No Records, No Nexus: Toxic Drinking Water at Diego Garcia and Other Overseas Military Installations

Why I’m Writing

Why Limited Energy

A. Executive Summary and the Ask

Naval Support Facility (NSF) Diego Garcia is a remote atoll in the Indian Ocean. Every gallon of drinking water there came from a shallow freshwater lens under the island. The government’s own records show that this water was put at risk for decades:

• 1991 jet-fuel leak. A ruptured underground JP-5 pipeline contaminated groundwater near one of the island’s major freshwater sources. Nobody knows how much fuel leaked. More than 134,000 gallons were recovered, and “substantial” fuel stayed in the aquifer [1][3].
• Very high PFAS levels. In 2017, out-of-service Air Operations wells averaged 8,066 parts per trillion (ppt) of combined PFOS/PFOA, and one reached 86,630 ppt. EPA’s 2016 health advisory was 70 ppt [6]. Three Diego Garcia systems were among only 24 DoD water systems worldwide found above that advisory [5].
• Unsafe tap water until 2018. In 2017, every tap was posted “Not suitable for drinking.” The Navy did not declare the tap water fit for drinking and cooking until February 28, 2018 [6][7]. The system still runs under a conditional permit, and its treatment still does not meet EPA’s surface-water filtration rule [9].
• Missing records. Diego Garcia water-quality reports are posted publicly for 2020 to 2025, and one report covers 2017. We could not find any public finished-water test results for the 1970s through about 2016 [6][9][10]. PFAS testing of overseas Navy water did not start until a 2015 policy [6].

The Ask

1. Recognize the exposure (Congress). Add NSF Diego Garcia, and other overseas installations with documented drinking-water contamination, to the PACT Act’s covered locations, or enact a Camp-Lejeune-style water presumption.
2. Designate a TERA now (VA). VA can use its existing authority to designate this service a Toxic Exposure Risk Activity, triggering nexus exams.
3. Pass and fix pending bills. Cosponsor H.R. 3639 (VET PFAS Act) and clarify that it covers overseas installations; support S. 2220 (FORGOTTEN Veterans Act).
4. Open the records and test going forward (DoD, via the NDAA). Require release of historical overseas drinking-water records and routine, published, PFAS-inclusive testing for every overseas system.
5. Concede exposure when records are missing, so gaps in government records never defeat a veteran’s claim.
6. State role. Ask the Texas Attorney General and state officials to press DoD and VA by formal letter and to support multistate action on service-member PFAS exposure.
7. Fund the science. Broaden VA’s PFAS review beyond kidney cancer to include inflammatory bowel disease (ulcerative colitis and Crohn’s disease).

Specific asks with their supporting evidence are in Section D.

B. Fact Sheet: Diego Garcia Water Timeline

Every entry below comes from a U.S. government source (USGS, DoD, U.S. Navy). Diego Garcia had about 3,500 residents and used roughly 0.8 to 1.2 million gallons a day, all of it pumped from the ground [1].

Units note: DoD’s 2017 AFFF report gives the 5,849, 102 and 74–78 values without a unit label. Its footnote compares them to the 70 parts-per-trillion advisory, so ppt is implied [4]. The 2017 Navy water report states its values in ppt [6]. What the records do not tell us is how much contaminated water service members actually drank in any given year. That uncertainty is the problem this packet asks Congress and VA to fix.

C. The Systemic Gap: No Records Means No Nexus

To get disability compensation, a veteran must connect an illness to service. Where Congress or VA has set a presumption (Agent Orange, the PACT Act burn-pit locations, Camp Lejeune), that connection is assumed based on where and when the veteran served. Everywhere else, the veteran has to document the exposure. At overseas installations like Diego Garcia, the system blocks that at every step:

Who is affected. This is not one person’s problem. Every service member, DoD civilian and contractor who lived or worked at NSF Diego Garcia drank from the same system. The same problem likely exists at other overseas installations where water records are thin or never made public. DoD’s own worldwide testing found 24 systems above the 70 ppt advisory in 2016–2017, and 26 as of Oct 30, 2019 [5].

D. Specific Policy Asks, Tied to the Evidence

Note on H.R. 3639 cosponsors: As of Oct 7, 2026, congress.gov lists Reps. Fitzpatrick (R-PA) and Kean (R-NJ) among the Republican cosponsors along with sponsor Rep. Lawler. Rep. Pfluger is not listed [24].

E. Research Summary, with Honest Caveats

Veterans are best served by an accurate account of the science, including where it is uncertain. That uncertainty is the reason presumptions exist: they settle questions that individual veterans cannot answer from incomplete records.

PFAS (PFOS/PFOA, from firefighting foam)

• C8 Science Panel (2012), which studied a highly exposed U.S. community, found a “probable link” between PFOA and ulcerative colitis, thyroid disease, high cholesterol, kidney cancer, testicular cancer and pregnancy-induced hypertension. It found no probable link for Crohn’s disease and many other conditions [27]. The PFOA conditions in H.R. 3639 track this list [24]. In 2022 the National Academies rated the evidence for PFAS and ulcerative colitis in adults as “limited or suggestive” [34][36].
• Steenland et al. (2018): ulcerative colitis patients had about 38% higher blood PFOA than controls. Caveat: blood was drawn after diagnosis [28].
• Fart et al. (2021): PFAS levels were higher in late-onset ulcerative colitis, and PFOA caused intestinal barrier defects in mouse intestinal tissue [29].
• Agrawal et al. (2024), military serum: used stored DoD Serum Repository samples taken up to 10 years before diagnosis. A PFAS mixture was associated with Crohn’s (OR 2.13) and ulcerative colitis (OR 1.76), and the association held across the pre-diagnosis years. Caveat: small pilot study (25 cases of each disease, 25 controls) with semiquantitative measurements, and average PFAS levels were similar to the general U.S. population [30]. In October 2026 NIH awarded Mount Sinai $3.3 million to study the same military cohort in depth [38].
• Counter-evidence: the Nurses’ Health Study found no association [31]. In Ronneby, Sweden, where firefighting foam contaminated a town’s drinking water, a registry study found no consistent increase in IBD [39]. A March 2026 review and meta-analysis found ulcerative colitis risk rose 7% per ng/mL PFOA, but the result was not statistically significant (95% CI −4.7% to +20.0%). It found no significant link for Crohn’s disease, and it rated overall confidence in the evidence as low [32].

Jet fuel (JP-5) and fuel hydrocarbons

• ATSDR (2017): human data on JP-5, JP-8 and Jet A are limited. Animal studies show immune effects for JP-8 and Jet A, but JP-5 immune effects have not been adequately evaluated [33]. That is a research gap, not reassurance.
• At Diego Garcia, rising benzene was documented in groundwater and soil vapor after the 1991 JP-5 leak [1]. How much reached finished drinking water in a given year is not in any public record we found.

Solvents, disinfection byproducts and lead

• Camp Lejeune’s presumptions rest on solvent-contaminated water [23]. In the public Diego Garcia records we reviewed, we did not find documented industrial-solvent (e.g., TCE/PCE) contamination of drinking water. We did find high total trihalomethanes (chlorination byproducts) that made every tap undrinkable in 2017, plus lead and copper exceedances [6]. Whether solvents were ever tested for historically is unknown.

F. Crohn’s, Ulcerative Colitis and IBS: What the Science Says and Why the Label Matters

Inflammatory bowel disease (IBD) is the family of diseases that includes Crohn’s disease and ulcerative colitis. Irritable bowel syndrome (IBS) sounds similar but is a different kind of condition. This section explains the difference in plain language, explains how IBD can develop silently and be worsened by service life, summarizes what the research does and does not show about contaminated water and IBD, and explains why the label on a veteran’s claim matters for veterans of Diego Garcia and other overseas bases. It summarizes published research and regulations for a general audience. It is not medical or legal advice.

Plain-language guide: Crohn’s, ulcerative colitis and IBS

Diagnoses often shift between Crohn’s, ulcerative colitis and IBD-unclassified

IBD can start silently, and service may trigger or worsen it

IBD often begins long before anyone names it. Researchers describe a preclinical phase in which the disease process is already under way but has not been diagnosed. Stored military blood shows this clearly. Among 100 service members later diagnosed with Crohn’s disease, 65 already carried Crohn’s-associated antibodies in their earliest stored sample, a median of six years before diagnosis, and those with more of these antibodies were more likely to have complications around the time of diagnosis [56]. In the larger PREDICTS study of DoD Serum Repository samples, a panel of blood proteins and antibodies predicted Crohn’s disease up to five years before diagnosis; it worked much less well for ulcerative colitis [57]. A Swedish study did find inflammatory proteins raised in blood drawn up to 15 years before an ulcerative colitis diagnosis [58].

That means some service members may enter service with IBD that is silent and undetected, and others may develop it during service and not be diagnosed until years later. During that window, service exposures and stress may trigger or worsen the disease. The evidence on exposures is still limited and is mostly associations (see the research below). Stress is better studied. In a population-based study in Manitoba, Canada, high perceived stress was the only factor that independently predicted a later IBD flare; NSAIDs, antibiotics and infections did not [59]. The relationship also runs the other way. About one in three people with IBD have symptoms of anxiety and one in four have symptoms of depression, more when the disease is active [54]. Long-term studies show that active IBD predicts later anxiety and depression, and that anxiety and depression predict later flares, hospital stays and surgery [55]. That two-way loop matters for veterans, because the years when IBD may be developing silently can also be years of sustained stress in service.

What the research shows, and which disease each study covers

The honest way to read this research is at the level of IBD as a whole, while being clear about which disease each study actually covers. Most results are associations, which means a pattern seen in groups of people. An association is not proof that an exposure caused any one person’s illness.

• C8 Science Panel (2012). Covers: ulcerative colitis and Crohn’s, separately. In a highly exposed community, the court-appointed panel concluded “there is a probable link between exposure to C8 (also known as PFOA) and ulcerative colitis,” and found “no probable link” between PFOA and Crohn’s disease [27]. In the published study behind that finding, ulcerative colitis risk rose with cumulative PFOA exposure (rate ratios of 1.76, 2.63 and 2.86 across the upper three exposure groups), with no trend for Crohn’s disease [35]. Caveat: this study was about PFOA specifically. Diego Garcia’s published results combine PFOS and PFOA, so the share that was PFOA is not public [6].
• National Academies (2022). Covers: ulcerative colitis. Rated the evidence for PFAS and ulcerative colitis in adults as “limited or suggestive,” one step below “sufficient” [34][36]. It recommended offering PFAS blood testing to people likely to have had elevated exposure, including people who lived near military bases, and, for those above 20 ng/mL, assessing for signs of ulcerative colitis at wellness visits [36].
• Agrawal et al. (2024), active-duty service members. Covers: Crohn’s and ulcerative colitis. This Mount Sinai study used stored DoD Serum Repository samples drawn up to 10 years before diagnosis. A mixture of PFAS chemicals was associated with higher odds of Crohn’s disease (OR 2.13) and ulcerative colitis (OR 1.76), and the association held at every time point before diagnosis [30]. Caveats: it was a pilot study (25 people with Crohn’s, 25 with ulcerative colitis, 25 controls) with semiquantitative measurements, and the authors note the small size could overstate results. Average PFAS levels were similar to the general U.S. population, so it was not a study of a contaminated base [30].
• NIH grant (October 5, 2026). Covers: Crohn’s and ulcerative colitis. NIH awarded Mount Sinai a five-year, $3.3 million R01 grant to study whether PFAS exposure disrupts the intestine’s protective lining and blood glycosylation years before Crohn’s disease or ulcerative colitis develops, using blood from the same military cohort [38]. This is research being funded, not a finding yet.
• How PFAS could plausibly affect the gut. The National Toxicology Program concluded that PFOA and PFOS are “presumed to be an immune hazard to humans,” mainly because they suppress antibody responses [40]. In mouse intestinal tissue, PFOA caused loss of intestinal barrier function [29]. Two 2026 mouse studies found that PFOA exposure made chemically induced colitis more severe and disrupted gut bacteria; one saw the effect only in male mice and found no added risk in mice genetically prone to colitis [52][53]. Lab and animal findings like these show plausibility, not proof in people. We found no human study showing that PFAS worsens the course of existing IBD; Mount Sinai’s new grant will look at complications at diagnosis [38].
• Evidence that points the other way. The Nurses’ Health Studies, which used blood drawn before diagnosis, found no association between PFAS and IBD in women [31]. In Ronneby, Sweden, where firefighting foam contaminated a town’s drinking water, a registry study found no consistent evidence that PFAS raised IBD risk. A small rise in Crohn’s disease among people exposed in the earliest period was not repeated in later, more heavily exposed periods [39]. A March 2026 meta-analysis found no statistically significant link between any single PFAS and either ulcerative colitis or Crohn’s disease, and rated confidence in the evidence as low. It could not include the military mixture study because that study did not report individual chemicals [32].

Jet fuel, benzene and solvents

• We found no peer-reviewed study linking JP-5 jet fuel, benzene, or the solvents TCE and PCE in drinking water to Crohn’s disease or ulcerative colitis. ATSDR reports that the immune effects of JP-5 have not been adequately evaluated [33]. That is a research gap, not reassurance.
• Camp Lejeune is the closest precedent for contaminated base water, but ATSDR’s major health survey of Camp Lejeune Marines and civilians did not ask about IBD [51], and none of VA’s eight Camp Lejeune presumptive conditions is a digestive disease other than liver cancer [23]. Solvent exposure has been associated with other autoimmune diseases, such as systemic sclerosis [35], but not established for IBD.
• In the same military serum cohort, a second Mount Sinai study found that a chemical mixture led by pesticides and one polycyclic aromatic hydrocarbon (pyrene) was associated with Crohn’s disease 6 to 10 years before diagnosis, and a pesticide-led mixture with ulcerative colitis [37]. It is small and says nothing specific about jet fuel in drinking water, but it shows that this military blood archive can be used to study exposures years before IBD appears.

Why the IBS label matters

Medically, IBS means symptoms without visible damage [43], while Crohn’s disease and ulcerative colitis are diagnosed by finding inflammation and damage [44]. Calling IBD “IBS” describes a condition that, by definition, does not damage the digestive tract.

In VA’s rating schedule (38 CFR 4.114), they are separate diagnostic codes [49]:

• DC 7319, irritable bowel syndrome: rated on abdominal pain and bowel-habit symptoms, with a maximum of 30 percent. Its note says it may include functional digestive disorders.
• DC 7326, Crohn’s disease or undifferentiated form of inflammatory bowel disease: rated from 10 to 100 percent. Its criteria refer to treatment with immunosuppressants or other biologic agents, and VA requires the diagnosis to be confirmed by endoscopy or radiologic studies.
• DC 7323, ulcerative colitis: “Rate as Crohn’s disease or undifferentiated form of inflammatory bowel disease (DC 7326).”

So under the current schedule, Crohn’s disease, ulcerative colitis and IBD-unclassified are all rated under the same IBD criteria. A change from one IBD subtype to another does not move a veteran out of that code. IBS is rated under a different code, with different criteria and a lower ceiling.

A systemic gap: IBD has rating codes but no presumptive path

To be precise about what exists: VA does have rating codes for IBD (DC 7326 for Crohn’s disease or undifferentiated IBD, and DC 7323 for ulcerative colitis, which is rated under DC 7326), and any veteran can claim IBD on a direct basis by showing an in-service event or exposure plus a medical opinion connecting the two [49]. What is missing is a presumptive path, the route that spares a veteran from proving the connection:

• The Gulf War presumption covers functional gastrointestinal disorders such as IBS and expressly excludes structural gastrointestinal diseases, which leaves out Crohn’s disease and ulcerative colitis [50].
• The PACT Act presumptions include gastrointestinal cancers of any type, but no inflammatory bowel disease [14].
• The Camp Lejeune water presumptions list eight conditions, none of them IBD [23]. Crohn’s disease and ulcerative colitis are not presumptive for any group we found.
• VA has no presumptions of any kind for PFAS exposure [20].

The result is a mismatch. The one digestive presumption that exists outside of cancer is built around IBS, so a veteran with chronic bowel disease and a toxic-exposure history can end up with a claim framed as IBS, the condition that has a presumption, rather than as the IBD they actually have. That presumption reaches only service in the Southwest Asia theater, which by VA’s definition does not include Diego Garcia [50]. And an IBD claim decided as IBS is then judged against criteria written for a different condition [49]. This is a gap in the system, not a failure by any one person who helped a veteran file.

How this connects to Diego Garcia

Three Diego Garcia water systems were among only 24 DoD systems worldwide found above EPA’s 2016 PFOS/PFOA advisory [5], out-of-service wells reached 86,630 ppt in 2017 [6], and benzene was documented in groundwater after the 1991 JP-5 leak [1]. No public record shows what was in the finished drinking water in earlier years, or how much any service member drank. That is why no study, and no veteran, can currently connect a specific dose at Diego Garcia to a specific case of IBD.

The research above points to a practical way forward. The DoD Serum Repository already holds service members’ blood samples, and it has been used to measure PFAS years before IBD was diagnosed [30]. The same resource could be used to study veterans who served at Diego Garcia and other overseas installations (see Ask 7 in Section D).

Veterans of Diego Garcia and other overseas installations who have Crohn’s disease or ulcerative colitis can run into the same problems described above: a shifting IBD diagnosis, no presumption, and a claim framed as IBS.

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Contact

Shawn C. Tovey, RCDD
U.S. Navy Veteran
Copperas Cove, TX
toveys@msn.com

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