Hepatic SteatosisThe term hepatic describes a condition that is related to the liver. Hepatic steatosis is another name for fatty liver disease. The Cleveland Clinic's Fatty Liver Disease page explains that non-alcoholic fatty liver disease (NAFLD) develops when your liver begins storing too much fat. Obesity, type 2 diabetes, insulin resistance, metabolic syndrome, and other circumstances can cause this condition. Researchers investigating Camp Lejeune water contamination also found that vinyl chloride can cause hepatic steatosis (NAFLD.) Sometimes, when you make the lifestyle changes your doctor recommends, your liver's regenerative ability restores it to normal. In other situations, the disease triggers a series of worsening pathologies.
- Fat accumulation (steatosis)
- Inflammation and swelling
- Non-alcoholic steatohepatitis (NASH), chronic inflammation
- Cell damage
- Fibrosis (scar tissue formation)
- Cirrhosis (extensive scarring)
- Hepatocellular carcinoma
Hepatic Steatosis SymptomsDuring hepatic steatosis' initial stages, most people experience no symptoms. If it progresses to cirrhosis, symptoms sometimes include:
- Abdominal pain in the upper right abdomen
- A feeling of fullness in the upper right abdomen
- Jaundiced (yellow) skin or eyes
- Loss of appetite and weight loss
- Leg and abdomen swelling
- Fatigue and weakness
Diagnosing Hepatic SteatosisSince hepatic steatosis typically shows no early symptoms, doctors usually detect the condition while testing blood for a different reason. If they find elevated liver enzymes, it is an indication that you might have a liver disorder. These additional procedures help confirm the diagnosis.
- CT Scan
- Liver Biopsy
- Fibroscan (a biopsy alternative that measures liver fat and scar tissue)
TreatmentDoctors have no approved medications for hepatic steatosis treatment. The National Institute of Diabetes and Digestive and Kidney Diseases shares information on current NAFLD and NASH clinical trials. In most instances, physicians recommended lifestyle changes to promote healing and minimize the risk of disease progression.
- Weight Loss
- Diet Changes (less sugar, fat, alcohol,
- Lower cholesterol and triglycerides
- Diabetes Management
Vinyl Chloride and Hepatic SteatosisAfter years of study and evaluation, researchers acknowledged how vinyl chloride became one of many contaminants in Camp Lejeune's water supply. As explained by the Agency for Toxic Substances and Disease Registry, vinyl chloride and 1,2-dichloroethylene (DCE) sometimes form as byproducts of trichloroethylene (TCE) and tetrachloroethylene (PCE) degradation. The Environmental Protection Agency describes these and other contaminants as volatile organic compounds (VOCs.)
Water ContaminationThe EPA, ATSDR, and other investigating organizations often listed the off-base dry cleaning plant as the primary polluter. An early 1985 confirmation study and a more recently posted ATSDR Camp Lejeune Morbidity study acknowledge contaminants from a broader range of sources. Both list the dry cleaning plant as a major polluter. The morbidity study and other reports describe contamination from these and other on-base activities.
- Leaking underground storage tanks
- Industrial area spills
- Waste disposal sites releasing fuel
- Chlorinated solvents
Camp Lejeune Water Treatment and Distribution PlantsInvestigations confirmed contamination at the three distribution centers supplying water to family housing and other areas throughout the base. An assessment completed by ATSDR in 2017 showed contamination at the Hadnot Point and Tarawa Terrace water distribution facilities. The Base shut down the Halcomb Boulevard facility in early 1985. Some reports refer to these facilities as water distribution systems, while others call them treatment plants. This distinction is important as researchers found contaminants even in treated water.
United States Maximum Contaminant LevelsWhen researchers conducted water testing at the base, the US/EPA had not yet established maximum contaminant levels (MCLs). The standards listed in the ATSDR's assessment report were current when they published it in 2017. The EPA measures contamination based on milligrams per liter (mg/L) or parts per million (ppm). The data, as reported, assists in understanding the degree of contamination. These maximum contaminant levels were in effect when ATSDR published its 2017 assessment.
- TCE: 5 parts per billion, effective 1989
- PCE: 5 parts per billion, effective 1992
- Vinyl Chloride: 2 parts per billion, effective 1989
- Benzene: 5 parts per billion, effective 1989
Hadnot Point Distribution/Treatment PlantThe Hadnot Point facility became operational in 1942. It provided water to the base's main areas, including the Mainside barracks. It also served four family housing areas: Hospital Point, Midway Park, Paradise Point, and Berkeley Manor. When the base opened the Halcomb Boulevard plant in June 1972, it assumed water distribution for Midway Park, Paradise Point, and Berkeley Manor. Researchers speculate that Hadnot Point Distribution system water remained contaminated since the 1950s. Studies conducted in 1982, 1984, and 1985 documented high contaminant levels for TCE and PCE. In 1982 researchers confirmed a TCE water contamination level of 1,400 parts per billion. They detected but did not measure vinyl chloride and benzene during these tests. A 2017 assessment estimates a 22 parts per billion median monthly average vinyl chloride contamination from 1975 to 1985.
Tarawa Terrace Distribution/Treatment PlantThe Tarawa Terrace facility provided water for the Tarawa Terrace residential area and the Knox Trailer Park. When tested in 1982, the water showed high contamination levels for PCE. They also detected benzene and vinyl chloride but did not measure the levels. Researchers estimate the median monthly average vinyl chloride contamination at the Tarawa plant was 6 parts per billion from 1975 to 1985.
Halcomb Boulevard PlantThe 2017 assessment of evidence does not address the Halcomb Boulevard water treatment plant. Beginning in1972, it supplied water to base family housing areas: Midway Park, Paradise Point, Berkeley Manor, and Watkins Village. The base closed this facility in early 1985. The ATSDR website notes that the Halcomb Boulevard wells were “...generally not contaminated...” The Hadnot Point facility began supplying contaminated water to housing areas the Halcomb Boulevard plant served before shutting down. The Hadnot Plant supplemented Halcomb's water to meet high summertime demands from 1972-1985.
Up to One Million People Exposed to ContaminantsContaminants at Camp Lejeune may have affected up to one million people. The total includes military personnel, families, workers, young children, pregnant women, and babies in utero. Anyone who lived or worked on the base from 1957 to 1985 came into contact with toxic contaminants. The base did not test for contamination or consider eliminating the toxins until the early 1980s. When scientists consider the potential for contamination-related medical issues, they look at several factors. These include the person's profile: pregnancy, infancy, in utero, and personal habits. They consider whether exposure involved water, soil, plants, or air. They also look at the degree of exposure and the length of time exposed. One assessment projected a typical Marine's exposure based on the amount of contaminated water they likely consumed while living on the base.
- Six liters of water per day, three days a week, while in training
- Three liters a day during the rest of the week
- One to two quarts of water per hour during warm weather
- Water used while showering, usually twice a day
- Water provided in the field, likely from the Hadnot Point water system
Camp Lejeune Is an EPA Superfund SiteDue to its extensive contamination, the EPA prioritized Camp Lejeune cleanup by designating it a Superfund Site. The base is also on the National Priorities List For Uncontrolled Hazardous Waste Sites. The EPA completed a remediation plan that divided the base into 26 separate “operable units.” They established the units according to proximity, types of waste, and operations. Each unit required specific remediation plans that accomplished the following.
- Remove contaminated soil, underground drums, storage tanks, batteries, waste liquids, and dense nonaqueous phase liquid
- Remove above-ground storage tanks
- Develop a groundwater treatment system
- Install a bio-treatment cell for contaminated soil
- Complete soil VOC heat extraction
- Set controls for groundwater monitoring
A Long Fight for JusticeIf you are a former Camp Lejeune Marine, a family member, or a civilian worker, you might already know about the battle for fair treatment. People of all ages developed delayed onset illnesses. Newborn children died, and rare diseases sickened older children. Still, the USMC remained silent about known contamination issues. When former Marines finally learned that contaminated water caused so much sickness and death, they began fighting for justice. Former Marines wrote letters to members of Congress and testified in a Congressional hearing. They appeared on the news, and their cause inspired a documentary. Former Master Sergeant Jerry Ensminger spent hours conducting research. He published USMC contamination-related documents that were otherwise unavailable to the public.
Camp Lejeune LitigationFormer Marines began filing lawsuits to recover compensation. A federal judge consolidated all of the individual lawsuits. Eventually, the court dismissed the multidistrict litigation. As the injured parties were neither exposed to the contamination nor manifested their injuries within ten years from their filing date, the North Carolina Statute of Repose prevented them from making a claim.
Congress Ultimately Took ActionIn response to ongoing activism, Congress passed legislation to support and assist veterans, their families, and Camp Lejeune's civilian workers.
Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012: Public Law 154Public Law 154 includes provisions from H.R. 1742, the Janey Ensminger Act of 2012. The original sponsor named the Ensminger Act after a little girl who died from leukemia related to Camp Lejeune contamination. The bill approved Veterans Administration benefits for people who lived on the base for a minimum of 30 days from January 1, 1957, to December 31, 1987. The bill lists Hepatic steatosis and 15 other conditions for which the VA requires no proof if you can prove residency according to the specified conditions. The law includes a copay waiver, nursing home expenses, telemedicine costs, and other medical benefits.
Honoring our PACT Act of 2022President Biden signed the Honoring our PACT Act into law on August 10, 2022. The bill includes the Camp Lejeune Justice Act of 2022. It removes the conditions that barred Marines, families, and workers from filing lawsuits for contamination-related injuries. The law includes several important provisions.
- Waives statute of limitations and repose and allows injured parties to file for delayed illnesses related to contamination.
- Prevents the United States from pleading immunity.
- Sets the United States District Court for the Eastern District of North Carolina as the sole jurisdiction for Camp Lejeune cases.
- Bars punitive damage claims.
- Establishes that settlements must deduct previously-paid Veterans Administration, Medicare, or Medicaid benefits for contamination-related illnesses.