A 2012 law that requires VA to cover healthcare of former Marines, sailors and family members with ailments linked to 1957-to-1987 water contaminations at Camp Lejeune, N.C., continues to surprise segments of the impacted population.
Some of the law’s details bitterly disappoint those who believe they’ve been harmed by exposure to poisons. But thousands of veterans who served at Lejeune during that era have gained access to VA healthcare and likely don’t know it yet.
The quirkiness of parts of the Caring for Camp Lejeune Families Act is coming into sharper focus as the Department of Veterans Affairs takes its final, long-awaited steps to fully implement the complex statute.
“Since the day the law was signed [Aug. 6, 2012] VA began providing health care to Lejeune veterans,” said Dr. Terry Walters, deputy chief consultant for post-deployment health for the VA’s Office of Public Health.
Yet it was only last month that VA began accepting applications from family members requesting payment or reimbursement for private sector care to treat 15 conditions that the law links to the toxin exposure at Lejeune. They are: cancer of lung, esophagus, breast, bladder or kidney; leukemia; multiple myeloma; myelodysplastic syndromes; renal toxicity; hepatic steatosis; female infertility; miscarriage; scleroderma; neurobehavioral effects or non-Hodgkin's lymphoma.
To qualify for coverage, family members must show they spent at least 30 days at Lejeune or in utero with mothers there from Jan. 1, 1957, to Dec. 31, 1987.
VA will cover any medical costs not covered by other health insurance but only for treatment of those ailments. VA also will make retroactive payments for such care, but only back to March 26, 2013, the date Congress funded the 2012 law through a separate appropriations bill.
Lejeune veterans with out-of-pocket health care costs for any one of the 15 conditions are not eligible for retroactive reimbursement, Walters explained. That’s because the law presumes VA has provided care to them since the law was signed. And the law doesn’t provide for retroactive coverage before that date.
The law’s greatest weakness for many Lejeune families is that it doesn’t compensate for deaths or illnesses they believe resulted from contaminated water.
“This is a huge issue for these people. They want to be compensated,” Walters said. “The law only provides for health care. A lot of people get those two things confused.”
VA needed two years to start family member coverage, she said, because VA effectively had to create a supplemental health insurance plan by writing rules, hiring clinical care reviewers, creating computer systems and billing mechanisms, and developing a method to transmit medical records from civilian doctor offices to VA’s financial service center for review.
“We’re been in the business of providing health care to veterans for a very long time. It’s why we exist,” Walters said. “But providing health care or medical services to family members is somewhat new business. That’s why it took a while to flesh out the program, figure out how exactly we were going to comply with the law and provide health care [coverage] to family members.”
[To apply online, visit: https://www.clfamilymembers.fsc.va.gov.]
Many Lejeune vets still may not know that the 2012 law grants them access to VA healthcare if they spent at least 30 days there over those 31 years -- even if they don’t have one of 15 illnesses listed. Word is beginning to spread, however. Through Sept. 30 this year, 16,320 Lejeune vets had applied for VA healthcare citing the law; only 1231 were receiving care for one of the toxin-related conditions.
The Marine Corps estimates that up to a million veterans and dependents lived or worked at Lejeune while the water was contaminated. Many of these vets already were eligible for VA healthcare because of service-connected ailments or financial need. But the law made many more eligible who otherwise wouldn’t be.
Some might perceive this as a windfall but the law also creates gaps. For example, it provides no health benefits to reservists who trained for months at Lejeune but today lack official “veteran” status, which the law requires.
Reservists deemed veterans must have completed a period of active federal service under Title 10, which usually involves 180 days’ active duty, though shorter periods also qualify. They also qualify as veterans if they were injured in the line of duty during drills, annual training or active duty for training and received a VA disability rating. One way for a reservist or Guard member to know if he or she is a veteran is receipt of a DD Form 214 upon discharge.
“I have a gentleman with scleroderma who was on active duty for training at Camp Lejeune who I can’t help,” Walters said. “I want to help him but, because we are implementing the law [as written], my hands are tied.”
The law also doesn’t help former civilian employees at Lejeune who have one or more of the 15 conditions but no health care coverage.
“Did they drink the water? Yes of course they did,” Walters said. A recent study by the Agency for Toxic Substance and Abuse Registry found elevated risk of death for Lejeune civilians from some types of cancers in comparing mortality rates with civilians who had worked at Camp Pendleton, Calif., during the same period.
Advocates for Marines, sailors and their families, and lawmakers who fought for passage, know about the law’s quirks. They still view it as an important first step to helping families impacted by contaminants that the Navy Department had failed for years to acknowledge.
Sen. Richard Burr (R-N.C.) and Rep. Brad Miller (D-N.C.) had high hurdles to clear to get any Lejeune bill passed, including resistance to new entitlement spending amid a national debt crisis and no conclusive scientific finding that toxins at Lejeune caused the many ailments reported by former Marine Corps families.
“Statistically speaking, there has been nothing really solid” to show the toxins caused diseases among Lejeune’s population of that era, said Walters. “There has been hints,” she added.
Certainly the water was fouled by trichloroethylene, tetrachloroethylene, benzene and vinyl chloride, which in high concentration can cause health problems. But “the science to show whether drinking the contaminated water results in cancers or adverse health effects is just not mature enough,” Walters said. Given the difficulty “to connect the dots,” she said, Congress voted “to provide some measure of healing, basically, of the injury to families and their active duty service members.”
The law’s intent is to get medical care to veterans and afflicted family members who have no other healthcare options. But the law also states that it does so “notwithstanding that there is insufficient medical evidence to conclude that such illnesses or conditions are attributable to such service.”
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# # # # #Tom Philpott has been breaking news for and about military people since 1977. After service in the Coast Guard, and 17 years as a reporter and senior editor with Army Times Publishing Company, Tom launched "Military Update," his syndicated weekly news column, in 1994. "Military Update" features timely news and analysis on issues affecting active duty members, reservists, retirees and their families.
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Beneficiaries who had to pay for any of these 35 tests since coverage first was denied back to Jan. 1, 2013, might be eligible for reimbursement. Send comments to Military Update, P.O. Box 231111, Centreville, VA, 20120, email email@example.com or twitter: Tom Philpott @Military_Update