The Defense Department and Department of Veterans Affairs recently expanded fertility treatment benefits to more people, but the VA's benefit stops short of covering surrogates, which the DoD covers for certain active-duty troops under Tricare.
The uneven coverage comes after both departments announced the expansions due to a lawsuit claiming their fertility benefits discriminated against unmarried service members and veterans, as well as same-sex couples.
The DoD said in March it will no longer limit in vitro fertilization, or IVF, treatments to married service members and will allow donor eggs and sperm. The VA then announced it would follow suit. But its revised rule for determining eligibility for IVF, released on April 4, says it won't cover something Tricare will: namely, surrogates who can carry and deliver a baby for parents.
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Both the DoD and VA policies apply to individuals whose service-connected injury, illness or disability leads to infertility. Conditions that may lead to infertility "include but are not limited to hydrocele, varicocele, prostate cancer, diabetes, benign prostate hypertrophy, erectile dysfunction, hysterectomy, and female sexual arousal disorder," VA Press Secretary Terrence Hayes said in a statement to Military.com.
IVF providers fertilize eggs with sperm in a lab then place resulting embryos into someone's uterus to try to start a pregnancy. A surrogate may carry the fetus and give birth.
The DoD expanded its benefit to include the IVF of such a "third-party gestational carrier" or unmarried partner, but only if that person is already otherwise eligible for or enrolled in Tricare and doesn't receive any payment for performing the surrogacy.
The VA, on the other hand, won't provide IVF counseling or treatments to anyone but the veteran or legal spouse because those are the only people listed in the separate federal regulations authorizing its provision of IVF, Hayes confirmed in the statement to Military.com.
"While the authorization specifically defined to whom VA can provide [assisted reproductive technology, or ART], it does not specifically define what types of care fall under ART," Hayes said.
Instead, the VA refers to DoD's policy for types of care. "For example ... [when] DoD's policy was amended to allow the use of donor gametes, VA's policy to prohibit the use of donor gametes was superseded."
However, the DoD's policy doesn't supersede VA's authorization for whom it can cover, Hayes said.
"This distinction is important, because if VA were bound by DoD's policy on who it could provide ART care, then it could not provide care to veterans, as the DoD policy only applies to certain active-duty [service members] with serious or severe (Category II or II) illnesses or injuries impacting their ability to procreate," he said.
Related: New Pentagon Policy Expands In Vitro Fertilization Options for Severely Ill or Injured Troops
