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Pages 1-10

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From page 1...
... report that reviewed the toxicologic and epidemiologic literature on solvents that had been used in the 1990–1991 Gulf War and their potential health effects. The NRC report assessed studies published after the IOM report and focused on the potential health effects of the solvents on Camp Lejeune residents and similarly exposed populations.
From page 2...
... In general, human and animal studies demonstrate that high-dose exposures are required for acute renal effects to be observed and that such effects are variable among species. In animal studies, acute exposure to high doses of 1  The 15 conditions in the act are esophageal cancer, lung cancer, breast cancer, bladder cancer, adult leukemia, kidney cancer, multiple myeloma, myelodysplastic syndromes, female infertility, miscarriage, hepatic steatosis, scleroderma, renal toxicity, and neurobehavioral effects identified by the 2009 NRC report as having limited/suggestive evidence of an association with exposure to TCE, PCE, or solvent mixtures; and non-Hodgkin's lymphoma.
From page 3...
... Therefore, the committee recommends that VA consider modifying the guidance and algorithm K -- as suggested in revised algorithm K -- to indicate that patients presenting with defined reductions in glomerular filtration rate or proteinuria AND who had abnormal renal function tests or urinalysis of unknown etiology while residing at Camp Lejeune should be accepted to the program. The committee also recommends that VA consider accepting into the Camp Lejeune program patients with chronic kidney disease, but without 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.
From page 4...
... The committee recommends that VA consider adding neurobehavioral effects as a result of neural tube defects in the Camp Lejeune clinical guidance and in algorithm B-1. Most of the new literature identified by the committee was the product of epidemiologic studies of a Cape Cod, Massachusetts, population that had been exposed to PCE in drinking water, from 1968 through 1980.
From page 5...
... Committee members were not in agreement on whether the two studies on illicit drug use and bipolar disorder provided enough evidence to warrant a recommendation on the inclusion of these two neurobehavioral effects in the guidance and algorithms. Nevertheless, in keeping with the VA policy that "in cases where there is reasonable doubt as to the diagnosis or primary cause for the diagnosis, clinicians should resolve in favor of the Camp Lejeune veteran or family member," the committee recommends that VA consider including adolescent and adult illicit drug use and bipolar disorder as neurobehavioral effects in the Camp Lejeune clinical guidance and algorithm B-1.
From page 6...
... The committee recommends that VA specifically include hormonal treatment and immunotherapy as part of the "active treatment" for cancer in the clinical guidance. Scleroderma (Systemic Sclerosis)
From page 7...
... The committee recommends that throughout the guidance and algorithm VA refer to "physical and mental health conditions" related to prior infertility or miscarriage, rather than to "medical conditions," "medical problem," or "medical treatment." Hepatic Steatosis Hepatic steatosis, also referred to as fatty liver, is associated with a variety of conditions, including type 2 diabetes, obesity, alcohol use, hepatitis, hyperlipidemia, and other liver diseases; the use of some medications (e.g., chemotherapeutic agents, antibiotics) ; and exposure to organic chemicals such as TCE, PCE, and chloroform.
From page 8...
... However, the descriptions and algorithms for the covered conditions, other than for female infertility and miscarriage, do not acknowledge that secondary conditions and medical complications can result not only from the presence of the condition itself, but also from disease progression and from treatment for the condition. The committee recommends that VA should consider adding the need to diagnose and treat second ary conditions to the descriptions or algorithms for the covered primary conditions.
From page 9...
... The committee finds the language in the guidance regarding the need to consider other causes of covered conditions for veterans or family members to be inconsistent and unclear. The committee recommends that VA state whether veterans must meet the same criteria as family members regarding other possible causes for a condition.


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