The Senate overwhelmingly approved an addition to its defense policy bill to expand the Department of Veterans Affairs' list of diseases considered related to exposure to Agent Orange, adding bladder cancer, hypothyroidism and Parkinsonism.
The measure's passage sets up a debate between the House and Senate over the issue when the two chambers reconcile the differences in their respective versions of the defense bill. In last-minute discussions this week, a similar provision was omitted from the House bill.
The Senate passed the amendment 94-6. Members are set to vote on the entire bill later this week.
Sen. Jon Tester of Montana, the ranking Democrat on the Senate Armed Services Committee who sponsored the bill, said Tuesday that justice for these veterans "was long overdue."
"Our sacred duty is to care for those who are wounded. We have refused to cover illnesses such as bladder cancer, hypothyroidism and Parkinsonism. [The VA] doesn't seem to think that exposure to these toxic chemicals in Vietnam is a cost of war. Let me tell you, they are wrong," he said in a speech on the Senate floor before the vote.
If signed into law, the provision would expand VA health care eligibility and disability benefits to roughly 22,000 affected veterans.
Former service members with these illnesses have been waiting since 2016 for a decision from the VA on whether the department would expand its list of 14 conditions to include the three new ones.
That year, the National Academies of Sciences, Engineering and Medicine found that there is suggestive or sufficient evidence that the three diseases are associated with exposure to herbicides used during the Vietnam War.
In 2018, the Academies concluded that "sufficient evidence" also exists linking hypertension and related illnesses in veterans to Agent Orange and other defoliants.
The proposal that passed the Senate did not include hypertension, however. The condition is common among the elderly and, if it had been included, may have added more than two million veterans to VA disability rolls in the next 10 years, at an estimated cost of $11.2 billion to $15.2 billion, according to the VA.
The decision not to include hypertension in the legislation this time was a compromise, and lawmakers and advocacy groups have pledged to keep pushing for it to be included.
In 2017, then-VA Secretary David Shulkin expressed support for including bladder cancer, hypothyroidism and Parkinsonism on the list of presumptive diseases, but he never formally announced his decision.
According to internal VA documents, Shulkin had been on the verge of including the three conditions when the Office of Management and Budget and other White House officials objected, citing what they called "limited scientific evidence" and cost.
Meanwhile, thousands of veterans have waited.
"The fact of the matter is that this administration -- the Trump administration -- has refused to expand the list of presumptive health conditions associated with Agent Orange," Tester said.
He sponsored the legislation in the Senate. On the House side, the amendment was promoted by Rep. Joshua Harder, D-California. It passed the House Armed Services Committee but was struck from the bill by the House Rules Committee, which decided that it did not include a requisite way to cover its cost, called a "pay-for."
A source close to the process said that the Congressional Budget Office provided an informal assessment of the cost of Harder's amendment that was in the "tens of billions," while the assessment given to Tester's office was "$10 billion."
The source questioned the $10 billion price tag.
"The cost is not going to increase. We are losing these people every day. There may be some spousal benefits, but the sad thing is, they also are of an age where they are going too," said the source, who spoke on background as he was not authorized to discuss the issue.
VA Secretary Robert Wilkie told lawmakers late last year he wants the results of two studies -- the Vietnam Era Health Retrospective Observational Study, or VE-HEROES, and the Vietnam Era Mortality Study -- to be reviewed for publication before announcing a decision on whether to broaden the presumptives list.
The VA began recognizing diseases associated with herbicide exposure in Vietnam in 1991, naming 14 diseases as presumed to be linked to exposure, including Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft-tissue sarcoma, chloracne, type-2 diabetes mellitus, light chain amyloidosis, ischemic heart disease, chronic B-cell leukemias, Parkinson's disease.
In addition, spina bifida is recognized as a disease linked to Agent Orange in the offspring of veterans.
The senators who voted against the measure were all Republicans: Mike Braun of Indiana, John Kennedy of Louisiana, Ted Cruz of Texas, MIke Lee of Utah, Rand Paul of Kentucky and Rick Scott of Florida.
Following the vote, Tester expressed confidence that the measure would make it into the final version of the bill, given the overwhelming support for it in the Senate.
As for those who voted against it, he said he'd love to "talk to those six people to see what's going on in their heads."
"I can't think of one good reason to vote against this. … You can say it cost money, but the fact of the matter is it's a cost of war," Tester said.