‘Blue Wa­ter Navy’ bill sink­ing in Se­nate de­spite late talks

The Sun Herald (Sunday) - - News - BY TOM PHILPOTT

As many as 90,000 ail­ing “Blue Wa­ter Navy” vet­er­ans are likely to have to wait for a new Congress to see leg­is­la­tion passed that would make them el­i­gi­ble for Agent Oran­gere­lated dis­abil­ity com­pen­sa­tion and VA-paid health care.

Sens. Johnny Isakson (R-Ga.), chair­man of the Se­nate Vet­er­ans Af­fairs Com­mit­tee, and Jon Tester (Mont.), its rank­ing Demo­crat, ne­go­ti­ated this week with vet­eran ser­vice or­ga­ni­za­tions, seek­ing to amend the House-passed Blue Wa­ter Navy Viet­nam Vet­er­ans Act (HR 299) in ways that would sat­isfy both vet­eran groups and Repub­li­can se­na­tors threat­en­ing to block a vote on the bill.

The ne­go­ti­a­tions ex­posed a deep­en­ing de­sire among Se­nate Re­pub­li­cans to im­pose tighter con­trols on cre­at­ing pre­sump­tions of ser­vice con­nec­tion be­tween cer­tain ex­po­sures, in­clud­ing her­bi­cides sprayed in the Viet­nam War, and dis­eases of vet­er­ans in­volved in past or fu­ture wars. Bat­tle lines are form­ing over whether Congress and past VA sec­re­taries have gone too far in build­ing lists of con­di­tions that VA pre­sumes are linked to tox­ins, burn pits and bat­tle­field en­vi­ron­ments.

The high-wa­ter mark for vet­eran ad­vo­cates might have been reached in June when the House passed a Blue Wa­ter Navy bill unan­i­mously. By Au­gust, a new VA Sec­re­tary, Robert Wilkie, re­versed that mo­men­tum, di­rect­ing deputies to strongly op­pose ex­ten­sion of Agent Or­ange-re­lated ben­e­fits to sailors and Marines who pa­trolled ter­ri­to­rial waters off Viet­nam but didn’t come ashore or op­er­ate in “brown wa­ter” nearer to sprayed fo­liage or runoff from dioxin-laced her­bi­cides.

Wilkie wrote to Isakson in early Septem­ber that the science doesn’t sup­port ex­tend­ing ben­e­fits to Blue Wa­ter Navy vet­er­ans, given that ex­po­sure lev­els are un­de­ter­mined and the po­tency of diox­ins sprayed over land likely was di­luted so as not to af­fect per­son­nel at sea. He also com­plained that pas­sage of HR 299 would slow ef­forts to end a back­log of VA com­pen­sa­tion claim ap­peals, and that the House bill would cover the cost of new ben­e­fits in part by rais­ing VA home loan fees, in­clud­ing, for the first time, im­pos­ing fees on dis­abled vet­er­ans, those who seek to buy higher priced homes us­ing VA-backed jumbo mort­gages.

At a late Septem­ber hear­ing with Wilkie, Isakson in­sisted to col­leagues that Wilkie had agreed to work with his com­mit­tee on a com­pro­mise Blue Wa­ter bill. Wilkie, how­ever, didn’t af­firm such co­op­er­a­tion that day or since.

Rep. Phil Roe (R-Tenn.), chair­man of the House Vet­er­ans Af­fairs Com­mit­tee, told me Tues­day he was stand­ing by to get a re­vised bill back from the Se­nate that vet­eran groups en­dorsed and the House could pass again for Blue Wa­ter vet­er­ans. But an eight-day win­dow to get all of that done was clos­ing fast, Roe warned.

Mean­while at least three Repub­li­can se­na­tors — Michael B. Enzi of Wyoming, Rand Paul of Ken­tucky and Mike Lee of Utah — were said to have put holds the Blue Wa­ter bill, which would block a swift yearend Se­nate vote. We learned their names hours be­fore dead­line and asked the se­na­tors’ of­fices to con­firm their op­po­si­tion.

Only Lee’s of­fice re­sponded im­me­di­ately, say­ing he “did ob­ject to pass­ing the bill by unan­i­mous con­sent. Other se­na­tors also have con­cerns. Sen. Lee wants to wait for a forth­com­ing study on the ex­tent of Agent Or­ange ex­po­sure,” which VA Sec­re­tary Wilkie promised to de­liver in 2019, “be­fore this bill is voted on.”

Isakson con­tin­ued his fight for a late-hour com­pro­mise. He did so by em­brac­ing an in­for­mal but con­tro­ver­sial pro­posal from first-term sen­a­tor and physi­cian Bill Cas­sidy (R-La.). Cas­sidy sup­ports the Blue Wa­ter leg­is­la­tion but to at­tract sup­port from more col­leagues, he pro­poses that the bill change cur­rent law to re­quire a stronger sci­en­tific as­so­ci­a­tion be­tween tox­ins and lists of med­i­cal con­di­tions that VA pre­sumes are caused by ex­po­sure.

Cas­sidy and Isakson asked ex­ec­u­tive di­rec­tors of the four largest vet­eran ser­vice or­ga­ni­za­tions — The Amer­i­can Le­gion, Vet­er­ans of For­eign Wars, Dis­abled Amer­i­can Vet­er­ans and Par­a­lyzed Vet­er­ans of Amer­ica — to back an amend­ment that would re­quire that the science show a “suf­fi­cient” as­so­ci­a­tion be­tween a toxin and a dis­ease be­fore a VA sec­re­tary can add it to a pre­sump­tive ail­ment list.

Un­der cur­rent law, a VA sec­re­tary can add an ail­ment to VA’s pre­sump­tive list if the Na­tional Academy of Medicine con­firms ei­ther a “lim­ited or sug­ges­tive” as­so­ci­a­tion be­tween ex­po­sure and dis­ease or a “suf­fi­cient” as­so­ci­a­tion.

The Cas­sidy pro­posal would dis­card the lim­ited or sug­ges­tive cat­e­gory but pro­tect vet­er­ans who gained ben­e­fits due to past VA sec­re­taries us­ing the lower as­so­ci­a­tion to build pre­sump­tive lists. The change would make it more dif­fi­cult to add dis­eases to cur­rent pre­sump­tive lists.

In­deed, a ma­jor­ity of con­di­tions on the cur­rent Agent Or­ange pre­sump­tive list were based on lim­ited or sug­ges­tive as­so­ci­a­tion to her­bi­cide ex­po­sure. These in­clude: type-2 di­a­betes; la­ryn­geal can­cer; can­cer of the lung, bronchus or tra­chea; prostate can­cer; mul­ti­ple myeloma; AL amy­loi­do­sis; ear­lyon­set pe­riph­eral neu­ropa­thy; Parkin­son’s dis­ease; por­phyria cu­tanea tarda; is­chemic heart dis­ease and stroke. VA con­tin­ues to study whether to add Parkin­son-like syn­dromes, hy­pothy­roidism and blad­der can­cer us­ing lim­ited or sug­ges­tive ev­i­dence.

If the Cas­sidy pro­posal were to be­come law, Viet­nam vet­er­ans newly di­ag­nosed with these ail­ments af­ter en­act­ment would not qual­ify au­to­mat­i­cally for dis­abil­ity com­pen­sa­tion and health care. A more thor­ough re­view process would be needed to es­tab­lish ser­vice con­nec­tion.

Vet­eran groups this week re­jected that pro­posal. Cas­sidy and Isakson coun­tered by adding a “sun­rise” fea­ture. That is, Congress would pass the Blue Wa­ter bill and adopt the stiffer pre­sump­tive stan­dard but de­lay its en­force­ment for two years. This would al­low Congress and vet­eran groups time to ne­go­ti­ate a more ac­cept­able path for strength­en­ing the science be­hind pre­sump­tive con­di­tions.

Vet groups made a counter pro­posal: Pass the Blue Wa­ter Navy bill and vet­eran groups would promise to en­gage in a pre­sump­tive de­ci­sion­mak­ing de­bate with con­cerned law­mak­ers in 2019. The bill also would amend the plan to pay for Blue Wa­ter ben­e­fits, ac­cept­ing Isakson’s idea to con­tinue to pro­tect all dis­abled vet­er­ans from VA home loans fees but ex­tend the pe­riod when higher fees are im­posed on other VA home loan users by two years. That’s where ne­go­ti­a­tions stood by Thurs­day.

How­ever, even a re­vised Agent Or­ange law would not man­date that a VA sec­re­tary adopt ev­ery Na­tional Academy rec­om­men­da­tion. Hy­per­ten­sion is so preva­lent among older Amer­i­cans that ev­ery VA sec­re­tary since 2010 has de­clined to add it the Agent Or­ange pre­sump­tive list even though the strength of as­so­ci­a­tion to her­bi­cide ex­po­sure matched that of less com­mon ail­ments on the list.

If, as ex­pected, the Blue Wa­ter Navy bill sinks in the Se­nate, Re­pub­li­cans are likely to keep its fate in the next Congress tied to their de­sire to strengthen the science be­hind pre­sump­tions of ser­vice­con­nected ex­po­sures.

To com­ment, write Mil­i­tary Up­date, P.O. Box 231111, Cen­tre­ville, VA, 20120. Twit­ter: Tom Philpott @Mil­i­tary_Up­date

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