[Senate Report 112-42]
[From the U.S. Government Publishing Office]
Calendar No. 123
112th Congress Report
SENATE
1st Session 112-42
======================================================================
CARING FOR CAMP LEJEUNE VETERANS ACT OF 2011
_______
August 1, 2011.--Ordered to be printed
_______
Mrs. Murray, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany S. 277]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee''), to which was referred the bill (S. 277), to amend
title 38, United States Code (hereinafter, ``U.S.C.''), to
provide hospital care, medical services, and nursing home care
to veterans who were stationed at Camp Lejeune, North Carolina,
while the water was contaminated at Camp Lejeune, and for other
purposes, having considered the same, reports favorably thereon
with an amendment in the nature of a substitute, and recommends
that the bill, as amended, do pass.
Introduction
On February 3, 2011, Committee Ranking Member Richard Burr
introduced S. 277, to provide hospital care, medical services,
and nursing home care to veterans who were stationed at Camp
Lejeune, North Carolina, while the water was contaminated at
Camp Lejeune, and for other purposes. Senators Grassley, Hagan,
and Nelson of Florida were original cosponsors. Senators
Blumenthal, Graham, Harkin, Isakson, and Johanns were later
added as cosponsors.
On June 8, 2011, the Committee held a hearing on pending
health and benefits legislation, including S. 277. Testimony
was offered by: Robert L. Jesse, M.D., PhD., Principal Deputy
Under Secretary for Health, Veterans Health Administration,
Department of Veterans Affairs; Jeff Steele, Assistant
Legislative Director, The American Legion; Joseph Violante,
National Legislative Director, Disabled American Veterans;
Raymond Kelley, Director, National Legislative Service,
Veterans of Foreign Wars of the United States; and Jerry
Ensminger, Master Sergeant, United States Marine Corps (Ret.).
Committee Meeting
After carefully reviewing the testimony from the June 8,
2011, hearing, the Committee met in open session on June 29,
2011, to consider, among other legislation, an amended version
of S. 277. The Committee voted without dissent to report
favorably S. 277, as amended, to the Senate.
Summary of S. 277 as Reported
S. 277, as reported (hereinafter, ``the Committee bill''),
would furnish hospital care, medical services, and nursing home
care to veterans who were stationed at Camp Lejeune, North
Carolina, while the water was contaminated at Camp Lejeune, and
for other purposes.
Section 1 would establish the short title for the bill,
``Caring for Camp Lejeune Veterans Act of 2011.''
Section 2 would provide certain veterans and their families
with eligibility for hospital care, medical services, and
nursing home care through the Department of Veterans Affairs
(hereinafter, ``VA'') if they were stationed or resided at Camp
Lejeune, North Carolina, during the period that the water was
contaminated on Camp Lejeune. It would also require the
Department of Defense (hereinafter, ``DOD'') to reimburse VA
for the costs of that care.
Section 3 would require DOD to merge and consolidate the
system of commissaries and exchange stores to achieve a single
system of stores.
Background and Discussion
In a few specific instances, Congress has acted to provide
benefits and health care to veterans who may have been exposed
to environmental hazards during their military service. On a
few occasions, Congress has extended health care and benefits
to the children of servicemembers and veterans based on a
concern that they were born more susceptible to certain
diseases or conditions because of a parent's exposure to an in-
service environmental hazard.
At an October 8, 2009, hearing, one exposure that was
specifically addressed by the Committee was the water
contamination at Camp Lejeune. The extent of the exposure at
Camp Lejeune is considered to have been the result of the
largest domestic environmental contamination incident in the
history of DOD and the complexity and scope of the
contamination presented questions that were both significant
and unprecedented because of exposure to military personnel and
their dependents.
Marine Corps base Camp Lejeune is an active military base
located on 236 square miles of land in Onslow County, North
Carolina, adjacent to the southern side of the City of
Jacksonville. It was commissioned in 1942 as a training area to
prepare Marines for combat and is the largest East Coast base
of the United States Marine Corps.
As explained by the Government Accountability Office
(hereinafter, ``GAO''), the drinking water at Camp Lejeune is
obtained from groundwater pumped from a freshwater aquifer
located approximately 180 feet below the ground. Groundwater is
pumped from wells located throughout the base. After the water
is treated, it is stored in ground and elevated storage
reservoirs. When needed, the treated water is pumped from the
reservoirs and tanks to facilities such as offices, schools, or
houses on the base. Camp Lejeune's only source of drinking
water is ground water wells.
According to the U.S. Marine Corps, Camp Lejeune officials
in 1980 first became aware of volatile organic compounds
(hereinafter, ``VOCs'') in finished drinking water (tap water)
samples that were being collected to comply with future
drinking water standards. After those results were compiled,
none of the water supply wells were tested for VOCs. In January
1982, the Navy Assessment and Control of Installation
Pollutants (hereinafter, ``NACIP'') Program at Camp Lejeune
began to identify potentially contaminated sites on the base.
In 1982 and 1983, continued testing identified two VOCs--
trichloroethylene (hereinafter, ``TCE''), a metal degreaser
used for industrial purposes on the base, and perchloroethylene
(hereinafter, ``PCE''), a dry cleaning solvent--in two water
systems that served Camp Lejeune base housing areas: Hadnot
Point and Tarawa Terrace. Base officials stated they did not
know the source of these VOCs; water treatment plants and
piping infrastructure were investigated as the possible
sources, but were eliminated as possible sources in 1983.
Following that unsubstantiated explanation, there was no effort
to test the water supply wells for VOCs.
That same year, the NACIP initial assessment study was
published. This study eventually led to the sampling of
individual water supply wells in 1984. A direct association
between VOCs in the Hadnot Point and Tarawa Terrace drinking
water and VOCs in the wells and groundwater was established
when the water supply wells were sampled beginning in July
1984, but analysis of those samples was not received at Camp
Lejeune until November 1984. Officials at Camp Lejeune
confirmed the wells were impacted by VOCs in November 1984 and
shut them down in late 1984 and early 1985.
Measurements of mixed water samples suggest that supply
wells TT-23 and TT-26 were major contributors to contamination
of the Tarawa Terrace water supply. The Agency for Toxic
Substances and Disease Registry (hereinafter, ``ATSDR'') lists
16 wells that served the Tarawa Terrace water supply system.
According to GAO, two wells, TT-23 and TT-26, were shut down on
February 8, 1985, because of PCE contamination. However, well
TT--23 was used briefly after that date--at least on March 11-
12, 1985, and on April 22, 23, and 29, 1985. ATSDR indicates
that TT-23 was removed from service in May 1985.
According to the National Research Council (hereinafter,
``NRC''), which functions under the auspices of the National
Academy of Sciences (hereinafter, ``NAS''), there were multiple
sources of potential pollutants, including an industrial area,
a drum dump, a transformer storage lot, an industrial fly ash
dump, an open storage pit, a former fire training area, a site
of a former on-base dry cleaner, a liquids disposal area, a
former burn dump, a fuel-tank sludge area, and the site of the
original base dump. The NRC stated that the contamination for
the Tarawa Terrace area appears to have begun in the middle
1950s and continued until the middle 1980s, when contaminated
supply wells were shut down. According to the Marine Corps,
nine of ten wells taken out of service have been permanently
demolished (piping removed and holes filled in). One well was
returned to service in 1993 following multiple clean samples.
This well is in service today. Currently, drinking water is
checked for VOCs quarterly to ensure water is not impacted.
Camp Lejeune was placed on the Environmental Protection
Agency (hereinafter, ``EPA'') National Priorities List in 1989.
The National Priorities List is part of the Superfund cleanup
process and lists the most hazardous environmental sites across
the United States and its territories. It serves primarily for
informational purposes, identifying for the states and the
public those sites that appear to warrant remedial actions.
Today, Camp Lejeune is still on that list, as are approximately
130 other military installations.
From 1991 to 1997, ATSDR conducted a public health
assessment (hereinafter, ``PHA'') at Camp Lejeune that was
required by law, under title 42, U.S.C., because of the
installation's listing on the National Priorities List. ATSDR
was particularly interested in routine drinking water tests,
conducted in the 1980s, that found VOCs at detectable levels in
some on-base drinking water supply wells. In 1998, ATSDR
completed a birth outcome study of women who conceived or gave
birth to children while at Camp Lejeune and concluded that
drinking water contaminated with VOCs may be associated with
decreased average birth weight-for-gestational-age births in
infants born to mothers over the age of 35 or in women who had
a history of adverse pregnancy outcomes. As reported by ATSDR,
health outcomes linked to exposure to PCE and TCE include eye
defects, miscarriages, fetal death, leukemia, and many forms of
cancer.
In response to concerns from many Marines and their
families who had been present at Camp Lejeune and to supplement
the few studies that had been undertaken and to help inform
decisions about addressing health claims, Congress mandated in
Public Law 109-364, the John Warner National Defense
Authorization Act for Fiscal Year 2007, that the Secretary of
the Navy enter into an agreement with the NAS to examine
whether adverse health effects are associated with past
contamination of the water supply at Camp Lejeune. The NRC
published its report on June 13, 2009, listing possible health
consequences of exposure to TCE and PCE in the contaminated
water at Camp Lejeune during the period from 1957-1985. All the
health outcomes listed in its report were placed into one of
two categories: limited/suggestive evidence of an association
or inadequate/insufficient evidence to determine whether an
association exists between exposure to TCE and PCE and adverse
health outcomes.
The strongest evidence was in the category of limited/
suggestive evidence of an association, which means there is
some evidence that people who were exposed to TCE or PCE were
more likely to have a certain disease or disorder but that the
studies were either few in number or had limitations. However,
associations between exposures and diseases or disorders placed
in the limited/suggestive evidence of an association category
cannot be ruled out. The other health outcomes reviewed were
placed in the category of inadequate/insufficient evidence to
determine whether an association exists, which means that the
studies were too few in number, limited in quality,
inconsistent, or inclusive in results to make an informed
assessment. Fourteen of the 59 health outcomes reviewed by the
NRC were placed in the limited/suggestive evidence of an
association category, and 45 were placed in the inadequate/
insufficient evidence category. According to the NRC, in many
cases the study subjects were exposed to multiple chemicals,
making it impossible to separate the effects of individual
chemicals. It is informative to note that the EPA has issued a
new draft risk assessment for TCE which classifies TCE as a
``known human carcinogen.''
In 2007, GAO reported that former residents and employees
of Camp Lejeune had filed more than 750 claims against the
federal government related to the contamination. Adjudication
of these claims and similar claims filed since then has been
postponed until completion of an ongoing study being performed
by ATSDR. This study on specific birth defects and childhood
cancers includes children born from 1968 through 1985 to
mothers who, for some time during their pregnancies, were
exposed to drinking water contaminated with VOCs at Camp
Lejeune. It is scheduled to be completed in 2011. However, Dr.
John R. Nuckols, a member of the NRC's Committee on
Contaminated Drinking Water at Camp Lejeune, testified at a
hearing in the 111th Congress that, because further research
was unlikely to provide definitive information, his committee
had concluded that there was no scientific justification for
the Navy and Marine Corps to wait for the results of ATSDR's
additional health studies before making policy decisions about
how to follow up on the evident solvent exposures on the base
and their possible health consequences.
In 2009, ATSDR retracted the 1997 PHA after ATSDR
acknowledged it had not fully investigated the extent of
benzene contamination on the base. ATSDR will reissue a revised
PHA and continues to conduct a series of studies and surveys to
investigate the contamination of the water system at Camp
Lejeune. The most prominent of these is a Water Model, which
will synthesize the data from multiple samples of the water and
other data in order to map out the most likely dispersion and
concentration of the VOCs on various areas of the base. The
Water Model and a Mortality Study of former base military
personnel are expected to be completed by early 2012. ATSDR
also began in July 2011 a Health Survey to be sent to 300,000
former residents of the base, military and civilian. This
survey is expected to be completed by 2014.
At the June 8, 2011, hearing, Jerry Ensminger, a retired
Marine Corps Master Sergeant, testified that his daughter, who
was conceived, carried, and born at Camp Lejeune, died at age
nine after she was diagnosed with acute lymphoblastic leukemia.
Mr. Ensminger, a member of ATSDR's Community Assistance Panel
for its Camp Lejeune studies, indicated that, since 2009,
significant new information pertaining to extensive fuel leaks
from underground tanks on the base and subsequent benzene
contamination had been discovered by ATSDR during reviews of
previously unavailable documents and that, in some of those
documents, Navy contractors had estimated the magnitude of the
fuel losses on the base at close to one million gallons over
several decades. The ATSDR Water Model will ascertain the
severity of benzene contamination in the base drinking water.
VA's Dr. Jesse testified thatone million people may have been
exposed to hazardous chemicals in the Camp Lejeune well water.
Also of note, at the Louisville, Kentucky, Regional Office,
VA has consolidated all disability claims based on exposure to
contaminated drinking water at Camp Lejeune from veterans
throughout the United States. A team of VA employees there is
tasked with reviewing and adjudicating these claims. As of the
June 8, 2011, hearing, that office had adjudicated 125 such
claims and had granted service connection in 22 percent of
those cases. That office had another 967 claims based on the
contaminated water pending adjudication.
Committee Bill. The Committee bill would authorize health
care benefits through VA to certain veterans for any illness
that is attributable to the contaminated drinking water on Camp
Lejeune beginning in fiscal year 2013. The Committee bill would
provide health care benefits to spouses and dependents of
veterans for conditions associated with exposure to the
contaminated drinking water on Camp Lejeune. The Committee bill
would direct DOD to transfer funds to VA to cover the costs of
the health care provided to these veterans and their families.
In order to pay for the increase in funding for providing
health care to veterans and their families, the Committee bill
would decrease DOD spending by consolidating the systems of
commissary and exchange stores in DOD.
Section 2(a) of the Committee bill would amend section
1710(e)(1) of title 38, U.S.C., to add a new subparagraph (F),
that would authorize VA to provide veterans who were stationed
at Camp Lejeune during the period the water was contaminated
with hospital care, medical services, and nursing home care for
any illness, despite insufficient evidence that the illness is
attributable to the contamination.
Section 2(b) of the Committee bill would amend subchapter
VIII of chapter 17 of title 38, U.S.C., by adding a new section
1787 that would make family members of Camp Lejeune veterans
eligible for hospital care, medical services, and nursing home
care for conditions that are associated with exposure to the
VOCs known to have been in the water at Camp Lejeune, North
Carolina. VA would be required to promulgate regulations that
specify the conditions associated with the exposure, and
disabilities related to those conditions.
Section 2(c) of the Committee bill would amend section 8111
of title 38, U.S.C., by adding new subsection (f) that would
require DOD and VA to enter into an agreement for DOD to
reimburse VA for the costs of providing hospital care to
veterans and their dependents under this bill. The costs would
include the overhead and administrative costs of the care and
services provided to veterans and their dependents. The
Committee believes that DOD should reimburse VA for costs of
treating the Camp Lejeune veterans and their family members.
Section 2(d) of the Committee bill would provide that the
changes made by section 2 would take effect on October 1, 2012,
and apply with respect to care provided on or after that date.
Section 3 of the Committee bill would, in a freestanding
provision, direct DOD to merge and consolidate the system of
commissary stores and the system of exchange stores into a
single system of commissary and exchange stores to eliminate
duplicative administrative functions. This section would
instruct DOD to achieve a single system of stores that would
operate on a self-sufficient basis without the need for
appropriated funds by September 30, 2015.
It is the Committee's intent that this provision would
create management efficiencies by consolidating management
functions. It is not the Committee's intent to close or
consolidate individual stores. The longstanding issue of the
contaminated water on Camp Lejeune will not be resolved without
a coordinated effort from the Committee on Armed Services of
the Senate (hereinafter, ``SASC''), DOD, VA and this Committee.
The Committee is not opposed to entertaining an alternative
cost savings provision within the DOD budget that SASC may deem
appropriate to fulfill the intent of this legislation.
Committee Bill Cost Estimate
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the Congressional Budget Office
(hereinafter, ``CBO''), estimates that enactment of the
Committee bill would, relative to current law, reduce
discretionary costs by about $2 billion over the 2012-2016
period, but would not affect direct spending or revenues.
Enactment of the Committee bill would not affect the budget of
state, local, or tribal governments.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:
Congressional Budget Office,
Washington, DC, July 25, 2011.
Hon. Patty Murray,
Chairman, Committee on Veterans' Affairs, U.S. Senate, Washington, DC.
Dear Madam Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 277, the Caring for
Camp Lejeune Veterans Act of 2011.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
S. 277--Caring for Camp Lejeune Veterans Act of 2011
Summary: S. 277 would authorize a new federal health
benefit for former military members who were stationed at Camp
Lejeune, North Carolina, and their dependents whose health was
affected by exposure to environmental contaminants while
residing on the base. The bill also would consolidate the
Department of Defense (DOD) Commissary and Exchange Systems.
CBO estimates that implementing this bill would, in total,
reduce discretionary costs by about $2 billion over the 2012-
2016 period, assuming appropriation actions consistent with the
bill.
Enacting S. 277 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
S. 277 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 277 is shown in the following table. The
costs of this legislation fall within budget functions 050
(national defense) and 700 (veterans benefits and services).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------
2012 2013 2014 2015 2016 2012-2016
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Camp Lejeune Health Benefits:
Estimated Authorization Level................... 0 32 101 155 193 481
Estimated Outlays............................... 0 29 93 149 188 459
Department of Defense Retail Consolidation:
Estimated Authorization Level................... 0 0 -400 -1,000 -1,700 -3,100
Estimated Outlays............................... 0 0 -300 -800 -1,400 -2,500
-----------------------------------------------------------
Total Changes:
Estimated Authorization Level................... 0 32 -299 -845 -1,507 -2,619
Estimated Outlays............................... 0 29 -207 -651 -1,212 -2,041
----------------------------------------------------------------------------------------------------------------
Basis of estimate: For this estimate, CBO assumes the
legislation will be enacted near the start of fiscal year 2012,
that the authorized amounts will be provided near the start of
fiscal year 2013 and each subsequent fiscal year, and that
outlays will follow historical patterns for similar and
existing programs.
Camp Lejeune Health Benefits
Effective October 1, 2012, section 2 would authorize
creation of a new federal health benefit for former military
members who were stationed at Camp Lejeune, North Carolina, and
their dependents whose health was affected by environmental
contamination. The drinking water at Camp Lejeune was
contaminated from 1957 through 1987, allegedly causing higher
incidence rates of some cancers (for example, esophageal,
breast, and kidney), birth defects, and other physical
ailments.
Based on information from the Department of Defense, CBO
estimates that 650,000 people were stationed at Camp Lejeune
during the period of contamination. However, CBO expects that
less than 10 percent of those individuals would eventually be
newly enrolled to receive certain health care benefits provided
by the Department of Veterans Affairs. That estimate is based
on take-up rates for two other government programs that provide
compensation for occupational illnesses: the Radiation Exposure
Compensation Program and the Energy Employees Occupational
Illness Compensation Program (EEOICP). The number of people
approved for benefits would be significantly smaller than the
population potentially exposed because many of those potential
beneficiaries either would not have adequate proof of an
ailment connected to the contamination (for dependents), would
not be able to be located, or would have died.
Of those who enroll for health benefits in the first five
years, CBO estimates that most--about 42,000--would be former
military members, while the rest--about 3,000--would be spouses
and children of former servicemembers. We expect that use of
this program would phase in over time, with about 9,000
individuals enrolling in the first year. CBO uses disease
prevalence rates from the Surveillance Epidemiology and End
Results Cancer Statistics Review to estimate roughly how many
spouses and children may have diseases that would make them
eligible for health benefits.
Based on the cost of health benefits provided to veterans
exposed to other environmental contamination, CBO estimates
that the cost of health care for each eligible veteran would be
about $2,700 in 2013. For spouses and children, CBO assumes
higher health care costs similar to those for health benefits
provided by EEOICP. CBO estimates that the annual cost of the
new health benefit for dependents would be about $10,700 in
2013 for each approved claim. Costs for dependents would be
higher than the average annual medical costs for veterans
because the bill specifies that spouses and children must be
diagnosed with diseases and conditions directly related to the
exposures in question. CBO estimates that per capita costs
would increase by about 6 percent each year, based on national
per capita health expenditure projections published by the
Centers for Medicare and Medicaid Services.
Based on costs for existing programs, CBO estimates
administrative costs to process the new health claims would
amount to $43 million over the 2013-2016 period. CBO assumes a
gradual implementation rate to reflect the time necessary to
establish regulations.
In total, CBO estimates that providing health benefits to
veterans and their family members previously stationed at Camp
Lejeune would cost $459 million over the 2013-2016 period,
assuming appropriation of the necessary amounts.
Department of Defense retail consolidation
Section 3 would require DOD to combine their retail stores
into a single system, beginning in fiscal year 2013. Currently
DOD operates a network of grocery stores (commissaries) that
serves all branches of the armed forces and three separate
chains of general retail stores (exchanges). One system of
exchanges serves the Army and Air Force, a second serves the
Navy, and a third serves the Marine Corps. The bill would
combine all those entities into one system, and require the
consolidated system to be self-sustaining (that is, operate
without appropriations) starting in fiscal year 2016.
Currently the commissary system relies on appropriated
funds to pay its operating costs. In fiscal year 2011, the
commissary system has received appropriations of approximately
$1.3 billion to pay for the salaries of employees, the
transportation of its inventory, and other costs associated
with operating and maintaining approximately 250 stores. The
commissary's inventory is financed on a revolving basis, using
the cash generated from sales of that inventory.
The three exchange systems are less reliant on
appropriations. Although certain expenses of the exchanges are
paid for through appropriations--including the transportation
of certain items and the salaries of military personnel
employed by the exchanges--the majority of the exchanges' costs
are funded from sales revenues generated by the exchanges.
Based on information from DOD, CBO estimates that
appropriations provided to DOD cover approximately $200 million
of exchange-related costs annually.
Overall, CBO estimates that DOD's retail system currently
receives approximately $1.5 billion in appropriated funds each
year, and, including the effects of inflation, those systems
could expect to receive approximately $1.7 billion in 2016. For
the retail system to operate without appropriated funds, CBO
anticipates that two adjustments would be necessary:
consolidating headquarters and certain operations and an
increase in sales revenue. CBO estimates that the efficiencies
that would result from consolidating operations would produce
approximately 20 percent of the saving necessary for the
combined system to achieve self-sufficiency.
The remaining portion of the funds to operate a self-
sufficient system would need to be generated through increasing
prices in the combined system. The commissary and exchange
systems currently offer their patrons savings of approximately
30 percent and 20 percent, respectively, as compared to retail
operations in the private sector. CBO estimates that prices in
the combined system would need to rise by approximately 7
percent to generate sufficient revenue to offset the loss of
appropriated funds. Assuming that the retail system is fully
consolidated by 2015, that such a price increase is phased in
gradually over the 2013-2016 period, and that appropriations
are in turn reduced over the same period, CBO estimates that
implementing section 3 of the bill would yield discretionary
savings of $2.5 billion over the 2013-2016 period.
Intergovernmental and private-sector impact: S. 277
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Estimate prepared by: Federal Costs: Health Benefits--Ann
E. Futrell; DOD Retail Consolidation--Jason Wheelock; Impact on
State, Local, and Tribal Governments: Lisa Ramirez-Branum;
Impact on the Private Sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Regulatory Impact Statement
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans'
Affairs has made an evaluation of the regulatory impact that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses or result in any impact
on the personal privacy of any individuals and that the
paperwork resulting from enactment would be minimal.
Tabulation of Votes Cast in Committee
In compliance with paragraph 7(b) of rule XXVI of the
Standing Rules of the Senate, the following is a tabulation of
votes cast in person or by proxy by members of the Committee on
Veterans' Affairs at its June 29, 2011, meeting. On that date,
the Committee, by voice vote, without objection, ordered to
favorably report S. 277, as amended.
Agency Report
On June 8, 2011, Robert L. Jesse, M.D., Ph.D., Principal
Deputy Under Secretary for Health, Veterans Health
Administration, VA, appeared before the Committee and submitted
testimony on, among other items, S. 277. Excerpts from this
statement are reprinted below:
ROBERT L. JESSE, M.D., PH.D., PRINCIPAL DEPUTY UNDER SECRETARY FOR
HEALTH, VETERANS HEALTH ADMINISTRATION, DEPARTMENT OF VETERANS AFFAIRS
Good Morning Chairman Murray, Ranking Member Burr and
Members of the Committee. Thank you for inviting me here today
to present the Administration's views on several bills that
would affect Department of Veterans Affairs (VA) benefits
programs and services.
* * * * * * *
s. 277, caring for camp lejeune veterans act of 2011
S. 277 would amend title 38 to extend special eligibility
for hospital care, medical services and nursing home care for
certain Vet- erans stationed at Camp Lejeune during a period in
which well water was contaminated notwithstanding that there is
insufficient scientific evidence to conclude that a particular
illness is attributable to such contamination. It would also
make family members of those Veterans who resided at Camp
Lejeune eligible for the same services, but only for those
conditions or disabilities associ- ated with exposure to the
contaminants in the water at Camp Lejeune, as determined by the
Secretary.
VA takes the Camp Lejeune matter very seriously but has a
variety of significant concerns with this bill. For example,
although we believe that the intent of S. 277 is to provide
these Veterans with the same enrollment and treatment authority
as for Persian Gulf and post-Persian Gulf Veterans, the bill
does not do so because it fails to amend section 1710(e)(2) to
address the new special eligi- bility provision. As the
legislation is written, VA would be required to provide
treatment for any condition that cannot be specifically
eliminated as related to the contaminated water at Camp
Lejeune. This bill would not make the special eligibility of
these Veterans subject to the limitation that care may not be
provided ``with respect to a disability that is found, in
accordance with guidelines issued by the Under Secretary for
Health, to have resulted from a cause other than the service or
testing described in such subparagraph.'' As a result, this
bill grants these Veterans a broader special eligibility than
that conferred on Persian Gulf and post-Persian Gulf Veterans.
The Agency for Toxic Substances and Disease Registry
(ATSDR) is conducting ongoing research related to the potential
exposures at Camp Lejeune. Current ATSDR research is
concentrating on refining hydrological modeling to determine
the extent of benzene contamination. This information will then
be used along with results from ongoing population studies to
determine if the potentially exposed population at Camp Lejeune
has experienced an increase in adverse health effects such as
birth defects, cancers, and mortality. VA will closely monitor
this research and will quickly consider the findings and take
appropriate action. In addition, VA will support these studies
by acting on ATSDR requests to confirm specific Veteran's
health issues. VA has a close working relationship with ATSDR
which allows the Department to stay informed about current
research.
We are also greatly concerned that the Department of
Defense (DOD), and consequently VA, is unable to accurately
identify those that may have visited for short periods of time
at Camp Lejeune and surrounding areas during the period of
potential exposure. While the legislation provides that the
Secretary in conjunction with ATSDR shall determine the
applicable period, discussion usually centers on the period of
1957-1987. DOD records have proven problematic in identifying
all potential beneficiaries, especially since the legislation
does not provide for any limitations as to how long an
individual had to be on base at Camp Lejeune. It is possible
through the Defense Manpower Data Center to identify Veterans
assigned to Camp Lejeune. However, it is impossible to identify
those Veterans who visited Camp Lejeune for temporary duty and
many of the family members who resided at or visited the base.
We note that VA treatment of family members as prescribed by
veterans.
Veterans who are part of this cohort may apply to enroll in
VA health care if they are otherwise eligible, and are
encouraged to discuss any specific concerns they have about
this issue with their health care provider. VA environmental
health clinicians can provide these Veterans with information
regarding the potential health effects of exposure to volatile
organic compounds and VA's War-Related Illness and Injury Study
Centers are also available as a resource to providers. Veterans
are also encouraged to file a claim for VA disability
compensation for any injury or illness they believe is related
to their military service. Currently, Camp Lejeune disability
claims are handled on a case by case basis and significant
weight is given to the opinions provided by qualified medical
examiners who are aware of the contaminants and their potential
long-term health effects. In an effort to provide fair and
consistent decisions based on service at Camp Lejeune during
the period of water contamination, VA has consolidated claims
processing at the Louisville Regional Office.
Because of these concerns and others about the adequacy of
the underlying scientific evidence, VA does not support this
bill.
It is unclear exactly how many people were potentially
affected by the water contamination at Camp Lejeune, but some
estimates place the number at one million Veterans and family
members. VA estimates that the costs associated with this bill
are $292 million in fiscal year 2012, $1.6 billion over five
years, and $3.9 billion over ten years. In addition, the
Department anticipates that this legislation would result in
lost revenue associated with collections. VA estimates this
loss of revenue to be $19.5 million in fiscal year 2012, $110
million over five years, and $213 million over ten years.
* * * * * * *
On June 8, 2011, DOD submitted testimony for the record on,
among other bills, S. 277. Excerpts from this statement are
reprinted below:
STATEMENT OF THE U.S. DEPARTMENT OF DEFENSE
Chairman Murray, Ranking Member Burr, and members of this
distinguished Committee thank you for extending the invitation
to the Department of Defense to address pending legislation
that would significantly affect our Servicemembers [including]
S. 277, the proposed ``Caring for Camp Lejeune Veterans Act of
2011.''
* * * * * * *
s. 277
The Department does not support S. 277. S. 277 would
furnish hospital care, medical services, and nursing home care
implemented and funded by VA to veterans who were stationed at
Camp Lejeune ``while the water was contaminated,'' as well as
family members who accompanied them. As explained in testimony
by the Department of Veterans Affairs (VA), there is
insufficient medical evidence to support this approach.
In addition, the Marine Corps notes that this bill creates
inequities between veterans, family members, civilian
employees, and government contractors. Section 2(a) of S. 277
provides that veterans who were stationed at Camp Lejeune
during the applicable period (to be determined by the VA
Secretary in consultation with Agency for Toxic Substances and
Disease Registry) would be eligible for hospital care, medical
services, and nursing home care from the VA ``for any illness,
notwithstanding that there is insufficient medical evidence to
conclude that such illness is attributable'' to water that was
contaminated by volatile organic compounds (VOCs). Section 2(b)
of S. 277 states that family members of veterans who resided at
Camp Lejeune during the applicable time would be ``eligible for
hospital care, medical services, and nursing home care'' from
the VA for any condition or disability associated with exposure
to contaminants in the water. The legislation makes no
provision for civilian employees and government contractors.
* * * * * * *
Changes in Existing Law
In compliance with paragraph 12 of rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
S. 277 as amended, are shown as follows (existing law proposed
to be omitted is enclosed in black brackets, new matter is
printed in italic, and existing law in which no change is
proposed is shown in roman):
Title 10. Armed Forces
* * * * * * *
Subtitle A. General Military Law
* * * * * * *
Part IV. Service, Supply, and Procurement
* * * * * * *
Chapter 147. Commissaries and Exchanges and Other Morale, Welfare, and
Recreation Activities
* * * * * * *
Subchapter I. Defense Commissary and Exchange Systems
Sec.
[2481. Defense commissary and exchange systems: existence and purpose.]
2481. Commissary and exchange system: existence and purpose.
* * * * * * *
[SEC. 2481. DEFENSE COMMISSARY AND EXCHANGE SYSTEMS: EXISTENCE AND
PURPOSE]
SEC. 2481. COMMISSARY AND EXCHANGE SYSTEM: EXISTENCE AND PURPOSE
(a) [Separate Systems.--] In General.--The Secretary of
Defense shall operate, in the manner provided by this chapter
and other provisions of law, [a world-wide system of commissary
stores and a separate world-wide system of exchange stores. The
stores of each system] may sell, at reduced prices, food and
other merchandise to members of the uniformed services on
active duty, members of the uniformed services entitled to
retired pay, dependents of such members, and persons authorized
to use the system under chapter 54 of this title.
(b) [Purpose of Systems.--] Purpose of System.--The defense
[commissary system and the exchange system] commissary and
exchange system are intended to enhance the quality of life of
members of the uniformed services, retired members, and
dependents of such members, and to support military readiness,
recruitment, and retention.
(c) Oversight.--
(1) The Secretary of Defense shall designate a senior
official of the Department of Defense to oversee the
operation of [both the defense commissary system and
the exchange system] the commissary and exchange
system.
(2) The Secretary of Defense shall establish an
executive governing body to provide advice to the
senior official designated under paragraph (1)
regarding the operation of the defense commissary and
[exchange systems and to ensure the complementary
operation of the systems] exchange system.
(d) Construction of References.--Any reference in this
subchapter to a commissary store shall be deemed to be a
reference to a store operated under the single system of
commissary stores and exchange stores required by subsection
(a). Any reference in this subchapter to the defense commissary
system shall be deemed to be a reference to such system of
commissary stores and exchange stores.
(e) [(d)] Reduced Prices Defined.--In this section, the
term ``reduced prices'' means prices for food and other
merchandise determined using the price setting process
specified in section 2484 of this title.
* * * * * * *
Subchapter II. Relationship, Continuation, and Common Policies of
Defense Commissary and Exchange Systems
Sec.
[2487. Relationship between defense commissary system and exchange
stores system]
[2488. Combined exchange and commissary stores]
2489. Overseas commissary and exchange stores: access and purchase
restrictions
[SEC. 2487. RELATIONSHIP BETWEEN DEFENSE COMMISSARY SYSTEM AND EXCHANGE
STORES SYSTEM
[(a) Separate Operation of Systems.--
[(1) Except as provided in paragraph (2), the defense
commissary system and the exchange stores system shall
be operated as separate systems of the Department of
Defense.
[(2) Paragraph (1) does not apply to the following:
[(A) Combined exchange and commissary stores
operated under the authority provided by
section 2489 of this title.
[(B) NEXMART stores of the Navy Exchange
Service Command established before October 1,
2003.
[(b) Consolidation or Other Organizational Changes of
Defense Retail Systems.--
[(1) The operation and administration of the defense
retail systems may not be consolidated or otherwise
merged unless the consolidation or merger is
specifically authorized by an Act of Congress.
[(2) In this subsection, the term ``defense retail
systems'' means the defense commissary system and
exchange stores system and other revenue-generating
facilities operated by nonappropriated fund
instrumentalities of the Department of Defense for the
morale, welfare, and recreation of members of the armed
forces.]
[SEC. 2488. COMBINED EXCHANGE AND COMMISSARY STORES
[(a) Authority.--The Secretary of Defense may authorize a
nonappropriated fund instrumentality to operate a military
exchange and a commissary store as a combined exchange and
commissary store on a military installation.
[(b) Limitations.--
[(1) Not more than ten combined exchange and
commissary stores may be operated pursuant to this
section.
[(2) The Secretary may select a military installation
for the operation of a combined exchange and commissary
store under this section only if--
[(A) the installation is to be closed, or has
been or is to be realigned, under a base
closure law; or
[(B) a military exchange and a commissary
store are operated at the installation by
separate entities at the time of, or
immediately before, such selection and it is
not economically feasible to continue that
separate operation.
[(c) Operation at Carswell Field.--Combined exchange and
commissary stores operated under this section shall include the
combined exchange and commissary store that is operated at the
Naval Air Station Fort Worth, Joint Reserve Center, Carswell
Field, Texas, under the authority provided in section 375 of
the National Defense Authorization Act for Fiscal Year 1995
(Public Law 103-337; 108 Stat. 2736).
[(d) Adjustments and Surcharges.--Adjustments to, and
surcharges on, the sales price of a grocery food item sold in a
combined exchange and commissary store under this section shall
be provided for in accordance with the same laws that govern
such adjustments and surcharges for items sold in a commissary
store of the Defense Commissary Agency.
[(e) Use of Appropriated Funds.--
[(1) If a nonappropriated fund instrumentality incurs
a loss in operating a combined exchange and commissary
store at a military installation under this section as
a result of the requirement set forth in subsection
(d), the Secretary may authorize a transfer of funds
available for the Defense Commissary Agency to the
nonappropriated fund instrumentality to offset the
loss.
[(2) The total amount of appropriated funds
transferred during a fiscal year to support the
operation of a combined exchange and commissary store
at a military installation under this section may not
exceed an amount that is equal to 25 percent of the
amount of appropriated funds that was provided for the
operation of the commissary store of the Defense
Commissary Agency on that installation during the last
full fiscal year of operation of that commissary store.
[(f) Nonappropriated Fund Instrumentality Defined.--In this
section, the term ``nonappropriated fund instrumentality''
means the Army and Air Force Exchange Service, Navy Exchange
Service Command, Marine Corps exchanges, or any other
instrumentality of the United States under the jurisdiction of
the armed forces which is conducted for the comfort, pleasure,
contentment, or physical or mental improvement of members of
the armed forces.]
* * * * * * *
Title 38. Veterans' Benefits
* * * * * * *
Part II. General Benefits
* * * * * * *
Chapter 17. Hospital, Nursing Home, Domiciliary, and Medical Care
* * * * * * *
Sec.
SUBCHAPTER VIII. HEALTH CARE OF PERSONS OTHER THAN VETERANS
* * * * * * *
1786. Care for newborn children of women veterans receiving maternity
care.
1787. Health care of family members of veterans stationed at Camp
Lejeune, North Carolina, while the water was contaminated at
Camp Lejeune.
* * * * * * *
Subchapter II. Hospital, Nursing Home, or Domiciliary Care and Medical
Treatment
SEC. 1710. ELIGIBILITY FOR HOSPITAL, NURSING HOME, AND DOMICILIARY CARE
* * * * * * *
(e)(1)(A) * * *
* * * * * * *
(F) Subject to paragraph (2), a veteran who, as a member of
the Armed Forces, was stationed at Camp Lejeune, North
Carolina, during a period, determined by the Secretary in
consultation with the Agency for Toxic Substances and Disease
Registry, in which the water at Camp Lejeune was contaminated
by volatile organic compounds, including known human
carcinogens and probable human carcinogens, is eligible for
hospital care, medical services, and nursing home care under
subsection (a)(2)(F) for any illness, notwithstanding that
there is insufficient medical evidence to conclude that such
illness is attributable to such contamination.
Subchapter VIII. Health Care of Persons Other Than Veterans
* * * * * * *
SEC. 1787. HEALTH CARE OF FAMILY MEMBERS OF VETERANS STATIONED AT CAMP
LEJEUNE, NORTH CAROLINA, WHILE THE WATER WAS
CONTAMINATED AT CAMP LEJEUNE
(a) In General.--A family member of a veteran described in
subparagraph (F) of section 1710(e)(1) of this title who
resided at Camp Lejeune during the period described in such
subparagraph or who was in utero during such period while the
mother of such family member resided at such location shall be
eligible for hospital care, medical services, and nursing home
care furnished by the Secretary for any condition, or any
disability that is associated with such condition, that is
associated with exposure to the contaminants in the water at
Camp Lejeune during such period.
(b) Limitation.--The Secretary may only furnish hospital
care, medical services, and nursing home care under subsection
(a) to the extent and in the amount provided in advance in
appropriations Acts for such purpose.
(c) Regulations.--The Secretary shall prescribe regulations
that specify which--
(1) conditions are associated with exposure to the
contaminants described in subsection (a); and
(2) disabilities are associated with such conditions.
* * * * * * *
Part VI. Acquisition and Disposition of Property
* * * * * * *
Chapter 81. Acquisition and Operation of Hospital and Domiciliary
Facilities; Procurement and Supply; Enhanced-Use Leases of Real
Property
* * * * * * *
Subchapter I. Acquisition and Operation of Medical Facilities
* * * * * * *
SEC. 8111. SHARING OF DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF
DEFENSE HEALTH CARE RESOURCES
* * * * * * *
(f) Camp Lejeune.--(1) The Secretary of Defense shall enter
into an agreement with the Secretary of Veterans Affairs under
subsection (a) to reimburse the Secretary of Veterans Affairs,
from amounts appropriated to the Secretary of Defense, for the
costs of all hospital care, medical services, and nursing home
care provided under sections 1710(e)(1)(F) and 1787 of this
title.
(2) Costs described in paragraph (1) shall include
reasonable and customary charges associated with oversight and
administration of the care and services described in such
paragraph.
(3) The Secretary of Veterans Affairs may use the authority
provided under section 1781 of this title, or such other
existing discretionary authorities as the Secretary considers
appropriate, to arrange for care and services described in
paragraph (1).
(g) [(f)] Annual Joint Report.--
* * * * * * *
(h) [(g)] Definitions.--For the purposes of this section:
* * * * * * *