In their report Veterans and Agent Orange: Update 2014 released March 10, 2016, the Institute of Medicine (IOM) changed the association category of spina bifida, a birth defect that has garnered attention in recent veteran health news. In this rare move, the IOM changed spina bifida birth defects in the offspring of those exposed to Agent Orange from the “Limited or Suggestive” category to “Inadequate of Insufficient Evidence to Determine an Association”.
There has been no new analyses or studies finding increased rates of spina bifida in children of men exposed to Agent Orange and other chemicals of interest since 1996. According to the IOM report, “biologic plausibility remains uncertain for paternal transmission following adult exposure”.
Changes to established benefits for persons born with spina bifida would not happen quickly, if at all. The VA is already moving towards adopting rule changes first proposed in May 2015 to provide clear definitions of available VA health care for the birth children of veterans who served in Vietnam and on the Korea DMZ who have been diagnosed with spina bifida and “certain other birth defects”. Health care services requiring preauthorization by the VA are also being updated. The changes are scheduled to take effect thirty days from the Federal Register Posting on April 6, 2016.
While many Vietnam Veterans are now in their 60s and 70s the subject of birth defects and continued availability of VA benefits is still relevant. Depending on the severity of the disability, babies born with spina bifida or other birth defects need life-long care and support.
Benefits | Federal Law and Regulations
Title 38, United States Code, Chapter 18 provides for these benefits:
- Monthly monetary allowances for various disability levels
- Health care
- Vocational training and rehabilitation
Federal regulations concerning health care for children authorized under 38USC18 are from 38CFR17.900 to 17.905.
These benefits are commonly referred to as “Chapter 18 benefits”.
Preauthorization required for these products and services (38CFR17.902)
- Rental or purchase of durable medical equipment (DME) for total costs in excess of $300
- Day health care on an outpatient care basis
- Dental services
- Homemaker services
- Outpatient mental health services (in excess of 23 visits per calendar year)
- Substance abuse treatment
- Training
- Transplantation services
- Travel
For spina bifida patients, the care must be determined to be medically necessary. For patients suffering from another covered birth defect, the care must be medically necessary AND related to the covered birth defect.
Spina Bifida
The most severe form and most common form of spina bifida (Myelomeningocele or open spina bifida) causes the baby’s spinal canal to remain open along several vertebrae. Skin may or may not cover the opening; exposed tissues and nerves make the baby prone to life-threatening infections.
Eligibility for VA benefits – Spina Bifida
- The child must be a natural child of a Veteran (male or female) with qualifying service in Vietnam or Korea; conceived during or after the covered service
Other covered birth defects
In addition to spina bifida, “Chapter 18 benefits” are available for birth defects potentially linked to a mother’s Vietnam service that resulted in permanent mental or physical disability. Here are a few of the covered birth defects:
- Achondroplasia
- Cleft lip and cleft palate
- Congenital heart disease
- Congenital talipes equinovarus (clubfoot)
- Esophageal and intestinal atresia
- Hip dysplasia
- Syndactyly (fused digits)
Eligibility for VA benefits – other “covered birth defects”
- For a child suffering from a “covered birth defect”, the child’s natural mother must be a Vietnam Veteran
References and Resources:
- National Institute of Neurological Disorders and Stroke
- Mayo Clinic
- March of Dimes
- Title 38, United States Code, Chapter 18 (38USC18)
- Tile 38, Code of Federal Regulations, Section 17 (38CFR17.900 to 17.905)
- M21-1, Part IV, Subpart ii, Chapter 2, Section B
- The Federal Register Notice scheduled for publication on 4.6.2016