Sunday May 19, 2013
Congressional Tug-of-War Over Veterans' Heathcare?Robert O'Dowd Salem-News.com
An unknown number of veterans and dependents were exposed to environmental hazards on military installations. DOD refuses to accept responsibility for the health effects of exposure. Two bills introduced in the Senate and House provide for health care coverage. Major differences in the bills need to be worked out.
(WASHINGTON D.C.) - The Department of Defense (DOD)’s refusal to accept responsibility for the health effects of exposure to contaminated water at Camp Lejeune, North Carolina, has left veterans and their dependents, many without health care, out in the cold.
Both the Senate and the House have introduced bills to provide the needed heath care, but the differences between the bills will require bipartisanship compromise.
The Senate bill includes environmental hazards at all military installations (except for those in Iraqi and Afghanistan) while the House bill covers only Marine Corps Base Camp Lejeune, North Carolina.
Other differences are potential deal breakers. The Senate bill requires that DOD provide health care through its TRICARE insurance program while the House bill gives the VA the responsibility for both veterans and dependents health care.
On January 28th, the Senate Committee on Veterans Affairs voted 9 to 5 along party lines in favor of an original bill sponsored by Senator Daniel Akaka (D, HI) to provide health care through the DOD TRICARE insurance program to Camp Lejeune veterans and dependents and exposed to environmental hazards from the contaminated base water wells.
The Akaka bill, “Examination of Exposures to Environmental Hazards During Military Service Act of 2010” requires that DOD provide compensation or health care to other veterans and dependents of other military installations whenever an Advisory Board found evidence of exposure to environmental hazards.
The bill excludes exposure to an environmental hazard at a military installation during a period when imminent danger pay is authorized. My read on this is that the exposure from contaminants in the Iraqi burn pits is excluded.
An Iraqi veteran who has been exposed to the toxins from the burn pits and is experiencing a breathing problem should file a disability claim with the VA. The C&P exam should include a Pulmonary Function Test (PFT) and as Jim Strickland, Veterans Advocate, noted “that will be an important baseline marker for your future.”
In a press release, Senator Akaka noted that “Based on what I have seen, it appears clear that elements in the Department of Defense have been less than forthcoming in addressing these concerns [potential exposures to toxic substances at Camp Lejeune. That failure does not relieve the Defense Department of its responsibility, nor mean that the burden should be placed on the Veterans Affairs Department.”
Scientists with the National Research Council (NRC) admit that "evidence exists that people who lived or worked at Camp Lejeune Marine Base in North Carolina between the 1950s and 1985 were exposed to the industrial solvents trichloroethylene (TCE) or perchloroethelyne (PCE) in their water supply."
The NRC report funded by the Navy stated that, "...strong scientific evidence is not available to determine whether health problems among those exposed are due to the contaminants." Among these heath conditions are birth defects, childhood leukemia, liver damage, and male breast cancer.
Other scientists disagree with the NRC report’s findings, expressing disappointment that the NRC report which took two years in the preparation “reached puzzling and in some cases erroneous conclusions.”
The Senate Veterans Affairs Committee has jurisdiction over the Department of Veterans Affairs. The Akaka bill will be reported by SVAC and go on the Senate calendar. There is no requirement that SASC be involved. It’s possible that SASC will seek to be involved but that has not happened to date, according to a Congressional source.
The problem is the Senate Armed Service Committee’s leadership supports DOD, according to another Congressional source.
Senator Akaka’s bill is not the first Congressional attempt to address the need for medical care for those injured by the health effects of exposure to contaminated water at Camp Lejeune.
Senator Richard Burr (R, NC), Ranking Minority member of the Senate Veterans Affairs Committee, in July 2009 introduced S-1518, “Caring for Camp Lejeune Veterans Act of 2009.”
The Department of Veterans Affairs is the designated health care provider in S-1518. However, Senator Burr’s bill could not clear the Senate Committee on Veterans Affairs.
Senator Burr vowed to continue the fight and to attach his bill to any bill on the Senate floor, whenever the occasion arose.
Acknowledging DOD’s hostility to providing health care benefits, Senator Burr commented: "The committee's vote today [January 28th] supposes that somehow by immaculate conception health care will appear for these veterans and their families."
A companion bill to S-1518 was introduced in the House on February 2nd.
Representative Brad Miller (D, NC) introduced “The Janey Ensminger Act,” which requires the Department of Veterans Affairs to provide health care to veterans and their family members who have experienced adverse health effects as a result of exposure to contaminated well water at Camp Lejeune.
The bill is named after Janey Ensminger, age 9, daughter of retired Marine Master Sergeant Jerry Ensminger who died from leukemia after exposure to contaminated drinking water at Camp Lejeune.
Camp Lejeune, however, is not the only base where veterans and their dependents were at risk for exposure to environmental hazards.
There are 130 military installations on the National Priority List (EPA Superfund list) and 1,400 military sites contaminated with trichloroethylene (TCE)—a degreaser widely used by the military and industry for many years and a major pollutant in water systems throughout the United States.
According to a Congressional source, it would take from 2 to 4 months to produce a Committee report on the Akaka bill, assuming the SASC does not object. If the jurisdictional issues raises its ugly head, don’t look for a quick passage of legislation.
"Hoosier poet" James Whitcomb Riley is credited with the quote: “When I see a bird that walks like a duck and swims like a duck and quacks like a duck, I call that bird a duck."
By making DOD the provider of health care and introducing the possibility of SASC objection, the Akaka bill is in danger of being a “dead duck.”
Closer Look at Senator Akaka’s Bill
For Camp Lejeune, eligible individuals would receive health care through DOD’s TRICARE insurance program. The bill gives DOD the authority to compile a list of eligible individuals exposed to environmental hazards at Camp Lejeune. Look for short list. It makes more sense to give this responsibility to a neutral party like the Agency for Toxic Substances and Disease Registry (ATSDR).
For other military installations, the bill establishes an Advisory Board with authority to submit a report with a recommendation that DOD should provide compensation or TRICARE health care benefits to veterans and their dependents exposed to environmental hazards. One obvious problem is this gives DOD the discretionary authority to reject Advisory Board’s recommendations. Look for lots of rejections.
Unlike other military installations, Camp Lejeune veterans and dependents are not given the choice of financial compensation or TRICARE health benefits. TRICARE requires eligible individuals to pay insurance premiums. There’s no provision in the bill to waive health insurance premiums.
For Camp Lejeune only, the bill provides a “Sunset” provision, which states that “eligibility for benefits under this section shall terminate on the date that is 5 years after the date of the enactment of the Act.” This assumes that all Lejeune veterans and dependents on the base when the water wells were contaminated have been notified of their eligibility for TRICARE health benefits within 5 years.
The bill establishes an Advisory Board and Science Review Panel with scientists with backgrounds in environmental exposure or environmental exposure assessments, health monitoring or other related fields would be an integral part of the administrative process.
The Advisory Board (except for Camp Lejeune) is responsible for providing expert advice relating to exposures of current and former members of the Armed Forces and their dependents. If there’s no evidence of exposure, the board makes a recommendation of such a finding to VA and DOD. Although no specifically addressed in the bill, the VA would likely use the board’s findings to deny a veteran’s disability claim.
With exception of Camp Lejeune where health care to eligible individuals is mandatory, the Advisory Board only has authority to submit reports with recommendations that DOD should provide compensation or TRICARE health care benefits to veterans and dependents exposed to environmental hazards. These recommendations are very likely to be dismissed by DOD who can readily provide scientific arguments supporting denial of compensation or health care.
There’s no provision in the bill to review the independence of scientists. For example, scientists who are employed by defense contractors or universities with DOD contracts or grants should be excluded from the Advisory Board and Science Review Panel.
Logically, it make sense to have an independent advisory board with access to scientists with environmental exposure backgrounds to evaluate military hazard claims. Without a major change in attitude on the part of DOD, it makes little sense to give DOD discretionary authority to make decisions about compensation or health care benefits.
Over the next several months, we’ll know the outcome of the tug-of-war between the Senate and the House. Stay tuned. In the immortal words of Yogi Berra, “It ain’t over till it’s over.”
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