Date:  March 11, 2015




IOM Report Reviews Draft VA Clinical Guidance Document for Health Conditions Identified by Camp Lejeune Legislation, Recommends Improvements


WASHINGTON – A new report from the Institute of Medicine offers recommendations to enhance a U.S. Department of Veterans Affairs draft clinical guidance document intended to help health care providers determine whether a veteran or family member has a medical condition that is covered by the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012 and whether an episode of care is related to a covered condition.  The study committee that reviewed the document said that the VA has done a commendable job in dealing with a scientifically and administratively complex task.  


Between 1957 and 1987, the groundwater at U.S. Marine Corps Base Camp Lejeune in North Carolina was inadvertently contaminated with chemicals that were later found to cause cancer and other health problems.  In 1980 the toxic chemicals, primarily trichloroethylene and perchloroethylene, were first detected at Camp Lejeune in treated drinking water, and by 1987 use of the contaminated water wells was discontinued.  It is estimated that between 500,000 and 1 million people may have used the contaminated water. 


In 2012, Congress passed the Honoring America’s Veterans and Caring for Camp Lejeune Families Act, which provides hospital care and medical services to veterans and family members who have any of 15 health conditions associated with use or consumption of the contaminated water.  These health conditions cover neurobehavioral effects, renal toxicity, esophageal cancer, lung cancer, breast cancer, bladder cancer, adult leukemia, kidney cancer, multiple myeloma, myelodysplastic syndromes, non-Hodgkin’s lymphoma, female infertility, miscarriage, hepatic steatosis, and scleroderma.  Neurobehavioral effects can include symptoms such as deficits in attention and motor function, and some perceptual or behavioral disorders. Eligible veterans and family members must have resided (including offspring who were in utero) at Camp Lejeune for 30 days or longer between Jan. 1, 1957 and Dec. 31, 1987.


The draft VA clinical guidance document takes a clinician through a series of both clinical and procedural decisions to determine an individual’s eligibility for the program and benefits for a particular medical service. To ensure that the guidance is scientifically sound and the latest scientific literature on neurobehavioral effects and renal toxicity is incorporated, the VA asked the IOM to review a draft of the document (Appendix B of the IOM report).  The committee recommended the VA should:

·         accept into the Camp Lejeune program patients with chronic kidney disease who may not have evidence of kidney damage during or around the time of residence at Camp Lejeune, if there are no other more likely causes of their kidney disease.

·         add Parkinson’s disease in the clinical guidance as a “neurobehavioral effect” that may result from exposure to contaminated drinking water at Camp Lejeune.

·         include a separate set of steps, specific to patients who were exposed to the toxic chemicals as children or in utero, for determining neurobehavioral effects.

·         admit into the program patients with second primary cancers – but not recurrent or metastatic cancers – whose primary cancer was one of the covered cancers, even if their primary cancer was diagnosed before residence at Camp Lejeune.  It should also cover precancerous conditions that may lead to a primary cancer.


The study was sponsored by the U.S. Department of Veterans Affairs.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows.



Jennifer Walsh, Senior Media Relations Officer

Christina Anderson, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail

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Pre-publication copies of Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation are available from the National Academies Press on the Internet at or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

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Board on the Health of Select Populations


Committee on the Review of Clinical Guidance for the Care of Health Conditions

Identified by the Camp Lejeune Legislation



David R. Nerenz (chair)

Director, Center for Health Policy and Health Services Research

Henry Ford Health System

Detroit, Mich.


Robert J. Alpern1


Yale University School of Medicine

New Haven, Conn.


Paolo Boffetta

Director, Institute for Translational Epidemiology, and

Associate Director for Population Sciences

The Tisch Cancer Institute

Icahn School of Medicine at Mount Sinai Hospital

New York City


Mary E. Davis


Department of Physiology and Pharmacology

West Virginia University Health Sciences Center



Michael E. Goldberg2

David Mahoney Professor of Brain and Behavior

Department of Neuroscience

Columbia University College of Physicians and Surgeons

New York City


Paul H. Grundy1

Director, Healthcare Transformation

IBM; and

Adjunct Professor

University of Utah Department of Family and Preventive Medicine

Hopewell Junction, N.Y.


Patricia Janulewicz

Assistant Professor, Environmental Health

Boston University School of Public Health



Nancy Keating

Associate Professor and Associate Physician

Harvard Medical School



Gary O. Rankin

Professor and Chair

Department of Pharmacology, Physiology and Toxicology

Joan C. Edwards School of Medicine

Marshall University

Huntington, W.Va.


Mark J. Utell

Professor of Medicine and Environmental Medicine

Departments of Medicine and Environmental Medicine

Pulmonary and Critical Care Division

University of Rochester School of Medicine and Dentistry

Rochester, N.Y.


Carol S. Wood

Staff Scientist

Toxicology and Hazard Assessment Group

Environmental Sciences Division

Oak Ridge National Laboratory

Oak Ridge, Tenn.


Albert W. Wu

Associate Professor

Health Policy and Management and Internal Medicine

Johns Hopkins Bloomberg School of Public Health





Roberta Wedge

Study Director


1Member, Institute of Medicine

2Member, National Academy of Sciences