Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation (2015) / Chapter Skim
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5 Use of the Guidance
5 Use of the Guidance
Pages 67-74
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From page 67... ...
. Such policy decisions can help reduce the administrative burden that Camp Lejeune veterans and family members -- and their health care providers -- face in proving an association between residing at Camp Lejeune during the period of drinking water contamination and the concurrent or subsequent development of a covered health condition.
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From page 68... ...
The guidance specifies that VA will reimburse eligible family members for screenings related to the 15 covered conditions if clinically indicated or if recommended by the U.S. Preventive Services Task Force only if the outcome of that screening leads to the diagnosis of a covered condition.
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From page 69... ...
Furthermore, there is no acknowledgment in the descriptions or algorithms for the other covered conditions 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. Examples include hepatic steatosis progressing to cirrhosis, a miscarriage or infertility that result in prolonged depression, or a treatment for breast cancer leading to lymphedema that requires treatment even if the cancer is in remission.
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From page 70... ...
70 HEALTH CONDITIONS IDENTIFIED BY THE CAMP LEJEUNE LEGISLATION TABLE 5-1 Criteria for Onset, Duration, and Exclusions for All Covered Conditions Neurobehavioral Effects Neurobehavioral Neurobehavioral Childhood or Adult Exposure In Utero Exposure Parkinson's Disease Renal Toxicity Description/ Chronic symptoms, Drug addiction Parkinson's Disease Chronic kidney disease criteria including Bipolar depression Foundation or other eGFR < 60 or protein Delayed reaction times Neurological problems accepted criteria urea or kidney biopsy Problems with short- associated with neural term memory, visual tube defects perception, attention, color vision Onset During CL residence Unknown After CL residence After CL residence Duration Persistent or intermittent Unknown n/a n/a since residence at CL Other likely causes Alzheimer's disease Diabetes Dementia Hypertension ALS Volume depletion ADHD Severe heart failure Basal ganglia disorders Acute tubular necrosis Bipolar disorder occurring with Multiple sclerosis hypotension or Parkinson's disease nephrotoxic agents Reductions in color Acute interstitial nephritis discrimination, hearing, due to medication or olfactory functions Obstructive uropathy Schizophrenia Hypertensive PTSD nephrosclerosis OCD Sickle cell kidney disease Panic disorder HIV-associated nephropathy Additional notes None Unknown None Atypical course (faster progression) may indicate exacerbation by CL exposure NOTE: ACR = American College of Rheumatology; ADHD = attention deficit hyperactivity disorder; ALS = amyotrophic lateral sclerosis; CL = Camp Lejeune; CT = computerized tomography; eGFR = estimated glomerular filtration rate; HIV = human immunodeficiency virus; MRI = magnetic resonance imaging; n/a = not available; OCD = obsessive compulsive disorder; PTSD = posttraumatic stress disorder; red = committee additions.
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From page 71... ...
USE OF THE GUIDANCE 71 Cancers Scleroderma Miscarriage Infertility Hepatic Steatosis Breast cancer ACR diagnostic Chronic persistent Chronic persistent Identified by ultrasound, Bladder cancer criteria physical or mental physical or mental CT, or MRI, or a Esophageal cancer health conditions health conditions biopsy Kidney cancer associated with associated with Leukemia miscarriage infertility Lung cancer Multiple myeloma Myelodysplastic syndromes Non-Hodgkin's lymphoma Any time during or Any time during or Miscarriage during CL Infertility during CL During CL residence, after CL residence after CL residence residence residence although may have been subclinical n/a n/a Problems with Problems with n/a miscarriage resolve infertility resolve during or shortly during or shortly after CL residence after CL residence Not considered Not considered Not considered Not considered Alcohol abuse Obesity Metabolic syndrome Some medications Hepatitis Dyslipidemia Other liver diseases All medical care is None None None None covered during the duration of cancer treatment (surgery, radiation, chemotherapy, immunotherapy, and hormonal therapy) to be certified by the treating physician at 6-month intervals
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From page 72... ...
for all covered conditions in order to ensure clarity, completeness, and consistency; that VA consider revising the text in the guidance on page 4, "Covered conditions whose onset occurs at the time of solvent exposure" to reflect the recommended revisions for neurobehavioral effects in adults and the new algorithm for children; and that VA consider removing neurobehavioral effects from the first sentence in this section because not all such effects may be evident during exposure.
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From page 73... ...
FUTURE CONSIDERATIONS The committee expects -- and VA has indicated -- that the guidance will be revised as VA receives feedback from clinicians on its utility and clarity, and as additional scientific information becomes available pertaining to the covered outcomes and their relationship to drinking water contaminants. This may be of particular importance for the neurobehavioral effects and renal toxicity endpoints as epidemiologic and toxicologic research continues on the association between exposure to the drinking water contaminants found at Camp Lejeune and adverse health effects in those two domains.
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From page 74... ...
VA has done a commendable job in dealing with a scientifically and administratively complex task. The committee hopes that the above recommendations in this report will clarify and enhance the guidance document so that Camp Lejeune veterans and their family members can receive hospital care and medical services under the Janey Ensminger Act with a minimum of confusion for them and for the clinicians from whom they seek care.
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