TAMPA — After Army Staff Sgt. Alex Dillman was paralyzed from the abdomen down in a bomb blast in Afghanistan, the Department of Veterans Affairs paid to retrofit his Chevy Silverado truck so he could drive it and bought him a handcycle so he could exercise.
But the agency that cares for former troops won't pay for what the onetime squad leader and his wife, Holly, ache for most: a chance to have children.
VA will not pick up the bill for in vitro fertilization, which fertility experts say offers those with spinal cord and genital injuries the best hope for a biological child.
Under a 23-year-old law, VA is prohibited from covering IVF. Congress adopted the ban as the result of conservative opposition to assisted reproduction and concern that some fertilized embryos might be discarded.
Now, however, veterans and lawmakers from both parties are pushing to overturn the ban. They argue that it is outdated and that IVF is widely accepted and performed worldwide.
The law also predates the wars in Iraq and Afghanistan, where widespread use of improvised explosive devices (IEDs) in attacks on U.S. forces has caused far more reproductive injuries than in past conflicts.
The Dillmans are among thousands of young post-combat couples who are struggling to start a family after blast injuries left them unable to conceive naturally.
But IVF costs tens of thousands of dollars and often takes multiple tries to produce a viable pregnancy. Combat wounded veterans say the financial burden and emotional toll are often overwhelming, especially on top of learning to live as an amputee or in a wheelchair. Some say they have to take on debt or skip getting an education afforded them under the GI Bill so they can rush back into the job market, or rethink plans to start a family altogether.
"At the end of the day, I'm so lucky to be alive. Part of that is this dream to be a parent. But this is a big pill to swallow for all veterans facing combat injuries, which have hurt their chances to have children," said Alex Dillman, 30, whose dirty-blond hair is still cut high and tight and whose tan arms are buff from years of exercise.
Their upcoming round of IVF will cost nearly $25,000, which will wipe out years of savings. Alex said that if the treatment doesn't work, he would be willing to curtail his education in information technology and delay his hopes for a job in "the virtual battlefield," for the Pentagon or another national security agency.
Last year, congressional efforts to overturn the law barring IVF and provide funding for veterans ran into resistance because of concerns over how to pay for it. But a new push is under way.
The Defense Department changed its policy in 2012 and said it would cover IVF for active military members in recognition of the increasing number of pelvic fractures and injuries to reproductive organs suffered during combat in Iraq and Afghanistan. More than 1,830 troops have suffered such wounds since 2003, according to the Pentagon. That is in addition to the thousands of veterans who have spinal cord injuries which can also impact fertility.
But under the law, wounded military members can be covered only during a window of time between their injury and their discharge from the military — a period of hospital stays, surgeries and adjusting to their new post-war bodies. Many wounded veterans describe it as the most stressful and disorienting time of their lives.
"The timing was just all wrong. It's the time when you are trying to learn to shower and get your mind around the fact that you will never walk again. I wasn't in the position to think about starting a family at that moment," Alex said.
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Alex had been on patrol on a snowy night four years ago in Ghazni, nearly 100 miles southwest of the Afghan capital of Kabul, when his vehicle hit an IED. He said he doesn't remember much, except waking up in a series of hospital beds.
He endured more than 25 surgeries — including painful procedures on his spinal cord as well as skin grafting for burns. He had a punctured lung and several broken vertebrae. He was on a feeding tube for so long that his weight dropped from 180 to 150 pounds. He spent a year in the hospital and another in and out.
Last summer, with Alex finally free of the hospital and with six months left before he was to be discharged from the Army, he and Holly started the IVF process.
Alex hoped for a "mini Holly, who would be earthy and like to play with worms and listen to Nirvana and Bjork." Holly dreamed of a "mini Alex, who would be adventurous and curious about how everything works and likes to go fishing and hunting." They agreed that if they had a son, his middle name would be Kristopher, for one of Alex's closest friends, Sgt. Kristopher Gould, who was killed in the same bomb blast that paralyzed Alex.
Two rounds of IVF failed.
"It was really stressful because we knew the stakes if it didn't work," said Holly, a petite 29-year-old with deep-set dark eyes and long black hair tossed into a ponytail.
So now they are trying again, this time paying for it themselves.
"The VA ban is literally adding insult to injury," Holly said. "It's like the approach to this is, 'We aren't going to do anything to help you. You get to go this one alone.' "
Alex and Holly had moved back in with her mother to save money to pay for IVF, expecting it could be a long time before they could afford to buy or rent their own place. But at the end of 2013, a nonprofit group, Homes for Our Troops, built them a wheelchair-accessible one-level house with wide hallways, kitchen shelves that pull down, an extra-large shower and no mortgage.
Buoyed by this fortunate turn, they poured their savings into one round of IVF.
On a recent morning, the Dillmans drove to their new IVF clinic for a saline ultrasound of Holly's uterus, a procedure that checks for any problems before attempting a pregnancy.
The ultrasound is often covered by private insurance, and Alex and Holly were surprised to learn that theirs would not cover the $800 bill. They sat in the fertility clinic stunned, discussing what to do because they hadn't budgeted for it. They decided to go ahead with the test and pay out of pocket.
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In the generation since VA funding for IVF was banned, fertility technology has dramatically improved. Doctors can now perform "testicular sperm extraction," removing a small portion of tissue from the testicle under local anesthesia and extracting sperm. The sperm is used to fertilize an extracted egg outside the body, and the embryo is then implanted in the womb.
Sen. Patty Murray, D-Wash., has called the ban on funding for this process "a shocking gap, outdated and just wrong" and introduced a bill to let VA pay for IVF. The measure also would cover the costs of surrogate pregnancies and adoption.
"It's a bill that recognizes the men and women who are harmed in the service of this country have bright, full lives ahead of them," she said. "To me, it's such a no-brainer. The technology is there now. Why can't we help them?"
Rep. Jeff Miller, R-Chumuckla, chairman of the House Veterans' Affairs Committee, had objected to Murray's plan to pay for her bill with $568 million designated for combat operations. But he said he was receptive to lifting the ban and introduced his own slimmed-down version. His measure is more limited — it wouldn't cover adoption or surrogacy, for instance.
VA officials say the agency supports any legislation that would allow it help pay for combat-wounded veterans to have children.
Retired Army Staff Sgt. Matt Keil and his wife, Tracy, spent $32,000 on IVF.
Keil was shot in the neck by a sniper in Ramadi, Iraq, six weeks after their wedding. He's now a quadriplegic, with only 10 percent of movement in his left arm.
"Our husbands already have so many limitations — why does not having children have to be another one?" Tracy Keil asked.
They were able to have twins — Faith and Matthew Jr. — who are now rambunctious 4½ year olds. They love to crawl on their dad's wheelchair and play in their home in Colorado Springs.
"To them, it's not just a veteran in a wheelchair — a quad. He's just Dad. And it's remarkable to see the healing that having these kids has given him and us as a couple. We are a family now," Tracy says.
That's what the Dillmans yearn for. In a sunny corner of their home is a cozy nursery — with fresh sheets tucked neatly into a new crib, a solar system mobile hanging above, and a closet full of frog and star onesies. Every day, Alex wheels past the open doorway of the room. Sometimes, he looks in, and sometimes, he said, he can't bear to.
At times, Holly said, people come up to her and say, "Just relax, it's going to happen."
"But people don't understand, we can't have sex because of his combat wounds," she said, her voice growing tight with emotion. "Do they think it's going to be immaculate conception? We need help to do this."