WASHINGTON — Army veteran Toni Hackney has always wanted a family, but as a single woman with endometriosis, she knew she would need fertility assistance.
A year after she sought approval from the Department of Veterans Affairs to cover the cost of in-vitro fertilization treatments, she was denied for what she called a ridiculous reason: She’s not married.
“The whole time I’m fighting with them about, OK, this isn’t fair, you know? Y’all say everything is on an equal basis and everything, but this don’t feel equal basis,” Hackney said in an interview. “It’s like they make it mandatory for you to get married in order to get treatment.”
In order to receive VA reproductive health care benefits, veterans must have suffered a service-connected injury, be married, and be able to supply their own eggs or sperm. Surrogacy is not covered.
That excludes unmarried veterans like Hackney, same-sex and transgender couples, and those who cannot produce eggs or sperm due to a service-connected injury or another medical issue, such as cancer treatments.
Khris Goins (right) and his wife, Dashonda, have been together for 11 years. They were married in 2014. Goins, a transgender man, can’t take advantage of the VA’s fertility benefit because it would require the couple to supply their own eggs and sperm. (Courtesy Khris Goins)
The VA added fertility coverage in 2016, largely because of the efforts of U.S. Sen. Patty Murray, D-Wash. Now some veterans and infertility advocates say the coverage should be made permanent and expanded to cover more people.
“It’s helping some, and trust me, we’re very happy and grateful for that,” said Barb Collura, president and CEO of Resolve, a national infertility advocacy organization. “But it’s showing, in very glaring form, who is being left out, and that’s not acceptable to us.”
Hackney, 47, of Atlanta, served in the Army for 16 years as an imagery analyst on intelligence projects. She was a member of the first battalion called for duty after 9/11, serving in an undisclosed domestic location from December 2001 until 2003.
“I want to experience pregnancy and giving birth,” she wrote on her GoFundMe page to raise money for her treatments. “For me, the experience is just more than a want. I need it.” She’s raised just $1,250 of her $45,000 goal.
VA’s ‘hands are tied’ by Congress
Last month, a House subcommittee on veterans’ affairs held a hearing to discuss veterans’ access to reproductive health care. Veterans advocates described the conditions veterans must meet to qualify for IVF treatments.
Those rules are so restrictive, only 567 veterans accessed the benefit between 2016 and 2019, according to news reports. Most are men with obvious external injuries, so their wives are the ones who receive the treatment.
“It’s like they make it mandatory for you to get married in order to get treatment.”
— U.S. Army Veteran Toni Hackney
Because most of the procedures are performed by third-party providers, the two parties must negotiate a rate. That requires extensive paperwork that is a burden on small centers, according to Joy Ilem, legislative director for Disabled American Veterans.
The VA’s “eligibility requirement is mandated by Congress,” a VA spokesperson said in an email.
Collura said that although the VA has said publicly it wants to offer the benefit to veterans struggling to conceive, “their hands are tied by what Congress has said.”
The legislation is as restrictive as it is simply because it lifted language from an existing Department of Defense benefit for active service members, Collura said.
Prior efforts to expand the VA’s coverage have failed because the issue touches on the debate over abortion, specifically the destruction of leftover embryos, which some Republican lawmakers oppose. The Family Research Council, a conservative Christian group, advocates funding IVF treatments only if they don’t destroy embryos.
The VA’s coverage pays for unlimited embryo storage to skirt that issue.
‘Power couple’ seeks biological child
Army veteran Khris Goins, a transgender man, and his wife have been together 11 years. Their friends in Columbus, Ohio, have dubbed them “the power couple.”
Goins, now 33, served in the Army at Fort Bliss, Texas, from 2006 to 2009. In 2015, he and his wife wanted to start a family, so they tried to get IVF treatment through the VA using sperm donated by someone they know.
After going through fertility assessments at a local clinic, the couple was disheartened to learn IVF wasn’t covered for them.
Goins and his wife, Dashonda, are trying to save money from the financial services business they run together and from donations. One attempt at pregnancy costs $12,000 on average.
The family’s last chance at a biological child and grandchild is IVF using Goins’ eggs.
It would be a blessing to have “a child to continue our bloodline and fill the void in our lives” left by the murder of Goins’ only sibling, his brother, he wrote on his GoFundMe page.
He hasn’t raised any money, which he believes is because he set up the campaign as the coronavirus pandemic struck.
Thirteen states mandate insurance policies cover IVF treatments, according to Resolve, but it’s not universally available. Mercer, a benefits consulting firm, found that 44% of insurance plans for companies with more than 20,000 employees and 28% of companies with more than 500 employees covered in vitro fertilization in 2018.
Though some private insurance policies are restrictive, “none of them are as restrictive as the ones we see in the military,” said Karla Torres, senior counsel at the Center for Reproductive Rights. The health issues and working conditions unique to veterans make expanded coverage of IVF even more important for them, she said.
What counts as a service-related injury?
Kerry Karwan, a veteran in San Leandro, California, and an advocate for the Service Women’s Action Network, fought for almost a year to get her treatments covered by the VA because she couldn’t prove she had a service-connected condition.
She served in the Coast Guard for years in a shipyard that exposed her to asbestos, lead paint, mold and chemicals. A fertility specialist told her the mold levels in her blood, which can cause infertility, were “off the charts,” she said.
There’s little research on the subject, but veterans advocates say infertility is tied to working conditions in the military. Ilem, of Disabled American Veterans, said that in addition to chemical exposure, infertility is tied to medication prescribed for psychiatric disorders — some related to one’s service, like post-traumatic stress disorder.
Many women also delay childbearing until after active duty — and after their peak fertility years — making it harder to conceive after they’re discharged.
But none of these are considered service-connected injuries, so the VA typically doesn’t cover IVF treatments in those cases.
Kerry Karwan poses by a Coast Guard helicopter after a flight in San Francisco in 2011. She worked for almost a year to show her fertility problems were connected to her service, a requirement for VA coverage. (Courtesy Kerry Karwan)
“You can’t document that [delayed childbearing] is a service-connected reason for being infertile because there isn’t this clear, demonstrable, ‘I got blown up’ situation, though it could in fact be related to your military service,” said Kayla Williams, senior fellow and director of the Military, Veterans and Society Program at the Center for a New American Security, and a veteran herself.
A recent study of veterans who served in Iraq and Afghanistan found about 16% of women and 14% of men reported struggling with infertility, compared with 12% of all American women and 9% of all American men.
Disabled American Veterans, the American Legion and other veterans’ groups call for more research on women’s reproductive health in the VA health care system. Women veterans weren’t treated as a separate category in military health studies until the 2000s.
Karwan did get the VA to cover her in-vitro treatments after convincing the agency that her infertility was partly tied to her inability to get proper treatment for polycystic ovarian syndrome while on active duty.
But she faced more obstacles as she looked for a fertility clinic because so few work with the VA. She believed the clinics available to her were a poor fit and didn’t handle her case with care. One even broke tubes carrying embryos she and her husband had frozen.
Now that she’s 45, she’s worried she has missed her prime reproductive window. “Here I am defending everyone else’s liberties and rights of happiness, and I’m getting denied my chance to have children,” she said.
Rep. Julia Brownley, D-Calif., chairwoman of the House Veterans’ Affairs subcommittee on health, announced in early August she plans to introduce legislation in the coming months “to address the needs of veterans facing barriers to having children.” She said in a written statement her bill would expand the VA’s reproductive benefit to include surrogacy and IVF for veterans “regardless of marital status, service-connection, or need for donated genetic material.”
In the meantime, veterans like Hackney, Goins and Karwan are scraping together tens of thousands of dollars to pay for the procedures themselves.
Although she’s also looking into adoption, Hackney hopes Congress will loosen the rules in time for her to have a biological child of her own. “Since Congress’ laws regulate the VA, they really need to not play a political game with people’s lives and futures,” she said. “This is my life.”
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