Study Finds Link Between Contaminated Drinking Water at Camp Lejeune and Increased Risk of Parkinson’s Disease

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Camp Lejeune, NC – A recent study in the Journal of the American Medical Association reveals that veterans and their family members exposed to contaminated water at Marine Corps Base Camp Lejeune have a 70% higher risk of developing Parkinson’s disease compared to other service members.

For years, the question of whether volatile organic compounds (VOCs) found in contaminated drinking water at Marine Corps Base Camp Lejeune up until the mid-1980s are associated with an increased risk of Parkinson’s disease has been a pressing concern. Neurologist Samuel Goldman, MD, MPH, has contributed to the limited human epidemiological evidence supporting a causal connection between the industrial solvent trichloroethylene (TCE) and Parkinson’s disease risk.

The recent study funded by the VA and published in JAMA Neurology adds to the growing body of evidence suggesting a link between TCE exposure in contaminated drinking water at Camp Lejeune and an increased risk of Parkinson’s disease. As the implications of this connection are significant for public health and military benefits, continued research and investigation into the relationship between contaminated water and Parkinson’s disease is crucial.

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The Connection Between TCE Exposure and Parkinson’s Disease

Goldman’s 2011 study of 99 discordant twin pairs found that exposure to TCE, the most common organic groundwater contaminant, was associated with a six-fold increased risk of Parkinson’s disease. However, the study’s findings required replication in other populations with well-characterized exposures due to the potential public health implications.

A decade later, the US Department of Veterans Affairs (VA) funded a new study, the results of which have been published in JAMA Neurology. The study focused on the contaminated drinking water at Camp Lejeune, which contained TCE, a known human carcinogen, tetrachloroethylene (PCE), a likely human carcinogen, and several other VOCs from 1953 to 1987. Monthly median levels of TCE in the base’s water supply were over 70 times the permissible amount.

Potential Exposure and Impact on Military and Civilian Staff

As many as one million military and civilian staff and their families may have been exposed to the contaminated water, according to the federal Agency for Toxic Substances and Disease Registry (ATSDR). Despite the limited human evidence, the VA has presumed since January 2017 that a diagnosis of Parkinson’s disease and seven other conditions, including six cancers, in former service members based at Camp Lejeune during the years of water contamination are service-related, entitling them to military benefits.

Goldman, a professor of medicine at the University of California, San Francisco Medical School and a staff physician at the San Francisco VA Medical Center, felt a personal responsibility to further investigate this issue due to the multibillion-dollar assumption based on his earlier twin study.

The ATSDR released a report in 2017 concluding that, based on a literature review of articles published through mid-2016, the evidence for a causal association between TCE exposure and Parkinson’s disease was “equipoise and above,” meaning the connection was at least as likely to be real as not.

Comparing Parkinson’s Disease Cases Between Two Military Bases

As part of the study led by Samuel Goldman, over 172,000 veterans stationed at Camp Lejeune in Jacksonville, North Carolina, and more than 168,000 at Marine Corps Base Camp Pendleton in Oceanside, California, were compared to examine the number of Parkinson’s disease cases and prodromal symptoms. Camp Lejeune had experienced contaminated drinking water, while Camp Pendleton did not. Health data was available for slightly over 158,000 veterans from January 1, 1997, to February 17, 2021.

The majority of the veterans were male, and on average, they spent around two years living at their respective bases between 1975 and 1985. This period saw the highest levels of volatile organic compound (VOC) contamination at Camp Lejeune. The veterans were around 20 years old when they first arrived at the bases.

Goldman’s team reported in JAMA Neurology that over three decades later, 279 veterans from Camp Lejeune and 151 from Camp Pendleton were diagnosed with Parkinson’s disease, resulting in a prevalence of 0.33% and 0.21%, respectively. In multivariable models, Camp Lejeune veterans had a 70% higher risk of Parkinson’s disease than those at Camp Pendleton.

Furthermore, among those without any diagnosis of neurodegenerative parkinsonism, living at Camp Lejeune was significantly associated with diagnoses of anxiety, tremor, or erectile dysfunction, all of which can be early indicators of Parkinson’s disease.

Briana De Miranda, PhD, an assistant professor of neurology and pharmacology and toxicology at the University of Alabama, who was not involved in the new study, called Goldman’s data “very strong” and said it has “been a long time coming.”

De Miranda noted that skepticism around the link between solvent exposure and Parkinson’s disease might have stemmed from the design of previous studies that lacked specificity regarding the actual chemicals involved.

Goldman pointed out the difficulty in studying specific solvents and emphasized that most prior research consisted of case-control studies that asked participants only if they had ever worked with a solvent.

This results of the study offers valuable data from a scientific perspective and may help reduce skepticism over the connection between solvent exposure and Parkinson’s disease.

The Widespread Solvent and Its Connection to Parkinson’s Disease

In March 2023, De Miranda coauthored an article with Goldman and others discussing the relationship between trichloroethylene (TCE) and Parkinson’s disease. They mentioned that well-known or easily identifiable causes and risk factors for Parkinson’s, such as specific genetic mutations and head trauma, only account for a small number of cases.

They proposed that TCE could be contributing to the more than doubling of Parkinson’s disease cases worldwide—from 2.5 million in 1990 to 6.1 million in 2016, according to a 2018 report—a growth that cannot be fully attributed to an aging population. The World Health Organization states that disability and death due to Parkinson’s disease are increasing faster worldwide than for any other neurological disorder.

De Miranda and Goldman’s article highlighted that TCE, used in various applications such as decaffeinating coffee, degreasing metal parts, and dry cleaning clothes, was first linked to parkinsonism in 1969. Parkinsonism is an umbrella term for neurological disorders that cause movement problems, the most common of which is Parkinson’s disease.

Case reports of idiopathic Parkinson’s disease in individuals with occupational TCE exposure prompted studies in animal models. Goldman noted, “When we give this stuff to rats, they get a movement disorder.” The damage in rats occurs specifically in the brain structure called the substantia nigra, mirroring what happens in Parkinson’s disease patients. This finding motivated their study in twins.

Due to TCE’s carcinogenic effects, the European Union has required companies to obtain government authorization for its use for the past decade. However, only Minnesota and New York have banned most uses of TCE in the United States.

Exposure to TCE isn’t limited to those who work with the chemical, as it also pollutes outdoor air and contaminates indoor air and groundwater. Like radon, TCE evaporates from soil and groundwater, entering buildings undetected. De Miranda and Goldman described seven cases in their March article where TCE may have contributed to an individual’s Parkinson’s disease.

One of these cases involves former National Basketball Association player Brian Grant, who was diagnosed with early-onset Parkinson’s disease in 2008 at age 36. Grant’s father, a Marine, moved the family to Camp Lejeune when Brian was three years old, around the time of peak TCE levels in drinking water. Grant later established a foundation to support people with Parkinson’s disease. His father passed away at age 65 from esophageal cancer, which has been linked to TCE exposure.

Monitoring the Affected Troops

Although the elevated TCE exposure levels at Camp Lejeune are well-documented, the precise identities of those exposed remain unknown.

Goldman observed that the VA maintains prospective cohorts for certain exposures, such as Agent Orange and Gulf War cohorts. However, there is no specific Camp Lejeune cohort, making it challenging to study this group due to the absence of a comprehensive enumeration.

Nonetheless, ATSDR supplied Goldman’s team with data on Marines and Navy personnel stationed at Camp Lejeune or Camp Pendleton between 1975 and 1985. This time frame was selected due to the peak contamination at Camp Lejeune and because the Defense Manpower Data Center file lacked information on military unit locations until April 1975.

The data served as the foundation for a 2014 ATSDR study that compared mortality rates between Camp Lejeune and Camp Pendleton Marines. By the end of the study’s follow-up period in 2008, there were insufficient Parkinson’s disease-related deaths to compare the two bases’ mortality rates.

Frank Bove, SciD, a senior ATSDR epidemiologist and the 2014 study’s first author, noted that examining mortality is not an effective method for assessing Parkinson’s disease unless the subjects are quite elderly. Bove and his colleagues are currently analyzing mortality rates through 2018, a decade longer than the period covered in their 2014 study.

Bove highlighted that Goldman’s team had access to comprehensive clinical data from the VA, allowing them to evaluate Parkinson’s disease incidence and clinical features. This approach, Bove said, is more effective for examining Parkinson’s disease than relying solely on mortality data.

However, Goldman acknowledged that his team lacked information on the service members’ specific TCE exposure levels during their time at Camp Lejeune and beyond. He explained that water distribution on the base varied over time and season, and individuals in certain roles might have experienced additional occupational exposure. Details about TCE exposure in the veterans’ civilian lives also remain unknown.

Determining If You’re Eligible For VA Disability Compensation

According to th VA, you may be eligible for disability compensation payments on a presumptive basis if you meet all of these requirements. These requirements apply to Veterans, Reservists, and National Guard members.

Both of these descriptions must be true:

You served at Camp Lejeune or MCAS New River, North Carolina, for at least 30 days total between August 1, 1953, and December 31, 1987, AND
You didn’t receive a dishonorable discharge when you separated from the military

And you must have a diagnosis of 1 or more of these presumptive conditions: