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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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           Review of

VA Clinical Guidance

              for the Health Conditions Identified by
              the Camp Lejeune Legislation

Committee on the Review of Clinical Guidance for the Care of Health Conditions
Identified by the Camp Lejeune Legislation

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
               OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
×

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001

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

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

International Standard Book Number-13: 978-0-309-31600-2
International Standard Book Number-10: 978-0-309-31600-6

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

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

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INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.nationalacademies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
×

COMMITTEE ON THE REVIEW OF CLINICAL GUIDANCE FOR THE CARE OF
HEALTH CONDITIONS IDENTIFIED BY THE CAMP LEJEUNE LEGISLATION

DAVID R. NERENZ (Chair), Director of the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI

ROBERT J. ALPERN, Dean, Yale Medical School, New Haven, CT

PAOLO BOFFETTA, Director of the Institute for Translational Epidemiology and Associate Director for Population Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York

MARY E. DAVIS, Professor, West Virginia University Health Sciences Center, Morgantown, WV

MICHAEL E. GOLDBERG, David Mahoney Professor of Brain and Behavior, Columbia University College of Physicians and Surgeons, New York

PAUL GRUNDY, Director of Healthcare Transformation, IBM, Hopewell Junction, NY

NANCY L. KEATING, Professor of Health Care Policy, Harvard Medical School, Boston, MA

PATRICIA JANULEWICZ LLOYD, Assistant Professor, Boston University School of Public Health, Boston, MA

GARY O. RANKIN, Professor and Chair, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV

MARK J. UTELL, Professor, University of Rochester School of Medicine, Rochester, NY

CAROL S. WOOD, Oak Ridge National Laboratory, Oak Ridge, TN

ALBERT W. WU, Professor and Director, Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

IOM Staff

ROBERTA WEDGE, Study Director

CARY HAVER, Associate Program Officer

HEATHER CHIARELLO, Research Associate

ADRIANNA MOYA, Senior Program Assistant (through May 2014)

FREDRICK ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Peter F. Buckley, Georgia Regents University

Matthew Cave, University of Louisville

Evan D. Kharasch, Washington University in St. Louis

Francine Laden, Harvard School of Public Health

Bruce P. Lanphear, Simon Fraser University

Lawrence H. Lash, Wayne State University School of Medicine

Bruce S. McEwen, The Rockefeller University

Martin A. Philbert, University of Michigan

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Lynn R. Goldman, George Washington University School of Public Health and Health Sciences, and Kenneth W. Kizer, University of California, Davis, School of Medicine. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Page viii Cite
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Acronyms and Abbreviations

ADHD

attention deficit hyperactivity disorder

AFLD

alcohol-related fatty liver disease

ALS

amyotrophic lateral sclerosis

ATSDR

Agency for Toxic Substances and Disease Registry

CI

confidence interval

CKD

chronic kidney disease

CNS

central nervous system

CT

computerized tomography

CYP3A

cytochrome P4503A

DCE

dichloroethylene

DCVC

dichlorovinylcysteine

DCVCS

dichlorovinylcysteine sulfoxide

DCVG

dichlorovinyl glutathione

DCVT

dichlorovinylthiol

eGFR

estimated glomerular filtration rate

EPA

U.S. Environmental Protection Agency

ESRD

end-stage renal disease

FMO3

flavin monooxygenase 3

GAO

Government Accountability Office

GST

glutathione S transferase

HIV

human immunodeficiency virus

HR

hazard ratio

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
×

IARC

International Agency for Research on Cancer

IOM

Institute of Medicine

IRIS

Integrated Risk Information System (of the EPA)

KIM-1

kidney injury molecule-1

MCL

maximum contaminant level

MRI

magnetic resonance imaging

MS

multiple sclerosis

NAcDCVC

N-acetyl dichlorovinylcysteine

NAcDCVCS

N-acetyl dichlorovinylcysteine sulfoxide

NAcTCVC

N-acetyl trichlorovinylcysteine

NAcTCVCS

N-acetyl trichlorovinylcysteine sulfoxide

NAFLD

non-alcoholic fatty liver disease

NAG

N-acetyl-β-D-glucosaminidase

NAT

N-acetyltransferase

NIOSH

National Institute for Occupational Safety and Health

NMDA

N-methyl-D-aspartic acid

NRC

National Research Council

NTP

National Toxicology Program

OCD

obsessive compulsive disorder

OR

odds ratio

OSHA

U.S. Occupational Safety and Health Administration

PCE

perchloroethylene (or tetrachloroethylene)

Pi-GST

Pi-glutathione S transferase

PTSD

posttraumatic stress disorder

RR

risk ratio

SIR

standardized incidence ratio

SMR

standardized mortality ratio

TAFLD

toxicant-associated fatty liver disease

TCA

trichloroacetic acid

TCE

trichloroethylene

TCOH

trichloroethanol

TCVC

trichlorovinylcysteine

VA

U.S. Department of Veterans Affairs

VHA

Veterans Health Administration (VA’s health care system)

γGTP

γ-glutamyltranspeptidase

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation. Washington, DC: The National Academies Press. doi: 10.17226/18991.
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U.S. Marine Corps Base Camp Lejeune, located in eastern North Carolina, is a large installation that covers 156,000 acres and is home at any given time to a population of about 170,000 active-duty personnel, family members, retirees, and civilian employees living on base or in the surrounding community. Between 1957 and 1987, the ground water at Camp Lejeune was inadvertently contaminated with chemicals, primarily industrial solvents that are now known to cause cancer and other health problems. In 1980, drinking water contaminants, primarily trichloroethylene (TCE) and perchloroethylene (PCE), as well as other solvents, were first detected at Camp Lejeune in treated drinking water. The contaminated wells were closed in 1987. In 1989, the U.S. Environmental Protection Agency placed Camp Lejeune on the National Priorities List, also known as Superfund. It is estimated that between 500,000 and 1,000,000 people may have used the contaminated water and many of them continue to have concerns about the long-term effects that might result from that exposure.

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

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