In the span of just a few weeks, Marc McCabe traveled this summer to
Puerto Rico, the Dominican Republic, California, and Texas. But the
74-year-old wasn’t on an epic retirement trip.

As a pro bono veterans advocate, he was searching for Vietnam
veterans and surviving family members who may be eligible for disability
compensation.

McCabe, a former combat corpsman attached to Marine Corps units
during the Vietnam War, has survived two bouts of cancer himself. He has
been a veteran’s advocate for two decades, but his job has gotten a lot
busier thanks to a spate of new legislation that has expanded benefits
for millions of veterans exposed to toxic chemicals in war.

Technically, the U.S. Department of Veterans Affairs should be the
ones notifying veterans when they may be eligible for new benefits—but
McCabe says they often don’t.

“They’re leaving them behind,” he says.

And the Department of Veterans Affairs’ very own Office of Inspector General agrees. In an unsparing report this summer, the watchdog estimated that VA has failed to inform up to 87,000
Vietnam war veterans and their survivors that they may now qualify for
retroactive compensation benefits because of exposure to toxic
herbicides such as Agent Orange.

If that sounds like a startling number, consider this: Those
overlooked veterans and their families could be entitled to more than
$844 million, the report said.

“There are millions of dollars at stake that Vietnam veterans and
their survivors should be receiving,” says Bart Stichman, co-founder of
the National Veterans Legal Services Program, which represents veterans
in benefits appeals.

And while there is widespread agreement that America should
compensate its veterans for their sacrifice and service, there’s a
growing concern about where all this money will come from—especially as
the cost continues to balloon thanks to the recently passed PACT Act,
which added coverage for potentially six million more veterans exposed
to toxins from burn pits and other sources during the Vietnam, Persian
Gulf and post-9/11 wars.

America will soon owe veterans trillions of dollars in medical and
disability compensation, said Linda Bilmes, a professor in public policy
at the Harvard Kennedy School.

Despite the pledge, she said, “we don’t really understand the cost. …
We don’t have a function that is keeping track of all of the accrued
promised benefits the way we should.”

Facing a record budget shortfall, VA may be unable to pay benefits to millions of veterans as soon as October.

Promises broken

In 1986, Stichman and other lawyers brought a class action lawsuit
against VA on behalf of Vietnam veterans and survivors. The resulting
consent decree required the department to recognize “presumptive
conditions” for Vietnam veterans—illnesses that VA assumes are caused by
exposure to Agent Orange during military service—and pay disability and
death payments to those who suffered from these ailments.

The decision was contentious. In 1989, Sen. Alan Simpson, a Wyoming
Republican, questioned the science connecting Agent Orange exposure to
veterans’ health problems and told Sen. Ted Kennedy on a radio program that providing coverage for presumptive conditions was “political pandering to powerful special interest groups.” Kennedy called Simpson “Agent Orange Al.”

By 2021, the scientific evidence was clear, linking Agent Orange
to even more illnesses. The National Defense Authorization Act that
year expanded the list of presumptive conditions for Vietnam veterans.
There are now more than 20 of these conditions, including bladder
cancer, lung cancer, prostate cancer, and more. But critics say VA has
always been resistant.

“They hate the fact they ever agreed to it,” says Stichman. “So they
try to think of every possible reason they don’t have to do what they
should do.”

When the list of presumptive conditions was expanded in 2021, VA announced that it would send letters to all Vietnam veterans
who were previously denied benefits to let them know they may now be
eligible. But using a statistical analysis of VA health records, the
Inspector General report found VA may have missed nearly 90,000 people.
The report also estimated each veteran was missing out an average of
$372 a month.McCabe, who volunteers with the nonprofit Vietnam Veterans of
America, said he has helped more than 800 veterans and survivors file
benefits claims or appeals since the list of presumptive conditions was
expanded in 2021. Even if a veteran gets a letter that they may be
eligible for benefits, McCabe says the technical jargon that VA uses is
confusing for veterans, who are often in their 70s and 80s. When it
comes to Agent Orange benefits, he said, the agency is simply “not
explaining it well enough.”

A fragmented system

One of the problems is the fragmented nature of the Department of
Veterans Affairs, which has multiple large branches that are tangled in
bureaucracy. Disability payments for veterans are governed by the
Veterans Benefits Administration, while the actual health care is done
at the Veterans Health Administration.

Brent Arronte, the VA’s Deputy Assistant Inspector General for Audits
and Evaluations, said the reason the estimated 87,000 letters were
never sent comes down to who has “custody” of a veteran’s health
information. The Office of Inspector General said a veteran should
automatically be notified about benefits if they have a diagnosis for a
presumptive condition in the Veterans Health Administration system of
records. The Benefits Administration disagrees.

Its interpretation, Arronte says, is that veterans should only be
notified about benefits if their health records are already included in a
claims folder in the Benefits Administration system. But Arronte says,
“that shouldn’t make a difference.” If the records are already in the
Veterans Affairs system, he says, “we think that they should look at
these veterans to see if they do require readjudication and possibly
back pay and earlier effective dates.”

One of the recommendations in the June report was that the Benefits
Administration send out new letters to tens of thousands of Vietnam
veterans and their survivors who may have been overlooked. Yet the
Benefits Administration took the unusual step of disagreeing with the
recommendation. “My best guess is that they know this is going to create
a lot of rework,” Arronte says.

He says that the Benefits Administration is currently under enormous
strain from the 2022 passage of the PACT Act, one of the largest
expansions of veterans benefits in history. It led to a massive VA hiring surge to keep up with new claims.

And after a long fight from advocates, VA also decided in August
to make medically unexplained chronic multisymptom illness, also known
as Gulf War Illness, a presumptive condition for more than 15,000
veterans—known as K2 vets—who served at the Karshi-Khanabad Air Base in
Uzbekistan.

“They really don’t need another 87,000 dumped into their lap,”
Arronte says. “But our opinion is we are here to make sure veterans are
made whole.”

VA wouldn’t respond to questions from The War Horse about the report,
instead referring to a memo from Joshua Jacobs, Department of Veterans
Affairs under secretary for benefits.

He said that the Office of Inspector General “repeatedly
mischaracterized” VA’s obligation. Jacobs wrote that the Inspector
General’s interpretation “is at odds with the text of the consent
decree, its enforcement history in the courts, and the parties’
understanding of the agreement.”

A bubble on the horizon

The $844 million that the VA may owe Vietnam veterans may be hard for
the department to come by. That’s because it is facing one of its
biggest financial crises ever, driven by the millions of veterans who
are owed compensation for their service-related disabilities.

In July, VA told members of Congress that the department was facing a
budget shortfall of $15 billion across the remainder of 2024 and 2025, raising the ire of House Committee on Veterans’ Affairs Chairman
Mike Bost, an Illinois Republican. He blamed “horrendous, top-to-bottom
mismanagement” for the massive deficit. It’s the largest budget
shortfall in the department’s history, and VA is attributing it to
increased costs caused by the PACT Act.

This budget shortfall means that 7 million veterans and their surviving family members are at risk of not receiving benefits payments as soon as Oct. 1. But $15 billion is only a drop in the bucket compared to the startling costs the department faces in the coming years.

“Veterans benefits always peak long, long after a war is finished,” says Bilmes.

While last year the VA paid out about $143 billion to about 6 million
veterans, Bilmes estimates that the U.S. owes more than $2 trillion in
medical and disability benefits to veterans just from the wars in Iraq
and Afghanistan.

“It is a staggering amount,” she says. “These are benefits that have
been promised to people but not paid out yet. It’s not speculative.”

In fact, the 2023 Financial Report of the United States Government,
compiled by the Department of the Treasury, lists veterans benefits as
one of the country’s most significant financial liabilities.

Suzanne Gordon, a senior policy analyst at the nonpartisan think tank
Veterans Healthcare Policy Institute, says that the U.S. has the
resources to fulfill its commitment to veterans.

“We’re a very rich nation,” she says. “There’s no question that we
can afford it. The question is, ‘Why don’t we want to afford it?’”

Bilmes says that previous U.S. wars were paid for by increasing taxes
and government budget cuts to nonwar spending. But since 9/11, she
says, “we’ve paid for all our wars entirely through borrowing,” which
has been one of the factors driving up the national debt.

One of Bilmes’ suggestions is to create a trust fund for veterans in
order to safeguard the promised money and plan for how much is needed.
We have “a huge bubble here that is on the horizon,” she says, which is
rapidly becoming bigger thanks to expanded presumptive benefits.

For Gordon, the answer is straightforward. “If we can afford war, we
can afford to take care of our veterans,” she says. “And if we can’t
afford to take care of veterans, then we shouldn’t engage in wars that
are often elective and nonessential to the defense of the nation.”

Mark Jackson, a K2 veteran and board member at the Stronghold Freedom
Foundation, says money is a constant conversation when it comes to
veterans’ benefits. But VA’s focus on money can end up commodifying the
lives of veterans.

“If you make this about money, it’s no longer about lives, it’s no
longer about service,” he said. “It becomes a line item that makes it a
whole lot easier to say no.”

‘It will change my life’

Though the Veterans Benefits Administration hasn’t agreed to send out
letters to the approximately 87,000 Vietnam veterans who may be owed
benefits, the agency did agree to create a working group to study how it
can improve the ways it identifies potentially eligible veterans.
Arronte says for now, the Inspector General office will hold the agency
to account by requesting an update on the working group’s progress every
90 days.

Meanwhile, McCabe won’t be out of a job anytime soon. He plans to
continue to travel across the country, hosting local town halls to talk
to Vietnam veterans and survivors about their eligibility for benefits.
Just recently he helped Susan Meyer, the widow of Vietnam veteran Henry
Meyer, appeal the denial of her husband’s claim for bladder cancer that
was filed 10 years ago—two years before he passed away from the disease.

“I’m not looking for the money,” says Meyer, who lives in Fort Myers, Florida. “I’m doing it for my husband.”

She said that it’s difficult to only get the claim approved after her
husband has passed away, when he was the one who served. Still, she
says, “it will change my life.”