The Defense Department has widened its fertility treatment benefit for severely ill or injured service members to include coverage for unmarried service members and those who need to use donor eggs and sperm.

Under the new policy, announced Friday by Assistant Secretary for Health Affairs Dr. Lester Martinez-Lopez, troops with serious wounds or an illness that contributes to infertility may qualify for in vitro fertilization^[1], or IVF, regardless of marital status and may use donated gametes procured at their own expense.

The policy also allows coverage of IVF and artificial insemination for a spouse^[2], unmarried partner or a third-party surrogate of a qualifying active-duty service member if that individual qualifies for or is enrolled in the Tricare^[3] health program.

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But while the policy allows for surrogacy agreements, it prohibits any paid arrangements. Under the benefit, the DoD, as well as the service member, is specifically barred from paying a partner or surrogate any compensation, although they may request a waiver to cover travel expenses.

The new policy evolved as a result of a lawsuit brought against the DoD and the Department of Veterans Affairs^[5] by military and veterans advocates who said the benefit, originally for married service members and veterans, discriminated against single troops and same-sex couples.

As part of the case, attorneys for the DoD said in December they planned to change the policy but provided little detail. In January, VA officials said they would follow suit based on the DoD's policy.

On Monday, the VA announced that it would provide the same benefits^[6] to severely ill or injured veterans regardless of marital status and allow the use of donor eggs, sperm or embryos.

"Raising a family is a wonderful thing, and I'm proud that VA will soon help more veterans have that opportunity," VA Secretary Denis McDonough said in a statement. "This expansion of care has long been a priority for us, and we are working urgently to make sure that eligible unmarried veterans, veterans in same-sex marriages, and veterans who need donors will have access to IVF in every part of the country as soon as possible."

According to the policy, to be eligible, service members must have a "Category II" or "Category III" illness or injury -- serious enough to render a member unlikely to return to duty and likely to medically separate.

Such illnesses or injuries may be neurological, anatomical or physiological, according to the memo.

Military personnel who don't qualify and pursue IVF must pay a fee at one of eight military treatment facilities where it is offered or cover the entire cost at a private facility.

The VA previously covered in vitro fertilization and other types of assisted reproductive technology treatments for veterans with infertility related to a military-connected illness or injury.

Veterans who don't meet the requirements have access to fertility testing, medication, artificial insemination, cryopreservation of gametes and counseling.

In a statement, Kimberly Lahm, program director for the DoD's Health Services Policy and Oversight office, said the changes reflect the department's commitment to ensure equity in reproductive health services.

"We continue to identify ways to lean forward as much as we can in support of equity of access to reproductive health care for our service members," Lahm said.

The lawsuit plaintiffs, including representatives from the National Organization for Women, the Yale Law School Veterans Legal Services Clinic and the National Veterans Legal Services Program, said Monday that the coverage is welcome. But, they added, it does not go far enough and they will continue their litigation.

"This is substantial progress," Donovan Bendana, a second-year student at Yale Law School, said in a statement. "But the onerous requirement of linking infertility to a specific service injury will deny many service members the opportunity to build a family. This is especially arbitrary in light of the military's decades-long disinterest in studying women's health, including the impact of service on fertility."

Under the DoD policy, qualifying service members can seek fertility services at a military treatment facility or private sector with prior authorization.

The Defense Department will cost-share storage until a member separates from the service or retires, at which point the service member can continue storage at their own expense.

DoD also will have no role in issues regarding ownership, future use, donation or destruction of gametes or embryos, according to the memo. Those concerns are normally governed by state law.

The new policy allows for up to six cycles of intrauterine insemination, six egg retrieval treatments and three cycles of IVF.

Sen. Patty Murray, D-Wash., has worked more than a decade to expand veterans' access to fertility treatments. On Monday, she praised the VA for expanding coverage, calling it an "important step forward."

But given that the new rules continue to exclude many military service members, veterans and their families, Murray is pushing for a bill, the Veterans Families Health Services Act, which would require that the VA and DoD to expand treatment to more veterans and allow troops to freeze their eggs or sperm before deploying to combat or other hazardous assignments.

"Service members and veterans have sacrificed so much for our country -- but they should never have to sacrifice their ability to start a family," Murray said in a statement.

The new policy does not allow for cryopreservation of gametes prior to deployment^[7], nor does it provide for extraction of gametes from deceased service members.

In 2019, the parents of a West Point^[8] cadet petitioned the court to have their son's sperm extracted while he was on life support following a skiing accident. A judge ruled in favor of the parents of Peter Zhu, giving them ownership of the cadet's frozen sperm for gestational purposes with a surrogate.

An attempt to reach Yongmin Zhu, Peter Zhu's father, for an update was unsuccessful.

Related: Nonprofits Are Filling a Void of Fertility Help for Service Members, But Hope Congress Steps Up^[9]

The Pentagon and Department of Veterans Affairs^[1] launched a shared electronic health record system at a Chicago hospital on Saturday, completing the military's adoption of the system and moving the VA a step closer to restarting its rollout across its 172 medical centers and clinics.

VA officials said the Captain James A. Lovell Federal Health Care Center in North Chicago, which serves more than 75,000 patients per year, adopted the Oracle Cerner electronic health record system -- the first launch for a VA site since it paused the program in April 2023 amid concerns over patient safety, training^[2] and user-friendliness.

The VA signed a $10 billion contract with Cerner for a systemwide electronic medical record program in May 2018, selecting the same contractor as the DoD to ensure that service members and veterans would have a continuous digital health record from their initial accession until death.

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While the rollout within the Defense Health Agency caused appointment cancellations and some delays in care related to training and implementation, the rollout at the VA has been fraught with issues. In July 2022, the VA Office of Inspector General found that the system caused harm to at least 149 patients at one facility,^[4] including a suicidal veteran who had to call the VA's crisis line after his psychiatry referral was lost.

The Defense Department, which calls its version MHS Genesis, is now using the program at 138 hospitals and clinics, while the Department of Veterans Affairs^[5] now has the Oracle Cerner EHR at six sites.

"This is one of the places where the value of a consolidated single electronic health record shared within the federal sector, currently by the Department of Defense, the Department of Veterans Affairs, the United States Coast Guard^[6] and the National Oceanic and Atmospheric Administration, [where] we hope to see the realization of the promise of a single electronic health record," Dr. Neil Evans, the acting program executive director for the VA's Electronic Health Record Modernization Integration Office, said during a call with reporters Friday.

As late as last month, VA officials said they would not introduce the electronic health records system at any site that was not ready. The VA recently completed a major upgrade to the system at the five sites, as well as the North Chicago hospital, before launching it at the facility Saturday.

Evans said the rollout at the Lovell center will help determine when the department can resume adopting the new records system across its facilities.

"There still is work to be done within the overall reset, but I do feel like we are seeing the evidence of a lot of effort that's been put in for the last nine months or so," Evans said.

The facility, the largest joint VA-DoD health care center, includes a 300-bed hospital and several outpatient clinics in Chicago and its suburbs. It serves more than 30,000 Navy^[7] recruits, 25,000 veterans and 10,000 military personnel, family members and retirees.

More than 3,200 VA and DoD employees work at the center and its satellite clinics. Evans said that prior to the "go-live," the VA and the DoD conducted extensive training and worked to ensure that staff was enthusiastic about the change. They relied on computer-based and instructor-led training but also on "super users," who like the system and want to help their colleagues learn about its capabilities.

"We added several events to really help empower our super users and help coach super users on some of the softer skills they could use to actually engage with their peers," Evans said.

He added that the training also now includes "learning labs" where users can go and work through the program, a type of "sandbox environment."

The system has received a major update that includes changes to its pharmacy packages at the five sites where it is in use: Mann-Grandstaff VA Medical Center in Spokane and VA Walla Walla Health Care System, both in Washington; VA Central Ohio Health Care; and VA Roseburg Health Care and the Southern Oregon VA Health Care System, both in Oregon.

The new pharmacy program is not yet live at the Lovell facility, Evans said. He said that while the pharmacy upgrade has been working in the "vast majority of cases" at the five sites, it sometimes was behaving "oddly," and VA officials decided to fix those bugs before introducing the upgrade at Lovell.

"We made a decision -- it was really a clinical decision, based on VA's pharmacy communities -- request that we not go live with the functionality until it is fully and completely fixed 100%," Evans said.

In November 2022, lawmakers said veterans may have died as a result of the health record system's complexities, with one patient never receiving a needed medication because of issues with the system's prescription tracking and another who missed an appointment but received no follow-up because the system failed to record the skipped appointment properly.

Related: VA Electronic Health Record Rollout Unlikely to Resume for a Year After Being Derailed by Problems^[8]