Wednesday, September 21, 2011

Steamed

Pissed off and right.... you really, really don't want me in that condition. Unfortunately, that's where I find myself, now. I recently got ahold of the initial results of my compensation and pension exams, and I've got to say, I've very rarely been quite this incensed.
The short version of their findings is: "You don't have any significant issues, and even if you did, we didn't do it." Wrong answer, buddy. The examinations in question were completely screwed up, and in several cases, the examiner simply assumed information that was completely incorrect, in effect falsifying information to provide answers that were more favorable to their side of the table. Seriously not good juju, there.
So, basically, I've been spending the last couple of days working with my local rep and putting together an appropriately scathing and articulate response, and gathering evidence that my issues have been acknowledged as probable effects of the toxin exposure I received in Japan, including some fun internal direction to the C&P department specifically on this subject. If you'd like a better idea of exactly what's going on, I've included the full text of my latest statement below, along with links to the evidence I'm submitting.
Also, as a special "treat" of sorts, I happened across a couple of videos that someone shot of the residential complexes on Atsugi while the incinerator was still in operation. Here they are, if you're curious as to what Jessie and I were living in for a couple of years, especially during the half of the year that winds directed the smog directly to us.

The good news is that my new nurse practicioner seems to be significantly better than my last one, and I've got a number of tests scheduled over the next few months that might help me lock down what's actually wrong a little better.

Joshua ********** – Reference – ********** – File # ********** - Statement in Support of Claim 2
(As dictated to, edited, and organized by Eden **********) September 19, 2011
As my ongoing symptoms of migraine and associated secondary effects have continued to worsen over the past several months, I recently requested a copy of my VA medical health record since March of this year, so that I might provide these reports as additional supporting evidence for my disability claim. Among the reports provided were copies of my Compensation and Pension benefit exams, and I must say that I was dismayed, insulted, and incensed by the opinions given, as well as the manner in which these examinations were given (rushed, incomplete, and in some cases, information/answers assumed by the examiner without bothering to ask relevant questions). Further, I wish to take this opportunity to respond to those opinions and to provide further evidence as appropriate prior to the VA rendering an initial decision on my case, so as to avoid the delay and expense that might be incurred by necessitating an appeal to that decision if it were to be based on these opinions alone.
Firstly, I would like to address a number of discrepancies and note a few items in the two records provided to me. Enclosure #1 is my Navy Medical Record, as provided to me upon discharge. I’d like to note that my separation physical was provided by a pharmacy assistant (as noted on Page 12, 23Oct00), rather than an actual physician, and thus may be considered somewhat suspect in thoroughness. When I left Japan (as noted on page 14, 18Jan00), more frequent colds, sinus congestion, and a pattern of progressively decreasing health were documented already, although my symptoms hadn’t increased to the debilitating level that they have assumed in recent years. Pages 15-19 document that I had been given Health and Environmental Fact Sheet, NAF Atsugi #1 (included as Enclosure #3) as part of the move to on base housing with my first wife, Jessie. I should point out that this move was not optional, and was in fact required as soon as space in on base housing opened up – at no point was an alternative to on base housing made available to service members expressing concern over these environmental issues, and the potential effect of those issues was verbally minimized in every possible way by housing personnel. Additionally, my wife and I were located in building 3056, just over 500 meters from the incinerators in question, and thus had very high exposure to the pollutants throughout our time there.
Pages 10, 13, and 22 document the decrease in hearing acuity that I suffered over my term of service. Pages 13, 23-25, and 75-76 document the skin irritation and psoriasis that developed during this time. Pages 14. and 75-76 document the increased breathing difficulty and bloody nasal discharge over the same period. Conspicuously missing are records of the half dozen or so visits to the doctor that I had documenting intervals of increased blood pressure and dizziness/tingling in the extremities during my service in Japan (the headaches that I currently suffer had not increased to catastrophic level at this time, and thus were attributed to this blood pressure increase). I would like to request that copies of my original medical records from NAF Atsugi and CTF 72 Kami Seya be obtained to provide records of these incidents.
Enclosure #2 is my VA Medical Record, as printed electronically on September 14th, 2011. Pages 44 and 49 both list my habits as drinking rarely; in point of fact I have not drunk alcohol since April of this year, at which point I was asked to discontinue my already infrequent alcohol use so as to avoid additional stress on my system. Pages 24, 64, 67, 70, 73, 76, 79, 83, 86, 88, 91, 94, 97, and 101 all indicate that Topirimate is in current use at the time of respective examinations; this was discontinued on 8/01/11. Page 26 indicates that my mother has dementia and that I had lost 10 lbs; it is my maternal grandmother that had dementia, and I had lost 23 lbs at that point. Page 130 lists ADHD as being symptomatic since childhood; this is incorrect – in fact symptoms have only been present since my military service, and I was not diagnosed as having ADHD until 2006 by Dr. Julien ********** of the Corvallis Clinic in Oregon.
Pages 104-111 are the findings of Dr. Dillon on 8/15/11 for my mental health evaluation for compensation and pension. I disagree with his findings on several specific points. I do, in fact, agree with at least part of his statement on page 105, "...Mr. Byram's depression (including memory gaps) is more likely than not caused by his headaches.", and will in fact state unequivocally that my current depression revolves entirely around my migraines and associated symptoms; I would regard my depression as a secondary symptom of same. As to my memory issues, it is unclear to me how much of that issue is directly related to the headaches and how much is a tertiary symptom created by said depression, or if in fact this is an unrelated symptom created through my toxin exposure at Atsugi.
On page 107, Dr. Dillon selected the response: "Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine, self-care, and conversation." – I would more accurately characterize my situation with this response, found on the same page: "Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood." He also states that "The veteran's occupational and social impairment is due to his psychological distress/depression." – I disagree with this wholeheartedly. My difficulties with school, work, and social life revolve entirely around my migraines, the inactive time required by them, the difficulty in thinking during an attack, lack of concentration and distraction provided by the severity of the pain and secondary effects, as well as the unpredictability of their pattern. Currently, my symptoms have increased to the point that I have migraines lasting 8-12 hours daily, incurring extreme pain, nausea, dizziness, and provide extreme sensitivity to light and sound as well as visual and spatial distortion. Friends and family have noted an increase in my general irritability, a decrease in logical thinking, and a general depressive mood, typified in the most extreme cases by some level of suicidal ideation during the most severe periods. Onset of symptoms has become both rapid and erratic, causing me to have to forgo driving for myself if at all possible since June of this year.
When I was laid off in 2009, part of the reason that I chose not to return to the workforce and instead attempt to change career fields by going back to school was as a delaying strategy to decrease the level of activity required of me from day to day in response to the increasing severity of my symptoms at that time. I had hoped to find some combination of medicine and/or avoidance of triggering effects that might allow me to decrease the impact of these issues. Instead, symptoms have only worsened since that point, eventually leading to a decision to withdraw from school in June of this year. Eventually, I came to the realization that further time at school at this level of medical control would only serve to increase my debt in terms of school loans without providing significant educational benefit.
On page 109, Dr. Dillon typifies my memory issues as: "Mild memory loss, such as forgetting names, directions, or recent events" – I would argue that the selection of "Impairment of short and long term memory, for example, retention of only highly learned material, forgetting to complete tasks", found on the same page, would be more accurate. At this point, nearly all of my memories of times before the last year or so is missing, and is only able to be mildly prompted by photos and letters from those years. The three years that I had with my first wife, Jessie, are almost entirely gone, and in point of fact, I have great difficulty in even being able to call her to mind. More recent events are, at best, blurry and indistinct, retaining only the most general outlines of experience. Insofar as short term memory is concerned, my daily life has become almost entirely dependent upon electronic alarms and aids, such as writing notes to myself for nearly any issue or concern via my mobile phone, as well as prompting by those around me.
Pages 133-153 are the findings of Dr. Tuna on 6/30/11 for my physical health evaluation for compensation and pension. While I do disagree with several of his findings, and will speak to this further later, the most concerning and immediate issue that I would like to address is that several sections of questions were skipped outright during the interview and simply marked as negative. I would like to address those here. On page 136-138, the sections “Genitourinary ROS” and “Abdominal/Gastrointestinal ROS” were skipped entirely and marked negative.
For Genitourinary ROS, I was not asked if there was a history of abnormal flow, urgency, dysuria, hesitancy, testicular pain, scrotal mass, erectile dysfunction, genital lesions, urethral discharge, flank pain, hematuria, stones, urinary frequency, nocturia, urinary incontinence, dialysis, obstructive voiding, repetitive urinary infection. Accordingly, hesitancy and erectile dysfunction are currently marked as negative and should instead be positive.
For Abdominal/gastrointestinal ROS, I was not asked if there was a history of nausea, vomiting, diarrhea, constipation, indigestion, heartburn, hemmoroids, hernia, abdominal mass, abdominal swelling, regurgitation, jaundice, fecal incontinence, post-prandial symptoms, dysphagia, hematemesis, melena, pancreatitis, gallbladder attacks, abdominal pain. Accordingly, nausea, vomiting, heartburn, gallbladder attacks, and abdominal pain are all currently marked as negative and should instead be positive.
On page 138, under Psychiatric ROS, history of speech difficulty, memory problems, and sleep impairment are all currently marked negative and should be positive. I often experience aphasia during migraine attacks, have extensive memory issues as indicated above, and currently experience both insomnia and night terrors. Both page 144 and 147 indicate that I was currently in school at the time of examination, when in fact I had already stopped going to school. Page 145 indicates no history of dizziness, which should instead be positive. Page 149 currently indicates migraine frequency during the past 12 months as “weekly”, which should be “daily”.
Page 150 asks for the effects on usual occupation and resulting work problem, to which Dr. Tuna responded: "difficulty concentrating at work when migraines occur". This is grossly understated, in my opinion, as is the response to "Are there effects of this problem on normal activities?” which is simply “No.” I must admit that I am simply stupefied as to how this is selected as the appropriate response when I am unable to make significant long term plans due to the unpredictability of my issues, am forced to spend many days simply waiting in the dark for the current attack to pass, and must currently be considered unemployable due to the sheer volume of time in which I would be unable to perform job related tasks. In point of fact, many short term trips (to the store and such) have had to be aborted due to rapid onset of symptoms without warning shortly after leaving the house. Quite apart from the “normal” level of discomfort and incapacitation that I have been experiencing up to this point, the severity of my symptoms has continued to accelerate, to the point that I was forced to seek care through the emergency department on 6/28/11 at Southwest Washington Hospital, as well as the Portland VA emergency department on 7/1/11, 8/18/11, 8/21/11, 8/22/11, and 9/08/11. I have also had increasing experiences with migraines lasting multiple days without break.
On page 151, Dr. Tuna states “The condition/disability headaches/migraines is not caused by or a result of service (and/or exposure to environmental toxins). Rationale for opinion given: No medical documentation of headaches/migraines in service (in fact veteran uniformly responded ‘no’ to headaches in all health questionnaires in service). No basis in medical fact to assert environmental toxin exposure resulted in headaches/migraines.” As indicated previously in this response, several records of medical visits documenting intervals of increased blood pressure and dizziness/tingling in the extremities during my service in Japan are missing, and my headaches at that time were within a range that were attributed to this increase in blood pressure, rather than being a symptom on their own. Insofar as these not being related to environmental toxins, I would refer you to enclosure #5, Page 23, and enclosure #9, page 3and 7, which outline headache/migraine associated with exposure. Enclosure #15 specifically indicates that among the toxins personnel were exposed to, carbon tetrachloride, cadmium, chloroform, mercury, trichlorethene, vinyl chloride, and 1,3-Dichloropropene are known to cause headache/migraine.
Also on page 151, Dr. Tuna states “The condition/disability pain due to light sensitivity (causing migraines) is not caused by or a result of service (or environmental toxin exposure). Rationale for opinion given: The only light sensitivity noted in the SMR’s was secondary to a single episode of acute conjunctivitis, which resolved. The conjunctivitis was likely the cause of both the ‘pain’ and ‘light sensitivity’ noted. No subsequent light sensitivity is documented, and none is associated with headaches or pain. There is no basis in medical fact to assert that environmental toxin exposures have resulted in pain due to light sensitivity.” I am not entirely sure as to why this is broken out as separate from my migraines, but my initial headaches were mild enough and infrequent enough that I did not experience or associate light sensitivity with my migraine symptoms until some years after my military service, nor was visual aura prominent enough to be identified as an ongoing symptom.
On page 152, Dr. Tuna states “The condition/disability chronic bloody discharge from the nose is not caused by or a result of service (including exposure to environmental toxins) Rationale for opinion given: Normal nose exam, no medical documentation of any bloody noses. The veteran repeatedly responded ‘no’ to medical questionnaires asking about any nose problems, while in service. There is no basis in medical fact to assert that toxin exposures have caused chronic bloody noses.” This is inaccurate; Pages 14, and 75-76 of my Navy medical record document the increased breathing difficulty and bloody nasal discharge I experienced during my time in Japan. Insofar as these not being related to environmental toxins, I would refer you to enclosure #3, Page 2, enclosure #5, Page 23-24, and enclosure #9, page 3 and 7, which outline breathing issues associated with exposure. Enclosure #15 specifically indicates that among the toxins personnel were exposed to, arsenic, beryllium, cadmium, nitrogen dioxide, particulate matter, sulfur dioxide, vinyl chloride, 1,2-Dichlorethane, 1,2-Dichloropropane, and 1,3-Dichloropropene are known to cause respiratory issues.
Also on page 152, Dr. Tuna states “The condition/disability psoriasis L pre-tibial area is at least as likely as not (50/50 probability) caused by or a result of service. Rationale for opinion given: SMR’s appear to support the diagnosis of psoriasis in the same area identified on exam today. The total amount of skin involvement appears stable or less than initially reported years ago.” This is only somewhat inaccurate, as the psoriasis initially appeared on the upper surface of my left foot and occupied an area approximately half the size of the current area. Pages 13, 23-25, and 75-76 of my Navy medical record document the skin irritation and psoriasis that developed during my enlistment. Insofar as this being related to environmental toxins, I would refer you to enclosure #3, page 7, enclosure #5, page 7 and 23, enclosure #8, page 2 and 12-13, and enclosure #9, page 3 and 7, which outline skin issues associated with exposure. Enclosure #15 specifically indicates that among the toxins personnel were exposed to, arsenic, cadmium, carbon tetrachloride, trichlorethelene, 1,2-Dichlorethane , 1,2-Dichloropropane, 1,3-Dichloropropene, and 2,3,7,8-tetrachlorodibenzo-paradioxin are known skin irritants. In addition to the symptoms specifically discussed in Dr. Tuna’s stated opinions, the nausea that was skipped over in the questionnaire is indicated as a known issue in enclosure #5, page 24, and enclosure #9, page 3 and 7, which outline nausea as one of the symptoms associated with exposure. Enclosure #15 specifically indicates that among the toxins personnel were exposed to, arsenic, cadmium, carbon tetrachloride, chloroform, mercury, trichlorethene, and 1,2-Dichlorethane are known to cause nausea.  Also skipped over were symptoms of vomiting, which are specifically indicated in enclosure #15 as potentially caused by cadmium, carbon tetrachloride, trichlorethelene, and 1,2-Dichlorethane, among the chemical toxins personnel were exposed to.
Additional symptoms experienced during or associated with these migraine attacks but not mentioned by the questionnaire are chest pain/angina (mentioned as a potential effect in enclosure #9, page 3, and acknowledged as potentially caused by exposure to beryllium and mercury in enclosure #15), anosmia (acknowledged as potentially caused by exposure to camium in enclosure #15), depression (acknowledged as potentially caused by exposure to chloroform in enclosure #15), dizziness (acknowledged as potentially caused by exposure to carbon tetrachloride, chloroform, trichlorethelene, vinyl chloride, 1,2-Dichloropropane, and 1,3-Dichloropropene in enclosure #15), irritability (acknowledged as potentially caused by exposure to chloroform in enclosure #15), insomnia (acknowledged as potentially caused by exposure to lead and mercury in enclosure #15), along with memory, concentration, confusion, and attention issues (acknowledged as potentially caused by exposure to mercury and trichlorethelene in enclosure #15).
Finally, also on page 152, Dr. Tuna states "Due to the veteran being an unreliable historian, it would be mere speculation to comment on unemployability due to migraine headaches. These headaches do not appear to be service connected in any event." I would respond that I have been as faithful a historian as has been practical under the circumstances, and have given the VA access to all available medical records, given my infrequent medical coverage over the years. The catastrophic effect of these migraines on my employability should be self evident, and the connection of these migraines with my service in Japan should be considered to be well proven, as they are listed as a known effect in several of the attached enclosures, and the latency period of associated symptoms is well documented.
Thus far, my experience with the VA health system has been haphazard at best, with some physicians providing excellent, informed service, and others simply seeming content with barely going through the motions. An example would be the experience that I have recently had with the nurse practioner initially assigned as my primary care giver. While her support staff seemed both eager and adequate, over the six months that I was officially under her care, I spent a total of 45 minutes speaking with her, the bulk of which occurred during my intake interview. Calls for follow up care following ER visits and repeated requests for referral to specialist(s) and additional testing were simply ignored, finally culminating in a necessary request for reassignment to another provider. My current referral to a staff neurologist actually came through the emergency department, after having been berated again during my third visit of the week for not following up with more qualified personnel.
Currently, I am experiencing extremely painful migraines lasting 6-8 hours per session, usually twice per day, and often punctuated by vomiting triggered by the sheer level of pain experienced during intermittent spikes of severity. Secondary effects concurrent with these attacks include dizziness, nausea, confusion, aphasia, aura, visual distortion, light and sound sensitivity. I spend a significant amount of time simply lying in the dark, trying desperately to avoid any additional stimulus that might further aggravate my symptoms, compromising my ability to participate social or productive activities, much less employment. I have also recently begun experiencing periods of crushing chest pain/angina lasting between 5-90 minutes per attack, and have experienced over a dozen of these attacks over the past two months. I’ve had insomnia for years now due to the pain interfering with sleep patterns, and have intermittent night terrors, especially during periods where I pass out while still in pain.
Frankly, at this point I’m very concerned about my situation. I’m scared that the pace and severity of these issues will continue to accelerate, and that further issues associated with my time in Atsugi will continue to surface. The extreme latency of known issues means that I will not likely know all of the long term effects for decades to come. I’m concerned for my fellow service members, who may not be aware of the health issues that have been incurred by their service alongside me in Japan. If it were not for the current severity of my own issues, I myself would not have known of the connections between the smog that bathed our housing units daily and the illnesses I have now, nor would I have known that I was entitled to care through the VA, as I found out last year.
At the time, the command made almost no effort to disseminate information, and minimized any potential risk verbally, despite multiple investigations into health risks and ongoing complaints issued to both the Japanese government and the Shinkampo operators. The sum total of guidance offered to me and my wife was a single 2 page flyer (Enclosure #3) outlining minor short term respiratory issues and a nearly infinitesimal potential increase in cancer rates for a very long length of exposure. We certainly weren’t made aware of the 240+ toxins found during these investigations, nor the additional known diseases and effects likely to be caused by exposure to these. In addition, neither myself nor any of these shipmates that I maintain contact with were contacted about these issues after our period of service in Japan, despite a directive to establish a registry of affected service members.
Further, I’m concerned about the long term effects of this on my mental status. My first wife, Jessie, had numerous health issues during her stay on base, including migraine, bronchitis, depression, and endometriosis, all of which only worsened as her time on Atsugi lengthened. She was driven to attempt suicide twice, and finally passed away in early 2001. I find myself scared that my own path will eventually follow hers, and that I will lose control of my faculties. The progress of my issues has gotten bad enough that my family have become scared of my actions during an attack, and my wife has asked that I carry her information on a prominent and easily accessible card so that she may be contacted if I am incapacitated.
In conclusion, I would invite the VA to examine the enclosed documentation, much of which was generated by the Atsugi command or under direction from the command. If more in depth C&P examinations are required, I will willingly make myself available for the appropriate testing, but would hope that the experience of having my responses to questions about my medical history simply being assumed to be negative without actually being asked would not be repeated. Thank you for your time,
Sincerely,
Josh *******
I hereby certify that the information I have given is true to the best of my knowledge and belief.
Signed 9/20/11 _______________________

Enclosures: Enclosure #1, Navy Medical Record, Joshua A. Byram, 1995-2000, 80 pages [Purpose of inclusion: To provide a complete record of my navy medical history, as given to me]
Enclosure #2, VA Medical Record, Joshua A. Byram, March 7, 2011-September 14, 2011, 200 pages [Purpose of inclusion: To provide a complete record of my VA medical history since joining the VA system on March 7, 2011]
Enclosure #3, Health and Environmental Fact Sheet #1, 3 pages (retrieved from: http://www-nehc.med.navy.mil/downloads/ep/Atsugi/FACTSHT1.pdf) [Purpose of inclusion: To illustrate the sum total of health information offered to myself and my wife upon being moved to on base housing]
Enclosure #4, Compensation and Pension Service Bulletin – October 2009, 8 pages (Excerpt, pages 1-2, retrieved from: http://www.atsugi-incinerator-group.com/CP_Bulletin_Oct_09.pdf?attredirects=0) [Purpose of inclusion: To direct Compensation and Pension personnel to their own internal guidance on this issue]
Enclosure #5 - US DOJ Petition from RADM Haskins on 22Aug97 to Governor Kanagawa.pdf, 28 pages (retrieved from: http://sites.google.com/site/srpusmc/USDOJPetition22Aug97GovernorKanagawa.pdf?attredirects=0) [Purpose of inclusion: To confirm that the USN was aware of environmental hazards at the highest levels, to confirm toxins found within incinerator output, and to confirm known health issues associated with same]
Enclosure #6, U.S. Senate Committee Letter and response from DOD & VA, 9 pages (retrieved from: http://www.atsugi-incinerator-group.com/SOCenvirotoxins09.pdf?attredirects=0) [Purpose of inclusion: Guidance for confirmation of exposure locations and times]
Enclosure #7, VA/DOD Response to Certain Military Exposures, 166 pages (Excerpt, pages 10, 21, 49-62, 76-82, 103, 118-123, 132-134, retrieved from: http://veterans.senate.gov/upload/10_08_09.rtf) [Purpose of inclusion: To provide official dialogue and responses regarding this issue, illustrate the effects on other residents and the extremely limited response by base authorities in controlling exposure]
Enclosure #8 - 2009 NAF Atsugi Health Study, NMCPHC, Executive Summary, 17 pages (retrieved from: http://www.atsugi-incinerator-group.com/NMCPHCJuly09ExecutiveSummaryNAFAtsug.pdf?attredirects=0) [Purpose of inclusion: To illustrate effects of exposure as indicated by the health study, to confirm a number of the known toxins that residents were exposed to, to indicate the inherent limitations assumed by these studies due to non-inclusion and issue latencies]
Enclosure #9, 97 Medical Effects and Pregnancy Study, 8 pages (retrieved from: http://www.atsugi-incinerator-group.com/97MedicalEffectsandPregnancyStudy.pdf?attredirects=0) [Purpose of inclusion: To provide study results for service members still working on base at the time of study as opposed to latent effects, to provide an alternate sampling of known toxins that residents were exposed to]
Enclosure #10, 98 Human Health Risk Assessment Atsugi, 47 pages (Excerpt, pages 14-15, 32-33 retrieved from: target="_blank">http://www.atsugi-incinerator-group.com/98HumanHealthRiskAssessmentAtsugi.pdf?attredirects=0) [Purpose of inclusion: To provide information as to concentrations of known pollutants provided by the incinerator]
Enclosure #11, EPA Mini-case studies, 29 pages (Excerpt, pages 3-5, retrieved from: http://epa.gov/osp/regions/minicase.pdf) [Purpose of inclusion: To illustrate pollutant concentration as derived from soil sampling at various distances from the incinerator]
Enclosure #12, Skywriter, October 10, 1997, Page 2, Captain’s Call, 1 page (retrieved from: http://sites.google.com/site/nafatsugi2/97CaptianCallNotransfers.pdf?attredirects=0) [Purpose of inclusion: To illustrate lack of concern from leadership as well as lack of information dissemination as to the seriousness of health concerns]
Enclosure #13, Email from u00pa2b@cpf.navy.mi on 8-7-98, 2 pages (retrieved from: http://sites.google.com/site/nafatsugi2/97EmaildataPeoplearenotawareonarriva.pdf?attredirects=0) [Purpose of inclusion: To illustrate that, at some level, command personnel were well aware of the seriousness of the situation and that there was a wide disconnect between that level and the level of concern conveyed as appropriate to base personnel]
Enclosure #14, Text of S.3378 as Placed on Calendar Senate, 4 pages (retrieved from: http://www.opencongress.org/bill/111-s3378/show) [Purpose of inclusion: To illustrate senate concern and action with regard to former NAF Atsugi personnel]
Enclosure #15 - Toxin Chemicals that exceeded EPA standards at NAF Atsugi, Japan, 16 pages (retrieved from: http://www.atsugi-incinerator-group.com/health) [Purpose of inclusion: To illustrate known connections between exposed toxins and associated health effects]

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