RUSSELL POWELL, FORMER U.S. ARMY STAFF SERGEANT

I’d like to thank you for having me here at this Senate hearing. My name is Russell Powell, I reside in Moundsville, West Virginia. I started my military career in 

January 1994; I was assigned to the 82nd Airborne Division as a paratrooper infantry medic. In 1997 I was reassigned as a flight medic at Howard Air Force Base 

Panama City, Panama. In 1999 I was again reassigned to 57th Dust off at Fort 

Bragg, North Carolina. August 2000, I was discharged from the army and in April 

2001 I joined with 1092nd West Virginia Army National Guard as a medic. The 

1092nd was deployed to Iraq in March 2003. In April 2003 to June 2004 1092nd 

Charlie Company was assigned as security for the KBR Contractors, my duties consisted of battalion medic and supplied defensive positions and cover fire if needed 

to protect KBR contractors at Qarmat Ali Water treatment plant in Basra, Iraq. 

When Charlie Company 2nd platoon arrived at the plant it was in total disarray 

and had been severely pillaged and destroyed. There was a coating of orange colored 

dust throughout the facility. At that time no one knew or made any concerns of 

what the powder was. The orange dust was located in large bags that were ripped 

open, causing the dust to be spread all over the facility. At times the orange dust 

was so thick there were at least two inches of dust on my boots. During my stay 

at the QA there were at least ten dust storms, they were like tornadoes blowing 

through the facility picking up the dust and other debris. At no time were we offered any kind of protective clothing, masks, or respirators to protect us from the 

elements. During these storms or shortly there after soldiers in the company, KBR 

workers and myself would have severe nose bleeds, coughing up blood, a hard time 

breathing, nausea, and/ or a burning sensation the lungs and throat. After a few 

weeks of being at the facility several personnel began getting lesions on their hands, 

arms, faces and nostril area. As a medic I felt very concerned for the safety and 

health of persons exposed. I questioned one of the KBR workers (I have forgotten 

his name), and he told me that his supervisors told him not to worry about it, that 

we were allergic to sand and dust. Shortly there after, there was another severe 

dust storm I ate an MRE (meals ready to eat) and my throat and stomach began 

to burn like nothing I have felt before, my nose began to bleed, and was nauseated. 

After this particular storm I was severely sick to the point that when we returned 

to Kuwait City, Kuwait (Camp Commando) I was told that I was not going out on 

the mission the following day. 

The following day I went to the Infirmary at Camp Commando, and was seen by 

a Naval Doctor. After a brief examination he dismissed me as being sick and prescribed me Motrin and Tylenol. Approximately thirty minutes later I went to a 

bombshell bunker to give myself an IV, a couple soldiers found me I was delirious 

and coughing up blood. I do not remember anything until waking up the following 

day in the Kuwait Soldiers Hospital. My face and lips were burnt and my throat 

was sore to the point I couldn’t swallow anything. I was there for almost a week 

getting antibiotics intravenously. The doctors had no explanation why I was sick or 

why my face and lips were burnt so badly. The day I was released from the Hospital 

I returned to Qarmat Ali with Charlie Company 2nd platoon. Upon my return to 

QA numerous soldiers were complaining of the same symptoms I was experiencing. 

I prescribed those soldiers antibiotics, however the symptoms persisted. At the end 

of June 2003 the Indiana National Guard relieved us of our duties. Our unit moved 

into northern Iraq. The nose bleeds subsided a little, but the nausea was still 

present daily. 

After leaving Iraq in April 2004 I went to the VA Clinic in Clarksburg, WV to 

talk to the doctors about my skin rashes and lesions, stomach problems, and nose 

bleeds. The doctors were unable to determine what the cause is of these problems 

were. In 2009 I received a letter from the WV national Guard stating we were possible exposed to Sodium Dichromate while serving at QA, and the VA doctors believe that this could be what’s causing my health issues, but because they know little about Sodium Dichromate they are researching and trying to figure out the affects of it on the human body. I know for a fact that Sen. Rockefeller is giving veterans and soldiers alike, much needed support through the VA system in WV. 

Once again I would like to thank you all of you for hearing my testimony. 

Chairman AKAKA. Thank you very much, Mr. Powell, for your 

testimony. I would like to say thank you again to our first panel. 

100 

Many of you have given heartfelt testimony regarding some very, 

very personal issues that have affected your lives. 

I know I speak for the entire Committee when I say that we appreciate your presence here today. I would like to ask my question 

to four of our witnesses, Mr. Partain, Mrs. Pennington, Ms. 

Paganelli and Mr. Powell. 

Are you satisfied with the military’s response to each of the exposures you or your family member was affected by, including highrisk lists or high-risk health problems? Mr. Partain? 

Mr. PARTAIN. As far as the military’s response to my exposures 

at Camp Lejeune, I would say no. I was diagnosed with male 

breast cancer in April 2007. My wife found the disease when she 

gave me a hug before bed one night. Two months later, I discovered 

that I had been exposed in the womb while at Camp Lejeune. I had 

no knowledge of my exposures until then. It just happened that my 

father was watching a newscast and saw a hearing about Camp Lejeune and that is how I became aware of this. 

Chairman AKAKA. Ms. Pennington? 

Ms. PENNINGTON. Actually, we were disappointed with the doctors at Duke University for orally citing the reasons for my brother’s aggressive AML. When pushed, again, they admitted it was 

definitely due to chemical exposure, but they could not prove it and 

there was some pushback that they received from the military 

there at Fort Bragg. I do not know the details to that. They would 

not elicit any further. 

I can tell you the Bumpus family, no, has not received any assistance from the VA or military because Matt ended his service 1 year 

after—or the disease came to light—1 year after his service. So, the 

VA has harshly denied the connection between the AML, his service in Iraq, and where he was stationed in Balad. 

So no, they are not receiving any benefits from the VA or military and are completely dissatisfied. 

Chairman AKAKA. Thank you. Mrs. Paganelli? 

Mrs. PAGANELLI. Thank you. I would say on behalf of Atsugi residents, or past Atsugi residents, no, because I really strongly believe 

there needs to be an accurate registry and so many families are not 

informed. I just really would like there to be a registry for these 

families and benefits for those who, further down the line, need 

them; some acknowledgement for that. Thank you. 

Chairman AKAKA. Thank you. Mr. Powell? 

Mr. POWELL. I think the Army did, or the Department of Defense 

did kind of lack an acknowledgement that we were even exposed 

later—about 5 years later—after we returned home. It was kind of 

an eye opener I will tell you. I guess we go to the VA and the VA 

has no idea what is going on with us, and they still are kind of 

timid on what to say, whether it was exposure or anything like 

that. They just are just trying to back away from it. 

So, we are all pretty disappointed. We are on a registry, but the 

registry to us still does not say that you guys were exposed; and 

a lot of the soldiers who tried to put in claims for the chemical exposure got denied. 

Chairman AKAKA. Dr. Gibb, how well do you think the Army understood the scientific literature associated with the exposure at 

Qarmat Ali? 

101 

Mr. GIBB. I do not think they understood it very well at all. Their 

statements by CHPPM that—well, they put a great deal of emphasis on the blood tests and the blood tests at that period of time 

were essentially worthless. 

As to how much exposure they could have had, they could have 

had fairly high exposure that might not have even have shown up 

in the blood test. They made a statement in their report that some 

people exposed to very high exposures for more than 2 years had 

developed lung cancer, but that is not—I think at the time in 2003, 

the leading study, and I hope to say this with modesty, was my 

study on chromium—sodium dichromate exposure. That would 

have told them that we had people exposed for less than 2 years 

that developed lung cancer. 

And also the statement about that most of the—98 percent of the 

samples were within or below the limit of detection, yet they could 

tell you that the exposure was between 5 and 8 micrograms per 

liter. I do not know how they could say that. I mean, I do not know 

what that means. 

I have shown that to other Ph.Ds and M.D.s; they cannot understand it. I mean, if M.D.s and Ph.Ds cannot understand what they 

are telling you in their fact sheet, how is the soldier who is not 

trained to understand these supposed to understand it? 

So, I think that the information—I mean, I have put together 

these kinds of fact sheets at the Environmental Protection Agency 

and press releases and it is important not to scare people unduly. 

But, it is also important to put the correct information out there 

and I do not think they did that. 

Chairman AKAKA. Thank you, Dr. Gibb. I now turn to Senator 

Burr, for his questions and we will follow that with Senator Rockefeller. 

Senator BURR. Thank you, Mr. Chairman. Dr. Feigley, your subcommittee was asked, number 1, to review the adequacy of the 

methods used to assess risk, the uncertainties identified, the risks 

to susceptible subpopulations such as pregnant women, young children, the scientific validity of the conclusions drawn. Number 2, 

recommend, depending on the evaluation, research to fill data gaps 

and options for mitigating the risk associated with exposure to incinerator emissions. 

Was the NRC subcommittee asked to review the final NEHC 

report? 

Mr. FEIGLEY. No, not to my knowledge. I will have to pass that 

off to some other folks back here from the NRC, but our committee 

was not asked, let me put it that way. 

Senator BURR. So, the subcommittee’s recommendations—you do 

not know whether any or all of the recommendations were taken 

into account from the draft report to the final report? 

Mr. FEIGLEY. I do not. 

Senator BURR. OK. Let me ask you, if you contracted with the 

NRC—if you were not on the subcommittee and you were going to 

contract with the NRC for that particular site, would you have limited the NRC review to the scope that the subcommittee was limited to? 

Mr. FEIGLEY. No, and in fact, I think we say in the report that 

we thought that the Navy should have used the NRC to review 

102 

their plans for doing their sampling. We recommended they do a 

comprehensive sampling at the base, a comprehensive risk assessment. However, I think they should have asked us to—us being 

NRC, not—I am not part of NRC, but I am just a volunteer. But 

I think they should have asked NRC to actually review their plans 

for doing the sampling because then I think a lot of things that we 

had—the negative things that we said about their report would 

have been said before they did the study and they could have corrected them. 

Senator BURR. Therefore, it is pretty difficult to believe that you 

could go back and reconstruct without reviewing in total the risks? 

Mr. FEIGLEY. There are some bright spots in what we saw that 

we thought perhaps further analysis might have revealed, especially some of the air quality modeling and the correlation between 

air quality modeling and the measurements that they did on the 

facility that could have revealed some things. 

Senator BURR. Let me get into thresholds and then Dr. Gibb, I 

am going to turn to you for your prior work—the 26 years at EPA. 

Mr. GIBB. Twenty-nine. 

Senator BURR. Twenty-nine, excuse me. Thank you for that service. An observation question. Is the threshold for risk at EPA different than the threshold for risk at the NRC? 

Mr. GIBB. I do not have an answer to that question. I mean, 

there is—— 

Senator BURR. Let me ask it in a different fashion. If it were different, would you find that to be a flaw? Shouldn’t the threshold 

for risk at both—which both assess the risk on a human population 

and U.S. population—shouldn’t that be the same? 

Mr. GIBB. That is a rather tricky question. 

Senator BURR. Well let me ask it in a more specific way. Should 

the NRC look at benzene differently than the EPA does? 

Mr. GIBB. I think the answer to that is no; I do not think they 

should look at it differently. 

Senator BURR. OK, I just wanted to clarify that. Now, Dr. 

Nuckols, before I ask you a question, I would like to ask the Chairman, after the NRC issued its report on Camp Lejeune earlier this 

year, other experts—including Camp Lejeune Community Assistance Panel, a group of five scientists, and the National Resource 

Defense Council—released documents criticizing the report. I would 

ask unanimous consent to include copies of those documents in the 

hearing record. 

Chairman AKAKA. The documents will be included. 

[The information referred to can be found in the Appendix.] 

Senator BURR. In one of those documents I just mentioned, Dr. 

Nuckols, it was noted that the National Research Council’s Hazard 

Evaluation in the Camp Lejeune report, and I quote, ‘‘did not take 

into account that benzene and vinyl chloride were contaminants in 

drinking water at Hadnot Point or Tarawa Terrace.’’ 

I guess I would ask you, is that accurate and can you explain 

benzene and vinyl chloride; what they are and what NRC sees as 

their hazard? 

Mr. NUCKOLS. First of all, hazard evaluation, in my mind, has 

a very specific definition and there is a portion of the report in 

103 

which a hazard evaluation was conducted. Is that—I just want to 

make sure that is what you are referring to? 

Senator BURR. Eventually where I am going to get to is that the 

basis of what the NRC subcommittee found, and I am reading out 

of your testimony, it says, ‘‘to evaluate the potential health effects 

to exposed residents, the committee undertook four kinds of reviews to determine what kinds of disease and disorders have been 

found to result from exposure to TCE and PCE, not to benzene or 

vinyl chloride.’’ 

So, the obvious thing is, did you take into account when you were 

assessing the risk to individuals exposed on the base to the groundwater contamination to the two chemicals of benzene and vinyl 

chloride? 

Mr. NUCKOLS. In the hazard evaluation that was conducted by 

a subset of the committee, which I think was in the toxicology subgroup that I mentioned, I do not think that benzene or vinyl chloride were considered. 

In the overall report, the charge, in my understanding and I 

think the majority of the committee, was the underlying words ‘‘a 

causative relationship.’’ The process that we took toward that 

was—in my group, which is in my summary, I pointed out—was to 

try to make a determination of the extent of chemical contamination, where it was, what chemicals, and so forth. 

In the initial work of the committee, a lot of focus was made on 

PCE and TCE because they had been the principal contaminants, 

the primary contaminants that were the focus of the ATSDR study 

and their risk assessment. 

Senator BURR. So, can I conclude from what you are saying that 

you did not assess in the same manner benzene and vinyl chloride 

as you did TCE and PCE? 

Mr. NUCKOLS. It was not included in the hazard evaluation. I am 

fairly certain of that. Where I was going with my response was 

that in the exposure assessment group we came across more information about benzene being—occurring—in the aquifer; that there 

were samples there that would lead us to believe that there was 

exposure. 

Our job, if you want to think of that group, that subgroup, was 

to provide chemicals to the toxicologists and the epidemiologists for 

their evaluation and we did, I think, include those, although they 

were not as rigorously examined as PCE and TCE. 

Senator BURR. Listen, I am in full agreement with you. The limitations that were on the NRC are prescribed in what you have 

been asked to look at and I think Dr. Feigley just confirmed that 

in another study. So, can I conclude that review of toxicology studies, epidemiological studies, and conduct of a hazard evaluation did 

not take place for benzene and vinyl chloride in the same fashion, 

if at all, as TCE and PCE? 

Mr. NUCKOLS. The procedure that was used by the epidemiologists and the toxicologists was to review published studies of 

whether there was causation between these chemicals and disease. 

They left it open pretty much to what was out there in terms of 

what we knew about the relationship. 

104 

To my knowledge, both benzene and vinyl chloride were considered in that way. They were not considered in the hazard evaluation that is published in the report. 

Senator BURR. I would only point this out that—I think this is 

at the root of part of the misunderstanding, was it or wasn’t it? I 

would even think that if it was, it would be in your testimony. It 

would be stated clearly in the report. But you only referenced TCE 

an PCE and there are these two other chemicals that I think Dr. 

Gibb would agree, are known carcinogens that under any study of 

the adverse health effects of contamination you could not exclude. 

And if you came to a conclusion that they play no part, it would 

be a need of the report to explain why because the EPA’s own scientific information says that there is a direct cause to benzene and 

vinyl chloride contamination. 

Mr. NUCKOLS. Can I respond to that, sir? First of all, I think that 

if you end the report, we do specifically list benzene and vinyl chloride as being—— 

Senator BURR. Present. 

Mr. NUCKOLS [continued]. Contaminant—well not just present, 

but contaminants of concern, chapter two. Read the conclusions of 

chapter two, Contaminants of Concern, and there is, in my mind, 

no place in the report that says these should not be studied; that 

they are not an issue. It is not there. 

There is, in fact, information about what studies are out there 

on benzene and vinyl chloride in—I think it is in the appendix to 

the study and that was because—and I agree, it was late coming 

on board in the time period that we were working on the report as 

to whether or not it was an issue of concern. ATSDR in their first 

risk analysis said that benzene was not of concern. 

But I think one of the important things that is overlooked in this 

report is that we have identified contamination and chemicals that 

were previously maybe not looked upon as being primary contaminants of concern at Camp Lejeune. 

Senator BURR. The Chairman has shown me great latitude and 

if the Chairman would allow me to ask one more question, I will 

not have to go to a second round. Unless the Chairman intends to 

go to a second round, I will wait. 

Chairman AKAKA. I Intend to do a second round. 

Senator BURR. You—no, go ahead, Jay. 

Chairman AKAKA. Go ahead. Continue with your question, Senator Burr. 

Senator BURR. I did not want to neglect Mike, since he is directly 

affected by Camp Lejeune. Mike, let me just ask you, what actions 

would you like to see Congress, the Department of Defense, and/ 

or Veterans Affairs do with regard to the exposures you are faced 

with and others have been faced with at Camp Lejeune? 

Mr. PARTAIN. Before I answer that, may I interject something on 

the previous conversation you were having with Dr. Nuckols? 

Senator BURR. Yes, sir. 

Mr. PARTAIN. Dr. Nuckols was referring to ATSDR’s work—that 

they had relied on ATSDR, he started to say, I believe, regarding 

the public health assessment. One thing I would like to point out 

concerning both ATSDR’s public health assessment and the work 

that the National Resource Council did with Camp Lejeune, was 

105 

that they had incorrect data concerning the benzene and vinyl chloride. 

More importantly, ATSDR, in their public health assessment, did 

not address benzene and that was one of the reasons why that document was basically withdrawn from public view in April of this 

year. So, they did not evaluate benzene with the correct data and 

that data was not given to the NRC. They, even in their tables, 

have the incorrect levels for the—they omit the July 1984 readings. 

To answer your question, we would like to see a full disclosure 

of what transpired at the base relating to the drinking water contamination. To accomplish that would mean the full cooperation of 

the Department of the Navy and the U.S. Marine Corps by disclosing all documents, plus full funding of all ATSDR’s initiatives 

concerning the Camp Lejeune studies. 

With the existence of documented exposure levels, any person 

who is now or was suffering from the effects of their exposures at 

Camp Lejeune, they should be giving medical care or compensation 

for their past suffering and disabilities. And for those who have lost 

loved ones, they should be afforded restitution. 

Senator BURR. Mr. Chairman, I want to again thank you for 

what I think has been a very insightful panel. I want to thank the 

witnesses for their very personal testimonies, the experts that we 

have, for their insight and knowledge, and the Chair for his indulgence. I apologize to Senator Rockefeller. 

Chairman AKAKA. Thank you, Senator Burr, for your questions. 

Now let me call on Senator Rockefeller for his questions. 

STATEMENT OF HON. JOHN D. ROCKEFELLER IV, 

U.S. SENATOR FROM WEST VIRGINIA 

Senator ROCKEFELLER. Thank you, Mr. Chairman. I will submit 

my statement for the record and go directly to questions. 

[The prepared statement of Senator Rockefeller follows:] 

PREPARED STATEMENT OF HONORABLE JOHN D. (JAY) ROCKEFELLER IV, 

U.S. SENATOR FROM WEST VIRGINIA

I want to thank the Committee for convening this important hearing. We have 

a responsibility to make clear to the DOD just how important it is to prevent exposures when possible, and to work with the VA to immediately notify and provide 

care for our veterans if they have been exposed—as soon as possible, not years after 

the fact. 

I am very proud that a former Staff Sergeant and medic in the West Virginia 

Army National Guard, Russell Powell, is here today, willing to step up and talk 

about his personal experiences as hard as that may be. The fact that his West Virginia National Guard Unit was deployed to Basra to provide security for contractors 

at the Qarmat Ali water treatment plant is part of the tough job our troops face. 

The fact that they were not warned of or protected from exposure to Sodium Dichromate—a dangerous chemical—is an enormously serious problem. 

The exposure was not public in West Virginia until this year when I learned of 

the problem. I wrote both the Secretary of Defense and the Secretary of the Department of Veterans Affairs for information and a report on what was being done to 

help exposed veterans. 

We have been here before. In 1993, as Chairman of the Senate Committee on Veterans’ Affairs, we investigated the possible causes of what was then referred to as 

‘‘Gulf War Syndrome.’’ 

I was deeply disturbed by senior Pentagon officials’ dismissal of serious health 

concerns then, and I am enormously worried today, that we may continue to get 

that same approach from the Pentagon. Even after it evaluated the site at Qarmat 

Ali, the Department of Defense failed to notify exposed National Guard members 

on time. 

106 

This much is clear: DOD and its contractors have failed to meet their responsibility to our men in uniform. They have failed to be honest and forthright about 

the risks. And they have failed to do everything within their ability to reach those 

exposed. 

Qarmat Ali took place in 2003: we still do not have all the answers and we still 

have not reached all of the guardsmen. Six years is simply unacceptable. 

While DOD couldn’t find and notify many West Virginia guardsmen, my staff 

worked with a number of executive branch agencies in collaboration with Secretary 

Shinseki to try to forward critical information to exposed West Virginia Guard members they had on file. 

But it should not require a U.S. Senator and his dogged staff to get this information to the men and women who need it so urgently. 

However, VA testimony suggests that the Department is taking the Qarmat Ali 

exposure seriously and working to revise the testing in the VA registry and considering how it will handle claims for benefits and care. (See October 8, 2009, letter 

and Attachment from Secretary Shinseki that follows.) This is promising, and my 

staff and I will monitor each effort carefully to be sure the Russell Powells and their 

colleagues get the care and support suggested and earned. 

This has been a cornerstone of who I am as a person and as a legislator throughout my career and I will never stop the fight for our men and women who serve. 

With so much at stake, we must share the truth as soon as possible. Only then 

can we continue to track and learn about the illness to provide our veterans the 

care they have earned and deserve, the best care possible. 

107 

ATTACHMENTS


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Senator ROCKEFELLER. I want to focus on you two, but I want to 

do it in a different fashion. Senator Burr’s questions were so good 

because they were so specific—related to different toxins and the 

effect and what was included in this study and that study. 

What fascinates me but angers me so much is that as I said— 

and you will remember this, Russell, from our August hearing—is 

there is such a direct comparison between this and the Gulf War 

Syndrome: the denial on the part of the military, their refusal to 

not only respond to soldiers whose lives are being shredded, could 

not sleep, could not keep marriages, could not get jobs, could not 

read newspapers because they were being told to take a pill which 

had never been cleared by the FDA for animal use much less for 

human use to protect them from what they thought Saddam HusVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00114 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN

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109 

sein was going to do. And it turned out actually that it was the 

wrong pill anyway. It was for the chemical he did not have. 

But that is another matter. But the refusal—I want to get into 

the military culture. I know the military is in the next panel. I am 

not going to be here on the next panel. But you are a medic, Russell, and you are a good one. You have been through this, you 

come, you testify, and you tell us what you are going through; and 

you have seen the letter from Eric Shinseki that he sent this 

morning. 

Mr. POWELL. Correct. 

Senator ROCKEFELLER. Which has some promise to it. He says he 

is going to give full pulmonary tests, and in West Virginia we have 

discovered all of those people who were not on the registry or were 

not yet found. In Indiana, I am not sure they have. They have a 

lot more of them, but I am not sure they have discovered all of 

those. 

But when you got into that situation with the orange dust and 

being a medic with some stature, you went over to that place to 

lie down and try and give yourself an I.V. and all the rest of the 

story, it says something about a soldier’s—well, first of all, it says 

something about the military’s inability to deal with something 

that might either be embarrassing for them or for which they cannot explain, perhaps because they are busy fighting wars, which is 

a rather large task. 

On the other hand, there are people who are doctors and who 

have medical responsibilities in the military who are not fighting 

wars; they are taking care of soldiers. There is something which 

prevents—and I have heard this in other sessions about other types 

of problems—soldiers taking on the military even as they suffer. 

I want to talk about that for a moment. From your point of 

view—first of all, I understand the chain of command. I understand 

that from my point of view this is kind of redundant. You went 

through this in 2003? 

Mr. POWELL. Correct. 

Senator ROCKEFELLER. And nobody discovered what you had 

until 2009. What is the culture problem we are dealing with here? 

Mr. POWELL. I do not think the Army knew fully—was fully 

aware of the chemicals being on the ground through KBR not actually providing them with that information. But the Army could 

have told us a little bit sooner whenever they did find out, in August 2003, but they did not. They did not tell any of the soldiers. 

There is a soldier that I talked to who is a government employee 

who just found out recently that he was one of the guys exposed 

to chemicals. He is a government employee and they were saying 

they could not find this gentleman. This is the Department of the 

Army saying they cannot find him. 

Well, one of the high-ranking officers from West Virginia was on 

an aircraft with him, this was a month or two ago, and still that 

individual—because I cannot really tell you what he does for the 

government, but he was talking to one of our generals. He told the 

general that he was in the 1092nd Charlie Company and the general did not say well maybe you might want to look at this or look 

at that. He was just dumbfounded until we linked up with that individual through e-mails while trying to find all of our soldiers. 

110 

Because we are trying to do our best to find out where our people 

went and give them the heads up on their actual medical problems, 

assuming a lot of them are having medical problems and just didn’t 

know why. When you go to the VA or anything like that, it is so 

horrible because you say you are a medic, a flight medic, they kind 

of look down on you in a sense because they say well, you already 

know everything Mr. Know-it-all. That is how most of the physicians act. 

We are not even trying to do that. We are saying hey, this is 

what is wrong with me. I am pretty sick. I am not faking the funk 

with you. I was doing medicine for a lot of years. I am not trying 

to get over on you. 

It is real frustrating because they are just kind of brushing us 

off. 

Now there are a few doctors that are really concerned and are 

actually trying to figure out the problems relating to those chemicals, but most of them at the VA just kind of brush me off. It is 

really a hard obstacle to get through. 

Senator ROCKEFELLER. Dr. Gibb, do you have any thoughts about 

that? Why is it that people, strong men like Russell, cannot—they 

look down at a medic—some doctors are good, some doctors are bad 

or whatever? 

I mean, for heaven’s sakes, they knew they were going to send 

you to this camp, to Qarmat Ali, and therefore, they had to have 

been there. Therefore, the fact of there being some orange dust 

must not have escaped them unless they were color blind. So, I do 

not understand that. 

There is a lack of thoroughness or a lack of concern, a lack of 

care. I mean, if you saw the orange dust, knowing what you now 

know and knowing what the world now knows 6 years later, it is 

not very complicated to me. They were entering into a risky environment and chose not to know about it, not to warn about it, not 

to take steps to clean it up or to do whatever. 

Now Dr. Gibb, do you have any thoughts on that? 

Mr. GIBB. I think they had a significant exposure there. I mean, 

some of the soldiers described it looking like orange powered 

donuts and it was all over the ground. Statements of the soldiers 

at the previous hearing indicated that it was everywhere. 

I think that—and the bags read sodium dichromate. It was not 

like guessing. So, they should have known and it should have been 

reported. Again, I do not think there was a good understanding of 

what sodium dichromate was or what its effects were. So, I think 

there was a significant exposure that should have been addressed 

immediately, as soon as they learned what it was. 

I think that there was just—I feel like it was dealt with irresponsibly. I cannot think of a better word. 

Senator ROCKEFELLER. Let me be a little tougher about it then. 

Doesn’t the military have a responsibility, particularly when you 

are not in a huge situation which varies a lot like the second world 

war or the first world war, you know, like those, instead you have 

a particular type of territory where there are certain factors which 

are common for all of that territory—Basra, I guess, was where you 

were—and then there is this orange dust. I do not understand that. 

111 

I do not understand why, if there are doctors who are in charge 

of the health, are they not in the deployment decision process in 

any way? Are they left out until somebody does get sick? Is there 

anybody here who can answer that question? 

Mr. GIBB. Again, I think that the knowledge of industrial hygiene is critical. I mean, you could recommend pre-deployment 

physicals and post-deployment physicals and all those kinds of 

things, but if you do not understand what substances you are dealing with, those kinds of physicals are not going to get the kind of 

information that you need. 

So, I think this was a lack of understanding of the industrial hygiene, the environmental health, and then the follow-up to that 

was, it was just sort of like do not worry about it, it is OK. That, 

to me, is just—I do not want to say unconscionable, but I think it 

is—this is a very serious substance. This is a very potent carcinogen. This is a very irritating substance. You do not have to look 

very far to find information about the effects of sodium dichromate. 

It is not some arcane chemical that we do not know about. We 

have known about the carcinogenicity of sodium dichromate since 

the early 1950s when the Public Health Service did a study of all 

the chromium production plants in the United States and reported 

huge lung cancer risks from the substance and the irritation of it. 

So, it has been known for a long period of time. 

I think, first, not having the knowledge to say well, we have soldiers in the facility and they are using this particular chemical, it 

is called sodium dichromate. What is sodium dichromate? Then you 

have to take steps to address that. I mean, this particular situation 

with the thousands of bags was that of 100-pound bags broken out, 

open and the dust blowing all over the place and everybody reporting orange dust. That should have been cause to say, this is a serious situation; we need to do something right now. 

And then to follow up to say, well, sodium dichromate is not that 

bad. You have to be exposed for high concentrations for about 2 

years to get lung cancer. Do not worry too much about it, the blood 

tests do not show anything. The blood tests essentially were worthless at that point. 

Blood tests might have even been worthless when they were 

being exposed because it takes a fair amount—it takes a large 

amount of hexavalent chromium to show concentrations in the 

blood. So, I think that the follow-up, the organization going into it, 

was inadequate. The follow-up was inappropriate. I mean, the soldiers deserve better than that. 

I think I would say what happened was a disservice to the soldiers. Disservice is putting it mildly. It was wrong. 

Senator ROCKEFELLER. It is shocking. It is just shocking. I have 

said before, maybe the last time, the very first Veterans’ Committee meeting I ever attended 25 years ago, there was a soldier 

who had been sent into that part of the Pacific where they were 

testing the atomic bomb. He described what it was to be dying having served your Nation, having followed orders way back then, 

when things were I guess a lot more primitive, but maybe not. He 

said it is just an amazing feeling to have your government say to 

you, well you cannot prove that your cancer was caused by your 

being in at that time, when we all know—and if you are a West 

112 

Virginian like Russell Powell, you know if you have been in a coal 

mine for 10 years you have Black Lung; you just have it. You do 

not need proof of it, you have it. There is a presumption of it. 

But we make the soldier prove everything, and then along comes 

Agent Orange. I was at that hearing when Admiral Zumwalt—nobody was paying any attention to Agent Orange. People were dying 

all over the place of the same thing, cancer. But when Admiral 

Zumwalt came up there and testified and said that his son had 

died or was in the process of dying from cancer, oh, then everybody 

got really alert and we started making good, so to speak, on people 

who had Agent Orange exposure. 

That is the wrong way to do things. The military is meant to 

know that stuff. And then we had the Gulf War Syndrome, which 

the military took I think something like 17 years to admit that 

they were wrong. We did a lot of studies and a lot of investigation 

on that when I was sitting in Dan Akaka’s seat. But they did not 

pay any attention. 

That same infuriating indifference to soldiers, meaning assuming 

that soldiers would be making excuses as opposed to soldiers having real medical problems that they had not taken the time to disclose because the order of battle may be presumed to be more important. But on the other hand, these are doctors and they are ignoring the symptoms. They are writing us letters saying, take an 

aspirin and go home, or you have a virus, go home, sleep, get some 

good sleep. It makes me mad. 

What scares me is that I do not know that the culture has 

changed. Now I get this letter from Shinseki, which you have seen, 

Mr. Powell, and I think you and I both think it is pretty good— 

that involved Guard members who have had an initial examination 

will be recalled and will have a complete exposure assessment as 

well as a more targeted physical examination and ancillary testing 

looking for indications of health outcomes that may be relevant to 

hexavalent chromium. 

Those who have yet to enroll in the Gulf War Registry—I like 

that part—will get this targeted examination, initially. They will 

also receive a chest radiograph and pulmonary function testing and 

that will be repeated every year and then every 5 years. 

So, I think the Veterans Administration—you know, I am a fan 

of Shinseki. I have no problems saying that. But he is on the receiving end of this. The doing in was with the military and I do 

not get why they do not learn. Maybe I am wrong, but until somebody shows me I am wrong, I am just mad. 

Please. 

Ms. PENNINGTON. Senator Rockefeller, I would just like to add 

what I neglected to mention when Chairman Akaka asked me if we 

were satisfied with what the military and the VA did with Sergeant Bumpus and my brother, Staff Sergeant Ochs. I need to tell 

you that my brother, upon return from his third tour in Iraq in the 

end of April 2007, suffered from flu-like symptoms almost immediately. 

He went to Womack Hospital at Fort Bragg, NC, three times. 

The doctors did exactly what you just said. They said you have 

some type of virus. They sent him home with 800 milligrams 

Ibuprofen. So, it was not until September 2007 when he had to get 

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special permission to be seen by a private hospital where the private hospital actually discovered that my brother had AML. 

I would also like to add that Sergeant Bumpus had a private doctor, Dr. Tim Grennan, do a chromosome analysis on the initial 

blood drawn before Matt underwent chemotherapy. He discovered 

chromosome mutations that would only happen if he was exposed 

to chemicals and this was something that you would see only after 

one receives chemotherapy. 

So, I just wanted to go on record and let you all know that. 

Thank you. 

Senator ROCKEFELLER. Well, Mr. Chairman, I have over—well, 

the timer has just gone flat to 0.00, so I guess I am in real trouble. 

But those of us in Congress get military health care and we go 

down a few flights from here to get it. There are a lot of doctors 

and Bethesda Naval Hospital available to us for whatever. 

It would be sort of nice and sort of important if your family and 

friends seeing your situation all felt like you could get the same 

thing. I have no reason to think there is anything that we are 

doing here more important than what your loved ones were doing 

and what you were doing in terms of the welfare of the Nation. Dr. 

Miller, please. 

Dr. MILLER. You know, I think when a soldier finds himself in 

a combat situation, there are a lot of unknowns and some things 

you cannot anticipate. But in the group that I have taken care of, 

there was a clear danger after it was identified and I thought that 

there was dissemination of inaccurate information to downplay 

what happened. 

For example, there was a memo sent out to the soldiers exposed 

in the 101st Airborne that said sulfur dioxide is not a problem. It 

has no known serious side effects and it is not a carcinogen. They 

had measurements that the levels were toxic, well above the military’s baseline of 13 parts per million, and they found them as high 

as 120 parts per million. 

Then there was a second report out from the 62nd Medical Brigade Preventative Medical staff that said that you would only have 

problems if you were exposed to 400 to 500 parts per million, which 

would do us all in. I think that there are things that you cannot 

anticipate, but when you do identify them, you have to make sure 

that the disseminated information is accurate. 

Senator ROCKEFELLER. OK, well I have gone way over my time, 

but I guess this letter, I do not know if it is available. I mean, it 

came in today. Ordinarily, I would be cynical and say well that is 

good timing, but I am not in this case because it is from General 

Shinseki and I think he is trying to do the right thing. 

There has always been a lack of coordination between the Department of Defense and the VA. One does everything on paper 

and the other does everything on IT medical records. It is a terrific 

health care system. I do not know how they coordinate. I do not 

know what has changed. 

Americans by nature react to episodes and then we sort of forget 

them. It is like—a little bit like when we go to war. We go to war, 

we win it, we tie, we lose it, or whatever; then we come home and 

sort of let everything military deteriorate. I just think in the case 

of the care of veterans, it would be nice if we had more activity on 

114 

the front end rather than waiting to have the VA try to clean up 

what the military failed to do, and that is just my point of view. 

I thank the Chair and I thank all of you, a lot. 

Mr. PARTAIN. Mr. Chairman, if I may. 

Chairman AKAKA. Mr. Partain? 

Mr. PARTAIN. When Senator Rockefeller was discussing the orange dust in Iraq at the facility out there and heard about the 

Atsugi Air Station in Japan, it befuddles the mind. It is almost like 

common sense: there is orange dust; someone should look into it. 

I know in our case at Camp Lejeune, our issue was solvents in our 

drinking water and in our research through the documents we 

came across an order, a Marine Corps order from the commanding 

general of the base, which identified organic solvents as a hazardous material and further stated that improper practices and disposal practices create hazards such as contamination of drinking 

water. 

From the very beginning, from the first public announcement in 

1984, to the residents and personnel aboard Camp Lejeune, the 

Marine Corps has maintained that they were in violation of Federal and State regulations. What they have failed to tell the public 

and everybody was that they were in violation of their own orders. 

This order I am referring to dates back to 1974 and it is the third 

order in a series. We have not found the other two. They have not 

been produced, but we suspect they may go back to the early 

1960s. It just almost seems like common sense. Organic solvents, 

they are listed in there as something that is hazardous, and then 

if you dispose of them improperly, they are going to end up being 

in the drinking water. 

Well that is exactly what happened at Camp Lejeune. Where is 

the common sense? Thank you. 

Chairman AKAKA. Thank you very much. I want to thank the 

witnesses in the first panel for sharing your personal experiences 

with us today. Again, this will be helpful to the Committee and we 

look forward to dealing with these problems that have been mentioned. 

Thank you very much, again, and I will call up the second panel. 

[Pause.] 

Chairman AKAKA. This hearing will be in order. I want to welcome our principal witness from VA, Dr. Michael Peterson, who is 

the Chief Consultant on Environmental Health for the Strategic 

Health Care Group at the Veterans Health Administration. He is 

accompanied by Dr. Stephen C. Hunt, the National Director for the 

Post-Deployment Integrated Care Initiative at VHA, and Bradley 

G. Mayes, the Director of the Compensation and Pension Service 

at the Veterans Benefits Administration. 

The next witness on the panel is Dr. Craig Postlewaite, Acting 

Director, Force Health Protection and Readiness Programs and Director, Force Readiness and Health Assurance at the Department 

of Defense. Next we have Dr. Paul Gillooly, who is the Public 

Health Assessor at Navy Marine Public Health Center. 

We also have Maj. Gen. Eugene Payne, Jr., the Assistant Deputy 

Commandant for Installations and Logistics for Facilities with the 

Marine Corps. Our final witness on the second panel is John Resta, 

115 

Scientific Advisor, U.S. Army Center for Health Promotion and 

Preventative Medicine. 

I thank you all for being here this morning. Your full testimony 

will of course appear in the record. Mr. Peterson, will you please 

begin with your testimony? 

STATEMENT OF MICHAEL PETERSON, DVM, M.P.H., DRPH, 

CHIEF CONSULTANT, ENVIRONMENTAL HEALTH, STRATEGIC HEALTHCARE GROUP, OFFICE OF PUBLIC HEALTH 

AND ENVIRONMENTAL HAZARDS, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Dr. PETERSON. Good morning, Mr. Chairman, Ranking Member 

and Committee Members. Thank you for this opportunity to discuss 

what VA is doing to support veterans with environmental exposures that occurred during military service. As you indicated, I am 

accompanied by Dr. Hunt and Mr. Mayes this morning. 

VA recognizes that servicemembers sometimes face exposures to 

toxicants or materials in the course of their military service that 

can have deleterious health effects. We have developed a robust 

program within the Office of Public Health and Environmental 

Hazards to address this need by: identifying potential sources of 

exposure in at-risk veterans; informing veterans and health care 

providers; and offering treatment and care for service-connected 

conditions. 

My written testimony provides background information about initiatives within VA to address these concerns, explains how VA 

works with DOD to identify and respond to environmental hazards 

and describes the four specific exposures cited earlier and actions 

taken by VA in response. 

I would like to spend the few minutes I have addressing how VA 

and DOD collaborate on not just these exposures, but any possible 

environmental hazard and how we help veterans receive the health 

care and benefits they deserve. One of the many lessons that VA 

has learned from experiences with Agent Orange and Gulf War veterans illnesses is that information regarding possible exposures to 

environmental agents and other toxicants both within the combat 

theatre and other areas in which our troops operate must be received and acted upon by VA as early as possible. 

Up-to-date information on these situations is invaluable to VA’s 

ability to identify veterans who may have been affected by an exposure, evaluate their individual risk of exposure, and for sequelae 

provide appropriate medial surveillance and mitigate untoward 

health effects that are known to be caused by these toxicants. 

In addition, where the possible outcomes are not known, it is important to perform epidemiological studies on exposed troops. This 

will better provide information than performing retrospective studies once it is determined that adverse health outcomes are being 

ascribed to a potential exposure. 

To this end, the joint DOD/VA Deployment Health Working 

Group was established. This working group reports to the Joint Executive Council through the Health Executive Council. The objective of this group is to identify and foster opportunities for sharing 

information and resources between VA and DOD in the areas of deVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00121 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
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ployment health surveillance, assessment, follow-up care, health 

risk communication and research and development. 

Each year this working group discusses deployment-related concerns and develops strategies by which to address them. The Deployment Health Work Group meets monthly to discuss a wideranging array of exposure issues, including those dating to the 

World War II era. The Deployment Health Work Group also actively seeks to discuss and recommend coordinated action to identify involved servicemembers, establish a determination of risks for 

this population and develop methods of outreach, risk communication, and where necessary, medical surveillance and appropriate 

health care for veterans with any condition that may have resulted 

from these exposures. 

Mr. Chairman, VA understands these issues are very important 

to you, all the Members of this Committee, and to veterans and 

their families. I can assure you VA is equally concerned and committed to working with DOD and other agencies to identify potential hazards, inform veterans of any risks to their health, develop 

appropriate responses, and deliver needed care and benefits to veterans and their families. Only through such cooperation will VA be 

prepared to deliver the proper health care and disability compensation benefits to those entitled. 

Before I conclude, I would like to tell you about a new study currently underway that VA is conducting to help assess and identify 

the environmental exposure risks faced by this latest generation of 

veterans. VA’s National Health Study for a New Generation of U.S. 

veterans begins with 30,000 veterans deployed to OEF/OIF and 

30,000 comparison veterans who were not deployed. 

This study includes veterans who served in each branch of service representing active duty, National Guard and Reserve members. Women are being over sampled to make sure they are represented and comprise 20 percent of the study. The study compares 

the deployed and non-deployed veterans in terms of chronic medical conditions, TBI, PTSD, and other psychological conditions, general health perceptions, reproductive health, pregnancy outcomes, 

functional status, use of health care, behavioral risk factors and VA 

disability compensation. 

This research will help us identify what conditions are disproportionally found within the deployed population, which can help us 

then provide an evidence base for health care treatment and possibly serve as presumption for benefits. 

Thank you again for the opportunity to testify. My colleagues 

and I are prepared to address any questions you or the Committee 

Members might have. 

[The prepared statement of Dr. Peterson follows:] 

PREPARED STATEMENT OF MICHAEL R. PETERSON, DVM, MPH, DRPH, CHIEF CONSULTANT, ENVIRONMENTAL HEALTH, STRATEGIC HEALTHCARE GROUP, OFFICE OF

PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Good morning, Mr. Chairman, Ranking Member and committee members. Thank 

you for this opportunity to discuss the work of the Department of Veterans Affairs 

(VA) in responding to certain exposures that occurred during military service, including respiratory exposures from an incinerator near the Naval Air Facility 

Atsugi, water contamination at Camp Lejeune, sodium dichromate at the Qarmat 

Ali Water Treatment Plant, and exposures to burn pits during the current conflicts. 

117 

I am accompanied today by Dr. Stephen Hunt, National Director, Post-Deployment 

Integrated Care Initiative, VA Puget Sound Health Care System, and Mr. Bradley 

Mayes, Director of Compensation and Pension Service, Veterans Benefits 

Administration. 

VA recognizes that servicemembers sometimes face exposure to toxicants or materials in the course of their military service that can have deleterious health effects. 

We have developed a robust program within the Office of Public Health and Environmental Hazards to address this need by identifying potential sources of exposure 

and at-risk Veterans, informing Veterans and health care providers, and offering 

treatment and care for service-connected conditions. My testimony will provide background information about initiatives within VA to address these concerns, explain 

how VA works with the Department of Defense (DOD) to identify and respond to 

environmental hazards, and describe the four specific exposures cited earlier and actions taken by VA in response. 

VA PROGRAMS SPECIFICALLY TARGETING EXPOSURE-RELATED DISEASE

VA is very concerned about environmental health concerns of Veterans and offers 

a range of programs including health registries, special training for staff, and education materials including web-based information, fact sheets, and brochures. VA actively monitors and provides support to Veterans and their health care providers 

concerning a range of potential environmental exposures and outcomes, including 

Agent Orange, Gulf War Veterans’ Illnesses, radiation, toxic embedded fragments 

including depleted uranium, thermal injuries, mustard gas, noise, vibration, and 

other physical exposures. More information about these programs specifically tailored to Veterans and health care providers can be found online at: http:// 

www.publichealth.va.gov/exposures/. VA notifies Veterans about these exposures 

through many different avenues. First, every VA medical center is required to have 

an environmental health clinician on staff. This person serves as a local resource 

for Veterans and clinical providers. In addition, the Transition Assistance Advisors 

(who work for the National Guard and receive training from VA) and Post-Deployment Integrated Care Clinics provide VA-wide expertise in a range of exposures and 

health outcomes commonly seen in returning Veterans. VA regularly provides letters, newsletters, brochures and other information to Veterans while maintaining 

registries specifically designed to track and inform Veterans with materials related 

to their unique health care needs. 

VA trains its providers to prepare to respond to the specific health care needs of 

all Veterans, which in turn helps providers inform Veterans of these risks. This 

training includes specific Clinical Practice Guidelines on post-combat deployment 

health and other issues. VA operates three War Related Illness and Injury Study 

Centers (WRIISCs) that provide specialized health care for combat Veterans from 

all deployments who experience difficult-to-diagnose or undiagnosed but disabling 

illnesses. Starting in 2002, the WRIISCs began serving as referral centers for Veterans with undiagnosed or difficult-to-diagnose complaints. Veterans referred to the 

WRIISCs are provided with a complete exposure assessment, outpatient or inpatient 

evaluation (including advanced neurological evaluations), and a detailed treatment 

plan, which is provided to the Veterans’ VA primary care providers. Based on lessons learned from the Gulf War, VA realizes that concerns about unexplained illnesses could also emerge after other deployments, and we are building our understanding of such illnesses. Furthermore, as we recognize that many unexplained illnesses or symptoms may be related to exposure to toxicants during deployment, the 

WRIISCs now provide extensive exposure assessments to patients referred to them. 

Following the Gulf War, VA developed the Veterans Health Initiative (VHI) Independent Study Guides (ISG) for health care providers as one of many options to provide tailored care and support of Veterans. These study guides were principally designed for the clinical care of Veterans of the Gulf War era, but have proven highly 

relevant for treating Operation Enduring Freedom/Operation Iraqi Freedom (OEF/ 

OIF) Veterans, since many of the hazardous deployment-related exposures are likely 

to be the same. VA developed ISGs for health care providers to deliver appropriate 

care to Veterans returning from Iraq and Afghanistan that cover topics such as gender and health care, infectious diseases of Southwest Asia, military sexual trauma, 

and health effects from chemical, biological and radiological weapons. Study Guides 

on Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) were 

also developed and made available for primary care physicians to increase understanding and awareness of these conditions. VHI ISGs are currently undergoing a 

comprehensive update to make them more relevant to busy providers and to 

modularize the content so that it is more accessible. The Office of Public Health and 

Environmental Hazards and the Employee Education System are working together 

118 

on this project. VA recently brought on board an American Association for the Advancement of Science fellow with advanced degrees in post-secondary education and 

computer technology to spearhead this effort. 

VA has also initiated a large, long-term study to look carefully at a broad array 

of health issues that may affect OEF/OIF Veterans and their counterparts who 

served during the same time period. VA’s ‘‘National Health Study for a New Generation of U.S. Veterans’’ will begin with 30,000 Veterans deployed to OEF/OIF and 

30,000 comparison Veterans who were not deployed. 

The study includes Veterans who served in each branch of service, representing 

active duty, Reserve, and National Guard members. Women are being over-sampled 

to make sure they are represented and comprise 20 percent of the study, or 12,000 

women. A combination of mail surveys, online surveys, telephone interviews, and inperson physical evaluations are used to collect data from Veterans. 

The study compares the deployed and non-deployed Veterans in terms of chronic 

medical conditions, Traumatic Brain Injury (TBI), Post Traumatic Stress Disorder 

(PTSD) and other psychological conditions, general health perceptions, reproductive 

health, pregnancy outcomes, functional status, use of health care, behavioral risk 

factors and VA disability compensation. VA has contracted with an independent 

Veteran-owned research firm to collect the data. 

Interaction and Information Exchange with DOD 

One of the many lessons that VA has learned from experiences with Agent Orange and Gulf War Veterans’ Illnesses is that information regarding possible exposures to environmental agents and other toxicants, both within the combat theater 

and other areas in which our troops operate, must be received and acted upon by 

VA as early as possible. Up-to-date information on these situations is invaluable to 

VA’s ability to identify Veterans who may have been affected by an exposure, evaluate their individual risk of exposure and for sequelae, provide appropriate medical 

surveillance, and mitigate untoward health effects that are known to be caused by 

these toxicants. In addition, where the possible health outcomes are not known, it 

is important to perform prospective epidemiological studies on exposed troops. This 

will provide better information than performing retrospective studies once it is determined that adverse health outcomes are being ascribed to a potential exposure. 

To this end, the Joint DOD/VA Deployment Health Working Group (DHWG) was 

established. This working group reports to the Joint Executive Council through the 

Health Executive Council (HEC). The objective of this group is to identify and foster 

opportunities for sharing information and resources between VA and DOD in the 

areas of deployment health surveillance, assessment, follow-up care, health risk 

communication, and research and development. Each year this working group discusses deployment-related concerns and develops strategies by which to address 

them. The DHWG meets monthly to discuss a wide-ranging array of exposure 

issues, including those dating to the World War II era. The DHWG also actively 

seeks to discuss and recommend coordinated action to identify involved servicemembers, establish a determination of risk for this population, and develop methods 

of outreach, risk communication and, where necessary, medical surveillance and appropriate health care for Veterans with any condition that may have resulted from 

these exposures. 

Now I will discuss in greater detail the four exposures about which the Committee 

asked for specific information. 

Incinerator at Naval Air Facility Atsugi 

Naval Air Facility Atsugi, Japan is located about 25 miles from Tokyo at the site 

of a Japanese Air Force base which the U.S. took control of in 1945. In 1985, a private waste incinerator, Shinkampo Incinerator Complex (SIC), began operations immediately southeast of the community areas of the base. The incinerator burned a 

variety of liquid and solid industrial waste, municipal solid waste, and construction 

debris. The incinerator released a plume of smoke, ash, particulate material, and 

fumes at ground level over the community area of the base. Complaints by residents 

regarding air quality led to multiple health risk assessments between 1988 and 

1999. These assessments demonstrated health risks related to the incinerator plume 

which resulted in efforts by representatives of the U.S. Government to close the incinerator. This was accomplished in 2001. It is estimated that over the 15 years of 

operation, 18,000 adults and 8,000 children could have been exposed, with a typical 

exposure duration of 3 years. 

The non-cancer health effects of primary concern are impairment of respiratory 

function from exposure to inhaled respiratory toxicants particularly among the resident children at the base. Permanent reduction in respiratory function can occur 

after several years of exposure to respiratory toxicants especially if exposure ocVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00124 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
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curred before age 16. The final health risk assessment completed in 2002 by DOD 

noted an increased risk of cancer, above the U.S. background rate, among residents 

of Naval Air Facility Atsugi during incinerator operations. 

In 2007, Battelle Corporation was asked by the Department of the Navy to conduct a review of the various health risk assessments and recommend what, if any, 

population-based medical surveillance of residents of Naval Air Facility Atsugi 

might be warranted, as well as the parameters and expected outcomes from such 

screenings. Battelle published its report in June 2008. The only recommendation 

from that report was that a health registry be established for residents of Naval Air 

Facility Atsugi. All medical surveillance recommendations were limited to the juvenile population at the base. 

Because all of the recommendations in this detailed report address medical surveillance of a population not within VA’s statutory authority, VA has not requested 

information regarding this cohort. Any Veteran who served at the Naval Air Facility 

Atsugi who may develop either a respiratory condition or cancer that competent 

medical authority ascribes to exposure at Naval Air Facility Atsugi would be eligible 

to submit a claim for direct service connection for the condition, provided they meet 

other eligibility criteria for benefits. VA will inform regional offices of the Naval Air 

Facility Atsugi situation and alert them to the possibility of disability claims from 

Veterans who were stationed there. All such claims will be evaluated on a case-bycase basis with evidentiary weight given to medical examinations and opinions from 

both private and VA physicians. In all cases, the benefit of doubt will be provided 

to the Veteran. VA’s assessment of issues related to Naval Air Facility Atsugi continues to be coordinated through HEC and the Office of Public Health and Environmental Hazards and we continue to monitor study outcomes that could inform future policy decisions. 

Water Contamination at Camp Lejeune 

From the 1950s through the mid-1980s, some persons residing or working at the 

U.S. Marine Corps Base Camp Lejeune were exposed to drinking water contaminated with volatile organic compounds. Two of the eight water treatment facilities 

supplying water to the base were contaminated with either tricholoroethylene (TCE) 

or tetrachloroethylene (perchloroethylene, or PCE). The Department of Health and 

Human Services’ Agency for Toxic Substances and Disease Registry (ASTDR) estimated that PCE drinking water levels exceeded current standards from 1957 to 

1987 and represented a potential public health hazard. The heavily contaminated 

wells were shut down in February 1985, but it is estimated that more than one million individuals may have been exposed. 

An ATSDR study begun in 2005 is evaluating whether children of mothers who 

were exposed while pregnant to contaminated drinking water at Camp Lejeune are 

at an increased risk of spina bifida, anecephaly, cleft lip or cleft palate, and childhood leukemia or non-Hodgkin’s lymphoma. The results of this report have not yet 

been released. In the same year, a panel of independent scientists convened by 

ATSDR recommended the agency identify cohorts of individuals with potential exposure, including adults who lived or worked on the base and children who lived on 

the base (including those that may have been exposed while in utero), and conduct 

a feasibility assessment to address the issues involved in planning future studies 

at the base. 

In October 2008, the Department of the Navy issued a letter to Veterans who 

were stationed at Camp Lejeune while in military service between 1957 and 1987. 

This letter informed Veterans that the Navy had established a health registry 

and encouraged them to participate. Veterans who received the letter from the Navy 

may visit the following Web sites for the most current updates about Department 

of Navy actions: http://www.atsdr.cdc.gov/sites/lejeune/index.html or 

www.marines.mil/clsurvey/index.html. Veterans may also call the Department of 

Navy toll-free at (877) 261–9782. 

VA is providing Veterans with information about this issue and offering contact 

information and referrals to the Navy registry. In December 2008, VA issued a VA 

Health Care Fact Sheet on the contamination of the ground water at Camp Lejeune. 

On June 13, 2009, the National Research Council of the National Academies’ Committee on Contaminated Drinking Water at Camp Lejeune released a report that 

indicated further research will unlikely provide definitive information on whether 

exposure resulted in adverse health effects. However, the report did find 14 conditions with limited or suggestive evidence of an association with exposure to PCE, 

TCE, or solvent mixtures. VA is convening a work group to evaluate the National 

Research Council’s report and any other relevant scientific studies. This will contribute significantly to further policy decisions. 

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VA does not operate a registry for this population and does not have special authority to enroll Veterans or their family members based upon this exposure. Veterans who are a part of this cohort may apply for enrollment if they are otherwise 

eligible, and are encouraged to discuss any specific concerns they have about this 

issue with their health care provider. Veterans are also encouraged to file a claim 

for VA disability compensation for any injury or illness they believe is related to 

their military service. VA environmental health clinicians can provide these Veterans with information regarding the potential health effects of exposure to volatile 

organic compounds and VA’s WRIISCs are also available as a resource to providers. 

VA takes the Camp Lejeune matter very seriously and has informed all regional 

offices of the situation. Disability claims based on contaminated drinking water exposure at Camp Lejeune will be evaluated on a case-by-case basis with evidentiary 

weight given to medical examinations and opinions from both private and VA physicians. In all cases, the benefit of doubt will be provided to the Veteran. 

Sodium Dichromate at Qarmat Ali Water Treatment Plant 

VA has been extremely proactive in its response to this exposure event. As you 

are aware, there are approximately 600 National Guard troops, primarily from four 

states (Oregon, South Carolina, West Virginia and Indiana), who may have been exposed to sodium dichromate (a source of hexavalent chromium) while serving at 

Qarmat Ali outside Basrah, Iraq. 

VA is obtaining the names and contact information of National Guard troops 

present at Qarmat Ali. We are also verifying the numbers of these Veterans who 

have either enrolled in care or received a Gulf War registry exam. We have already 

augmented the Gulf War Registry (GWR) to reflect service at Qarmat Ali. The involved Guard Members who have had an initial exam will be recalled to have a complete exposure assessment as well as a more targeted physical exam and ancillary 

testing to detect indications of health outcomes that may be related to hexavalent 

chromium. Those who have yet to enroll in the GWR will receive this targeted examination initially. They will also receive a chest radiograph and pulmonary function testing. This evaluation will be repeated periodically (every year for an exam 

and every 5 years for a chest radiograph). All of this testing can be done within the 

GWR’s existing authority. 

Once we have made all the these modifications to the GWR, and have established 

the appropriate process for the involved VA medical centers, VA will send letters 

to each servicemember explaining the new process and details regarding how to receive an examination. Because this group of Veterans is relatively small and already 

identified, and because the health risks of exposure to hexavalent chromium are 

well established, VA believes this is the best cohort to develop its new program of 

targeted medical surveillance. VA hopes that experience with this program can be 

a model for other medical surveillance programs for returning Veterans who may 

have been exposed to environmental toxicants. 

VA has begun analyzing the available list of identifiable servicemembers to determine who has filed claims for disability benefits for any condition potentially related 

to toxin exposure. It is important to note that this analysis is still ongoing and is 

primarily focused on, but not limited to, diseases of the skin and respiratory system. 

On preliminary review, it appears that approximately 25 percent of potentially exposed members have filed claims for such conditions. This assessment takes into 

consideration all identifiable members of the Guard who have previously filed disability claims for such conditions and who have claims currently pending for such 

conditions. It also assumes that such claims were filed after exposure and related 

to exposure. This analysis has the potential to identify Veterans whose claims are 

based on disabilities resulting from exposure at Qarmat Ali and to provide regional 

office personnel with relevant historical information to assist with evaluating these 

claims. 

Many of these claims may have been adjudicated prior to VA’s learning of potential toxin exposure at Qarmat Ali. Therefore, we are currently working on the best 

possible methods to educate our field-station employees of the circumstances surrounding this incident, ensure those stations have easy access to all identifiable 

data on the potential exposure of National Guard members, and determine whether 

VA must readjudicate any claims that were previously adjudicated without such 

information. 

Burn Pits and Other Environmental Exposures 

During a May 14, 2009 Deployment Health Work Group meeting, VA was apprised of 24 potential exposure incidents in OEF/OIF. This included various open 

burn pits for waste disposal, sulfur fires, non-potable water contamination, exposure 

to industrial waste, and others. DOD and VA have made significant progress in 

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sharing information and assessing health risks. VA works diligently to obtain and 

interpret data from DOD and formulate appropriate responses to better serve combat Veterans. 

Exposure to open burn pits for solid waste disposal has created significant concern 

among Veterans and their families. The most widely publicized of these was the 

burn pit at Balad Air Base in Iraq. According to a May 2008 report from the U.S. 

Army Center for Health Promotion and Preventive Medicine (USA CHPPM), the 

amount of solid waste being burned was estimated at about 2 tons of material per 

day in the early stages of troop deployment and currently may be as much as several hundred tons per day. This 2008 risk assessment concluded that the overall 

risk estimate for 12 month exposure was low. It states that the risk for both cancer 

and non-cancer outcomes did not exceed Environmental Protection Agency guidelines for acceptable risk. Affected troops did report upper respiratory irritation due 

to burn pits. This outcome was expected. Because of uncertainty related to specific 

exposures, as well as questions about methodology and estimates, VA officials must 

rely on objective facts developed on a case-by-case basis. VA understands DOD tested air samples at Balad in 2005, 2006, and 2007. USA CHPPM’s May 2008 risk assessment was based on the air samples performed in 2007. 

VA anticipates that concerns about potential long-term health effects from exposure to pollutants generated from open pit waste burning used throughout the Iraq 

and Afghanistan theaters will be an ongoing issue for affected Veterans. VA has 

learned many lessons from previous conflicts wherein servicemembers were exposed 

to various toxins on the battlefield. In many of those situations, too much time 

lapsed between Veterans’ exposure to such toxins and an easy path to the many VA 

benefits they had earned. After VA learned of potential exposure for servicemembers 

to burn pits, and to help address health concerns of Veterans and their families, VA 

began initiating a contract with the Institute of Medicine to provide a review of potential long-term health effects from exposure to burn pit pollutants. 

In addition to these efforts, VA has started presenting one-day seminars to VA 

and non-VA providers on many of these exposures. These seminars give information 

regarding the nature of the exposures, their possible health outcomes, how to perform an exposure assessment for Veterans, appropriate medical surveillance, treatment options, and risk communication. 

VA is analyzing data on the number of Veterans from the first Gulf War, the Gulf 

War Era, and OEF/OIF, who have filed service connection claims for a variety of 

conditions, including respiratory and skin disabilities. This information will hopefully serve as a valuable tool to help VA observe any early, discernable trends such 

as increased disability claims for diseases potentially related to toxins. VA is currently exploring the best information to include in communication and how best to 

deliver such information to field employees responsible for adjudicating disability 

claims, specifically those related to toxins. This analysis is not yet complete. 

CONCLUSION

Mr. Chairman VA understands these issues are very important to you, all the 

Members of this Committee, and to Veterans and their families. I can assure you 

VA is equally concerned and committed to working with DOD and other agencies 

to identify potential hazards, inform Veterans of any risks to their health, develop 

appropriate responses, and deliver needed care and benefits to Veterans and their 

families. Only through such cooperation will VA be prepared to deliver the proper 

health care and disability compensation benefits to those entitled. Sharing this information is important because many factors may contribute to adverse, long-term 

health effects for servicemembers and Veterans. 

Thank you again for the opportunity to testify. My colleagues and I are prepared 

to address any questions you or the other committee members might have. 

RESPONSES TO POST-HEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

MICHAEL PETERSON, DVM, MPH, DRPH, CHIEF CONSULTANT, ENVIRONMENTAL

HEALTH, STRATEGIC HEALTHCARE GROUP, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. What proactive measures is your Department taking to notify the people on the Marine Corps’ online health registry for Camp Lejeune that they may 

be eligible for VA benefits due to exposures? 

Response. VA and DOD have a Data Use Agreement (DUA) that permits VA to 

obtain the names on the Camp Lejeune, N.C., registry. VA received data from DOD 

in early March containing registry data as of February 12, 2010. Information in the 

registry identifies individuals self-reporting by name, address, and telephone numVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00127 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
122 

ber. The registry also contains a subset of approximately 45,000 names of the approximately 157,000 names in the registry that were identified by the Defense Manpower Data Center (DMDC) as active duty members stationed at Camp Lejeune 

from 1975 to 1985. (Electronic records at DMDC are available only from 1975 forward) VA is developing recommendations for the Secretary based on the 2009 National Research Council Report. ‘‘Contaminated Water Supplies at Camp Lejeune, 

Assessing Potential Health Effects.’’ The Secretary will consider all available evidence and recommendations in determining the content of any necessary future notification of Veterans. 

Question 2. Dr. Robert F. Miller testified concerning veterans who had been exposed to fumes from burn pits and other sources in Iraq. Veterans reporting shortness of breath had normal standard respiratory evaluations including chest x-rays, 

chest CT scans and pulmonary function testing. None of these routine tests could 

explain the cause for the soldiers’ limitations. When Vanderbilt physicians performed surgical biopsies on 45 of 70 soldiers referred for unexplained shortness of 

breath on exertion, all except one demonstrated some form of bronchiolitis. Given 

these findings, what actions should be taken by VHA and VBA, including specialized testing and evaluations, when a veteran claims a disability due to shortness 

of breath after exposure to environmental toxins? 

Response. Any exposed Veteran who complains of shortness of breath, that has 

persisted or gotten worse since an exposure while in the military, should have a 

chest radiograph and complete pulmonary functions, including pre-and post bronchodilators and what is known as alveolar diffusion capacity (a lung function test). 

A high resolution CAT Scan (CT) may also be useful. According to a recent scientific 

symposium on this issue lung biopsy is only used after other diagnostic modalities 

have been exhausted. VBA will instruct Regional Office (RO) personnel that special 

methods must be followed when handling disability claims involving various conditions, including shortness of breath, from Veterans exposed to contaminants associated with hazardous material in Iraq and Afghanistan. VBA will issue this instruction in the form of a training letter, which is currently in concurrence. VA is also 

in the process of requesting from DOD data containing all known locations of burn 

pits in Iraq and Afghanistan so that VA can provide such information to all field 

stations. 

The exposure training letter will instruct RO personnel to specify that a medical 

examiner must conduct any reasonably feasible testing for a wide range of respiratory disabilities, including any form of bronchiolitis that may be the result of 

toxicants. Results must be provided in the examination report along with a medical 

opinion as to whether it is; ‘‘at least as likely as not’’ that any diagnosed respiratory 

system condition is related to such exposure. 

Question 3. Will VA be contracting with the Institute of Medicine to study the 

health effects of exposure to burn pits? If so, what is the timeline for that report? 

Response. The contract with the Institute of Medicine was signed on October 29, 

2009. The contract will end on April 30, 2011, with a report due on that date. 

Question 4. If a recently-separated veteran seeks health care at VA and mentions 

that he was exposed to a burn pit or sodium dichromate, what happens? Is the result the same if the veteran is more than five years removed from active military 

service? 

Response. Necessary care and/or treatment would be provided to all eligible Veterans claiming exposure to a burn pit or sodium dichromate. 

Combat Veterans (within their five years of post discharge) will be enrolled upon 

application for enrollment/care and are eligible for cost-free hospital and treatment 

for conditions associated with the theater of operation. VA clinicians have wide latitude in determining if a Veteran’s condition is associated with Veteran’s combat 

service and thus, cost-free care. This decision does not require the same rigor or 

standards used for adjudication of a service-connected claim. 

Combat Veterans more than five years removed from their date of discharge from 

the military/release from active duty must meet the applicable eligibility and enrollment requirements that apply. Under current rules, this means that Veterans without other special eligibility factors whose income places them in Priority Group 8 

above the current enrollment income threshold could not be enrolled or treated by 

VA. In such cases, VA would encourage the Veteran to file a claim for service-connected disability rating. If service-connection were granted, VA would offer enrollment and necessary treatment as required. 

If the Veteran served in Iraq (but not Afghanistan) even if they were not otherwise eligible for care they would be eligible for a Gulf War registry exam. Based 

upon the results of this exam, they would be referred to VBA to file a claim for service connection. Once service connection is established for any condition related to 

123 

the exposure, they are eligible for further care. VHA and VBA are working together 

to establish a process for expedited service connection for these conditions. We anticipate that our model exposure-related assessment within the Gulf War registry 

will be available in spring 2010. The conditions which will be expedited based upon 

this exposure have been identified. If the model exposure-related assessment within 

the Gulf War Registry is ready by spring, then it is feasible that VBA can prepare 

rating-related training by summer 2010. 

The Deployment Health Working Group, a joint DOD/VA work group, has recently 

begun an effort to establish a permanent agreement between the VA and DOD that 

will permit the transfer of information from DOD to the VA whenever an exposure 

incident occurs. The outcome of this effort will be a listing of Soldiers, Sailors, Airmen and Marines exposed in any given incident. 

Question 5. What occurs when a veteran claims service-connection for a condition 

due to exposure to contaminated water at Camp Lejeune? 

Response. VA RO personnel were alerted to the Camp Lejeune contaminated 

water situation in the June 2009 C&P Service Bulletin and instructed to adjudicate 

each related claim on a case-by-case basis, with the benefit of any doubt provided 

to the Veteran. All available evidence related to the claim will be obtained. Service 

connection may be granted if the evidence shows: (1) a current chronic disability, 

(2) military duty at Camp Lejeune during the period of water contamination (as 

verified though Official Military Records), and (3) a medical nexus or relationship 

between the current disability and the service at Camp Lejeune. A statement of this 

medical nexus may be provided by a competent VHA or private medical examiner. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO MICHAEL PETERSON, DVM, MPH, DRPH, CHIEF CONSULTANT, ENVIRONMENTAL

HEALTH, STRATEGIC HEALTHCARE GROUP, VETERANS HEALTH ADMINISTRATION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. At the hearing, I asked whether VA could create a special enrollment 

category for Veterans potentially affected by the contaminated drinking water at 

Camp Lejeune using the Secretary’s general authority to provide needed health care 

to categories of Veterans not specified in the law and the question was to be taken 

back to VA General Counsel. What is the VA General Counsel’s opinion on that 

question? 

Response. VA is required to establish and operate a system of annual patient enrollment, 38 U.S.C. 1705(a). The law requires that VA manage the enrollment of patients in accordance with the priorities set forth in section 1705(a)(1)–(8) but specifically authorizes VA to establish subpriorities within each statutory priority group. 

In accordance with the law, VA established an enrollment system by regulation in 

38 CFR 17.36. The system provides subpriorities within the two lowest priority categories (7 and 8). VA currently enrolls all Veterans in priority 1–7 and the highest 

subpriorities of priority 8. VA could, in accordance with the regulatory process, revise its enrollment regulations to establish in priority 8 an additional subcategory 

for Veterans who are potentially affected by the contaminated drinking water at 

Camp Lejeune. 

Question 2. During the hearing, there was confusion about whether VA had, in 

fact, received from the Marine Corps the registry of names of former Camp Lejeune 

residents. 

A. Has this list been shared with VA? If so, when? 

Response. VA and DOD have a Data Use Agreement (DUA) that permits VA to 

obtain the names on the Camp Lejeune, NC, registry. VA received data from DOD 

in early March containing registry data as of February 12, 2010. Information in the 

registry identifies individuals self-reporting by name, address, and telephone number. The registry also contains a subset of approximately 45,000 names of the approximately 157,000 names in the registry that were identified by the Defense Manpower Data Center (DMDC) as active duty members stationed at Camp Lejeune 

from 1975 to 1985. (Electronic records at DMDC are available only from 1975 forward.) 

B. If not, will VA work with the Marine Corps to obtain the registry so that VA 

can better identify the medical history of those who are already receiving VA health 

care and proactively outreach to those who are not? 

Response. See response to A above. 

Question 3. It is my understanding that there is an on-going initiative funded by 

the Department of Energy (DOE) that provides eligibility to former DOE workers 

to participate in a program that provides examinations and specialized testing for 

124 

health effects that may be related to exposures they encountered during their time 

as employees or contractors to DOE. In addition, if health effects that could be 

linked to those exposures are identified, these former employers may be provided 

health care and the opportunity to file for compensation. 

A. Has VA discussed this program with the Department of Energy? If so, what 

have you learned from those discussions? 

Response. Subject matter experts in the Environment Agents Service in the Office 

of Public Health and Environmental Hazards, Veterans Health Administration are 

familiar with this program. The Environmental Health Strategic Healthcare Group 

has discussed this program with the medical director of The Building Trades Program. This program is the basis of the War Related Interactive Online Referral and 

Surveillance (WARRIORS) program. It is an initiative which is funded by VA’s Office of Rural Health and will be utilized to assist rural physicians without access 

to VA expertise on these issues to perform a conflict/exposure specific evaluation to 

include history/examination, ancillary testing and recommended follow-up and consultation. The contractor for development of this program is in the process of being 

approved and an award is expected to be made by the end of FY2010. 

B. If no, are there lessons that VA could learn from further examining this DOE 

program? 

Response. See response to A above. 

Question 4. At the hearing, a VA representative testified that guidance to the 

field—in the form of a Fast Letter—would be sent regarding how to handle disability claims from Veterans who were stationed at Camp Lejeune during the period 

that the water was contaminated. 

A. Has that been done? Would you please provide a copy of the Fast Letter when 

it has been sent out? 

Response. VBA will instruct Regional Office (RO) personnel that special methods 

must be followed when handling disability claims arising from six separate exposure 

events including the Camp Lejeune contaminated water incident. The other events 

include burn pits used throughout Iraq, Afghanistan, and the Horn of Africa; high 

particulate matter levels throughout Iraq, Afghanistan, and the Horn of Africa; the 

2003 Iraqi sulfur fire incident; the 2003 sodium dichromate exposure incident at 

Qarmat Ali, Iraq; and, the Atsugi, Japan incinerator incident. VBA will issue this 

instruction in the form of a training letter. VA will provide the Committee a copy 

as soon as it is complete. 

The exposure training letter will consist of three elements. The first section will 

serve as an educational tool on each specific exposure, including the Camp Lejeune 

incident. The second section contains claims processing instructions that are specific 

to these exposures. Finally, the third section functions as an additional educational 

tool that VA adjudicators will use to alert Compensation and Pension (C&P) examiners to a Veteran’s specific exposure incident(s) so that any subsequent examinations and/or medical opinions are fully informed. 

Through this process, all VBA employees involved in adjudicating claims, and 

C&P examiners, will become well aware of the details of each of the six exposure 

incidents, including the water contamination at Camp Lejeune. 

B. With respect to the other three exposures discussed at the hearing (Qarmat 

Ali, burn pits, Atsugi), has any guidance been sent to the field on how to adjudicate 

claims from potentially exposed veterans? If so, please provide copies of any such 

guidance and a timeline for when the guidance was provided to the field. 

Response. The October 2009 C&P Service Bulletin provided information to RO 

personnel on the environmental contamination history of Naval Air Facility (NAF) 

Atsugi, Japan and instructed them to handle any related disability claims on a caseby-case basis, with the benefit of any doubt provided to the Veteran. VBA is currently in the process of developing instructions for the field on methods for handling 

disability claims based on chromium exposure at Qarmat Ali, Iraq and exposure to 

the toxic contaminants associated with burn pit sites, as well as others in Iraq and 

Afghanistan. 

The information needed to assess these sites and the contaminants associated 

with them will require additional research and cooperation from the Department of 

Defense. VA received the names of National Guard members who were potentially 

exposed to toxins at Qarmat Ali, Iraq. We are generating requests for information 

related to additional exposures. 

VA also contracted with the Institute of Medicine to investigate the possible 

health outcomes of exposure to burn-pit emissions. When this research is completed, 

a Fast Letter and/or training letter will be released to the field. The November 2009 

C&P Service Bulletin also provided basic information. 

125 

C. If guidance has not been provided to the field with respect to any of these exposures, would you please provided a timeline for when you anticipate providing such 

guidance? 

Response. Guidance on handling Veterans’ claims based on exposure at Camp 

Lejeune and NAF Atsugi has already been provided to the field through the C&P 

Service Bulletin. When additional research is completed in the next few months, 

Fast Letters and/or training letters will be released to the field providing information on handling claims based on all known exposure events in Iraq and Afghanistan. 

Question 5. At the hearing, we also heard testimony about a sulfur mine in Iraq 

that was set on fire in 2003. Would you please provide an update on what steps 

VA has taken to date with regard to that exposure incident? 

Response. Please see post-hearing Question 2 from Senator Akaka and VA’s subsequent response. VA was made aware of this fire and potential exposures in March 

2009. DOD has determined that bronchiolitis in Veterans with known exposure to 

the 2003 sulfur fire is ‘‘plausibly’’ related to such fire. The subject of the sulfur fire 

will be covered extensively in VBA’s forthcoming training letter on hazardous exposures in Iraq and Afghanistan. 

Chairman AKAKA. Thank you very much, Mr. Peterson. The chair 

calls for a slight recess and we will be right back. 

[Recess.] 

Chairman AKAKA. The hearing will come to order. And now I call 

for the testimony of Dr. Postlewaite. 

STATEMENT OF R. CRAIG POSTLEWAITE, DVM, M.P.H., ACTING 

DIRECTOR, FORCE HEALTH PROTECTION AND READINESS 

PROGRAMS, OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE (HEALTH AFFAIRS), U.S. DEPARTMENT OF DEFENSE 

Mr. POSTLEWAITE. Good afternoon, sir. Thank you very much. 

Mr. Chairman, distinguished Members of the Committee, thank 

you for the opportunity to discuss the Department of Defense Occupational Environmental Health Program, our program to assess 

health risks associated with the environment in our workplaces. 

I am Dr. Craig Postlewaite, Acting Director of Force Health Protection and Readiness Programs for the Assistant Secretary of Defense for Health Affairs. I am also a veteran with 26 years active 

duty service. Under my purview is the policy and oversight for the 

deployments—or for the department’s Deployment Health Program. 

A key component of the Deployment Health Program is our Occupational and Environmental Health Program, or OEH, as I will 

refer to it. 

Its goal is to protect our personnel from accidental death, injury, 

or illness caused by hazardous, occupational, or environmental exposures. This includes preventing or minimizing short-term health 

effects, especially those severe enough to interfere with mission accomplishment and also any long-term effects that may affect our 

servicemembers’ health and quality-of-life in the years to follow. 

To prevent or limit hazardous exposures, both in peace time and 

in deployed settings, the Department applies a rigorous risk management program. Mr. Chairman, the Department’s many fine 

OEH professionals take their responsibility seriously and are fully 

dedicated to protecting and preserving the health of our personnel 

by identifying hazards, ascertaining the significance of those health 

hazards in terms of risk, determining appropriate controls and 

communicating the risk information to commanders and affected 

personnel. 

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Since 2001, our OEH professionals have collected over 17,500 individual environmental samples throughout the U.S. Central Command Theatre of Operations, including nearly 10,000 in Iraq, more 

than 3,500 in Kuwait and over 3,300 in Afghanistan. In the vast 

majority of cases, these samples indicate that U.S. personnel are 

not experiencing any exposures that would put their long-term 

health at risk. 

However, with the current technology and under war time conditions, it is not always possible to monitor the working locations of 

all servicemembers for all hazards, especially for those who operate 

outside of our base camps. 

While our focus continues to remain on exposure prevention and 

control, we realize that some hazardous exposures can and will 

occur despite our best efforts. And unfortunately, some individuals 

may develop short-term or long-term health effects as a result. 

First and foremost, we want to ensure that those affected individuals get the very best care and treatment they are entitled to 

through the Military Health System and the VA. Second, these fine 

veterans have our profound sympathies for the pain and suffering 

they and their families experience. They have earned our sincere 

gratitude for their service. 

Our Department of Defense Instruction, Occupational Environmental Health, DODI 6055.05, requires DOD to share hazard and 

exposure data with the VA to assist in the adjudication of veterans’ 

disability claims. Such records also are valuable in establishing diagnosis and proper treatment. 

To ensure that VA is aware of individual hazardous exposures, 

all exposure-related information is to be entered into each individual’s medical record so it will be available to the VA at time of 

treatment or claims adjudication. 

Once the DOD electronic exposure record becomes a reality—and 

I discuss that more in my written testimony, hopefully it will be 

in the next few years—it will also be made available to the VA. For 

a number of years, the DOD and VA have collaborated through the 

DOD/VA Deployment Health Working Group, as Dr. Peterson mentioned. We use that forum to share, on a frequent basis, information related to exposures. 

While the Department of Defense is in-garrison and deployed, 

OEH programs have been quite effective in identifying and controlling chemical, biological, and physical hazards which our servicemembers or DOD civilians may encounter. We, of course, are fully 

committed to improving those programs wherever we can. 

Mr. Chairman, thank you for the opportunity to discuss the 

DOD’s OEH program today. I appreciate it. 

[The prepared statement of Mr. Postlewaite follows:] 

PREPARED STATEMENT OF R. CRAIG POSTLEWAITE, DVM, MPH, ACTING DIRECTOR, 

FORCE HEALTH PROTECTION AND READINESS PROGRAMS, OFFICE OF THE ASSISTANT

SECRETARY OF DEFENSE (HEALTH AFFAIRS) 

Mr. Chairman and distinguished Members of the Committee, thank you for the 

opportunity to discuss the Department of Defense’s (DOD’s) Occupational and Environmental Health (OEH) Program. 

The OEH program is an important component of the Department’s efforts to enhance Force Health Protection. DOD understands the importance of anticipating, 

recognizing, evaluating, and controlling health hazards associated with exposure to 

chemical, physical, and biological hazards. Our goal is to protect our personnel from 

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accidental death, injury, and illness caused by hazardous occupational or environmental exposures. This goal includes preventing and/or minimizing short-term 

health effects, especially those severe enough to interfere with mission accomplishment and, any long-term effects that may affect a Servicemember’s health and quality of life in years to come. 

To prevent or limit hazardous exposures, both in peacetime and in deployed settings, the Department applies a rigorous risk management program. Mr. Chairman, 

the Department’s many fine OEH professionals take their responsibilities seriously, 

and are dedicated to protecting and preserving the health of our personnel by identifying hazards, ascertaining the significance of any health or safety risks associated 

with the hazards, determining appropriate options to control the hazards, and communicating risk information to commanders and affected personnel. 

In the peacetime setting, the policies and procedures governing our OEH program 

are contained in DOD Instruction (DODI) 6055.05, ‘‘Occupational and Environmental Health.’’ Our OEH policies and procedures for the deployed setting are established in three documents: DODI 6055.05; the Joint Staff memorandum, MCM 

0028–07, ‘‘Procedures for Deployment Health Surveillance’’; and DODI 6490.03, ‘‘Deployment Health.’’ 

Mr. Chairman, in August 2006, the Under Secretary of Defense for Personnel and 

Readiness issued updated policy guidance for deployment OEH in the revision to 

DODI 6490.03. This revision significantly strengthened requirements for deployment OEH surveillance, including OEH data reporting and archiving; medical 

record entries documenting exposures; deployment health risk communications; and 

established a new requirement to track and report once daily the locations for all 

deployed Servicemembers so environmental hazards at a particular location could 

be linked with the individuals who may have been exposed to them during the time 

those hazards existed. 

The deployment OEH program actually begins during our pre-deployment preparation phase, when occupational and environmental hazard assessments for the current theater of operations, and any other theater of operation or deployed location 

as well, are conducted based on medical intelligence provided by the National Center of Medical Intelligence and other sources. Once in theater, we accomplish baseline, periodic, and incident-driven OEH surveillance by monitoring the air, water, 

soil, food, and disease-carrying vectors. 

Since 2001, we have collected more than 17,500 individual environmental samples 

throughout the U.S. Central Command Theater of Operations, including nearly 

10,000 in Iraq, more than 3,500 in Kuwait, and more than 3,300 in Afghanistan. 

In the vast majority of cases, these data indicate U.S. personnel are not experiencing any exposures that would put their long-term health at risk. However, with 

the current technology, it is not possible, in a wartime environment, to monitor the 

working locations of all Servicemembers for all hazards, especially for those who operate outside of base camps. 

While our focus continues to remain on exposure prevention and control, we realize that some exposures can, do, and will occur despite our best efforts. In recognition of that reality, we revised DODI 6490.03 and the Joint Staff memorandum on 

Deployment Health Surveillance to take steps to effectively address gaps that had 

hindered the assembly of electronic individual deployed longitudinal exposure 

records as called for by the President in August 1998 in Presidential Review Directive 5, ‘‘A National Obligation, Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families after Future Deployments.’’ 

Today, the process of assembling individual longitudinal exposure records is labor 

intensive, but it can be done with available data. Over the next several years, we 

anticipate it will be possible to extract the medical record entries of all personnel 

who have received medical evaluation and care for confirmed exposures and also access an individual Servicemember’s assignment history (dates and locations), including their peacetime, in-garrison assignments as well as their recent deployments. 

Their deployment histories will be used to retrieve archived OEH monitoring data 

for those deployment locations where exposures may have occurred, or existed, during the time the individual was deployed to that location. By merging deployment 

environmental monitoring data with the in-garrison occupational monitoring data 

and adding the medical record entries, we will be able to achieve the vision established by the President. 

In addition, the Department will be able to access population-at-risk databases, 

such as the Personnel Blast and Contaminant Tracking System that records the 

names and other identifiers of personnel who have been involved in exposure incidents but may not have been affected severely enough to result in medical evaluation or treatment. 

128 

Department of Defense Instruction 6055.05, ‘‘Occupational and Environmental 

Health,’’ requires DOD to share hazard and exposure data with the Department of 

Veterans Affairs (VA) to assist in adjudication of veterans’ disability claims. Such 

records also are valuable in establishing diagnoses and treatment. 

To ensure that VA is aware of individual hazardous exposures, all individual exposure-related information is entered into each individual’s medical record so it will 

be available to VA at the time of treatment or claims adjudication. Once electronic 

individual exposure records become a reality, they will be made available to VA. 

For several years, DOD and VA have collaborated through the DOD/VA Deployment Health Working Group, to focus on issues related to the post-deployment 

health of Servicemembers and veterans. Environmental and occupational exposures 

are a major focus of the group and discussed at nearly every monthly meeting. 

To reduce hazardous exposures or the resulting health impacts from potential exposures to deployed personnel, the Department provides all deploying Servicemembers comprehensive pre-deployment health threat and countermeasures briefings. Additionally, members also complete a pre-deployment health assessment; provide serum samples; and obtain all necessary immunizations, preventive medications, and personal protective equipment they need prior to deployment. 

Following deployment, members provide an additional serum sample and complete a post-deployment health assessment within 60 days of return from deployment, followed by a post-deployment health reassessment within 90–180 days. In 

addition, personnel are referred to healthcare providers as necessary for the evaluation of any self-reported OEH exposures or for other health concerns. 

For Operation Enduring Freedom and Operation Iraqi Freedom, we estimate that, 

on average, approximately four percent of deployed Servicemembers seek care for 

a non-battle related injury or illness each week. This is the lowest rate of disease 

and non-battle injuries ever recorded for a large operation in a time of war, and is 

a reflection, in part, of the effectiveness of Force Health Protection and OEH programs. 

Overall, the Department is pleased with both in-garrison/peacetime and deployed 

OEH programs that have been quite effective in identifying and controlling chemical, biological, and physical hazards. Of course, there is always room for improvement, and we are fully committed to bringing about those improvements. 

Mr. Chairman, thank you for the opportunity to discuss the DOD Occupational 

and Environmental Health Program with you. I would be pleased to answer any 

questions you may have. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

CRAIG POSTLEWAITE, DVM, M.P.H., ACTING DIRECTOR, FORCE HEALTH PROTECTION AND READINESS PROGRAMS, OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE (HEALTH AFFAIRS), U.S. DEPARTMENT OF DEFENSE

Question 1. What is the timeline for replacing burn pits with incinerators? Will 

all burn pits be closed? 

Response. U.S. Central Command (USCENTCOM) environmental operational 

guidance to its Service components in Iraq and Afghanistan is to eventually replace 

burn pits with incinerators. USCENTCOM Regulation 200–2 directs that when establishing expeditionary bases, ‘‘Develop a burn pit, landfill and/or incinerator operation to dispose of non-reusable solid waste. If a burn pit is used, develop a plan 

to transition to an incinerator as the camp matures and population increases.’’ The 

regulation goes on to say, ‘‘This will be done as soon as practical after the base is 

established.’’ 

In Iraq, to date, we have procured large commercial incinerators through Military 

Construction funding (MILCON) projects and, in most cases, turned them over to 

Logistics Civil Augmentation Program for daily operation. Because the MILCON 

process is slow, in Afghanistan, we purchased smaller incinerators (below MILCON 

threshold) through the Joint Acquisition Review Board process. Although procuring 

smaller units has required us to purchase more units, this process has allowed incinerators to arrive faster. More than 105 incinerators have been purchased or established at bases in both Iraq and Afghanistan, and have either replaced or significantly reduced the need for burn pits. However, to prevent the development and 

spread of disease carried by flies, rats, and other vermin, we will continue to require 

burn pits as a healthy and safe means of disposing of solid waste where camps are 

either immature or do not have the population to support an incinerator. Where feasible, landfill options or local commercial disposal are preferable alternatives to 

burn pits on U.S. bases but neither of these options are viable in our current operational environment. In Iraq, there are 23 solid waste incineration units in operVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00134 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
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ation at major camps with two units under construction (these are separate and distinct from a similar number of medical waste incinerators and two units for hazardous waste, also in operation). The burn pit at Joint Base Balad was closed on 

October 1, 2009. United States Forces will continue to use burn pits at selected locations in Iraq until the final United States withdrawal of forces in 2011. In Afghanistan, there are 82 solid waste incinerators in the works, planned, or contracted for 

purchase and United States Forces—Army and USCENTCOM are developing requirements for additional incinerators. As a result of the drawdown in Iraq, 

USCENTCOM will transfer reusable incinerator equipment from Iraq to Afghanistan as it becomes available. 

Question 2. The number of servicemembers exposed to burn puts is high. How can 

health effects be properly monitored given the number affected? 

Response. The health of personnel in-theater is monitored at several levels: 

• At provider level, as individuals seek medical treatment at our in-theater medical treatment facilities and by medics deployed in the field. When a Servicemember 

is treated, the provider considers the cause of the illness. When an environmental 

factor may be responsible that is affecting several individuals, this information is 

elevated through command channels. • Individual diagnoses and symptoms are entered into the Servicemember’s electronic medical record and sent to the Joint Medical Workstation, where populationbased trends at the installation and in the theater can be identified to indicate if 

a problem requires investigation. • A health assessment questionnaire is provided (to those who deployed) at the 

conclusion of deployment and again at 90 to 180 days after returning. This questionnaire offers the Servicemember the opportunity to identify any health concerns or 

problems experienced, and to identify any occupational or environmental exposure 

experienced or of concern. These questionnaires are reviewed by medical personnel 

to identify Servicemembers who warrant further evaluation or medical treatment. • Health outcome data, including any associated with the inhalation of burn pit 

smoke, is reviewed by the Armed Force Health Surveillance Center and the Department of Defense Deployment Health Research Center. Both organizations are examining the data closely to determine whether there may be any long-term health effects associated with smoke inhalation. While they have generated some preliminary 

assessments, it is too early to draw any conclusions until further studies are completed. 

We are aware that inhalation of the smoke from burn pits by our Servicemembers 

is responsible for mild, short-term health effects in some personnel to include red, 

watery eyes and irritation of the upper respiratory system and, in some cases, a 

cough. We also believe that, in a small number of people with either increased susceptibility to the smoke (genetic/family history, preexisting medical conditions) or 

combined burn pit smoke exposure with some other inhalation exposure, such as tobacco smoke, may be affected by more serious long-term health effects. The number 

of these people is quite small compared to the numbers exposed, so it is difficult 

to establish statistically solid relationships. 

Question 3. The Committee understands that there were four National Guard 

units—Indiana, West Virginia, Oregon and South Carolina—that were present at 

Qarmat Ali for a period of time. Please provide chronological data (timeline) on 

when each unit arrived, for what amount of time the unit was present, and when 

each unit left. In addition, please provide the approximate amount of personnel each 

unit had, and how many members of each unit were stationed at Qarmat Ali. 

Response. There were no U.S. Army units stationed at the Qarmat Ali water 

treatment facility. The U.S. Soldiers were based either in Kuwait or Basra, they 

provided individual protection details to KBR contractors. During the time a unit 

performed this mission, some soldiers may have been sent repeatedly to the Qarmat 

Ali facility, while others may have never been sent to the facility. 

The exact timelines for the mission support are not available, the approximate 

dates of the missions were: 

1st Battalion 162nd Infantry (Oregon Army National Guard)—started the 

personal security mission in April 2003, when KBR began to conduct site visits 

and repairs. They continued the mission until replaced by the Indiana Army 

National Guard in the middle of June. After an overlap with the Indiana ARNG 

Soldiers, the Oregon ARNG Soldiers moved to new missions at the end of June. 

The unit supported the mission from Kuwait. Since the actual work began at 

the site in May, the Oregon ARNG Soldiers supported the mission for approximately six weeks. The Oregon ARNG reported 278 soldiers were involved in this 

particular mission. In 2003, when the Army conducted site testing and medical 

evaluations, the unit reported 48 Soldiers having been at the site. 

130 

1092nd Engineer Battalion (West Virginia Army National Guard)—From 

April until July 2003 the unit was assigned the personal protection detail. The 

WV ARNG was based out of Kuwait and chose to perform the mission by assigning the responsibility to C Company for the entire period of the mission. 

The WV ARNG period overlapped the Oregon and Indiana ARNG mission 

change. In 2008, the unit reported having 124 Soldiers involved in the Project 

RIO mission. 

1st Battalion 152nd Infantry (Indiana Army National Guard)- started the personal security mission in June 2003 when they replaced the Oregon ARNG Soldiers. While the unit was based in Kuwait, they chose to perform the mission 

by assigning it to their C Company for the entire time. The C Company was 

moved to Basra to be closer to the mission site. The Indiana ARNG Soldiers 

performed the mission from June 2003 until December 2003. The Indiana 

ARNG reported 128 Soldiers involved in mission. In 2003, when the Army conducted site testing and medical evaluations, the unit reported 128 Soldiers having been at the site. 

133rd Military Police Company (South Carolina Army National Guard)—did 

not perform the personal protection mission. The SC ARNG had a quick reaction force mission responsibility. Should a unit in the area be engaged or need 

support, they would call the 133rd and the 133rd would respond with rapid 

movement and additional firepower. The SC ARNG Soldiers had this mission 

from August 2003 until December 2003. The SC ARNG reported having 142 Soldiers involved in the mission. In 2003, when the Army conducted site testing 

and medical evaluations, the unit reported 37 Soldiers having been at the site. 

In 2008, during the Army review of the incident, the units reported that soldiers 

not involved in the mission may have visited the site for a variety of administrative 

reasons. The ARNG headquarters of each state began a mission to contact each soldier to determine the exact number of soldiers who visited the site at Qarmat Ali 

between April and October 2003. 

Question 4. There have been several references made to correspondence between 

then-Secretary of Defense Cohen and then-Ambassador Foley regarding the effects 

of the exposure from the Shinkampo Incineration Complex (SIC) near NAF Atsugi 

and possible courses of action by the Navy to protect the residents stationed there. 

Please provide copies of all correspondence between these individuals between 1985 

and 2001 regarding NAF Atsugi. 

Response. [The Committee had not received the requested information by press 

time.] 

Question 5. The Department of Defense has stated that it is in the process of attaining the Social Security Numbers (SSNs) of soldiers from the four separate units 

that rotated through Qarmat Ali so that these individuals can be added to a database and their health effects can be analyzed. When do you expect this process to 

be complete? What will happen once this information is attained—who will it be 

shared with? 

Response. Gathering of information has been more difficult than anticipated and 

is taking longer than expected. More than 1,100 Servicemembers were deployed to 

Iraq in the four units. Only about one third of those were known to have been directly involved in the mission that placed them at the Qarmat Ali facility (the site 

of the incident); the number of Servicemembers who may have had an incidental 

contact with the site (administrative visit, resupply effort, etc.) is unknown. The 

Army will count all unit members as potentially exposed until it confirms whether 

they were at the site. To complete this process, the Army will have to contact each 

individual. The Army’s biggest challenge is to locate and contact those individuals 

who are no longer serving. Some have moved and not left forwarding contact information, others have not responded to attempts by the Army to contact them. Others 

are still in the Army, but are now deployed again to Iraq or Afghanistan. The Army 

continues to work this issue and will not stop until they have confirmed every individual who spent even a single day at the Qarmat Ali site. It is anticipated that 

there will be an initial transfer of SSNs that will occur by December 15, 2009, with 

monthly updates thereafter. 

The SSNs will be shared with two agencies: the Office of the Assistant Secretary 

of Defense for Health Affairs (OASD(HA)) and the Department of Veterans Affairs 

(VA). The VA will use the information to track the Servicemembers through a separate registry that they are establishing for this incident. The individuals will receive 

an entry level medical evaluation and regular medical evaluations to monitor their 

health and any issues that may arise from the exposure. The OASD(HA) will determine if any individuals were treated while in theater or after returning, and if any 

131 

of those treatments were for conditions that may have been related to sodium dichromate exposure. 

Question 6. When will you provide the Department of Veterans’ Affairs (VA) the 

data it has requested from you pertaining to veterans potentially exposed to chemicals at Camp Lejeune, so that VA can better determine care and compensation for 

these veterans? 

Response. The Veterans’ Benefits Administration requested access to that data on 

October 21, 2009. The Deputy Commandant of the Marine Corps for Installations 

and Logistics will provide access to the requested data for the veterans possibly exposed to chemicals. The Marine Corps has contacted the VA and projects that access 

will be available in approximately three months (January 2010), depending on privacy act requirements and necessary permissions. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO

CRAIG POSTLEWAITE, DVM, MPH, ACTING DIRECTOR, FORCE HEALTH PROTECTION

AND READINESS PROGRAMS AND DIRECTOR, FORCE READINESS AND HEALTH

ASSURANCE

Question 1. At the hearing, Mr. John Resta indicated that the Department of Defense (DOD) may be moving forward with additional air sampling and studies regarding the potential health effects of burn pits being used in Iraq and Afghanistan. 

A. Please provide additional details regarding any ongoing or planned air sampling related to burn pits. 

B. Is ongoing sampling being done near the living quarters of Servicemembers in 

Iraq? 

C. Would you please provide a timeline of when additional studies will be initiated 

and when we can expect the results? 

Response. Air sampling for particulate matter is conducted across Iraq and Afghanistan at locations with deployed preventive medicine personnel, which includes 

most of the larger United States base camps. Sampling for volatile organic compounds is also conducted. A multi-Service group is developing a comprehensive air 

sampling strategy for United States Central Command, focusing on sites with significant air pollution sources such as burn pits. The group is considering potential 

air hazards, methods to collect samples in a deployed area, and how such data could 

be used to better characterize the air and estimate the health risk to deployed Servicemembers. The group’s members will travel to six locations in Iraq and Afghanistan in early November 2009 to brief on historical air sampling results, discuss the 

current situation with medical personnel, and gain further understanding of the exposure situation and concerns. Upon return, they will update the draft strategy and 

present it to the Joint Environmental Surveillance Work Group Executive Committee in late November 2009 and to the Defense Health Board at the end of November 2009. Sampling is expected to begin by early 2010, assuming operational security conditions allow it. 

Air sampling locations are selected by deployed preventive medicine personnel 

based on their assessments of air hazards and the possible impact on the mission 

and potentially affected populations. These sampling locations frequently include 

living areas. 

Additional burn pit studies are expected to begin in early 2010. The actual dates 

may be affected by: equipment purchase and shipping, training, coordination of laboratory assistance, rotation schedules, or the operational situations at the locations 

of interest. Results are expected three to six months after the completion of field 

work. 

Epidemiologic studies to examine health outcomes that may be associated with 

smoke exposures have been initiated on behalf of the Armed Force Health Surveillance Center and the DOD Deployment Research Center, with two already completed. Each provided important data, but neither can be considered definitive in 

terms of whether any long-term health risks are present. A plan for additional studies to be accomplished has been outlined and several additional studies are underway. Some of these are hypothesis-generating studies that may require further studies. At this time, it is not possible to provide a firm date on when a determination 

can be made regarding the impact of breathing burn pit smoke on the incidence of 

chronic health conditions, but we should have a better idea by March 2010, when 

the planned studies are complete. 

Question 2. A February 2009 article in Inhalation Toxicology, written by employees from the United States Army Center for Health Promotion and Preventive Medicine, noted that authors of a 2005 journal article had ‘‘conducted a survey of 15,000 

132 

military personnel deployed to [Operation Enduring Freedom/Operation Iraqi Freedom] and estimated that 69.1% reported experiencing respiratory illnesses, of which 

17% required medical care,’’ and that ‘‘[t]he frequency of respiratory conditions doubled from a pre-combat period to a period of combat operations in this group.’’ 

A. What steps are being taken to ensure that possible respiratory illness is addressed in Post-Deployment Health Assessments? 

B. To what extent does the smoke from burn pits potentially contribute to respiratory health problems of deployed Servicemembers? 

Response. Post-Deployment Health Assessments that are accomplished within 30 

days of returning to the Servicemember’s home base or station and have a number 

of questions pertaining to smoke exposure and respiratory illness that each Servicemember is requested to answer: 

• Question #8, ‘‘. . . cough lasting more than 3 weeks; trouble breathing more 

than 3 weeks; chest pain or pressure, and other’’; 

• Question #16, ‘‘Are you worried about your health because of exposure to chlorine gas, fog oils (smoke screen), garbage, industrial pollution, JP8 or other fuels, 

smoke from burning trash or feces, and other?’’; 

• Page 6, Question #10, ‘‘Do you have any other concerns about possible exposures or events?’’; and 

• Question #11 (to be asked by a provider), ‘‘Do you currently have any questions 

or concerns about your health?’’ 

Positive or ‘‘yes’’ answers to these questions are followed up by the healthcare provider to determine if a medical referral is needed, including for respiratory illness. 

The increase in respiratory conditions in-theater noted in the article was detected 

by analyzing the Post-Deployment Self Assessment data. Individuals’ self-reporting 

of symptoms on questionnaires seems to increase from pre- to post-deployment, but 

the increase is not reflected in more objective measures of health status, namely 

health care encounters. The Army’s Center for Health Promotion and Preventive 

Medicine has assessed the frequency of post-deployment inpatient and ambulatory 

care visits for respiratory conditions, and not found them to be associated with deployment (i.e., number of deployments and cumulative time deployed). The Department of Defense recognizes that exposure to burn pits smoke can cause acute, shortterm and, (most often) mild respiratory health problems in Servicemembers. These 

symptoms include red, watery eyes, and mild upper system symptoms, (depending 

on the degree of smoke exposure) such as coughing and sinus congestion. It is possible that some individuals who have preexisting respiratory conditions may have 

those conditions aggravated by smoke exposures, or because of special 

susceptibilities, unique medical histories, or even as a result of combined exposures 

(such as use of cigarettes or cigars), could develop some type of chronic health effects. What is not known is what health conditions might fall into this category and 

how frequently such conditions may develop. The studies conducted to date have not 

demonstrated a significant increase on a population-wide basis in respiratory health 

outcomes after deployment. Additional epidemiologic studies are underway to identify any associated health conditions and the extent of any risks toward the development of long-term, chronic conditions. 

Chairman AKAKA. Thank you very much, Dr. Postlewaite. And 

now we will receive the testimony of Dr. Gillooly. 

STATEMENT OF PAUL B. GILLOOLY, Ph.D., CAPT., MEDICAL 

SERVICE CORPS, U.S. NAVY (RET.), NAVY/MARINE CORPS 

PUBLIC HEALTH CENTER 

Mr. GILLOOLY. Chairman Akaka, distinguished Members of the 

Committee, I am Dr. Paul Gillooly, representing Navy Medicine. I 

am here to discuss Navy Medicine’s efforts in evaluating the potential health risks for U.S. Navy personnel and their families living 

and working at Naval Air Facility Atsugi, Japan, from the operation of the adjacent privately-owned Shinkampo Incineration 

Complex referred to as the SIC. 

It is important to make clear our role in Navy Medicine is to conduct such studies when tasked and to act as advisors to Navy Line 

Officers, who as risk managers, make the final decisions with reVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00138 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
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gard to implementing new policies or visions to existing policies in 

response to potential health threats in these situations. 

The incinerators were installed first in the early 1980s and 

burned municipal waste. Navy health concerns first arose around 

1985 when the incinerator applied for and was granted a license 

to burn industrial waste. Navy Medicine’s involvement began in 

1994 and continued through the closing of the incinerator in 2001. 

Following the closure of the incinerator, we completed a comprehensive health risk assessment report in 2002. Navy Medicine 

conducted or sponsored three human health risk assessments, 

three epidemiological studies, and a medical screening study, all of 

which underwent high level external peer review. In addition, we 

coordinated the execution of a robust health and environmental 

risk communication plan. 

The first two screening health risk assessments conducted in 

1994 and 1997 raised concerns for both cancer and non-cancer effects from exposure to the incinerator. In October 1997, the Bureau 

of Medicine and Surgery was tasked by Commander-in-Chief, U.S. 

Pacific Fleet to conduct a comprehensive health risk assessment. 

The most significant results of the comprehensive risk assessment 

were as follows: 

The cancer risk for children under the age of six living on base 

for a 3-year tour of duty suggested that a child’s exposure to contaminants from air and soil could potentially result in an additional lifetime cancer risk of 1.1 per 10,000. The calculated cancer 

risk for adults living or working on base for a 3- or 6-year tour of 

duty suggested that an adult’s exposure to contaminants from air 

and soil falls within the EPA’s acceptable cancer risk range of 1 in 

10,000 to 1 in 1,000,000. 

We worked closely with EPA throughout the life of this project, 

and EPA procedures and guidance were used in the development 

of the sampling plan, collection of the air quality data, quality assurance audits and procedures, and execution of the entire risk assessment methodology. This is an important point in that due to 

the absence of equivalent regulatory oversight by the Government 

of Japan, the U.S. Navy assumed that role. To ensure that equivalent standard of environmental protection we were committed to 

using the accepted and legal risk assessment methodology of the 

EPA. 

To respond to NAF Atsugi community concerns, Navy Medicine 

was given permission to conduct three health studies: a children’s 

respiratory health study in 1998; a pregnancy loss or miscarriage 

study for women at NAF Atsugi, also in 1998; and a retrospective 

cohort study of disease just completed in 2009. 

There were no significant findings in either the children’s respiratory study or the pregnancy loss study. The recently completed 

retrospective cohort study of disease was designed to determine if 

the incidence of disease associated with exposure to the emissions 

from the incinerator significantly differ for residents of NAF Atsugi 

from 1985 to 2001 when compared to a similar population in Yokosuka over that same time period. 

The study included over 5,600 active duty and over 11,000 family 

members at NAF Atsugi former-resident cohort and found a significantly higher risk for dermal complaints, a non-cancer health efVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00139 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
134 

fect, in the Atsugi population when compared to the Yokosuka population. No other area of analysis found significant differences in 

disease and illness incidence or health complaints. 

Navy Medicine then requested Battelle Memorial Institute, an 

external independent private agency, to review all available Navy 

Atsugi health risk assessment data and make recommendations for 

possible additional medical screening. Battelle stated: ‘‘The conclusion of all previous evaluations are remarkable for their consistency. Residents of NAF Atsugi were exposed to ambient air and 

soil contaminants due primarily to emissions from the Shinkampo 

Incinerator Complex that were sufficient to produce an incremental 

increase in lifetime risk of cancer and increase the risk of respiratory non-cancer effects. However, since the incremental risk was 

relatively small, it would not be scientifically meaningful to provide 

broad medical screening for all potential exposed personnel.’’ 

In April 1998, at the direction of the Assistant Secretary of the 

Navy for Manpower and Reserve Affairs, Navy Medicine developed 

a comprehensive risk communication and health consultation plan. 

This plan addressed the means for providing information to the 

community, establish procedures for providing formal risk communication to everyone onboard NAF Atsugi and personnel negotiating orders to Atsugi, and implemented health consultations and 

documentation describing the potential exposure conditions at NAF 

Atsugi. 

In coordinating with the VA, the primary process followed by 

DOD and Navy Medicine is to ensure the VA is aware of individual 

hazards exposures and that the information is entered into the 

medical records of those affected, so it is available to the VA at the 

time of treatment or claims adjudication. 

This process was initiated for NAF Atsugi base residents beginning around 1995 to 1998 timeframe and continued until the incinerator closed in 2002. In June 2009, following a brief by Navy Medicine, the DOD/VA Deployment Health Working Group agreed the 

VA would receive a list of all affected active duty personnel stationed at NAF Atsugi from 1985 to 2001. This collection of information will aid in any future outreach or surveillance activities for 

this population as indicated. 

Presently, Navy Medicine, through the Navy and Marine Corps 

Public Health Center, has developed a Web site that provides all 

publicly available documents related to NAF Atsugi and a frequently asked questions section as a means of providing information to former Atsugi residents, their health care providers, and the 

VA. This Web site also has a link allowing any VA medical care 

provider the opportunity to contact a Navy physician directly for 

any additional information on health issues related to the NAF 

Atsugi exposures. 

Mr. Chairman, distinguished Members of the Committee, thank 

you for the opportunity to share with you Navy Medicine’s efforts 

in evaluating exposures from the incinerator at NAF Atsugi. 

[The prepared statement of Mr. Gillooly follows:] 

PREPARED STATEMENT OF PAUL GILLOOLY, PH.D., CAPTAIN, MEDICAL SERVICES

CORPS, U.S. NAVY (RETIRED) NAVY/MARINE CORPS PUBLIC HEALTH CENTER

Chairman Akaka, Senator Burr, distinguished Members of the Committee: I am 

Dr. Paul Gillooly, representing Navy Medicine, to address Navy Medicine’s efforts 

135 

in relation to potential health risks for U.S. Navy personnel and their families living 

and working on Naval Air Facility (NAF) Atsugi, Japan, from the operation of the 

adjacent, privately owned, Japanese Shinkampo Incineration Complex (SIC). 

Navy Medicine conducted or sponsored three human health risk assessments, 

three epidemiological studies and a medical screening study. 

HEALTH RISK ASSESSMENTS

At the request of the Commanding Officer (CO), NAF Atsugi, in 1994, the Navy 

Environmental Health Center (NEHC) conducted a screening human health risk assessment (HRA) with data collected in July, August and September 1994 by Naval 

Facilities Engineering Services Center (NFESC). The assessment was considered to 

be a screening assessment because the air quality data collected by NFESC was not 

intended for human health risk assessment purposes but for compliance purposes, 

as it was collected over a limited period of time, of short duration and air was the 

only medium sampled. Groups of chemicals sampled included Volatile Organic Compounds (VOCs); Polycyclic Aromatic Hydrocarbons (PAHs); Organochlorine pesticides and Polychlorinated Biphenyls (PCB); Dioxins and Furans; and metals and 

particulates. The screening assessment was released in October 1995 and can be 

found at http://www-nmcphc.med.navy.mil/downloads/ep/Atsugi/NAF%20ATSUGI% 

20SCREENING%20RISK%2095%20image.pdf. This screening HRA indicated that 

the air quality at NAF Atsugi could raise the additional lifetime cancer risk to levels 

higher than the U.S. Environmental Protection Agency’s (USEPA’s) acceptable lifetime cancer risk range (i.e., 1 in 10,000 to 1 in 1,000,000 additional cases of cancer) 

for children (under the age of six) spending a normal three-year tour of duty at NAF 

Atsugi. This risk assessment is based on the interpretation of the National Contingency Plan 40 CFR Part 300 (2003) Subpart E—Hazardous Substance Response Section 300.430 Remedial Investigation/Feasibility Study (d) Feasibility Study 

(2)(i)(a)(2). Current EPA regulatory risk assessment procedures estimate cancer 

risks as additional lifetime incidence. The screening risk assessment also indicated 

concerns for non-cancer health effects, related to trimethyl benzenes and chromium. 

The Commander in Chief, U. S., Pacific Fleet (CINCPACFLT) requested NEHC 

to conduct another screening HRA with 1997 air quality data collected by Earth 

Tech under contract to Naval Facilities Engineering Command Pacific. The data was 

collected to address compliance issues, as a result of the SIC owner’s request to the 

Government of Japan to modify the operating permit to allow for an increase in operating hours and throughput. The second screening HRA supported the first with 

regard to indicating a similar level of concern for calculated cancer risk and concern 

for non-cancer health effects in the exposed population. It can be found at http:// 

www.nmcphc.med.navy.mil/downloads/ep/Atsugi/SCREENING%20LEVEL%20AIR_ 

TECHNICAL%20MEMO%20NOV%2098.pdf. 

In October 1997, the Bureau of Medicine and Surgery (BUMED) was tasked by 

Commander in Chief U.S. Pacific Fleet, to conduct a comprehensive HRA. Sampling 

for the assessment was conducted from March 1998 until July 2000. Eight groups 

of air pollutants were monitored, including: acid gases; aldehydes and ketones; 

dioxins; PCBs and pesticides; particulate matter (PM10 and PM2.5) and heavy metals, mercury, VOCs, and semi-volatile organic compounds (SVOCs). In soil, sampling 

was conducted for metals; pesticides and PCBs; SVOCs; and dioxins. Sampling was 

conducted to collect representative data that is spatially and temporally distributed 

over various seasons and various weather and incinerator operating conditions. The 

results of the comprehensive health risk assessment were as follows: http://www. 

nmcphc.med.navy.mil/downloads/ep/Atsugi/Complete_Health_Risk_Assessment.PDF. 

• The cancer risk for children (under the age of 6) living on base for a 3-year tour 

of duty suggested that a child’s exposure to contaminants from air and soil during 

a 3-year tour of duty could potentially result in an additional lifetime cancer risk 

of 1.1 per 10,000. 

• The calculated cancer risk for adults living or working on base for a 3 or 6-year 

tour of duty suggested that an adult’s exposure to contaminants from air and soil 

falls within the cancer risk range of 1 in 10,000 and 1 in 1,000,000. 

• Eight groups of air pollutants were monitored, including: acid gases; aldehydes 

and ketones; dioxins; PCBs and pesticides; particulate matter (PM10 and PM2.5) 

and heavy metals, mercury, VOCs, and semi-volatile organic compounds (SVOCs). 

In soil, sampling was conducted for metals; pesticides and PCBs; SVOCs; and 

dioxins 

• Potential adverse non-cancer health effects that may be related to concentrations of chemicals in the air such as irritation of the eyes and upper respiratory system, headaches, and skin rash are short lived and directly related to exposure. 

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fects may be reversible when an individual leaves NAF Atsugi. However, there is 

some concern that repeated long-term exposure to chemicals, in combination with 

others, might result in long-term, non-cancer health effects. • Because risk assessments use many assumptions and estimates, the final risk 

numbers always contain some uncertainty. Because of this, the numbers need to be 

interpreted with caution. The true risk numbers may be higher or lower; however, 

they are likely lower because there were many conservative assumptions and estimates used in the risk assessment to be health protective, as it was based on an 

upper bound risk. In the U.S., risk assessment results similar to those found at 

NAF Atsugi may, in some contexts, result in additional USEPA regulatory action. 

Legal and political action initiated by the U. S. Department of Justice eventually 

resulted in the closure of the Shinkampo Incinerator Complex in 2001. 

EPIDEMIOLOGICAL HEALTH STUDIES

To respond to NAF Atsugi community concerns, NEHC conducted three health 

studies, a Children’s Respiratory Health Study (children at Yokosuka, Japan, and 

those on and off-base at Atsugi), a Pregnancy Loss Study for Women at NAF Atsugi, 

and a Retrospective Cohort Study of Disease. 

Children’s Respiratory Study 

The Children’s Respiratory Study was designed to determine if air pollutants from 

the Shinkampo incinerator were affecting the respiratory health of children. Between 7 May 1998 and 5 June 1998, 127 fifth and sixth grade children who attended 

Atsugi or Yokosuka DOD schools volunteers participated in a health study. The 

study can be found at: http://www-nmcphc.med.navy.mil/downloads/ep/Atsugi/ 

Complete_Health_Risk_Assessment.PDF. 

There were two primary goals of this study. The first was to determine if there 

were differences in respiratory health between children who live or go to school at 

NAF Atsugi and similar children who live at Yokosuka. The second goal was to 

identify whether the children who live or go to school at Atsugi have more respiratory symptoms on days when they were exposed to higher levels of pollutants 

from the SIC. 

Given the limits of this study, we were not able to document differences in the 

respiratory health of children living on or off base at NAF Atsugi versus those at 

Yokosuka. 

Pregnancy Loss Study 

The Pregnancy Loss Study, designed to describe the rate of miscarriage at NAF 

Atsugi and other naval facilities in Japan, was conducted in the summer of 1998. 

The researchers examined hospital and clinic records for Navy personnel or their 

dependents who were pregnant and living in Japan at some point between June 

1995 and May 1998. Information used to calculate the miscarriage rates came from 

three different sources, Delivery Logs at Naval Hospital Yokosuka (NHY), Pathology 

records at NHY and the Prenatal Log at the Atsugi Branch Medical Clinic. The 

study can be found at: http://www-nmcphc.med.navy.mil/downloads/ep/Atsugi/ 

Complete_Health_Risk_Assessment.PDF. 

A total of 1862 pregnancies with known outcomes from NHY (including Atsugi, 

Yokosuka, Sasebo and Iwakuni) were examined. There were 1701 live births and 

130 miscarriages between June 1995 and May 1998. The corresponding miscarriage 

rate for this period was 7.1%. The rate at NAF Atsugi, determined from review of 

the prenatal log during the same period, was 8.8%. Statistically, there is no difference between the overall NH Yokosuka rate and the Atsugi rate. This rate was 

based on the examination of 353 total pregnancies, with 322 live births and 31 miscarriages. 

Within study constraints, the results of the study indicated that the risk of miscarriage at NAF Atsugi was comparable to Yokosuka, 

Retrospective Cohort Study of Disease 

In March 2007, Navy and Marine Corps Public Health Center (NMCPHC), formerly NEHC, was requested by the Navy Bureau of Medicine and Surgery 

(BUMED) to investigate the long-term health effects that might be associated with 

exposure to SIC emissions. NMCPHC reviewed the HRA to determine the appropriate diseases to study based on chemicals identified in the environmental sampling results. Target organs and illnesses were selected based on published environmental exposure literature from USEPA and peer reviewed literature. Using this information, the Atsugi Health Study was designed to determine if incidence of disease associated with exposure to the emissions of the SIC significantly differ for 

residents of NAF Atsugi from 1985 to 2001 when compared to a similar population 

137 

over the same time period. The study can be found at: http://www-nmcphc.med. 

navy.mil/downloads/ep/Atsugi/Complete_Health_Risk_Assessment.PDF. 

The study included over 5,600 active duty and over 11,000 family members in 

NAF Atsugi former-resident cohort. Current medical information was available for 

24% of active duty and 28% of dependents compared to 19% and 25% for comparison 

population. Outcomes were studied for 11 cancer types and non-cancer outcomes for 

ocular, dermal, and respiratory disorders. 

The results of the study found a significantly higher risk for dermal complaints, 

a non-cancer health effect, in the Atsugi population when compared to the Yokosuka 

population. No other area of analysis found significant differences in disease and illness incidence or health complaints. None of the types of cancer considered as possible associated with exposure to SIC pollution had significantly different risk ratios 

between the populations. 

Medical Screening Study 

Navy Medicine, via the Navy and Marine Corps Public Health Center, requested 

Battelle Memorial Institute, an external private agency, independent from the Navy, 

to review the health risk assessment data and make recommendations for possible 

additional medical screening. Battelle Memorial Institute was requested to answer 

a specific question with supporting evidence: ‘‘For those who lived aboard NAF 

Atsugi during the time of incinerator operation, what, if any, additional populationbased medical screening might be indicated? Provide the medically supported basis 

for that determination.’’ Furthermore, if additional population-based medical screening is indicated, recommend screening parameters, include the standard used and 

the expected outcome such screening would have on the population’s health. 

As background for those not familiar with population-based medical screening, the 

U.S. Preventive Services Task Force (USPSTF), established in 1984 under the U.S. 

Department of Health and Human Services, has routinely published recommendations for primary care practitioners on what medical screening or testing should be 

provided to apparently healthy persons based on age, sex and risk factors for disease. These are general medical screening recommendations that are appropriate for 

any and all members of the U.S. population that are in the recommended screening 

group. These provide early detection of diseases ranging from cancer to mental 

health conditions. The recommendations can be accessed at: http://www.ahrq.gov/ 

clinic/prevenix.htm. 

From the Battelle report’s Executive Summary: ‘‘The conclusion of all previous 

evaluations are remarkable for their consistency: residents of NAF Atsugi were exposed to ambient air and soil contaminants [based on chemicals analyzed for the 

2002 human health risk assessment], due primarily to emissions from the SIC, that 

were sufficient to produce an incremental increase in lifetime risk of cancer and increase the risk of respiratory non-cancer health effects. However, since the incremental risk was relatively small, it would not be scientifically meaningful to provide 

broad medical screening for all potentially exposed personnel.’’ Because of the authors’ opinion that there is no epidemiologic study protocol, with or without medical 

testing, capable of detecting the small number of cancers that could possibly have 

been caused by an environmental exposure from the incinerator against the normal 

background of cancer incidence in the human population, no additional screening or 

testing is recommended for disease that is not already evident. 

COMMUNICATIONS

Communication with NAF Atsugi Population 

In April 1998, at the direction of Assistant Secretary of the Navy for Manpower 

and Reserve Affairs (ASN(M&RA)), NEHC developed a comprehensive risk communication and health consultation program. This was coordinated with the Bureau of 

Medicine and Surgery, NAF Atsugi, Branch Medical Clinic Atsugi, Commander 

Naval Forces Japan, Bureau of Naval Personnel and Commander in Chief, U.S. Pacific Fleet. The plan established procedures for providing formal risk communication 

to everyone onboard NAF Atsugi and personnel with orders to Atsugi. One-on-one 

health consultations were conducted for all adults extending for more than six years 

on station, all adults who had children under the age of six, those with chronic respiratory conditions and pregnant or nursing women. A standard entry was made in 

medical records that described potential exposure conditions at NAF Atsugi. 

The program required that Navy Detailers mention the air quality issue and refer 

military members to medical and base points of contact for further information. It 

required overseas medical screeners discuss the health risks and provide a focused 

health consultation for individuals with orders to NAF Atsugi and a provide a fact 

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proach was established to inform individuals of potential risks to adults and children living or working at NAF Atsugi. 

A Health and Environmental Risk Communication Plan addressed the means for 

providing information to the community (e.g., base newspaper articles, public availability sessions, fact sheets, web sites, library repositories). 

Several different medical record forms were used at NAF Atsugi to respond to 

concerns from NAF Atsugi military personnel and their families about medical documentation and full disclosure of their potential exposure and possible health effects. 

All forms were placed in personnel and family permanent health records. Branch 

Medical Clinic Atsugi, with Bureau of Medicine and Surgery’s approval, developed 

a medical record form that listed the maximum sampling concentrations measured 

in 1994 for 12 chemicals exceeding USEPA or New York State ambient air quality 

standards during the air quality study. These chemicals included: sulfur dioxide, nitrogen dioxide, hydrochloric acid, carbon tetrachloride, benzene, dioxins, cadmium, 

mercury, nickel, chromium, arsenic and respirable particulates. (http://www-nmcphc. 

med.navy.mil/downloads/ep/Atsugi/Appendix_A_appendices.pdf) Cancer risks were 

also provided on this form. Beginning 1 March 1996, this form was inserted in medical records of all individuals that requested the documentation. 

During health risk communication and consultation at NAF Atsugi, which began 

in June 1998, a revised form was completed for every individual at NAF Atsugi and 

those with orders to NAF Atsugi. This new form documented full disclosure of potential exposures and possible health effects, related to environmental conditions, 

for each military member and family member based upon their medical history. The 

new form was signed by each adult family member (18 years and older) to acknowledge receipt of risk communication. The sponsor or spouse signed the new form for 

children under the age of 18. Additionally, all servicemembers and family members 

over the age of 17 indicated that they received a risk communication briefing by 

signing an ‘‘Administrative Remarks NAVPERS 1070/613 (Rev. 10–81),’’ commonly 

referred to as a ‘‘Page 13’’ entry to be retained in their military record. Prior to detachment from NAF Atsugi, another medical form was completed to document arrival and departure dates and locations of residence, schools attended and employment, while assigned to NAF Atsugi. 

Communication with the Department of Veterans Affairs (VA) 

The primary process followed by the DOD and Navy Medicine to ensure the VA 

is aware of individual hazardous exposures is to ensure all individual exposure-related information is entered into individual medical records of those affected so it 

is available to the VA at the time of treatment or claims adjudication. This process 

was initiated for NAF Atsugi base residents beginning in the 1995–1998 timeframe 

and continued until the incinerator closed in 2001. Navy Medicine follows the DODI 

6055.05, ‘‘Occupational and Environmental Health,’’ Paragraph 2.c., ‘‘Data Sharing,’’ 

which requires DOD to share hazard and exposure data with the VA to assist in 

adjudication of veterans’ disability claims. However, there is no specific policy that 

identifies the conditions or circumstances that require notification to the VA of possibly harmful exposures. 

Presently, Navy Medicine, through the Navy and Marine Corps Public Health 

Center (NMCPHC) has developed a Web site that provides all publicly available documents related to NAF Atsugi and a Frequently Asked Questions (FAQ) section as 

means of providing information to former Atsugi residents, their health care providers, and the VA. These documents include the two health risk assessments from 

1995 and 1998 and the final comprehensive health risk assessment from 2002, 

which along with other studies and reviews, provides the necessary information 

from which the VA can adjudicate filed claims from military members stationed at 

NAF Atsugi. The Web site also has a link allowing any VA medical care provider 

the opportunity to contact a Navy physician directly for any additional information 

on health issues related to the NAF Atsugi exposures. 

For several years, DOD and VA have collaborated in the DOD/VA Deployment 

Health Working Group, which focuses on post-deployment health of Servicemembers 

and veterans. This working group has a major focus on environmental and occupational exposures, and it discusses these issues at nearly every monthly meeting. 

These issues have specifically included the Atsugi incinerator. In the case of the personnel who were stationed at Atsugi, Japan, the DOD/VA Deployment Health Work 

group received a briefing on the incinerator-generated exposures in June 2009 by 

the BUMED Occupational Medicine Program Head. 

In June 2009, following a brief by Navy Medicine, the DOD/VA Deployment 

Health Working Group agreed the VA would receive a list of all affected Active Duty 

personnel stationed at NAF Atsugi from 1985–2001. These data come to the Navy 

and Marine Corps Public Health Center from the NAF Atsugi Retrospective Cohort 

139 

Study of Disease, a cohort epidemiology investigation that utilized personnel records 

from the Defense Manpower Data Center to assemble the two cohorts for analysis. 

There were 5,635 Active Duty servicemembers identified from the Defense Manpower Data Center personnel records as being stationed at NAF Atsugi from 1985– 

2001. This collection of information will aid in any future outreach or surveillance 

activities for this population as indicated. 

MEDICAL SURVEILLANCE

After the Shinkampo Incinerator Complex shut down in 2001, outreach and 

health consultation activities centered on the specific environmental health exposures for the NAF Atsugi base population, were discontinued. The final health risk 

assessment performed by the Navy Environmental Health Center (NEHC), forwarded for release in 2002, did not reveal any major changes in the types of materials that posed risk to base residents nor the potential consequences to their health 

as determined in the 1995 and 1998 health risk assessments. Excess cancer risk 

was considered to be one new cancer above baseline per 10,000 individuals who as 

adults stayed more than 6 years at NAF Atsugi or as child under six years of age 

stayed longer than 3 years. For perspective, this excess cancer risk is approximately 

the same for adults who live in Denver as opposed to another city at sea level due 

to increased exposure to naturally occurring ionizing radiation at the higher altitudes. 

Mr. Chairman, distinguished Members of the Committee, thank you for the opportunity to share with you Navy Medicine’s efforts in relation to exposures at NAF 

Atsugi. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY DANIEL K. AKAKA TO PAUL

B. GILLOOLY, PH.D., CAPT, MEDICAL SERVICES CORPS, U.S. NAVY (RET.), NAVY/ 

MARINE CORPS PUBLIC HEALTH CENTER

Question 1. Please provide the best estimate of the size of the population that was 

at Atsugi between 1983 and 2001. Of this population, how many were servicemembers and how many were dependents, both adult and children? Please also provide the ages of the children. 

Response. Due to past Navy initiatives at paperwork reduction, archive/disposal 

rules and available storage space, there is limited data available. Review of NAF 

Atsugi’s primary mission reflected no major operational revisions during this time 

period and therefore the number of personnel on base would have remained fairly 

constant. Snapshot reviews of Command History, Housing Department files, and 

School records reflect the estimated population averages and demographics as 

follows: 

Officers Authorized ......................................................................................... 373 

Enlisted Authorized ........................................................................................ 2,532 

U.S. Civilians Authorized (U.S.C.S.) ............................................................. 273 

NAFI Assigned ................................................................................................ 271 

Japanese Nationals (Master Labor Contract) .............................................. 1,298 

Dependents on base ........................................................................................ 1,866 

Dependents off base ........................................................................................ 610 

Total servicemembers ..................................................................................... 2,905 

Dependents on/off base ................................................................................... 2,476 

NAF Atsugi only maintains an Elementary School. Junior and Senior Schools are 

offsite. School attendance records are not available between the years of 1993–2001. 

Children ages are not available, but school grades are provided (from which approximate ages can be extrapolated). Based on attendance files from 2006 to 2009 the 

following average enrollments numbers are: 

Pre-School ........................................................................................................ 18 

Kindergarten ................................................................................................... 85 

1st Grade ......................................................................................................... 88 

2nd ................................................................................................................... 85 

3rd .................................................................................................................... 78 

4th .................................................................................................................... 66 

5th .................................................................................................................... 70 

6th .................................................................................................................... 51 

Question 2. Is there a study that can be done that will provide more accurate data 

than those done in the past? What would that look like? 

140 

Response. The safety and health of our personnel deployed overseas is our number 

one priority. Therefore, a comprehensive human health risk assessment was conducted which included accurate and extensive ambient air, indoor air, and soil sampling in areas where our military and civilian members and their families lived, 

worked, and played. 

The June 2002, comprehensive ambient air samples were conducted approximately once every 6 days between April 1998 and June 1999. Five different ambient 

air locations and seven indoor air locations were sampled. A total of 344 ambient 

air samples and 67 indoor air samples were collected. During each sampling event, 

wind speeds and directions were also taken in order to correlate this data with ambient air findings. In March 1998, extensive soil samples were collected across the 

base. 

To ensure that the best science was used in the health risk assessment, Navy 

Medicine requested that the US Environmental Protection Agency (USEPA) and the 

National Academies of Science (NAS) review and comment on the draft comprehensive health risk assessment. 

USEPA scientists reviewing this health risk assessment generally concurred with 

the study design, methodologies, and conclusions. The NAS made positive comments 

regarding their confidence in the sampling techniques, data collected, and meteorological monitoring. Both made recommendations for the final report. 

Consequently, Navy Medicine made changes to the draft comprehensive health 

risk assessment report in response to USEPA and NAS comments and recommendations. The final comprehensive risk assessment report, dated June 2002, includes 

additional information and revisions in response to their comments and recommendations. The final report includes Navy Medicine responses to comments received from USEPA (Appendix B—51 pages) and the NAS (Appendix C—98 pages), 

which follows this response. Navy Medicine expended approximately an additional 

nine months, responding to these recommendations and incorporating changes to 

the comprehensive health risk assessment, to ensure the best science possible was 

used in support of our Navy community. 

Last, the Agency for Toxic Substances and Disease Registry (ATSDR) reviewed 

the health risk assessment and provided the following statement: ‘‘Based on the 

level of detail presented in the Navy’s assessments and the reviews of those documents, especially those performed by the National Research Council [NAS], we concluded that additional public health assessment activities by ATSDR are not necessary as they would not provide an evaluation that is any more definitive than 

those that have already been conducted.’’ 

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Question 3. Why did the Navy wait so many years before acting against the SIC 

operation? 

Response. The incinerator operation was located outside the fence line of NAF 

Atsugi on the sovereign territory of the host Nation. The operation began as a small 

burn pit and grew to a full scale incinerator over the years. The Navy was very 

proactive and began monitoring plant operations and air sampling as early as September 1988, followed by the conduct of the Navy Medicine Comprehensive Health 

Risk Assessment . The Navy shared the data with the GoJ via USFJ, and pursued 

solutions through the Host government at the highest levels of DOD, the State Department, and other official channels [Justice Department] until the GoJ finally 

took action on the issue and the operation was subsequently closed in 2001. 


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Question 4. On what date did the Navy require SF600s to be placed in servicemembers’ medical records? 

Response. Beginning in March 1996 and ending sometime after the incinerator 

was shut down in May 2001, several different SF600s were developed for inclusion 

in medical records of individuals assigned to Naval Air Facility Atsugi. 

• The first SF 600 developed, listed the maximum sampling concentrations measured in 1994 for 12 chemicals exceeding USEPA or New York State ambient air 

quality standards during the air quality study conducted by Naval Facility Engineering Services Center. Cancer risks were also provided on this SF600. Beginning 

1 March 1996, this SF 600 was inserted in medical records of all individuals that 

requested the documentation. 

• In February 1998, BUMED sent an Administrative Message regarding overseas 

screening for NAF Atsugi Japan indicating ‘‘Effective immediately, for all family 

members being screened for overseas assignment for NAF Atsugi, place an overprinted SF600 articulating the situation in the individuals health records text for 

the SF600 follows: ‘‘To be retained permanently in the health record. This SF600 

is to document full disclosure of potential environmental exposures for all personnel 

and their families who are assigned to NAF Atsugi. Authority: Chief BUMED 

262200ZFebruary 98. 

• In May 1998, Commander in Chief, U.S. Pacific Fleet sent an Administrative 

Message regarding ‘‘Risk Communication and Health Consultation Plan for Naval 

Activities Onboard Naval Air Facility Atsugi Japan.’’ The message addressed the 

implementation of a Comprehensive Risk Communication and Health Consultation 

Plan. 

• In July 1998, BUMED sent an updated Administrative Message regarding overseas screening for NAF Atsugi Japan to address this ‘‘Detailed Comprehensive Risk 

Communication and Health Consultation Plan for NAF Atsugi.’’ 

The comprehensive health risk communication and consultation at NAF Atsugi 

began in June 1998. A revised SF 600 was developed to be permanently retained 

in the medical records for every individual at NAF Atsugi and those with orders to 

NAF Atsugi. The purpose of the SF600 was to document potential exposures and 

possible health effects, related to environmental conditions, for each military member and/or family member based upon their medical history. An SF600 overprint 

was to be completed at the time of the member’s Departure Health Consultation to 

document the history on where servicemembers and family members lived, worked, 

or attended school or day care while at NAF Atsugi. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO

PAUL B. GILLOOLY, PH.D., CAPT, MSC, USN (RET.), PUBLIC HEALTH ASSESSOR, 

NAVY MARINE CORPS PUBLIC HEALTH CENTER

Question 1. The Shinkampo Incineration Complex operated near Naval Air Facility (NAF) Atsugi from 1985 to 2001. 

A. During that time, were there any recommendations made within the Navy to 

relocate military families stationed at Atsugi? 

B. If any such recommendation was made, where did the recommendation originate in the Navy and what was the final disposition of the recommendation? 

Response. Relocation of families was considered, but was regarded as a significant 

morale issue for a forward-deployed air wing. At a point during the time period, 

families were provided notice of the concerns surrounding the Shinkampo Incineration Complex prior to moving to Atsugi NAF and had the option of curtailing their 

tour. USFJ was fully engaged in the Shinkampo issue, and consistently raised the 

Shinkampo problem at Joint Committee meetings with the Government of Japan. 

Question 2. In June 2009, the Navy and Marine Corps Public Health Center released an ‘‘Executive Summary for NAF Atsugi Health Study,’’ which compared 

health outcomes experienced by NAF Atsugi residents with health outcomes of individuals stationed at another base in Japan. According to that summary, ‘‘[c]entral 

nervous system, liver and kidney damage were not included [in the study] for their 

non-cancer effects because the available literature was felt to be inadequate regarding the very low levels reported’’ in the Navy’s 2002 Human Health Risk Assessment. However, the medical records of former NAF Atsugi residents contain a form 

explaining that they were exposed to 12 emissions that exceeded the Environmental 

Protection Agency’s ambient air quality standards. 

A. Is the Navy aware that the Agency for Toxic Substances and Disease Registry 

has found that exposure to some of those chemicals, such as carbon tetrachloride, 

may cause liver, kidney, and central nervous system damage? 

291 

Response. Yes, the Navy is aware that the Agency for Toxic Substances and Disease Registry (ATSDR) publishes a list of reported health effects from studies that 

include some of the chemicals that were also found in the NAF Atsugi Health Study. 

These documents were reviewed when determining the health effects to include in 

the NAF Atsugi Study. ATSDR also reported levels of exposure at which these effects might be observed in humans, but these levels were much greater than those 

reported in the Navy’s 2002 Human Health Risk Assessment. The presence of a 

chemical is not sufficient to associate it as the cause of disease. The studies cited 

by ATSDR were mostly occupational and had exposures much higher than those 

measured, during the NAF Atsugi, Japan Human Health Risk Assessment, dated 

June 2002. 

As stated in the full report of the NAF Atsugi Health Study (Paragraph V.A.2), 

the ambient air concentrations measured in Atsugi were primarily compared to the 

concentrations reported by the US Environmental Protection Agency (USEPA). If 

the USEPA did not have a current risk assessment, other sources were used for the 

health effects comparison. As an example, the mean ambient air concentration for 

carbon tetrachloride was reported to be 0.616 micrograms per cubic meter of air (ug/ 

m3). For comparison to the levels reported by USEPA and in the literature, the 

mean value had to be converted to parts per million (PPM). Based on the atomic 

mass of carbon tetrachloride, 0.616 ug/m3 converts to 0.1 PPM (at 20 degrees centigrade and 1 atmosphere of pressure). When this level is compared to the studies 

cited in the ATSDR Toxicological Profile for Carbon Tetrachloride, no non-cancer 

health effects were observed in humans. 

B. What steps does the Navy intend to take to ensure that these or other relevant 

health effects are considered in investigating the long-term health effects that might 

be associated with the exposures at NAF Atsugi? 

Response. Navy Medicine has not been tasked to investigate the long-term effects 

for residents of Atsugi when the incinerator was operating. Navy Medicine does not 

have full access to the medical information for persons once they leave active service. 

Question 3. The Navy testified that a Department of Defense and Department of 

Veterans Affairs working group ‘‘agreed the VA would receive a list of all affected 

Active Duty personnel stationed at NAF Atsugi from 1985–2001’’ and that this information ‘‘will aid in any future outreach or surveillance activities for this population.’’ 

A. In addition to maintaining a Web site with information related to NAF Atsugi, 

what future outreach activities and public communications does the Navy intend to 

use to ensure that former NAF Atsugi residents are aware of the environmental exposures related to the Shinkampo incinerator? 

Response. The Navy Marine Corps Public Health Center (NMCPHC) web page is 

BUMED’s primary means of communicating the information to those with questions 

and concerns. 

The maintenance and updating NMCPHC’s Web site is Navy Medicines primary 

means of communicating this information. Further communication plans fall outside 

of Navy Medicine’s purview. 

B. Has the Navy already shared with VA the names of individuals who were stationed at NAF Atsugi between 1985 and 2001? If not, when will those names be provided to VA? 

Response. As mentioned during the hearing, Navy Medicine has presented the 

pertinent information before the DOD/VA Deployment Health Working Group focusing on environmental exposures on 11 June 2009. The VA is aware of the type of 

information Navy Medicine has available, but to date no official request from the 

VA has been received by Navy Medicine. 

Chairman AKAKA. Thank you very much, Dr. Gillooly, for your 

testimony, and now we will receive the testimony of General 

Payne. 

STATEMENT OF MAJOR GENERAL EUGENE G. PAYNE, JR., ASSISTANT DEPUTY COMMANDANT, INSTALLATIONS AND LOGISTICS (FACILITIES), HEADQUARTERS, U.S. MARINE CORPS. 

General PAYNE. Senator Akaka, Senator Burr, thank you for the 

opportunity to appear before you and participate in this hearing regarding past drinking water exposures at Marine Corps Base Camp 

Lejeune. 

292 

My name is Major General Gray Payne and I am the Assistant 

Deputy Commandant for Installations and Logistics for Facilities. 

In that regard, I am responsible for Marine Corps facilities and 

services issues on all of our installations, to include environmental 

protection. 

The health and welfare of our Marines, sailors, their families, 

and our civilian workers are a top priority for the Marine Corps. 

The Marine Corps is and always has been a very large family and 

we all know people, including myself, who are stationed or worked 

at Marine Corps Base Camp Lejeune during their military careers. 

The Marine Corps is deeply concerned with all the military and 

civilian families who are experiencing or have experienced any 

health issues. We understand that there are those who believe 

their health concerns may be a result of time spent at Camp Lejeune. The Marine Corps consists of war fighters and those who directly support war fighters. We have no public health experts. 

Accordingly, we rely on the expertise of the scientific organizations like the Agency for Toxic Substances and Disease Registry, or 

ATSDR, and the National Academies National Research Council, or 

NRC, to inform our understanding of this issue. We have provided 

over $14.5 million in funding and have exhausted countless man 

hours and direct support of research initiatives. Unfortunately, the 

studies completed to date have not determined whether or not 

there is an association between the past contamination and adverse 

health effects. 

We would like nothing more than to have those hard questions 

answered. So, we will continue to support and cooperate with the 

Department of Veterans Affairs, the ATSDR, and the NRC in an 

effort to get answers for those of our Marine Corps family who may 

have been exposed to volatile organic compounds in drinking water 

at Camp Lejeune in the past. 

Sir, you have my written statement, so in the interest of time, 

I will conclude my remarks, and I am certainly available to answer 

any questions you may have. 

[The prepared statement of General Payne follows:] 

PREPARED STATEMENT OF MAJOR GENERAL EUGENE G. PAYNE, JR., ASSISTANT DEPUTY COMMANDANT FOR INSTALLATIONS AND LOGISTICS (FACILITIES), HEADQUARTERS, U.S. MARINE CORPS. 

Senator Akaka, Senator Burr, distinguished Members of the Committee; thank 

you for the opportunity to appear before you and participate in this hearing regarding past drinking water exposures at Marine Corps Base Camp Lejeune. My name 

is Major General Gray Payne and I am the Assistant Deputy Commandant for Installations and Logistics for Facilities. I am responsible for Marine Corps facilities 

and services issues on our installations, to include environmental protection. 

The health and welfare of our Marines, Sailors, their families, and civilian workers are a top priority for the Marine Corps. The Marine Corps is and always has 

been a large family, and we all know people, including myself, who were stationed 

or worked at Marine Corps Base, Camp Lejeune during their military careers. The 

Marine Corps is deeply concerned with all the military and civilian families who are 

experiencing or have experienced any health issues and we understand that there 

are those who believe their health concerns may be a result of time spent at Camp 

Lejeune. The Marine Corps consists of war-fighters, and those who directly support 

war-fighters. We have no epidemiological experts, and accordingly we rely on the expertise of scientific organizations like the Agency for Toxic Substances and Disease 

Registry (ATSDR) and the National Academies, National Research Council (NRC) 

to inform our understanding of this issue. We have provided over $14.5 million in 

funding and have exhausted countless man-hours in direct support of research iniVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00298 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
293 

tiatives. We will continue to support and cooperate with the Veterans Administration, the ATSDR and the NRC in an effort to get answers for those of our Marine 

Corps family who may have been exposed to volatile organic compounds (VOC) in 

drinking water at Camp Lejeune. 

HISTORY OF DISCOVERY

It is important to keep in mind that the events surrounding this situation occurred 

over 25 years ago. Environmental standards and regulations have changed dramatically over the intervening years as a result of advances in scientific knowledge and 

increased public awareness. The events at Camp Lejeune must be considered in 

light of the scientific knowledge, regulatory framework, and accepted industry practices that existed at the time, rather than in the context of today’s standards. 

Trichloroethylene [TCE] and tetrachloroethylene [PCE] were discovered in the 

Camp Lejeune drinking water in the early 1980’s. The circumstances that led up 

to the discovery are as follows. In 1981, Camp Lejeune officials became aware that 

VOCs were interfering with the analysis of potable water samples that were being 

collected in preparation for the implementation of future drinking water standards 

for Total Trihalomethanes (TTHM). Sampling conducted by a Navy contractor revealed that another chemical present in the water sample was interfering with the 

analysis; however, the type of chemical and source were unknown. Base personnel 

continued to sample the water for TTHMs over the next several years using various 

laboratories with varying results. Through targeted sampling in 1982, two of Camp 

Lejeune’s eight public drinking water systems were determined to be contaminated 

by two chemicals—TCE and PCE. TCE and PCE are chemicals commonly found in 

degreasing agents and dry cleaning solvents respectively. It is important to note 

that there were no drinking water regulations in place for TCE, PCE, benzene, or 

vinyl chloride at the time of discovery. In the early 1980’s, the Naval Assessment 

and Control of Installation Pollutants (NACIP) program, a precursor to the Department of the Navy (DON) Installation Restoration Program, was already in the process of identifying contaminated sites on Base for further sampling and investigation. 

Plans were in place to sample potable wells near the identified contaminated sites. 

It was these sampling events that identified, between late 1984 and early 1985, individual wells that contained groundwater impacted with TCE and PCE and other 

VOC’s such as benzene. As the Base received sampling data on impacted wells, the 

wells were promptly removed from service. A separate investigation by the State of 

North Carolina in 1985 revealed leaks from an off-base dry cleaner had contaminated the wells near the Tarawa Terrace housing area. The Hadnot Point water system was contaminated by on-base sources. As referenced above, no drinking water 

standards for TCE or PCE were in place at the time of discovery, and all impacted 

wells were voluntarily removed from service promptly by Base direction in late 

1984/early 1985. Initial regulation of these volatile organic compounds under the 

Safe Drinking Water Act did not begin until 1987. Final regulations on the chemicals were in force in 1989 and 1992, respectively. 

NOTIFICATION

Camp Lejeune first notified military personnel and family members about the impacted drinking water on December 13, 1984, through an article appearing in Camp 

Lejeune’s newspaper, The Globe. Camp Lejeune also distributed a public notice to 

residents of Tarawa Terrace on April 30, 1985. In May 1985, Camp Lejeune issued 

a press release announcing the water contamination problem and explaining the 

steps being taken to restore water services to the affected base residents. Jacksonville Daily News and Wilmington Morning Star printed stories on the situation on 

May 11 and 12, 1985. 

In 2000, ATSDR requested assistance from the Marine Corps to reach additional 

participants for a survey they were conducting. At the time, the number of participants was approximately 6,500. ATSDR needed over 12,000 for a statistically valid 

study. The Marine Corps played an active role in assisting ATSDR in identifying 

participants eligible for the survey through both targeted and global notifications. 

In January 2000, Camp Lejeune held an ‘‘open house’’ with base residents and the 

Jacksonville community to discuss issues about the drinking water previously discovered to contain VOCs. In August 2000, Headquarters Marine Corps sent a message to all Marines worldwide in an effort to reach potential ATSDR survey participants. In addition, articles were published in numerous base newspapers including 

the Quantico Sentry, Camp Lejeune Globe, and Camp Pendleton Scout, which have 

a large readership of both active duty and retired military members. Camp Lejeune 

also solicited participants for the ATSDR survey by sending a press release to other 

military base publications. In November 2000, Headquarters Marine Corps held a 

294 

press brief at the Pentagon asking media to assist in helping to reach survey participants. On January 25, 2001, Headquarters Marine Corps sent a second message 

to all Marines worldwide in an effort to reach potential ATSDR survey participants. 

In February 2001, regional media outreach efforts began, and outlets reached 

included: 

(A) TV Stations—1027 outlets 

(B) Daily Newspapers—1373 outlets 

(C) Weekly Newspapers—1171 outlets 

Total: 3571 media outlets contacted. 

In 2001, Headquarters Marine Corps requested approval from the Department of 

Defense to release to the ATSDR the Social Security numbers of potential survey 

participants. In July 2001, Headquarters Marine Corps received approval from DOD 

for a limited release of Social Security Number information covered by the Privacy 

Act to the ATSDR in order to support the ATSDR’s survey participant location efforts. Based on extensive data searches by Headquarters Marine Corps, contact information for the names of potential survey participants was identified and forwarded to the ATSDR. 

The FY08 National Defense Authorization Act mandated that the Secretary of the 

Navy attempt to directly notify former residents of Camp Lejeune of their potential 

exposure to the chemicals. The Act also required that ATSDR develop a health survey to be included with the notification letter. On Sept. 14, 2007, the Marine Corps 

posted a link to the registration database on its Web site (www.marines.mil/ 

clsurvey) so that former Camp Lejeune residents and workers as well as interested 

parties can be placed on a contact list to receive notification and information regarding this important issue. The call center became operational September 17, 2007 

and is used as another tool to locate former residents and workers and register them 

to receive additional updates to the ongoing studies. In addition to direct notifications, the Marine Corps continues to use various general communication venues to 

reach former base residents and workers to encourage them to register. This general 

notification has included articles and/or advertisements in: newspapers such as USA 

Today; periodicals such as Time and Newsweek; internet advertisements on general 

consumer Web sites such as WebMD and Weather.com.; military related Web sites 

such as the Leatherneck, U.S. Navy Institute, and the Vietnam Veterans Association; internet search engines such as Yahoo! and Google; and radio broadcasts. As 

of September 28, 2009, more than 140,000 individuals have been registered with the 

Marine Corps. 

ATSDR HEALTH INITIATIVES

All military installations on the National Priorities List of hazardous waste sites, 

including Camp Lejeune which was listed in 1989, undergo a Public Health Assessment conducted by the ATSDR to determine if there are any current or past health 

concerns resulting from past practices. 

In 1992, the Agency for Toxic Substances and Disease Registry (ATSDR) made its 

first of many site visits to Camp Lejeune as part of its statutory duty to conduct 

a public health assessment (PHA). In 1997, the ATSDR published its PHA for Camp 

Lejeune. In the PHA, the ATSDR stated that the Volatile Organic Compound-impacted water would not likely harm adults. (Earlier this year ATSDR withdrew the 

PHA from their Web site in part because it believes that the statement was overly 

reassuring.). The ATSDR recommended, however, an epidemiological study of 

former Camp Lejeune residents to determine what effect, if any, the VOCs may 

have had on the health of prenatal children. This population was considered by the 

ATSDR to be the most susceptible population to health impacts from VOCs. In support of this recommendation, a health study began in 1999 as a survey to determine 

whether or not a statistically significant study population could be reached for a 

case control study. In January 2002, the ATSDR closed its survey with 12,598 eligible participants, and began its analysis of survey results. In July 2003, the ATSDR 

released a progress report of the survey and concluded that a follow-on case control/ 

epidemiological study was warranted. The Marine Corps actively participated in 

publicizing this report through a press release, a Web cast by the Deputy Commandant for Installations and Logistics, and by posting survey information on the 

Marine Corps Camp Lejeune drinking water web page. ATSDR also determined in 

2003 that extensive water modeling would be needed at Camp Lejeune in support 

of the case control study. That water modeling continues today and is currently projected to be complete in September 2011. The case control study will be completed 

sometime thereafter. 

In 2005, the Marine Corps hired a contractor to perform a comprehensive search 

of Camp Lejeune to provide a better confidence level that all potentially relevant 

295 

documents had been found. ATSDR and other interested parties have been provided 

access to all documents that were found. In addition, we have been working with 

agencies outside of the Marine Corps to ask them to provide information that may 

be under their control. 

INDEPENDENT REVIEWS AND INVESTIGATIONS

Three independent reviews have been conducted of the actions taken by Marine 

Corps personnel on this matter: an Independent Drinking Water Fact-Finding Panel 

chartered by the Commandant of the Marine Corps, an EPA Criminal Investigation 

Division investigation, and a Government Accountability Office review. 

In 2004 the Fact-Finding Panel determined that Camp Lejeune provided drinking 

water at a level of quality consistent with general water industry practices in light 

of the evolving regulatory requirements at the time. 

In 2005 the EPA concluded that there had been no violations of the Safe Drinking 

Water Act, no conspiracy to withhold information, falsify data, or conceal evidence. 

In 2007 the GAO issued a report that describes efforts to identify and address the 

past contamination, activities resulting from concerns about possible adverse health 

effects and government actions related to the past contamination. The report had 

no findings or recommendations for the Marine Corps. 

In accordance with the 2007 National Defense Authorization Act, the Marine 

Corps contracted with the National Academy of Sciences—NRC to review the evidence regarding potential associations between exposure to contaminated drinking 

water at Camp Lejeune and adverse health effects in prenatal children, children, 

and adults. The NRC review report concluded that while former Camp Lejeune residents and workers were exposed to unregulated solvents, there are no conclusive associations between adverse health effects and exposure to the impacted water at the 

base. The report opined that further study was unlikely to provide definitive information about the health effects of such exposure. The report noted that the highest 

levels of either TCE or PCE measured in the mixed-water samples at Camp Lejeune 

were much lower than the lowest dose that caused adverse effects in the most sensitive strains of species of laboratory animals. The review concluded, however, that 

even though adverse effects were unlikely, they could not be ruled out completely 

and that the DON (and other policymakers) should move forward with responses 

they deem appropriate based on available information. 

We are aware of ongoing assessment activities currently being undertaken by the 

US EPA and remain interested in that process. 

COORDINATION WITH DEPARTMENT OF VETERANS AFFAIRS

As part of the Marine Corps robust outreach and notification campaign we have 

worked extensively with various Veterans Affairs offices. In 2007 and 2008 we sent 

notification and registry posters to a total of 210 VA centers in all 50 states as well 

as the US Territories and Washington, DC . We also sent copies of posters in 2007 

and 2008 to VFW District Offices and Military Treatment Facilities in all fifty 

states, US Territories and Washington, DC. In addition, in March of this year, we 

worked with VA public affairs to alert VA program directors and other executives 

of new information about the water contamination issue via an email release. In 

particular, this email release provided information on the pending release of the National Research Council research. VA personnel were asked to directly contact HQ 

USMC public affairs for additional information and assistance. 

CONCLUSION

I have received letters from, and have personally spoken with individuals who feel 

that they have been harmed by Camp Lejeune water. Their stories are very sad, 

and my heart goes out to them. The Marine Corps has done and is doing everything 

it can for them, recognizing that we are not scientists or health care professionals, 

and neither can we address claims for compensation. What we can do, have done, 

and commit to continuing to do is to cooperate with the Veterans Administration, 

the ATSDR, the NAS, and other appropriate agencies and scientific organizations 

as they address the scientific and medical issues, and keep our Marine family informed of any progress. 

296 

RESPONSE TO POST-HEARING QUESTION SUBMITTED BY HON. DANIEL K. AKAKA TO

MAJOR GENERAL EUGENE G. PAYNE, JR., ASSISTANT DEPUTY COMMANDANT FOR IN- STALLATIONS AND LOGISTICS (FACILITIES), HEADQUARTERS, U.S. MARINE CORPS. 

Question 1. Please provide us with a detailed breakdown of the number of servicemembers and family members who lived or worked on Camp Lejeune between 1957 

and 1987. Specifically, please detail the number of active duty servicemembers, 

spouses, children, and number of babies born to servicemembers during that time 

period. 

Response. Unfortunately, detailed data for servicemembers and family members 

who lived or worked on Camp Lejeune between 1957 and 1987 does not exist. The 

Marine Corps can only make crude estimations extrapolated from the limited available data using assumptions that will likely produce conservatively high estimations. We estimate that at Camp Lejeune between 1957 and 1987 there were: 

• As many as 630,000 servicemembers. • As many as 60,000 spouses. • As many as 60,000 dependent children. • As many as 30,000 births. • Total population estimate = 500,000–800,000 

Note: These estimates do not include Marine Corps Air Station New River. Data 

from the Defense Manpower Data Center (DMDC), Camp Lejeune housing, Camp 

Lejeune schools, and Agency for Toxic Substances and Disease Registry (ATSDR) 

studies were used to produce these estimates. 

Question 2. How many servicemembers who were on active duty between 1957 

and 1987 at Camp Lejeune are still on active duty? 

Response. The Marine Corps does not maintain such data. We have contacted the 

Defense Manpower Data Center to see if an estimate is possible. 

Question 3. When did the Marine Corps know about TCE and PCE contaminants 

in the water at Camp Lejeune, and what did the Marine Corps do about it? 

Response. Volatile organic compounds (TCE, PCE, benzene and others) were discovered in the drinking water at Camp Lejeune in the early 1980’s. 

In 1981, Camp Lejeune officials first became aware that VOCs were interfering 

with the analysis of potable water samples that were being collected in preparation 

for the implementation of future drinking water standards. 

In 1982 and 1983, continued testing identified two VOCs of primary concern—trichloroethylene (TCE), a metal degreaser, and tetrachloroethylene (PCE), a dry 

cleaning solvent—in two water systems that served base housing areas, Hadnot 

Point and Tarawa Terrace. Notably, TCE and PCE were not regulated under the 

Safe Drinking Water Act until 1989 and 1992 respectively. Additional testing at the 

same sources, but later in time, resulted in variances on the level of contaminants 

discovered within the water. Navy Assessment and Control of Installation Pollutants (NACIP) program plans were already in place to identify contamination sites 

and to sample potable wells near such sites. 

In 1984, the source of contamination was found when the NACIP program identified VOCs in some of the individual wells serving the Hadnot Point and Tarawa 

Terrace water systems. As impacted wells were identified, they were promptly removed from service. 

Following the initial discovery of contamination in the wells in 1984, the Base 

Commanding General sent a notification letter to residents, and the Public Affairs 

Office ran an article in the Base newspaper and held a press event with local media. 

As more information became available through further studies the Marine Corps’ 

outreach efforts broadened to the national population. 

The Marine Corps has collaborated with the ATSDR from the beginning of its 

studies to determine the extent of the contamination, and whether adverse health 

effects may have resulted from it. For example, in 1999, the Marine Corps conducted an outreach/mass media campaign to assist the ATSDR in locating potential 

participants for the scientific study. This study population included parents that 

were pregnant while living in on-base housing from 1968–1985. To assist ATSDR 

with its recruiting efforts for the study, the Marine Corps distributed announcements to more than 3,500 media outlets (TV, daily & weekly newspapers), as well 

as releasing two (2) separate worldwide Marine Messages. The USMC has and will 

continue to actively help with outreach for ATSDR’s studies. Collaboration with 

ATSDR continues to the present day. 

Additionally, the Congress at Public Law 109–364, Section 318 directed the Navy 

to request a review by the National Academies’ National Research Council (NRC) 

to address the scientific evidence on whether reported adverse health effects can be 

associated with past contamination of the water supply at Camp Lejeune. This 

297 

recently published study (released June 13, 2009) by the NRC, an independent 

Council of scientific experts, addressed TCE and PCE as the primary contaminants 

of concern. A copy of the report can be obtained at http://nationalacademies.org/ 

morenews/20090613.html. 

Among other things, the NRC report stated that it ‘‘cannot be determined reliably 

whether diseases and disorders experienced by former residents and workers at 

Camp Lejeune are associated with their exposure to past contaminants in the water 

supply because of data shortcomings and methodological limitations, and these limitations cannot be overcome with additional study.’’ In addition, the report states 

that the results of their comparison of the lowest dose of TCE and PCE at which 

adverse effects were observed in animal studies against approximated doses to 

former residents measured in mixed water ‘‘suggest that the highest levels of either 

TCE or PCE measured in the mixed-water samples at Camp Lejeune were much 

lower than the lowest dose that caused adverse effects in the most sensitive strains 

and species of laboratory animals.’’ 

Three independent reviews have been conducted of the actions taken by the Marine Corps at the time (2004 Drinking Water Fact-Finding Panel, an EPA Criminal 

Investigation Division investigation, and the 2005 Government Accountability Office 

review). 

The Fact-Finding Panel determined that Camp Lejeune provided drinking water 

at a level of quality consistent with general water industry practices in light of the 

evolving regulatory requirements at the time. 

The EPA Criminal Investigation Division concluded that there had been no violations of the Safe Drinking Water Act, no conspiracy to withhold information, falsify 

data, or conceal evidence regarding violation of any law. 

The GAO report describes efforts to identify and address the past contamination, 

activities resulting from concerns about possible adverse health effects and government actions related to the past contamination, and the design of the current 

ATSDR study, including the study’s population, timeframe, selected health effects, 

and the reasonableness of the projected completion date. 

Additional information on the Fact-Finding Panel, the EPA investigation, and the 

GAO report are available at: www.marines.mil/clwater. 

Finally, the Marine Corps is working to notify anyone who lived or worked at 

Camp Lejeune prior to 1987 of the historic drinking water issue. To identify and 

inform these individuals, the Marine Corps developed an outreach response using 

multiple forms of communication and media. 

• Distributed print articles to more than 10,000 newspapers nationwide 

• Created radio spots distributed to more than 6,500 radio stations 

• Developed online advertising for consumer- and military-related Web sites, including Yahoo, Google, WebMD, Vietnam Veterans of America and Leatherneck and 

Gazette Web site 

• Placed advertising in national publications, including USA Today, Time and 

Newsweek 

• Placed advertising in military-related publications, such as Leatherneck, Gazette 

and Semper Fi. 

• Provided posters and print announcements distributed to VA facilities nationwide 

• Distributed posters to all US-based commissaries 

• Conducted interviews with newspaper and broadcast journalists 

• Created a Web site providing a compilation of information on the historic drinking water issue and links to other sites with related information 

In addition, the Marine Corps has worked with the Internal Revenue Service to 

locate former Marines who have lived or worked on Camp Lejeune 1987 and before. 

The IRS used its database to mail an estimated 150,000 letters from August 1 to 

October 1, 2008. 

Currently, approximately 145,000 former residents are registered, and the Marine 

Corps encourages anyone who has not registered to do so by calling 877–261–9782 

or online at https://clnr.hqi.usmc.mil/clwater/index.html. 

Question 4. When did the Marine Corps notify residents of Camp Lejeune about 

the water contamination, and in what form did that notification occur? 

Response. Following the initial discovery of contamination in the wells in 1984, 

the Base Commanding General sent a notification letter to residents, and the Public 

Affairs Office ran an article in the Base newspaper and held a press event with local 

media. 

As more information became available through further studies the Marine Corps’ 

outreach efforts broadened to the national population. 

298 

The Marine Corps has collaborated with the ATSDR from the beginning of its 

studies to determine the extent of the contamination, and whether adverse health 

effects may have resulted from it. For example, in 1999, the Marine Corps conducted an outreach/mass media campaign to assist the ATSDR in locating potential 

participants for the scientific study. This study population included parents that 

were pregnant while living in on-base housing from 1968–1985. To assist ATSDR 

with its recruiting efforts for the study, the Marine Corps distributed announcements to more than 3,500 media outlets (TV, daily & weekly newspapers), as well 

as releasing two (2) separate worldwide Marine Messages. The USMC has and will 

continue to actively help with outreach for ATSDR’s studies. Collaboration with 

ATSDR continues to the present day. 

Finally, the Marine Corps is working to notify anyone who lived or worked at 

Camp Lejeune prior to 1987 of the historic drinking water issue. To identify and 

inform these individuals, the Marine Corps developed an outreach response using 

multiple forms of communication and media. 

• Distributed print articles to more than 10,000 newspapers nationwide • Created radio spots distributed to more than 6,500 radio stations • Developed online advertising for consumer- and military-related Web sites, including Yahoo, Google, WebMD, Vietnam Veterans of America and Leatherneck and 

Gazette Web site • Placed advertising in national publications, including USA Today, Time and 

Newsweek • Placed advertising in military-related publications, such as Leatherneck, Gazette 

and Semper Fi. • Provided posters and print announcements distributed to VA facilities nationwide • Distributed posters to all US-based commissaries • Conducted interviews with newspaper and broadcast journalists • Created a Web site providing a compilation of information on the historic drinking water issue and links to other sites with related information 

In addition, the Marine Corps has worked with the Internal Revenue Service to 

locate former Marines who have lived or worked on Camp Lejeune 1987 and before. 

The IRS used its database to mail an estimated 150,000 letters from August 1 to 

October 1, 2008. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO

MAJOR GENERAL EUGENE G. PAYNE, JR., ASSISTANT DEPUTY COMMANDANT FOR IN- STALLATIONS AND LOGISTICS (FACILITIES), HEADQUARTERS, U.S. MARINE CORPS. 

Question 1. The term ‘‘organic solvents’’ has been used since the 1970s to reference organic liquids, such as Volatile Organic Compounds. When Major General 

Payne was asked at the hearing whether he knew if the specific term ‘‘organic solvents’’ in Camp Lejeune Base Order 5100.13B had changed over the years since the 

order was published, Major General Payne indicated that he was not knowledgeable 

on that issue. 

A. Was Major General Payne stating that, in his official capacity, he should not 

be expected to know the purpose or relevant details of Camp Lejeune Base Order 

5100.13B, a Marine Corps order that has been referenced in formal requests for information to the Marine Corps by Members of Congress and an order that was cited 

during Senator Burr’s recent meeting with the Commandant of the Marine Corps 

regarding the Camp Lejeune water contamination? 

B. Was Major General Payne stating that the Marine Corps does not know and 

understand the formal definition of the term ‘‘organic solvents’’ or have access to environmental experts who know and understand the formal definition of the term ‘‘organic solvents’’ as it appears in Camp Lejeune Base Order 5100.13B, an order that 

detailed the procedures for the proper disposal of chemicals and hazardous waste 

on Camp Lejeune? 

C. Does the Marine Corps agree that the term ‘‘organic solvents’’ includes Volatile 

Organic Compounds (see the definition from National Institute of Occupational 

Safety and Health)? If the Marine Corps does not agree that ‘‘organic solvents’’ include Volatile Organic Compounds, what types of chemicals was the Marine Corps 

referencing when using the specific term ‘‘organic solvents’’? 

Response. Major General Payne was asked to speculate on the accepted definition 

of the term ‘‘organic solvent’’ circa 1974, how the authors of Camp Lejeune Base 

Order 5100.13B defined that term when they wrote the Order in 1974, and whether 

the definition of that term had changed over the years since the order was published. Major General Payne is neither a scientist, nor a subject matter expert on 

299 

‘‘organic solvents,’’ nor a historian. Accordingly, he properly declined to answer the 

questions. To the more specific question: today, does the term ‘‘organic solvents’’ include VOCs; as we understand the definition today, we believe that VOCs are properly categorized as organic solvents. 

Question 2. The Marine Corps maintains a Camp Lejeune Water Study database 

for the former residents of Camp Lejeune. The registry now contains over 144,000 

registrants. 

A. How many of the registrants are military veterans who once served on Camp 

Lejeune? 

Response. The Marine Corps does not put any stipulations on who is allowed to 

register with the Camp Lejeune Historic Drinking Water Registry; therefore, anyone 

interested in receiving additional information and notifications may request to be 

placed in the registry. 

The registry does not require registrants to identify if they are Military veterans. 

Using several assumptions, the Marine Corps estimates that as of October 29, 2009; 

approximately 87,000 registrants may be Military veterans who once served at 

Camp Lejeune, NC. 

B. How many of the registrants are former dependents or family members of veterans who once served on Camp Lejeune? 

Response. The Marine Corps again uses several assumptions in estimating the 

number of registrants who may be former dependents or family members of veterans who once served at Camp Lejeune, NC. We estimate that approximately 

58,000 individuals in the registry fall into this category. 

C. Does the Marine Corps plan to share the names of those individuals with VA 

so that it may use that information to better treat veterans already enrolled in VA’s 

health care system or proactively outreach to those not yet enrolled? 

Response. The Marine Corps has contacted the VA and has begun the process to 

transfer information from our database to the VA. 

1. The Marine Corps has established contacts that will make the official request 

for the data. 

2. The Marine Corps has provided the VA with a data dictionary in order for them 

to determine what available information they need to accomplish their task. 

3. The Marine Corps will follow the Federal statute that requires placing a notice 

in the Federal Register to update the System of Records Notice (SORN) associated 

with the Camp Lejeune database in order to share the data with the VA. 

The Marine Corps will continue to collaborate with the VA in order to identify 

the most appropriate manner in which to transfer the data. 

Chairman AKAKA. Thank you very much, General Payne. Mr. 

Resta, your testimony, please. 

STATEMENT OF JOHN J. RESTA, SCIENTIFIC ADVISOR, U.S. 

ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE 

MEDICINE 

Mr. RESTA. Good afternoon, Senator Akaka, Senator Burr. 

Thanks for the opportunity for me to speak today about the occupational environmental health exposures in military operations. 

My name is John Resta. I serve as Scientific Advisor for the U.S. 

Army Center for Health Promotion and Preventive Medicine, also 

known as the CHPPM. Our workforce at the CHPPM is dedicated 

to keeping soldiers healthy. One of our primary responsibilities is 

to provide deployed commanders assistance in identifying, assessing, and countering occupational and environmental health hazards. 

During military operations, soldiers, sailors, airmen, Marines, 

and civilian employees who also deploy may encounter numerous 

occupational and environmental health hazards that have the potential to cause illness and injury. In our written statement, we 

provided the Committee specific details on what actions we have 

taken to address these hazards at the Qarmat Ali Water Treatment 

Plant and the Joint Base Balad Burn Pit with an emphasis on the 

300 

results of the medical evaluations and health risk assessments we 

have conducted to date. 

These risk assessments have relied on numerous medical examinations, clinical lab tests, exposure questionnaires, and thousands 

of occupational and environmental samples. At Qarmat Ali, we concluded from the medical evaluations conducted on the soldiers and 

Department of Army civilians who served at the site during the assessment period that no significant exposure to sodium dichromate 

had occurred. These results, coupled with the occupational environmental samples that were collected, indicate that all soldiers and 

Department of Army civilians who served at the site at any time 

are unlikely to experience future adverse health effects. 

This conclusion was validated by the Defense Health Board following their review of the health risk assessment. The Defense 

Health Board is an independent advisory panel made up of nationally recognized medical and scientific experts from academia and 

industries. Our burn pit health risk assessments have concluded 

that smoke exposures could lead to short-term, reversible irritant 

health effects. 

Smoke from burning trash and other wastes, especially in combination with hot, dry, dusty conditions, cause temporary irritation 

of the eyes, nose and throat in most people, regardless of their 

health condition. However, no environmental monitoring to date 

collected at Joint Base Balad has identified a risk for future adverse health effects. 

It is possible that combinations of some exposures, such as smoke 

from the burn pits, high levels of airborne dust, and cigarette 

smoking, may increase the risk of chronic health conditions in a 

small number of people. We have no direct evidence of this at this 

present time. We will be monitoring the air quality at Joint Base 

Balad in concert with the Air Force and the Navy over the next 

year, even though municipal solid waste incinerators have largely 

replaced open burning there. 

We are continuing to communicate the findings and limitations 

of these risk assessments to our soldiers and other servicemembers 

in an understandable form. We have challenges in this endeavor. 

For example, it is often difficult to answer the fundamental question, will I get sick? 

Current health risk assessment science does not adequately address the health risks from combined exposures like burn pit 

smoke, nor can it determine whether a disease that has multiple 

causes and develops over a long period of time in an individual was 

caused by a specific exposure. We continue to seek more innovative 

methods to assess health risks and are working with both the National Academy of Sciences and the Defense Health Board. 

We continue to address our soldiers’ health concerns and are 

working to ensure that they and their health care providers are informed about these incidents. 

Mr. Chairman, thank you for the opportunity to be here today 

and discuss our role in these important actions. I look forward to 

answering any questions you or the Committee might have. Thank 

you. 

[The prepared statement of Mr. Resta follows:] 

301 

PREPARED STATEMENT OF JOHN J. RESTA, SCIENTIFIC ADVISOR, U.S. ARMY CENTER

FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE

Chairman Akaka and distinguished Members of the Committee, thank you for inviting me here today to speak about occupational and environmental health exposures in military operations and the efforts of my organization, U.S. Army Center 

for Health Promotion and Preventive Medicine (USACHPPM), in preventing disease 

and non-battle injuries to our Soldiers and deployed civilian employees. 

The USACHPPM is a subordinate command of the U.S. Army Medical Command. 

USACHPPM’s military and civilian personnel are experts in more than 50 public 

health disciplines. They include occupational and environmental medicine physicians, public health and occupational health nurses, epidemiologists, industrial hygienists, environmental engineers, health risk assessors, chemists, toxicologists and 

many others. We provide consultative services in these disciplines through a worldwide network, with our headquarters at Aberdeen Proving Ground, Maryland, and 

five subordinate commands at Landstuhl, Germany; Camp Zama, Japan; Fort 

George G. Meade, Maryland; Fort Sam Houston, Texas; and Fort Lewis, Washington. Since Operation Desert Storm in 1991, the USACHPPM has been providing 

technical assistance and support to deployed preventive medicine units and personnel who conduct occupational and environmental health surveillance activities. 

This continues through our current efforts in support of Operations Iraqi Freedom 

and Enduring Freedom. 

Today, I’d like to speak with you about two specific occupational and environmental health exposures, the potential exposures to sodium dichromate at the 

Qarmat Ali Water Injection Facility in Iraq and the exposures to smoke from the 

open burning of solid waste in Iraq, Afghanistan and the Horn of Africa. 

QARMAT ALI WATER INJECTION FACILITY

On September 15, 2003, the 1st Battalion, 152nd Infantry from the Indiana National Guard notified the Combined Forces Land Component Command-Surgeon 

(CFLCC-Surgeon) of its concerns regarding the site contamination at the Qarmat Ali 

Water Injection Facility. The Qarmat Ali facility was being repaired as part of Task 

Force Restore Iraqi Oil (TF-RIO) by an Army Corps of Engineers contractor. Within 

a day of notification, the site was placed off-limits and the CFLCC-Surgeon requested assistance from the USACHPPM in assessing the health risks associated 

with potential exposures to sodium dichromate. By this time, the contractor had 

started encapsulating the contaminated areas on the site. The DOD Inspector General is currently conducting a review of Army actions regarding the exposure of personnel to sodium dichromate at Qarmat Ali. 

On September 30, 2003, a USACHPPM team comprised of an occupational-environmental medicine physician, environmental scientists, engineers, and industrial 

hygienists arrived at Qarmat Ali and started an Occupational and Environmental 

Health Survey and Risk Assessment, which they completed on October 24, 2003. 

This assessment included environmental samples from the soil, air, and living and 

working areas as well as medical examinations of the Soldiers and Department of 

Army civilians assigned to the site. No medical exams were provided to civilian contractors because occupational health for contractor employees is the employing contractor’s responsibility. 

The USACHPPM team conducted environmental soil, air and surface-wipe sampling, to include ambient air monitoring of the location and breathing-zone monitoring of USACHPPM team and military security team members. Soil sample results were below the Military Exposure Guidelines for hexavalent chromium and 

total chromium in all onsite areas, but were over the guidelines in one offsite area 

where exposure was not expected. The USACHPPM team recommended that the 

contractor perform further containment to encapsulate those areas. The average 

concentrations for hexavalent chromium and total chromium in the air were below 

the one-year Military Exposure Guidelines. In fact, no hexavalent chromium was detected in any breathing-zone air sample. The survey’s surface-wipe sample results 

for hexavalent chromium dust indicated that the interior of the contractor trailer 

located at the Qarmat Ali Water Injection Facility compound was contaminated with 

hexavalent chromium dust. The USACHPPM team recommended moving the trailer 

to the boundary of the compound and completely decontaminating it. 

Medical examinations were administered to 137 of the 161 potentially exposed 

Soldiers and DOD civilians in the 1st Battalion, 152nd Infantry from the Indiana 

National Guard and TF-RIO from the U.S. Army Corps of Engineers. There were 

14 members who were not available for evaluation and 10 who declined all or part 

of the testing. The exams were conducted within 30 days of the last potential exposure at the site and within 120 days of site encapsulation. They included adminVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00307 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
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istering exposure (i.e., how long, how often a person would have been onsite) and 

symptom questionnaires as well as specific clinical medical tests tailored to assess 

chromium exposure. The people who were examined were the people who, according 

to their answers to the questionnaire, had the most potential for exposure in terms 

of time frequency and locations visited at the water treatment plant. The Soldiers 

were there before encapsulation (arriving in June 2003) as well as after encapsulation. 

The comprehensive medical exams provided consisted of a medical history, a general physical exam, blood and urine testing (including red blood cell and serum chromium levels, complete blood counts, serum chemistries, liver and renal function 

tests, and routine urine analysis). Ancillary testing included chest x-rays and 

spirometry testing. Previously published information that the Soldiers and DOD civilians only received serum and urine analysis for chromium is incorrect. 

Less than 30 percent of the people examined reported symptoms, and the symptoms that were reported were symptoms that could have a variety of causes. Eye 

or throat irritation was the most common symptom reported. None of those examined exhibited symptoms of over-exposure to chromium. All of the people tested had 

normal blood levels; more than half of the chromium blood tests were actually below 

the detection limit of the test. If a significant inhalation exposure to hexavalent 

chromium (the element of sodium dichromate that has been shown to be a lung carcinogen in studies of industrial workers exposed to high levels for more than two 

years) had occurred, elevated levels of chromium would have remained in the red 

blood cells for at least 120 days following exposure. Red-blood-cell testing of potentially exposed people occurred within 30 days of their last expected exposure and 

within 120 days of site encapsulation. Analysis of the blood testing for chromium 

was done at the Armed Forces Institute of Pathology in Washington, DC. Whole 

blood testing was chosen because other medical tests (serum, urine) weren’t sensitive enough to detect chromium exposures beyond 30 days. The recent disclosures 

of severe symptoms by Soldiers (i.e., coughing up blood, chrome holes, etc.) were not 

reported to the risk assessment team in October 2003. The extent of these concerns 

cannot be determined with any objective data at this point, though we are attempting to locate medical records of servicemembers present at the site prior to the 

USACHPPM’s arrival to determine if any specific medical conditions may have been 

linked to these Soldiers’ service at the site. 

The USACHPPM concluded that these medical results indicated that no significant exposure to sodium dichromate had occurred, and that the symptoms reported 

could be related to existing personal medical conditions and desert environment-related exposures, such as heat, sand, dust and wind. Based on the medical team’s 

evaluation of medical and exposure assessment results, specific long-term follow-up 

surveillance of these people as a group was not recommended because the potential 

for long-term health effects caused by assignment to duty at the site was unlikely. 

The Soldiers and DOD civilians located at the site were provided fact sheets about 

the potential exposures during the assessment and at a town hall meeting (open 

forum) with a question-and-answer session. Town halls were sponsored by unit leadership for all interested Soldiers and DOD civilians. The results of each person’s 

medical exams, to include the whole blood test results were placed in the individual, 

hard-copy deployment medical records, along with a description of the potential exposure on a Standard Form 600 (Chronological Record of Medical Care Medical 

Record). The Army confirmed that the test results did in fact reach the Soldiers’ 

hard-copy records. Potentially exposed Soldiers and DOD civilians were also instructed to direct healthcare providers to this information in their medical records 

and to raise any remaining concerns about this incident during their post-deployment health assessments. Medical follow-up for those Soldiers who have health concerns is available through the military medical system or the Department of Veterans Affairs, depending on the military status of the Soldier. 

Based on the limited adverse health findings of the assessment, the survey team 

felt that there was limited benefit to conducting a medical evaluation on Soldiers 

that had relocated from the site prior to the arrival of the USACHPPM assessment 

team. The assessment team determined that units from the 1st Battalion, 162nd Infantry from the Oregon Army National Guard and 133d Military Police Company 

of the South Carolina Army National Guard were present at the site prior to the 

team’s arrival. Soldiers from these units were asked to complete an exposure and 

symptom survey, either directly through unit town hall meetings or through medical 

providers at their new locations if they had relocated to another area. For these 

past-exposed Soldiers, there were no unit records available to document who served 

at the site and for how long. The completed surveys, along with a fact sheet for medical providers, was to be placed in Soldier medical records by the unit as documentaVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00308 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
303 

tion of potential exposure to sodium dichromate and for reference in case of future 

health concerns. 

Throughout the assessment, the USACHPPM team ensured that the operational 

commanders were kept apprised of the assessment findings and conclusions, to include daily situational reports to the CFLCC medical cell and briefings to the commanders of the four deployed and potentially exposed units/groups (1st Battalion, 

152nd Infantry, of the Indiana Army National Guard; 133rd Military Police Company of the South Carolina Army National Guard; 1st Battalion of the 162nd Infantry of the Oregon Army National Guard; and Task Force Restore Iraq Oil of the U.S. 

Army Corps of Engineers). A formal Occupational and Environmental Health Survey and Risk Assessment report containing all of the results and recommendations 

was submitted to CFLCC on January 15, 2004. 

This report was initially classified in accordance with U.S. Central Command 

guidance; an unclassified report was published on January 10, 2009. At the time, 

DOD, Army, Joint Staff and U.S. Central Command Force Health Protection policy 

did not include a procedure for reporting deployment exposures or other operational 

public health information to non-deployed, rear area units such as the Indiana National Guard State Adjutant General or the U.S. Army Forces Command. This policy 

is being reevaluated at this time. 

In addition to medical record information that is available to Department of Veterans Affairs (DVA) providers, the Deputy Assistant Secretary of Defense, Force 

Health Protection and Readiness has facilitated our collaboration with the DVA. In 

December 2008, DVA personnel reviewed a copy of the classified Occupational and 

Environmental Health Survey and Risk Assessment report. A copy of the declassified report was provided to the DVA in January 2009, and a presentation was 

made to the DOD/VA Deployment Health Working Group in May 2009. 

The medical response to this incident was exemplary. The site was placed off-limits within a day of notification to the Combined Forces Land Component Command 

Surgeon. The USACHPPM deployed a team to theater within two weeks of request. 

The methodology and results of the USACHPPM assessment were reviewed, validated and cited as exemplary by the Defense Health Board, an independent review 

entity made up of medical and scientific professionals from academia and industry. 

BURN PITS

As far back as Operation Joint Endeavor in Bosnia in 1996, military preventive 

medicine personnel recognized that while open burning of solid waste is sometimes 

an operational necessity during combat operations, it should be used to the 

minimum extent possible based on the operational situation. When open burning operations are necessary, they should be located as far downwind of personnel as 

possible. 

In 2004, the USACHPPM deployed a response team to Camp Lemonier in Djibouti 

to assess the potential health risks from the burn pit smoke from an off-post burn 

pit located about 1.5 miles south of Camp Lemonier. At this location, the local population open-burned all of the solid waste from the surrounding area, to include the 

U.S. operations on Camp Lemonier. There was a solid waste incinerator present, but 

it was not in use at the time. The assessment consisted of advanced air sampling 

from volatile organic compounds, polyaromatic hydrocarbons, dioxins/furans and 

particulate matter less than 10 microns in diameter. The assessment concluded that 

the operational health risk estimate was moderate due to the elevated presence of 

acrolein and aluminum. Deployed preventive medicine teams have conducted several rounds of additional sampling at this location since. The operational health risk 

from acrolein was found to be low and was only detected above Military Exposure 

Guidelines sporadically. 

In 2005, the burn pit operations at the Joint Base Balad were initially sampled 

by deployed preventive medicine teams. From their results, the USACHPPM concluded that additional sampling was needed to fully characterize the site. The 

USACHPPM and the U.S. Air Force School of Aerospace Medicine jointly performed 

both an operational health risk assessment and a long-term health risk assessment 

based on large-scale sampling events at Joint Base Balad in 2007. The sampling 

plan focused on burn pit emissions. Other potential and/or known sources of air 

emissions including airfield operations, diesel generators, ground vehicle operations, 

and naturally blowing sand and dust were also collected in the samples. The longterm health risk assessment was conducted using the U.S. Environmental Protection Agency (USEPA) standard health risk assessment methodology. The USEPA 

method is specifically designed to focus on people who may be the most sensitive 

to the effects of a particular exposure; therefore, it is considered to be very 

protective. 

304 

Using the USEPA method, the potential for short-term, reversible, irritant health 

effects to U.S. personnel was identified. Smoke from burning trash and other waste, 

especially in combination with hot, dry, dusty conditions, can cause temporary irritation of the eyes, nose and throat in some people, regardless of their health condition. However, no environmental monitoring data collected at Joint Base Balad to 

date have identified an increased risk for long-term health conditions. It is possible, 

however, that combinations of some exposures, such as smoke from burn pits, the 

high levels of airborne dust, and/or tobacco smoke in smokers, may increase the risk 

of chronic health conditions in a small number of people, although we have no direct 

evidence of this at the present time. Due to anecdotal concerns raised about possible 

dioxin exposures at Joint Base Balad, the USACHPPM conducted a pilot study in 

cooperation with the Centers for Disease Control and Prevention, National Center 

for Environmental Health Laboratory (CDC-NCEH). Serum samples of Balad veterans from the DOD’s Serum Repository were randomly selected for dioxin analysis 

at the CDC-NCEH. Both pre- and post-deployment samples were selected from the 

sera of personnel who had been deployed to Joint Base Balad at least twice for at 

least one year per deployment. The analyses did not find elevated levels of dioxin 

in the sera, as would be expected if personnel had been breathing elevated concentrations of dioxin during their deployments. 

The USACHPPM and U.S. Air Force School of Aerospace Medicine have authored 

various risk communication products, including fact sheets and briefing slides, so 

that Service Members are aware of the results of sampling and health risk assessments as they are completed. The fact sheets can be found on both the USACHPPM 

Web site and in Department of Defense Deployment Health and Family Readiness 

Library. 

To improve on the lessons we’ve learned from this situation, we authored guidance on the use, operation and location of burn pits that was published in Headquarters, Department of the Army, Technical Bulletin, Medical 593, Guidelines for 

Field Waste Management, September 2006. This guidance is straightforward. The 

preferred method of solid waste disposal is incineration. Open burning should only 

be used in emergency situations until approved incinerators can be obtained. The 

potential use of improper burning methods can lead to significant occupational and 

environmental health exposures to deployed troops. We recommend that burn pit 

operations be conducted as far downwind as possible (at least 450 feet) from troop 

locations and living areas. Hazardous waste, batteries and medical waste should not 

be burned. 

The USACHPPM and U.S. Air Force School of Aerospace Medicine briefed the Department of Defense/Department of Veterans Affairs Deployment Health Working 

Group in March 2009 on the burn pit health risk assessments at Joint Base Balad. 

The meeting focused on the air quality surveillance efforts at Joint Base Balad, 

Iraq, which included sampling for a range of toxic chemicals potentially produced 

by open burning of solid waste. We discussed the short- and long-term health effects 

expected based on the analyzed chemicals, data gaps, and possible future efforts to 

better characterize potential burn pit smoke exposures. We also addressed the 

DVA’s questions arising from various misleading media accounts of burn pits and 

burn pit exposures. Since that time we have been consulting with the DVA on their 

inquiries into the extent of burn pit operations and the results of air sampling at 

other burn pit locations in the U.S. Central Command area of responsibility. 

The USACHPPM, U.S. Air Force School of Aerospace Medicine, and the Navy and 

Marine Corps Public Health Center are jointly developing an air surveillance program for contingency operations, with a focus on locations with burn pits. The sampling plan will be coordinated with the Defense Health Board with the goal of identifying a field-expedient sampling strategy that is considered representative and defensible. The USACHPPM also is collaborating with the U.S. Army Engineer School 

Directorate of Environmental Integration to update Army deployment environmental management doctrine. 

As a result of its assessments at Balad and Qarmat Ali, the USACHPPM continues to modify, update and expand deployment occupational and environmental 

health surveillance and preventive medicine activities from our experiences and lessons learned. Specific surveillance lessons learned from the Qarmat Ali Water Injection Facility and Joint Base Balad incidents include: 

• Producing, disseminating and archiving both classified and redacted deployment 

occupational and environmental health surveillance reports on both classified and 

unclassified networks. 

• Ensuring that our military and civilian personnel who deploy to active theaters 

of operation for deployment occupational and environmental health incidents are 

continually trained and up to date on personal deployment requirements. 

305 

Mr. Chairman and distinguished committee members, my thanks for inviting me 

to speak with you about the U.S. Army Center for Health Promotion & Preventive 

Medicine’s role in environmental surveillance and health assessment of potential sodium dichromate exposures and open-pit burning in overseas contingency operations. Thank you for holding this hearing and for your enduring support of servicemembers serving across the globe. I look forward to your questions. 

RESPONSE TO POST-HEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

JOHN J. RESTA, SCIENTIFIC ADVISOR, U.S. ARMY CENTER FOR HEALTH PROMOTION

AND PREVENTATIVE MEDICINE

Question 1. The Army has stated that there is no evidence that exposure to sodium dichromate at Qarmat Ali will cause adverse or long term health effects, and 

that symptoms can be attributed to other factors. What other, environmental or otherwise, factors could be responsible for such conditions? 

Response. During the CHPPM evaluation in 2003, Soldiers from the 1–152nd IN 

BN (INARNG) and DA Civilian employees from Task Force Rio were questioned regarding symptoms (symptoms are complaints) and observed for signs (signs are visible findings on examination). In the desert environment of Iraq and Kuwait, the 

symptoms reported by the Soldiers were a common experience for Soldiers in the 

country. Of the total population, about 77% did not report symptoms and 23% reported symptoms. The symptoms that they complained of were irritative or inflammatory in nature, and included irritation of the nose (9%), throat (7%), eyes (6%), 

lungs (4%), skin (1.4%), sinuses (1.4%), and general/other (3%). Overall, there was 

a low incidence of each individual symptom, with nasal symptoms being the most 

common. These symptoms are non-specific, meaning that they are not specific to a single 

etiology or cause. As stated in the report, irritation of the eyes, nose and throat are 

not uncommon in a dry and dusty desert environment, due to heat, sand, dust, and 

wind. In a survey performed by Roop, et al on the prevalence of symptoms during 

deployment, 50% of non-asthmatics reported cough, and 55% reported allergy symptoms while deployed. (See ‘‘Military Medicine Volume 172 Number 12 Dec 2007’’) 

In addition to these environmental factors, the differential diagnosis (or list of other 

possible medical conditions to consider) for these symptoms are myriad. 

Common causes of irritation and inflammation symptoms of the upper and lower 

airways are many, and include asthma, allergic rhinitis (‘‘hay fever’’), chronic bronchitis (tobacco), emphysema, bronchiectasis, and infections (such as the common 

cold, influenza, pneumonia, tuberculosis, or whooping cough). 

With irritation of the eyes, possible medical conditions to consider would include 

conjunctivitis, which is inflammation and irritation of the conjunctiva, the mucous 

membrane that lines the eyelids. Conjunctivitis can be caused by many things, such 

as allergy, viral infections or bacterial infections, sicca (dry eye), irritation from excessive heat or cold or chemical solutions, or exposure to ultraviolet rays or foreign 

bodies. 

Skin irritation and inflammation can be caused by allergies (drugs, foods), common scaling disorders such as atopic dermatitis (eczema, allergic component), psoriasis (genetic basis), seborrheic dermatitis and dandruff (may be reaction to yeasts), 

fungal infections of the skin (ringworm, jock itch, athlete’s foot), and intertrigo 

(caused by effect of heat, moisture and friction). Other common causes are allergic 

contact dermatitis (due to irritants such as soap or detergents or an allergen such 

as poison ivy) and folliculitis due to infection, irritants, perspiration, and rubbing 

of fabrics on the skin. 

Question 2. The Committee is aware that following notification by the Commander 

of the Indiana National Guard in late September 2003, an Army team arrived at 

Qarmat Ali to assess contamination of the site, to conduct an exposure assessment 

and to evaluate any potential health effects. Please comment on the methodology 

used to determine any potential risk associated with exposure, the amount of testing 

that was conducted and for what period of time the testing occurred. 

Response. Soil sampling, ambient air monitoring (including breathing zone monitoring), and surface wipe sampling were conducted by the USACHPPM Team as 

part of the Deployment Occupational and Environmental Health Survey and Occupational Health Risk Assessment from 30 Sep–2 Nov 2003. Samples were collected 

by trained personnel that included certified industrial hygienists, environmental scientists with over two decades of contamination site assessment experience and enlisted preventive medicine technicians. Sampling and laboratory analytical methods 

were derived from those used during contaminated site and workplace assessments 

developed by the Environmental Protection Agency (EPA) and National Institute for 

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Occupational Safety and Health. Sample results were compared to the one-year 

Military Exposure Guidelines (MEGs) for air and soil. MEGs are concentrations for 

chemicals in air, water and soil that are used to assess the significance of an exposure to a contaminant. They represent a concentration above which certain types 

of health effects may begin to occur in a population after an exposure of a specified 

duration. They are guidelines and not health standards. When these guidelines are 

exceeded, they serve as an action level for additional investigation/study. They have 

been derived from existing regulatory guidance published by the EPA, Occupational 

Safety and Health Administration and other Federal agencies. Additional information can be found in USACHPPM Technical Guide 230, Chemical Exposure Guidelines for Deployed Military Personnel available at http://chppm-ww.apgea.army.mil/ 

documents/TG/TECHGUID/TG230.pdf and the Reference Document (RD) 230 Chemical Exposure Guidelines for Deployed Military Personnel available at http://chppmwww.apgea.army.mil/documents/TG/TECHGUID/TG230RD.pdf. Risks were estimated by determining the hazard severity and exposure potential in accordance 

with Army Composite or Operational Risk Management Guidance. Additional information can be found in USACHPPM Technical guide 248, Guide to Deployed Preventive Medicine Personnel on Health Risk Management available at http://chppmwww.apgea.army.mil/documents/TG/TECHGUID/TG248.pdf. These were reviewed 

by the National Academy of Sciences Committee on Toxicology in 2004. This review 

is available at http://www.nap.edu/catalog.php?record_id=10974#toc. 

Soil Sample Results. A total of 60 soil samples were collected in different areas 

of the Qarmat Ali site from 7–12 Oct 2003. Only one offsite area tested above the 

One-Year MEG for Total Chromium or Hexavalent Chromium [Cr VI] in soil. However, four areas of the site tested above the MEG for polychlorinated biphenyls 

(PCBs). The severity of this exposure was estimated to be Negligible due to the 

short exposure durations. 

Air Sample Results. Eighty three breathing zone samples were collected 7–12 October 2003, 43 were analyzed for Cr VI and 40 for Arsenic, Chromium (Total), Lead 

and Selenium. Twenty eight area air samples were collected between 8–11 October 

2003 and analyzed for Antimony, Arsenic, Beryllium, Cadmium, Chromium (Total), 

Lead, Manganese, Nickel, Vanadium, Zinc and Particulate Matter Less than 10 microns (PM10). 

The survey’s breathing zone and general area air sample results for heavy metals, 

to include Cr VI were well below the Cr VI MEG. 

The majority of the sample results for PM10 exceeded the 1-year MEG of 70 

micrograms/cubic meter. Although these results indicate that on-site personnel may 

have been exposed to concentrations greater than the MEG, they are consistent with 

PM10 concentrations experienced in and around US base camps located throughout 

Southwest Asia. 

However, these sample results only estimated exposure conditions at the time of 

the survey (i.e., some post-containment of sodium dichromate-contaminated grounds 

had occurred, light winds blowing in an easterly direction, and limited oil well water 

injection operations) rather than past conditions (i.e., pre-containment of sodium dichromate-contaminated grounds and potentially high winds) and future conditions 

(i.e., potentially high winds blowing in a westerly direction and full-scale oil well 

water injection operations). Air concentrations prior to encapsulation were modeled 

using the EPA’s Particulate Emission Factors model used in hazardous waste site 

restoration. This model indicated that Soldiers present at the site prior to encapsulation could have been exposed to Cr VI at concentrations greater than the MEG 

but lower than the OSHA Permissible Exposure Limit. The one year-MEG for Cr 

VI was much lower than the OSHA Permissible Exposure Limit in place at the time. 

Surface Wipe Sampling. The survey’s surface wipe sample results for Cr VI dust 

indicated that the interior of the contractor trailer located on the site was contaminated with Cr VI dust. These results also indicated a lesser degree of Cr VI dust 

cross-contamination from the Qarmat Ali Water Injection Facility (WIF) compound 

to the TF RIO work trailer (located in contractor’s Pioneer Camp near the Basra 

International Airport). Although no occupational and/or environmental exposure 

limits currently exist for Cr VI dust, personnel living and working in the contractor 

trailer may have been overexposed to Cr VI dust unless properly protected. Recommendations were made to relocate the Qarmat Ali Industrial WIF’s KBR trailer 

nearer to the western boundary of the compound, and thoroughly decontaminate the 

trailer with soap and water prior to reoccupation. The study also recommended that 

the work and living areas of personnel known to have been on the Qarmat Ali WIF 

compound be cleaned with soap and water to remove any cross-contamination residue. 

Medical Evaluations. The comprehensive medical exams provided by the 

USACHPPM SMART-PM team consisted of a medical history, a general physical 

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exam, blood and urine testing (including red blood cell and serum chromium levels, 

complete blood counts, serum chemistries, liver and renal function tests, and routine 

urine analysis). Ancillary testing included chest x-rays and spirometry (pulmonary 

function) testing. 

No nasal perforations or ulcerations were noted in any of the individuals examined. To evaluate exposure above the permissible levels in workplace settings, urine 

is tested before and at the end of the shift, or the end of the workweek, and increases are noted. This is because individuals can have different levels in their 

urine based on age, sex, smoking, and diet. As stated above, for these individuals, 

urine measurement would not have been sufficient to assess their exposure, and 

there were no available pre-exposure urines for comparison. The decision to test 

whole blood (plasma, serum and red blood cells) was made with this understanding, 

and reference values were obtained from the literature and the laboratory at the 

Armed Forces Institute of Pathology for comparison purposes. Most of these blood 

tests were below the detection limit of the laboratory test, and 100% of the tests 

were within ‘‘normal’’ reference ranges identified in the literature. Based on the collected information, there did not appear to be a concern that overexposure had occurred. Individuals were therefore at negligible risk for any long-term health effects 

from chromium exposure. 

The medical evaluations supported the low to negligible overall long-term health 

risk, with only sporadic potentially-related minor health effects being observed. 

Question 3. The Army has stated that a number of soldiers who were present at 

Qarmat Ali had the opportunity to be given a medical exam and have blood work 

tested for any abnormal levels of chromium. Results of this testing showed that 

blood chemistry for chromium was average. Given the Army has stated that it did 

not know National Guard Units from West Virginia, Oregon and South Carolina 

were present at the time of this testing and only tested those in the Indiana National Guard Unit, how can testing of the Qarmat Ali population be conclusive if 

a number of the Qarmat Ali population were not surveyed or tested? 

Response. The Army assessment team provided comprehensive medical testing to 

those Soldiers and DA Civilian employees who were present at the site during the 

assessment. The Army knew of the presence of the South Carolina and Oregon 

Army National Guard at the site. The West Virginia Army National Guard unit 

(1092nd Engineer Battalion) was the only unit whose presence at the site was not 

known during the site and medical evaluation in 2003. 

The Soldiers from the 1–152nd IN BN (INARNG) and DA Civilian employees from 

Task Force Rio reported the highest average time on the site. Soldiers that had 

served at the site prior to the assessment team’s arrival from the 1–162nd IN BN 

(ORARNG) and the 133d MP (SCARNG) and had already departed were provided 

an exposure survey to estimate their overall exposure duration and frequency. These 

units were asked about the period of time that they spent at the site and they reported an average time on site of approximately 8.6 hours. Soldiers from the 1– 

152nd IN BN (INARNG) reported that they had spent on average147 hours on site. 

They did not show any specific signs of overexposure to chromium and the medical 

evaluations and site testing determined that they were not at an increased risk for 

future health effects. Since the 1–162nd IN BN (ORARNG) and the 133d MP 

(SCARNG) spent significantly less time on site than the IN NG units, the assessment team concluded that their exposure was considerably less than that experienced by the 1–152nd IN BN (INARNG) and any risk of future health effects was 

also minimal. This conclusion was validated by the Defense Health Board in their 

October 2008 review of the risk assessment 

There was no official record of the presence of the 1092nd Engineer Co 

(WVARNG) provided to the assessment team. The presence of the 1092nd Engineers 

was identified during site visits to the 1–152nd IN BN and 1–162nd IN BN. Interviews with Soldiers from the 1092nd Engineers by a team from the office of the Assistant Secretary of the Army for Manpower and Reserve Affairs suggests that these 

soldiers were exposed for a similar duration and at a similar level to the 1–152nd 

IN BN (INARNG) Soldiers. Unfortunately, there is no testing that can be administered this long after exposure to determine the risk of future health effects for these 

Soldiers. 

Question 4. The Army has stated that on average, soldiers spent 147 hours at 

Qarmat Ali. Given that any information in the surveys was self-reported, how can 

the Army guarantee the accuracy of these statements, in regard to the amount of 

time that was spent at Qarmat Ali? Were official unit records used to validate information that was given in soldiers’ statements? 

Response. There was no official system of records in place at the time of the incident that would independently document the amount of time a Soldier is present 

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at a site. Current policy now requires recording a Soldier’s duty location during a 

deployment once daily. Exposure duration and frequency for Soldiers of the 1–152nd 

IN BN (INARNG) were determined from exposure questionnaires completed by individual Soldiers. This is a common technique used in the field of Industrial Hygiene. 

Only the Soldiers of the 1–152 IN BN (INARNG) reported the average exposure of 

147 hours. The Soldiers of the South Carolina and Oregon Army National Guard 

units reported considerably less average exposure (8.6 hours). 

Question 5. The Army has stated that all results of the aforementioned testing 

were included in the medical records of soldiers who participated. In addition, the 

Army has said that these soldiers were encouraged to discuss their results along 

with any health concerns, on their post-deployment health assessments and with 

their health care providers. Have these soldiers’ medical records, in regard to any 

testing done in relation to potential exposure to sodium dichromate, been shared 

with any other organization or been added to any exposure database? Has any additional testing for sodium dichromate exposure been conducted on these individuals? 

Are these individuals currently being monitored? 

Response. All occupational and environmental sample results from the site assessment have been provided to the Department of Veterans Affairs (VA) to include a 

by-name list of whole-blood chromium monitoring results for those Soldiers eligible 

for VA medical care. Since early 2009, the DOD Deputy Assistant Secretary of Defense, Force Health Protection and Readiness, has assisted in facilitating the 

USACHPPM attending and participating at quarterly scheduled DOD/VA Deployment Health Working Group meetings. On 14 May 2009, the USACHPPM presented 

a briefing to the Working Group entitled ‘‘Operation Enduring Freedom and Operation Iraqi Freedom Deployment OEH Incidents.’’ This briefing contained a section 

on the Qarmat Ali Water Injection Plant incident. 

The Assistant Secretary of the Army, Manpower and Reserve Affairs, in coordination with the National Guard Bureau has conducted extensive outreach to Army National Guard units who were at the site but were not evaluated. As of late September 2009, 1164 Soldiers were estimated to have deployed with the units who 

served at the site, 863 of these Soldiers have been contacted by their State Joint 

Force Headquarters, informed about the incident, and encouraged to enroll in the 

VA registry; 258 had enrolled in the registry; and 154 were reported to have had 

completed medical examinations provided by the VA. 

The VA has established a separate registry for this incident. All of the Soldiers 

from this incident currently enrolled in the VA’s Gulf War Registry will be added 

to this registry. As part of this enrollment, the VA will provide routine follow up 

examinations, to include x-rays, to monitor the Soldiers involved in the incident. 

The ARNG Joint Force Headquarters in each state will retain the medical records 

of the Soldiers to ensure that a second record of the exposure is maintained and 

available to the Soldiers. 

There has not been additional testing done for sodium dichromate exposure. There 

are no medical tests that can detect exposure this long after the incident. 

Question 6. The Committee is aware that in 2004, a report was issued by the 

Army with findings and recommendations in regard to the situation at Qarmat Ali 

and that report was subsequently sent to the Defense Health Board. Other than 

commenting that ‘‘the standard of care was exceeded’’ what other recommendations, 

comments or concerns did the Defense Health Board express with respect to this 

report? Was the report shared or critiqued by any other independent medical or scientific body, such as the Institute of Medicine? 

Response. The Defense Health Board (DHB) provided 14 specific and general observations and recommendations on the study. These included such observations 

that while environmental contamination was present at the site, all available evidence indicates a low level of personal exposure and no expectation of future health 

effects. They also observed that Soldiers who were similarly exposed but not studied 

should be reassured that this finding applies to them as well. They also recommended that information about the incident be conveyed to medical providers 

and included in the involved Soldiers’ permanent record and that this incident be 

used to train personnel in the best practices to address future similar incidents. 

We did not seek additional outside review due to the time available and the fact 

that the chair of the DHB review also serves as the Chairman of the National Academy of Sciences Committee on Toxicology. 

Detailed information on the DHB review is available at: http://www.health.mil/ 

dhb/recommendations/2008/DHB%20Review%20of%20USACHPPM%20Assessment% 

20at%20Qarmat%20Ali%20Final%20Report.pdf. 

Question 7. In Dr. Gibb’s testimony, he noted that there were several data inconsistencies in CHHPM’s report. Specifically, CHHPM’s report cited test results that 

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showed that 98 percent of blood samples showed chromium levels within a range 

of 4 to 5 micrograms per liter in one area of the report, then CHHPM stated that 

nearly all results were below the limit of detection in another area of the report. 

How do you account for these inconsistencies in data in CHHPM’s report? 

Response. Dr. Gibbs’s testimony contained a factual error. The CHPPM report 

states on page 15 that ‘‘The majority of test results were below the detection limit 

of the test method’’ and ‘‘All the results, to include the earlier tests done by KBR, 

were within the first reference range (0.2 to 10.0 μg/L) and 98% of the results were 

within the second reference range (4 to 5 μg/L).’’ Of the 135 tests done, 73 were 

below the level of detection of 0.5 μg μg/L, with the remaining ranging from 0.5 μg/ 

L to a maximum of 8.7 μg μg/L. All were below 10 μg/L, meaning all were within 

the first range. Only two results (7 μg/L and 8.7 μg/L) were above 5 μg/L. It is common within the field of occupational medicine for results to be called ‘‘within normal 

limits’’ or within the normal range as long as they are not above the upper limit 

of the range. Dr. Gibbs incorrectly concluded that CHPPM had claimed that the results were between 4 to 5 μg/L. 

Question 8. What type of surveillance, medical and otherwise, does the Army provide in areas where burn pits currently exist? 

Response. Army preventive medicine personnel conduct initial occupational and 

environmental health surveillance to determine what potential environmental hazards may exist at a given location. These may include: toxic industrial chemicals 

and toxic industrial materials from local sources that may be in the air, water, or 

soil; ionizing radiation; non-ionizing radiation; physical hazards such as extreme 

noise, heat and cold, and altitude; food-, water-, vector-, and arthropod-borne 

threats; endemic diseases; and any by-products of US forces activities (noise, smoke 

from burn pits, exhaust, etc.). The results are documented in a site-specific Occupational and Environmental Health Site Assessment. Identified hazards are assessed 

for potential impact on the mission and for long-term health concerns. The hazards 

are eliminated, reduced or otherwise controlled as feasible within mission constraints. Surveillance is conducted when hazards cannot be eliminated and a decision is made by commanders to accept the health risks associated with the exposure 

situation. Surveillance relating to burn pits can include ambient air sampling, surface soil sampling, and reviewing medical encounter data. 

Soldiers (and other Servicemembers) are asked to discuss any concerns that they 

have about burn pits or other environmental exposures with a health care provider 

as part of their mandatory post-deployment health assessment process. This assessment is a two-step process that occurs within 30 days of their return from a deployment and again within 6 months after their return from deployment. Specific information on this program and the survey forms is available at http://afhsc.army.mil/ 

Documents/DOD_PDFs/DODI_6490_03.pdf 

Question 9. When will additional environmental assessments from burn pit sites, 

in addition to the one already done at Balad, be conducted? 

Response. A tri-service group is developing an air sampling strategy for the 

CENTCOM AOR, focusing on sites with significant air pollution sources such as 

burn pits. The group is considering potential air hazards, methods to collect samples 

in a deployed area, and how such data could be used to better characterize the air 

and the health risk to deployed Service Members. Personnel from the group are 

traveling to 6 locations in Iraq and Afghanistan in early November 2009 to brief 

command personnel on historical air sampling results, discuss the current situation 

with medical personnel, and gain further understanding of the exposure situation 

and concerns. Upon return, the draft sampling strategy will be updated and presented to the Joint Environmental Surveillance Work Group Executive Committee 

in late November 2009. It will then be reviewed by the Defense Health Board at 

the end of November 2009. Sampling is expected to begin in early 2010, assuming 

that operational security considerations are sufficient to allow this to occur safely. 

Question 10. What other environmental exposures is the Army currently monitoring? 

Response. Currently, Army preventive medicine personnel are conducting occupational and environmental health surveillance to determine what potential environmental hazards and risks exist at all large US Base Camps in Iraq and Afghanistan. Surveillance includes periodic sampling of ambient air quality, potable and 

non-potable water sources, and contaminated soil. The results are documented in a 

site-specific Occupational and Environmental Health Site Assessment. Since 2001, 

more than 17,000 environmental samples have been collected throughout the 

CENTCOM Area of Operations with almost 10,000 in Iraq, more than 3,500 in Kuwait, and 3,300 in Afghanistan. 

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Question 11. What preventative measures are taken by the Army before it sends 

soldiers into areas where there are potential environmental hazards? 

Response. The preventive measures undertaken by the Army prior to deployment 

are addressed in Army Regulation (AR) 11–35, Deployment Occupational and Environmental Health Risk Management, Headquarters Department of the Army, 16 

May 2007. These include an assessment of occupational and environmental health 

hazards such as industrial chemicals, hazardous noise levels, or radiation or other 

hazard present or being generated by local national agricultural, industrial, or commercial activities. Ideally, these assessments are completed pre-deployment as part 

of an Occupational and Environmental Health Site Assessment or an Environmental 

Baseline Study prior to the establishment of a forward operating base or other deployment location. These considerations are included in the Army composite risk 

management process to balance mission risks when developing contingency and 

operational plans. Operational planners attempt to identify these hazards as part 

of the overall intelligence preparation of the battlefield but they are often unable 

to obtain the needed data prior to US Forces occupation of a site. As a result, a 

primary component of the DOD/Army Deployment Occupational and Environmental 

Health Risk Management program is the principle of hazard recognition and avoidance. Commanders at all levels are required, by DOD, Joint Staff and Army Policies, 

to ensure that Occupational and Environmental Health hazards are identified and 

assessed during periodic monitoring as part of their overall composite risk management plan for the operation, similar to the risks from combat, CBRN attacks, and 

physical safety hazards. 

RESPONSE TO POST-HEARING QUESTIONS BY HON. RICHARD BURR TO JOHN J. RESTA, PE, MS, SCIENTIFIC ADVISOR, U.S. ARMY CENTER FOR HEALTH PROMOTION AND

PREVENTIVE MEDICINE

Question 1. At the hearing, Mr. John Resta indicated that the Department of Defense may be moving forward with additional air sampling and studies regarding 

the potential health effects of burn pits being used in Iraq and Afghanistan. 

A. Please provide additional details regarding any on-going or planned air sampling related to burn pits. 

Response. Air sampling for Particulate Matter is being conducted across Iraq and 

Afghanistan at locations with deployed preventive medicine personnel which includes most of the larger US base camps. Sampling for volatile organic compounds 

(VOCs) is also being performed because of burn pits and other sources of VOCs at 

the base camps such as generator and vehicle exhaust. 

A tri-service group is developing a comprehensive air sampling strategy for the 

CENTCOM Area of Responsibility, focusing on sites with significant air pollution 

sources such as burn pits. The group is considering potential air hazards, methods 

to collect samples in a deployed area, and how such data could be used to better 

characterize the air and estimate the health risk to deployed Service Members. Personnel from the group are traveling to 6 locations in Iraq and Afghanistan in early 

November 2009 to brief command personnel on historical air sampling results, discuss the current situation with medical personnel, and gain further understanding 

of the exposure situation and concerns. Upon return, the draft strategy will be updated and presented to the Joint Environmental Surveillance Work Group Executive 

Committee in late November 2009. It will then be presented to the Defense Health 

Board at the end of November 2009 for their review and comment. Sampling is expected to commence by early 2010 assuming operational security conditions are adequate to allow this to occur safely. 

B. Is on-going sampling being done near the living quarters of servicemembers in 

Iraq? 

Response. Air sampling locations associated with burn pit smoke are selected by 

deployed preventive medicine personnel based on their assessment of air hazards 

and their impact on the mission and potentially affected populations. These sampling locations frequently include living areas. 

C. Would you please provide a timeline of when additional studies will be initiated 

and when we can expect the results? 

Response. As discussed above, additional burn pit studies would be expected to 

begin in early 2010. The actual dates may be affected by: equipment purchase and 

shipping, training, coordination of laboratory assistance, personnel rotation schedules, and/or the operational situation at the locations of interest. Results would be 

anticipated 3–6 months after the completion of field work. 

Question 2. A February 2009 article in ‘‘Inhalation Toxicology’’ written by employees from the U.S. Army Center for Health Promotion and Preventive Medicine noted 

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that authors of a 2005 journal article had ‘‘conducted a survey of 15,000 military 

personnel deployed to [Operation Enduring Freedom/Operation Iraqi Freedom] and 

estimated that 69.1% reported experiencing respiratory illnesses, of which 17% required medical care,’’ and that ‘‘[t]he frequency of respiratory conditions doubled 

from a pre-combat period to a period of combat operations in this group.’’ 

A. What steps are being taken to ensure that possible respiratory illness is addressed in post-deployment health assessments? 

Response. Soldiers (and other Servicemembers) are asked to discuss any health 

concerns that they have about burn pits or other environmental exposures with a 

health care provider as part of their mandatory post-deployment health assessment 

process which is a two-step process that occurs within 30 days of their return from 

a deployment and again within 6 months after their return from deployment. Specific information on this program and the survey forms is available at http:// 

afhsc.army.mil/Documents/DOD_PDFs/DODI_6490_03.pdf. 

The increase in respiratory conditions in theatre noted in the article occurred during deployment by analyzing these post-deployment self assessment data. Soldiers’ 

self-reporting of symptoms on questionnaires seems to increase from pre-to-post-deployment, but the increase is not reflected in more objective measures of health status, namely health care encounters. CHPPM has assessed the frequency of post-deployment inpatient and ambulatory care visits for respiratory conditions, and not 

found them to be associated with deployment (i.e. number of deployments and cumulative time deployed). 

B. To what extent does the smoke from burn pits potentially contribute to respiratory health problems of deployed servicemembers? 

Response. It is not possible to state to what extent any one exposure contributes 

to ‘‘respiratory health problems of deployed servicemembers.’’ It is recognized that 

exposure to burn pits smoke can cause acute, short-term and, most often, mild respiratory health problems in servicemembers such as red, watery, and mild upper system symptoms, depending on the degree of smoke exposure, such as coughing and 

sinus congestion. It is also suspected that a fairly small number of personnel who 

may have preexisting respiratory conditions may have those conditions aggravated 

by smoke exposures, or because of special susceptibilities, unique medical histories, 

or possibly even as a result of combined exposures (such as use of open burning and 

smoking cigarettes or cigars, etc.) could develop some type of chronic health effects. 

What are not known is what conditions might fall into this category and how frequent such conditions may develop. Epidemiologic studies are underway to identify 

any associated conditions and the extent of any risks toward the development of 

long-term, chronic conditions. The studies conducted to date have not demonstrated 

a significant increase in respiratory health outcomes post-deployment. Additional 

epidemiologic studies are underway to identify any associated health conditions and 

the extent of any risks toward the development of long-term, chronic conditions. 

Question 3. In his testimony, Mr. Resta indicated that the U.S. Army Center for 

Health Promotion and Preventive Medicine and the U.S. Air Force School of Aerospace Medicine ‘‘performed both an operational health risk assessment and a longterm health risk assessment based on large-scale sampling events at Joint Base 

Balad’’ and that ‘‘no environmental monitoring data collected at Joint Base Balad 

to date have identified an increased risk for long-term health conditions.’’ 

A. Can you explain the extent to which the presence of particulate matter was 

considered in reaching that conclusion about long-term health conditions? 

Response. The risk assessment conclusions for the burn pit health risk assessments were based on the chemical test results and did not consider particulate matter (PM) exposures primarily because a CENTCOM-wide PM characterization study 

was in progress during the time of the risk assessments and the potential health 

effects of PM exposures are not well understood. USACHPPM has requested that 

the National Academy of Sciences evaluate the existing PM data set and provide 

recommendations on assessing the health risks from exposures to PM. This evaluation is ongoing and expected to be completed in 2010. 

B. What impact do open burn pits potentially have on particulate matter levels? 

Response. Products of combustion include particulate matter, which is a broad 

term for particles which can be inhaled and include acid aerosols, metals and other 

compounds. Thus, burn pits add particulate matter to the surrounding air and potentially raise particulate matter levels. However, PM levels at Balad and across the 

region are naturally much higher than those found in the US. The year-long sampling effort for the CENTCOM-wide PM characterization study showed PM levels 

at Balad were similar to other locations in the region, some of which had burn pits 

and some that did not. 

C. Would you explain the findings that were published in ‘‘Inhalation Toxicology’’ 

in February 2009 with regard to the health effects of exposure to particulate matter 

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(article entitled ‘‘Potential Health Implications Associated with Particulate Matter 

Exposure in Deployed Settings in Southwest Asia’’) and what impact those findings 

may have on your conclusions regarding the long-term health risks associated with 

open burn pits? 

Response. The article was a review of some of the health effects associated with 

particulate matter, and specifically, what has been published regarding potential relationship of particulate matter in military populations. Based on the literature to 

date, no clear consensus regarding long-term health risks associated with particulate matter in deployed settings has emerged. Thus, the article discusses potential 

health risks. The article identifies burn pits as a potential source of particulate matter, and notes that burning and products of combustion may contribute to long-term 

health effects. 

Chairman AKAKA. Thank you very much, Mr. Resta. 

My first question is for all of the DOD witnesses. I am really interested in the timeline for each of the exposures. So, General 

Payne, tell me about Camp Lejeune. When did the Marine Corps 

first learn about some potential problems there and when were 

your VA partners and servicemembers first notified about that? 

General PAYNE. Sir, there was an indication, I am told, in approximately 1979 that there were VOCs that were interfering with 

the testing of the water. But our ability to determine the specific 

chemicals involved took several years. 

Once we found out the specific chemicals, the specific wells, we 

began shutting down those wells in late 1984. The first notification 

was through the base newspaper and I have no idea, sir, why that 

route was chosen. Looking back from 2009, it seems to me to be 

a very inadequate response and an inadequate notification, quite 

frankly. I cannot speak for why the decision was made at that time 

in late 1984 and again in 1985 to use that means of notification 

of the potentially affected residents. 

Chairman AKAKA. The same question I would like to ask of Dr. 

Gillooly. Can you share the timeframe for Atsugi? 

Mr. GILLOOLY. Yes sir. As mentioned in my introductory remarks, the incinerators were constructed in the early 1980s. They 

were burning municipal waste. They applied for a permit to burn 

industrial waste in 1985. I think that was when the first concerns 

arose. There were some studies done by other organizations within 

the Navy, not Navy Medicine, in the late 80s and early 1990s. We 

were not involved in those studies. 

We were tasked, or asked rather, in 1994 to come in and look at 

what had been done and at that point, we had done a screening 

risk assessment. So, that is when we first became aware of the air 

emission problems, then wrote a fact sheet and began some risk 

communication on base at that time. 

We followed that up in 1997 with another screening risk assessment using data that was primarily collected, not by us, but for 

compliance purposes, and each time we recommended that we go 

to a full comprehensive risk assessment study that would involve 

a year-long study of the air pollutants. In other words, we would 

sample for the whole year. 

As you are aware, the Department of Justice filed suit, I believe, 

in 1999–2000, against the incinerator complex and it was closed in 

2001. 

Chairman AKAKA. When were your VA partners notified about 

this or the other servicemembers? 

313 

Mr. GILLOOLY. Pardon? Could you repeat that, please? I did not 

hear that. When was—— 

Chairman AKAKA. Yes. When was this information passed on to 

VA? 

Mr. GILLOOLY. Well, to my understanding, this year. In fact, 

there was a formal presentation to the VA about the Atsugi retrospective cohort epidemiological studies. So, I think, to my knowledge, that is the first formal presentation to the VA. 

Chairman AKAKA. Mr. Resta, your timeline in Qarmat Ali and 

the burn pits, when did the problems come to light and when were 

your servicemembers and VA notified? 

Mr. RESTA. For Qarmat Ali, my organization became aware of it 

on 15 September 2003, when we were contacted by the Coalition 

Forces Land Component Command, also known as CFLCC. 

CFLCC, on about the same day, also put the site off limits for all 

U.S. military personnel. 

We deployed and arrived on 30 September, started our field 

work, completed our study in November 2003, and published a report in January 2004, which was classified at the time in accordance with CENTCOM classification guidance. Between 2005 and 

2007 there were several informal contacts between members of my 

organization and various physicians within the VA asking questions about the incident. 

The first formal data transfer was of the classified report in December 2008, and then we subsequently prepared an unclassified 

report that was provided to them in January 2009. 

In terms of burn pits, our first involvement with burn pits occurred in 2004 at Camp Lemonier in Djibouti on the Horn of Africa, where we conducted our first study. 

We identified the risks at Balad as part of an occupational and 

environmental health site assessment in the 2006 timeframe, we 

started conducting environmental sampling there in 2007. That environmental sampling continues with certain periodicity today, and 

we started providing informal—at the technical level between physicians—information on that to the VA probably as early as 2007. 

We provided formal information to the VA in May of this year. 

They have gotten all the data to date that we have—all the sampling data that we have on Joint Base Balad to date. 

Chairman AKAKA. Thank you. Let me ask Dr. Postlewaite if you 

have any further comments on this. 

Mr. POSTLEWAITE. I think the timelines are accurate, sir. I have 

nothing to add to that. 

Chairman AKAKA. Dr. Peterson, what happens when information 

about exposures arrives at VA’s doorsteps; and Dr. Hunt, do you 

begin to assess the health of a veteran who has served in an area 

where exposure is known to have occurred? 

Dr. PETERSON. Mr. Chairman, I would reference my opening 

statement about the DOD/VA Deployment Health Work Group. As 

other witnesses have explained on the DOD side, that has become 

the venue in the last few years of both discussions related to exposures and a venue for the transfer of information to include things 

like lists of potential people exposed. 

When through that working group the VA is notified, we have a 

discussion with others at the Health Work Group, and internally 

314 

to VA, concerning the appropriate course of action. What do we feel 

based on work done by DOD up to that particular period of time 

in terms of exposure, how much of a risk is there? 

We identify methods by which to communicate with both veterans and providers that the exposure has occurred and what they 

need to be concerned about from a provider’s perspective; from the 

prospective of care and where necessary, we begin to conduct medical surveillance and provide appropriate health care as authorized 

under statutory authority. 

I think Dr. Hunt can provide us a very interesting perspective 

in terms of what you have asked him to do and also to kind of balance out what I said in terms of when that information is provided 

to our providers in the field, when veterans become aware and 

start asking questions, how those questions are addressed, and how 

the care is handled at that point. 

So, I will ask Dr. Hunt to address that. 

Chairman AKAKA. Dr. Hunt? 

Dr. HUNT. First, I would like to thank the Chairman and Ranking Member for the invitation to come speak with you today, as 

well as the staffers. I commend you on the work that you are doing. 

I feel like I am sitting here with 3,000–3,500 veterans that I 

have seen over the years. I am a primary care physician, occupational environmental medicine trained, and have done many hundreds of Gulf War registry exams, Agent Orange exams, Project 

SHAD exams, and ionizing radiation exams. I have sat with many 

of these veterans and feel like I will try to represent today their 

needs and their experiences. 

I cannot get the stories out of my head that Stacy told today and 

Laurie and Russell. I think of Senator Burr’s friends, Jerry and 

David. Day in and day out, I sit with these individuals that have 

concerns about environmental agent exposures. I feel like there are 

two very important kind of paths that these situations take. 

If we have a situation like Qarmat Ali, Camp Lejeune, where we 

have what seemed to be fairly clear exposure incidents, I feel like 

we are putting in place both through the work in the DOD and 

CHPPM and the Office of Public Health Environmental Hazards 

with our risk centers, a very nice approach that—I wish Senator 

Rockefeller was still here because it is still not where we want it 

to be. But we are really moving in the direction of being able to 

take care of these incidents in a way that more quickly provides 

relief for these veterans and their families. 

Many of the people that we see—I think of Senator Burr’s comments—have situations where we still do not have the answer, or 

situations where we are waiting for science. Tuesday, going to clinic, I ran into a Gulf War veteran that I had not seen for 6 or 7 

years. I had done his initial Gulf War registry exam back in 1994 

or 1995. Hadn’t seen him for a long time. He was doing great. He 

had been down to Florida. He was being seen in a VA down there. 

We had a short chance to talk and I thought, he is really doing 

well, this fellow. When he first came in, he had medically unexplained symptoms, as 20 percent of the veterans from the first Gulf 

War did. We still do not know exactly what that is about. We still 

do not fully understand it. 

315 

But what we do know is that there are many things we can do 

to help these veterans before we fully understand everything that 

is going on in terms of direct associations between exposures and 

health problems. 

So I guess to answer your question, what we try to do when a 

veteran comes in is to first of all acknowledge their service, acknowledge their sacrifice, take a step back from the chief concern 

about the exposure and the health concerns and reassure them 

that we will be spending time on that, but to take a step back and 

look at the greater context of their needs and their situation, particularly combat veterans. 

These exposures in combat particularly are a part of a very complex matrix of exposures that have to do with environmental 

agents, psychological traumas, sleep deprivation, and all the other 

potentially deleterious experiences a person has in combat. 

So, we try to assess kind of the full spectrum of risks that this 

person has been exposed to. We try to put the assessment of their 

environmental exposures in the context of that overall risk. We try 

to get the services set up that they need, including getting them 

service connected, getting them benefits, getting them the support 

that they need so that even before we know the answers to is this 

particular symptom related to this particular exposure, there are a 

lot of things we can do to help them get back on track and get back 

on their feet, particularly combat veterans. 

Chairman AKAKA. Thank you very much, Dr. Hunt. Senator 

Burr, your questions. 

Senator BURR. Thank you, Mr. Chairman. I apologize to the witnesses that I was not here to hear the testimony, but I have tried 

to go over it as best I could. 

Let me go to you, Dr. Peterson, and to any of your colleagues 

from the VA that feel appropriate to potentially answer. The Navy 

sent out letters to veterans stationed at Camp Lejeune between 

1957 and 1987, encouraged them to participate in the health registry. To date, roughly 140,000 individuals have responded and it 

is reasonable to conclude that many responded because they are in 

fact suffering from health problems and are worried they could be 

linked to the service at Camp Lejeune. 

Has the Navy or the Marine Corps volunteered to share the 

names, addresses of those individuals with the VA potentially so 

the VA could let them know whether they are eligible for VA care? 

In other words, have they provided the registry to the VA? 

Dr. PETERSON. Yes, in fact, the VA is providing veterans with information about this issue and offering contact information and referrals to a registry that the Navy has established in the past. So 

we have—the Navy has been proactive in—— 

Senator BURR. The 140,000-plus name registry has been provided 

to the VA? 

Dr. PETERSON. Yes. 

Senator BURR. OK. Has the VA proactively gone after those 

140,000 individuals to counsel them relative to their potential benefits within the VA system? 

Dr. PETERSON. We make the benefits aware to all of our veterans 

in a variety of ways. We have not specifically targeted that group. 

What has happened, coincidentally, with working issues like inVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00321 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
316 

forming our veterans and going after them and indicating what 

benefits there are available to them, we have also—— 

Senator BURR. They have responded to a Navy/Corps notification 

that they were at Camp Lejeune over a period of time where they 

potentially were exposed to toxic substances in the water. That list 

of people who responded and said, I acknowledge I was there, I 

might have a concern, has been supplied to the VA, but we do not 

do anything proactive from a standpoint of the VA to reach out to 

those individuals? 

Dr. PETERSON. No, we do reach out proactively. I guess the point 

I am trying to make is while we are in the process of beginning 

to do that, we are also finding out that the National Research 

Council has produced a document, as was talked about earlier on 

the first panel, that indicates from their findings that we need to 

move forward in terms of research. Having been accomplished, 

there is no more research that indicates any more studies need to 

be done. This is a finding of the commission. 

Senator BURR. Dr. Peterson, seriously, I do not want to get into 

the NRC results with the Veterans Administration. I look at the 

VA from the standpoint of the agency mandated to provide service, 

health care service specifically, and you have thrown me a curve 

ball because the VA says and the Marine Corps says they have 

never—the Marine Corps says they have never given the VA registry the registry, and the VA says they have never gotten the registry. 

For you to tell me that you have the registry is something new. 

Dr. PETERSON. OK. Brad, did you want to answer that? 

Senator BURR. Mr. Mayes, would you like to clarify that? 

Mr. MAYES. Senator—I think I turned it off there. I am not 

aware and I can speak for what we have done in the Benefits Administration, that we specifically have the names to conduct the 

outreach. We have been made aware of the situation at Lejeune. 

What we have done on the benefits side of the house is we have 

gone out and tried to make our field personnel sensitive that you 

are going to start seeing veterans coming into our regional offices—— 

Senator BURR. Let me ask a real specific question. 

Mr. MAYES. Yes, sir. 

Senator BURR. To whoever would like to take it. Have you taken 

whatever list you think has been provided for you and compared 

it to the veterans that are enrolled within the VA system to see 

who might already be enrolled, receiving services from the Veterans Administration, where it would be extremely beneficial to 

that veteran for their doctor to know that they were potentially exposed to toxic substances at Camp Lejeune in their treatment? 

Mr. MAYES. Sir, the short answer is I do not think we have the 

registry with all of the names. So to my knowledge, we have not 

matched that up. 

Senator BURR. Well, let me go to the logical next question. 

Mr. MAYES. I know what it is. 

Senator BURR. Isn’t that essential to the performance of your job, 

the delivery of health care to individuals, just if we limit it for a 

second to the ones who qualify for VA benefits? I mean, Dr. Hunt, 

I know exactly what you were saying earlier. Having as much inVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00322 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
317 

formation about the individual you are treating gives you specific 

insight as to the treatment therapies that you might pursue, knowing where they were exposed to the same thing if it is two—if it 

is one place versus the other might give you insight. 

Based upon others you have seen, to me, it seems like an issue 

that the VA would actually be proactive with the Corps and the 

Navy, saying, we need this to do our job. The more information we 

get, the more effective we can be at the treatment of these individuals. 

Let’s forget the ones that do not know whether they qualify 

today. Does that—am I right there? 

Dr. HUNT. [Nodding affirmatively.] 

Senator BURR. I take the shaking of the head in the affirmative—OK. Dr. Peterson, in your testimony, you state that the VA 

does not have special authority to enroll Camp Lejeune veterans 

and their family members in the VA health care system. 

As you know, I have introduced legislation that would explicitly 

authorize the VA to care for veterans and family members that 

show illnesses that might be the result of their time at Camp Lejeune. It appears to me that the VA could create a special enrollment category for those affected veterans using the Secretary’s general authority to provide needed health care to categories of veterans not specified in law. 

Does the VA have such legal authority? 

Dr. PETERSON. I can’t answer that question without asking general counsel. I do not know. I do not know. 

Senator BURR. Could I ask you to take that to the general counsel? 

Dr. PETERSON. I would be happy to, sir. 

[See Question 1 in post-hearing questions by Senator Burr.] 

Senator BURR. I think you will find out the answer to that is affirmative. 

Dr. PETERSON. OK. 

Senator BURR. And if that is the case, and I will not pose this 

in the form of a question, I will pose it in the form of a statement. 

Why would we rather wait to see if I pass legislation versus initiate the authority of the Secretary to create through that general 

authority the coverage for individuals that we fear might have a 

condition which is the result of having served at Camp Lejeune 

during a period that the groundwater was contaminated to a degree yet to be determined, OK? 

Mr. Mayes, I cut you off earlier and this question might go to the 

heart of it, and I will let you answer in a complete statement. If 

veterans who were stationed at Camp Lejeune, have evidence that 

they have one of the diseases that might be the result of that contaminated water, how does VA evaluate a disability claim for an 

individual who might fall into that matrix? 

Mr. MAYES. Yes sir, I think I understand the question. At the 

present time, we need evidence, of course, that they have a disease 

and then we would put them at Camp Lejeune, which we would 

certainly not question if they were at Camp Lejeune during the affected period, that they were clearly exposed to whatever was in 

the water—they would be drinking and bathing and using the 

water. 

318 

And then we would be looking for a medical nexus opinion between the disease and exposure to some toxic substance that might 

have been in the water. At the present time, that is required for 

service connection in those particular cases. 

Senator BURR. If I happen to visit any VA facility in the country, 

how familiar would that person who sees that veteran coming in— 

that doc in that facility—be about Camp Lejeune potential contamination if in fact they found somebody that met that criteria; would 

the average person out there even know anything about it? 

Mr. MAYES. The average adjudicator out there should know 

about it, Senator. We have a monthly call with all of our field managers that manage those veteran service centers that adjudicate 

those claims. It was in June that we made all of those managers 

aware that this was an issue. 

We had anecdotal evidence that people were coming in and filing 

claims, that they needed to be sensitive to this and then, in fact, 

they had to sympathetically view those claims, order an exam if it 

is necessary, but at the end, they would still need the disease exposure at Lejeune and then that nexus opinion. 

Senator BURR. I take for granted somewhere there exists a 

memorandum stating that information to them? 

Mr. MAYES. Sir, we have not put it in a formal, what we call a 

fast letter, which would be guidance. We do document—we do document what we say on those calls. 

Senator BURR. I feel fairly confident you will after this hearing. 

Mr. MAYES. Yes, sir. 

Senator BURR. Therefore, I would like you to send me a copy of 

it when you do. 

Mr. MAYES. Will do, Senator. 

Senator BURR. For the purposes of the Committee. 

Mr. MAYES. Yes, sir. 

Dr. HUNT. Senator? 

Senator BURR. Yes, sir? 

Dr. HUNT. On the clinical side, we—that information is being disseminated. Two weeks ago we had a conference on post-combat 

care in the VA. There were 3,000 people that attended from around 

the country. It is the biggest conference the VA has ever had. 

There were several sessions at the conference that were done by 

the Office of Public Health Environmental Hazards, including one 

talking about Camp Lejeune and these other four exposure incidents as well. Also, we have monthly conference calls for this postdeployment in-grade care initiative and the one next month is done 

by the War-Related Illness and Injury Study Centers to further disseminate information to clinicians in the field about Camp Lejeune 

and these other exposure incidents. 

There is also a monthly conference call through the Environmental Hazards Group where they discuss this too. So, clinicians 

certainly are getting the word about these veterans. So, if they 

come in, at least clinicians are increasingly aware of. 

Senator BURR. Thank you for that, Dr. Hunt, and thank you for 

noticing that I blurred the line between disability back to medical 

care, unintentionally, but I am glad that I did so that you could 

sort of fill me in on that. 

Mr. Chairman. 

319 

Chairman AKAKA. Thank you very much, Senator Burr. This 

question to Dr. Hunt builds on what Senator Burr was asking 

about. 

VA has said that records are shared between DOD and VA for 

purposes of adjudicating claims, but what about for the purpose of 

providing health care? The bottom line is, can a VA doctor look at 

a veteran’s health record and tell what environmental hazards they 

were exposed to during their deployment? 

Dr. HUNT. One of the advantages of having been in the system 

for a period of time is knowing how absolutely absent that sort of 

communication was in the past. There is no question that we are 

moving forward with bidirectional health information exchange, 

with remote data access. 

I confirm the chart when I am seeing a patient. I can click on 

remote data. I can get data from Fort Lewis or from military treatment facilities and among those data are information from the 

Post-Deployment Health Reassessment, PDHRA, which has information on exposure, and that is very useful for sure. 

So we are increasingly gaining access to those sorts of records 

that are very helpful. 

Chairman AKAKA. On the question of Qarmat Ali, Dr. 

Postlewaite, in your written testimony you called DOD’s response 

to the exposures at Qarmat Ali exemplary. How would you characterize DOD’s efforts to prevent exposures there? Specifically, how 

did your program help soldiers and workers at the water treatment 

plant? 

Mr. POSTLEWAITE. Thank you, Senator. Actually, that testimony 

you quoted is Mr. Resta’s, but I would like to take an opportunity 

to address your question, if I may. The word ‘‘exemplary’’ that was 

used in that testimony was a quote from the Defense Health Board 

when they reviewed the Army medical response to Qarmat Ali. 

They found it to be timely based on the minimal time since notification. 

The Army was able to put together a team of experts, including 

occupational health physicians, get them into theater. This was in 

2003. This is a very difficult time because we were very much engaged in hostilities at that time. This is out away from the base 

camp, where there wasn’t lots of protection. 

But nevertheless, the leadership said go for it and they were 

pulled in very, very quickly. The environmental assessment was 

done very quickly, as well as the medical assessment. We felt that 

under very extraordinary circumstances it was a very timely response. 

Chairman AKAKA. Dr. Postlewaite and Mr. Resta, Dr. Gibb stated that the symptoms that have been reported by soldiers and civilian workers at Qarmat Ali are consistent with what has been experienced by other workers similarly exposed. He also said that blood 

samples were not taken until 1 month after remediation measures 

were taken to limit the exposure and that kind of delay does not 

allow for an accurate measure of exposure. 

How confident are each of you that you have properly identified 

servicemembers’ risk of exposure at Qarmat Ali? 

Mr. POSTLEWAITE. This is a very complex situation with Qarmat 

Ali, Senator Akaka. Again, in 2003 when this occurred, the Army 

320 

came in very quickly, did the assessments on the individuals that 

were currently assigned there at Qarmat Ali, became aware of 

some units that had been there previously, felt after the environmental assessment was done, taking a look around the area, interviewing the troops and during that time, I think as is in the reports that you all have read, there were some symptoms noted primarily related to dried nasal membranes and upper respiratory 

kinds of symptoms that would be very consistent with the desert 

environment. 

At that point in time, the team had no knowledge at all of these 

severe effects that have been coming out in the media over the last 

year since KBR raised these issues. That was not brought up at the 

time. So, based on the information that was available when those 

assessments were done, including the blood chromium, which we 

felt was the correct test because it measured the chromium in the 

red blood cells (which stays around longer), the hexavalent chromium that you would find in the serum, based on symptoms and 

based on the physical exams that were given, and based upon the 

blood samples that were drawn at the time, we felt very confident 

that we had fully assessed the situation and that there were no 

reasons to suggest long-term health effects. 

As I said, we now have additional information and we are certainly reopening our book on this to take a closer look and we are 

very interested in what the VA physical exams will show for these 

individuals to see whether those health symptoms that they were 

experiencing may be consistent with these exposures. 

This caught us very much by surprise because we did not have 

all that information. We had an individual this morning, the medic 

that spoke to us, who indicated that he took care of treatment for 

a number of the people in his unit, which was very valiant of him, 

but it may have prevented some of that information related to 

health effects from actually getting back to the medical facility 

where people could start putting two and two together to identify 

a real problem. 

So, there are a lot of complex issues to this that are not easily 

navigated. 

Chairman AKAKA. Mr. Resta? 

Mr. RESTA. If I could just add a few things, sir, is that the physician that ran this response is a board-certified occupational medicine physician who works in industrial situations for the Army and 

is well versed in occupational medicine. 

Through his physical examinations and ancillary testing—not 

solely blood chrome levels, but including pulmonary function tests, 

chest x-rays and things like blood and urine and liver functions 

and the like that are outside of my area of expertise—he concluded 

that the symptoms that veterans or soldiers at that point were 

complaining about, the signs that he observed, were not consistent 

with hexavalent chromium exposure. 

Dr. Gibb’s testimony had a few factual errors in it, which makes 

me believe we need to share some information with him. The blood 

chemistries that we did for chromium, 73 of 135, were less than the 

level of detection, which was 0.5 micrograms per liter, not 5 to 6 

micrograms per liter, as he testified. 

321 

Twenty-one of 135 were in excess of 1.0 micrograms per liter 

with a maximum detected of 8.7 micrograms per liter. And these 

are well within U.S. national averages. At the time we were using 

a national average range of 0.1 to 10 micrograms per liter. But the 

blood tests alone—just to clear up potential confusion—the blood 

test alone was not the sole determination of whether or not a significant exposure had occurred. It was predominately the physical 

examination by the occupational medicine physician. And so I just 

wanted to clear that up. 

Chairman AKAKA. Before I yield to Senator Burr, I would like to 

ask this question on burn pit exposures. Dr. Postlewaite—— 

Mr. POSTLEWAITE. Yes, sir. 

Chairman AKAKA. We have heard stories about servicemembers 

experiencing medical difficulties due to service near burn pits in 

Iraq and Afghanistan. For several years now we have known this. 

What active measures does your office take to ensure the environmental safety of our servicemembers around the areas of these 

burn pits? 

Mr. POSTLEWAITE. Yes, sir. Burn pits, as you probably know, 

were utilized at a number of camps within Iraq and also Afghanistan for an expedient means to dispose of waste that was generated 

at those camps, so that the waste itself would not generate a 

health hazard. 

Unfortunately, some of these burn pits were located quite close 

to the camps, in some cases, upwind of the camps. Some of that 

was due to the fact with hostilities in the area the commanders did 

not feel like they could locate them very far away from the installations without putting their people at risk. 

In other cases, the burn pits were located in the periphery, but 

as the base grew in size, the population expanded around it. As a 

result, we have a number of situations like this in-theater. The 

largest burn pit in theater, Balad Air Base, at the time was the one 

that was most easily studied. We could study it without putting 

people out in the far reaches of the territory where their protection 

would have been an issue. 

We felt that, because it was the largest burn pit, this one would 

be a good one to study in depth because we felt it would be representative of the others. There were over 400 air samples that 

were taken at Balad Air Base in 2007, constituted the data necessary for a risk assessment as well as an addendum. 

Both the addendum and the risk assessment looking at all the 

substances that were analyzed did not indicate a health risk. We 

took that information, that risk assessment, and had it reviewed by 

the Defense Health Board because we wanted third-party validation that our interpretation was correct. 

Nevertheless, we do feel like some people probably have suffered 

some untoward health effects as a result of it. We do not feel like 

the numbers are large based on the total numbers of people that 

probably were exposed to smoke throughout the theater. In fact, 

the Post-Deployment Health Assessments that were mentioned earlier, I believe the figure that I saw last was about 56 percent of 

all the individuals deployed actually checked that square on the 

Post-Deployment Heath Assessment. 

322 

So, it was a very wide exposure. We have looked at our health 

outcome data from our returning veterans. We just are not seeing 

any significant elevations of the kinds of conditions that we would 

expect as a result of exposure to the smoke. But with that said, we 

are continuing to peel back the layers of the onion, if you will. We 

are doing site-specific studies on just the troops who were at Balad, 

for example, to see if their health experience was any different. 

Right now we do not have any strong evidence to suggest that 

this smoke affected large numbers of people, but we really do feel 

like some people probably had increased susceptibilities. They may 

have had combined exposures. They may have had previous health 

conditions which would place them at greater risk. 

So, we will not say that nobody is suffering from these exposures. 

Chairman AKAKA. Let me follow up with Mr. Resta. According to 

your testimony, the risks of burn pits were recognized as far back 

in Bosnia in 1996. Were the soldiers located near burn pits in Iraq 

and Afghanistan issued any protective gear or warned in any way 

of the potential harms associated with burn pits? 

Mr. RESTA. I am not aware that there was any specific personal 

protective equipment that was ever issued to any soldiers. I have 

heard anecdotes, stories of soldiers who were immediately downwind pulling guard duty wearing dust masks and things like that 

to essentially try to reduce the smell per se. But I am not aware 

that we have ever issued anything there. 

In terms of notification, once we got the results of the first risk 

assessment, we tried, again, to communicate those risks to the people present at Balad via various town hall meetings, fact sheets, 

and the like. The challenge of doing that in such a large operational setting is that a lot of the people who had previously been 

there were no longer there, new people were there, and the situation and conditions had actually changed. 

That is one of the reasons that we embarked on additional sampling and continue to do that today even while we are operating 

incinerators, which in the last report I received has reduced the 

amount of open burning by over 90 percent. 

Chairman AKAKA. Thank you. Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. General Payne, welcome, and let me say for the record upfront, when this controversy 

at Camp Lejeune existed you were not in your capacity today. 

Now, I have in my hand, as do probably numerous people, Base 

Order 5100.13B which is entitled, ‘‘Safe Disposal of Contaminants 

and Hazardous Waste,’’ specifically prohibiting the improper disposal of, and I quote, ‘‘organic solvents’’ and defined improper practices as those, and again I quote, ‘‘create hazards such as contamination of drinking water.’’ 

Now in your testimony, I interpreted what you said to mean the 

Marine Corps did not violate any regulations. I guess I have to ask, 

is not complying—how does not complying with the base order 

square with that? 

General PAYNE. Sir, again, looking back with the lens of 2009, 

you look at that and one just shakes their head as to how this happened based on the timeframes. I think that you have to start with 

understanding that even in 1984, when we started closing the wells 

323 

in early 1985, when we concluded, that was still long before these 

chemicals were regulated. 

TCE and PCE were not even regulated until 1989 and 1992, respectively. I can only surmise, sir, because I was not involved in 

the decisionmaking at that time, I can only surmise that we simply 

did not understand the ramifications of that contamination. 

Senator BURR. But would you agree with me pertinent words 

here are ‘‘organic solvent?’’ I mean, there is a little room for poisonous chemical waste or other unsuitable compounds; either organic solvents or compounds, the definition of organic solvent has 

not changed. Would you agree with me on that? 

General PAYNE. Sir, I am not a scientist. I am a war fighter, so 

I really cannot answer that. 

Senator BURR. OK. 

General PAYNE. Whether it has changed, whether we knew what 

that meant at the time, and whether that definition has changed, 

I’m sorry, sir. 

Senator BURR. Well, we both cannot reconstruct the personnel or 

the decisions that were made at the time and I think in an effort 

to try to provide a fresh start, my hope is that we can identify that 

we have done some things wrong in the past and that now it is 

time to make the commitment to get the information we need to 

know how to go forward. 

Let me, if I could, turn over to Dr. Gillooly. 

General PAYNE. And we concur with that, sir. 

Senator BURR. Thank you, sir. Why was the—I take for granted, 

you are the Public Health Center? 

Mr. GILLOOLY. Yes, sir, Navy-Marine Corps Public Health Center. 

Senator BURR. Did that used to be called the Navy Environmental Health Center? 

Mr. GILLOOLY. Yes, sir. 

Senator BURR. So, you have changed your name? 

Mr. GILLOOLY. Yes, sir. 

Senator BURR. OK, I just wanted to make sure I asked the right 

person the right question. Why was NRC not asked to review a 

broader set of risks? 

Mr. GILLOOLY. We had the NRC review our previous two screening health risk assessments in 1995 and 1997. They more or less 

agreed with our findings and conclusions for those. 

Senator BURR. The 2000 draft that they reviewed, they found— 

they raised several questions. How did you incorporate into the 

final rule what they raised? 

Mr. GILLOOLY. Sir, we took their recommendations seriously. We 

worked approximately 6 more months just working those issues, incorporating where we could their primary issues about reducing 

the uncertainty and better characterization of the health risks. We 

provided to them a 100-page report that listed point-by-point which 

of those items we could actually do that were practicable at that 

point in time and they were included in the final report. 

Senator BURR. But several of the issues were structural problems 

with the way you conducted your analysis throughout the thing. I 

am not sure how you could go back and remediate that unless it 

was to guess. 

324 

Mr. GILLOOLY. Well, I think I should back up. Number 1 is, when 

we first asked the National Resource Council to look at the report, 

typically you have an opportunity to discuss with them what you 

intend to do onsite and we were not able to because the Department of Justice had litigation ongoing. 

So, issues such as challenges and limitations of trying to do a 

risk assessment overseas from a source that was privately owned 

outside the fence were very real. For example, the gold standard 

would be to get on that stack, that incinerator stack and measure 

the pollution coming out of the stack. We did not do that. 

Senator BURR. Adopting that rationale would tell me that you 

would lean heavier on a contractor versus a DOD arm to actually 

conduct more of the study. 

Mr. GILLOOLY. Well, it is a team approach. We had both contractors and—— 

Senator BURR. OK. Why would the NRC not be asked to look at 

the final report before it was published? 

Mr. GILLOOLY. All I can tell you is the Navy Bureau of Medicine 

and Surgery forwarded the final draft report to the Commander in 

Chief, U.S. Pacific Fleet, for release. What happened after that I 

cannot comment on. In fact, I was surprised today when Dr. 

Feigley indicated he had not seen that. 

Senator BURR. Mr. Resta, in your testimony, first paragraph, excuse me, first paragraph of burn pits, you said it should be used 

to minimum extent possible based on the operational situation. 

When open burning operations are necessary, they should be located as far downwind of personnel as possible. 

That would suggest that there is a human risk to those burn 

pits. Am I making the right assumption? 

Mr. RESTA. Yes sir, you are. Breathing smoke is not healthy. 

Senator BURR. Then share with me this. Earlier this year, in the 

Defense Authorization Bill, I offered an amendment to study the 

issue of burn pits. The Committee rejected my amendment and 

said, due to objections from the Department of Defense. 

Share with me any rational reason why the Department of Defense would not want to know whether burn pits had more than 

just smoke inhalation problems for our troops. 

Mr. RESTA. I certainly cannot speak for the Department of Defense given where I am located, the Department of Army. I can hypothesize that perhaps our objections were that we are already 

working with the National Academy of Sciences on that very issue. 

I would have to really take that for the record to find out what 

exactly we forwarded up there. 

Senator BURR. Take that back for the record. 

Mr. RESTA. Yes, sir. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. RICHARD BURR TO

JOHN J. RESTA, PE, MS, SCIENTIFIC ADVISOR, U.S. ARMY CENTER FOR HEALTH

PROMOTION AND PREVENTIVE MEDICINE

The Department of Defense (DOD) concurred in principle with the amendment, 

but due to the short timeline and lack of specificity, the amendment was not 

implementable. It is not possible to accomplish all the environmental monitoring indicated, have all the samples analyzed, and perform the necessary risk assessments, 

nor determine all health effects from burn pits within 180 days. Further hindering 

compliance, the 15 military installations or facilities required to be included in the 

325 

report were not specified. These gaps caused the DOD to object to the proposed 

amendment. 

Senator BURR. I think even though you are in a very specialized 

area, I would think that you would be consulted on a decision like 

that. 

Mr. Chairman, I have a ton more questions. I would like unanimous consent to be able to provide written questions and to get answers because one, we have been here a long time and I know you 

have things to do. These witnesses have been here for a long time. 

But I do want to make one observation. 

Chairman AKAKA. Yes, Senator Burr. I have some questions too. 

We will certainly—— 

Senator BURR. OK, may I make one observation? 

Chairman AKAKA [continuing]. Send them for the record. 

Senator BURR. This Committee has struggled to try to make 

seamless the handoff of active duty troops to our Veterans Administration from the standpoint of the health care needs of our veterans. 

Today I have come to the conclusion that our problem is far 

worse than just working with DOD on the electronic medical 

records making this is a seamless process where when you go into 

a new health care system they know exactly what you have been 

exposed to, they know exactly where you have been, they can assess what your health needs are based upon where you have served 

and what you might have been exposed to. 

Today I found that it is much worse because even where we identify things that potentially could cause long-term health conditions 

to our active duty Reserve and called-up Guard, there is not an attempt to download that information to where we know these individuals will be, at some point, receiving their health care. 

I sort of paint everybody on one side and I also paint everybody 

on the VA side for not screaming about the need to get this information. We have made tremendous progress between VA and DOD 

to try to get electronic medical records that are seamless. 

If, in fact, exposure to burn pits has some potential downstream 

effects, then I want to make sure a VA doctor knows exactly where 

that person was so that they can see them and treat them based 

upon what their exposure might be. If they were at Camp Lejeune 

for those years, that information is absolutely essential to the VA 

side to take care of them. 

If they were exposed to an incinerator—and it really does not 

matter what the conclusion of the report was, that is pertinent information to a medical doctor who is making a decision about an 

individual based upon what he sees and what he reads. And if he 

only has what he sees, the care cannot be as complete as if he 

matches that with what he reads. 

So, I would hope on both sides of this table that the VA would 

become proactive in asking for the information that is pertinent to 

delivering care to these warriors on the active duty side, that we 

understand this is not about minimizing the potential effects of 

what we are in charge of. It is about making sure that we get the 

most pertinent information to all the people that can affect the best 

long-term quality-of-life for the individuals that may or may not 

have been affected. 

326 

Again, I thank all of you for your testimony. Thank you, Mr. 

Chairman. 

Chairman AKAKA. Thank you very much, Senator Burr. This has 

been a great hearing. In closing, I again want to thank all of our 

witnesses for appearing today and for your responses as well. 

To the veterans and family members of veterans affected by the 

exposures discussed today, I truly appreciate your willingness to 

share your stories with the Committee. I understand that these 

deeply personal matters are sensitive and are not always easy to 

speak so freely about. 

As Chairman, I am committed to ensuring that VA continues to 

study the health effects related to these exposures and that VA 

adapts to meet the treatment needs of individuals affected by toxin 

exposures. 

As I mentioned in my opening statement, in order for VA to do 

this DOD must first determine who was exposed and what they 

were exposed to and the health consequences of such exposure. The 

information must then be shared with VA. This Committee is not 

charged with direct oversight of DOD. That falls to the Armed 

Services Committee. However, this Committee shares the responsibility for oversight where the roles of DOD and VA intersect and 

we share several members, including me and Senator Burr. 

To quote President Obama, ‘‘We cannot let burn pits and other 

exposures be this generation’s Agent Orange.’’ We have a responsibility to ensure that the newest era of veterans receive the highest 

quality of care and prevent the tragic stories we have heard today 

from happening again. 

I thank you again for sharing your comments and thoughts and 

without question, it is going to be helpful to what we are trying to 

do to help the veterans of our country. 

This hearing is now adjourned. 

[Applause.] 

[Whereupon, at 1:37 p.m., the Committee was adjourned.] 

(327) 

A P P E N D I X 

PREPARED STATEMENT OF PAUL C. AKERS, BS, MS, MD, 

CAMP LEJEUNE, NC (1954–60) 

My name is Paul C. Akers, M.D., and as you know from my preliminary information, I am a Marine Corps dependent, the son of MSgt. Paul A. Akers (deceased). 

I was born on August 3, 1945, at Miramar (Marine Corps Air Station). My family 

was stationed at Quantico, VA; El Toro, CA; Cherry Point, NC; and at Santa Ana, 

CA, prior to being stationed at Camp Lejeune, NC. 

While we were stationed at Camp Lejeune, we lived in Tarawa Terrace II at 2505 

Bougainville Drive (1954–59) and at 3040 Saipan Drive (1959–60). My sister and 

I attended base schools on Brewster Avenue, all schools being on one campus and 

encompassing grades one through twelve. My father was head of the meat department at the commissary and he was also assigned to Camp Geiger, ITR and other 

locations during our stay at Camp Lejeune. My mother was a housewife, and volunteered as a Grey Lady in the library of the Camp Lejeune Naval Hospital. The 

neighborhood students rode to school and to extracurricular destinations on USMC 

buses driven by enlisted Marine personnel. We played little-league baseball at a 

field adjacent to Tarawa Terrace I and little-league football on a field at Camp 

Geiger. Camp Lejeune High School teams practiced at the school but held their 

games in the outfield of the base baseball field or at the base football field, and they 

played basketball games at the base field house. Baseball games were played at the 

high school. Children played in the woods around Tarawa Terrace; the neighborhood 

boys played pick-up games on a make-shift diamond beneath a water tower in the 

complex. 

Families drank, bathed in, cooked with, and ate food prepared with this water. 

In addition, families watered the flowers and lawns, washed their clothes, and children played in wading pools filled with this water. There were swimming pools on 

base, but I do not know the source of the water used to fill them. They were closed 

periodically during the summers due to polio outbreaks. Not only was Hospital Point 

the location for the base hospital, but it was also the site for social events, such as 

oyster roasts, birthday parties, etc. In the early 1950’s, my family was stationed at 

Cherry Point MCAS, and I was sent to Camp Lejeune Naval Hospital to have my 

tonsils taken out. My mother was diagnosed with metastatic breast cancer in the 

mid-1950’s; she had found a lump in her breast about a week or two before her diagnosis. Adm. Joseph L. Yon, M.D. was her surgeon. She had positive lymph node biopsies and underwent a radical mastectomy and subsequent radiation therapy. I 

was in the third or fourth grade at the time of her diagnosis. My mother died May 

27, 1960 in the Naval Hospital in Quantico, Virginia. She and my father are both 

buried in Arlington National Cemetery. At the time of my mother’s death, I was 

fourteen, and my sister was twelve. 

My sister died with metastatic malignant melanoma on June 2, 2009, after having 

been diagnosed in early May, 2009. She was sixty-two years old at the time and 

had previously had some Gyn atypia as well. I was diagnosed with stage 4, nonHodgkins lymphoma on April 29, 2009, and am currently undergoing treatment. Except for my mother, my sister, and myself, there is no history of malignancy on either side of our family. 

As a physician and as a scientist, I am concerned on both a personal and professional level. Three of the major contaminants in the Camp Lejeune Water Study are 

classified as carcinogens and capable of causing the cancers that have been reported 

in my family. As a practicing physician, I would be highly concerned for my patients 

and would monitor their health statuses closely immediately after becoming aware 

of their exposure to the above-mentioned carcinogens. Believing the exposure was 

related to their duty stations—Camp Lejeune, El Toro, and other sites—I feel that 

the U.S. Government should assume the responsibility for monitoring these people’s 

328 

health statuses and their associated medical. Since the exposure occurred during 

their service to the military (Marines, Navy, civilian base employees and dependants), the logical location for such monitoring and any subsequent related health 

care would be at a local VA hospital with all related expenses covered by the Veterans Administration. Validation of exposure potential may be obtained by review 

of the service or employee records. 

I regret that I will be unable to deliver this testimony in person; however, as I 

mentioned earlier, I am still undergoing treatment and have an intrathecal 

methotrefate treatment scheduled for October 7, 2009. If I may provide any additional information, either in person or in writing, please do not hesitate to contact 

me. 

PREPARED STATEMENT OF THE AGENCY FOR TOXIC SUBSTANCES AND

DISEASE REGISTRY (ATSDR) 

CONTAMINATED DRINKING WATER AND HEALTH EFFECTS AT MARINE BASE CAMP

LEJEUNE: FINAL PLANS OF THE AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY

AUGUST 2009

EXECUTIVE SUMMARY

ATSDR has been assessing the human health risks from hazardous substances at 

U.S. Marine Corps Base Camp Lejeune since the late 1980s. The agency conducted 

public health assessments, initiated a variety of epidemiological studies, and employed state-of-the-art computational tools (modeling) to reconstruct exposures to 

volatile organic compounds (VOCs) from drinking water systems. In 1997, ATSDR 

characterized the VOC drinking water pollutants as a ‘‘past public health hazard,’’ 

a position ATSDR continues to maintain. Since then, ATSDR has focused on epidemiological studies designed to measure the occurrence of illness and death among 

the service men and women and their families exposed to the contaminated drinking 

water. 

Several documents or reviews of ATSDR’s work have been completed during the 

past 14 months. ATSDR finalized An Assessment of the Feasibility of Conducting Future Epidemiologic Studies at USMC Base Camp Lejeune in June, 2008. ATSDR 

later held an April, 2009 Expert Panel to assess ATSDR’s plans for historical reconstruction of drinking water contamination at Hadnot Point and Holcomb Boulevard. 

In June, 2009 the National Research Council (NRC) issued a report, Contaminated 

Water Supplies at Camp Lejeune—Assessing Potential Health Effects. This document 

considers this information and defines ATSDR’s plans for completing our research 

activities at Camp Lejeune. 

Tarawa Terrace exposure modeling: ATSDR will use its modeling to generate 

semi-quantitative exposure estimates for the planned epidemiologic studies rather 

than limit the use of the historic reconstruction to exposed/unexposed. ATSDR believes that the models provide a reliable means for assigning individuals to multiple 

exposure categories useful in epidemiologic studies. ATSDR’s approach is supported 

by two previous expert panels that focused on exposure reconstruction efforts. 

Hadnot Point exposure modeling: ATSDR will apply simpler modeling techniques 

for Hadnot Point and Holcomb Boulevard then those used for Tarawa Terrace. The 

Hadnot Point area is significantly larger than the Tarawa Terrace area and contains 

multiple contaminant source locations. Applying the complex numerical models used 

at Tarawa Terrace to the entire Hadnot Point area would be time consuming, costly, 

and add another level of uncertainty to the water modeling analysis. This approach 

is supported by both the NRC report and the ATSDR 2009 expert panel. 

Reanalysis of birth outcomes study: ATSDR will proceed with its planned reanalysis of the birth outcomes study to correct for errors in exposure classification. To 

avoid further exposure misclassification, ATSDR will await the completion of the 

historic exposure reconstruction of the Hadnot Point drinking water system. 

Birth defects and childhood cancer studies: ATSDR will complete its case-control 

study of birth defects and childhood cancers. The analysis will proceed expeditiously 

once the historic exposure reconstruction of the Hadnot Point drinking water system 

is completed. 


ATSDRlogo.eps
329 

Further epidemiological studies: ATSDR has proposed mortality and morbidity 

studies. The morbidity study will be based upon a ‘‘health survey’’ that would solicit 

information about diagnosed illnesses (e.g., cancer) from former service men and 

women and their families. ATSDR plans to move forward as quickly as possible to 

conduct the mortality study which has adequate study power and can be completed 

in a relatively short time period. ATSDR recognizes that a scientifically valid morbidity study based upon a health survey is time consuming and costly. The utility 

of the health survey depends upon high participation rates and the ability to secure 

objective confirmation of reported medical conditions. ATSDR will alter its plans for 

the health survey by using a phased approach, evaluating participation rates and 

diagnosis verifiability in advance of a complete survey of all eligible participants. 

ATSDR will define scientifically sound criteria for evaluating the results of the first 

phase, and for deciding upon the feasibility of a complete survey. 

ATSDR concludes that the portfolio of epidemiologic studies is not only scientifically useful, but also a service to the community of service men and women and 

their families exposed to contaminated drinking water at USMC Base Camp 

Lejeune. 

TABLE OF CONTENTS

Executive Summary......................................................................................................... 1 

Table of Contents............................................................................................................. 4

I. History and Purpose .................................................................................................... 5 

II. Science and Service .................................................................................................... 6 

III. Partnerships and Oversight ..................................................................................... 7 

IV. ATSDR Camp Lejeune Portfolio............................................................................... 8 

V. The NRC Recommendations ......................................................................................12 

VI. Implementation and Timeline ..................................................................................21 

VII. References.................................................................................................................22 

I. HISTORY AND PURPOSE

ATSDR has been assessing the human health risks from hazardous substances at 

U.S. Marine Corps Base Camp Lejeune since the late 1980’s. The agency conducted 

public health assessments, initiated a variety of epidemiological studies, and employed state-of-the-art computational tools (modeling) to reconstruct exposures to 

volatile organic compounds (VOCs) from drinking water systems. In 1997, ATSDR 

characterized the VOC drinking water pollutants as a past public health hazard, a 

position ATSDR continues to maintain. Since then, ATSDR has focused on epidemiological studies designed to measure the occurrence of illness and death among the 

service men and women exposed to the contaminated drinking water. ATSDR has 

enlisted four different Expert Panels and a Community Assistance Panel to help 

guide the development of this work. 

Several documents or reviews of ATSDR’s work have been completed during the 

past 14 months. ATSDR finalized An Assessment of the Feasibility of Conducting Future Epidemiologic Studies at USMC Base Camp Lejeune in June, 2008. ATSDR 

later held an April, 2009 Expert Panel to assess ATSDR’s plans for historical reconstruction of drinking water contamination at Hadnot Point and Holcomb Boulevard. 

In June, 2009 the National Research Council (NRC) issued a report, Contaminated 

Water Supplies at Camp Lejeune—Assessing Potential Health Effects. ATSDR has 

carefully evaluated these reports, comments from the Camp Lejeune Community Assistance Panel, and comments from additional scientists and an environmental nongovernmental organization. ATSDR’s plans take into consideration the underlying 

science, our commitment to serving communities exposed to hazardous substances, 

and address the comments and concerns of the reviewers. 

II. SCIENCE AND SERVICE

ATSDR has a unique mandate to conduct human health research related to community exposures to hazardous substances. Although our knowledge of the relationships between chemical exposures and human health is often based upon studies of 

highly exposed workers or animal toxicology testing, there remains a pressing need 

to know whether lower level exposures, away from the workplace, cause human illness. ATSDR identified the drinking water contamination at Marine Base Camp Lejeune as an opportunity for conducting this type of research. 

ATSDR recognizes the importance of setting appropriate expectations for our research. Our research studies must be of high quality. ATSDR research should contribute to the understanding of the human health effects of hazardous exposures 

such as VOCs in drinking water. While no single study can be conclusive, our reVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00335 Fmt 6601 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
330 

search should add information to the overall weight-of-evidence regarding associations between hazardous exposures and human health outcomes. 

Our science serves a secondary, service-related, function: the right to know. At 

Camp Lejeune, hundreds of thousand of men and women lived and worked providing service to their country. Many were unknowingly exposed to VOCs in their 

drinking water. Beyond contributing to our general knowledge about these hazardous substances, ATSDR research studies will provide information that former 

service men and women of Camp Lejeune want to know about the health risks from 

these past exposures. 

ATSDR believes conditions are appropriate to continue research at Camp Lejeune. 

ATSDR’s research should help inform policy decisions that respond to the health 

concerns of the service men and women exposed to contaminated drinking water. 

However, the development of these policies need not await the results of ATSDR research. The policy decisions should be based a weight-of evidence assessment of all 

relevant human and animal studies and consider authoritative assessments that 

have previously been published. Policies should be flexible enough to incorporate 

new information, such as the results from the ATSDR studies. 

III. PARTNERSHIPS AND OVERSIGHT

ATSDR serves the men and women who lived at Camp Lejeune while the drinking 

water was contaminated. Our work at Camp Lejeune would not be possible without 

the support and partnership of multiple people and organizations. Although no single person or group represents this diversity of people, many former marines have 

become active partners by serving on our Community Assistance Panel (CAP). The 

Department of Navy and United States Marine Corps have dedicated significant resources and efforts to assist ATSDR. Both groups have been instrumental in helping 

us understand the complexity and history of Camp Lejeune’s drinking water systems. The quality of our efforts would have suffered without the dedicated interest 

and help from these people. 

ATSDR recognizes the value of objective scientific review. Over the years ATSDR 

has assembled four separate expert panels as we developed our epidemiological 

studies and computer-based models of drinking water contamination. Two panels 

have addressed the historic reconstruction of contaminated drinking water at Camp 

Lejeune: first the Tarawa Terrace system and second the Hadnot Point and Holcomb Boulevard systems. A third expert panel focused on whether or not ATSDR 

should conduct epidemiologic studies of the Camp Lejeune population beyond studies of birth outcomes, birth defects, and childhood cancers. The fourth expert panel 

provided advice to ATSDR on scientific approaches to a congressionally mandated 

health survey. The NRC report provides an additional opportunity for objective external review. In addition, protocols and reports of ATSDR’s work have routinely 

been peer-reviewed by experts outside the Agency. 

IV. ATSDR CAMP LEJEUNE PORTFOLIO

ATSDR’s work at Camp Lejeune is briefly described below for background 

purposes. 

• 1990: Public Health Assessment for ABC One-Hour Cleaners, Jacksonville, 

Onslow County, North Carolina. The first assessment related to Camp Lejeune focused on the contamination of ground water by tetrachloroethylene released from 

the ABC One-Hour Cleaners. This assessment found that PCE, detected in onsite 

and offsite wells, was the primary contaminant of concern. 

• 1997: Public Health Assessment for U.S. Marine Corps Base at Camp Lejeune, 

Military Reservation, Camp Lejeune, Onslow County, North Carolina. This assessment formed the basis for future public health research, including the ongoing water 

modeling, exposure reconstruction, and epidemiological studies. Although the drinking water section of the report needs to be updated, the report contains valuable 

and accurate historical information about nine other exposure pathways. ATSDR 

concluded in this report that exposures from VOCs in the drinking water at Camp 

Lejeune were a past public health hazard. ATSDR plans to reassess the drinking 

water pathway once the historic reconstruction efforts are completed. 

• 1998: Volatile Organic Compounds in Drinking Water and Adverse Pregnancy 

Outcomes, United States Marine Corps Base, Camp Lejeune. In 1995, ATSDR began 

a study of a variety of adverse pregnancy outcomes at Camp Lejeune in relation to 

drinking water VOC exposure. The study analyzed live births to women residing in 

base family housing when they delivered during the period January 1, 1968, 

through December 31, 1985. Birth certificates were studied from 6,117 tetrachloroethylene (PCE)-exposed women, 141 short-term trichloroethylene (TCE)-exposed 

women, 31 long-term TCE-exposed women, and 5,681 unexposed women. AssociaVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00336 Fmt 6601 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
331 

tions between PCE and the study outcomes were observed in two potentially susceptible subgroups: infants of mothers 35 years of age or older and infants whose mothers had histories of fetal deaths. ATSDR also reported a reduction of birth weight 

for gestational age in male babies within the long-term TCE-exposed group. ATSDR 

later identified an error in the exposure classifications used in this study. ATSDR 

is planning to reanalyze this study with updated exposure information. • 2005: Expert Peer Review Panel Evaluating ATSDR’s Water-Modeling Activities 

in Support of the Current Study of Childhood Birth Defects and Cancer at U.S. Marine Corps Base Camp Lejeune, North Carolina. Analyses of Groundwater Resources 

and Present-Day (2004) Water-Distribution Systems. ATSDR requested a panel of 

nine experts to provide input on the Agency’s groundwater resources and water-distribution system modeling activities conducted from March–December 2004 at U.S. 

Marine Corps Base, Camp Lejeune, North Carolina. Overall, the experts indicated 

that this was an important study to conduct and were impressed with the quality 

of work performed to date. The panelists noted specific principal issues that needed 

to be addressed, and made recommendations for ATSDR’s next steps. ATSDR has 

since followed the advice of the panel members. • 2005: Report of the Camp Lejeune Scientific Advisory Panel. In February 2005, 

ATSDR asked a panel of experts for advice regarding additional epidemiological 

studies related to people’s exposure to contaminated drinking water at Camp Lejeune. The panel discussed a large range of possible adverse health impacts that 

could be related to short- and long-term exposure to TCE and other VOCs in the 

drinking water of Camp Lejeune. Several of these would be extremely challenging 

to study, and may not be feasible subjects for investigation, such as studies of effects 

that could involve medical evaluation of hundreds of individuals now living in widely scattered locations. There was agreement, however, that a study of mortality outcomes would be feasible (assuming the availability of adequate personal identifiers) 

and that a cancer incidence study might be feasible. Before embarking on full-scale 

studies however, the members recommend that ATSDR conduct one or more feasibility or pilot studies. • 2007: Analyses of Groundwater Flow, Contaminant Fate and Transport, and 

Distribution of Drinking Water at Tarawa Terrace and Vicinity, U.S. Marine Corps 

Base Camp Lejeune, North Carolina: Historical Reconstruction and Present-Day 

Conditions. Two of three water-distribution systems that have historically supplied 

drinking water to family housing at U.S. Marine Corps Base Camp Lejeune, North 

Carolina, were contaminated with VOCs. Tarawa Terrace was contaminated mostly 

with tetrachloroethylene (PCE), and Hadnot Point was contaminated mostly with 

trichloroethylene (TCE). Because limited measurements of contaminant and exposure data are available to support the epidemiological study, ATSDR used modeling 

techniques to reconstruct historical conditions of groundwater flow, contaminant 

fate and transport, and the distribution of drinking water contaminated with VOCs 

delivered to family housing areas. Based on probabilistic analyses, the most likely 

dates that finished water first exceeded the current maximum contaminant level 

(MCL) for PCE ranged from October 1957 to August 1958 (95 percent probability), 

with an average first exceedance date of November 1957. Exposure to drinking 

water contaminated with PCE and PCE degradation by-products stopped after February 1987 when the Tarawa Terrace water treatment plant was closed. 

• Ongoing: Exposure to VOCs in Drinking Water and Specific Birth Defects and 

Childhood Cancers, United States Marine Corps Base Camp Lejeune, North Carolina. ATSDR has undertaken a study to determine if children born during 1968– 

1985 to mothers who were exposed to VOC-contaminated drinking water at Camp 

Lejeune at any time during the pregnancy were more likely to have specific birth 

defects or childhood cancers. The birth defects include spina bifida, anencephaly, 

and cleft lip and/or palate. The childhood cancers include leukemia and non-Hodgkin’s lymphoma. The study design for the case-control study was completed in 2004 

and underwent peer-review. Case-control interviews and the medical records confirmation phase of the study are complete. The study is awaiting completion of the 

water modeling. 

• 2008: An Assessment of the Feasibility of Conducting Future Epidemiological 

Studies at USMC Base Camp Lejeune. ATSDR released a feasibility assessment of 

conducting future epidemiological studies at the base. ATSDR visited the Naval 

Health Research Center (NHRC), the Defense Manpower Data Center (DMDC), and 

the DOD Education Activity storage facility at Fort Benning, Georgia, to determine 

whether available databases could identify adults and children who lived at the 

base, or civilians who worked at the base, during the period when drinking water 

was contaminated with VOCs. ATSDR also convened a panel of epidemiologists with 

experience in military and occupational cohort studies to provide recommendations 

on future studies (Appendix A of the report). ATSDR concluded that a mortality 

332 

study and a cancer incidence study are feasible. Available DOD personnel databases 

can identify active duty Marines and naval personnel and civilian employees stationed at the base during the period when the Hadnot Point and Tarawa Terrace 

drinking-water systems were contaminated with VOCs. ATSDR also concluded that 

it may be feasible to include in the cancer incidence study those who participated 

in the ATSDR 1999–2002 survey and those who will participate in the congressionally mandated Navy/Marine Corps health survey scheduled for 2009. These studies 

should have sufficient statistical power to detect moderate excesses (e.g., standardized mortality ratios [SMRs] <2.0) in specific cancers among those exposed to the 

contaminated drinking water (see Appendix B). ATSDR completed internal clearance of the feasibility assessment and released it to the public. 

• 2009: Expert Panel Assessing ATSDR’s Methods and Analyses for Historical Reconstruction of Groundwater Resources and Distribution of Drinking Water at 

Hadnot Point, Holcomb Boulevard and Vicinity, U.S. Marine Corps Base, Camp Lejeune, North Carolina. ATSDR convened a panel of 13 groundwater modeling, waterdistribution system analysis, and epidemiological experts to help the agency evaluate the information, data, and modeling methods to be applied to Hadnot Point, Holcomb Boulevard, and vicinity at Camp Lejeune. The panel provided specific recommendations. Individual experts stated that the project was worthwhile and 

agreed that it would be possible for ATSDR to reconstruct potential historical exposures for the proposed epidemiological studies. 

V. THE JUNE 2009 NRC RECOMMENDATIONS

The National Research Council released its report, Contaminated Water Supplies 

at Camp Lejeune—Assessing Potential Health Effects, in June 2009. The summary 

recommendations directed at ATSDR, and a summary of our science-based position 

regarding these recommendations, are described below. 

NRC Recommendation 1: For the purpose of epidemiologic studies, the results of 

the Tarawa Terrace historical reconstruction can be used to characterize people as 

being exposed or unexposed on the basis of date and location of residence or workplace. The monthly estimates imply more accuracy than is appropriate and should 

not be used to characterize exposure of individual people. 

ATSDR will use its modeling to generate semi-quantitative exposure estimates for 

the planned epidemiologic studies rather than limit the use of the historic reconstruction to exposed/unexposed. ATSDR believes that the models provide a reliable 

means for assigning individuals to multiple exposure categories useful in epidemiologic studies. ATSDR’s approach is supported by two previous expert panels that focused on our exposure reconstruction efforts. 

The usefulness of the Tarawa Terrace model-estimated monthly average PCE concentrations has been clearly demonstrated by its concordance with measured PCE 

concentrations in water samples taken from the Tarawa Terrace water treatment 

plant prior to distribution to its customers (i.e. finished water samples). A ‘‘goodness 

of fit’’ comparison between the model calibrations and measurements of finished 

Tarawa Terrace water lead ATSDR, as well as our drinking water panel of experts, 

to conclude that the modeled monthly estimates can be used to create reasonably 

accurate exposure categories for the epidemiological studies. 

The use of an exposed/unexposed classification for past drinking water contamination would result in a significant loss of important scientific information. ATSDR reviewed the distribution of modeled monthly drinking water exposures at Tarawa 

Terrace and documented that significant variability of exposure exists across the 

study population. Children in the birth defect and childhood cancer study who received drinking water from Tarawa Terrace during the first month of gestation were 

exposed to estimated average monthly drinking water contamination levels that 

range from 3 ppb to 182 ppb. A similar distribution is seen for mothers who lived 

at Tarawa Terrace and were included in the birth outcome study. 

The use of an exposed/unexposed classification system would inaccurately assess 

risk and potentially miss an observed effect if one truly exists. It is important to 

utilize all relevant information in the exposure assessment so that exposure categories can be created that are as homogeneous as possible with respect to risk. The 

NRC report (p. 29) acknowledged this point when it emphasized the importance of 

correctly classifying the magnitude of exposure, differentiating ‘‘between those who 

are exposed at magnitudes that could result in adverse health effects (sensitivity) 

and those who are exposed at lower magnitudes (specificity).’’ Moreover, an important research question is whether the risk for a disease increases with increasing 

exposure. This question cannot be addressed using an exposed vs. unexposed classification. 

333 

Recommendation 2: Because any groundwater modeling of the Hadnot Point system will be fraught with considerable difficulties and uncertainties, simpler modeling approaches should be used to assess exposure from the Hadnot Point water 

system. Simpler modeling will not reduce the uncertainty associated with the estimates, but they have the advantage of providing a broad picture of the timeframe 

and magnitude of exposure encountered by people who used water from that system 

more quickly and with less resources than complex modeling exercises. 

ATSDR will apply simpler modeling techniques for Hadnot Point and Holcomb 

Boulevard then those used for Tarawa Terrace. The Hadnot Point area is significantly larger than the Tarawa Terrace area and contains multiple contaminant 

source locations. Applying the complex numerical models used at Tarawa Terrace 

to the entire Hadnot Point and Holcomb Boulevard areas would be time consuming, 

costly, and add another level of uncertainty to the water-modeling analyses. This 

approach is supported by both the NRC report and the ATSDR 2009 expert panel. 

The information from the models will be used in all of ATSDR’s epidemiological 

studies to classify individuals into categories of exposure and provide a service to 

the affected community. 

The models needed to reliably estimate water concentrations for Hadnot Point and 

Holcomb Boulevard will be developed specifically to address issues for these areas. 

If available, better field characterization and details will be added to conceptual 

models to improve understanding of both hydraulics and transport at selected sites 

where potential exposure was high. ATSDR will use locally-refined grids to model 

selected sites of interest. ATSDR will select and develop simulation tools based on 

site-specific conditions, characteristics, and requirements. 

Recommendation 3: The Committee recommends that ATSDR go forward with reanalyzing its study of birth outcomes to correct for errors in exposure classification 

without awaiting the results of groundwater modeling of the Hadnot Point system. 

. . . Reanalyses should include development of a detailed written analysis plan. 

Despite the Committee’s concerns about the statistical power of the study of birth 

defects and childhood cancer, it recommends that the study be completed as soon 

as possible. 

ATSDR will proceed with its planned reanalysis of the birth outcomes study to 

correct for errors in exposure classification. To avoid further exposure misclassification, ATSDR will await the completion of the historic exposure reconstruction of the 

Hadnot Point drinking water system. ATSDR will complete its case-control study of 

birth defects and childhood cancers. The analysis will proceed expeditiously once the 

historic exposure reconstruction of the Hadnot Point drinking water system is completed. ATSDR has developed a detailed analysis plan for these studies. 

ATSDR believes that due to significant variability of exposures among people at 

Hadnot point and Holcomb Boulevard, it is essential to complete the simpler water 

modeling for Hadnot Point. Monthly average contaminant levels will likely vary depending on when contaminated wells were operating. In addition, exposure will vary 

because of the transfer of water from Hadnot Point to Holcomb Boulevard during 

the dry spring-summer months. 

The birth outcome study cannot be reanalyzed without awaiting the Hadnot point 

water-modeling results. The previous analysis considered the drinking water supplied in Holcomb Boulevard uncontaminated, even though the area had originally 

been supplied contaminated water from Hadnot Point. The Hadnot Point water 

models must be completed to accurately classify exposures in Holcomb Boulevard 

during those years. Once, an acceptable historic dose-reconstruction of exposures at 

Holcomb Boulevard and Hadnot Point become available the epidemiological data 

will be analyzed. 

Recommendation 4: The Committee found that although ATSDR did consider the 

major issues bearing on the feasibility of the proposed studies and proposed reasonable approaches to conducting the studies, there remain serious, unresolved questions about the feasibility and ultimate value of the studies. . . . the Committee 

concluded that most questions about whether exposures at Camp Lejeune resulted 

in adverse health effects cannot be answered definitively with further scientific 

study. New studies should be undertaken only if their feasibility and promise of providing substantially improved knowledge on whether health effects have resulted 

from water exposure at Camp Lejeune are established in advance. 

ATSDR has proposed mortality and morbidity studies. The morbidity study will 

be based upon a ‘‘health survey’’ that would solicit information about diagnosed illnesses (e.g., cancer) from former service men and women and their families. ATSDR 

plans to move forward as quickly as possible to conduct the mortality study which 

has adequate study power and can be completed in a relatively short time period. 

ATSDR recognizes that a scientifically valid morbidity study based upon a health 

survey is time consuming and costly. The utility of this survey depends upon high 

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participation rates and the ability to secure objective confirmation of reported medical conditions. ATSDR will alter its plans for the health survey by using a phased 

approach, evaluating participation rates and diagnosis verifiability in advance of a 

complete survey of all eligible participants. ATSDR will define scientifically sound 

criteria for evaluating the results of the first phase, and for deciding upon the feasibility of a full study. To determine whether a full research study can be conducted, 

ATSDR will conduct a pilot study, contacting a 10% sample (35,000 to 40,000) of 

those targeted for the health survey and evaluate the ability to locate participants, 

achieve an adequate participation rate, and confirm self-reported diseases. ATSDR 

will mail a health survey to the remaining 90% of the study group to assure compliance with congressional authorizing language. If the pilot study demonstrates adequate response rates and medical confirmation, the same methods will be extended 

to the entire population. ATSDR will develop algorithms to determine the needed 

participation rate and diagnosis verification rate to assure valid results, and will 

evaluate the pilot study accordingly. If participation rates and medical confirmation 

are inadequate for a scientifically valid health survey, ATSDR will analyze and report the survey results without costly efforts to improve participation and assure 

medical confirmation. 

ATSDR has confirmed that adequate personnel data to establish a study cohort 

are available from the Defense Manpower Data Center’s databases. These are the 

primary sources of data on former active duty and civilian employees for the mortality study and the health survey. These data contain names, social security numbers and dates of birth as well as other information such as rank, job duties, and 

length of employment or active duty service, and a unit code that places active duty 

men and women within Camps Pendleton and Lejeune. These data are sufficient for 

conducting a National Death Index search for the mortality study and initiating the 

search to contact people for the health survey. 

ATSDR has assessed the statistical power of the proposed mortality and morbidity 

studies. Statistical power is the probability of finding an exposure-disease association if an association does exist. The study power calculations were included in the 

study protocols which were not reviewed by the NRC committee. The study power 

estimates for the cancer mortality endpoints are adequate. The study power estimates for the health survey are also considered adequate, the health survey calculations are based upon a 65% participation rate which may be optimistic. The statistical power calculation on comparisons between Camp Lejeune and the general population showed that an SMR of 1.6 could be detected for kidney cancer with 90% 

power and a type 1 error (α error) of .10. For the comparison with Camp Pendleton, 

and assuming a similar cancer rate at Pendleton as for the general population, an 

SMR of 2.0 can be detected with 90% power and incorporating a 10 year latency. 

Lower SMRs can be detected with 90% power for other cancers of interest such as 

non-Hodgkin’s lymphoma, leukemia, lung, colon/rectal, liver, and brain cancer. 

[Note: Because the U.S. rate for each cancer is based on very large numbers, the 

variability in the rate is ignored in power/sample size calculations. However, the 

variability in the rate for each cancer at Camp Pendleton must be taken into account in the power/sample size calculations. The result is that the SMR or SIR that 

can be detected with a specified sample size, latency, type 1 error, and type 2 error 

will be higher for the comparison between Camp Lejeune and Camp Pendleton than 

it will be for a comparison between Camp Lejeune and the U.S. population.] Statistical power was evaluated for the morbidity study protocol that was approved by the 

CDC IRB and peer-reviewed. Comparing Camp Lejeune with Camp Pendleton, assuming a 65% participation rate, incorporating a 10 year latency period, and using 

a type 1 error of .10 and a type 2 error of .10 (i.e., 90% power), an RR of <1.6 can 

be detected for kidney cancer incidence. Lower RRs can be detected for non Hodgkin’s lymphoma, lung, and colon/rectal cancer. 

Selection bias in the health survey is possible even with a 65% or higher participation rate. The degree to which bias might influence the study results is related 

to disease prevalence. Rare diseases are more easily influenced by low participation 

than common diseases. Although a high participation rate decreases the likelihood 

of bias, a low participation rate does not guarantee that bias will occur. On the 

other hand, low participation rates do diminish study power and decrease the overall confidence in study results. 

The health survey will utilize several approaches to achieve adequate participation rates to reduce the likelihood of selection bias. To enhance participation rates 

in the Camp Lejeune and Camp Pendleton populations, ATSDR proposes to have 

the Commandant of the USMC sign the letter that accompanies the survey encouraging participation. The Commandant’s endorsement will ensure that active duty 

and retired Marines and their families perceive the study as legitimate. The selection of Camp Pendleton as a comparison population should also help to reduce the 

335 

likelihood of selection bias. Both bases have had problems with toxic waste sites and 

are likely to have similar workplace exposures. To motivate populations at both 

bases to participate in the survey, all mailings will encourage those who experienced 

any environmental or workplace exposures to participate. The health survey will 

utilize a standard methodology that has been demonstrated to enhance participation 

rates in mailed surveys (the Dillman method). Participation will be made convenient 

by giving respondents the choice of completing a hard copy or web-based survey, and 

the survey instrument will be of optimum length to address the research questions 

of interest without overburdening the respondent. 

ATSDR recognizes the importance of accurately ascertaining adverse health outcomes. For the mortality study, a standard approach will be used: vital status will 

be determined using an algorithm that utilizes several national databases and the 

National Death Index will be used to identify causes of death. For the morbidity 

study, only health outcomes confirmed by medical records or cancer registrations 

will be evaluated in the analyses. ATSDR plans to utilize all 50 state cancer registries, the VA cancer registry, and the DOD cancer registry to confirm self-reported 

cancers identified from the health survey. ATSDR will obtain confirm disease status 

by obtaining medical records for non-cancer outcomes of interest. 

ATSDR has been meeting with state cancer registries that are funded by CDC’s 

National Program of Cancer Registries (NPCR) and National Cancer Institute’s Surveillance and Epidemiology End Results (NCI SEER). ATSDR also has had discussions with the VA and DOD cancer registries. All are supportive of working with 

ATSDR to confirm self-reported cancers from the health survey. In addition, a major 

consideration in the selection of a contractor for the health survey will be the demonstrated ability of the contractor to obtain medical records for disease confirmation. 

VI. IMPLEMENTATION AND TIMELINE

ATSDR is moving ahead as planned with its portfolio of activities, dependent 

upon funding from the Department of Navy. ATSDR will provide an updated 2010 

Annual Plan of Work based on this final plan. ATSDR hopes to proceed with the 

Mortality Study immediately if the research contract can be awarded in FY2009. 

The health survey cannot begin before FY2010 because of limitations with the 

planned funding mechanism and the decision to conduct a pilot study. A revised 

time-line will be developed for the morbidity study that is based upon the health 

survey. The pilot phase of the health survey is likely to begin sometime after March 

2010. 

VII. REFERENCES

Agency for Toxic Substances and Disease Registry. Preliminary Public Health Assessment for ABC One-Hour Cleaners, Jacksonville, Onslow County, North Carolina. Atlanta GA: U.S. Department of Health and Human Services; 1990. Report 

No.: NCD024644494. 

Agency for Toxic Substances and Disease Registry. Public Health Assessment for 

U.S. Marine Corps Base at Camp Lejeune, Military Reservation, Camp Lejeune, 

Onslow County, North Carolina. Atlanta, GA: U.S. Department of Health and 

Human Services; 1997. Report No.: NC6170022580. 

Agency for Toxic Substances and Disease Registry. Volatile Organic Compounds 

in Drinking Water and Adverse Pregnancy Outcomes, United States Marine Corps 

Base, Camp Lejeune. Atlanta, GA: U.S. Department of Health and Human Services; 

1998. 

Agency for Toxic Substances and Disease Registry. (ATSDR) 2005a. Report of the 

Camp Lejeune Scientific Advisory Panel. June 24, 2005. http://www.atsdr.cdc.gov/ 

sites/lejeune/panel—report.html 

Agency for Toxic Substances and Disease Registry. (ATSDR) 2005b. ATSDR Response to the Report of the Camp Lejeune Scientific Advisory Panel. 2005. http:// 

www.atsdr.cdc.gov/sites/lejeune/panel—report—response.html 

Contaminated Water Supplies at Camp Lejeune—Assessing Potential Health Effects. National Research Council. June 2009. 

Maslia ML. Expert Peer Review Panel Evaluating ATSDR’s Water-Modeling Activities in Support of the Current Study of Childhood Birth Defects and Caner at 

U.S. Marine Corps Base Camp Lejeune, North Carolina. Atlanta, GA: Agency for 

Toxic Substances and Disease Registry; 2005. 

Maslia ML, Sautner JB, Faye RE, Sua ́ rez-Soto RJ, Aral MM, Grayman WM, Jang 

W, Wang J, Bove FJ, Ruckart PZ, Valenzuela C, Green JW Jr, and Krueger AL. 

Analyses of Groundwater Flow, Contaminant Fate and Transport, and Distribution 

of Drinking Water at Tarawa Terrace and Vicinity, U.S. Marine Corps Base Camp 

Lejeune, North Carolina: Historical Reconstruction and Present-Day Conditions— 

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Chapter A: Summary of Findings. Atlanta, GA: Agency for Toxic Substances and 

Disease Registry; 2007. 

Sonnenfeld N, Hertz-Picciotto I, and Kaye WE. Tetrachloroethylene in Drinking 

Water and Birth Outcomes at the U.S. Marine Corps Base at Camp Lejeune, North 

Carolina. American Journal of Epidemiology. 2001;154(10):902–908. 

PREPARED STATEMENT OF THE CAMP LEJEUNE COMMUNITY ASSISTANCE PANEL (CAP) 


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PREPARED STATEMENT IN RESPONSE TO NATIONAL RESEARCH COUNCIL REPORT

ON CAMP LEJEUNE

We are disappointed and dismayed at the report titled, ‘‘Contaminated Water 

Supplies at Camp Lejeune—Assessing Potential Health Effects,’’ released by the National Research Council (NRC) on Saturday, June 13, 2009. This report was two 

years in preparation by scientists, many of whom we know and respect, that 

reached puzzling and in some cases erroneous conclusions. We are aware of the complex situation regarding availability and access to data, and each of us has participated in committees advising the Agency for Toxic Substances and Disease Registry 

(ATSDR) about how to move forward with health studies. It is our view that the 

Marines and their families who were exposed to dangerous chemicals in the Camp 

Lejeune drinking water over several decades deserve to know if this exposure has 

had an effect on their health. The most direct way to assess this is to conduct valid 

epidemiologic studies of those who lived or worked there, and we urge ATSDR to 

continue their efforts to carry these to conclusion. The overall judgment about the 

impact of the chemicals on health can then be informed both by the general scientific literature the NRC reviewed, plus findings from directly relevant studies of 

the exposed population. 

Specific areas where we disagree with the NRC report include their assessment 

of the water distribution modeling, their assessment of the risk caused by exposure 

to two of the principal contaminants (TCE and PCE), and the likelihood of conducting meaningful epidemiologic studies in this setting. We view the water modeling undertaken by ATSDR and its consultants as ‘‘state-of-the-art’’ and worth carrying through to completion so that it can be used in the on-going and proposed 

health studies. There may be uncertainties about specific levels of exposure for individual households or people, but these can be described in the study results. We also 

agree with the National Toxicology Program that TCE and PCE are ‘‘reasonably anticipated to be human carcinogens’’ and reject the characterization of the evidence 

as ‘‘limited/suggestive’’ as presented in the NRC report. We note that this characterization of solvent mixtures actually steps back from previous work done by the National Academy of Sciences Institute of Medicine in 2003. Finally, we disagree with 

the thrust of the NRC report that it is unlikely that scientifically informative epidemiologic studies of the Camp Lejeune population can be done. The NRC doubts 

that ‘‘definitive’’ answers can come from any study, but this sets the bar too high— 

no one study can provide definitive answers, and all studies must be considered in 

the light of other scientific evidence. From our experience in other settings, we believe that useful studies of the Camp Lejeune population are possible and furthermore that the Marines and their families deserve our government’s best efforts to 

carry them out. 

For these reasons, we urge the ATSDR to consider this particular NRC report in 

the context of other expert advice they have received during the past decade and 

the competent work already done by agency staff. Since the NRC report is at such 

variance with the recommendations of other water modeling and epidemiologic experts, we believe it should not stand as the final word. 

Sincerely, 

ANN ASCHENGRAU, SC.D., 

Professor, Associate Chair of the 

Department of Epidemiology, Boston 


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University School of Public Health 

RICHARD CLAPP, D.SC., MPH, 

Professor, Boston University School of 

Public Health 

DAVID OZONOFF, MD, MPH, 

Professor and Chair Emeritus of the 

Department of Environmental Health, 

Boston University School of Public 

Health 

DANIEL WARTENBERG, PH.D., 

Professor, Environmental and 

Occupational Medicine, Robert Wood 

Johnson Medical School 

SANDRA STEINGRABER, PH.D., 

Scholar in Residence, Ithaca College 

PREPARED STATEMENT OF DAVID A. BRISCOE, U.S. MARINE (RET.) 

Good morning, my name is David Briscoe and I served my country faithfully for 

8 years in the United States Marine Corps. I spent 7 of those 8 years at Camp Lejeune and for 3 of the 7 years I lived in base housing with my family. What I didn’t 

know was the fact that the tap water that served both my place of duty and my 

home was highly contaminated with PCE, TCE, DCE, vinyl chloride, benzene, toluene, ethylbenzene, and xylene. 

Five and one-half years following my honorable discharge from the USMC, I was 

diagnosed with adenocystic carcinoma of the right pallet. I had a surgical resection 

performed at the Baltimore VA hospital and multiple postoperative radiation treatments in Washington, DC. I would later require 25 hyperbaric oxygen treatments 

at various treatment facilities because of poor healing believed to have been caused 

by the radiation therapy. 

Following my cancer surgery and treatments my family and I moved back to 

Onslow County, NC, which is my wife’s original home. It was shortly after this relocation that I became aware of the contamination in the drinking water at Camp Lejeune. It was at this time that I began pursuing my VA benefits related to service 

connection because of my exposure to the high levels of contamination in the tap 

water on the base. The period of time which my exposure to these chemicals took 

place, the Department of the Navy and United States Marine Corps officials knew 

of their existence in our tap water (see attachment A, B, C, & D). In a September 

1985 Raleigh News and Observer article (see attachment E) related to the contamination aboard Camp Lejeune, Robert Alexander, a base environmental engineer, 

was quoted as saying, ‘‘Of all the contamination sites aboard the base, no people 

had been directly exposed to any of the pollutants.’’ Then on 25 February 1988, the 

Assistant Chief of Staff, Facilities Marine Corps Base, Camp Lejeune, NC, Colonel 

Thomas J. Dalzell was interviewed by the base newspaper the ‘‘Globe.’’ (see attachment F) The title of this article was ‘‘HAZARDOUS WASTES AND THEIR EFFECTS EXPLAINED.’’ During this interview, Col. Dalzell was asked many questions, but two of these questions along with the Colonel’s responses really stood out. 

The dialog was as follows: 

Question. Is my health or the health of my family in any danger? 

Response. No, it’s not. All the wells which we get our raw water out of are 

continually tested and the wells that were identified as being contaminated 

have been closed off. All the other wells with water coming out contain no 

health problems at all to any individual who is living or working aboard 

Camp Lejeune or anyone in the local community. 

Question. What about prior to 1983? 

Response. At that time, we were not aware of any of these particular compounds that might have been in the ground water and we have no information that anyone’s health was in danger at that time. 

Both of these authority figures were fully aware of the fact that no less than four 

laboratories had identified contaminants in Camp Lejeune’s tap water as early as 

October 1980. On 10 August 1982, Grainger Analytical Laboratory in Raleigh, NC, 

wrote a letter to the Commanding General of Camp Lejeune warning him that what 

they had discovered in the base’s drinking water was ‘‘more important from a health 

stand point’’ than what the water was initially being tested for. In their letter, 

Grainger laboratory went on to identify and quantify the contaminants they discovered. Both of these men knowingly lied to the tens of thousands of Marines, Sailors, 

344 

their family members and civilian employees whose health and safety these men 

were entrusted. 

Once the Department of the Navy (DON) and United States Marine Corps 

(USMC) claims that ‘‘no people had been exposed to any pollutants’’ was proven 

wrong, they began a new campaign of dis/misinformation related to regulatory 

standards for these chemicals. They (DON/USMC) then began stating ‘‘we had violated no state or EPA standards regarding these specific chemicals in drinking 

water.’’ While there is an ounce of truth in this claim, because there were no state 

or USEPA standards regulating the presence of these chemicals in public water supplies at that period of time, they (DON/USMC) had detailed, explicit regulations/ 

standards for both drinking water and the chemicals which had contaminated Camp 

Lejeune’s water supply dating as far back as 1963 (see attachments G, H, I). I have 

learned that when dealing with the DON/USMC in this situation that it isn’t so 

much as ‘‘what they say’’ which counts, it is what they ‘‘don’t say!’’ 

Based upon what is known regarding the Camp Lejeune drinking water issue, 

there is absolutely no reason that it took me 8 years to acquire the VA benefits 

which I so rightfully deserved and am now receiving (See attachment J). It is quite 

obvious that the DON/USMC publicly misrepresented the human exposures and 

their own regulatory responsibilities at the base and there is absolutely no reason 

for any veteran who served at Camp Lejeune during the contamination period who 

is suffering health consequences to be denied his or her service-connected VA benefits. Absolutely NONE! 

PREPARED STATEMENT OF CANDY LITTLE

MY LATE HUSBAND GEORGE AND I WERE STATIONED AT CAMP 

LEJEUNE FROM 1970–1972. THERE WE CONCEIVED A DAUGHTER, 

MICHELLE, MY PREGNANCY WAS NORMAL UNTIL SEPT. 14, 1972, WHEN 

OUR LIVES WERE CHANGED FOREVER. MICHELLE WAS STILLBORN, 

CAUSE OF DEATH, INTRA UTERINE ASPHYXIA PLACENTAL INSUFFICIENCY, AND NO ONE HAD ANY ANSWERS TO GIVE US. 

WE HAD 2 SONS NOT CONCEIVED AT CAMP LEJEUNE AND THEY ARE 

BOTH HEALTHY. 

TRAGEDY STRUCK AGAIN WHEN I WAS 5 MONTHS ALONG WITH OUR 

YOUNGEST SON, GEORGE WAS DIAGNOSED WITH ACUTE LYMPHOSITIC 

LEUKEMIA, CANCER OF THE BLOOD AND BONE MARROW, WHAT THEY 

CALL A CHILD’S DISEASE. HE SUFFERED TERRIBLY. HE RECEIVED CHEMOTHERAPY PLUS HE HAD TO ENDURE TESTS ON HIS BONE MARROW, 

WHICH MEANT A NEEDLE INSERTED INTO HIS RIBS TO EXTRACT HIS 

BONE MARROW FOR TESTING. ON JAN. 15, 1977 HE DIED, JUST 5 DAYS BEFORE OUR SON TURNED 1, HE WAS 25 YEARS OLD. I NOW FOUND MYSELF 

A WIDOW WITH 2 SMALL CHILDREN, I WAS 23 YEARS OLD. 

MY HEALTH PROBLEMS BEGAN IN 1989, IT STARTED WITH MY BACK 

AND I HAVE BEEN IN EXCRUCIATING PAIN EVER SINCE. I AM THANKFUL 

I HAVE A WONDERFUL HUSBAND WHO DOES EVERYTHING HE CAN TO 

HELP ME. HE HAS TAKEN ME TO NUMEROUS DOCTORS OVER THE PAST 

20 YEARS. 

MY MEDICAL HISTORY IS LONG AND COMPLICATED. JUST A FEW 

THINGS WRONG ARE, THAT AFTER 18 YEARS I WAS FINALLY GIVEN A 

NAME TO MY PROBLEM, FYBROMYALGIA, ALSO FAILED BACK SYNDROME, 

WHICH INCLUDES 3 FAILED BACK SURGERIES, FAILED SPINAL COLUMN 

STIMULATOR, MIGRAINE HEADACHES (TWICE A DAY), PLUS BONE AND 

MUSCLE DETIORATION, I HAVE 2 METAL DISCS IMPLANTED INTO MY 

BACK TO MAKE MY DISCS THE SAME SIZE PLUS TRY TO RELIEVE THE 

PAIN IN MY LEFT LEG DUE TO THE FACT THAT THE COLLAPSED DISC SAT 

THERE FOR 10 YEARS, SO NOW I HAVE PERMENANT NERVE DAMAGE. I 

ALSO HAVE 2 TITANIUM SCREWS FUSED TO MY SPINE. 

I’VE HAD 24 DOCTORS OVER THE YEARS, MOST BAFFLED AS TO THE SEVERITY OF MY PAIN. I HAVE ALSO HAD 9 SURGERIES IN THE PAST 20 

YEARS. THIS IS A LONG TIME TO BE IN CONSTANT PAIN. I AM NOW BEING 

TREATED WITH MORPHINE, I’VE BEEN ON IT SINCE 1999. I ALSO TAKE A 

TOTAL OF 41 PILLS A DAY, THAT’S DOWN FROM 68 PILLS BACK IN 2003. IN 

2004 I LOST ALL OF MY TEETH DUE TO BONE DETIORATION, MY DENTURES NEVER FIT PROPERLY AFTER THAT, I HAD 4 FAILED SURGERIES 

ON MY MOUTH TO REPAIR 2 HOLES LEFT WHEN MY MOLARS WERE 

PULLED. IN 2006 I FINALLY HAD A SUCCESSFUL SURGERY AND THE 

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HOLES WERE FILLED, AND I FOUND A DENTIST THAT COULD REPAIR MY 

DENTURES SO I COULD WEAR THEM. 

AS YOU CAN SEE, MY LIFE HAS NOT BEEN EASY, BUT MY STORY, SAD 

AS IT IS, THERE ARE THOUSANDS OF PEOPLE OUT THERE WITH STORIES 

JUST AS SAD AND TRAGIC AS MINE, PLUS THOUSANDS MORE THAT DO 

N0T KNOW ABOUT THIS STORY AT ALL. 

IN MY OPINION ALL OF THE ABOVE MEDICAL PROBLEMS ARE CAUSED 

BY THE CONTAMINATED WATER AT CAMP LEJEUNE. I FEEL THIS IS A 

VERY IMPORTANT STORY, ONE THAT SHOULD BE TOLD. WE NEED THE 

HELP FROM THE MEDIA TO BRING THIS STORY TO LIGHT. 

DURING THE 60’S AND 70’S OUR YOUNG SOLDIERS WERE FIGHTING A 

WAR IN VIETNAM AND LITTLE DID WE KNOW WHAT THE DEVISTATING 

EFFECTS AGENT ORANGE WOULD HAVE ON OUR YOUNG SOLDIERS AND 

THEIR FAMILIES. 

THE MARINES HAS A MOTTO: ‘‘WE TAKE CARE OF OUR OWN’’, IT SHOULD 

BE ‘‘MARINES KILLING MARINES’’. I HOPE YOU WILL CONSIDER HELPING 

US, WE SURE COULD USE IT. IT’S TIME THIS GOVERNMENT ‘‘TOOK CARE 

OF IT’S OWN’’. 

THERE IS A WEB SITE I HAVE REGISTERED ON. IT’S 

WWW.WATERSURVIVORS.COM WHEN YOU’VE LOST A LOVED, ESPECIALLY 

A CHILD, NO MATTER HOW MANY YEARS HAVE GONE BY YOU NEVER FORGET THEM. 

I’M SO THANKFUL FOR THE LOVED ONES IN MY LIFE, MY HUSBAND, MY 

SONS, BUT ESPECIALLY OUR 6 BEAUTIFUL GRANCHILDREN. IT GOES TO 

SHOW YOU THAT NO MATTER HOW MUCH TRAGEDY ENTERS YOUR LIFE, 

THERE IS ALWAYS A BRIGHT LIGHT AT THE END OF THE TUNNEL. 

THANK YOU, 

SINCERELY, 

CANDY LITTLE, 

DALTON, MA. 

October 8, 2009. 

Hon. DANIEL K. AKAKA, 

Chairman, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

Subject: Hearing on the VA/DOD Response to Certain Military Exposures 

DEAR MR. CHAIRMAN: We thank you for holding hearings regarding military exposures to hazardous agents. We understand the hearings focus on a few locations 

your Committee has concerns about regarding potential health hazards. We are providing very brief comments for your consideration and the record. We request that 

you pursue actions to mitigate health problems arising from hazardous exposures 

at US military bases. 

Marines and others who serve anticipate hazardous conditions will occur. While 

efforts should be made to minimize hazards, some activities are inherently dangerous and even lethal. We realize that knowledge of chemical hazards was neither 

as extensive nor widespread in past decades. But the degree of hazard is clearly indicated by the 130 current and former military bases that are federally-designated 

Superfund sites (Attachment 1). This designation requires extensive proof of hazardous chemical contamination. Carcinogenic, neurotoxic, and mutagenic chemicals 

were used during military duties (e.g., jet fuels and other fuels, degreasing solvents) 

without personal protective gear. Burn pits and other operations created additional 

toxic airborne chemicals, and often the soil, dust, and water on bases were contaminated. The burden of exposure and disease is only now being fully realized. 

El Toro is one of many bases operated to serve US defense needs, manned by people who put their lives on the line to protect and defend our citizens. The prevalence 

of hazards on bases is illustrated by the example shown in Attachment 2. Many veterans have difficulty locating information on chemicals that they were exposed to, 

if they know that the information exits. Medical evaluations of their exposures and 

illnesses that may result in a Nexus statement are very expensive. Yet this is required to receive essential medical care and disability support. This process is indefensible given the substantial medical science available to the VA on chemical hazards. 

346 

While we welcome an opportunity to provide additional information, for the sake 

of brevity we request that your Committee carefully consider and prompt the VA 

to take the following actions essential to preserving the health of Veterans: 

• Disclosure hazardous agents used on military bases, with information on potential health effects of the agents 

• For those highly exposed to hazardous agents, provision of medical monitoring 

and access to tests for early diagnosis of diseases related to hazardous agents 

• Medical care and disability for those with medical conditions related to their 

military service 

Valuing the service provided by Veterans requires the VA and DOD’s participation in basic public health outreach and services. This will provide the Veterans the 

best opportunity for good health, improve the economic viability of their families, 

and it is fundamentally the right and just thing to do. We are submitting these comments as Marines, family members of Marines, and health professionals working 

with Marines who served at the El Toro Marine Base in Irvine California. 

Respectfully submitted by the following individuals, 

ROBERT O’DOWD, 

Somerdale, NJ, Marine Veteran, 

Former Financial Manager, Defense 

Logistics Agency 

JAMES DAVIS, 

Garden Grove, CA, Founder and 

President of Veterans for Change, Son 

of Marine 

MARY DAVIS, 

Garden Grove, CA, Former Judge 

Advocate General (JAG) employee, 

Wife of Marine 

TIM KING, 

Salem, OR, Marine Veteran, Journalist 

BONNIE KING, 

Salem, OR, Wife of Marine Veteran, 

Journalist 

JOHNNY P. BARRON, 

Desoto, TX, Marine Veteran, Sr. 

Systems Programmer 

DR. KATHLEEN BURNS, 

Lexington, MA, Director, Sciencecorps 

DR. PHILIP LEVEQUE, 

Forensic Toxicologist, Molalla, OR 

DR. MICHAEL HARBUT, 

Chief, Center for Occupational and 

Environmental Medicine, Royal Oak, 

MI, Chair, Science Committee, 

Michigan Agent Orange Commission, 

1987–1988’’ 

DR. DANIEL TEITELBAUM, 

Denver, CO, Adjunct Professor, 

Colorado School of Public Health & 

University of Colorado at Denver 

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Jacksonville, NC, October 8, 2009. 

Hon. DANIEL K. AKAKA, 

Chairman, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN, RANKING MEMBER BURR, AND OTHER MEMBERS OF THE SENATE VETERANS’ AFFAIRS COMMITTEE: Thank you for taking the time to read my 

statement for the record regarding the toxic exposure at NAF Atsugi, Japan. 

We cannot undo the fact that for nearly 18 years, roughly 3,000 families, every 

year, lived on NAF Atsugi Japan and was exposed to hundreds of toxic chemicals, 

including dioxin, volatile organic and inorganic chemicals, lead, benzene, mercury, 

cadmium, arsenic, trichloroethylene (TCE) Polychlorinated Biphenyls (PCBs), and 

other lethal toxins that exceeded Maximum Contaminant Levels (MCL), but we can 

support our Military Veterans’, their families and provide them adequate health 

care and benefits. 

For all that is human and right, please STOP allowing the Department of Navy 

(DON) to investigate itself. After the incinerator was shut down in 2001, the Navy 

did not take any action to notify personnel, provide information to US Department 

of Veterans Affairs (VA) or assist with health concerns until 2007, when former residents starting questioning their exposure at NAF Atsugi, Japan. 

After my husband was diagnosed with Renal cell carcinoma (RCC): kidney cancer, 

in his early 40’s, I started questioning Navy Medicine about the chemicals we were 

exposed to at NAF Atsugi, Japan, almost a decade earlier. 

On 14 February 2007, the Navy and Marine Corps Public Health Center 

(NMPCHC) sent a team from Portsmouth, VA to Camp Lejeune, NC to meet with 

my husband and I. The members of this team included Captain Gillooly, Verona 

Walker, CDR Mohon, and Mary Ann Simmons. Capt. Gillooly and Ms. Walker 

worked on the Atsugi contamination issues and had a wealth of knowledge regarding the toxic exposure. 

The DON continues to minimize the specifics surrounding this issue, another example, and I can give many, of this is the fact that the 2008 NAF Atsugi Health 

study eliminated the Central nervous system, liver and kidney damage in their report. This is because the NMCPHC concluded that the available literature was felt 

to be inadequate regarding the low levels reported in the Final Health Assessment 

in 2002. 

However, let met point our specific facts, the Standard Form (SF) 600 that Navy 

Medicine added to our medical records in late 1997 stated we were exposed to 12 

toxic chemicals that exceeded USEPA and New York State ambient air quality 

standards. I have provided some of the toxicological profiles as determined by the 

Agency for Toxic Substances and Disease Registry (ATSDR) ToxFAQsTM for your 

reference for a few of those chemicals: 

• Carbon Tetrachloride: High exposure to carbon tetrachloride can cause liver, 

kidney, and central nervous system damage. 

• Mercury: Exposure to high levels of metallic, inorganic, or organic mercury can 

permanently damage the brain, kidneys, and developing fetus. 

• Trichloroethylene (TCE): Breathing large amounts of trichloroethylene may 

cause impaired heart function, unconsciousness, and death. Breathing it for long periods may cause nerve, kidney, and liver damage. 

• Cadmium: Long-term exposure to lower levels of cadmium in air, food, or water 

leads to a buildup of cadmium in the kidneys and possible kidney disease. 

• Dioxin: (VA provides benefits for those exposed to Agent Orange) Dioxins are 

believed to affect the growth regulation of cells. It can cause transient mild liver 

damage (hepatotoxicity), Peripheral nerve damage (neuropathy), Respiratory cancers, Multiple myeloma (malignant tumor of the bone marrow), Prostate cancer, 

Porphyria cutanea tarda (liver dysfunction and photosensitive skin lesions), Type 2 

diabetes, Neurobehavioral development effects in infants. 

As you can see, from the data, it was documented in past studies that former NAF 

Atsugi residents were being exposed to high levels of toxic chemicals that have been 

categorized by ASTDR to specifically damage our central nervous system, kidneys 

and liver. 

Why did the NMCPHC removed these illnesses from the study? The only answer 

could be to continue to cover up how ill former Atsugi resident truly are with toxic 

related diseases and cancers. 

Additionally, the Agency for Healthcare Research and Quality has determined 

that there are no screening recommendations for kidney or liver disease. For the 

NMCPHC not to recommend these tests along with the U.S. Preventative Services 

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Task Force guidelines for routine preventive care is a grave mistake and potentially 

life threatening for to many former Atsugi residents! 

The Committee of Toxicology (COT) stated in the Review of the US Navy’s Human 

Health Risk Assessment of the Naval Air Facility at Atsugi, Japan (2001) that there 

was, ‘‘The issue of plume-warning properties has not been addressed. Many contaminant concentrations are higher indoors than outdoors’’ (but the NAVY told us to go 

inside when the plum covered the base). 

One step that was provided by the NEHC was to have our children wash their 

hands after being outside, however the COT states, ‘‘Washing of hands, forearms, 

face, tools, toys, and so on, after outdoor activities that result in direct contact with 

soil or dust is good advice and practice, but risk reduction by such measures has 

not been determined (Pioneer 2000; p. 93).’’ 

The COT also recommended that NEHC use both approaches, to (surveillance) especially where data are already available. Surveillance can be either active or passive. However no health surveillance was performed by the DON. 

In 2008, the NMPCH contract Battelle Memorial Institute to see if an additional 

population-based medical screening might be indicated. 

The NMPCHC has a public Web site about NAF Atsugi, posted in 2007, available 

for former Atsugi residents with some study information, however, the Web site has 

not been widely publicized and many former Atsugi residents does not know of its 

existence. 

Battelle recommended that children who were under 16 Respiratory Heath screening. The NMCPHC stated that NAF Atsugi children were compared to those living 

at Yokosuka failed to show any difference, so retesting any children who were under 

the age of 16 while living at NAF Atsugi was unnecessary. (The study states that 

untrained people were used to administer the test to the children and it appeared 

that some of the children were encouraged to blow harder.) 

Battelle recommended for a Neuro-Behavioral outreach program from effects of 

lead exposure; The NMCPHC stated that there was a lead screening program in 

place at NAF Atsugi for much of the time that the SIC was in operation and that 

only 2 children had elevated lead levels out of 650 test from 1993–2001, therefore 

no additional counseling is required. (Even though, during a meeting with 

NMCPHC health officials, on 14 February 2007 while discussion as to why all children’s lead levels were not tested as there was significant evidence to warrant testing for all children, CDR Mohon stated that it was determined that most the residential population utilized for the elevated blood test were children who lived at 

Navy Support Facility (NSF) Kamiseya. 

Another recommendation was to evaluation of Current NAF Atsugi Soil Contamination. Soil sampling was conducted and heavy metals and dioxin levels were confirm to still be present in NAF Atsugi, Japan soil. Is NAF Atsugi still a health risk 

to residents? 

Although I did petition for ATSDR to provide further studies on NAF Atsugi, 

Japan, the petition was denied. It was deemed not necessary as the DON has already concluded by 1995, ‘‘that there was sufficient and compelling evidence showing that VOC, PBCs, Pesticides, PAHs, dioxins and furans, particulars and heavy 

metals were released to the air at levels that exceeded EPA health risk based guidelines while the incinerator was in operation s from 1983–2001. 

In June 2009 the NMCPHC published a long-term health effect that might be associated with the exposure of the SIC. The study admittedly has several faults or 

bias, which are as follows: 

• Misclassification of Exposure, 

• Occupational differences, 

• Case identification (Clinical classification of disease), 

• Overseas screening differences for respiratory illnesses, 

• Environmental awareness, 

• Selection of the comparison group, 

• The Loss of follow up and that medical data for all persons in the study were 

not consistently available. 

Even though they knew there were latency health risks, the NMCPHC did not 

produce an Atsugi registry until 2009. CDR McMillian, BUMED, has stated me that 

the data from the current NAF Atsugi Health Study will be used as registry. Unfortunately, the registry is inadequate data because of the lost of follow-up participates. The initial total active duty and family members included in the 2009 study 

for NAF Atsugi were 16804 people; however at the end of the study only 4504 people remained. This number also does not include more than half the people who 

were stationed at NAF Atsugi between 1983–2001, nor does it include civilian perVerDate Nov 24 2008 12:13 Nov 23, 2010 Jkt 000000 PO 00000 Frm 00358 Fmt 6601 Sfmt 6621 H:\111TH HEARINGS\53367.TXT SVETS PsN: PAULIN
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sonnel and their dependents, children who were conceived but not born at NAF 

Atsugi and the medical data was not available for the entire study. 

Additionally, former Atsugi resident have is the fact that the Selection of the comparison group was, Commander Fleet Activities Yokosuka, Japan (CFAY) because 

it shared the same environmental characteristics as Atsugi resident except for the 

exposure of the SIC. 

CFAY was not an appropriate selection because of the soil contamination which 

included high levels of mercury and arsenic in the underground soil, discovered in 

2001 within the residential area, where new high rises were being built. Additionally, in 1988 heavy metal contamination was discovered at Yokoula’s berth 12, 

which lead to the groundwater near berth 12 to have lead contamination that was 

250 times the Japan environmental quality standards in 1993–1994 timeframe. 

Although the NMCPHC study states that there are significantly higher risks for 

dermal complains among the NAF Atsugi population, and Atsugi residents had 

higher incidents of liver cancer diagnoses, but the differences were not statistically 

significant than CFAY residents. 

We also believe that the types of cancers and diagnosis codes allowed in the study 

were too vague, as it has been documented that Atsugi residents were exposed to 

over 200 toxic chemicals, to included Dioxin, which is already been recognized by 

the DVA for those exposed to agent orange. 

I have asked the DON, several times for a list of cancer types and the numbers 

associated with cancer, however, I was informed by per CDR McMillian via email 

on October 6, 2009, that all my questions and or request now have to be sent 

through the Surgeon General, VADM Adam Robinson. 

Why can the NMPHC not find cancer cases in the case study when I can find 59 

cases of cancer in roughly 750 former residents? This includes, but is not limited 

to 8 cases of Brain cancer, 7 cases of Cervical Cancer, 6 cases of Thyroid cancer, 

3 Leukemia and 3 Lymphoma. Other cases such as Kidney, Lung, Skin and Softtissue sarcoma’s which has been linked to dioxin. 

The Navy’s track record regarding the SIC emissions clearly demonstrates a gross 

lack of concern for the long-term health and welfare of US military personnel and 

their families. Would it not be financially feasible and cost effective to contact 

former residents and ask them what cancers and illnesses they are suffering from? 

Remember the DON has already spent over 18 million on this subject. It is an abuse 

of power and a waste of government funding to continue to allow the DON to investigate this complex and life threatening issue. 

There is no reason not to recognize well-established toxic links, illnesses and cancers to certain diseases that ASTDR has already documented, specifically the chemicals that exceeded MCLs at NAF Atsugi, Japan! 

How many chances does the NMPCH have to get it right? The NMCPHC are professionals who primary jobs are to spin and embellish the truth about chemicals exposures with the DON, and when the questions get tough, they cutoff all communication. They continue to make the same mistakes, as military dependents are at 

risk today as I type this statement. Dependents are being exposed to toxins at Naval 

Support Activity (NSA) Naples and the NMCPHC is busy with their usual efforts 

of ‘‘risk communication.’’ It is time that someone puts a stop to exposing military 

families to toxic waste! 

According to DOD 4165.63M, DOD Housing Management dated September 1993, 

‘‘The Installation Commanders Shall: (C1.4.6.1.) Provide excellent living conditions 

for all military personnel, eligible civilians, and their families and (C1.4.6.9) Protect 

members and their families from environmental and safety hazards in housing 

areas.’’ It is evident that the DON failed to adhere to this specific Department of 

Defense (DOD) Directive, as the DON had full knowledge that toxic chemicals, 

which exceeded MCL, were being release by the SIC and polluting the residential 

area, which was confirmed to adversely affect NAF Atsugi’s residents health and 

well-being, especially our children. 

Finally, the Navy stated in 1998 in a Q&A sheet that if resident felt they were 

sicken by the SIC, they should file a claim. The results of our claims are as follows: 

• The statue of limitations for timely filing of the claim was two years from the 

date of the incident and the claim was not received until almost a decade after the 

Parulis family left Atsugi. The lawsuit in 2000 and the purchase and closure of the 

facility in 2001 should have provided notice of the problems associated with the facility. The claim for injuries was not filed until 2008. 

• The discretionary function defense protects the United States for decisions that 

are not required or mandated by law, but rather involve some element of judgment. 

This means that the United States Navy cannot be liable for its actions in this instance. 

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I formally request that Navy to notify, mass media/mailing, all those stationed at 

NAF Atsugi, Japan from 83–01 and record what type of disease/cancers which have 

been associate with all and any chemicals that were recorded to be over the levels 

of Maximum Contaminant Level (MCL) for air, soil and drinking water that was 

documented at NAF Atsugi, Japan. This should be done in a timely manner and 

not prolonged or put off as the Navy wishes. 

Thank you for all your support in this matter, please contact me should you require further data. I have posted numerous DON studies and various supporting 

documentation at www.atsugi-incinerator-group.com 

Best Regards, 

SHELLY PARULIS, 

Jacksonville, NC. 

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