After the MISSION Act was passed in 2018, veterans across the U.S. who require transplants have raised concern about the lack of implementation for some of their claims according to nationwide media accounts.

The MISSION Act was passed with the goal of broadening the scope of veteran care through VA and non-VA institutions throughout the U.S.

Secretary of Veterans Affairs Denis McDonough was given the task to ensure veterans receive these benefits. However, veterans across the country dealing with vital organ failure reported that the new law was not being implemented properly.

The MISSION Act guarantees access to local transplant care for veterans as traveling hundreds of miles for a transplant can heighten the likelihood of complications according to government officials. However, many veterans across the country are claiming this promise is not being enacted.

One veteran in Marion has been experiencing issues with a vital organ and has been experiencing complications with the VA and the MISSION Act promises, but he says he is likely not the only one.

“I would say that anybody that requires living donors – that would be kidney transplant, liver transplant and anything that requires bone marrow transplant – could be affected,” said veteran Jeff Krevda. “It’s not a huge amount of people I suppose, but it’s me.”

The VA Northern Indiana Health Care System (VANIHCS) provided information on the length that the MISSION Act covers for veterans in Indiana.

According to VANIHCS, the law allows for more health care options for veterans overall. These include clearer eligibility requirements for community care, a consolidated program for community care, increased access to community care and a new urgent care benefit for veterans.

According to VANIHCS, veterans must be enrolled in VA’s health care system or have a proven need for services, which would exempt them from the need to be enrolled, to comply with the Community Care Program (VCCP) that was established under the MISSION Act.

“All care under VCCP, including transplantation, must be authorized by VA in advance and must be with a provider that has a contract or agreement with VA,” said VANIHCS. “Every transplant center, within or outside of the VA, has its own criteria for candidacy for transplantation.”

Krevda recognizes that every transplant center has its own criteria, but focused upon the two facilities that he is currently involved with for his condition.

“To get to that point, what they did is they didn’t allocate the money right off the bat. There is a lot of stuff they are requiring in this bill, as far as education wise and stuff and criteria that these hospitals have to follow to meet the VA’s criteria” said Krevda. “In most cases, that criteria at IU is more inclusive than what the VA is asking for.”

Krevda stressed that the local VA does not offer the transplant services that he requires, so his need for local transplant care was met through a hospital in Pittsburgh. This “local” transplant center required him to travel hundreds of miles to receive care in the future if a donor was acquired, which could increase the risk of complications.

Krevda was eventually placed on the transplant list at IU Health after almost four years of trying to switch after being placed in Pittsburgh.

He now has access to the “organ swap” program that allows for organs to be swapped around for the best fit if one donor does not fit their preferred patient to hopefully satisfy both patients in need. The swap increases the likelihood of a patient receiving an organ. This was not a program at the Pittsburgh hospital.

The MISSION Act was enacted for the purpose of aiding veterans by providing a more effective and easier access to care. However, Krevda was required to take extreme measures to finally be placed on the list at IU Health which would fulfill that section of the act, such as contacting the U.S. government.

Organ donors cannot receive compensation for their donation due to national legislation. However, VANIHCS claimed that donors receive extensive care during the donor’s processing.

“Once a Veteran is approved for a transplant with a living donor, VA will provide care for the donor at VA or authorize indicated care at a contracted transplant facility. If a living donor travels to a transplant facility, the VA provides reimbursement for travel and lodging expenses,” said VANIHCS. “VA is responsible for costs of authorized screening, donation procedures and related medical care following donation, regardless of whether authorized services are performed within a VA or community transplant center.”

VANIHCS also claimed that insurance was not required for the parties, and that both the donor and recipient would be covered for the expenses, but insurance companies may be contacted if insurance is provided.

“When VA authorizes living donation for a Veteran recipient, VA will pay the costs of the care for both the Veteran and the donor,” said VANIHCS. “If the Veteran has other health insurance and the transplant is not related to their service-connected condition, VA may bill the other health insurance for the services.”

Krevda denounced this claim as his personal experiences with the costs had been much different in the past.

“I called up the financial department at IU Health and said ‘okay. I’m on the list. Now, if I’ve got a donor, what does that donor have to do to get screened by IU? They said, ‘well you have to show proof of insurance,’” said Krevda. “That was the very first thing out of their mouth. I said, ‘well, the VA is going to take care of it.’ No, they’re not.’”

Krevda pushed this further as he was led to believe that if the criteria was met for both him and his donor under the VA and the MISSION Act, that expenses and specifics would be covered.

“The VA isn’t doing anything. What that bill requires is that once all criteria is met – I am on the transplant list at IU Health – I’d say the criteria is met...” said Krevda.

Krevda continued with his claim that the VA does not cover many of the aspects they claim to cover, but he does recognize that some expenses are paid off by the VA.

“Where (they) claim that the outside hospitals contracted with the VA also take care of the live donors in the same manner – in a manner that the VA hospitals that have a transplant center do – is totally incorrect,” said Krevda. “They pay for the person getting the transplant, but they do not take care of any of the medical expenses for the living donor at this point.”

Krevda’s claim reflects on the screening process as well, where he states that the VA does not help pay for the process to get the living donor prepared for a transplant at an outside hospital. He believes this is an incorrect implementation of the law due to its wording as well as the strict criteria that must be met by donors.

“Everything about these donors is covered in that bill. Specifically, the criteria is the same as it is for the VA hospitals to where if you have a donor, that donor contacts the VA, they put them through the tests, they try to accumulate everything they’ve got, like labs or something from their own health records, and they’ll take anything they can get,” said Krevda. “They go all the way down to the tissue labs, take 17 vials of blood and they check you for everything. You can’t be a smoker. You can’t be a drug user or anything. If you’re perfect, then you can be a donor.”

VANIHCS claimed that the local contract for transplants through the community transplant program is responsible for the care of living donors, but many veterans have still claimed that this care was flawed.

Despite the qualifications required to receive VA help at a non-VA institution, VANIHCS claimed that the MISSION Act does not dictate any criteria for an “eligible” versus “ineligible” veteran for care.

While not being enforced through the MISSION Act, Krevda has been questioned for his eligibility with the VA completely at one point in his journey.

“I started getting letters from the VA that were questioning my eligibility for anything from the VA. So, I’m calling these people back and they’re sending me pieces of paper I have to fill out and turn back to them. Then, I get another one. They were from three different locations,” said Krevda.

Krevda was eventually able to come into contact with non-VA government officials and claimed that he was contacted by IU Health within a week afterward and the VA eligibility letters finally stopped.

After his initial surgery to remove his inflamed kidneys, which have been studied consistently without any medical conclusion about the condition that caused it, Krevda was placed in contact with a geneticist from Salt Lake City to help his condition and study the kidney tissues.

According to Krevda, the geneticist applied for funds through the VA to help further the research for Krevda, but she was reportedly denied any funding.

Both Krevda and VANIHCS realize the importance of the MISSION Act, but Krevda just has not received the care he believes is represented in the law.

Krevda would like to make it clear that although most VA facilities are vastly understaffed, his care for 18 years by existing medical staff has been exemplary. Krevda underwent a kidney transplant in 2004 at the VA Hospital in Nashville, but now requires another transplant.

A U.S. Senator, U.S. Congressman and a facilitator from the American Legion have all contacted VA Leadership on behalf of Krevda to answer questions about the current disparity. These inquiries have never received a response.

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