By Sandra Basu
WASHINGTON — Veterans whose combat-related trauma left them infertile now have access to in vitro fertilization (IVF) treatment covered by VA, thanks to implementation of a new interim final rule.
“We are moving ahead with coverage for service-connected IVF. It’s long overdue,” VA Secretary David Shulkin, MD, told lawmakers last month during his confirmation hearing.
Currently, VA provides certain infertility services other than IVF to veterans as part of the medical benefits package. With the interim rule, VA is amending its regulation to authorize IVF for a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment.
The regulation also states that VA may provide fertility counseling and treatment using assisted reproductive technologies, including IVF, to a spouse of a veteran with a service-connected disability affecting fertility.
Advocacy groups applauded the change in law.
“Thousands of veterans and their families now have new hope with an additional path to start or expand their families, which is often critical to many veterans’ transition back to civilian life after duty,” said Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America (IAVA). “With these new treatment options, veterans are no longer burdened with paying out of pocket to welcome a new member to their family, which only adds to the list of burdens surrounding the choice to do so.”
The new regulation comes as a result of a law passed by Congress, which had been promoted by advocacy groups concerned that VA was not authorized to provide the medical treatment.
In congressional hearings, proponents argued that DoD and the TRICARE program already provided advanced fertility treatments, including assisted reproductive technology, to troops with complex injuries.
Legislation addressing the matter did not make it out of Congress until late last year when lawmakers passed a provision giving VA the authority to provide assisted reproductive technology through fiscal year 2018. Sen. Patty Murray (D-WA), a leader in getting the provision passed, said senators will work to make the change permanent.
Meanwhile, at the confirmation hearing of Shulkin, Murray and Sen. Richard Blumenthal (D-CT) both sought assurance from Shulkin that VA would get the provision implemented.
“I’m concerned the Trump administration, in some reckless attempt to reverse regulations, will prevent this from happening,” Murray told Shulkin.
Shulkin assured lawmakers that the provision is law and that it would be implemented.
In lauding the legal change, advocates pointed out that the most common cause of battlefield injuries are explosive devices, which frequently result in genitourinary injury.
The interim final rule noted, “1 in 5 warriors were evacuated from Operation Enduring Freedom (OEF) combat in October 2011 with a genitourinary injury. This increasingly common trauma can have catastrophic reproductive results.”
VA determined that there was “good cause to publish this rule as an interim final rule without prior opportunity for public comment and to publish this rule with an immediate effective date,” according to the document, adding, “The secretary finds that it is impracticable and contrary to the public interest to delay this rule for the purpose of soliciting advance public comment or to have a delayed effective date. This rule-making will benefit those veterans and spouses most in need of ART services including IVF, and delay might cause a significant hardship for affected veterans and spouses.”
The rule also stated that “VA will consider and address comments that are received within 60 days of the date this interim final rule is published in the Federal Register.”
VA’s implementation of the change in law will be consistent with DoD’s policy guidance which “addresses assisted reproductive services available to servicemembers, providing specific guidance on the availability of IVF, as well as a wide range of services that VA considers fertility treatment.”
In terms of timing, the VA said it would “utilize and optimize existing capabilities for care in the community and develop internal processes that will provide veterans with a seamless path to receiving ART services.”
“Veterans can immediately schedule appointments with their local healthcare system for eligibility determinations, clinical evaluation and consultation, and initial treatment as we work to build this structure,” the agency explained.
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.