This article by Leo Shane III originally appeared on Military Times, the nation's largest independent newsroom dedicated to covering the military and veteran community.

 

Marine Corps veteran Jeremy Williams was humiliated last summer when his front six teeth fell out of his mouth in the middle of a business meeting.

 

Almost a year later, he’s infuriated that he still can’t get his Veterans Affairs health insurance to correct the problem.

 

“It sucks,” the 42-year-old said. “I don’t smile as much anymore, because I’ve got no teeth to show. I don’t know what it’s like to bite into a steak or a burger without having to cut it into little pieces. Right now, I have to cut my food up like I did for my kids when they were three and four.”

 

Williams’ dental problems stem from an injury he suffered in 2006 during a roadside bomb attack in Ramadi, Iraq. The blast threw him face-first into his weapon mount, cracking the upper bones in his mouth.

 

But despite what would seem to be an obvious service-connected injury, Williams has spent most of the last 22 years adrift in the VA health care system, forking over tens of thousands of his own money to cover an array of dental problems stemming from the injury. And for the last 10 months, he’s been trying to figure out how to get the VA to pay for surgery to put his front teeth back into his mouth.

 

“It’s so frustrating because if I was missing a limb from war, I know I’d be able to get a prosthetic right away,” he said. “VA is good at that. But dental stuff doesn’t work that way.”

 

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Advocates say those shortcomings in VA dental coverage are a common complaint among veterans, both those with minor and serious injuries.

 

“This is not really an issue of ... denied claims, because for the most part, dental care is just not really available to veterans,” said Patrick Murray, director of the Veterans of Foreign Wars’ National Legislative Service. “But if they could get it and use it, it would save money in veterans’ care down the line.”

 

VA leaders say they are working to improve the system and have added hundreds more dental workers in the last year. But officials also anticipate hundreds of thousands more individuals will be added to dental care programs over the next few years, thanks to recent changes in VA health care eligibility rules.

 

Whether the staff additions will be enough to keep up with demand — and address ongoing shortfalls in the system — remains unclear.

 

Who Gets VA Dental Care?

The primary complaints regarding VA dental care usually focus on eligibility or accessibility.

 

Generally, to be eligible for department dental coverage, veterans must have a service-connected disability specifically related to their teeth or mouth, or be rated 100% disabled because of other service injuries. Individuals can be eligible in other circumstances, but most of those situations provide only temporary or partial dental help.

 

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Currently, VA provides medical care for more than 9 million veterans. Of that group, only about 1.8 million were eligible for dental care last year as part of their veterans health care benefits. And just around 40% of those eligible individuals — about 685,000 veterans — actually used the care last year. VA does offer an option to purchase dental care to some veterans through a department-run insurance program, but fewer than 100,000 veterans are currently enrolled in that plan.

 

In a report released earlier this year, researchers from the American Institute of Dental Public Health and CareQuest Institute found higher rates of dental problems among veterans than their civilian peers, including issues with tooth decay (56% among veterans versus 37% in the general population) and gum disease (42% versus 27%).

 

They estimated that nearly 600,000 veterans, many of them currently not covered under VA rules, missed time at work or saw their productivity significantly hurt due to oral health problems in recent years.

 

Emergency department visits to treat those issues total roughly $1.7 billion annually. VA spending on dental care for eligible veterans amounted to about $2.5 billion last year.

 

“Veterans pay 65% more in out-of-pocket dental costs on average compared to non-veterans,” the report stated. “The fragmented health care system that veterans and many Americans experience perpetuates inequitable and costly outcomes.”

 

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Annaliese Cothron, executive director of the institute, said the issue isn’t unique to veterans.

 

“Most Americans are experiencing inequitable and inadequate oral health care that’s often costly,” she said. “And the divorce of the mouth from the rest of the body has affected everyone.”

 

Cothron added that veterans are particularly vulnerable to dental problems because of other service-related issues like battlefield injuries, mental health difficulties or military toxic exposure complications. Poor dental health can lead to larger problems in those other medical areas, and vice versa.

 

Finding a Dentist

These difficulties are all too familiar to Williams, who said his overall health has been significantly hurt by his dental problems.

 

After being medically retired from the service following his injuries in Iraq, the VA provided care for Williams’ traumatic brain injury, muscular damage and other assorted health issues.

 

But, save for an initial cursory dental appointment, his oral issues went unaddressed for almost 10 years, when he bit into a piece of chicken and left several teeth behind.

 

“I had to go see a private dentist in my hometown, because the wait times for a VA dentist were astronomical,” he said. “So, I had to pay for it all myself.”

 

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Williams thought the $12,000 fix was a permanent one. But early last summer, he was at a meeting at the Ukrainian embassy in Washington, D.C., when his rebuilt upper teeth fell into his palm mid-sentence.

 

“I do have full dental insurance through VA, and they had increased my rating to 100% disabled,” he said. “But I find out the network of providers they have aren’t available for emergencies. So, I start driving home, my teeth in hand, calling every dentist I can find in Virginia.”

 

Murray said many individual VA medical centers don’t have the staff or community partners to handle oral exams for veterans. When there are practices available, wait times can be extensive.

 

“For services like maternity care, most of those cases end up being sent out,” he said. “But it just doesn’t work the same way for dental care, for unknown reasons.”

 

After hours of calls, Williams managed to locate a dentist who could deal with his immediate health problems and stabilize his mouth. But getting his mouth put back together would require more lengthy surgeries, including drilling new anchors into his skull to permanently hold the teeth in place.

 

“We developed a plan, but VA won’t pay for it, because this dentist isn’t in their network,” Williams said. “And I used to work as a legislative advocate, so I tried to convince the oral surgeon to join the network so I could have VA cover the costs. But he won’t do that, because he knows payments from VA can take anywhere from 12 to 18 months.”

 

So now Williams, who has spent more than a year with a significant gap in his upper row of teeth, must choose between paying for the procedure himself once more or starting the reconstruction process over again with a new dentist, a decision that might also include a months-long wait for an initial evaluation appointment.

 

“The pain is manageable right now,” he said. “I’m never not in pain. But I can still work and do things. I just don’t know what the next step is.”

 

Filling in the Gaps

Advocates believe those subsequent steps need to come from Congress.

 

At least part of the solution is cleaning up VA’s community care programs, a common complaint among lawmakers who say the process is too cumbersome for both patients and providers. They want to see quicker scheduling options and much faster reimbursements.

 

[RELATED: MOAA's Legislative Action Center]

 

Officials from the American Institute of Dental Public Health are also backing a collection of legislative proposals pending in Congress to specifically improve dental coverage and programs.

 

One bill from Rep. Julia Brownley, D-Calif., would authorize the VA to provide dental care to all veterans enrolled in the VA health care system, essentially expanding dental options to millions more veterans.

 

“We simply cannot address veterans’ whole health without addressing the critical and dire need for dental care, which is just as integral as all other care,” she said in a statement introducing the bill in spring 2023. “It is our duty to ensure that our nation’s veterans receive first-class medical care and this bill moves us closer to that goal.”

 

Murray said that approach would be revolutionary for the veteran community.

 

“With unlimited resources, you can imagine a VA medical center where floor one is where the pharmacy is, floor two is where the dental care is, everyone can get everything taken care of in one place,” he said.

 

But it would also be expensive, potentially adding tens of billions in new spending. That would be a difficult sell in a Congress that’s already engaged in annual fights over how large the federal budget has become.

 

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A more modest plan is a proposed pilot program from Sen. Bernie Sanders, I-Vt., which would “provide comprehensive dental care to veterans diagnosed with diabetes and ischemic heart disease.”

 

It would add up to 3 million veterans diagnosed with those illnesses to the list of individuals eligible for VA dental care, and cover those costs for four years.

 

But Cothron said those backing the plan believe it will save taxpayers in the long run, in the form of reduced care costs for a host of medical issues related to poor oral hygiene.

 

“It’s an investment in health that will help everyone long-term,” she said.

 

Lawmakers held a hearing on the idea late last year, but the measure hasn’t advanced since. Given the tight legislative schedule in this election year, it’s unclear whether the proposal can gain any traction over the next few months.

 

Brushing Up the Workforce

With or without legislative changes, more veterans will be eligible for dental care in the years ahead.

 

During a May 2 appearance before the Senate Appropriations Committee, VA Secretary Denis McDonough said department officials estimate the number of veterans who qualify for some type of dental coverage will reach nearly 2.8 million by 2028. That’s double what the total was at the start of 2021.

 

The reason for the sharp rise has to do less with veterans’ teeth and more with recent legislation surrounding troops’ exposure to toxic chemicals in war zones.

 

The 2022 Promise to Address Comprehensive Toxics Act — better known as the PACT Act — created a host of new health care benefits for veterans exposed to burn pit smoke, chemical defoliant sprays and other toxic chemicals during their time in the service.

 

It also made it easier for many veterans with existing injuries to push their disability rating to 100%, triggering the dental care eligibility.

 

[RELATED: 1 Million Veterans Have Now Received Health Benefits for Toxic Exposure Through the PACT Act]

 

The VA secretary said officials are aware of a potential wave of veterans looking for help with oral problems in the coming years. The department currently employs about 3,500 full-time dental staffers and another 600 or so part-time specialists.

 

Total dental staffing was up to about 5% from 2022 to 2023, but McDonough said he knows many more will be needed as the demand increases.

 

“Our budget request [for fiscal 2025] gets us going on that process,” McDonough said. “But we’re in a transition period now, until we have dentists and hygienists and chairs in our facilities, we’re going to have to be relying on the community for that care.”

 

That means more veterans like Williams searching for private-sector solutions to their health problems, all while hoping that the VA will eventually pick up the bill.

 

Williams said department handlers have indicated they may have another option for his facial reconstruction: Getting both oral surgery and behavioral health therapy done at a world-class clinic in California, with VA picking up the full tab.

 

But even if that plan comes together, it will mean multiple cross-country trips over the coming months before the issues are fixed. For now, the exasperated Williams must navigate the lack of fast or easy fixes for his situation.

 

“I’m 100% disabled, it’s 100% combat related, I’m a Purple Heart recipient who is medically retired,” he said. “I don’t know why this is so hard.

 

“But at this point, I don’t care if it takes another 10 years to fix it. Uncle Sam is going to pay for my new teeth.”

 

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