The Senate on Thursday took a major step toward broadening America’s commitment to take care of sick veterans, passing a bill to offer new health care and tax-free disability benefits to as many as 3.5 million veterans on an 84-14 vote.
Under the legislation written by Veterans' Affairs Chairman Jon Tester, D-Mont., and ranking member Jerry Moran, R-Kan., the Department of Veterans Affairs would consider a veteran with any of 23 conditions, ranging from brain cancer to hypertension, who was deployed to a combat zone during the wars in Iraq or in Afghanistan automatically eligible for care at government cost, based on the presumption that exposure to toxic chemicals in the war zone caused the ailments.
"Generations after generations of Americans have gone to war, backed by a promise that we made to them when they signed up that we would care for them when they got home," Tester said in a floor speech. "Unfortunately, that didn’t happen in the case of toxic exposure. We failed them. This bill is about righting a wrong that has been ignored for just way too damn long."
The House must now pass the revised bill before President Joe Biden can sign it, which seems likely. The legislation largely mirrors, and slightly expands on, a House bill by Veterans' Affairs Chairman Mark Takano, D-Calif., that passed 256-174 in March. Biden issued a statement at the time saying he supported the measure.
Under current law, veterans who believe toxic exposure during their service caused them to develop a disease can have trouble proving it, even when the linkage is known. So it's likely that many veterans are denied care and disability benefits they deserve, advocates say. The new law, at a projected cost of $278.5 billion over 10 years, shifts the calculus, meaning the government will now pay for the care of veterans whose sickness is tied to their service, as well as others whose ailments might not be.
Republicans fretted about the cost and outside budget watchdog groups, such as the Committee for a Responsible Federal Budget, questioned senators' decision to make the new benefits mandatory and not to offer offsetting budget cuts or tax increases to pay for it.
But the sense that America owed sick veterans the benefit of the doubt overwhelmed those concerns.
“The indignity, the callousness, of forcing veterans who got sick as they were fighting for us, because of exposure to these toxins, to have to fight for years in the VA to get the benefits they deserve, well, that will soon be over, praise God,” Senate Majority Leader Charles E. Schumer said on the floor Thursday.
A clear link
There's little doubt that many veterans were sickened while they served by exposure to chemicals, including smoke from burn pits in which troops disposed of garbage, such as medical materials and vehicle parts, by dousing it in jet fuel and setting it ablaze.
The practice was widespread during the wars in Iraq and Afghanistan, and medical experts say exposure is linked to a host of illnesses that can present themselves years later, including cancers, chronic respiratory conditions and lung damage.
But for the better part of the post-9/11 era, the military did not keep thorough records of where burn pits were used. The smoke from the pits can also travel for miles, potentially affecting troops far afield. For veterans trying to prove that they qualified for toxic exposure treatment through the VA, it could be their word against the Pentagon’s.
“I was in a very small, remote patrol base in southern Afghanistan, and we had a burn pit like everybody did. When I got out in 2011, there was nothing in my medical record that proved I was near a burn pit, because the [Defense Department] wasn’t tracking this stuff,” said Marine Corps veteran Travis Horr, the government affairs director for Iraq and Afghanistan Veterans of America, an advocacy group.
The bill’s presumption of toxic exposure matches legislation introduced by Sen. Kirsten Gillibrand, D-N.Y., in 2020.
Gillibrand said the new bill was the result of a massive, coordinated lobbying campaign.
"It was this huge effort to get people on board. We've been doing press conferences and rallies and calling offices and finding co-sponsors for the last two years. And it just culminated with this momentum of people really demanding that we do right by our veterans," Gillibrand said. "So it's an example of the veterans themselves and their family members doing the work, coming to Washington over and over and putting a spotlight on it so that no senator could not be informed about how urgent this was for their constituents."
The bill would extend, from five years to 10 years, the period after veterans' separation from the military during which they can seek out health care from the VA. If within that time period the veteran qualifies for care, he or she will continue to receive it indefinitely.
Also in the legislation is an expansion of benefits for veterans exposed to radiation during the Cold War, an expansion of the list of illnesses linked to the use of Agent Orange during the Vietnam War and an extension of benefits to Vietnam War-era veterans who served in Thailand, Laos, Cambodia and Guam and may have been exposed to Agent Orange there.
It would also greatly expand the VA’s physical footprint by setting up 31 new, major medical clinics across 19 states while hiring thousands more claims processors and staff.
In addition to health care, eligible veterans will receive disability benefits as high as $3,332 a month, depending on the severity of the ailment.
A victory for the House, and Democrats
In February, the Senate passed by voice vote a narrower version of the bill that the Congressional Budget Office said would cost $7.6 billion. It would expand health care to more veterans who served in areas with known toxic exposure, but it wouldn’t provide disability compensation.
House Democrats said that Senate bill wouldn't help enough veterans — about 19,000 out of the 3.5 million potentially eligible Iraq and Afghanistan veterans would become eligible for VA health care at first, according to the CBO, rising to 66,000 over time — and declined to take it up.
In the interim, Democrats argued it was not necessary to offset the cost with new taxes or fees, or budget cuts elsewhere, because of ill veterans' pressing needs, and they derided the Senate's original bill as stingy.
“It’s the cost of war,” Speaker Nancy Pelosi said after the House's March vote.
A coalition of more than 40 veterans groups also backed the Democrats' argument, while comedian Jon Stewart — who successfully lobbied Congress to provide compensation to people exposed to toxic air in New York City stemming from the Sept. 11, 2001, terrorist attack — joined the cause and raised the pressure.
While veterans' health care is historically funded through the annual appropriations process, the bill calls for reclassifying a chunk of that money as mandatory spending outside of appropriators' direct control. And it's not just new spending that could be subject to the shift. About $390 billion in current-law spending that would otherwise be subject to discretionary appropriations caps over the next 10 years might be affected, the CBO estimated.
Tester said the shift to mandatory spending would provide much-needed financial relief to appropriators working under tight caps on discretionary spending. "If it applied to caps, it would have been a problem," he said of his bill.
Republicans sought amendments to the bill to restore appropriators' control, but even after Democrats rebuffed them most in the GOP caucus voted aye.
David Lerman contributed to this report.