Defense Health Care: Issues Related to Past Drinking Water Contamination at Marine Corps Base Camp Lejeune
Published: 2007-06-12T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: In the early 1980s, volatile organic compounds (VOC) were discovered in some of the water systems serving housing areas on Marine Corps Base Camp Lejeune. Exposure to certain VOCs may cause adverse health effects, including cancer. Since 1991, the Department of Health and Human Services' Agency for Toxic Substances and Disease Registry (ATSDR) has been examining whether individuals who were exposed to the contaminated drinking water are likely to have adverse health effects. ATSDR's current study is examining whether individuals who were exposed in utero are more likely to have developed certain childhood cancers or birth defects. GAO was asked to testify on its May 11, 2007 report: Defense Health Care: Activities Related to Past Drinking Water Contamination at Marine Corps Base Camp Lejeune (GAO-07-276). This testimony summarizes findings from the report about (1) efforts to identify and address the past drinking water contamination, (2) the provision of funding and information from the Department of Defense (DOD) to ATSDR, and (3) an assessment of the design of the current ATSDR study. GAO reviewed documents, interviewed officials and former residents, and contracted with the National Academy of Sciences to convene an expert panel to assess the current ATSDR study.
section_title: What GAO Found
paragraphs: Efforts to identify and address the past drinking water contamination at Camp Lejeune began in the 1980s, when Navy water testing at Camp Lejeune detected VOCs in some base water systems. In 1982 and 1983, continued testing identified two VOCs--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. In 1984 and 1985 a Navy environmental program identified VOCs, such as TCE and PCE, in some of the individual wells serving the Hadnot Point and Tarawa Terrace water systems. Ten wells were subsequently removed from service. DOD and North Carolina officials concluded that on- and off-base sources were likely to have caused the contamination. It has not been determined when contamination at Hadnot Point began. ATSDR has estimated that well contamination at Tarawa Terrace from an off-base dry cleaner began as early as 1957. Since ATSDR began its Camp Lejeune-related work in 1991, the agency has not always received requested funding and has experienced delays in receiving information from DOD. However, ATSDR officials said that while funding and access to records were probably slowed down and made more expensive by DOD officials' actions, their actions did not significantly impede ATSDR's Camp Lejeune-related health study efforts. The ATSDR officials also stated that while issues such as limitations in access to DOD data had to be addressed, such situations are normal during the course of a study. Members of the expert panel that the National Academy of Sciences convened for GAO generally agreed that many parameters of ATSDR's current study are appropriate, including the study population, the exposure time frame, and the selected health effects. Regarding the study's proposed completion date of December 2007, the panel experts had mixed opinions: three of the five panel experts who commented said that the projected date appeared reasonable, while two said that the date might be optimistic. DOD, the Environmental Protection Agency, and the Department of Health and Human Services provided technical comments on a draft of the May 11, 2007 report, which GAO incorporated where appropriate. Three members of an ATSDR community assistance panel for Camp Lejeune provided oral comments on issues such as other VOCs that have been detected at Camp Lejeune, and compensation, health benefits, and additional notification for former residents. GAO focused its review on TCE and PCE because they were identified by ATSDR as the chemicals of primary concern. GAO's report notes that other VOCs were detected. GAO incorporated the panel members' comments where appropriate, but some issues were beyond the scope of the report.

section_title: Letter
paragraphs: I am pleased to be here today as you examine issues related to past  drinking water contamination at Camp Lejeune. In the early 1980s,  Department of the Navy water testing at Marine Corps Base Camp Lejeune  identified contamination in water systems that served housing areas on the  base. Further water testing revealed that some of the individual wells  serving two of the water systems were contaminated with volatile organic  compounds (VOC), such as trichloroethylene (TCE), which is a metal  degreaser and an ingredient in adhesives and paint removers, and  tetrachloroethylene (PCE), which is a solvent used in the textile industry  and a dry cleaning solvent. Although it is not known precisely when the  wells became contaminated, the Department of Health and Human  Services’ (HHS) Agency for Toxic Substances and Disease Registry  (ATSDR), which is investigating the issue, has estimated that the  contamination may have begun as early as the 1950s. According to ATSDR,  the VOCs of primary concern at Camp Lejeune were TCE and PCE, and  the agency notes that exposure to these chemicals may cause adverse  health effects. For example, exposure to low levels of TCE may cause  headaches and difficulty concentrating. Exposure to high levels of both  TCE and PCE may cause dizziness, headaches, nausea, unconsciousness,  cancer, and possibly death.
Former residents of Camp Lejeune have taken legal action against the  federal government for injuries alleged to have resulted from exposure to  the contaminated water. As of June 2007, about 850 former residents and  former employees of Camp Lejeune have filed tort claims with the  Department of the Navy related to the past drinking water contamination.  Two of these claims have resulted in the filing of lawsuits in Federal  District Courts in Texas and Mississippi. In addition, some former  residents have expressed concern over the Marine Corps’ handling of and  response to the drinking water contamination, noting that even though  contaminants were detected as early as 1980, the wells that were  determined to be contaminated were not removed from service until 1985.  Some former residents have also asserted that there have been delays in  the provision of funding and information from the Department of Defense  (DOD) to ATSDR.
My statement is based on our May 11, 2007 report, Defense Health Care:  Activities Related to Past Drinking Water Contamination at Marine  Corps Base Camp Lejeune (GAO-07-276). For this report, the Ronald W.  Reagan National Defense Authorization Act for Fiscal Year 2005 directed  that we study and report on the past drinking water contamination and  related adverse health effects at Camp Lejeune, including identifying the  type, source, and duration of the contamination and determining the  actions taken to address the contamination, and assessing the current  ATSDR health study. My remarks today will summarize our findings  related to the history of events related to drinking water contamination at  Camp Lejeune, specifically, (1) efforts to identify and address the past  contamination; (2) the provision of funding and information from DOD to  ATSDR for its work related to the past contamination at Camp Lejeune;  and (3) an assessment by an independent panel of experts of the design of  the current ATSDR health study, including the study’s population, the  exposure time frame, selected health effects being measured, and the  reasonableness of the projected completion date.
To do this work, we reviewed more than 1,600 documents related to past  and current drinking water activities at Camp Lejeune. We focused our  review on the past TCE and PCE contamination because ATSDR had  noted that these chemicals were the VOCs of primary concern at Camp  Lejeune. However, we also reviewed documentation regarding other VOCs  detected at Camp Lejeune. For this testimony we focused on  contamination in Camp Lejeune’s Hadnot Point, Tarawa Terrace, and  Holcomb Boulevard water systems, as they provided drinking water to  most of the installation’s housing areas during the period of interest. We  interviewed current and former officials from various DOD entities,  including Camp Lejeune, Headquarters Marine Corps, and the Department  of the Navy, to obtain information about the history of events related to  the past drinking water contamination at Camp Lejeune, including efforts  to identify and address the contamination. The current and former officials  interviewed often provided information based on their memory of events  that occurred more than 20 years ago. We attempted to corroborate their  testimonial evidence with documentation whenever possible. The former  officials we interviewed were responsible for environmental activities at  Camp Lejeune or the Department of the Navy during the time in which the  contamination was detected. The current officials we interviewed are  responsible for environmental activities at Camp Lejeune, Headquarters  Marine Corps, or the Department of the Navy. Some of these current  officials were also responsible for environmental activities during the time  in which the contamination was detected. We also met with 19 interested  former residents and individuals who worked on the base during the  1960s, 1970s, and 1980s, in order to obtain their perspective on historical  events and to learn about their concerns related to the drinking water  contamination. A former resident who is active in matters related to the  past drinking water contamination at Camp Lejeune identified most of the  interested former residents; others were identified at an ATSDR public  meeting. Additionally, we examined reports from and interviewed officials  with the Environmental Protection Agency (EPA) and with the North  Carolina Department of Environment and Natural Resources who were  knowledgeable about activities and costs related to the cleanup of the  suspected sources of contamination. We also interviewed ATSDR officials  and reviewed ATSDR’s Camp Lejeune-related documents and publications,  including a 1997 public health assessment and an ATSDR health study  released in 1998. We also interviewed officials with the Department of the  Navy and the U.S. Army Center for Health Promotion and Preventive  Medicine, which serves as a liaison between DOD and ATSDR. To assess  the design of the current ATSDR health study, we contracted with the  National Academy of Sciences (NAS) to convene a panel of seven subject  area experts for a 1-day meeting. The expert panel was charged with  evaluating the study’s population, exposure time frame, selected health  effects, and completion date. We relied primarily on information gleaned  from the expert panel meeting and the panel experts’ subsequent written  responses to the set of questions that were discussed during the 1-day  meeting. Not all panel members commented individually about each of the  questions discussed during the 1-day meeting. Additionally, some panel  members noted that certain questions addressed subjects that were  outside their areas of expertise. We also reviewed study-related  documentation furnished by officials from ATSDR, the Marine Corps, and  the Navy Environmental Health Center, and interviewed officials from  those agencies. We conducted our work from May 2005 through April 2007  in accordance with generally accepted government auditing standards.
In summary, we found that efforts to identify and address past drinking  water contamination at Camp Lejeune began in the 1980s, when the Navy  initiated water testing, and are continuing with long-term cleanup and  monitoring. In 1980, VOCs, including TCE, were first detected at Camp  Lejeune during an analysis by a Navy-contracted laboratory that combined  treated water from all base water systems. During the same year, the Navy  began monitoring Camp Lejeune’s treated water for total trihalomethanes  (TTHMs), contaminants that are a by-product of the water treatment  process. The TTHM monitoring indicated interference from unidentified  chemicals. In 1982 and 1983, continued TTHM monitoring identified TCE  and another VOC, PCE, as contaminants in two separate water systems  that served base housing areas, Hadnot Point and Tarawa Terrace.  Sampling results indicated that the levels of TCE and PCE found in the  water systems varied. Former Camp Lejeune environmental officials said  that they did not take additional steps to address the contamination after  TCE and PCE were identified. The former officials recalled that they did  not act because at that time they had little knowledge about TCE and PCE,  there were no drinking water regulations that gave enforceable limits for  these chemicals, and variation in water testing results raised questions  about the tests’ validity. Also in 1982, a Navy environmental program  began investigating potentially contaminated sites at many Marine Corps  and Navy bases, including Camp Lejeune. Testing initiated under that  program in 1984 and 1985 found that individual wells in the Hadnot Point  and Tarawa Terrace water systems were contaminated with TCE, PCE,  and other VOCs. Camp Lejeune officials removed 10 contaminated wells  from service in 1984 and 1985. Camp Lejeune officials determined that  several areas on base where hazardous waste and other materials were  disposed of may have been the sources of contamination for the Hadnot  Point water system, and North Carolina environmental officials  determined that an off-base dry cleaner was the likely source of  contamination for the Tarawa Terrace water system. Efforts are ongoing  by ATSDR to determine when contamination at Hadnot Point began. In  2006, ATSDR estimated that well contamination from the off-base dry  cleaner began as early as 1957. In 1989, both Camp Lejeune and the off- base dry cleaner were placed on EPA’s National Priorities List.
Regarding the provision of funding and information from DOD to ATSDR  for its work related to the past contamination at Camp Lejeune, we found  that since ATSDR began its Camp Lejeune-related work in 1991, the  agency has not always received requested DOD funding and experienced  delays in receiving information from DOD. For example, for 3 of the 16  fiscal years during which ATSDR has conducted its Camp Lejeune-related  work (fiscal years 1998 through 2000), no funding was provided to ATSDR  by the Navy or any DOD entity. ATSDR also had difficulties getting  documents needed from Camp Lejeune while it was conducting a public  health assessment for the base. However, ATSDR officials said that while  funding and access to records were probably slowed down and their Camp  Lejeune related work made more expensive by DOD officials’ actions,  their actions did not significantly impede ATSDR’s Camp Lejeune-related  health study efforts. The ATSDR officials also stated that while issues such  as limitations in access to DOD data had to be addressed, such situations  are normal during the course of a study.
The experts convened by NAS to assess the design of the current ATSDR  health study generally agreed that many parameters of ATSDR’s current  study are appropriate. Regarding the study population, all seven panel  experts agreed that ATSDR’s study population of individuals who were  potentially exposed in utero to the contaminated drinking water at Camp  Lejeune between 1968 and 1985 was appropriate, as this population was  arguably the most vulnerable to the effects of the contamination. Panel  experts generally agreed that the 1968-1985 study time frame was  reasonable, based on limitations in data availability for the years prior to  1968. Regarding the health effects studied, five of the seven panel experts  discussed health effects and said that the selected birth defects and  childhood cancers were relevant. Regarding the proposed completion  date, the panel experts had mixed opinions: three of the five panel experts  who commented said that the projected December 2007 date appeared  reasonable, while two said that the date might be optimistic.
DOD, EPA, and HHS provided technical comments on a draft of the   May 11, 2007 report, which we incorporated where appropriate. We  provided the seven former Camp Lejeune residents who are members of  an ATSDR community assistance panel for Camp Lejeune the opportunity  to provide comments on our draft—three of the panel members provided  both technical and general oral comments, and four declined to review the  draft report. The three panel members commented generally on issues  such as VOCs other than TCE and PCE that have been detected at Camp  Lejeune, compensation and health benefits for former residents, and  additional notification for former residents. We incorporated the panel  members’ technical comments where appropriate, but some issues they  discussed were beyond the scope of the report.
subsections: section_title: Background
paragraphs: Drinking water can come from either groundwater sources, via wells, or  from surface water sources, such as rivers, lakes, and streams. All sources  of drinking water contain some naturally occurring contaminants. As  water flows in streams, sits in lakes, and filters thorough layers of soil and  rock in the ground, it dissolves or absorbs the substances that it touches.  Some of these contaminants are harmless, but others can pose a threat to  drinking water, such as improperly disposed-of chemicals, pesticides, and  certain naturally occurring substances. Likewise, drinking water that is not  properly treated or disinfected, or which travels through an improperly  maintained water system, may pose a health risk. However, the presence  of contaminants does not necessarily indicate that water poses a health  risk—all drinking water may reasonably be expected to contain at least  small amounts of some contaminants. As of July 2006, EPA had set  standards for approximately 90 contaminants in drinking water that may  pose a risk to human health. According to EPA, water that contains small  amounts of these contaminants, as long as they are below EPA’s  standards, is safe to drink. However, EPA notes that people with severely  compromised immune systems and children may be more vulnerable to  contaminants in drinking water than the general population.
subsections: section_title: General Information about Camp Lejeune and Its Water Systems
paragraphs: Camp Lejeune covers approximately 233 square miles in Onslow County,  North Carolina, and includes training schools for infantry, engineers,  service support, and medical support, as well as a Naval Hospital and  Naval Dental Center. The base has nine family housing areas, and families  live in base housing for an average of 2 years. Base housing at Camp  Lejeune consists of enlisted family housing, officer family housing, and  bachelor housing (barracks for unmarried service personnel).  Additionally, schools, day care centers, and administrative offices are  located on the base. Approximately 54,000 people currently live and work  at Camp Lejeune, including about 43,000 active duty personnel and 11,000  military dependents and civilian employees.
In the 1980s, Camp Lejeune obtained its drinking water from as many as  eight water systems, which were fed by more than 100 individual wells  that pumped water from a freshwater aquifer located approximately 180  feet below the ground. Each of Camp Lejeune’s water systems included  wells, a water treatment plant, reservoirs, elevated storage tanks, and  distribution lines to provide the treated water to the systems’ respective  service areas. Drinking water at Camp Lejeune has been created by  combining and treating groundwater from multiple individual wells that  are rotated on and off, so that not all wells are providing water to the  system at any given time. Water is treated in order to remove minerals and  particles and to protect against microbial contamination. (See fig. 1 for a  description of how a Camp Lejeune water system operates.)
From the 1970s through 1987, Hadnot Point, Tarawa Terrace, and  Holcomb Boulevard water systems provided drinking water to most of  Camp Lejeune’s housing areas. The water treatment plants for the Hadnot  Point and Tarawa Terrace water systems were constructed during the  1940s and 1950s. The water treatment plant for the Holcomb Boulevard  water system began operating at Camp Lejeune in 1972; prior to this time,  the Hadnot Point water system provided water to the Holcomb Boulevard  service area. In the 1980s, each of these three systems had between 8 and  35 wells that could provide water to their respective service areas. In 1987  the Tarawa Terrace water treatment plant was shut down and the  Holcomb Boulevard water distribution system was expanded to include  the Tarawa Terrace water service area.
Generally, housing units served by the Tarawa Terrace and Holcomb  Boulevard water systems consisted of family housing, which included  single- and multifamily homes and housing in trailer parks. Housing units  served by the Hadnot Point water system included mainly bachelor  housing with limited family housing. Based on available housing data for  the late 1970s and the 1980s, the estimated annual averages of the number  of people living in family housing units served by these water systems at  that time were:    5,814 people in units served by the Tarawa Terrace water system,    6,347 people in units served by the Holcomb Boulevard water system, and    71 people in units served by the Hadnot Point water system.
In addition to serving housing units, all three water systems provided  water to base administrative offices. The Tarawa Terrace, Holcomb  Boulevard, and Hadnot Point water systems also served schools and other  recreational areas. Additionally, the Hadnot Point water system also  served an industrial area and the base hospital.
section_title: Department of the Navy Environmental Functions
paragraphs: Certain Navy entities provide support functions for Marine Corps bases  such as Camp Lejeune. Two entities provide support for environmental  issues:    The Naval Facilities Engineering Command began providing  environmental support for bases in the 1970s. The Naval Facilities  Engineering Command, Atlantic Division (LANTDIV) provides  environmental support for Navy and Marine Corps bases in the Atlantic  and mid-Atlantic regions of the United States. For example, LANTDIV  officials work with Camp Lejeune officials to establish environmental  cleanup priorities and cost estimates and to allocate funding to ensure  compliance with state and federal environmental regulations.
The Navy Environmental Health Center (NEHC) has provided  environmental and public health consultation services for Navy and  Marine Corps environmental cleanup sites since 1991. NEHC is also  designated as the technical liaison between Navy and Marine Corps  installations and ATSDR and, as a part of this responsibility, reviews and  comments on all ATSDR reports written for Navy and Marine Corps sites  prior to publication. Prior to 1991, no agency was designated to provide  public health consultation services for Navy and Marine Corps sites.
In 1980, the Department of the Navy established the Navy Assessment and  Control of Installation Pollutants (NACIP) program to identify, assess, and  control environmental contamination from past hazardous material  storage, transfer, processing, and disposal operations. Under the NACIP  program, initial assessment studies were conducted to determine the  potential for environmental contamination at Navy and Marines Corps  bases. If, as a result of the study, contamination was suspected, a follow- up confirmation study and corrective measures were initiated. In 1986 the  Navy replaced its NACIP program with the Installation Restoration  Program. The purpose of the Installation Restoration Program is to reduce,  in a cost-effective manner, the risk to human health and the environment  from past waste disposal operations and hazardous material spills at Navy  and Marine Corps bases. Cleanup is done in partnership with EPA, state  regulatory agencies, and members of the community.
section_title: Environmental Laws and Regulations Related to Drinking Water Contamination and Hazardous Waste Contamination at Camp Lejeune
paragraphs: Congress passed the Safe Drinking Water Act in 1974 to protect the  public’s health by regulating the nation’s public drinking water supply. The  Safe Drinking Water Act, as amended, is the key federal law protecting  public water supplies from harmful contaminants. For example, the act  requires that all public water systems conduct routine tests of treated  water to ensure that the water is safe to drink. Required water testing  frequencies vary and range from weekly testing for some contaminants to  testing every 3 years for other contaminants. The act also established a  federal-state arrangement in which states may be delegated primary  implementation and enforcement authority for the drinking water  program. For contaminants that are known or anticipated to occur in  public water systems and that EPA determines may have an adverse  impact on health, the act requires EPA to set a nonenforceable maximum  contaminant level goal, at which no known or anticipated adverse health  effects occur and that allows an adequate margin of safety. Once the  maximum contaminant level goal is established, EPA sets an enforceable  standard for water as it leaves the treatment plant, the maximum  contaminant level. A maximum contaminant level is the maximum  permissible level of a contaminant in water delivered to any user of a  public water system. The maximum contaminant level must be set as close  to the goal as is feasible using the best technology or other means  available, taking costs into consideration. The North Carolina Department  of Environment and Natural Resources and its predecessors have had  primary responsibility for implementation of the Safe Drinking Water Act  in North Carolina since 1980.
In 1979, EPA promulgated final regulations applicable to certain  community water systems establishing the maximum contaminant levels  for the control of TTHMs, which are a type of VOC that are formed when  disinfectants—used to control disease-causing contaminants in drinking  water—react with naturally occurring organic matter in water. The  regulations required that water systems that served more than 10,000  people and that added a disinfectant as part of the drinking water  treatment process begin mandatory water testing for TTHMs by November  1982 and comply with the maximum contaminant level by November 1983.  TCE and PCE were not among the contaminants included in these  regulations.
In 1979 and 1980, EPA issued nonenforceable guidance establishing  “suggested no adverse response levels” for TCE and PCE in drinking water  and in 1980 issued “suggested action guidance” for PCE in drinking  water. Suggested no adverse response levels provided EPA’s estimate of  the short- and long-term exposure to TCE and PCE in drinking water for  which no adverse response would be observed and described the known  information about possible health risks for these chemicals. Suggested  action guidance recommended remedial actions within certain time  periods when concentrations of contaminants exceeded specific levels.  Suggested action guidance was issued for PCE related to drinking water  contamination from coated asbestos-cement pipes, which were used in  water distribution lines.
The initial regulation of TCE and PCE under the Safe Drinking Water Act  began in 1989 and 1992, respectively, when maximum contaminant levels  became effective for these contaminants. (See table 1 for the suggested no  adverse response levels, suggested action guidance, and maximum  contaminant level regulations for TCE and PCE.)
The Comprehensive Environmental Response, Compensation, and  Liability Act (CERCLA) of 1980 established what is known as the  Superfund program to clean up highly contaminated waste sites and  address the threats that these sites pose to human health and the  environment, and assigned responsibility to EPA for administering the  program. CERCLA was amended by the Superfund Amendments and  Reauthorization Act (SARA) of 1986. Among other things, SARA requires  that federal agencies, including DOD, that own or operate facilities on  EPA’s CERCLA list of seriously contaminated sites, known as the National  Priorities List, enter into an interagency agreement with EPA. The  agreement is to specify what cleanup activities, if any, are required and to  set priorities for carrying out those activities. SARA also established the  Defense Environmental Restoration Program, through which DOD  conducts environmental cleanup activities at military installations. Under  the environmental restoration program, DOD’s activities addressing  hazardous substances, pollutants, or contaminants are required to be  carried out consistent with the provisions of CERCLA governing  environmental cleanups at federal facilities. Based on environmental  contamination at various areas on the base, Camp Lejeune was designated  as a National Priorities List site in 1989. EPA, the Department of the Navy,  and the state of North Carolina entered into a Federal Facilities Agreement  concerning cleanup of Camp Lejeune with an effective date of March 1,  1991.
section_title: ATSDR’s Assessment of the Adverse Health Effects of Hazardous Substances at DOD Superfund Sites
paragraphs: ATSDR was created by CERCLA and established within the Public Health  Service of HHS in April 1983 to carry out Superfund’s health-related  activities. These activities include conducting health studies, laboratory  projects, and chemical testing to determine relationships between  exposure to toxic substances and illness. In 1986, SARA expanded  ATSDR’s responsibilities to include, among other things, conducting  public health assessments, toxicological databases, information  dissemination, and medical education. SARA requires that ATSDR conduct  a public health assessment at each site proposed for or on the National  Priorities List, and that ATSDR conduct additional follow-up health studies  if needed. Potentially responsible parties, including federal agencies, are  liable for the costs of any health assessment or health effects study carried  out by ATSDR.
SARA requires that ATSDR and DOD enter into a memorandum of  understanding to set forth the authorities, responsibilities, and procedures  between DOD and ATSDR for conducting public health activities at DOD  Superfund sites. Based on the memorandum of understanding signed  between ATSDR and DOD, ATSDR is required to submit an annual plan of  work to DOD, in which it must describe the public health activities it plans  to conduct at DOD sites in the following fiscal year, as well as the amount  of funding required to conduct these activities. After the annual plan of  work has been submitted, DOD has 45 days to respond and negotiate the  scope of work to be conducted by ATSDR. The memorandum of  understanding states that DOD must seek sufficient funding through the  DOD budgetary process to carry out the work agreed upon.
From 1991 to 1997, ATSDR conducted a public health assessment at Camp  Lejeune that was required by law because of the base’s listing on the  National Priorities List. The health assessment evaluated several ways in  which people on base had been exposed to hazardous substances,  including exposure to the VOC-contaminated drinking water. In its 1997  report, ATSDR recommended that a study be carried out to evaluate the  risks of childhood cancer in those who were exposed in utero to the  contaminated drinking water and also noted that adverse pregnancy  outcomes were of concern. In 1995, while the health assessment was being  conducted, ATSDR initiated a study to determine whether there was an  association between exposure to VOCs in drinking water and specific  adverse pregnancy outcomes among women who had lived at Camp  Lejeune from 1968 through 1985. The study, released in 1998, originally  concluded that there was a statistically significant elevated risk for several  poor pregnancy outcomes, including (1) small for gestational age among  male infants born to mothers living at Hadnot Point, (2) small for  gestational age for infants born to mothers over 35 years old living at  Tarawa Terrace, and (3) small for gestational age for infants born to  mothers with two or more prior fetal losses living at Tarawa Terrace.  However, ATSDR officials said they are reanalyzing the findings of this  study because of an error in the original assessment of exposure to VOCs  in drinking water. While the study originally assessed births from 1968 to  1972 in the Holcomb Boulevard service area as being unexposed to VOCs,  these births were exposed to contaminants from the Hadnot Point water  system. An ATSDR official said the reanalysis may alter the study’s results.
In 1999, ATSDR initiated its current study examining whether certain birth  defects and childhood cancers are associated with exposure to TCE or  PCE at Camp Lejeune. The study examines whether individuals born  during 1968 through 1985 to mothers who were exposed to the  contaminated drinking water at any time while they were pregnant and  living at Camp Lejeune were more likely than those who were not exposed  to have neural tube defects, oral cleft defects, or childhood hematopoietic  cancers. The current study began with a survey to identify potential cases  of the selected birth defects and childhood cancers. The study is also using  water modeling to help ATSDR determine the potential sources of past  contamination and estimate when the water became contaminated and  which housing units received the contaminated water. The water modeling  data will help ATSDR identify which pregnant women may have been  exposed to the contaminated water, and will also help ATSDR estimate the  amount of TCE and PCE that may have been in the drinking water. ATSDR  officials said that the study is expected to be completed by December  2007.
section_title: Possible Adverse Health Effects of TCE and PCE
paragraphs: According to ATSDR’s Toxicological Profile, inhaling small amounts of  TCE may cause headaches, lung irritation, poor coordination, and  difficulty concentrating, and inhaling or drinking liquids containing high  levels of TCE may cause nervous system effects, liver and lung damage,  abnormal heartbeat, coma, or possibly death. ATSDR also notes that  some animal studies suggest that high levels of TCE may cause liver,  kidney, or lung cancer, and some studies of people exposed over long  periods to high levels of TCE in drinking water or workplace air have  shown an increased risk of cancer. ATSDR’s Toxicological Profile notes  that the National Toxicology Program has determined that TCE is  reasonably anticipated to be a human carcinogen and the International  Agency for Research on Cancer has determined that TCE is probably  carcinogenic to humans. Unlike TCE, the health effects of inhaling or  drinking liquids containing low levels of PCE are unknown, according to  ATSDR. However, ATSDR reports that exposure to very high  concentrations of PCE may cause dizziness, headaches, sleepiness,  confusion, nausea, difficulty in speaking and walking, unconsciousness, or  death. HHS has determined that PCE may reasonably be anticipated to be  a carcinogen.
section_title: Efforts to Identify and Address Past Drinking Water Contamination at Camp Lejeune Began in the 1980s and Continue with Long-term Cleanup and Monitoring
paragraphs: Efforts to identify and address past drinking water contamination at Camp  Lejeune began in the 1980s, when the Navy initiated water testing at Camp  Lejeune. In 1980, one water test identified the presence of VOCs and a  separate test indicated contamination by unidentified chemicals. In 1982  and 1983, water monitoring for TTHMs by a laboratory contracted by  Camp Lejeune led to the identification of TCE and PCE as the  contaminants in two water systems at Camp Lejeune. Sampling results  indicated that the levels of TCE and PCE varied. Former Camp Lejeune  environmental officials said they did not take additional steps to address  the contamination after TCE and PCE were identified. The former officials  recalled that they did not take additional steps because at that time they  had little knowledge of TCE and PCE, there were no regulations  establishing enforceable limits for these chemicals in drinking water, and  variations in water testing results raised questions about the tests’ validity.  In 1984 and 1985, the NACIP program identified VOCs, including TCE and  PCE, in 12 of the wells serving the Hadnot Point and Tarawa Terrace water  systems. Camp Lejeune officials removed 10 wells from service in 1984  and 1985. Additionally, information about the contamination was provided  to residents. Upon investigating the contamination, DOD and North  Carolina officials concluded that both on- and off-base sources were likely  to have caused the contamination in the Hadnot Point and Tarawa Terrace  water systems. Since 1989, federal, state, and Camp Lejeune officials have  partnered to take actions to clean up the sources of contamination and to  monitor and protect the base’s drinking water.
subsections: section_title: Navy Water Testing Beginning in 1980 Identified VOCs in Camp Lejeune Water Systems
paragraphs: The presence of VOCs in Camp Lejeune water systems was first detected  in October 1980. On October 1, 1980, samples of water were collected from  all eight water systems at Camp Lejeune by an official from LANTDIV, a  Navy entity that provided environmental support to Camp Lejeune. The  water samples were combined into a single sample, and a “priority  pollutant scan” was conducted in order to detect possible contaminants in  the water systems. The results of this analysis, conducted by a Navy- contracted private laboratory and sent to LANTDIV, identified 11 VOCs,  including TCE, at their detection limits, that is, the lowest level at which  the chemicals could be reliably identified by the instruments being used.
Separately, in 1980 the Navy began monitoring programs for TTHMs at  various Navy and Marine Corps bases, including Camp Lejeune, in  preparation for meeting a future EPA drinking water regulation.  LANTDIV arranged for an Army laboratory to begin testing the treated  water from two Camp Lejeune water systems, Hadnot Point and New  River, in October 1980. At that time, these two water systems were the  only ones that served more than 10,000 people and therefore would be  required to meet the future TTHM regulation. From October 1980 to  September 1981, eight samples were collected from the Hadnot Point  water system and analyzed for TTHMs. Results from four of the eight  samples indicated the presence of unidentified chemicals that were  interfering with the TTHM analyses. Reports for each of the four analyses  contained an Army laboratory official’s handwritten notes about the  unidentified chemicals: two of the notes classified the water as “highly  contaminated” and notes for the other two analyses recommended  analyzing the water for organic compounds.
The exact date when LANTDIV officials began receiving results from  TTHM testing is not known, and LANTDIV officials told us that they had  no recollection of how or when the results were communicated from the  Army laboratory. Available Marine Corps documents indicate that Camp  Lejeune environmental officials learned in July 1981 that LANTDIV had  been receiving the results of TTHM testing and was holding the results  until all planned testing was complete. Subsequently, Camp Lejeune  environmental officials requested copies of the TTHM results that  LANTDIV had received to date, and LANTDIV provided these results in  August 1981. The next documented correspondence from LANTDIV to  Camp Lejeune regarding TTHM monitoring occurred in a February 1982  memorandum in which LANTDIV recommended that TTHM monitoring be  expanded to all of Camp Lejeune’s water systems and noted that Camp  Lejeune should contract with a North Carolina state-certified laboratory  for the testing. Current and former LANTDIV officials recalled that their  agency played a limited role in providing information or guidance  regarding environmental issues at Camp Lejeune, and that this assistance  generally would have been at the request of Camp Lejeune officials.  However, former Camp Lejeune environmental officials recalled that at  that time they had little experience in water quality issues and relied on  LANTDIV to serve as their environmental experts.
section_title: Further Tests Identified TCE and PCE in Two Camp Lejeune Water Systems in 1982 and 1983; Camp Lejeune Officials Do Not Recall Taking Action to Address the Contamination at That Time
paragraphs: Following LANTDIV’s recommendation to expand TTHM monitoring to all  base water systems, Camp Lejeune officials contracted with a private  state-certified laboratory to test samples of treated water from all eight of  their water systems. According to an August 1982 memorandum, in May  1982 a Camp Lejeune official was informed during a telephone  conversation with a private laboratory official that organic cleaning  solvents, including TCE, were present in the water samples for TTHM  monitoring from the Hadnot Point and Tarawa Terrace water systems. In  July 1982, additional water samples from the two systems were collected  in an effort to investigate the presence of these chemicals. In August 1982  the contracted laboratory sent a letter to base officials informing them that  TCE and PCE were identified as the contaminants in the May and July  samples. According to the letter, the testing determined that the Hadnot  Point water system was contaminated with both TCE and PCE and the  Tarawa Terrace water system was contaminated with PCE. The letter also  noted that TCE and PCE “appeared to be at high levels” and were “more  important from a health standpoint” than the TTHM monitoring. Sampling  results indicated that the levels of TCE and PCE varied. The letter noted  that one sample taken in May 1982 from the Hadnot Point water system  contained TCE at 1,400 parts per billion and two samples taken in July  1982 contained TCE at 19 and 21 parts per billion. Four samples taken in  May 1982 and July 1982 from the Tarawa Terrace water system contained  levels of PCE that ranged from 76 to 104 parts per billion. (See table 2 for  the May and July 1982 sampling results.)
Former Camp Lejeune environmental officials recalled that after the  private laboratory identified the TCE and PCE in the two water systems,  they did not take additional steps to address the contamination for three  reasons. First, they had limited knowledge of these chemicals; second,  there were no regulations establishing enforceable limits for these  chemicals in drinking water; and third, they made assumptions about why  the levels of TCE and PCE varied and about the possible sources of the  TCE and PCE. The former Camp Lejeune environmental officials told us  that they were aware of EPA guidance, referred to as “suggested no  adverse response levels,” for TCE and PCE when these contaminants were  identified at Camp Lejeune. However, they noted that the levels of these  contaminants detected at Camp Lejeune generally were below those  outlined in the guidance. One Camp Lejeune environmental official also  recalled that at the time they were unsure what the health effects would be  for the lower amounts detected at the base. Additionally, in an August  1982 document and during our interviews with current Camp Lejeune  environmental officials, it was noted that EPA had not issued regulations  under the Safe Drinking Water Act for TCE and PCE when the private  laboratory identified these chemicals in the drinking water. The former  Camp Lejeune environmental officials also said that they made  assumptions about why the levels of TCE and PCE varied. For example,  they attributed the higher levels to short-term environmental exposures,  such as spilled paint inside a water treatment plant, or to laboratory or  sampling errors. Additionally, in an August 1982 memorandum, a Camp  Lejeune environmental official suggested that based on the sampling  results provided by the private laboratory, the levels of PCE detected  could be the result of using coated pipes in the untreated water lines at  Tarawa Terrace. The former Camp Lejeune environmental officials told us  that in retrospect, it was likely that well rotation in these water systems  contributed to the varying sampling results because the contaminated  wells may not have been providing water to the Hadnot Point and Tarawa  Terrace systems at any given time. However, both they and current Camp  Lejeune environmental officials said that at that time the base  environmental staff did not know that the wells serving both systems were  rotated.
After August 1982, the private laboratory continued to communicate with  Camp Lejeune officials about the contamination of treated water from the  Hadnot Point and Tarawa Terrace water systems. All eight of Camp  Lejeune’s water systems were sampled again for TTHMs in November  1982. In a December 1982 memorandum, a Camp Lejeune environmental  official noted that during a phone conversation with a chemist from the  private laboratory the chemist expressed concern that TCE and PCE were  interfering with Tarawa Terrace and Hadnot Point TTHM samples. The  chemist said the levels of TCE and PCE were “relatively high” in the  November 1982 samples, though the specific levels of TCE and PCE were  not provided to Camp Lejeune officials. The private laboratory report  providing the November 1982 results said that the samples from Tarawa  Terrace “show contamination” from PCE and the samples from Hadnot  Point “show contamination” from both TCE and PCE. All eight of Camp  Lejeune’s water systems were sampled again for TTHMs in August 1983,  and the private laboratory report providing these results said that the  samples from Tarawa Terrace “show contamination” from PCE and the  samples from Hadnot Point “show contamination” from both TCE and  PCE. Former Camp Lejeune environmental officials recalled that they did  not take any actions related to these findings.
section_title: Discovery of Contamination in Individual Wells in 1984 and 1985 Prompted Their Removal from Service, and Information Was Provided to Residents and the Media
paragraphs: In 1982, Navy officials initiated the NACIP program at Camp Lejeune with  an initial assessment study, which was designed to collect and evaluate  evidence that indicated the existence of pollutants that may have  contaminated a site or that posed a potential health hazard for people  located on or off a military installation. The initial assessment study  determined that further investigation was warranted at 22 priority sites  and a confirmation study to investigate these sites was initiated in July  1984.
As a part of the confirmation study, a Navy contractor took water samples  from water supply wells located near priority sites where groundwater  contamination was suspected. Current and former Camp Lejeune officials  told us that previous water samples usually had been collected from  treated water at sites such as reservoirs or buildings within the water  systems rather than being collected directly from individual wells at Camp  Lejeune. In November 1984, Camp Lejeune officials received sampling  results for one Hadnot Point well located near a priority site, which  showed that TCE and PCE, among other VOCs, were detected in the well.  This well was removed from service, and in December 1984, water  samples from six Hadnot Point wells that were located in the same general  area and treated water samples from the Hadnot Point water plant were  also tested. Results of the analysis of the well samples indicated that both  TCE and PCE were detected in one well, TCE was detected in two  additional wells, and other VOCs were detected in all six wells. Results for  the treated water samples also detected TCE and PCE. Four of these six  wells were removed from service in addition to the original well removed  from service. For the two wells that were not taken out of service, while  initial results indicated levels of VOCs, including TCE, other test results  showed no detectable levels of VOCs. Documents we reviewed show that  continued monitoring of those two wells indicated no detectable levels of  TCE. During December 1984, seven additional samples were taken from  the treated water at Hadnot Point water plant and revealed no detectable  levels of TCE and PCE. According to two former Camp Lejeune  environmental officials, once the wells had been taken out of service and  the samples from the water plant no longer showed detectable levels of  TCE or PCE, they believed the water from the Hadnot Point water system  was no longer contaminated.
Although the December 1984 testing of water from the Hadnot Point water  system showed no detectable levels of TCE or PCE, in mid-January 1985  Camp Lejeune environmental staff began collecting water samples from all  wells on the base. Sampling results were received in February 1985 and  detected VOCs, including TCE and PCE, in 3 wells serving the Hadnot  Point water system and 2 wells serving the Tarawa Terrace water system.  As a result, those 5 wells were removed from service. According to current  Camp Lejeune officials, all 10 wells had been removed from service by  February 8, 1985. According to memoranda dated March 1985 and May  1985, 1 of the 2 wells removed from service at Tarawa Terrace was used  on 1 day in March 1985 and on 3 days in April 1985 for short periods of  time to meet water needs at the base. See table 3 for the dates that wells  were removed from service and for the levels of TCE and PCE that were  detected in the wells prior to their removal from service in 1984 and 1985.  See app. I for the levels of all VOCs that were detected in the wells prior to  their removal from service in 1984 and 1985.
In addition, while base officials were waiting for sampling results from  January 1985 of samples collected from wells serving Hadnot Point, water  from this system was provided to a third water system for about 2 weeks.  In late January 1985, a fuel line break caused gasoline to leak into the  Holcomb Boulevard water treatment plant. During the approximately   2-week period the treatment plant was shut down, water from the Hadnot  Point system was pumped into the Holcomb Boulevard water lines.  Former Camp Lejeune environmental officials said that they used water  from the Hadnot Point water system because it was the only water system  interconnected with the Holcomb Boulevard water system, and because  they believed the water from the Hadnot Point water system was no longer  contaminated. Prior to restarting the Holcomb Boulevard water system,  samples of treated water were tested and no gasoline was detected in any  of these samples. However, the samples were found to contain various  levels of TCE; these results were attributed to the use of water from the  Hadnot Point water system. About 5 days after these samples were taken,  the Holcomb Boulevard water system was restarted because the fuel line  had been repaired. “Two of the wells that supply Tarawa Terrace have had to be taken off line because minute  (trace) amounts of several organic chemicals have been detected in the water. There are no  definitive State or Federal regulations regarding a safe level of these compounds, but as a  precaution, I have ordered the closure of these wells for all but emergency situations when  fire protection or domestic supply would be threatened.”
The notice asked residents to reduce water use until early June, when the  construction of a new water line was to be completed. In May 1985,  another article in the base newspaper stated the number of wells that had  been removed from service, stated why the wells were removed from  service, and noted the potential for water shortage at Tarawa Terrace as a  result. In addition, the Marine Corps provided us with copies of three  North Carolina newspaper articles published from May 1985 to September  1985 discussing contamination at Camp Lejeune. All three articles  included information about the drinking water contamination and noted  that 10 wells serving two water treatment systems at Camp Lejeune had  been removed from service.
section_title: Past Contamination Was Estimated to Have Originated from Both On- base and Off-base Sources, and Cleanup Activities at These Sources Are Under Way
paragraphs: The sources of past contamination for the Hadnot Point water system have  not been conclusively determined. However, DOD officials have estimated  that eight contaminated on-base sites in the proximity of the Hadnot Point  water system may be the sources of contamination for that water system.  These eight sites were contaminated by leaking underground storage tanks  containing fuel, by degreasing solvents, by hazardous chemical spills, and  by other waste disposal practices. Efforts by ATSDR are ongoing to  conclusively determine the sources of past contamination in the Hadnot  Point water system, as well as when the contamination began. For the  Tarawa Terrace water system, North Carolina officials determined that the  contamination likely came from a dry cleaning solvent that had been  released into a leaking septic tank at an off-base dry cleaning facility— ABC One Hour Cleaners—which built its septic system and began  operation in 1954. Both the dry cleaning facility and its septic tank were  located off base but adjacent to a supply well for the Tarawa Terrace  water system. Based on the environmental contamination at this site, ABC  One Hour Cleaners was designated as a National Priorities List site in  1989. As part of its current health study, ATSDR has estimated that  beginning as early as 1957 individuals were exposed to PCE in treated  drinking water at levels equal to or greater than what became effective in  1992 as EPA’s maximum contaminant level of 5 parts per billion.
Since 1989, officials from Camp Lejeune, North Carolina, and federal  agencies, including EPA, have taken actions to clean up the suspected  sources of the contamination in the Hadnot Point and Tarawa Terrace  water systems. Because the contamination is thought to have come from  both on- and off-base sources, and because those sources are part of two  separate National Priorities List sites—Camp Lejeune and ABC One Hour  Cleaners—cleanup activities for the suspected sources of contamination  are being managed separately. Cleanup activities have included the  removal of contaminated soils and gasoline storage tanks and the  treatment of contaminated groundwater and soils.
section_title: Although ATSDR Did Not Always Receive Requested Funding and Experienced Delays in Receiving Information from DOD, Officials Said Their Work Has Not Been Significantly Delayed
paragraphs: Since ATSDR began its Camp Lejeune-related work in 1991, the agency did  not always receive requested funding and experienced delays in receiving  information from DOD entities. Although concerns have been raised by  former Camp Lejeune residents, ATSDR officials said these issues have  not significantly delayed its work and that such situations are normal  during the course of a study.
subsections: section_title: Funding of ATSDR’s Camp Lejeune Work
paragraphs: ATSDR received funding from DOD for 13 of the 16 fiscal years during  which it has conducted its Camp Lejeune-related work, and ATSDR  provided its own funding for Camp Lejeune-related work during the other  3 years. Under federal law and in accordance with a memorandum of  understanding between DOD and ATSDR, DOD is responsible for funding  public health assessments and any follow-up public health activities, such  as health studies or toxicological profiles related to DOD sites as agreed to  in an annual plan of work. For fiscal year 1997, funding for ATSDR’s Camp  Lejeune-related work came from the Navy.
From fiscal year 1998 through fiscal year 2000, no funding was provided to  ATSDR by the Navy or any DOD entity for its Camp Lejeune-related work  because the agencies could not reach agreement about the funding for  Camp Lejeune. In June 1997, ATSDR proposed conducting a study of  childhood leukemia and birth defects associated with TCE and PCE  exposure at Camp Lejeune during fiscal years 1998 and 1999 at an  estimated cost of almost $1.8 million. In a July 1997 letter to the Navy, an  ATSDR official noted that during a June meeting the Navy appeared to be  reluctant to fund the proposed study; however, the official noted that DOD  was liable for the costs of the study under federal law. In an October 1997  letter responding to ATSDR, a senior Navy official stated that the Navy did  not believe it should be required to fund ATSDR’s proposed study because  the cause of the contamination was an off-base source, ABC One Hour  Cleaners. The Navy official said that it was more appropriate for ATSDR to  seek funding for the study from the responsible party that caused the  contamination. However, ATSDR officials told us that while they  expected that the study would focus primarily on contamination from the  dry cleaner, the study was also expected to include people who were  exposed to on-base sources of contamination. An ATSDR official reported  that the agency submitted its funding proposals for the Camp Lejeune  study to DOD in each of the annual plans of work from fiscal year 1998 to  fiscal year 2000, but that during that time period the agency received no  DOD funding and funded its Camp Lejeune-related work from general  ATSDR funding.
In fiscal year 2001 the Navy resumed funding of ATSDR’s Camp Lejeune- related work. We could not determine why the Navy decided to resume  funding of ATSDR’s work at that time. Since fiscal year 2003, funding for  ATSDR’s Camp Lejeune-related work has been provided by the Marine  Corps. According to a DOD official, the Marine Corps has committed to  funding the current ATSDR study. The DOD official also noted that per a  supplemental budget request from ATSDR for fiscal year 2006, the Marine  Corps agreed to fund community assistance panel meetings and portions  of a feasibility assessment for future studies that will include  computerization of Camp Lejeune housing records.
section_title: Provision of Information to ATSDR by DOD
paragraphs: ATSDR has experienced some difficulties obtaining information from  Camp Lejeune and DOD officials. For example, while conducting its public  health assessment in September 1994, ATSDR sent a letter to the  Department of the Navy noting that ATSDR had had difficulties getting  documents needed for the public health assessment from Camp Lejeune,  such as Remedial Investigation documents for Camp Lejeune. The letter  also noted that ATSDR had sent several requests for information, and  Camp Lejeune’s responses had been in most cases inadequate and no  supporting documentation had been forwarded. ATSDR also had difficulty  in obtaining access to DOD records while preparing to conduct its survey,  the first phase of the current ATSDR health study. In October 1998, ATSDR  requested assistance from the Defense Manpower Data Center, which  maintains archives of DOD data, in locating residents of Camp Lejeune  who gave birth between 1968 and 1985 on or off base. An official at the  Defense Manpower Data Center initially did not provide the requested  information because he believed that doing so could constitute a violation  of the Privacy Act. Between February and April 1999, Headquarters  Marine Corps facilitated discussion between ATSDR and relevant DOD  entities about these Privacy Act concerns and some information was  subsequently provided to ATSDR by DOD. In April 2001, Headquarters  Marine Corps sent a letter to the Defense Privacy Office suggesting that  the Defense Manpower Data Center had only provided a limited amount of  information to ATSDR. However, in a July 2001 reply to Headquarters  Marine Corps, the Defense Privacy Office noted that it believed that  relevant data had been provided to ATSDR by the Defense Manpower Data  Center in 1999 and 2001.
In December 2005, ATSDR officials told us that they had recently learned  of a substantial number of additional documents that had not been  previously provided to them by Camp Lejeune officials. ATSDR then sent a  letter to Headquarters Marine Corps seeking assistance in resolving  outstanding issues related to delays in the provision of information and  data to ATSDR. In an attachment to the letter, ATSDR provided a list of  data and information needed from the Marine Corps in order to complete  water modeling activities for its current study. In a January 2006 response,  a Headquarters Marine Corps official noted that a comprehensive review  was conducted of responses to ATSDR’s requests for information and that  the Marine Corps believed it had made a full and timely disclosure of all  known and available requested documents. The official also noted that  while ATSDR had requested that the Marine Corps identify and provide  documents that were relevant or useful to ATSDR’s study, the Marine  Corps did not always have the subject matter expertise to determine the  relevance of documents. The official noted that the Marine Corps would  attempt to comply with this request; however, the official also noted that  ATSDR was the agency with the expertise necessary to determine the  relevance of documents.
section_title: Effect on ATSDR’s Work
paragraphs: Despite difficulties, ATSDR officials said the agency’s Camp Lejeune- related work had not been significantly delayed or hindered by DOD.  Officials said that while funding and access to records were probably  slowed down and made more expensive by DOD officials’ actions, their  actions did not significantly impede ATSDR’s health study efforts. The  ATSDR officials also stated that while issues such as limitations in access  to DOD data had to be addressed, such situations are normal during the  course of a study. The officials stated that ATSDR’s progress on the study  has been reasonable in light of the complexity of the project. Nonetheless,  as some former residents have learned that ATSDR has not always  received requested funding and information from DOD entities, they have  raised questions about DOD’s commitment to supporting ATSDR’s work.  For example, when some former residents learned during a community  assistance panel meeting that it took about 4 months for DOD to respond  to a supplemental budget request from ATSDR for fiscal year 2006, they  questioned DOD entities’ commitment to ATSDR’s Camp Lejeune-related  work. However, DOD and ATSDR officials described this delay in  responding as typical during the funding process.
section_title: Experts Convened by NAS Generally Agreed That Many Parameters of ATSDR’s Current Study Were Appropriate
paragraphs: The seven members of an expert panel convened by NAS at our request  generally agreed that specific parameters of ATSDR’s current study were  appropriate, including the study population, the exposure time frame, and  the selected health effects. The expert panel members had mixed opinions  on ATSDR’s projected completion date.
subsections: section_title: Study Population
paragraphs: The seven panel experts concurred that ATSDR logically limited its study  population to those individuals who were in utero while their mothers  were pregnant and lived at Camp Lejeune during the 1968 through 1985  time frame, and who may have been exposed to the contaminated drinking  water. The current study follows recommendations from the agency’s  1997 public health assessment of Camp Lejeune, which noted that studies  of cancer among those who were exposed in utero should be conducted to  further the understanding of the health effects in this susceptible  population. Panel experts said that ideally a study would attempt to  include all individuals who were potentially exposed, but that limited  resources and data availability were practical reasons for limiting the  study population. Additionally, panel experts agreed that those exposed  while in utero were an appropriate study population because they could be  considered at higher risk of adverse health outcomes than others, such as  those exposed as children or adults. In addition, two panel experts said  that studying only those who lived on base was reasonable because they  likely had a higher risk of inhalation exposure to VOCs such as TCE and  PCE, which may be more potent than ingestion exposure. Thus, pregnant  women who lived in areas of base housing with contaminated water and  conducted activities during which they could inhale water vapor—such as  bathing, showering, or washing dishes or clothing—likely faced greater  exposure than those who did not live on base but worked on base in areas  served by the contaminated drinking water.
section_title: Study Time Frame
paragraphs: The seven panel experts agreed that the 1968 through 1985 study time  frame was reasonable, based on limitations in data availability. This time  frame was adopted from ATSDR’s 1998 study of adverse pregnancy  outcomes, which limited the study population to include those potentially  exposed between 1968 and 1985. According to ATSDR’s study protocol,  these years were chosen because 1968 was the first year that birth  certificates were computerized in North Carolina and 1985 was when the  affected water wells were removed from service. Four of the panel experts  said they did not see any benefit in using an earlier start date than 1968  because collecting birth records before 1968 could require a significant  amount of resources to collect data. In addition, while the initial exposure  to contaminated drinking water may have occurred as early as the 1950s,  at the time the ATSDR study time frame was selected officials were unable  to determine precisely when the contamination began. Four of the panel  experts commented that exposure was likely highest in the latter part of  the study time frame—presumably, they said, as a result of a higher  accumulated level of contamination over time—thus making the  uncertainty of when the contamination began less significant and  supporting ATSDR’s decision to study the later time frame.
section_title: Study Health Effects
paragraphs: The five panel experts who discussed health effects said that those  selected for the study were valid for individuals who were potentially  exposed in utero at Camp Lejeune. Based on previous ATSDR work and  existing literature, the health effects chosen for the study were neural tube  defects, oral cleft defects, and childhood hematopoietic cancers, including  leukemia and non-Hodgkin’s lymphoma. Two panel experts said that  ATSDR had limited its study to health effects that are rare and that  generally occur at higher levels of exposure to VOCs such as TCE and PCE  than are expected to have occurred at Camp Lejeune. They said that this  may result in ATSDR not identifying enough individuals with these health  effects to determine meaningful results in the study.
section_title: Study Completion Date
paragraphs: ATSDR has projected a December 2007 completion date for the study,  which would include activities such as identifying and enrolling study  participants, conducting a parental interview, confirming each reported  diagnosis, modeling the water system to quantify the amount and extent of  each individual’s exposure, analyzing the data, and drafting a final report.  Panel experts had mixed opinions regarding ATSDR’s completion date. Of  the five panel experts who commented on the proposed completion date,  three said that the date appeared reasonable, and two others said that  based on the complexity of the water modeling the projected completion  date might be optimistic.
Mr. Chairman, this completes my prepared statement. I would be happy to  respond to any question you or other Members of the Subcommittee may  have at this time.
section_title: Contacts and Acknowledgments
paragraphs: For further information about this testimony, please contact Marcia  Crosse at (202) 512-7119 or crossem@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on the  last page of this testimony. Bonnie Anderson, Assistant Director; Karen  Doran, Assistant Director; Danielle Organek; and Christina Ritchie made  key contributions to this testimony.
section_title: Appendix I: Volatile Organic Compounds Detected in Wells at Hadnot Point and Tarawa Terrace Water Systems
paragraphs: Concentrations of chemicals in parts per billion4  and 195 and are one-time sampling results. We did not find documentation that tied the decision to  remove the wells from service to any particular level of contamination included in related  Environmental Protection Agency (EPA) guidance or enforceale regulation.  oth natural processes and human activities. Some  industries use enzene to make other chemicals which are used to make plastics, resins, and nylon  and synthetic fiers. Benzene is also a natural part of crude oil, gasoline, and cigarette smoke.  Breathing enzene can cause drowsiness, dizziness, and unconsciousness; long-term enzene  exposure causes effects on the one marrow and can cause anemia and leukemia. The Department  of Health and Human Services (HHS) has determined that enzene is a known carcinogen.  uid used as a solvent for  waxes and resins; in the extraction of rubber; as a refrigerant; in the manufacture of pharmaceuticals  and artificial pearls; in the extraction of oils and fats from fish and meat; and in making other organics.  EPA has found trans-1,2-DCE to potentially cause central nervous system depression when people  are exposed to it at levels aove 100 parts per illion for relatively short periods of time. Trans-1,2- DCE has the potential to cause liver, circulatory, and nervous system damage from long-term  exposure at levels aove 100 parts per illion.  uid with a mild, sweet, chloroform-like odor. Virtually  all of it is used in making adhesives, synthetic fiers, refrigerants, food packaging, and coating resins.  EPA has found 1,1-DCE to potentially cause liver damage when people are exposed to it at levels  aove 7 parts per illion for relatively short periods of time. In addition, 1,1-DCE has the potential to  cause liver and kidney damage as well as toxicity to the developing fetus and cancer from a lifetime  exposure at levels aove 7 parts per illion.  urns. HHS has determined that methylene chloride can e  reasonaly anticipated to e a cancer-causing chemical.  uid which occurs naturally in crude oil and in the tolu tree. It is also  produced in the process of making gasoline and other fuels from crude oil and making coke from  coal. Toluene may affect the nervous system. Low to moderate levels can cause tiredness, confusion,  weakness, drunken-type actions, memory loss, nausea, loss of appetite, and hearing and color vision  loss. Inhaling high levels of toluene in a short time can result in feelings of light-headedness,  dizziness, or sleepiness. It can also cause unconsciousness, and even death. High levels of toluene  may affect kidneys. Studies in humans and animals generally indicate that toluene does not cause  cancer.  stance that does not occur naturally. It can  e formed when other sustances such as trichloroethane, TCE, and PCE are roken down.  Breathing high levels of vinyl chloride for short periods of time can cause dizziness, sleepiness, and  unconsciousness and at extremely high levels can cause death. Breathing vinyl chloride for long  periods of time can result in permanent liver damage, immune reactions, nerve damage, and liver  cancer. HHS has determined that vinyl chloride is a known carcinogen.
Well TT-23 is also referred to as “TT-new well” in Marine Corps documents.
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