Marine Col. Anthony White had already lost a kidney to cancer that doctors attributed to living on Camp Lejeune, N.C., where thousands were sickened by contaminated water for more than three decades. So when he found out in 2011 that his home at Okinawa's Plaza housing area had exposed him and his family to elevated levels of radon, White took action.
He discovered the problem after watching workers install a radon mitigation system at a nearby house that had been vacated by a family leaving Okinawa. He recognized the system from his home in Virginia, where, as in most of the United States, elevated radon levels are a required disclosure upon sale or rental of a home.
"Unlike the experience in northern Virginia, where you are notified of the potential health hazard, [the housing department] never communicated anything to people who were moving into base housing," said White, who retired in 2013 after serving as the 3rd Marine Division's assistant chief of staff and head of intelligence.
"I reached out to base housing and started inquiring about the house in close proximity, and asked them, 'Do you have test results?' I could tell right away that they didn't really want to disclose this information."
White's family is among several past and present families in Okinawa living in homes that register well above the Environmental Protection Agency action level for radon exposure, according to data obtained by Stars and Stripes.
Most scientists agree that exposure to elevated radon levels for a few years is statistically very unlikely to cause cancer. However, despite several families' uncertainty over how much radon they've been exposed to during their lives and no clear threshold for when or if radon will cause cancer, some find themselves waiting more than a year for radon mitigation. Others move at their own expense or stay in place and hope they won't eventually get sick.
A Defense Department Inspector General report in October cited a lack of mold and radon standards as "serious health hazards" and called for Pentagon-level regulations on mold mitigation. Pentagon officials disagreed, stating that because there are no federal radon standards -- a point the IG disagreed with -- no standards could be applicable to federal buildings outside the United States. For now, radon regulations are left up to the individual services.
On Okinawa, all housing falls under Kadena Air Base and Air Force radon regulations. Kadena's rules have required that radon levels be five times higher than the EPA action level before a home will be fixed, when funding has been available.
The average wait time for home mitigation on Okinawa is 442 days, Kadena officials said. That is actually much quicker than the three years than Air Force regulations allow in most cases.
Three years is also the length of an average military tour, meaning families could repeatedly move from one home with elevated radon gas to the next without ever knowing it.
Other services provide even more time for installations to act. At five times the EPA action level, the Army and the Department of the Navy allow up to five years for mitigation, but six months for levels beyond that. At 40 times EPA action limits, the mitigation must be done within three weeks.
Assessing health risk
Radon is emitted by decaying uranium found in soil. It dissipates outside but becomes trapped in homes, particularly those with little ventilation, or in basements and closets.
About one in 15 homes in the United States are estimated to have radon levels above the EPA action limit. The highest concentrations are typically found in the Northeast, Midwest and Great Plains states.
In Guam, home to a large military population, 27 percent of homes are estimated to be above the EPA action level.
Most of Japan typically has low radon readings, according to World Health Organization figures. However, the gas is a particular problem among the concrete military buildings in Okinawa, according to Bill Brodhead, a contractor who wrote about his findings after installing mitigation systems in Guam and Okinawa, more than 10 years ago.
"The buildings are also built to withstand typhoons and consequently are very airtight," Brodhead wrote.
Mark Pinnau, 718th Civil Engineer Squadron deputy commander, emphasized that the EPA measures radon risk over a lifetime. Kadena officials do not consider short-term exposure above the EPA's standard of four picocuries per liter, or pCi/L, to be a concern in most cases.
That is a "fairly accurate" position if Kadena followed EPA testing protocols, said Bill Field, a University of Iowa College of Public Health professor who studies radon and its health effects.
EPA statistical tables state that if 1,000 people are exposed to four pCi/L over 70 years, seven nonsmokers, or 62 smokers, would be expected to get lung cancer. At 20 pCi/L, the numbers jump to 36 and 260, respectively.
However, it isn't possible to tell how and when radon exposure will cause an illness.
"There is no safe, or threshold, value for radon exposure," Field said. "Even low exposures carry risk ... the 4 pCi/L is not a health-based guideline."
In the U.S., two-thirds of radon-related lung cancers occur from long-term exposure at less than 4 pCi/L, Field said. Field's 2008 testimony to the President's Cancer Panel cited studies from the U.S., Europe and China saying significant risk increases at 2.7 pCi/L, which is the World Health Organization's action level. Kadena has tested about 3,000 homes for radon within the past three years, Pinnau said, adding that the military currently has 75 pending mitigation projects and 64 about to begin.
Concrete housing and energy-efficient measures designed to lower air-conditioning bills combine with geology to make radon an ongoing issue, Pinnau said.
"Yes, it's persistent," Pinnau said. "You're going to have it here because it's fairly rocky soil here, a lot of stone similar to what see in the eastern United States. There are a lot of radon issues there, too."
The mitigation process depends on the home, but typically in Okinawa, it's sub-slab depressurization. Workers drill through the foundation and place one or more suction pipes in the ground underneath. A connected fan draws out the gas from below the home and releases it into open air. Most U.S. crews install the systems in a single day, but the time required depends on the house.
Living with radon
Servicemembers and their families talked about living with radon to Stars and Stripes after the IG report on military housing in Japan detailed numerous flaws. The report didn't limit its concern to Okinawa, or even Japan. Radon mitigation and notification is normally regulated by the states. Lack of a federal policy means the military isn't required to tell overseas-based families about elevated radon levels. Families must instead depend on local installation and service policy.
On Okinawa, military housing residents now sign a disclosure letter alerting them to the most recent radon reading, Pinnau said.
Anne Suess-Whisenant, who has two children and is pregnant with a third, is living in a Camp Lester home that registered a level of 16.4 pCi/L, more than four times the EPA action level for fixing a home. She's especially concerned because children are more sensitive to radon; their lungs are smaller and their respiratory rates are twice as high, according to an online report from the University of Minnesota School for Public Health.
By age 10, a child receives twice the lung dose of an adult who's been exposed to radon for the same length of time, according to the report.
Suess-Whisenant said she was told by a housing official that remediation is not expected until fall at the earliest. The housing department told the family that their radon level fell within the "higher moderate end."
"So we're not in the high classification, which makes me assume other houses are waiting for mitigation systems before us," she said.
In the meantime, Suess-Whisenant says she's been told by housing officials to open her windows. This can lower radon levels temporarily, but they often return to their baseline levels within 12 hours of closing the windows, according to the EPA website.
Another family spent $1,500 to move out of an on-base home with elevated readings after living there for more than five years.
The family, which asked not to be identified for security reasons, has a family history of radon-related cancer and a 4-year-old daughter with a kidney illness. They were told their home wasn't scheduled for mitigation for about two more years.
"That would have been a total of eight years of high radon exposure," the spouse said. "And they still said there's really nothing we can do."
A housing office manager said they could file for a medical waiver to move. They did so in October. The paperwork stalled for three months until the husband's commander threatened a legal complaint, the spouse said. Two days later, the waiver was approved.
Their new home was last tested at 2.6 pCi/L, a rate at which the EPA recommends that residents consider mitigation, but does not call for immediate action.
Little funding to fix it
The Air Force says it now has ample funding to install radon mitigation systems, but it hasn't always been that way on Okinawa.
White and others wrote letters to base officials and congressional representatives in California in 2011. Soon afterward, Kadena Air Base held public forums to address the elevated levels of radon found in dozens of homes on the island.
White was alarmed to find out that the elevated radon levels in his home were low compared with others.
"We have 40 other units waiting for mitigation construction with higher radon levels than your home," Kadena officials told White in a 2011 email obtained by Stars and Stripes. "Since we received zero funds last year and (because of) the cut in (the) Military Family Housing budget this year, it is unlikely we will be able to obtain funds in a timely manner to start construction."
Given the lack of funding, White said he moved to a different on-base home.
Kadena began receiving funding to install radon mitigation systems at hundreds of on-base homes in 2012.
The cost of radon mitigation at Kadena averages $4,500 per home -- well over the $1,200 typical cost cited in a Colorado State University fact sheet -- due to asbestos testing before drilling, transport of equipment from the United States and the higher Japanese labor rate, Pinnau said.
Kadena officials say they will test on-base homes in Okinawa by request. In one case, a home registered a reading of 110 pCi/L and the family was moved within a week, Pinnau said.
In cases where the radon reading is only slightly above the EPA action level, the family isn't generally offered new on-base quarters.
Multiple Okinawa residents said the longer they wait for mitigation, the more their concern grows.
"Our hands are tied, and it's frustrating," Suess-Whisenant said. If the family lived in a rental house in the U.S., "we'd find a way. If it was our own home, we'd find a contractor. My hands wouldn't be this tied, as they are here. We don't have the options."