Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation (2015) / Chapter Skim
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4 Other Health Outcomes
4 Other Health Outcomes
Pages 51-66
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From page 51... ...
CANCER AND RELATED CONDITIONS Overview The Janey Ensminger Act lists eight malignant neoplasms (esophageal cancer, lung cancer, breast cancer, bladder cancer, kidney cancer, leukemia, multiple myeloma, and non-Hodgkin's lymphoma) and myelodysplastic syndromes among the 15 conditions covered by the act.
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(2014a) compared the mortality of Marine Corps and Navy personnel exposed to contaminated drinking water at Camp Lejeune with that of Marine Corps and Navy personnel stationed at Camp Pendleton.
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VA Guidance and Core Algorithm For the eight cancers and myelodysplastic syndromes covered by the act, there are well-established diagnostic criteria. The Camp Lejeune program includes additional health care benefits in the form of comprehensive medical care during active cancer treatment, because such treatment (including surgery, chemotherapy, and radiation)
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. Risk factors for scleroderma include abnormal immune activity, environmental triggers, and genetic predisposition (NORD, 2014)
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. Most of the immune alterations associated with scleroderma involve antigen recognition, cell signaling, and cytokine production, but there may be multiple mechanisms by which environmental exposures initiate or contribute to the development of scleroderma (Mora, 2009)
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On the basis of four additional studies of occupational solvent exposure (IOM, 2003) , in 2009 the NRC concluded that the evidence of an association between mixed solvent exposure and scleroderma is limited/suggestive with some evidence pointing toward TCE exposure in particular (NRC, 2009)
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. In contrast to the occupational studies, a study on a general population cohort of women exposed to PCE-contaminated drinking water in Cape Cod did not find any meaningful associations between exposure and pregnancy loss (Aschengrau et al., 2009)
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. Various health conditions including thyroid hormone abnormalities, cancer and cancer treatments, celiac disease, Cushing's disease, sickle cell disease, kidney disease, diabetes, and genetic abnormalities, as well as certain medications can also reduce a woman's fertility.
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W4 -- Applicant has a physical or mental health condition requiring continued medical treatment from a miscarriage experienced while exposed to contaminated water at Camp Lejeune. Clinicians should carefully assess whether continued health care is needed for chronic, persistent medical problems associated with a miscarriage that occurred during solvent exposure at Camp Lejeune; if care needs are persistent, the applicant is accepted into the Camp Lejeune program.
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From page 60... ...
. VA Guidance and Algorithm The VA guidance states that in evaluating whether a veteran or a family member has hepatic steatosis that may be the result of exposure to drinking water at Camp Lejeune, the clinician should first consider whether it is more likely than not that the patient's hepatic steatosis is the result of a "known etiology." The most common causes include obesity and significant alcohol consumption; less common causes include dyslipidemia; metabolic 2 See http://niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/standard-drink (accessed November 5, 2014)
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Medical record data to be considered by the clinician include elevated body mass index, a history of hepatitis, alcohol use, and liver disease or metabolic syndrome. If a patient's hepatic steatosis is not consistent with those other possible causes, then the patient is accepted to the Camp Lejeune program.
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Other possible causes include dyslipidemia, metabolic syndrome, diabetes, hepatitis or other liver disease, and some medications such as methotrexate, tamoxifen, corticosteroids, griseofulvin, diltiazem, anti-retroviral therapy, amiodarone, nifedipine, and valproate. Applicant has clinical evidence of hepatic steatosis due to a cause other than exposure at Camp Lejeune.
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? No 3 Identify data in the health record regarding H2 BMI, history of hepatitis, alcohol use/abuse, liver disease, diabetes, or metabolic syndrome 4 Is the hepatic steatosis consistent Yes with another known cause?
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2012b. Non-alcoholic fatty liver disease: A new and important cardiovascular risk factor?
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2014. Drug induced liver disease: Steatosis (fatty liver)
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2002. AGA technical review on nonalcoholic fatty liver disease.
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