Genetic Discrimination In The Military

by hilzoy

From the LATimes:

"While genetic discrimination is banned in most cases throughout the country, it is alive and well in the U.S. military.

For more than 20 years, the armed forces have held a policy that specifically denies disability benefits to servicemen and women with congenital or hereditary conditions. The practice would be illegal in almost any other workplace.

There is one exception, instituted in 1999, that grants benefits to personnel who have served eight years.

"You could be in the military and be a six-pack-a-day smoker, and if you come down with emphysema, 'That's OK. We've got you covered,' " said Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University."But if you happen to have a disease where there is an identified genetic contribution, you are screwed.""

(Full disclosure: Kathy Hudson is a colleague.)

There are many problems with this system. The most obvious is its fundamental unfairness: it does not deny coverage for all diseases that are not caused by a person's military service. If no one has any idea why you got sick, or even if, as in the emphysema case discussed above, it's clear that your illness is not due to your military service but to some other non-genetic cause, you're covered. But if you have a genetic disease, you're out of luck. Another is that it seems wrong not to cover veterans with serious illnesses: they put their lives on the line for us, and we should be willing to help them when they need it. A third problem that it gets the nature of genetic disease wrong:

"Only in a few cases, such as Huntington's disease, does a specific mutation in a particular stretch of DNA guarantee the onset of illness.

In most cases, a faulty gene increases an individual's risk of developing a disease, but does not ensure it. Typically, an external event is necessary to trigger the onset of a medical condition.

Such was the case with an Army helicopter gunship pilot who was reassigned to desk duty after she became too pregnant to fly.

Dr. Melissa Fries, an Air Force geneticist who became involved in the case, said the pilot developed a blood clot in her leg -- a typical complication of pregnancy that is exacerbated by inactivity.

She was diagnosed with chronic thrombophlebitis, a condition that disqualified her from flying. The pilot, who declined to discuss her case, decided to retire from the Army.

As part of her medical work-up, doctors discovered she had a genetic mutation for Factor V Leiden, which is found in 5% of Caucasians and increases their risk of developing blood clots.

An Army physical evaluation board, which determines disability benefits, denied her claim because of the mutation.

Her military doctors were stunned since her thrombophlebitis was probably caused by her pregnancy and desk job. They downplayed the role of her mutation because 99% of Factor V Leiden carriers never develop blood clots.

Military doctors now discourage their patients from getting potentially life-saving genetic tests, undermining their ability to provide top-notch care.

"If someone called me up with regard to genetic testing, I had to say, 'That might not be something you want to pursue,' " Nunes said. "That's very hard to say.""

If you are in the military, you get sick, and it turns out that there's a genetic component to your illness, then you will be denied coverage unless you can show that your service exacerbated your condition -- a hurdle that people with non-genetic diseases do not have to meet. The genetic component of your disease might not be very large, and it might not increase your risk of getting the disease by that much; its existence alone is enough to have your coverage denied. As I said above, this is unfair. But it's also likely to become a much larger problem in the future. As time goes on, we are going to discover that more and more diseases have some genetic component, and therefore more and more members of our armed services are going to discover that they are not eligible for health benefits after discharge, even if they have diseases that were covered without question before.

This is just wrong, and someone should try to change this policy.

Note: the DoD policy in question is here; see, for instance, p. 32.

Comments

[OCSteve]

The military has a long long history of this: atomic bomb testing, Agent Orange, Gulf War Syndrome, etc.

On the one hand, there will always be people who try to game the system. Disability payments are for life. So they do have a responsibility to the taxpayers to get it right. OTOH they tend to go way too far in that direction.

I mean we have veterans right now who have been blown up by IEDs resulting in permanent brain damage who have to fight for disability.

[Ugh]

I think the military would rather spend funds on their neat toys.

[OCSteve]

who have to fight for disability

What am I talking about – they have to fight not to be sent back to the front lines…

[G'Kar]

This is an unfortunate policy. I won't speculate on why the DoD policy is in place, as I'm sure there are plenty of people who can do that better than I. I concur with hilzoy, however, that the policy is wrong and should be repealed. As OCSteve notes, the DoD works very hard to protect taxpayer dollars when it comes to disability; if everyone in government was as mindful of money as the DoD with disability requests, the federal government would never run a deficit. This is something that Congress should act to repeal as quickly as possible, and make it retroactive so veterans already affected can receive the benefits they have earned.

As for where the funds can come from, I have some ideas, but they will wait for another time.

[Justin]

There's a really easy way to solve said problem - Universal Health Care.

[S Brennan]

As OC said these guys [An Army physical evaluation board, which determines disability benefits] have been making headlines for sometime. Many who have been through their grinder know they are highly political group and their evaluations reflect that.

[OCSteve]

OK I get a really bad feeling when everyone who responds to me on a thread here agrees with me…

Something is wrong. It ain’t natural.

Hmmm. To restate:

If their parents had done the proper genetic testing and aborted the fetus this wouldn’t be a question right? Why should DoD pay for the parent’s obvious mistake?

Note: For those who don’t know me this is me being silly – don’t freak.

[md 20/400]

Yuck. It is of a piece with the denial of disability benefits if the US can claim there were pre-existing psychiatric conditions.