By: Christina Ralph
Journal of Global Rights and Organizations Senior Articles Editor & Veterans Legal Clinic Student Attorney
In 2022, there were 171,736 United States military service members permanently stationed overseas. While these service members are representing the U.S. across the globe, they are making connections to people and places, that will last a lifetime. It is unsurprising then that most will travel abroad at some point after they finish their service, and some will make another country their temporary or permanent home. What many of the people serving our country do not know is that while they earn healthcare benefits through their service, once they are veterans should they experience a non-service related emergency while outside of the U.S., the U.S Department of Veterans Affairs (VA) will not cover the cost of their care.
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if their medical issue is deemed not service-connected | Photo Courtesy of Getty Images
Whether a veteran lives overseas or is just traveling outside of the US, the VA denies them reimbursement for emergency services determined not connected to their service. This includes veterans who are 100% disabled. Thus, veterans are not provided the emergency care to which they are entitled, and which would be completely covered by the VA if their medical emergency had occurred in the US. The reimbursement process causes Veterans to wait “long periods of time and endure great financial hardships” waiting to find out whether they will be reimbursed by the VA for the cost of their emergency care. Denial of reimbursement often forces veterans to choose between their physical health and their financial well-being.
American service members are sent all over the world as part of their service to our country. These overseas assignments are the catalyst for veterans who travel abroad and especially for those who become expatriates. There are many reasons veterans choose to live abroad. Most common is that many, such as Ken in Germany, meet their spouses while on assignment in another country. Ken and his wife raised their daughter in Germany where he worked 21 years for the Army and Air Force Exchange Service. Despite living in Germany, Ken remains a “strongly patriotic” American citizen. He is active in the local VFW and is the Commanding Officer of the 1982 American Legion. While he used to travel back to the U.S. often, traveling to access VA healthcare is not a viable option for him. Now widowed, Ken resides with his daughter and his grandchildren in Germany. Ken continues to help other veterans navigate the VA claims process, even while he struggles to get the VA services he needs.
Another reason veterans live outside the US is that they can live a better quality of life, funded by their VA retirement or disability payments, in countries where the cost of living is significantly less than it is in the U.S. Donny in the Dominican Republic, retired from the U.S. Air Force. Rather than seek work to supplement his military pension, he and his wife chose to move near her family in the Dominican Republic where the cost of living has allowed them to fully retire and have the “lifestyle they want right away”. Donny and his wife currently travel to the U.S. for their healthcare. Donny has not had an emergency in the Dominican Republic, but if he does, he plans to seek care at a private hospital, then undertake the long process of seeking reimbursement from the VA.
As you might imagine, given that they chose to serve in the US military, these veterans are staunchly patriotic. They remain US citizens, pay US taxes, vote in US elections, and stay abreast of issues affecting the US. As Ken, in Thailand says, “An American is an American, no matter in what country he/she resides”. Regardless of the reasons for deciding to live abroad, these veterans have earned their VA healthcare benefits, but are being denied them, simply because they do not live in the U.S.
Neither the Department of Defense nor the VA tracks the number or location of veterans who live abroad. Some estimate approximately 77,058 veterans live abroad. The estimate of disabled veterans living abroad is 28,000. These veterans are denied non-service related emergency and basic healthcare merely because they live abroad, leaving many feeling forgotten and abandoned by the very agencies that are tasked with honoring their service by providing the benefits they have earned. This was especially true during the Covid pandemic when the VA refused to provide vaccinations, tests, or care for Veterans who were not in the US. Jesse in Mexico, suffers from service-connected sleep apnea, but could not get a Covid vaccine. In his opinion, veterans living abroad were “completely left behind”. Despite begging the VA for help, Jesse and others like him were denied assistance. According to Jesse, it is because expatriate veterans “are obviously not very high on the secretary’s list of priorities.” It is hard to argue with his logic given that reimbursing veterans for the cost of emergency care is at the discretion of the VA secretary, but the VA still chooses to outright deny veterans coverage for non-military related emergency care outside the US.
Representative Dingell of Michigan declared, “no veteran should ever have to worry about whether they can afford costly medical expenses, especially when it comes to an emergency,” when, in 2021, legislation was passed requiring the VA to reimburse veterans for emergency health care claims. However, the VA has interpreted the legislation to exclude emergencies experience by veterans outside the U.S., despite the provision having no such limiting language. So, veterans traveling or living abroad are still being denied emergency services when their medical issue is deemed not service-related, requiring veterans to pay for these emergency services out of pocket. The government has been discussing the issue of healthcare benefits for veterans who travel or live abroad since at least 1962, but the problem persists.
Even though the well-being, and even the lives, of tens of thousands of veterans, are affected by the lack of basic healthcare and medical emergency coverage they have earned through their service the VA claims it cannot act, and neither Congress, nor the courts, seem willing to act on what they claim is a complicated issue. But veterans around the world do not see it that way. As Ken in Thailand says it is simply “shameful at best; cruel and deceitful at worst” that the VA makes a veteran’s location a condition of receiving healthcare benefits.
For more information, please see:
Court Rules that VA Must Reimburse Veterans for Emergency Care at non-VA Facilities – 3 Nov. 2022
Disabled American Vets Living Overseas Are Getting Screwed Out of Healthcare – 12 May 2018
Expat Retiree Profile: Retiring in the Dominican Republic – 26 Apr. 2023
Medical Care for Veterans Outside the U.S. – 7 Aug. 2022
The Civilian Lives of US Veterans: Issues and Identities – 2016
USA Facts – What Is the State of the Military and How Are US Veterans Faring?
Van Dermark v. McDonough, 57 F.4th 1374 (Fed. Cir. 2023)Vets Living Abroad Left to Navigate Pandemic Problems Without VA Help – 9 Dec. 2020
