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2023 HSR&D/QUERI National Conference Abstract

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4109 — Women Veteran Marines and Exposure to Environmental Toxins: The Case of Camp Lejeune

Lead/Presenter: Frances Weaver,  COIN - Hines
All Authors: Weaver FM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital & Loyola University, Chicago), Cao L (CINCCH, Hines VA Hospital) Stroupe KT (CINCCH, Hines VA Hospital & Loyola University) Tanner C (University of California, San Francisco & VA San Francisco) Goldman S (VA San Francisco & UCSF)

Objectives:
The number of women who entered the armed services, completed their service and were discharged as US Veterans has grown significantly since the Vietnam era. Many of these women have been exposed to various toxicants as a result of their service, yet almost nothing is known about their exposure or subsequent health outcomes. One group for which information is lacking are women Veterans who were Marines stationed at Camp Lejeune, North Carolina where the water supplies were contaminated with cleaning solvents including trichloroethylene (TCE), perchloroethylene (PCE), and benzene. Eight conditions have been given presumptive status for service-connected disability due to this exposure including 7 cancer-related conditions and Parkinson’s disease. Objectives: To compare the characteristics and the prevalence of service-connected conditions in female Marines based at Camp Lejeune to a similar group of female Marine Veterans at Camp Pendleton who were not exposed to these toxicants.

Methods:
Women Veterans who were Marines stationed at Camp Lejeune, North Carolina or Camp Pendleton, California between 1975 and 1985 identified from the Agency for Toxic Substances and Disease Registry (ATSDR). Using a non-equivalent comparison group design, we examined VA files including the corporate data warehouse and the VETSNET disability compensation records, plus Centers for Medicare and Medicaid Services (CMS) claims files to characterize this cohort.

Results:
Results: 14,557 women Veterans spent at least 3 months at one of two Marine base camps. 50% (n = 7302) utilized any VA or Medicare health care between 2000-2021. Women from Camp Lejeune were more often black (30% v. 23%; p < .0001) and a larger percentage had used VA or CMS care (52% v. 47%, p < .05) than the women from Camp Pendleton. Women in the utilization cohort are currently about 60 years old, on average, with only 2% having served in combat. The large majority of women who utilized VA and/or CMS care have been evaluated for service-connected status (SC; 85%), with 37% of those evaluated having received a zero rating indicating that the disability existed but there was insufficient evidence for compensation. Ten percent had a SC rating of 100%; any SC rating for PTSD or migraine headaches were common and similar in both camps (26% and 21%, respectively). A review of the 8 presumptive conditions found small numbers of these conditions in both camps. The exceptions were malignant gynecological growths (2.75% v. 1.79%; p = .052) and for removal of uterus, ovaries or both, reason not specified, (7.29% v. 5.23%; p < .014) being higher in the Lejeune group.

Implications:
A significant proportion of female Marines were determined to have service-connected disabilities. SC disability related to gynecological surgeries and malignant growths may be associated with toxicant exposure at Camp Lejeune. Further examination of this relationship is warranted.

Impacts:
Little is known about military and environmental exposures in women Veterans and how it may have affected their health. These data suggest that women may have been adversely affected. Examination of other potentially associated conditions (e.g., breast cancer) is also needed to ensure appropriate care and compensation is provided to these women.