Due to the lengthy military construction process, the center won’t be completed until the end of 2028. In the meantime, Army and Air Force officials are working on interim child care solutions.

For years, soldiers in the 7th Special Forces Group at Camp “Bull” Simons and their families, along with Navy and Air Force members in the area, have faced a child care shortage.

Special Forces soldiers in NW Florida still awaiting child care center

It’s a decision Army families have long anticipated — and fought for — but it’s not exactly the best solution for everyone, said Molly Tobin, the wife of an Army Special Forces officer. The center will be built about 20 minutes northeast of Camp “Bull” Simons in the Crestview civilian community, where 60% of the 7th SFG families live, but families have been fighting for it to be built on the actual compound.

Tobin, who was formerly the family readiness group leader for the 7th SFG’s 3rd Battalion, and her husband relocated to another base in Florida a year ago. Despite the move, she continues to advocate for families at Camp “Bull” Simons.

Families are worried about the security of children at an off-base location and the inconvenience for soldiers not living in Crestview. Although the Air Force will build the center to strict military construction guidelines, the absence of guards at an installation entrance raises questions about security. Information about specific plans for the security of the center wasn’t immediately available from Eglin Air Force Base.

“The Air Force plans to construct the Crestview CDC in accordance with DOD child care facility integrated base standards,” said Gabe Myers, spokesman for the 96th Test Wing at Eglin, in an email to Military Times. “Commanders and the Crestview CDC program coordinators will ensure it meets the emergency, operation, unit readiness, and training mission requirements.”

Air Force officials are working on the process to acquire land for the future center, and the funding for the center will be part of the fiscal 2026 budget request.

Camp “Bull” Simons, an Army installation that is technically part of Eglin Air Force Base, has faced disagreements between Army and Air Force officials over the construction of a child care center.

In October 2022, Secretary of the Army Christine Wormuth announced plans to build a child care center on the camp. Specifically, Army officials and 7th SFG families wanted the center near the chapel out of convenience for soldiers. Air Force officials, however, have raised safety concerns due to the post’s proximity to Eglin’s active bombing range.

The camp, which was carved out of a remote area of Eglin as part of the 2005 Base Closure and Realignment action, includes a chapel, troop clinic, barracks and an AAFES shopette but lacks family housing and a commissary. About 2,600 military and civilian workers live and work there.

Finding affordable, high-quality child care has long been a challenge for many military families, with issues varying by location. For the 7th SFG — one of the Army’s most elite units handling covert missions across Central and South America and the Caribbean — child care has been a persistent struggle since the group relocated from then-Fort Bragg, North Carolina, in 2011.

How bad is the child care shortage? Ask these Florida families

Aside from the 60% of families living in the Crestview community, many others reside south of Camp “Bull” Simons, meaning they would need to drive past the camp and then back south to drop off and pick up their children at a Crestview CDC, Tobin said.

“The convenience factor is gone for anyone outside Crestview,” Tobin said.

It’s uncertain what civilian housing availability in Crestview will be by 2028.

“Families are upset the center won’t be on the compound,” Tobin said. “There are parents who are very frustrated. It’s not the convenience we requested, the security we requested, the number of spaces we requested.”

The Air Force’s Crestview center will offer 250 spaces for military children, but, according to the most recent count, there are over 400 children of child care age in the 7th SFG alone. While not all need child care, the exact number is unclear because some families have given up on finding child care, Tobin said.

In the interim, other options

Meanwhile, most families with young children living there now will miss the chance to enroll their kids in the CDC, as their children will be too old by the time the center opens in 2028.

In response, Air Force and Army officials have explored other options to improve child care options in the area. Despite ongoing child care worker shortages, they increased staffing at the current Eglin CDC and opened two more classrooms. The Air Force is also restoring a CDC on Eglin to care for 118 children. While this will assist some families south of Camp “Bull” Simons, it still will require additional driving time, Tobin said.

The Air Force has doubled the number of Air Force-certified family child homes in the last year — to a total of 17 homes — with the capacity to provide care for up to 102 children. Another 13 homes are in the certification process.

The Army is initiating a one-year pilot program to provide hourly, part-time and intermittent child care support for up to 100 active-duty Army families beginning in the fall.

The Air Force and Army are also in contact with a local commercial child care provider that plans to open a new facility in the Crestview community by late 2025.

Still, Tobin said some families feel the solutions are falling short. She said one Army parent who attended a recent town hall detailing the decision told her, “The Air Force said they’d take care of us. They’re just trying to shut us up.”

“Once again, our child care has been pushed to the side,” said Tobin. “My 7th Group family lives there. Just because I moved doesn’t mean I don’t still have heartstrings back there. I have friends who are giving birth to babies. I have friends whose kids are 2, 3, 4 years old. They’re still hurting because there’s no child care,” she said, adding that inflation has made a dual income even more of a necessity.

“If you’re a service member who is concerned about the child care provided for the family … the mind is going to be somewhere else,” she said, rather than focused 100% on the mission.

7th SFG leaders understand that completely, and have been supportive of their soldiers and families, Tobin said.

“The 7th Group command team has excelled at that and advocated for families consistently, whether it’s [attending] meetings, surveys requested or any other hoops that the Air Force has thrown at them to slow processes of taking care of our families.”

Eight airlines, including German airline Lufthansa, had announced they would no longer allow dogs to fly in the cabin or cargo hold on the same flight as their owner due to new dog importing rules issued by the Centers for Disease Control and Prevention.

The new CDC rules take effect Aug. 1, and many military families were left scrambling to find ways to transport their dogs, especially during the busy moving season. For some, this means using a pet shipper, a more expensive option than transporting the dog on the owner’s flight.

The policy was implemented to protect the U.S. from the reintroduction of dog rabies, which has been eliminated in the country since 2007. There are over 100 countries where the issue of dog rabies is not controlled, according to the CDC.

In an email response to Military Times on July 26, Lufthansa spokesman Joerg Waber noted that “existing bookings for the transportation of dogs remain unaffected, provided that all CDC requirements are met.”

That includes bookings previously made for flights scheduled for August or later. Many military families overseas book flights months in advance.

New Lufthansa bookings for dogs on or after Aug. 1 “will only be accepted for the airports in Washington, D.C., New York-JFK, Atlanta, Miami, Los Angeles and Philadelphia that provide the necessary infrastructure and meet criteria required by the CDC in case the animal is denied direct entry to the U.S.,” Waber added.

That infrastructure includes, for example, placement in a CDC-approved animal care facility, Waber said. If the CDC rules are not followed, the dog will not be allowed to enter the U.S.

The transportation of assistance dogs — and dogs separately shipped as air freight on their own tickets — to other U.S. airports, is still possible, as long as the owners meet the new CDC requirements, Waber said.

“They’re moving in the right direction,” said Liz Hensel, CEO of Leave No Paws Behind USA. But the Lufthansa website is not clear about what families should do, leaving travelers confused, she added.

“Families are under the impression they don’t have support,” said Hensel, a veteran who was named the 2024 Armed Forces Insurance Marine Corps Spouse of the Year.

As of July 26, Lufthansa had posted new information on its website, noting that already confirmed bookings will be honored after August 1, 2024, provided all CDC requirements can be fulfilled.

They’ll offer additional options if a dog’s booking was confirmed before July 3, 2024, including rebooking to a flight before Aug. 1; rebooking without the dog; and a refund of the ticket.

On July 22, the CDC loosened their new rules for importing dogs, announcing that through April 30, 2025, it won’t require veterinary documents for dogs that have spent the previous six months in rabies-free or low-risk countries. The only form needed is the CDC Dog Import Form, which can be completed online by the traveler or importer.

In addition to the dog import form, dogs coming from low-risk or no-risk countries for rabies:

• must appear healthy upon arrival.

• must be at least 6 months old at time of entry or return to the U.S.

• must have a identifying microchip that can be detected with a universal scanner.

Two versions of the CDC Dog Import Form exist: one for dogs coming from no-to-low risk countries for dog rabies, and the other for dogs coming from high-risk countries for dog rabies. Dogs coming from high-risk countries have more requirements, which can be assessed here.

How is this affecting Patriot Express flights?

Rep. Michael Waltz, R-Fla., sent a letter on July 25 to the commander of Air Mobility Command, asking how the new CDC rules are impacting military families bringing dogs onto military-contracted Patriot Express flights. Patriot Express is a contracted commercial charter mission providing support for official duty travelers and their families to and from overseas areas.

“I am disturbed that the CDC’s rule … has already caused unnecessary confusion, with some airlines preventing dogs from onboarding with their families on international flights back home,” he wrote to Air Force Gen. Mike Minihan.

Waltz asked what assurances have been provided to service members and their families that AMC’s contracted airlines won’t issue blanket bans on dogs from onboarding; and what outreach AMC has done with the CDC for clarification and application of the rule to mitigate the negative impact on military families.

“At this time, the policy is so new [that] it is too soon to say how it is affecting Patriot Express flights enough to approach carriers about changes to the contract,” Scott Ross, spokesman for U.S. Transportation Command, told Military Times.

Military families overseas may get relief in dog travel rule fixes

The Patriot Express contract has a set number of pet spaces per flight, and those allocations can’t change without mutual agreement between the airline and the government.

Ross said current Patriot Express-contracted commercial airline carriers have requested — and some have received — their 90-day waivers from the CDC, which allows them to transport dogs without a document known as an air waybill.

Airlines can request waivers from CDC

New CDC rules require an air waybill for each dog beginning Aug. 1. Until now, air waybills have only been required if the dog was traveling separately as manifest cargo — essentially, on its own ticket on a separate flight from its owner.

The changes announced July 22 by CDC allow airlines to request a 90-day waiver if they are unable to create an air waybill for each dog transported to the U.S. This allows airlines to transport the dog in the cabin or as excess baggage in the cargo hold without an air waybill.

Lufthansa spokesman Joerg Waber confirmed that the airline has applied for and received the 90-day waiver.

None of the airlines are currently equipped for the process of receiving dogs as excess baggage or in the cabin with their own air waybill.

The passenger terminal, where pets arrive as excess baggage or to travel in the cabin, is not connected to the cargo facilities where air waybills are required for pets traveling as manifest cargo. So, airlines are not presently set up to clear a pet coming into the passenger terminal, according to Angela Passman, owner and president of World Pet Travel.

Those 90-day waivers, according to CDC, are provided within one business day of being requested by the airlines. The airlines can also request a waiver that can last nine months, which involves a longer approval process.

Airlines continue to be able to transport dogs if the dog is traveling separately as manifest cargo — on its own ticket, and as in the past, creating an air waybill for the dog.

Without being able to transport dogs on the same flights, many owners have no other option except to hire pet shipping companies accustomed to meeting rigid requirements.

That route, however, can cost anywhere from approximately $2,500 to over $4,000, depending on the dog. Hensel noted that bringing the dog on the same flight as the owner generally costs around $400.

The rules will still take effect Aug. 1 during the busy military moving season, and the impact of the changes is unclear. It remains to be seen whether overseas airlines will reverse their decisions to stop allowing overseas families to travel back to the U.S. with their dogs either in the cabin or as excess baggage on the plane.

The CDC rules prompted eight airlines to previously announce they will no longer fly the dogs with their owners, leaving many military families scrambling to find alternative transportation — with a number of departures scheduled in early August.

“CDC values the feedback received from various countries, industry partners, and the public,” officials stated Monday. “CDC simplified the process for meeting requirements for dogs arriving from rabies-free or low-risk countries.”

In easing some of the requirements, the CDC announced Monday that through April 30, 2025, it won’t require veterinary documents for dogs that have spent the previous six months in rabies-free or low-risk countries. The only form needed is the CDC Dog Import Form, which is completed online by the traveler or importer. This makes it easier for owners of dogs coming from low-risk countries.

There are two versions of the CDC Dog Import Form: one for dogs coming from no-to-low risk countries for dog rabies, and the other for dogs coming from high-risk countries for dog rabies. The list of high-risk countries is here. Dogs coming from those countries have more requirements, such as documentation and testing.

Military families overseas scrambling as U.S. dog travel rules change

The CDC requirements are aimed at preventing the introduction of dog rabies into the United States. While dog rabies was eliminated in the United States in 2007, there are over 100 countries where dog rabies isn’t controlled, according to the CDC.

Liz Hensel, a Marine Corps wife and CEO of Leave No Paws Behind USA, said she is hopeful the update will be helpful to military families. “It’s clear our voices are being heard,” said Hensel, who has been advocating for change in the rules to help military families.

However, she said, “There has to be communication between CDC and the airlines. The faster we can clarify, the better for our military families on standby for that Aug. 1 deadline.”

The CDC said it will also have a waiver process for airlines. Starting Aug. 1, airlines must create an air waybill document for each dog transported to the U.S. If they can’t create that air waybill, they can request a waiver. Unless the airlines create the air waybills or have a waiver, they can’t transport dogs as hand-carried or excess baggage to the U.S. If they are granted a provisional waiver for 90 days, they can transport dogs as hand-carried or excess baggage to the U.S. with an air waybill. They can also submit an application to apply for a longer-term waiver to last nine months.

Airlines continue to be able to transport dogs if the dog is traveling separately as manifest cargo — on its own ticket, and as in the past, creating an air waybill for the dog. But for dogs traveling as excess baggage or in the cabin with their owner, none of the airlines are currently equipped for the process of receiving dogs traveling as excess baggage or in the cabin with their own air waybill, according to Angela Passman, owner and president of World Pet Travel.

“The passenger terminal, where pets arrive as excess baggage or [to travel] in the cabin, is not connected to the cargo facilities, so they are unable to clear a pet coming into the passenger terminal,” Passman said. “They are simply not set up for this, and this is a requirement insisted upon by the CDC for bringing a pet into the continental U.S.”

If the CDC rules aren’t followed, the dog won’t be allowed to enter the U.S.

“If denied entry, your dog will be sent back to the last country of departure at your expense. Country of departure is where the last trip originated — not where the dog was born or where it lives,” officials state on the CDC’s website.

If families can’t travel with their dogs, they may be left with no alternative other than to use a pet shipper to navigate the complex requirements. While the cost for a dog to travel with the family has been around $400, it will now be more than $2,000, Hensel said, noting that the cost to ship a dog from overseas through a pet shipper could be anywhere from $2,500 to over $4,000, depending on the dog, location and other factors.

Lawmakers also urged the CDC to delay implementing the blanket requirements, as the rules affect low-risk dogs personally owned by various types of individuals.

Families are posting on Facebook about departure dates happening as soon as the first weeks of August — but now transportation is uncertain for their dogs due to new U.S. regulations and some airlines refusing to allow dogs to travel back to the states.

“Why do things always have to be so complicated for military families to bring our pet family members with us when we move?” one military wife asked on the platform. “As if moving far from home and family every few years isn’t stressful enough.”

The issue stems from new requirements from the U.S. Centers for Disease Control and Prevention that take effect Aug. 1, aimed at preventing the introduction of dog rabies into the United States. While dog rabies was eliminated in the United States in 2007, there are over 100 countries where dog rabies isn’t controlled, according to the CDC.

The new regulations will be cumbersome for some military families, and there’s some confusion. But the more immediate problem is that eight airlines will stop allowing dogs to travel back to the states with their families either in the cabin or as excess baggage in the cargo hold.

German airline Lufthansa is the most recent airline to make the announcement. “Due to new restrictions imposed by the U.S. authorities it is no longer possible to import dogs into the USA after 1 August 2024 until further notice,” the Lufthansa website states.

The abrupt policy changes have some military advocates baffled by it all.

“I 100% agree we have to protect the population from rabies,” said Liz Hensel, CEO of Leave No Paws Behind USA. “But there must be a better way than to leave hundreds of military families stranded in a situation where they have no idea what to do with their dogs,” she said.

There are more than 100,000 service members stationed in Europe alone, she noted. It remains to be seen how this will play out around the world.

“Our household pets really help with mental health not only for the men and women serving, but for the family dynamic as a whole,” said Hensel, a veteran who is also the 2024 Armed Forces Insurance Marine Corps Spouse of the Year.

The decision by Lufthansa is “heartbreaking,” as the airline has been one of the most pet friendly airlines for military families, Hensel said.

The new CDC requirements standardize the process for importing dogs, including standard requirements for the minimum age of imported dogs, microchips, the CDC Dog Import Form, and other documentation. This will “streamline the importation process and allow for safer and more efficient entry of dogs into the United States,” according to the CDC.

The rules require some documentation that generally only commercial pet shippers were required to do, and which could require extra steps such as translating the CDC form into the local language for host-nation veterinarians and their supervisors, Hensel said.

Hensel is advocating for urgent policy adjustments by the CDC, including exemptions for military families in recognition of their unique circumstances; increased quarantine and vaccination facilities; airline partnerships; and streamlined import processes with clear and consistent guidelines.

Lawmakers have stepped in to urge the CDC director to allow an 18-month delay in implementation of the blanket requirements, because the rules affect low-risk dogs personally owned by various types of individuals.

A July 8 letter from Rep. Nick Langworthy, R-N.Y., has been signed by six additional members of Congress. Among other things, the dog import form has caused concern because of its delayed public availability and potential concern among dog owners, Langworthy wrote.

Information was not immediately available from the CDC about whether any solutions are being considered for military families.

Hensel speculates that the airlines are backing away from transporting the pets with their families on the same flight because they don’t want to be held liable.

According to the CDC website, if their rules aren’t followed, the dog won’t be allowed to enter the U.S. “If denied entry, your dog will be sent back to the last country of departure at your expense. Country of departure is where the last trip originated—not where the dog was born or where it lives,” officials state.

Many military families will now be forced to use pet shippers, which can continue to ship on the airlines, Hensel said.

But the cost will be a great hardship for many families.

“What has been costing around $400 will now be over $2,000,” she said, noting that the cost to ship a dog overseas through a pet shipper could be anywhere from $2,500 to over $4,000, depending on the dog, location and other factors.

Hensel worked for four years to advocate for a law to allow service members to be reimbursed for up to $2,000 of pet transportation expenses to or from overseas during a PCS move, and up to $550 for pet transportation in a move within the continental U.S. DOD implemented that benefit Jan. 1.

“And now this?” she said.

Military issues new details on reimbursing pet travel costs

Limited spaces are available to transport dogs on military-contracted Patriot Express flights on PCS moves, although U.S. Transportation Command increased the cabin flight spaces from 10 to 20, in 2021.

TRANSCOM officials are aware of the issue, said spokesman Nate Allen.

“This is where the conversations between passengers and their local transportation management offices are crucial,” he said. “While there is no immediate plan to increase pet spaces, if presented with a significant increase in requirements, we have and will engage with commercial partners to increase capacity where possible.”

Passengers traveling on the Patriot Express flights will also be required to comply with the CDC’s new import requirements, Allen said.

One family posted that they are being relocated stateside for a humanitarian reassignment, which is already stressful.

“I literally don’t know how I’m going to get our dog home with us,” the military wife posted. “This is to the point I’m in tears. This is just another stressor military families don’t need.”

The Paris Olympics will take place from July 26 to Aug. 11, and authorized users can stream the action through their personal devices and computers through ShopMyExchange.com.

All service branches are eligible. Due to content rights restrictions, an active ShopMyExchange.com account is required. Online verification of your military or veteran status is required by law to establish a ShopMyExchange.com account. Veterans who have been honorably discharged have online exchange shopping benefits.

Coverage will include live competitions across all 39 sports and all 329 medal events, top stories and moments and livestreams of select practice and warmup sessions, according to a joint announcement by AAFES and NBCUniversal. There will also be video content such as event recaps, highlights, viral moments and interviews.

To watch, visit NBCOlympics.com on a computer or use the NBC Sports app (in the U.S. only) and choose the Exchange as the service provider.

Overseas viewers must be on a military location with internet service from an authorized provider to gain access.

Authorized providers that have worked with AAFES to allow streaming on U.S. military installations overseas include 101 GLOBAL, Allied Telesis, Americable, Babtel, Basefix, Boingo, DHI/TravelWifi, DSN, LG Uplus, Mediatti Broadband, Solutions by STC, Telecom Italia, TKS and US Wicom.

Find step-by-step instructions for accessing the livestream here.

“We value our relationship with Comcast NBCUniversal and are thrilled to once again be able to team with them to bring the Olympic Games to service members and their families, wherever they are called to serve,” said Air Force Chief Master Sgt. Rich Martinez, AAFES’ senior enlisted adviser, in the announcement.

“It’s our privilege to provide unprecedented access to this historic event to U.S. military service members and veterans, where the world’s greatest athletes will compete against the backdrop of one of the most beautiful cities in the world,” said Mona Dexter, vice president of military and veteran affairs at Comcast NBCUniversal.

More information about watching NBCUniversal coverage of the Olympics is available here.

The Government Accountability Office concluded that around 8 in 10 of those listings could be incorrect after posing as Tricare beneficiaries on hundreds of covert calls to providers. The watchdog agency encountered a host of problems with the directories, from faulty contact information to incorrectly showing whether a provider is taking new Tricare patients.

Finding behavioral health care services to treat mental health conditions and substance use disorders is already difficult for military beneficiaries amid a nationwide shortage of therapists and psychiatrists. Flawed directories compound the unique challenges facing military families, who rely on the listings to find care and have long complained about directory shortcomings. Frequent moves exacerbate the problem.

To help remedy the issue, GAO recommended that the Defense Health Agency specifically monitor the accuracy of behavioral health listings in the Tricare network, in addition to the agency’s broader checks of the directory overall.

“Access to behavioral health care is paramount for Tricare beneficiaries, as demand for these services [has] increased among active duty service members and their families,” auditors said in the report.

More than 9 million Tricare beneficiaries receive care at military facilities, or through networks of civilian providers in two regions, Tricare East and West. Contractors in each region manage online provider directories spanning more than 1 million listings of health providers and specialists; the contractors are required to ensure listings are accurate and audit a portion of them each month. Defense health officials monitor the findings of those audits.

Congress mandated a GAO investigation in 2022 amid ongoing complaints about the quality of the directories. GAO dug into a fraction of the nearly 130,000 listings for behavioral health providers — with lackluster results.

The watchdog called a random sample of 342 behavioral health providers in the Tricare directories in July and August 2023, the report said. That was enough to estimate that 85% of nearly 61,000 such listings in Tricare East were inaccurate, and 79% of nearly 68,000 listings in Tricare West had errors, GAO said.

A listing was considered accurate if each of the elements required by the Pentagon were correct: a provider’s name, gender, specialty, sub-specialty, address, phone number and fax number. Auditors estimated that about 19% of all behavioral health listings in Tricare East, and about 22% of those listings in Tricare West, show a disconnected phone number or outdated address.

The study also considered whether providers were accepting new Tricare patients. Of the listings GAO contacted that advertised accepting new Tricare patients, the watchdog found that only a small percentage actually were — 34% of those in Tricare East; and 19% of those in Tricare West.

DHA and Tricare’s contractors have tried to encourage health providers to accept more Tricare patients. But providers can be reluctant to accept Tricare because they want to avoid the system’s low reimbursement rates for services provided, a lack of awareness of the Tricare system, a preference for private insurance or avoiding insurance altogether, or burnout.

As part of its research, GAO also met with organizations representing Tricare beneficiaries and behavioral health providers, and interviewed defense officials and representatives from the two regional contractors.

Health Net Federal Services, the Tricare West contractor, argues that more than 8 in 10 of its listings across all providers are accurate.

The contractor told Military Times it “proactively works with our network providers to obtain timely, accurate directory data.”

“HNFS conducts monthly audits on a randomly selected, statistically valid sample of provider records, including those for behavioral health providers,” the company said.

Health Net said GAO hasn’t provided details of which listings it audited so the company can try to replicate its findings.

Officials with Humana Government Business, the Tricare East contractor, didn’t immediately respond to a request for comment.

Karen Ruedisueli, director of government relations for health affairs for the Military Officers Association of America, said the advocacy group is “not at all surprised” by the findings.

“They validate beneficiary complaints we have heard for years about ‘ghost directories,’” Ruedisueli told Military Times. “Military families face so many challenges. Those reaching out for help should not have to slog through dozens of inaccurate listings to find a mental health provider.”

A recent survey conducted by the Military Family Advisory Network found that about 28% of actively serving families who sought out mental health care reported obstacles in getting appointments.

That comes amid a spike in the need for those services. Service members experienced a fourfold increase in mental health diagnoses from 2005 to 2021, according to the Defense Health Board, an independent committee that advises the defense secretary. Military children saw a sixfold increase in mental health diagnoses.

Struggles to keep provider directories accurate are not unique to the military health system; state and federal laws and regulations designed to curb the problem have fallen short of that goal.

The Defense Health Agency, which manages Tricare, said multiple factors likely cause listing inaccuracies. Behavioral health providers are more mobile than others, the agency said, and may lack the administrative staff to update those details. DHA added that provider availability can change daily, and that some don’t post phone numbers because they prefer patients contact them by email or text.

Responding to GAO’s findings, DHA said it would look into how feasible it may be to require Tricare contractors to audit behavioral health listings as well as the directories at large, and agreed to address what could be causing possibly significant differences in the accuracies of behavioral health listings compared to Tricare providers overall.

While GAO said the contractors contend their overall accuracy rate hovers around 82%, auditors estimate just 15% of behavioral health listings are right in Tricare East and 21% in Tricare West.

Defense Health Agency officials pushed back on the report’s recommendation to ensure those rates are consistent, pointing to differences in the providers’ resources and how they conduct business.

Defense officials also disagreed with the GAO recommendation that they periodically monitor the accuracy of the behavioral health provider listings in relation to the overall directory.

Tricare’s current contracts, as well as a new pair set to take effect in January, don’t require the network managers to audit individual specialties. Doing so would require more money, DHA Director Army Lt. Gen. Telita Crosland wrote in a response to GAO.

The agency itself also lacks the manpower to sufficiently pore over provider directories, Crosland said.

GAO maintains that the Pentagon should check Tricare’s behavioral health provider listings “to help ensure that beneficiaries have the best information available when they need to access behavioral health care.”

Have you had to cut back on the amount of groceries you’re buying? Are you giving up some previous indulgences or buying cheaper cuts of meat — or no meat? Scouring for coupons or doing more comparison shopping? Shopping at the commissary more often? Driving less or changing vacation plans? Diving into savings? Charging necessities on credit cards?

'Feeding our paycheck to the pump': Troops, families deal with inflation

If you’re making a permanent change of station move this summer, has inflation impacted that move, and in what way?

Have any steps taken by Congress and DOD over the last several years helped you financially, such as pay increases, housing allowance increases or the new Basic Needs Allowance?

Tell us about your experience, and include some of your advice and tips that we can share with others in the military community. Include your rank, branch of service, location and how many people are in your family.

Email your answers to reporter Karen Jowers at kjowers@militarytimes.com. Your response may be published online or in print. Let us know if it’s OK to use your name. Thanks for your help.

The lawmakers are concerned that the Defense Health Agency has decided to retain Express Scripts as the sole pharmacy benefit manager for Tricare, the military insurance system serving 9.6 million troops, retirees and their families.

Military pharmacies resume regular operations after cyberattack

In a letter sent Wednesday to Assistant Secretary of Defense for Health Affairs Lester Martinez-Lopez and DHA director Army Lt. Gen. Telita Crosland, the lawmakers questioned whether Express Scripts may be using anticompetitive tactics to overcharge Tricare.

Express Scripts is the second-largest pharmacy benefit manager in the country. PBMs act as middlemen for pharmacies, drug companies and insurers and play a key role in negotiating drug prices between the various players, as well as helping to decide which medicines an insurer will cover.

Critics argue PBMs’ often secretive work has forced scores of Americans to overspend on medication or kept them from being able to access the medicine they need. PBM proponents argue they ultimately drive down costs in the medical system and ensure the prescription drug enterprise runs smoothly.

The letter, led by Sen. Elizabeth Warren, D-Mass., Sen. Mike Rounds, R-S.D., Sen. Peter Welch, D-Vt., and Rep. Buddy Carter, R-Ga., demands answers by July 2 from defense officials on how they monitor the Express Scripts contract, how robust the pharmacy network is, and whether DHA tracks Express Scripts’ denials for expensive specialty drugs requested by Tricare beneficiaries. Twenty additional members of Congress signed onto the letter.

At issue is the narrow set of companies through which troops and their families receive medicine under Tricare health plans.

Tricare members can obtain prescription drugs through two entities: Express Scripts, which handles nonspecialty medication, or Accredo, which handles specialty drugs for conditions like cancer and multiple sclerosis. Accredo has served as Tricare’s primary in-network specialty pharmacy since the beginning of 2023, though patients can buy specialty drugs through other pharmacies as well.

Both companies are Cigna subsidiaries. Lawmakers worry the arrangement makes Tricare customers vulnerable to higher drug prices, and may ultimately drive up the cost to taxpayers who cover government-provided health insurance.

“Because Cigna also owns Accredo, it can effectively keep much of its business in-house, using its [pharmacy benefit manager Express Scripts] to steer patients to its own pharmacy while disadvantaging competitors,” the lawmakers wrote.

Lawmakers want to know whether DHA has compared the prices Express Scripts charges for specialty drugs through Accredo versus what it charges for the same drugs at independent pharmacies. They also ask how much Express Scripts charges for each of the 10 most frequently prescribed products purchased through Accredo, and how much it charges for the same prescriptions when they are purchased through independent pharmacies.

In a statement provided to Military Times, Express Scripts officials said Tricare beneficiaries aren’t required to fill the majority of specialty prescriptions through Accredo, “though many choose to because of the highly personalized support they receive from their pharmacists, nurses, clinicians, dietitians and social workers.”

Company officials said they provide Tricare beneficiaries “with high quality, affordable health care while achieving billions of dollars in savings for the government and taxpayers. Tricare beneficiaries have access to the full range of generic, brand, and specialty medications on the market today through our robust network of chain, independent, military, specialty and home delivery pharmacies.”

Tricare members have fewer independent and retail pharmacies to rely on than they did a few years ago. In 2022, 15,000 pharmacies left the Tricare network while refusing to accept the contract’s terms for reimbursement from Express Scripts. After public pressure, Express Scripts reopened its network, but fewer than 5,000 pharmacies rejoined.

“This exodus of independent and retail pharmacies can be catastrophic for Tricare beneficiaries, especially for those with complex medical conditions who are ill-served by mail-order pharmacies,” the lawmakers wrote.

There are currently more than 42,000 pharmacies, including nearly 12,000 independent pharmacies in the Tricare network. Ninety-eight percent of beneficiaries have a Tricare retail pharmacy within a 15-minute drive.

Lawmakers ask how the Defense Health Agency verifies that Express Scripts obeys patient access requirements, including that at least one in-network pharmacy is located within a 15-minute drive of 90% of Tricare beneficiaries.

They noted that the Defense Health Agency can revise the terms of the contract or leave the exclusive agreement with Express Scripts each year until the contract ends in December 2029.

A DHA spokesperson on Friday declined to comment on the letter: “It isn’t appropriate for us to comment on questions until we have responded formally to the members of Congress.”

The agency has previously told Military Times that the contract allows Express Scripts to use its own discretion in contracting with pharmacies to establish a competitively priced network that meets contract access standards, directly passing savings to the government.

A new report from a leading advocacy group argues it’s time to give the pace of those moves, known as permanent changes of station, a fresh look.

“We’re seeing PCS as being a big moment that puts people in a situation of vulnerability,” Shannon Razsadin, chief executive officer of the Military Family Advisory Network, told Military Times on Tuesday.

The group’s 2023 Military Family Support Programming Survey, released Wednesday, explored some of the perennial challenges that burden military families. The 109-page report questioned whether changing the frequent shuffle between bases — which military officials argue is necessary to meet operational requirements and fill empty jobs — could affect recurring issues related to financial stability, such as military spouse unemployment, and other concerns such as children’s education.

“Is there a capacity to expand telework to provide more stability?” the report asked. “There is an opportunity to explore the cost savings of less frequent moves, not just for military families, but also for taxpayers.”

The survey drilled into some of the second- and third-order effects of frequent moves, when people struggle with everything from the amount of time spent in temporary lodging to security deposits, extra rent and unreimbursed expenses.

“These things are adding up. When you move every two to three years, and layer on top of that potential gaps in employment, you have this ‘aha’ moment where it’s not surprising that people are having a hard time getting ahead,” Razsadin said.

More than half of the survey’s respondents made a PCS move in the previous two years, the advocacy group said. Those who did were more likely to report poor family well-being than those who hadn’t moved, at 25.7% and 20.3%, respectively, according to the survey.

About 4 in 10 respondents who PCSed in the past two years reported low or very low food security; around half reported it was “difficult or very difficult” to find a place to live.

The MFAN survey, conducted online from Oct. 2 to Dec. 10, 2023, sought to hear from current and former members of the military community. Of the 10,149 participants, 39% said they were active duty spouses, 19% were veterans, and 11% were active duty troops. Seventy-six percent of respondents identified themselves or their spouse as enlisted, whether active duty, retiree or veteran.

The survey isn’t a scientific poll because researchers did not verify the identity of respondents, or conduct a random sample, for instance. The 2023 report is the survey’s fifth iteration since it began in 2014.

Researchers measured family well-being using the Family Health Scale, a research tool of 10 questions that measure factors like relationships, health care, lifestyle, financial health and housing.

Other findings related to PCS moves include:

• Most respondents reported spending between $500 to $1,000 out of pocket on moving expenses that aren’t reimbursed by the military.
• 53% of active duty military family respondents say they are paying more than $251 out of pocket each month for rent/mortgage or utilities.
• 43% said the reimbursement process took one to two months after they moved.
• 29% reported staying in temporary lodging between 11 to 30 nights during their PCS move; another 21% reported staying in temporary lodging between 31 to 60 nights.
• 56% of respondents said their household goods were lost or damaged during their most recent move, including retirees and veterans. 70% filed a claim. “Respondents who filed a claim most commonly experienced a financial loss between $500 and $1,000 above the reimbursement for their claim,” according to the report.
• 46% of respondents said moving has the greatest impact on children and their education, social life, and adjustment to a new location. “It takes a great deal of work to support the children before, during and after a move. The ripple effect is large and long lasting,” said one active duty sailor who responded to the survey.
• 38% said that moving affects the entire family’s mental health and well-being, “oftentimes causing stress, sadness, depression, anxiety, loneliness, and even adjustment disorder,” according to the report.
• 30% cited the effects of PCS moves on military spouse employment; 36% of unemployed active duty spouses shared stories of challenges with frequent moves.
• 11% of respondents cited moving or PCS as a barrier to saving money.
• 30% of respondents said they had difficulty establishing mental health care in a new location.

“The journey of a military family like yours or mine comes with sacrifices,” said Christine Grady, wife of Vice Chairman of the Joint Chiefs of Staff Adm. Christopher Grady, during an event Wednesday announcing the results of the survey. “It comes with great rewards.”

Overall, military family well-being has declined since the last MFAN survey in 2021. In the past two years, those reporting poor family well-being increased from 14% in 2021 to 26.5% in 2023. Those who described their well-being as “excellent” fell from 41.3% in 2021 to 27.9% in 2023.

Enlisted families with children — one of the largest groups in the survey — were less likely to report excellent well-being, at 20%.

Razsadin said one of the more disheartening results is the uptick in loneliness reported among military and veteran families, which rose by 5 percentage points to 59% in 2023.

“I found it surprising,” she said. “The last time we fielded the survey was in 2021, in the pandemic. We have to figure out how we can create meaningful connections with people.”

Among the bright spots in the findings, said Gabby L’Esperance, MFAN’s insights director, was the increase in usage of mental health support. Nearly 60% of respondents sought out mental health services in the previous two years, up from 46% in 2021.

Survey results showed that families with poor or moderate well-being were less likely to recommend military life to others, as were enlisted families, veteran families, respondents with children under 18, and those who joined military life in the last 10 years.

Nearly 58% of those surveyed in 2023 would recommend a military career, a 5-percentage-point drop since 2021. Those who recommend military life to others has fallen steadily since 2019, when it stood at 74.5%.

Many said they would recommend military life with a healthy dose of caution, or as short-term service instead of a career.

The advocacy group warned that failing families can have wider repercussions for retention and recruitment — and in turn, military readiness — than on those households alone.

“Ensuring families can thrive in service isn’t just the right thing to do,” the report said. “There are long-term consequences if they don’t.”

While the Defense Department has worked to improve nutritious options at military dining facilities in an effort to retain a fit and healthy force, gaps continue to limit officials’ ability to manage and evaluate the effectiveness of nutrition programs, the Government Accountability Office said in a report published Monday.

More food options, better access coming for commissary customers

“Poor health and nutrition are growing challenges that threaten the department’s ability to recruit and retain a fit and healthy force,” according to the report.

Clear guidance from the top, crafted by a congressionally mandated board, is needed for effective implementation, oversight and evaluation of nutrition programs on military bases, auditors wrote. DOD has yet to establish that board.

Auditors also urged military officials to improve how food is labeled, in addition to expanding the availability of healthy options on base.

Defense Department officials did not weigh in on the report’s recommendations ahead of its release and did not immediately respond to a request for comment from Military Times.

The military services run more than 400 dining facilities around the world, most of which belong to the Army. But troops have long griped about the lack of healthy dining options on base, from limited operating hours to stingy portions doled out by food service workers to few sources of protein for those stuck at the end of the line.

To help service members find the healthiest choices in those dining halls, the military launched a color-coded nutrition-labeling program called “Go For Green,” or “Fueled to Fight” in the Marine Corps.

Green, yellow and red labels signify the proportion of saturated and total fats, fiber and sugar in a particular food, as well as how they were processed and prepared. Green means “eat often,” yellow is “eat occasionally” and red means “eat rarely.”

But some installations haven’t fully implemented the labeling program, auditors found. Beyond color-coding foods, bases are required to follow placement and promotion guidelines, like putting “green” foods first in the chow line; obey set minimums and maximums for the number of “green” and “red” items athat are available; and employ a certain number of workers who are trained on the program.

GAO auditors recommended that the services be required to establish guidance on what steps the dining facilities need to take to incorporate each of those required elements into their nutrition-labeling programs.

Stronger guidance could help ensure the food on troops’ plates meets minimum nutrition standards, and the labeling program’s requirements, so service members have an easier time making informed decisions about their diets, auditors said.

Inconsistencies can lead to “suboptimal food choices and service member confusion or distrust in the labeling programs,” auditors argued.

Troops in 4 of 5 of discussion groups run by GAO said they didn’t trust that nutrition labels were accurate and ignored them when choosing meals, according to the report.

Though the Defense Department promised to create a congressionally required “leadership cell for food transformation” by September 2022, that team hasn’t yet come to fruition.

Military health officials told GAO they have drafted a charter for what will be known as the “Defense Feeding and Nutrition Board,” tasked with developing policies and procedures to reform the military food enterprise.

But disagreements over who should lead the board have stopped the panel from starting its work.

While the undersecretary of defense for acquisition and sustainment was initially proposed to co-chair the board, that plan has fallen through amid the acquisition branch’s concerns that the panel would overlap with the Pentagon’s existing nutrition committee, GAO wrote. DOD health officials, on the other hand, argue that committee has “insufficient expertise and influence” on the military’s food operations, the report said.

In the meantime, the board’s delays “have prevented critical oversight of food transformation efforts,” auditors said. They recommend the defense secretary clarify or adjust responsibilities for the leadership of that board.

And while the services and DOD do collect some feedback on the food available on military installations, GAO suggested that a stronger set of goals and performance metrics would help track whether those options offer troops well-rounded meals.

Another major hurdle to healthy eating on base is the array of other venues — such as officer clubs, bowling centers, snack bars and commercial restaurants — that aren’t subject to the same nutritional requirements as taxpayer-funded dining facilities and are open longer. Those venues comprise at least three-quarters of on-base food vendors, according to DOD.

For instance, the report said, one large installation has 47 retail food venues that serve customers from 5 a.m. to midnight, compared to 14 military dining facilities, most of which close by 6 p.m.

Restaurants and other vendors that are part of a chain with at least 20 locations must publicly display calorie data on their menus. But that’s not enough, GAO said.

Auditors recommended that military health officials, along with the future Defense Feeding and Nutrition Board, develop a strategy for growing the number of healthy options at those retail establishments, and better define their role in providing nutritious food on military installations.

As an Army infantryman, Ernest Barrington was very familiar with the thick smoke and fumes that came off the burn pit at Joint Base Balad in Iraq. The toxic dust that wafted from the huge, open-air ditches where the military burned everything from tires and ordnance to medical waste and plastic would coat his skin and settle on the inside of his nose and under his eyelids.

“You go to take a shower, it’s in the shower with you. So you’re cleaning your skin, and as you’re drying, the stuff is landing on your body. By the time you make it back to your room, you have the toxins right back on you,” he said. “Every day that you’re there, you’re breathing it in.”

Everyone on base breathed it in — Barrington’s fellow soldiers and the foreign military members from allied nations, the burly ex-Special Forces operators who took lucrative gigs working contracted security, the workers from Pakistan, the Philippines, and Nepal who ran the laundry and the chow hall and drove the fuel trucks.

The toxic ash was the same, but access to care for those battling cancers almost two decades later is not. Veterans are now guaranteed coverage; the estimated tens of thousands of contract workers debilitated by burn pits are not.

One group who served their country during the “forever wars” is now rightly protected, advocates say. But members of the other group are left to fight with insurance companies, one by one, claim by claim, beaten down by bureaucracy, exhausted by illness.

Barrington understands the predicament.

A historic commitment

When he retired from the Army in 2007, Barrington turned around at 40 and picked up a series of private contracting jobs, which took him from Kuwait to Saudi Arabia and eventually back to Iraq. In 2020, on a trip from Washington, D.C., to Erbil, the charter plane Barrington was in landed hard on the tarmac. He felt his back seize up.

Over the next few weeks, the pain got worse. An MRI revealed multiple shattered vertebrae, he told The War Horse. It was an unusual injury, doctors told him, so they ran some tests. Soon it made more sense. They diagnosed him with two separate types of cancer: prostate and multiple myeloma, a fairly uncommon blood cancer.

In the 13 years since Barrington had put his uniform away, veterans who served at bases with burn pits started getting sick with respiratory diseases and unusual cancers. Certain forms of multiple myeloma were among them. Years of advocacy around the issue led to the passage two years ago of the PACT Act, a historic commitment that for the first time removed veterans’ burden for proving their exposure to burn pit toxins was directly responsible for their sickness.

The law established a “presumptive service connection” for certain diseases — if a veteran was diagnosed with a condition on the list and had served at a base with a burn pit, VA would presume it was caused by their service, and the veteran would be entitled to care. After the law passed, Barrington said, he filed a claim with VA.

But Barrington, who now lives in Jacksonville, Florida, with his wife, says it’s unclear if his cancer stemmed from his time at Balad Air Base as a soldier, or if it’s connected to the toxins he was exposed to during his time working as a contractor—or both. So he’s also filing a claim under a World War II-era law called the Defense Base Act, which requires contracting companies to carry insurance for their workers’ war zone injuries or illnesses.

The hundreds of thousands of private contractors who served alongside uniformed service members in Iraq or Afghanistan—often doing similar work — have many of the hallmark injuries and illnesses of the post-9/11 wars: rare cancers, post-traumatic stress, traumatic brain injuries.

But those contracted workers injured on bases overseas aren’t protected by the PACT Act for cancers or lung diseases that follow their deployment. Instead, they must file a workers’ comp claim under the Defense Base Act, which can lead to medical coverage and monetary compensation for sick workers. Civilians who work directly for the government must file an entirely different type of claim.

But many workers are unaware that they are covered, and the arcane, bureaucratic process to see a claim through means civilian workers can wait years to get compensation for the harm they suffered. Many never get any at all.

The growing ‘camo economy’

Last month, President Biden announced that VA had granted more than a million PACT Act claims to veterans for cancers and lung diseases stemming from burn pit exposure. In the 23 years since 9/11, only about 150,000 Defense Base Act claims — for every type of illness or injury — have been filed by contractors who deployed to Iraq or Afghanistan.

The disparity is even more significant considering another trend: Civilians are playing a dramatically larger role in America’s wars.

For 200 years, the ratio of U.S. military members to contract workers remained fairly constant — about one contractor for every 100 soldiers.

But that changed after Vietnam. The American public had little stomach for the heavy toll the war had taken on its troops, and the end of the draft significantly decreased the size of the fighting force.

Privatizing government work was popular in Washington, and jobs previously done by soldiers, sailors, and airmen were increasingly contracted out to civilians. By the first Gulf War, there was one contractor for every 50 military personnel. By 2009, the ratio was 1-to-1 in Iraq and Afghanistan. And as troops began to withdraw, many contract workers stayed and soon exceeded the number of military members.

“When we talk about how many American troops are going overseas, we’re not also counting the number of contractors going overseas,” says Heidi Peltier, a Brown University economist who has studied what she calls the “camo economy” — the military contracting industry. “And when they talk about injuries and deaths, that’s usually the military injuries and deaths, not the contractor injuries and deaths. … The impact is much less visible.”

Brown University’s Costs of War project has estimated that more contractors than service members died in the post-9/11 wars — 8,189 to 7,053.

In Iraq and Afghanistan, civilian workers guarded bases, fuel convoys, and American diplomats. They maintained equipment and weaponry. They cooked and cleaned and did laundry.

Some of that work paid well. Private security contractors who worked for companies like Blackwater could make upwards of $1,000 a day. But much of the labor was subcontracted out to foreign workers from poorer countries, who were sometimes paid just $300 or $400 a month.

“This is one of the things my Afghan friends always used to joke about, they would sort of call the base an American base. But if you went onto the base, there were very few Americans there,” says Noah Coburn, a political anthropologist at Bennington College who has studied foreign labor on U.S. bases.

Coburn says that ostensibly, the military only uses contractors in support roles. But in reality, many civilian workers face the dangers of war: Macedonian janitors were taken hostage by the Taliban. Pakistani fuel tank drivers dodged enemy fire. Ugandan security guards were ambushed with rocket fire.

Under the Defense Base Act, anyone who works for a U.S. military contractor overseas is entitled to file compensation and health care reimbursement claims for injuries or illnesses that resulted from their work. In practice, though, filing can be nearly impossible for workers who return to their home countries with little idea how to navigate the process. It can be nearly impossible for workers to connect with American lawyers to file paperwork, Coburn said. Doctors abroad may not be aware of how to best document a medical condition to increase a claim’s chance of success.

Coburn has found that workers who file a claim from a non-U.S. address have a lower chance of getting claims approved than those from U.S. addresses. But even for Americans, getting compensation for their injuries can be difficult.

“There’s a whole bunch of these people that need help,” says Scott Dillard, a former Army officer who later worked as a contractor in Afghanistan and now helps fellow former contractors navigate the claims process. “They have no clue that there are resources available to them because they’re not educated on it.”

Military contractors are supposed to inform their employees about the Defense Base Act and post notices about workers’ rights to compensation. But Dillard says he never saw a notice.

When civilian contractors do file a claim, proving the condition stemmed from their work overseas can be difficult. The law’s statute of limitations begins when a worker becomes aware of his or her condition. That means that if an illness pops up years later, a worker can still potentially file for benefits — but it may be harder to prove what caused it.

That can be a problem. Collecting evidence can be difficult and expensive, and insurance companies say they need to scrutinize claims to make sure people aren’t abusing the system.

“When it comes to losses like this, you’re going to have people that are going to see what they can get for free, and you’re going to have legitimate claims,” says Brian Smith, who specializes in Defense Base Act coverage as a vice president at Insurance Office of America, an insurance broker firm. “The issue has to do with the validity of the claim when you go back that many years.”

‘Not going to deal with this’

Veronica Landry knows well the white-hot scrutiny of insurance companies.

In 2004, she took a contract job in Mosul, Iraq, staffing the base gym and the recreation center, then was quickly promoted to working as an operations specialist and historian. The work wasn’t as danger-free as it sounded. The air turned black when tires were in the burn pits. During her assignment, the dining facility was blown up by a suicide bomber. And when a soldier was hit with a mortar round in a separate incident, Landry tried to use CPR to keep her alive, she said.

She filed a claim for PTSD when she came home, but she says the insurance company denied it.

Lawyers who spoke with The War Horse said that’s not unusual. If an insurance company denies a claim, the person who files it can escalate it to a formal adjudication process through the Department of Labor. But Landry didn’t know that at the time.

“I thought when they said ‘denied,’ it’s just, that’s it. You’re done,” she said. And she didn’t feel up for a fight.

As the years passed, Landry began having trouble breathing. In 2015, her lungs collapsed. When she was diagnosed with obliterative bronchiolitis, an irreversible lung condition, she suspected her exposure to burn pits in Iraq might be the cause. This time, she said she did her research. She was prepared for the fight.

Landry’s new claim took two years to wind its way through the process. There are only 37 administrative law judges in the Department of Labor and more than 10,000 Defense Base Act claims pending adjudication as of March, according to data provided by the department.

For others, the wait can stretch past three years. And for those who aren’t able to work because of their injuries, it can feel interminable.

“You’re four years in,” says Howard Grossman, a lawyer who specializes in Defense Base Act claims, “and the client is living on ramen noodles and microwave popcorn.”

Landry says that investigators for the insurance company, AIG, combed through her social media accounts and used photos of her exercising to make the case that she wasn’t as sick as she said she was. AIG declined to comment.

Grossman said he has seen private investigators for insurance companies convince people to sign blank authorization forms that the firms can use to access personal medical and pharmaceutical information.

“The VA is not perfect, as we know, but its role in life is to help injured veterans,” says Gary Pitts, the attorney who represented Landry. “What happens with the contractors is they come home, and they have to deal with a worker’s comp insurance company whose role in life is to help the worker’s comp insurance companies.”

But Landry’s case was a victory: In 2018, a judge ruled that her condition was related to her toxic exposure in Iraq, citing Landry’s description of breathing in the thick, black burn pit smoke, and her doctor’s determination that she suffered from a “deployment-related lung disease.”

It was the first judicial decision in the country linking any burn pit exposure to a serious lung condition. Groups advocating for the PACT Act seized on the ruling as evidence that VA should do more to help veterans with lung diseases and cancers who were exposed to burn pits.

Obliterative bronchiolitis became one of the conditions that VA guarantees coverage for veterans under the PACT Act. But contractors like Landry, with the same condition, are still on their own and must find a lawyer to fight on their behalf for compensation.

“It’s one by one,” Pitts says. In 23 years of working on the Defense Base Act, his firm has filed around 11,000 claims.

In Landry’s case, the judge determined her insurance company should pay her medical bills. But Landry says that she had to fight AIG for every bill to be reimbursed. Eventually, she gave up and settled out of court.

Before settling, she was also awarded monetary compensation. The amount ended up being as small as the system made her feel.

Just $4 a week.

This War Horse feature was reported by Sonner Kehrt, edited by Mike Frankel, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar. Abbie Bennett wrote the headlines.

Troops and their families often travel separately when moving to another base so they can set up their new household, or to attend training and other work requirements in the midst of the transition. The policy aims to help cover out-of-pocket costs for breastfeeding parents while they are separated from their children, which can squeeze service members’ budgets at hundreds of dollars per shipment.

The new Defense Department policy, which took effect May 24, is similar to an earlier policy enacted in 2022 that helps troops recoup the cost of shipping breast milk when they are on temporary duty travel for work trips longer than three days.

The new rule applies to service members who are breastfeeding children up to 12 months old. Troops are responsible for making their own arrangements for transporting breast milk.

In doing so, service members are allowed to be reimbursed for commercial shipping fees, excess baggage fees, and dry ice or regular ice, according to the Joint Travel Regulations.

The policy won’t cover the cost of packaging and packing material, as prohibited by federal law, or of a rental vehicle.

Service members must receive prior authorization for reimbursement, to be included on their PCS orders, before incurring those expenses. The service member must claim the costs on their PCS voucher once the move is complete. All receipts, regardless of the amount, must be submitted along with the claim.

Christopher Woods, the Defense Travel Management Office’s policy branch chief, acknowledged those costs can add up.

“The fact is that this milk must be stored in a cold environment,” Woods said. “Service members are having to purchase things like ice and dry ice in order to keep the milk frozen or cool.”

As part of an initial draft of the Senate Armed Services Committee annual defense authorization bill, panel members announced plans for a 4.5% pay raise for all servicemembers in 2025 (in line with White House plans) and an extra 1% boost for troops ranked E-3 and below.

The extra money is designed to recognize the financial strain facing some young military families and the low base pay junior troops receive. Currently, some young enlisted service members can make as little as $24,000 in basic pay, although that total does not include other compensation such as housing allowances and free health care.

“I’d like to see even more for our active-duty military, but right now we have to stay under budget caps,” said Sen. Elizabeth Warren, D-Mass. and chairwoman of the committee’s personnel panel. “We squeezed as many dollars from every place else in the Defense Department budget that we could to get this.”

Junior enlisted pay bump to cost as much as two new aircraft carriers

For troops ranked E-2 with less than two years of service, the pay boosts will bring their annual base salary to almost $29,000, about $1,500 more than this year. That’s about $280 more than the White House’s plan for those servicemembers.

But it’s far short of House lawmakers’ plan for a major rewrite of the military basic pay tables next year.

Under that plan — being considered on the House floor this week — troops ranked E-4 and below would see pay raises up to 19.5%, bringing nearly every servicemembers’ annual salary above $30,000 a year. All troops regardless of rank would see a 4.5% pay raise under the plan.

Servicemembers ranked E-3 with two years of service would see their annual salary jump about $4,500 in 2025 under the plan. E-5s with less than 10 years service would see smaller increases too, to ensure their pay stays above lower-ranked troops.

Those targeted pay raises would cost more than $24 billion over the next five years, according to the Congressional Budget Office.

On Tuesday, White House officials announced the president “strongly opposes” the idea, saying the plan “would lead to pay compression in some parts of the enlisted military basic pay table” and should be delayed until a full review of military compensation rules is completed next year.

That statement drew a sharp rebuke from House Armed Services Committee Chairman Mike Rogers, R-Ala.

“President Biden believes providing the men and women who serve in our armed forces with adequate compensation is too costly. This is offensive and wrong,” he said in a statement. “Too many military families are relying on food banks, SNAP, and WIC in order to put food on the table. Republicans and Democrats on our committee agreed this is unacceptable.”

The Senate plan unveiled Wednesday may indicate support in both chambers of Congress for a compromise path, one less ambitious than the House pay table revisions but still providing more cash-in-hand to junior enlisted troops.

The House authorization bill draft also includes more money for military housing stipends and other quality of life improvements left out of the Senate plan. Senators could still add in some of those provisions later this week, when the armed services committee finishes its bill markup, or when the legislation heads to the chamber floor.

Lawmakers are expected to spend most of the summer negotiating a compromise between the two measures, with an eye towards passing a final bill sometime this fall.

The authorization bill has passed out of Congress for more than 60 consecutive years, making the budget policy measure one of the few areas of bipartisan agreement despite ever-present partisan tension on Capitol Hill.

The calculation comes as both House and Senate leaders debate how to help young military families avoid financial difficulties while ensuring the armed forces have sufficient funding for maintaining operations.

House lawmakers will vote on the enlisted pay raise plan — which would guarantee nearly every service member a base pay of $30,000 a year — in coming days as part of the chamber’s draft of the annual defense authorization bill.

The measure outlines policy and spending targets for nearly $885 billion in national security programs, including an across-the-board 4.5% pay raise for all troops in 2025 and a further pay raise of up to 15% for troops in ranks E-4 and below. E-5s with less than 10 years service will see an average bump of 7%.

Junior enlisted to get 20% pay bump, E5s get 13% more under House plan

For an E-2 with two years of military service, that increase will mean about $5,000 in extra pay next year. For an E-4 with four years of military service, it’s almost $7,500 more.

House appropriators have already signaled they intend to fund the plan in their budget bills later this month, but the financial investment is significant. The Congressional Budget Office on Monday estimated the plan will add $24.4 billion in extra defense spending from fiscal 2025 through fiscal 2029.

The White House on Tuesday put the five-year estimate at just under $22 billion, and at a cost of $3.3 billion next year alone.

Defense planners have balked at similar pay plans in the past because of the significant monetary strain such moves put on the entire military budget.

In recent months, they have lobbied lawmakers behind the scenes to delay any action on junior enlisted pay until next year, when a Pentagon analysis on service member compensation is complete. White House officials on Tuesday issued a new statement of opposition to the pay plan, citing the cost.

For the two aircraft carrier comparison, the USS John F. Kennedy is scheduled to be completed next year at a total construction cost of about $11.4 billion. The USS Enterprise, meanwhile, is set to be finished in 2028 at a price tag of around $12.3 billion, according to statistics from the Congressional Research Service.

The pay plan also approaches the total cost of the Space Force budget for fiscal 2025, estimated by service leaders to be $29.6 billion.

But House lawmakers have argued the investment is necessary to ensure that the military services can keep pace with recruiting and retention goals, and to properly reward young troops and their spouses for the sacrifices of military life.

The House plan also includes a boost in service member housing stipends and more money for on-base daycare services. The plan received bipartisan support in the House Armed Services Committee last month but faces a difficult path on the chamber floor because of potential social issue amendments on issues such as abortion and transgender medical care.

Senate Armed Services officials thus far have been noncommittal on the House’s ambitious enlisted raises. They are expected to unveil the first draft of their service member quality of life ideas on Wednesday, with a committee vote on their draft of the authorization bill later in the week.

A compromise between the separate House and Senate versions of the authorization and appropriations bills is not expected until sometime this fall or winter, possibly leaving the fate of the pay raises unsettled until just a few weeks before the start of 2025.

Frequent military moves pose unique difficulties for business-owning spouses, who can take significant hits to their revenue or be forced to shutter altogether as they navigate a web of state regulations and bureaucratic delays. To help keep those entrepreneurs afloat, the military will cover at least part of the cost of moving and removal services for business equipment, new equipment purchases, information technology costs, and fees for business permits, registration and inspections.

“We owe it to them to provide any opportunity to not just have a job, but build a fulfilling career,” said Lt. Gen. Kevin Vereen, who as a deputy chief of staff overseeing installations is the Army’s top quality-of-life official.

Lawmakers included the new benefit in the 2023 National Defense Authorization Act, prompting each branch of the military to craft their own implementation guidelines. The Army announced its new reimbursement policy June 4; the Navy issued its policy April 29. The Air Force and Space Force finalized their own version last fall. The Marine Corps is still developing its guidelines, officials said.

Spouses could already recoup as much as $1,000 spent to obtain new professional licenses due to a permanent change of station — a policy that has been in place for several years. Now they can be reimbursed for both types of spending, totaling up to $2,000 per PCS move.

As long as the spouse owned their business or held the professional credential at a prior duty station — not only the most recent duty station — they can qualify for reimbursement, the Army, Navy and Air Force said.

For example, say a spouse owns a business while at Fort Stewart, Ga., but stops operating the business after moving to Fort Liberty, N.C. A few years later, when the business owner moves again for their spouse’s assignment at the Pentagon, the spouse could still ask the Army to reimburse the costs of operating their business.

The opportunity is available to spouses married to troops who received PCS orders dated Dec. 22, 2023, or later, and will run through the end of 2029. Navy and Air Force spouses must submit requests for reimbursement within 24 months after the PCS orders are issued. The Army did not immediately provide instructions on filing for reimbursement.

More information on reimbursement rules and applications is available through each military branch, or from DOD’s Spouse Education and Career Opportunities Program.

Air Force and Space Force: Service members should contact their installation’s Military and Family Readiness Center with questions about eligibility and how to submit a claim. The finance office will work with the service member and the spouse to verify eligibility and to ensure they provide the right paperwork to prove their qualified expenses.

Navy: The Navy policy points sailors to MPM-1754-04 for information on documentation requirements. That includes documents such as the Memorandum Spouse Licensure Reimbursement Request; the OF-1164 Claim for Reimbursement for Expenditures on Official Business; a copy of PCS orders; a copy of previous license/certificate and the new license/certificate; and a copy of receipts for a new license/certificate or qualified business relocation costs. The package must be scanned and sent by secure email to ASKMNCC.FCY@NAVY.MIL.

Army: The Army directive states that officials will publish an all-Army activities message providing instructions for filing for reimbursement.

The product marks one of the most significant steps forward for TBI patients’ care in the past 20 years, Lt. Col. Bradley Dengler, an Army neuroscientist who directs the Military Traumatic Brain Initiative at the Uniformed Services University in Bethesda, Maryland, said in a recent release announcing the product’s approval by the Food and Drug Administration.

The test can ascertain whether a person’s blood contains the protein markers associated with a mild TBI, or concussion, after 15 minutes. In combat, that speed can help military medics quickly decide how to treat an injured service member, avoiding unnecessary evacuations and CT scans and improving TBI case management in the field, officials said.

Earlier tests designed to help diagnose concussions or more severe TBIs rely on blood plasma or serum, and must be processed in a laboratory that can take hours or days to issue results.

The new test requires about 20 microliters of blood, which is about half the volume of a raindrop or a teardrop. Similar to at-home blood glucose tests, a patient’s blood is placed on a cartridge that is inserted into a portable device for analysis. While glucose tests use a finger prick, these tests require blood drawn from a vein.

The new test doesn’t offer a firm diagnosis but can flag indicators of a TBI and intracranial hemorrhage. The higher the protein levels the test detects, the more significant an injury might be. The device can be used to evaluate patients up to 24 hours following an injury.

The Analyzer Traumatic Brain Injury system, approved for use in the spring, is expected to be fielded to the Army in fiscal year 2025, said Damien Hoffman, a biomedical engineer and product manager with the Army’s Medical Materiel Development Activity. Hoffman’s organization developed the test in partnership with medical device manufacturer Abbott Laboratories.

The other military branches can purchase the tests through the Defense Logistics Agency.

Known as one of the signature injuries of troops wounded in Afghanistan and Iraq, TBIs can alter a person’s physical abilities as well as their memory, mood and focus. Effects of the “invisible wounds” can range from headaches, vision and hearing problems, to death or extended coma or amnesia in severe cases.

Nearly 500,000 service members worldwide received a TBI during military training or deployment, or day-to-day activities such as sporting events, from November 2000 through December 2023, according to the Defense Health Agency.

This story was updated June 6 at 11:30 a.m. Eastern to clarify aspects of how the test works.

The U.S. Department of Transportation’s “Support Our Troops” dashboard offers a chart comparing each airline’s policies on fee waivers, free luggage and refunds for military families during personal travel, or when travel plans change because of a military order. Four companies — Allegiant Air, Frontier Airlines, Southwest Airlines and Spirit Airlines — offer some combination of those perks, according to the chart.

Alaska Airlines, American Airlines, Delta Air Lines, Hawaiian Airlines, JetBlue Airways and United Airlines are also included in the roundup but have not committed to provide current troops and their families with additional benefits.

In April, Transportation Secretary Pete Buttigieg sent a letter to the CEOs of these 10 largest airlines, urging them to improve their military travel benefits and publicize them more effectively.

The department “appreciates that carriers currently provide active duty service members and their families various military travel benefits,” Buttigieg wrote. “However, these benefits are not consistently detailed in carriers’ public-facing customer service plans, resulting in many service members being unaware of them.”

The travel benefits “often do not fully address the needs of service members who may need to cancel or change personal travel plans due to military directives,” Buttigieg added.

Following the letter, Spirit, Allegiant and Frontier stepped up their existing commitments to troops and families, according to the Department of Transportation.

Six others — Alaska, American, Delta, Hawaiian, JetBlue and United — declined to make “clear and enforceable” promises of extra benefits, the department said.

Airlines are required to stick to the benefits outlined in their customer service plans, including commitments to care for service members and their families. The department pledges to hold airlines accountable if they fail to do so.

To build the new “Support Our Troops” dashboard, DOT and Pentagon officials collaborated to evaluate airlines on four basic commitments the government believes are the top priorities for troops and families on the go:

• Whether they waive cancellation fees and ensure full refunds for service members and accompanying family members who cancel travel plans because of a military order or directive (documentation may be required). Three airlines make this commitment.
• Whether they waive change fees for service members and accompanying family members who reschedule flights because of a military order or directive (documentation may be required). Four airlines make this commitment.
• Whether they offer at least one free standard carry-on and at least two free standard checked bags for service members and their accompanying spouse and children, with appropriate identification such as a valid military ID. Four airlines make this commitment.
• Whether they provide the lowest fare for a flight for immediate family members to visit service members recently injured in the line of duty, with supporting documentation. Two airlines make this commitment.

Two airlines — Allegiant and Spirit — pledge to provide all four benefits.

Airlines might offer additional perks to troops and their families, but for those benefits to be reflected on the dashboard, the airlines are required to make those commitments in their customer service plan and provide them to all service members, the department said in a release.

The dashboard applies to current members of the military who are serving or may be called to serve, and who hold a current military ID. That includes members of the Army, Navy, Air Force, Marine Corps, Space Force, Coast Guard, National Guard and reserve components; cadets of the military academies and the Merchant Marine Academy; the U.S. Public Health Service’s Commissioned Corps and Ready Reserve Corps; and the National Oceanic and Atmospheric Administration’s officer corps.

More information is available on the airlines’ websites or by contacting customer service agents.

The military community can also compare prices and snag discounts on upcoming travel through the Defense Department’s American Forces Travel website, which offers deals on flights, hotels, rental cars, cruises and travel packages, and event tickets.

While “tens of thousands of [commissary] beneficiaries” practice a religion with unique dietary rules, the stores offer limited certified kosher and halal options and fail to promote them well, Reps. Ayanna Pressley, D-Mass., and Chrissy Houlahan, D-Pa., wrote to commissary director John Hall.

They warned that failing to sell a wider range of kosher foods, which adhere to strict Jewish dietary laws, and halal options, which are permissible under Islamic law, undermines the military’s diversity and discourages members of those religions from serving in the U.S. armed forces.

“It is critical the Department of Defense ensures that active duty personnel of all religions, including Islam and Judaism, are able to access foods that respect their faith traditions,” wrote Pressley and Houlahan, the highest-ranking Democrat on the House Armed Services Committee’s quality-of-life panel.

“No active duty personnel should have to sacrifice their faith to serve in our military.”

The commissary agency operates 235 grocery stores on bases around the world, offering groceries at a discount to the military community. But troops, constituents and others have told Pressley’s office of the difficulties they face due to the stores’ dearth of kosher and halal options — which can force observant Jews and Muslims to shell out more money to ship groceries from specialty stores or restrict their eating altogether.

Food is certified as kosher or halal if it does not contain ingredients banned under those dietary laws, like pork or shellfish, and if it is butchered or prepared at a compliant facility and approved by a religious authority or organization such as the Orthodox Union, among other rules. How much kosher or halal food a grocery store stocks depends on how much of a demand for it exists in the local community.

“We request DeCA urgently address issues regarding access to foods that meet religious dietary restrictions,” the lawmakers wrote. They also asked that the agency work with service members and their families “to advertise items as they are made available, incorporate items in meal solutions and special observances promotions, and ensure availability during religious holidays.”

The lawmakers’ press release announcing the letter cited endorsements from two organizations, including the National Military Family Association.

“Military families need access to healthy, familiar food no matter where they live in the world,” NMFA Chief Executive Officer Besa Pinchotti said in the release. “But just as important, they need access to food that adheres to their religious dietary requirements.”

Commissaries and the food industry “constantly strive to offer a wide range of products to serve the diverse military population across the globe in areas where commercial alternatives are limited,” said Steve Rossetti, president of the American Logistics Association, a trade organization of companies whose products are sold in commissaries and exchanges. The ALA also endorsed the lawmakers’ letter to the commissary agency.

“We need to ensure that all consumer tastes and preferences, including religious dietary options, are represented in the commissary offerings,” Rossetti said.

Rossetti also told Military Times that the commissary agency “reserves a significant amount of shelf space to accommodate local patrons’ tastes and preferences,” as well as products from small businesses.

Customers can ask their local commissary to order items that may not be in stock. Information was not immediately available about whether that includes requests for food that complies with religious law, or how often people ask for those products.

The military has taken steps to accommodate the religious dietary needs of service members in settings where there may be no other options, such as on ships and other deployments. For example, the Defense Logistics Agency provides kosher and halal Meals, Ready to Eat to accommodate those who follow strict religious diets.

The Army recently said it would review the rules around the Basic Allowance for Subsistence stipend after concerns surfaced that soldiers had funds deducted from their food allowance for daily meals even when local officials could not provide religious accommodations.

Military treatment facilities are designed to offer medical care to troops, retirees and their families. While MTFs can also take civilians who are unaffiliated with the armed forces, those patients must first navigate an approval process to be seen by military doctors.

The 2017 law aimed to change that by allowing the defense secretary to waive those rules for civilians and vets who are severely wounded or injured in a terror attack, offering them an easier path to further medical treatment after the initial emergency response. The law applies to MTFs worldwide.

“I urge the Department to fully utilize this authority and ensure that victims of terror are aware of their options to receive care at MTFs,” Sen. Elizabeth Warren, D-Mass., wrote Thursday in a letter to Lester Martinez-Lopez, the assistant secretary of defense for health affairs.

“MTFs can provide life-changing treatment for victims of acts of terror,” Warren wrote.

Warren, who chairs the Senate Armed Services Committee’s personnel panel, introduced the legislation in 2017 — titled the “Jessica Kensky and Patrick Downes Act” for a young married couple who each lost legs in the 2013 Boston Marathon bombing. The couple credited the specialized team at Walter Reed National Military Medical Center for helping them achieve a fuller recovery than they may otherwise have had.

“In return, Jessica and Patrick wanted to ensure other victims of terror have access to appropriate care at military medical facilities,” Warren wrote in her letter.

The care Kensky and Downes received at Boston trauma centers was important to their survival and initial recovery, they told Warren. But when they sought extra medical expertise at Walter Reed, the outsiders instead ran up against the military bureaucracy that needed to approve their specialized care.

In emergencies, anyone can receive care in an MTF to prevent undue suffering or loss of life or limb. Treating civilian emergency patients helps military medical personnel keep their clinical skills current, and a number of MTFs have built relationships with local communities to bolster an area’s civilian trauma care capabilities. And over the years, DOD has gained extra authorities to expand the scope of its medical care, like the flexibility to treat terror victims.

More than 50 terror attacks, including mass shootings, took place in the United States each year since the Kensky-Downes law was enacted in 2017 through 2020, the latest year tracked by the Global Terrorism Database at the University of Maryland. Many did not lead to injuries or fatalities.

Warren seeks answers from DOD by June 6, including the number of civilians treated at MTFs over the past 10 years for trauma-related and non-trauma incidents; which cases involved mass shootings and acts of terror; where those civilians were treated; and what types of injuries people incurred and the incidents that caused them.

Warren has also requested:

• A description of the process for requesting and providing care;
• A description of DOD policies in place to use its authority granted by law;
• The number of terror victims who requested the care, whether any were denied care, and how long it took for care to be approved;
• Whether DOD and MTFs have notified local communities, hospitals and civilians of the authorities and options for care in military medical facilities;
• and information about waiving costs of care for civilians in these cases.

Meanwhile, DOD is in the midst of an effort to bring more military beneficiaries back to the MTFs from civilian doctors, where the military has pushed patients to seek care over the last few years. That decline in patients, in turn, spurred the military services to seek private-sector training opportunities for medical staff to keep their clinical skills current. The Pentagon is now working to boost MTF staffing to address a current provider shortage and support the demand that may follow as patients return to MTFs.

Under the new policy, a person can collect a daily stipend based on their monthly housing allowance rate without dependents, the Department of the Air Force said May 15. For instance, a major who lives near Maxwell Air Force Base, Alabama, while attending Air Command and Staff College can earn about $1,600 a month.

The new allowance is paid on top of the housing stipend an airman or guardian already receives at their primary residence.

Troops qualify for the pay bump if they are stationed at the training location for less than a year, have orders to return to their previous base, and do not live in free government housing like dormitories.

The change offers more flexibility for troops whose permanent changes of station can financially crunch families who stay behind while a service member is away at school. Those monthslong relocations are critical steps on an airman or guardian’s effort to climb the career ladder, but can squeeze a family’s budget when trying to pay for two homes at once.

“We understand that these short moves, while necessary, can be disruptive to the lives and finances of airmen and guardians with families — particularly in situations where they are slated to return to their original duty station,” Alex Wagner, the service’s civilian personnel boss, said in a release. “This new allowance gives our service members and their families additional resources to weather these times away without the added stress of financial uncertainties.”

Congress directed the military to adopt the new policy as part of the 2023 National Defense Authorization Act, which became law in December 2022. Pay is retroactive to Dec. 23, 2022.

The Pentagon added the rule to its Joint Travel Regulation last fall. The Air Force and Space Force’s rule took effect May 7; the Navy and Marine Corps enacted their own versions in March. The Army has not yet issued a parallel update.

“The November 2023 Joint Travel Regulation update entitled eligible Army service members to these allowances even without Army policy implementation,” Army spokesperson Heather Hagan said Wednesday. “We are in the process of updating our policies.”

The Military Spouse Career Accelerator Pilot will for the first time provide early-career opportunities “for those younger spouses who might need to put their foot in the door and start the process of having employment and a career,” Patricia Barron, deputy undersecretary of defense for military community and family policy, told reporters Monday. That’s in addition to the program’s current “career-ready” fellowships for spouses with more education and experience to prepare them for the positions.

In an earlier announcement, defense officials said the newly added entry-level fellowships could target specific career fields such as taxes or insurance.

The fellowship program, now in its second year of a three-year test period, has been a “rousing success,” Barron said.

Spouses of U.S. Army, Navy, Marine Corps, Air Force and Space Force troops across the active duty, reserve and National Guard can apply for a 12-week position at 250 public- and private-sector employers. The U.S. Chamber of Commerce Foundation’s Hiring Our Heroes program pairs applicants with fellowships as they become available, at employers like Equinix, a company that operates data centers, and Frog Street, an early childhood education curriculum company.

The number of fellowships available depends on what employers decide to offer; the Defense Department pays fellows’ salaries through the Chamber. Applications are accepted throughout the year.

The program’s goal is to land fellows in permanent positions with their employers at the end of the 12-week run.

More than 400 spouses were placed in fellowships in 2023, the program’s first year. About 83% of the “career-ready” fellows have received offers for permanent jobs, Barron said, “which is unheard of.” Salaries for those jobs averaged about $60,000, defense officials said.

Lawmakers on the House Armed Services Committee’s military quality-of-life panel have recommended that the program be made permanent.

“It’s been a great program. To be able to sustain it throughout the years would be phenomenal,” Barron said. “We’re getting an awful lot of really good feedback from the military spouses that are involved.”

The unemployment rate for military spouses has stubbornly hovered around 21% for the past decade, according to various surveys.

The problem is exacerbated by the frequent moves military service requires, as well as state licensing rules for many professions and other bureaucratic hurdles.

A number of advocates have asked for the Labor Department to officially track their unemployment rate, as it does for veterans.

“We do have a great relationship with the Department of Labor and have connected with them on various things. The tracking of unemployment for military spouses is something that we’ve both talked about,” Barron said. “I think it’s a little bit harder to track military spouse unemployment, because it’s not a protected group, so sometimes it’s hard to find the information you need.”

“However, we’ve got new tools available to us now, through AI, through some of the analytics that a company like Google might provide,” she said. “I’m not saying that’s what we’re doing, but what I’m saying is that we have new tools we can look at to help us get after that number.”

Online resources in May

For years, military officials have worked to tackle the policy issues that keep the spouse unemployment rate from budging. They’ve also tried to open new opportunities to help military husbands and wives navigate the modern job market.

This month, job seekers can learn from a lineup of speakers and breakout sessions on a range of spouse employment topics as part of a free, virtual career symposium and hiring fairs May 14-30. Participants can register to view the recorded events like “Finding and Mastering Remote Employment” and “Know Your Worth: How to Negotiate Your Perfect Fit,” and to participate in upcoming sessions, at Military OneSource.

A series of webinars, one-on-one resume reviews and mock interviews from Tuesday to Thursday will prepare spouses for next week’s hiring fair.

That fair, scheduled for May 29-30 from 10 a.m. to 2 p.m. Eastern time, will connect spouses to hiring managers and representatives from more than 700 employers who have committed to recruiting, hiring, retaining and promoting military spouses through DOD’s Military Spouse Employment Partnership.

Under plans unveiled Monday, House Armed Services Committee members next week will consider language in their annual defense authorization bill draft that includes highly revised military pay tables designed to bring all junior enlisted pay to at least $30,000 a year.

Currently, some young enlisted service members can make as little as $24,000 in basic pay, although that total does not include other compensation such as housing allowances and free health care.

But both Republicans and Democrats on the panel have expressed concerns that enlisted troops’ low base pay make it difficult for military recruiters to woo young adults away from civilian careers, where a $15-per-hour wage translates into just over $30,000 a year in salary.

Higher enlisted pay, full housing stipends included in new House plan

Last month, committee leaders announced a broad plan to boost all pay for all troops ranked E-4 and below by 15%, a move that would add several hundred dollars in monthly pay for those individuals.

However, specifics of the plan released this week show an even more generous base pay hike. Committee staffers confirmed the 15% boost does not include a 4.5% increase planned for all troops, bringing the actual salary increase planned by the committee to 19.5% next year.

For an E-2 with two years of military service, that increase will mean about $5,000 in extra pay next year. For an E-4 with four years of military service, it’s almost $7,500 more in salary.

To ensure E-4s aren’t getting paid more than E-5s, the pay table overhaul also includes increases for mid-career enlisted troops. Combined with the 4.5% across-the-board raise, some E-5s could see up to a 12.5% pay increase next year.

An E-5 with six years service can expect a pay boost of about $4,300 next year under the house plan. An E-5 with eight years will get a $3,500 raise.

All other ranks would see the 4.5% pay increase.

But whether that plan can become law remains unclear.

House Armed Services Committee leaders have vowed to push for the military salary increases, and will vote on the measure next week. House appropriators backed similar plans in their budget bills last year and have signaled ongoing support for the idea.

But Defense Department officials have lobbied lawmakers to wait on the ideas until next year, when their ongoing review of military compensation issues is complete.

And senators — particularly those on the Senate Armed Services Committee, which is currently drafting its own version of the authorization bill — have deflected questions on the issue, saying they need to see what the total costs will be and how that fits into other military priorities.

House committee officials said the price tag for the pay raise and other compensation reforms — including increasing housing stipends and broadening eligibility for the military’s Basic Needs Allowance — will cost about $4.2 billion this year. Total military spending outlined in the authorization bill is nearly $882 billion.

Even if the pay raise is signed into law later this year, appropriators will still need to pass budget language to supply funding for the higher salaries.

Senators are calling for a return of manufacturing medicines in the United States due to national security concerns over risks to the Defense Department’s pharmaceutical supply chain, and possible risks to service members and their families.

But that includes the possibility of some military manufacturing, according to Sen. Elizabeth Warren, D-Mass., chair of the Senate Armed Services subcommittee on personnel, during a hearing on April 30.

“It’s a critical national defense issue. It’s also critical to the health of our people,” Warren said. One issue is that commercial manufacturers don’t have the right incentives in place to produce many drugs in the U.S.

Additionally, she said, “we don’t even have the right information in place to require meaningful domestic manufacturing and meaningful insight into the supply chain to know we are safe in the drugs we are getting,” and their ingredients.

Warren said she plans to introduce legislation that would direct the Defense Department to manufacture drugs, devices, vaccines and other products when DOD determines there are risks of shortage or quality concerns.

“Most of the time DOD will continue to purchase drugs from the commercial drug market. But there are some instances where it makes sense for DOD to produce the medication itself, for example, when DOD is the only customer,” Warren said. DOD spends more than $5 billion a year on pharmaceuticals, she said, which is about 2% of the entire U.S. commercial pharmaceutical market.

A number of drugs that are used in the military are not commonly needed in the commercial market, defense officials testified. Some of these are drugs that are needed to fight infectious diseases and are not commercially available because there’s no market for them.

If the manufacturing challenges are too great for smaller — but needed — quantities of drugs, Warren said, the government may have to move to military manufacturing. “Otherwise, we’re just not going to get them. Or we’ll pay prices that are so outrageous that it would have been cheaper to have built [the manufacturing facilities] internally,” she said.

One example of that is the adenovirus vaccine. While adenovirus typically causes mild cold or flu-like symptoms, she said, “it is a major cause of serious respiratory illness among service members, particularly those who are in basic training.” That’s why the Walter Reed Army Institute of Research developed the adenovirus vaccine and licensed it to private industry.

But in the 1998-1999 time frame, DOD exhausted its last supply of the vaccine after the sole manufacturer decided to stop making it. At that time, DOD estimated that the lack of vaccine would lead to about 10,000 preventable infections from adenovirus, over 4,200 medical visits by recruits, and over 850 hospitalizations within a year, said Bryce H.P. Mendez, a specialist in defense health care policy for the Congressional Research Service, testifying before the panel. “To an extent, DOD did observe that,” he said.

But that’s not unique, Mendez told lawmakers, adding that the Defense Department has had challenges over many decades in getting certain medicines. Current challenges include the production of medicines to address anthrax, botulism, cholera, hemorrhagic fevers, and others, he said.

Lawmakers should consider legislation that establishes clear options for creating a government-owned facility to manufacture priority health products to meet the military’s needs, said Melissa Barber, an expert in pharmaceutical manufacturing who is a postdoctoral fellow at the Yale School of Medicine, Yale Law School and Yale Collaboration for Regulatory Rigor, Integrity and Transparency. “Such a facility would ensure reliable access to quality drugs for service members, as well as generate significant cost savings.” For example, she told lawmakers, the current contract for producing the adenovirus vaccine costs the government about $38 million a year. “That’s a lot of money to pay for a single vaccine,” she said.

Barber cited an Army report that estimated the startup costs for the government to manufacture the adenovirus vaccine would be about $100 million, with annual costs of about $10 million. DOD would break even in about three years by building and operating its own facility for producing that vaccine, she said.

Government-owned and operated facilities for manufacturing medicines is not a new concept, Barber said. The first example she’s aware of, she said, is during the Civil war, when the U.S. Army set up facilities to manufacture some needed medicines.

The Walter Reed Army Institute of Research does vaccine research and manufactures test batches, but its manufacturing is limited, and the military relies on commercial manufacturers for quantity.

Despite drug shortages, military has mostly been able to find alternative supplies

The larger problem of drug shortages

According to the Food and Drug Administration, almost half of the drugs on DOD’s operational medicines list are in shortage, and most of these are generics, Warren said. This list includes drugs necessary for warfighting, she said. Some of those in short supply include the blood thinner heparin, the common anesthesia drug midazolam and morphine for pain management.

And many drugs, and their key ingredients, come from foreign manufacturers, including China. The Defense Department has less visibility over its operations, and thus, the safety of the drugs.

Following a congressionally-mandated requirement, DoD analyzed 12,917 specific drugs, or about 10% of the total U.S. marketplace as part of efforts to evaluate the military pharmaceutical supply chain. The medicines are identified in the FDA Essential Medicine List. Only a quarter of the drugs analyzed have domestic manufacturers.

According to DOD’s November report, 27% of the drugs analyzed are at a very high risk because they are either dependent on Chinese manufacturers using Chinese ingredients, or were derived from unknown sources.

“I don’t know anybody in their right mind who trusts anything made in China,” said Sen. Rick Scott, R-Fla., the ranking member of the panel.

“During COVID, we learned the hard way that relying on non-allied countries for our medical supply chain poses a real danger. For that reason, it is imperative that we work to ensure DOD supply chains are independent from non-allied nations for necessary pharmaceutical treatments,” Scott said. “In future contingencies, these supply chains could easily cease to exist.”

Defense officials are assessing the chain, and developing policies and procedures to enable the allocation of resources in the case of supply chain disruptions, said Dr. Lester Martinez-Lopez, assistant secretary of defense for health affairs.

When a DOD provider can’t get a critical drug because of the shortage, that provider has to look at alternatives, Martinez-Lopez said. He used the example of amoxicillin, an antibiotic made overseas, used for basic infections. “Let’s say I don’t have it. Now I have to [use] another antibiotic, at the same time I’m trying to combat resistance to antibiotics, using an antibiotic that’s not indicated for that condition. So there I lose twice. One, because I’m not giving the right antibiotic to my patient, but on top of that, I’m losing ground on my fight against antibiotic resistance.”

In other cases, such as when an epinephrine injection is not available to treat a severe allergic reaction, he said, “that can be life and death. We don’t have hours to decide what the alternate is. So that might translate into a life, right on the spot. So this creates a conundrum for all health care professionals. I don’t think it’s just us. It’s across the nation, we’re facing this.”

Questioned by Scott about buying from China, Matthew R. Beebe, director of acquisition for the Defense Logistics Agency agreed that the military shouldn’t buy from them, but said the reality is that current regulations sometimes require it. “We don’t buy from China unless it’s the only source available,” Beebe said. If the end product is available domestically or from a country that’s an ally, that’s where they buy it, he added.

“But we don’t always have visibility over the sourcing,” the ingredients used to make the medicines which are called active pharmaceutical ingredients, and the ingredients used to make those APIs, Beebe said.

About 5% of the active pharmaceutical ingredients are coming from China, said Martinez-Lopez, but officials aren’t able to determine the source of about 20% of the remainder.

The percentage of those unknown sources is “equally troubling, that I don’t even know how to characterize the risk,” Beebe said. He and the other officials said they support bringing more manufacturing back to the U.S.

Scott questioned the witnesses about why the military couldn’t just immediately stop buying any pharmaceuticals that are sourced or produced in any way in China. Because of the volume of pharmaceuticals that would fall into that category, it would mean some medicines wouldn’t be available, officials said.

Of the 60 vital medicines in the U.S. about 20% are solely sourced in China, said retired Army Col. Victor A. Suarez, founder of Blu Zone Bioscience & Supply Chain Solutions.

For many of these medicines, it’s not economically viable for companies to manufacture them here in the U.S., Suarez said. Over the last several decades, much of drug manufacturing has moved overseas. China has used its competitive advantages — such as cheap labor — to drive down prices, and that has forced some U.S. companies out of business.

And 40% of generic drugs sold in the U.S. have just one manufacturer, Warren said.

Scott asked the DOD witnesses to help craft a letter to a number of associations in the health care community, to invite them to a conference call for ideas on helping build a domestic market for pharmaceuticals. The letter would come from DOD and other government officials as well as from members of Congress, Scott said.

“Half of our customers are choosing not to shop, even though we saved [customers] 25.5% last year, and we’re at 25% this year” compared to civilian grocery stores, Defense Commissary Agency Director John Hall said at a recent meeting of the American Logistics Association.

“In certain categories, the savings are almost unbelievable. With meat, we’re at 40% and have very, very high quality,” he said.

Hall is working on several initiatives to better serve customers, from newly allowing troops to use their meal cards to purchase food, to expanding the number of items on sale.

“Part of it is the price savings we give, but part of it is what we offer,” Hall said. “We want to look, feel, and have products available that look like commercial grocery chains.”

Those initiatives include:

• Possibly offering more prepared foods — ready to cook, ready to eat, and ready to heat — in stores that have space.
• Expanding seafood offerings.
• Expanding the military’s grocery-delivery service to include all stateside commissaries this year, up from eight stores that currently offer the option.
• Working with the Army and Air Force to allow service members to use their meal card benefits at the commissary. “When I visit commissaries, I see service members in line buying at the deli,” Hall said. “They’re using their own money, and choosing not to use that benefit that can get a free meal essentially, at the dining facility,” he said. Being able to use that meal card benefit “will be a huge, huge change,” he said.
• Offering bulk delivery of grocery items to military units. Hall is also reviving the Guard and Reserve’s “on-site sales,” where commissaries took orders from eligible shoppers who lived far from a store and delivered their items to a selected location for pickup. The commissary agency expects the first on-site sales will take place in June or July.
• Expanding the number of Army installations with conveniently located outposts or kiosks supplied by the commissary. Soldiers can pick up sandwiches, sushi, salads, breakfast sandwiches, fresh-cut fruit and drinks. Hall also plans to begin offering prepared foods in the kiosks.

Anyone with a DOD Common Access Card can purchase what’s available at the outposts or kiosks using their meal card or other forms of payment. Dining facility workers order food for kiosks and outposts from the commissary through a master catalog vetted by an Army dietitian.

There are currently 15 such outposts at 13 installations. Officials aim to launch 13 more this year at nine locations: Ansbach, Germany; Fort Campbell, Kentucky (three locations); Fort Liberty South (two locations) and Fort Liberty North, North Carolina; Fort Stewart, Georgia; Fort Drum, New York; Fort Cavazos, Texas (two locations); Fort Riley, Kansas; and Fort Myer, Virginia.

The commissary agency is also studying its supply chain, with the goal of reducing costs for suppliers and, ultimately, for military families. They’re working to increase commissaries’ overall in-stock rate, or the percentage of goods that are available at a given time, to 98%. Right now, the figure stands at 95%.

“95% is good, but [the difference between 95% and 98%] is … $200 million of product that’s not available to our customers on a yearly basis,” Hall said.

The commissary agency received $1.4 billion to fund operations in 2023, and returned more than $1.5 billion in savings to customers, Hall said. Because the agency gets taxpayer dollars to cover daily operating costs, such as cashiers at the 235 stores worldwide, the commissaries don’t have to pass on those expenses as part of the price customers pay for groceries.

Hall aims to increase sales to $8 billion within five years — up from $4.6 billion in fiscal year 2023 — following a steady decline in commissary sales over about a decade.

“It’s not that we want to get to $8 billion in sales,” he said. “It’s that we want to get $1.1 billion more to our customers in savings.”

Sales this fiscal year are up by about 5% over the same time period last year, and are on track to total about $5 billion this year, Hall said.

That bump is due to inflation as well as foot traffic in stores. Between October and March, there were 33.5 million transactions, or about 1.56 million more transactions than in the same period the previous year — an increase of about 5%.

Commissaries got a big boost from Defense Secretary Lloyd Austin in September 2022 as his “Taking Care of Our People” initiative pumped more money into the stores in order to cut the prices at the register.

By removing the 2017 Defense Department requirement that commissaries had to make a profit to offset operational costs, Austin enabled commissary officials to drop prices by 3% to 5% across more than 30,000 products in their stores. They targeted reductions in items that most or all shoppers want, like milk, eggs and bread.

Overall savings comparisons vary by region. Each is based on market basket research in a geographic area to determine how much, on average, a commissary shopper could expect to save on grocery purchases compared with local commercial grocers in that area outside the gate.

Those eligible for the commissary shopping benefit include active duty, Guard and Reserve members, military retirees, Medal of Honor recipients, and their authorized family members. Veterans with any Department of Veterans Affairs documented service-connected disability rating are also eligible for commissary shopping, as well as Purple Heart recipients, former prisoners of war, and individuals approved and designated by the VA as the primary family caregivers of eligible veterans.

These popular, traditional sidewalk sales will be held at various times throughout the month, depending on the commissary. As the name suggests, they’re generally located on sidewalks immediately outside of a store.

All stateside stores, and those in Hawaii and Alaska, will participate in the sales, generally over two or three days. Discounts vary, but promise to cut customers’ costs over and above their usual commissary savings.

This year, regular commissary prices are already 25% lower on average than those at commercial stores outside the gate, officials said.

Products being offered on sale include: baby products; non-food items such as paper towels, toilet paper, wipes and cleaning products; health and beauty products; pet food; snacks, such as nuts, chips and candy; cold cereals; beverages, including flavored water, juices and energy drinks; international foods; and baking and canned goods.

A number of items are sold in bulk, so check your pantry to make sure you’ve got some storage space, and be mindful of how much your vehicle will hold as you transport your stash home. Shoppers in Hawaii, where commissaries won’t offer plastic or paper bags starting Wednesday, should remember to take plenty of reusable bags with them.

Check the Defense Commissary Agency sidewalk sales web page for specific dates. The first sales are slated to start Wednesday at 11 stores:

• Charleston Naval Weapons Station, South Carolina
• New River Marine Corps Air Station, North Carolina
• Aberdeen Proving Ground, Maryland
• Newport Naval Station, Rhode Island
• Key West Naval Air Station, Florida
• Fort Cavazos I (Clear Creek store) and Kingsville NAS, Texas
• Arnold Air Force Base, Tennessee
• Beale AFB and El Centro Naval Air Facility, California
• Fort Huachuca, Arizona

Check your local store’s website or ask the store manager for any schedule changes, such as postponements because of weather delays. And as usual, if you’re scheduled to move this summer, keep that in mind as you make your purchases — especially when it comes to things like cleaning supplies, which the movers may not be able to pack in your shipment.

These sales are traditionally held twice a year, in the spring and fall. While they are specific to U.S. stores, customers overseas should check with their commissaries to see if there might be some special deals.

Those eligible for the commissary shopping benefit include active duty, Guard and Reserve members, military retirees, Medal of Honor recipients, and their authorized family members. Veterans with any Department of Veterans Affairs-documented, service-connected disability rating are now eligible for commissary shopping, as well as Purple Heart recipients, former prisoners of war, and individuals who have been approved and designated as the primary caregivers of eligible veterans by the VA.