Soldiers from Ft. Lee, Virginia help mark Veterans Day ceremonies at the World War II Memorial Nov. 11, 2011 in Washington, D.C. Veterans Day in the United States honors those who have served in the nation’s military and also coincides with the anniversary of the conclusion of hostilities on the western front in World War I. (Win McNamee/Getty Images)

Ahead of Veterans Day, Biden administration officials said Friday the Department of Veterans Affairs will expand health care coverage for certain groups of veterans and their families and create new programs meant to make care more accessible.

The VA will make coverage of certain toxic burn pit-related conditions available sooner than anticipated. Family members of veterans who served at North Carolina’s Marine Corps Base Camp Lejeune from 1953-1987 will be eligible to have the costs of treating Parkinson’s disease. And all World War II veterans will be eligible for no-cost health care, including at nursing homes, the department said in a series of news releases.

The administration will also create a new graduate medical education program to help expand health care availability for veterans in rural, tribal and other underserved communities, the department said. And the VA will spend $5 million on an advertising campaign aimed at having more veterans sign up for services.

“As we head into Veterans Day, we’re reminded of the fundamental promise that our country makes to anyone who signs up to serve in the military: If you fight for us, we’ll fight for you,” Veterans Affairs Deputy Secretary Tanya Bradsher told reporters on a Thursday call in advance of the announcements.

The administration announced five changes meant to expand veterans’ benefits.

The VA will speed up coverage for burn pit exposure that was part of a bipartisan law passed last year.

The law, which provides health care benefits to veterans exposed to toxic chemicals from burn pits in Iraq and Afghanistan and certain other veterans, was written to be phased in over no more than 10 years.

But President Joe Biden is directing the VA to make all affected veterans eligible for expanded benefits by early next year, according to a White House fact sheet.

The Camp Lejeune Family Member Program will be expanded to cover Parkinson’s disease. The program, which covers a host of conditions related to the contaminated drinking water at the base, did not previously include Parkinson’s.

Veterans of World War II who served anytime from Dec. 7, 1941, to the end of 1946, are entitled to no-cost VA health care, meaning no co-pays or monthly premiums, the department said. That includes care at nursing homes.

To expand availability, the department is also creating a pilot program to reimburse residents and residency programs, including those outside of VA facilities, that serve veteran patients. The program would fund 100 physicians in rural, tribal and underserved communities, according to a VA news release.

And to encourage veterans to take advantage of their benefits, the department is planning a national advertising campaign focused on “some of the most tangible, cost-saving benefits” veterans are entitled to, according to the VA.

The multimedia campaign will tout the low-cost or no-cost health care, education, home loan and memorial service programs, the VA said.

The waiver change wouldn't require legislative action. (Getty Images)

This story discusses suicidal ideation and sexual assault. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

If you’ve been sexually assaulted, you can call the Rape, Abuse & Incest National Network helpline at 800-656-4673 or chat with someone from RAINN online at https://hotline.rainn.org/online.?

LOUISVILLE — At age 17, Jeremy Harrell was helping senior citizens fill their grocery store orders when it snowed.?

Six months later, he was learning to kill.?

And that’s where post-traumatic stress disorder starts for a lot of soldiers, Harrell said: at boot camp, when the values they were raised with are replaced.?

But the disorder can look different person to person — and much more than war can trigger it, ?therapists who treat the condition told the Kentucky Lantern. Even seeing something traumatic happen to someone else can lead to PTSD.?

Car wrecks can cause it, as can home invasions, threats and sexual violence.?

The latter caused Caroline Wormald’s PTSD.?

She was a first-year undergraduate at Northern Kentucky University studying psychology, when a stranger she’d just met on a dating app?sexually assaulted her in her dorm.?

She was 19 when it happened — in March, right after Spring Break 2019.?

The flashbacks started as Wormald underwent an exam in the emergency room shortly thereafter. They joined with nightmares to keep her awake at night. ?She lives with symptoms of PTSD to this day.

Clinicians who treat post-traumatic stress disorder in Kentucky said PTSD is a complicated condition and can feel quite isolating – statements that are true in Harrell and Wormald’s cases.?

Natasha R. Porter, the CEO and clinical director of Beacon of Light Behavioral Health, said PTSD develops when a person’s brain is exposed to something that it cannot process nor move past.?

The brain gets “stuck,” she said. “And that’s why we have the nightmares and the flashbacks and all the emotion surrounding it.”?

Porter, herself an Army veteran, said it’s important to note that PTSD isn’t restricted to soldiers, though many do experience it.?

The United States Department of Veteran Affairs says that veterans are more likely than civilians to develop PTSD, especially if they were deployed. However, around 6% of the general population experiences PTSD at some point in life, according to the VA.?

That number jumps to 8% among women, who are more likely to experience sexual violence.?

Jeremy Harrell’s story?

Louisville’s Harrell, an Army veteran who served both stateside and in Iraq from 1999 to 2008, was diagnosed with PTSD after he returned to civilian life.?

But the journey to a diagnosis — and to accepting it — wasn’t a direct one.?

For Harrell, the journey to diagnosis took five years. It was that long before he knew something was off.?

He turned 21 while serving overseas. When he came home, he thought all the changes in his life were because he was older. He wasn’t happy — ever. He didn’t enjoy the same things he did before, he forgot information and struggled to stay awake in work meetings.?

“I guess this is kind of part of maturing and becoming a man,” he recalls thinking. “I just assumed that everybody else was in the same boat.” He had a young child at home and another on the way. This was all part of that, he reasoned.?

He finally went to Veteran Affairs for evaluation. Mostly, he said, he wanted to prove everyone who thought he had PTSD wrong.?

He did not.?

“Looking back, I’m glad that they evaluated me for all these things. That’s a blessing, to be evaluated,” he said. “But at the time, it was demoralizing and I felt like my whole world had collapsed.”?

The testing process made him feel like a “hamster in a cage,” he said. He felt exposed, broken.?

Depression took over, leading to suicidal thoughts so he wouldn’t “be a burden to my family.”?

“It’s really a terrible, terrible space,’ Harrell said. “I wouldn’t wish it on my worst enemy.”?

Finally, a light.?

Harrell decided to approach his PTSD like a war. “I thought: ‘if I’m going to win against this enemy, PTSD … then I must learn all I can about it.’”?

He decided to use his story to help fellow soldiers so that “maybe, just maybe, they won’t have to suffer in silence for a decade before they realize something’s wrong.”?

He founded Veteran’s Club, which is based in the Louisville area and advocates for mental health through a variety of programs. Now, he’s a well-known advocate for mental well-being in Kentucky.?

Caroline Wormald’s?story?

Wormald went to NKU’s Norse Violence Prevention Center?shortly after the assault in 2019 and reported the incident to the school, which she said was quite supportive of her during the process.?

The center’s staff helped guide her to the hospital and to the police, she said.?

She also got free weekly therapy through NKU to help cope with the flashbacks and other fallout of the assault, she said.?

Through that therapy, she got a post traumatic stress disorder diagnosis.

“I definitely felt like my sense of safety was interfered with, especially the night it happened because he was a complete stranger,” Wormald said. “I was afraid he was going to come back.”?

Wormald suffered from flashbacks and nightmares, as well as “terrifying” hallucinations.?

“I’d wake up in the morning and I’d be full on hallucinating and I knew I was but it was terrifying,” she recalled. “I had a guitar at the time … one morning … I woke up and I just saw him there and for a second I thought it was real. So … I went and … I leaned over and tried to punch him and I punched my guitar at, like, seven in the morning.”?

She missed classes and school from sleep issues — waking up from the nightmares, exhausted. It was difficult to get out of bed until everyone was awake in the dorm and the lights were on. Sleep medication finally helped her rest.?

Four years later, Wormald plans to return to NKU this fall as a law student and plans to use her experience to fight for others.?

“I want to work with families and people like me who’ve had situations similar to mine,” she said, “and just … be an advocate and stand up for them in regards to the legal system.”?

The COVID-19 effect

After her assault, Wormald socially isolated herself. She didn’t make new friends and became “petrified of strangers, but specifically men.”?

COVID-19 only exacerbated that.?

“I was isolating myself even before COVID happened,” she said. “And then with COVID happening, it just made it worse. Now I had a general reason, really, not to put myself out there.”?

The pandemic was “detrimental” to the veteran community as well, Harrell said.?

Similarly to Wormald’s experience: “It gave veterans who tend to isolate a justification to do so.”?

Kentucky got its first case of COVID-19 in March 2020. Massive shutdowns and physical distancing defined much of that year — and the next couple.?

The national emergency declaration ended in May 2023, but the virus is still present.?

So, too, is the continued fallout: educational setbacks, child welfare concerns, workforce challenges?and mental health struggles.?

“I know everybody wants to say, ‘COVID is over, quit talking about it,’” Harrell said. “But the reality is: that was a very, very serious event that lasted a long time that will forever have residual effects on our society and individuals.”?

What’s the treatment for PTSD??

Because PTSD looks different person to person, so does treatment. Common treatments include eye movement desensitization and reprocessing (EMDR) therapy, and cognitive behavioral therapy (CBT or talk therapy).?

Brothers and clinicians Travis and Anthony Andrews said PTSD can sometimes find its roots in gun violence and its effect on neighborhoods.?

Together they founded Andrews Counseling & Consulting, and also work with One Lexington, which is part of the mayor’s office and seeks to address violence in Fayette County

They said talk therapy is the main way they treat it. But, they said, to truly address PTSD requires a much more holistic approach.?

Thinking holistically about PTSD?

While a lot of people hear “PTSD” and think of acute trauma — one traumatic event or incident — there are more layers, Travis Andrews said. There is also chronic trauma, such as domestic violence or other abuse that happens over time. Finally, complex trauma features multiple traumatic events.?

“What makes this very prevalent is the fact that a lot of these traumas have been left untreated,” he explained. “So it’s no different than us going to a medical doctor and we have an ankle injury at age 4, 6, 10 and we never got that treated … and now we will be going into the doctor five or six years later saying ‘hey, can I get some rehabilitation on my leg?’”?

He also sees misdiagnoses when it comes to children with PTSD because of poverty, socioeconomic status, gun violence or other social-ecological factors.?

“People are not getting their basic needs met,” Travis said. “They’re living in a day to day not knowing how they’re going to eat, seeing domestic violence in their household, seeing all these negative incidents that they’re living with daily, which will result (in) other criminal activities.”?

Generational trauma and oppression can also result in PTSD and untreated stress, Travis said, because trauma becomes the accepted normal.?

“We think about oppressed communities … majority communities of color who have been subjected to discrimination, harsh living conditions, things of that nature,” he said. “These communities have been taught just to have a level of resilience. So what does resilience look like? Sometimes that means avoiding the problems. … So that means a person is left untreated.”?

Fighting a ‘debilitating stigma’?

Porter sees stigma constantly when treating PTSD — and exaggerated depictions in films and on television only make it worse.?

“The stigma is there and it’s horrible,” she said. “And it’s debilitating, honestly.”?

Anthony Andrews said mainstream films that show mental health as horror, as a person escaping a psychiatric ward and terrorizing their community, only hurt real people who have PTSD.?

“The media plays a huge part because what they show is going to be how people connect,” Anthony said. If movies and news only show PTSD as it relates to mass shootings, he said, “‘well, people only have PTSD when they experience mass shootings.'”?

If it’s depicted only in war movies, then, he said, people will believe “‘this is what PTSD looks like.’”?

In military circles, Porter’s heard PTSD called weak. But nothing could be further from the truth.?

“Think of your worst nightmare,” she explained. “(Imagine) the worst time that you’ve ever had, and imagine it replaying in your mind all day.”?

That’s what PTSD feels like, she said. And it sometimes drives some to think of ending their lives.?

“Suicide happens because they feel trapped,” she said. “And they don’t feel like there’s another way and they feel like a burden.” But, she said, there is always hope. Therapy can help.?

Harrell hears that suicidality a lot in his advocacy work with fellow veterans now.?

But: “That’s just a transference of pain from the person who committed suicide to their family,” he said. And: “I can assure you: the worst day with you is much better than not having you.”?

Policy opportunities?

To truly address PTSD through policy, the Andrews brothers said, lawmakers must look at those ecological factors and find ways to incorporate treatment into culture. What would it look like, they wonder, if whole campuses — professors, coaches, cafeteria workers — spoke through trauma-informed care??

Policymakers should look at ways to increase funding for mental health care and access to it, they said. Workplaces should also offer broad accommodations for mental health conditions.?

So many people have anxiety, stress and PTSD, the therapists said. Because of that, they said: everyone should have equal access to treatment and mental health care.?

Veterans Memorial, Devou Park, Covington. (City of Covington photo)

Memorial Day marks the start of summer, a long weekend to kick back, relax and enjoy the lake or a steak. It also is something more —? a time to remember military veterans who gave their lives for our country.

Each service member, living and dead, means something to their communities, families, veterans and those still serving.

According to VA.gov, Memorial Day has been recognized in some form since 1866, just after the Civil War. Though relatively informal, Union veterans organized Decoration Day to decorate the graves of the recently buried soldiers.?

In 1868, Decoration Day was more organized and widespread than the original recognitions in 1866, when only 25 cities celebrated.

After World War I, Memorial Day was observed in honor of all those who died in American wars, not just the Civil War as it had mostly been recognized before. More than 150 years after the first Decoration Day, the practice continues and serves as a time to remember the more than 1 million lives lost in military service, as well as the millions of veterans who died after serving.?

An unknown but certainly significant number of Kentuckians gave the ultimate sacrifice defending the freedom that Americans celebrate.?

According to the U.S. Census Bureau, Kentucky’s 250,427 living veterans make up a little more than 1.4% of the more than 17 million living veterans in the U.S., about the same proportion as Kentucky’s population as a whole.

In 1971, Congress declared Memorial Day a national holiday, officially to be recognized on the last Monday in May. Some say spring was chosen because flowers would be in bloom, and because it was not too close to other holidays. Cemeteries around the nation are decorated with American flags, flowers and other decorations during May, often on graves of those who served and those who did not.?

Kentucky events

The U.S. Department of Veterans Affairs (VA) is hosting commemoration ceremonies Monday at six national cemeteries. Dates and times may change due to inclement weather or other circumstances, says the VA, which encourages visitors to contact the national cemetery to confirm information prior to the event.

Camp Nelson, 11 a.m., 6980 Danville Road, Nicholasville, 859-885-5727.

Cave Hill, 11 a.m.,701 Baxter Avenue, Louisville, 502-893-3852.

Lebanon, 2 p.m., 20 Hwy 208, Lebanon, 270-692-3390.

Lexington, 11 a.m., 833 West Main Street, Lexington, 859-885-5727..

Mill Springs, 11 a.m., 9044 West Highway 80, Nanc. 859-885-5727. At 9 a.m there will be a remembrance ceremony at Zollicoffer Park to reflect on the Civil War battle with guest speaker Stuart W. Sanders, author of “The Battle of Mill Springs, Kentucky.” ?

Zachary Taylor, 2 p.m., 4701 Brownsboro Road, Louisville, 502-893-3852.

The Kentucky Department of Veterans Affairs will host ceremonies Monday at the state’s five cemeteries for veterans. The events will include posting of the colors, singing of the national anthem, wreath laying, a guest speaker and taps.? (All times are local.)

Kentucky Veterans Cemetery West, 11 a.m. Hopkinsville, 5817 Fort Campbell Blvd.?

Kentucky Veterans Cemetery Central, 11:30 a.m., Radcliff, 2501 N Dixie Blvd.

Kentucky Veterans Cemetery North, 11 a.m.,? Williamstown, 205 Eibeck Lane.

Kentucky Veterans Cemetery North East 10 a.m., Grayson, 100 Veterans Memorial Drive.

Kentucky Veterans Cemetery South East, 11 a.m., Hyden, 1280 KY 118.

Other events:

Louisville: Flag retirement ceremony, 2:30 p.m to 4 p.m., Morning Pointe Senior Assisted Living, 4711 South Hurstbourne Parkway, hosted by The Roll Call Foundation.

Northern Kentucky will commemorate Memorial Day with ceremonies and parades at communities across the region. Here is a comprehensive list of events in Northern Kentucky by LINK nky.?

Covington: 7 a.m. to 3:15 p.m. Salutes at six sites will include prayer, 21-gun salute, playing of taps and the placing of a wreath. At 2 p.m. the parade will leave Holmes High School by Eastern Avenue and proceed west on 19th Street, north on Holman Avenue and west on 13th Street to Linden Grove Cemetery, where a ceremony will begin at 3:15 p.m.

Florence, 10 a.m. Parade begins at Boone County High School and ends at the Florence Government Center, where a ceremony will begin at 11:30 a.m. at the Boone County Veterans Memorial.?

Owensboro: Memorial Day Walk for the Fallen, remembrance ceremony at 8 a.m. at the Shelton Memorial, 99 West Veterans Boulevard, followed by a 5K run, 1 mile walk and ruck march.

Supporters of House Bill 367 say losing food assistance would encourage able-bodied adults to get a job. Opponents say the bill would harm local economies, increase administrative burdens on school lunch programs and disqualify people for having even small savings. (Photo by Justin Sullivan/Getty Images)

Congressional Republicans’ efforts to slash federal spending by tying work requirements to Medicaid and SNAP would have far-reaching consequences for people with mental health issues, chronic health problems, and some people with disabilities if enacted, policy experts on anti-poverty programs say.

They say the work requirements as laid out by House Speaker Kevin McCarthy’s “Limit, Save, Grow Act of 2023” — the Republican plan to raise the country’s debt ceiling —? would be devastating for many Americans and hard for states to implement, especially in the thick of the pandemic public health emergency ending. The bill narrowly passed the House in April, 217 to 211 with four Republicans joining Democrats in voting against it. If a deal isn’t reached, the U.S. will default on its debt as early as June 1.?

Democrats have pushed back on the work requirements, but McCarthy has said they are non-negotiable. Reports that Biden is showing some flexibility on the issue have upset some Democrats. The House Freedom Caucus has also pushed for McCarthy to stop the discussions with the White House until the Senate passes the bill.

Ten million Medicaid expansion enrollees are at risk under the bill, according to the Center for Budget and Policy Priorities. The Health and Human Services Department estimated that 21 million people are vulnerable to the work reporting requirements. The Congressional Budget Office found that 1.5 million people would lose coverage and 600,000 would become uninsured. It’s possible that the CBO could be underestimating how many people would lose their coverage, some experts say. Although the requirements apply to every state, the CBPP explained in its analysis of the bill that “it would heavily impact people covered by the Affordable Care Act (ACA) Medicaid expansion.”

“People with mental health issues, people with substance use disorders, people with chronic health conditions and even forms of disability could be encompassed within the expansion population and would need to navigate an entirely new system that’s really not well-specified in the bill to get an exemption and we know that that sets up a massive coverage loss potential,” Allison Orris, senior fellow at the Center for Budget and Policy Priorities, told States Newsroom.

The bill includes work-reporting requirements for Medicaid that are even more severe than a 2018 Arkansas law that has since been blocked by the courts, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy. Unlike other work requirement proposals, the bill would not exempt people during their pregnancy and into their postpartum period and there isn’t an automatic exemption for people receiving Supplemental Security Income because they have a disability or Social Security Disability Insurance. It would undercut gains made by Medicaid expansion because even people eligible could lose coverage because of the complexity of the “red tape” they would be forced to navigate, Park said. The unwinding of pandemic policies adds to the potential complications.

“You have all the coverage losses where some people are going to be inappropriately disenrolled, particularly for procedural reasons. They won’t return in the mail. They never got their renewal packet. … And then you have on top of that, this onerous work-reporting requirement with red tape and because states are so overwhelmed with unwinding over the next year or so, it’s hard to see how they could implement a work-reporting requirement that implements the exemptions,” he said.

Park added that House Republicans who characterize this provision of the bill, which requires recipients to work 80 hours per month, do community service or be involved in an employment program, as only affecting able-bodied adults without children is inaccurate.

“… Based on how this proposal has been designed, you know, it’s not targeted to that group at all,” he said.

He explained, “We know that many people who are disabled who are receiving disability benefits do work to a limited extent and they aren’t necessarily unfit for employment. There’s limits on how much they can work to maintain their benefits. But federal policy, up to this point, has been encouraging those with disabilities to work to increase their employment hours while being able to maintain their health coverage.”

Expanding SNAP work requirements

The SNAP work requirements are equally concerning to advocates. Currently 18- to 49-year-olds without children at home can only receive benefits for three months in any three-year-period unless they prove they’ve worked a 20-hour week. Under McCarthy’s bill, those work requirements would be expanded to include people up to age 55.?

Craig Gundersen, an economics professor at Baylor University whose research focuses on food insecurity and food assistance, said it may look like that the work requirements are successful because cases will fall, but the reality will be different.

“What’s going to happen is if you impose work requirements you’re going to have an increase in food insecurity in our country,” he said.

He said the bill’s provision on SNAP doesn’t make sense.?

“SNAP doesn’t discourage work. So why would you want to impose work requirements? The second thing is that SNAP is an anti-hunger program full stop,” he said. “That’s what it was designed to do. If that’s its main goal, why would we ever want to say to people that you have to work to get these benefits.”

Nine-hundred thousand people in the U.S. aged 50 to 55 are at risk of losing SNAP, according to CBPP.

The SNAP restrictions also make it harder for states to provide support for SNAP recipients dealing with unique circumstances that would exempt them from the three-month time limit to receive benefits. The number of exemptions states can use are currently tied to their caseloads and if they aren’t used, states can roll them over into the next year. McCarthy’s bill wouldn’t let states carry over unused exemptions.?

??Temporary Assistance for Needy Families (TANF) would also be affected by the stricter work requirements in the House debt ceiling legislation. Families subject to work requirements — 540,000 families — could potentially lose their cash benefits, the CBPP estimated, worsening child poverty.

Housing assistance, student loan forgiveness targeted

In addition to these effects on anti-poverty programs, many other services and benefits in housing and education would likely suffer from the huge cuts proposed in the bill. The CBPP’s analysis of this bill shows average cuts of 13% in 2024 even if cuts were evenly spread across discretionary programs.

The legislation would also kill Biden’s student loan forgiveness plans regardless of the outcome in the courts and nix student loan repayment plans that were designed to be more affordable for people with student debt. It would “likely eliminate Pell Grants altogether for 80,000 students,” according to the Department of Education.

“Here you are cutting one of the premier programs that serves low-income students who are trying to access this level of education, who have long been marginalized in the labor market,” said Katherine Gallagher Robbins, senior fellow at the National Partnership for Women & Families. “And what you’re saying to them is, ‘Oh, hey, by the way, we’re not even going to give you the support that will pay dividends for years to come in your own earnings.”

Department of Housing and Urban Development Secretary Marcia Fudge has estimated that nearly 1 million people could lose housing assistance and that nearly 120,000 people may be cut off from homelessness services.

“Stable housing is such an essential part of any family’s economic security,” Gallagher Robbins said. “ … The cuts that they’re talking about here …, you’re going to end up eliminating almost 300,000 families’ support for their housing. Not all of those families will end up being unhoused, but some of them will. It creates this downward spiral that is very challenging to recover from, especially as other benefits are cut …”

The ending of the pandemic public health emergency has already resulted in the loss of financial support for some families, and now with these potential cuts, the people who benefited most from the recovery would be hurt the most from this bill, Gallagher Robbins said.?

“We’re already seeing things like less access to school lunch, less access to the child tax credit,” she said. “So families are already struggling with what that looks like and that has been mitigated to an extent, obviously not fully, by the current strength of the economy. Everything is up for grabs here, basically, in terms of harming families who are already absorbing this most recent kind of cut in support.”

Veterans who served at Camp Lejeune fought for decades to get the federal government to admit that their illnesses and those of their families were linked to the toxic chemicals in the water at the Marine base. Retired Marine Corps Master Sgt. Jerry Ensminger, shown here on Capitol Hill in 2014, helped uncover the contamination after his 9-year-old daughter died of leukemia. (Photo by Chip Somodevilla/Getty Images)

David and Adair Keller started their married life together in 1977 at Camp Lejeune, a military training base on the Atlantic Coast in Jacksonville, North Carolina. David was a Marine Corps field artillery officer then, and they lived together on the base for about six months.

But that sojourn had an outsize impact on their lives.

Forty years later, in January 2018, Adair was diagnosed with acute myeloid leukemia. She died six months later at age 68. There’s a chance her illness was caused by toxic chemicals that seeped into the water military families at the base drank, cooked with, and washed with for decades.

When the PACT Act passed last August, David asked a neighbor who worked at a personal injury law firm in Greenville, South Carolina, if he thought he might have a case. Now Keller is filing a wrongful death claim against the federal government under a section of that measure that allows veterans, their family members, and others who spent at least 30 days at Camp Lejeune between August 1, 1953, and the end of 1987 to seek damages against the government for harm caused by exposure to the toxic water.

The Camp Lejeune Justice Act didn’t attract the spotlight like the aspects of PACT that deal with the harms soldiers experienced from burn pit fumes overseas. But for veterans who served at this North Carolina post, it is the realization of a decades-long effort to hold the government accountable.

Legal fees could eat into awards

As cases begin to proceed through the legal system, some veterans’ advocates worry that families who have already suffered from toxic exposure may get shortchanged by a process that’s supposed to provide them with a measure of closure and financial relief. They support limiting lawyers’ fees, some of which may exceed half of a veteran’s award.

The government estimates as many as a million people were exposed to Camp Lejeune’s contaminated water during the 34-year period covered by the law. Personal injury lawyers have taken notice. In recent months, TV ads trying to drum up business have been impossible to ignore: “If you or a loved one were stationed at Camp Lejeune between 1953 and 1987 and developed cancer, call now. You may be entitled to significant compensation.”

During the year that ended in March, TV ads soliciting Camp Lejeune claims reached an estimated $123 million, according to X Ante, a company that tracks mass tort litigation advertising. Camp Lejeune TV ads currently rank third among the top targets for mass tort claims since 2012, behind only asbestos and mesothelioma ($619 million) and Roundup weed killer ($132 million).

“The attorneys have calculated out that they stand to make a pot of money,” said Autrey James, chairman of the American Legion’s Veterans Affairs & Rehabilitation Commission. “We need Congress to put caps on how much these attorneys can charge.”

For Keller, a 73-year-old former workers’ compensation lawyer, it’s a matter of accountability. Because of his experience, he came out of retirement last year to represent Camp Lejeune victims. He is now working part time at the Greenville law firm he spoke with originally and that now represents his late wife. It currently has roughly 65 Camp Lejeune cases.

Under the law, veterans must first file an administrative claim with the Judge Advocate General of the Navy’s Tort Claims Unit. If, after six months, the Navy hasn’t settled the claim, or if it denies the claim, veterans can file suit in the U.S. District Court for the Eastern District of North Carolina.

So far, approximately 23,000 claims have been filed with the Navy, none of which have been fully adjudicated, said Patricia Babb, a spokesperson for the Judge Advocate General’s office.

Decades of fighting for relief

This legal remedy has been a long time coming. In the early 1980s, the Marine Corps learned that three of Camp Lejeune’s water distribution systems were contaminated with industrial chemicals that had seeped into the water from leaking underground storage tanks, industrial spills, and waste disposal sites. The Corps shut them down in the mid-1980s and the area was declared a hazardous waste site in 1989 under the Environmental Protection Agency’s Superfund law.

Federal studies later showed that toxic chemicals in the water — benzene, vinyl chloride, and TCE, among others — were present at levels that could have caused a range of cancers and other serious illnesses. In 2012, after an intense lobbying campaign by veterans, Congress passed a law that gave veterans and their families free medical care if they got sick with any of more than a dozen diseases associated with the toxic water.

But thousands of veterans who felt the Navy had stonewalled and delayed addressing the contamination filed civil suits seeking damages. In 2019, the federal government denied all the claims, citing state and federal statutes that shielded the government.

The Camp Lejeune Justice Act opened a two-year window for veterans and their families to pursue cases against the federal government.

‘They’re being preyed upon’

And Liz Hartman, the commander of American Legion Post 539 in nearby New Bern, now sees new reason for alarm. Some veterans are signing contingency fee contracts in which they agree to pay lawyers representing them 40% to 60% of any money they receive, Hartman said.

“Many of these people are elderly and very vulnerable, and they’re being preyed upon,” she said.

Personal injury lawyers generally work on a contingency basis. If they win the case they receive a portion of the award, often one-third. If they lose, they get nothing. The firm Keller is working with charges 40% for Camp Lejeune cases.

If anything, fees for the Camp Lejeune cases should be lower than usual, not higher, said Matt Webb, senior vice president for legal reform policy at the U.S. Chamber of Commerce Institute for Legal Reform.

“The PACT Act changed the burden of proof and made it so much easier for claimants to win their cases,” he said. Under the law, the evidence must show that the exposure was as likely as not to have caused the harm, rather than having to prove that there’s a greater than 50% chance that the claim is true, called a “preponderance” standard.

In addition, the law requires that any award a veteran receives be offset by any amount they received in a disability payment or health benefit related to their condition. This could substantially reduce the amount of their award.

Veterans “could end up owing money,” Webb said. “I’m not saying it’s going to happen, but particularly if a lawyer is taking a huge chunk in fees, it could happen.”

Trial lawyers say a marginally lower burden of proof doesn’t mean the cases will be easy to win.

It’s a new law with no case law or judicial opinions to refer to, said Mike Cox, a Livonia, Michigan, lawyer and former Marine infantryman who was stationed at Camp Lejeune in the early 1980s. He’s now representing more than 200 veterans in such cases.

Many of the diseases and conditions people developed are not among those the government acknowledges may be linked to the contaminated water, Cox said. Even for veterans whose illnesses are recognized by the government, lawyers will have to show where they were based, what kind of cancer they have, and their level of toxic exposure, he said. His fee for representing these veterans is 33% of any award they receive.

In addition to proving they were stationed at Camp Lejeune during the years covered by the law, “the claimant also must demonstrate to the Navy he/she is suffering from an injury that is related to the exposure to (or ingestion of) contaminated water,” said Babb, the Judge Advocate General spokesperson.

Congress steps in

With stories circulating of attorney contingency fees that could potentially eat up more than half of veterans’ awards, some lawmakers have stepped in.

Under a bill proposed by Reps. Jerrold Nadler (D-N.Y.) and Mark Takano (D-Calif.), Camp Lejeune attorney fees would be capped at 20% in cases settled as administrative claims and 33.3% in those filed as civil lawsuits in court.

Another House proposal, introduced by Reps. Darrell Issa (R-Calif.) and Mike Bost (R-Ill.), is identical to one introduced in the Senate by Sen. Dan Sullivan (R-Alaska), which would cap fees at 12% and 17% under similar circumstances.

According to David Keller, based on his conversations with other lawyers, “nobody is objecting to something that is reasonable,” such as caps at 20% and 33%.

Many of Keller’s clients are older men who are really sick and probably won’t live long, he said. Some tell him they’re reluctant to sue the government.

“What I say to them is, ‘When we signed the contract with Uncle Sam, we gave Uncle Sam a blank check for our arms, our legs, and maybe even our lives. But we didn’t sign a blank check to get a serious disease from contaminated water, either them or their spouses or children.”

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Kentucky Gov. Andy Beshear on Wednesday signed a bill providing $16.3 million to complete construction of the Bowling Green Veterans Center.

House Bill 2 provided an appropriation from the Budget Reserve Trust Fund to complete construction of the $53 million facility expected to be finished next year.

The Veterans Centerwill be the state’s fifth long-term skilled nursing care facility. The 80,000-square-foot facility will provide 60 beds and is being built on 25 acres donated by the Inter-Modal Transportation Authority at the Kentucky Transpark in Warren County. It will create 120 jobs, according to a release from the governor’s office.

The single-story skilled nursing facility was designed using the federal Department of Veterans Affairs’ small-house design, which provides a private suite for each veteran and will include common living and support areas.

Ground was broken for the facility in November.