The number of veterans who have their reproductive organs damaged in combat is growing, leading a top senator to propose legislation that would make fertility care a bigger part of Veterans Affairs hospitals' missions — including paying for surrogate pregnancies.
Wounded male veterans' spouses would be able to get artificial insemination at VA hospitals, and wounded women could designate surrogate mothers who would be able to receive fertility treatment on their behalf at the VA under legislation written by Sen. Bernard Sanders, Vermont independent and chairman of the Veterans' Affairs Committee.
As it stands, an injured man could have his sperm extracted at a VA hospital, for example, but his partner would have to be artificially inseminated by a private doctor — and on their own dime, said Tom Tarantino, chief policy officer at Iraq and Afghanistan Veterans of America.
"Starting a family is a two-person job," he said. "Part of the treatment of that injury is bringing your spouse in. It's not only appropriate, but necessary to take care of the spouse or, medically if they needed to use a surrogate, a surrogate."
The comprehensive bill includes reform in several other areas, including expanding education benefits for service members who recently left the military as well as survivors, providing better sexual assault care at VA hospitals, reducing the VA claims backlog and repealing the cuts to military retirees' cost-of-living adjustment that was part of the 2013 budget deal. A spokesman for Mr. Sanders said he expected the bill to be brought up in the Senate sometime this week.
At a time when troops are surviving injuries that a generation ago would have meant death, the bill raises complex questions about the extent of care the government owes those who have served.
Mr. Sanders proposed requiring the VA to cover assistive reproductive technology, such as in-vitro fertilization, for spouses or designated surrogates if the veteran could not conceive naturally or carry a child because of service-related injuries, rather than making military families pay out of their own pockets. In-vitro fertilization expenses vary but can cost at least $12,000 per round and usually take more than one try, according to the National Institutes of Health.
It would not cover care during pregnancy for spouses or surrogates and would not require the VA to find surrogates.
Just how far the care should go, however, remains up for debate.
Pete Hegseth, CEO of Concerned Veterans for America, said the VA exists to help veterans deal with all types of service-related injuries, so providing fertility treatments to spouses of injured veterans makes sense.
"Spouses serve alongside the service members, too, and they're affected by an injury, too, particularly an injury that affects fertility," he said. "Working with that family to help them conceive, I think, is a responsible use of VA resources."
But he said he doesn't support long-term maternity care and would draw the line at granting surrogates access to VA facilities. Artificial insemination or any other fertility care for the surrogate should be transferred to private facilities, he said.
"You get into a slippery slope when you bring in other people who aren't veterans to receive care because they're connected to a service member," he said.
These benefits likely wouldn't be available to workers injured at their jobs in the private sphere.
Frank Kearney, a workplace compensation lawyer at Donahoe Kearney in Washington, said he had never heard of a statute covering the inability to have children.
Mr. Tarantino said the veteran population cries out for the care.
Especially in Afghanistan, where many troops patrol on foot in heavily mined areas, some blasts cause debilitating injures to the reproductive organs.
"You have young men and women, 18 to 30 years old who were planning on starting families. Suddenly, they can't do it through traditional means because they've suffered a blast injury below the waist," he said.
More than 2,000 active-duty military members sustained injury to their genitals or urinary tracts in fiscal 2012 and 2013, according to Lt. Col. Cathy Wilkinson, a Defense Department spokeswoman, though it's unclear how many of those would have trouble having children because of their injuries.
Mr. Tarantino spoke specifically about in-vitro fertilization, surrogacy and sperm extraction as procedures that could help injured veterans conceive, but said some unique injuries may require creativity to find a solution.
"We want to leave it broad enough to allow for treatment options," he said.
Mr. Tarantino said the topic is uncomfortable to discuss but is just about helping veterans start families after being injured while serving their country.
"Usually everyone just clams up and doesn't want to talk about this," he said. "This is not something as visible as losing an arm or a leg, it's not on the top of people's minds. The more we educate people about the needs of service members, the less resistance we can have and the more we can help these people."
Mr. Sanders' bill also would boost adoption benefits for wounded warriors who can't have children naturally because of service-related injuries. Under current law, the military will refund up to $2,000 of adoption expenses per child, and no more than $5,000 per calendar year.
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