There’s not enough data to determine the risk of long-term health effects caused by exposure to that kerosene-based aviation fuel, known as JP-5, according to the report, which was based on research conducted by the National Academies of Sciences, Engineering, and Medicine.

The authors did find “limited, suggestive evidence linking jet fuel exposure to short-term respiratory, gastrointestinal, skin and mental health symptoms,” which many military families experienced early on after the fuel leak.

The researchers cited the dearth of information and data about the detection, treatment and long-term effects of exposure to jet fuel in the 282-page report, titled “Clinical Follow-up and Care for Those Impacted by the JP-5 Releases at Red Hill.”

The research was sponsored by the departments of Defense and Veterans Affairs.

In a Thursday webinar, researchers said the limitation of data needs to be addressed so that long-term health effects can be better understood. They recommended various long-term research efforts.

Meanwhile, medical providers caring for people who were potentially exposed to the contaminated water should document exposure history, carefully evaluate and document symptoms and ensure continuity of primary care, the researchers recommended.

About 93,000 people were affected by the Navy’s two accidental releases of JP-5 in 2021. The fuel releases contaminated the drinking water supply for Joint Base Pearl Harbor-Hickam and the Aliamanu Military Reservation.

Immediately after the contamination, Navy officials told families it was OK to drink and bathe in the water. Some families experienced severe rashes, diarrhea and other gastrointestinal problems, as well as respiratory problems, mental health symptoms and other issues.

Military officials later gave families the choice of moving to hotels while the fuel was being flushed from the water distribution system and paid their expenses.

More than four years later, families continue to be concerned about their long-term health, including their children. Many babies were bathed in the contaminated water. Some people have had persistent, continuing symptoms. About 2,000 military families have filed lawsuits against the government alleging negligence and harm to their health.

There are no diagnostic or screening tests to determine past exposure, and there are no specific laboratory tests for detecting JP-5 in blood or urine. The report recommended research to develop and validate biological markers of petroleum associated with exposure to jet fuel, supported by the Centers for Disease Control and Prevention, National Institutes of Health, DOD and VA.

There are no known medical procedures that can detox or neutralize the effects of JP-5, the researchers stated.

In addition to their extensive review of available scientific evidence, the researchers visited Red Hill and the Honolulu Board of Water Supply and held 15 meetings with those affected in the community, including service members, military families, civilians and other Oahu residents. They also held additional in-person and virtual listening sessions.

A central theme that emerged from these community interactions was the breakdown of trust between residents and the medical system, researchers found. Families reported repeatedly trying to seek help for themselves and their children, while their conditions worsened.

Those individuals who were affected by the fuel leaks have been encouraged to sign up for registries, including the University of Hawaii Red Hill Independent Health Registry and, for the DOD population, the Red Hill Defense Occupational and Environmental Health Readiness System (DOEHRS) Registry.

But the researchers recommended that DOD link their Red Hill registry with patients’ electronic health records and claims data. Many in the mobile military community who were affected have relocated, and their electronic health record follows them.

Researchers recommended that DOD maintain this registry and expand it to include all individuals who lived or worked at Joint Base Pearl Harbor-Hickam or Aliamanu from May 6, 2021 to March 18, 2022.

Based on their review, the Academies researchers recommended other actions that could make a positive impact on the lives of people who are affected by these incidents in the future, such as developing a standardized environmental sampling and chemical analysis methods to test for petroleum contamination in drinking water.

“For military families, the event was experienced as a breach of trust, while for many civilians and Native Hawaiians, it confirmed enduring concerns about military activities and their impact on land and water,” the report stated.

“The contamination of drinking water at Red Hill stands as a defining environmental health event for Hawaii and for the nation,” the report continued. “It reveals how deeply the safety of water, the health of communities and the integrity of institutions are intertwined.

“For thousands of families the crisis raises serious questions about drinking water safety and breached trust with institutions.”

With the U.S. and Israel attacks against Iran in their third week, Americans’ thoughts and actions have been turning toward sending care packages with various hygiene products, snacks and a host of other items.

But according to the U.S. Postal Service, there are currently 28 ZIP codes where mail services have been temporarily suspended, all of which appear to be Army or Air Force post offices. No ships are currently listed, although mail service is sporadic in many locations because of operational needs and restrictions. There are also 17 Diplomatic Post Office (DPO) suspensions.

The U.S. Postal Service doesn’t share exact locations associated with APO, FPO or DPO ZIP codes with the public, said David P. Coleman, a spokesman for the Postal Service. The decisions about suspensions of service to military and diplomatic post offices are made by the Military Postal Service Agency and the Department of State.

The Military Postal Service Agency serves as an extension of the U.S. Postal Service and provides postal services to Defense Department personnel and their families at locations around the world.

What happens to those care packages if they can’t be delivered?

Packages that were accepted before their particular ZIP code suspension took effect are held for future delivery after the suspension is lifted, Coleman said.

“No packages are being returned to sender at this time,” he said.

If a customer takes a package to a postal counter for mailing, the automated system will inform the postal employee that mail services have been suspended for that ZIP code, and the representative will hand the package back to the customer. If the customer drops off the package in a receptacle, the package will be held for future delivery after the suspension is lifted.

Scott Raab, director of operations for Troopathon, a nonprofit charity that has sent over 1,000 tons of hand-packed boxes of items to troops over the past two decades, said he sent 1,000 boxes to the aircraft carrier Gerald R. Ford on March 12, and another 2,000 boxes to troops elsewhere that week.

The organization always checks to make sure service members’ ZIP codes are not on the suspension list, he told Military Times. He urges others to check the U.S. Postal Service’s suspension list, which is updated frequently, and has been updated daily this week.

While Troopathon primarily uses the Postal Service, they also have contacts within units, where they can find additional ways to get boxes to troops to fulfill their needs. There’s a form for requesting a care package at Troopathon.org. Troops can request the packages, and families can request them for their deployed service members.

The Troopathon boxes are always free to the troops or their families who request them, and they contain a couple hundred dollars’ worth of items, Raab said. Troopathon also raises money for postage, which is generally about $15 to $20 for each 12X12x6 box. Popular items include basic hygiene products, snacks, cookies, coffee and socks.

One military mother posted on social media about the needs of her son’s squadron at his base in the Middle East after their military exchange had to close. That post quickly spread to other spouse groups, and Amazon found out about it — and contacted her about sending items.

“Now all of these people from all over the world are sending his base thousands of dollars of goodies like protein bars, cans of coffee, energy drinks, tampons, toilet paper, body wipes and toothbrushes,” she told Military Times.

“I don’t know when they’re ever going to get it because they’re not delivering mail, because they have more important things to deliver, but when they do deliver, they’re going to have a whole lot of goodies coming their way,” added the Air Force mother, who asked to remain anonymous.

“I told my son, ‘I understand that you guys aren’t getting any mail, but there’s going to come a time when your people get tired and they’re going to need some care packages just for morale.’”

Those civilians, who aren’t eligible beneficiaries of military medical care, include a variety of people, from Department of Defense civilian employees to other civilians who received emergency and trauma treatment at any military treatment or clinic, both overseas and stateside, since June 21, 2023.

Military medical facilities can provide care to individuals who aren’t eligible beneficiaries in certain circumstances, by law, usually on a reimbursable basis. But the high cost of medical care was putting some of these civilians in financial distress. So Congress passed a provision in the 2023 National Defense Authorization Act that gave DOD the authority to protect patients from financial harm, to apply a sliding fee scale and catastrophic fee waiver.

The billing was paused in June 2023 in order for DOD to develop the new Military Health System Modified Payment and Waiver Program, to help these civilians who face financial difficulty.

Once the patient receives a medical bill, if they face financial harm, they are encouraged to apply for the program, officials stated in an email response to questions.

“We encourage all non-beneficiary civilians who received treatment in an MTF or clinic after June 21, 2023 to take full advantage of this program to see how much financial relief they may qualify for when they receive their bill,” officials stated.

While officials did not provide a timeline for the bills, a Feb. 6 Federal Register final rule implementing the program stated it became effective March 9. Information was not available about the estimated total amount of the billing. Each individual bill will vary and is determined by the length and type of treatment.

According to the Military Health System, if patients have other health insurance, the military hospital or clinic where they received care will file medical claims on their behalf. The patient will be responsible for copays, coinsurance, deductibles, nominal fees and non-covered services.

Those without health insurance will get a bill from the military hospital or clinic where they received care.

Each bill will include instructions on how to apply for financial relief through the program.

All complete applications will be evaluated based on the standards outlined in the final rule, applying a sliding fee scale and catastrophic waiver benefits, officials said. The final rule also guarantees flexible installment plans to allow patients to spread out their payments over up to 72 months.

The Federal Register rule outlines an initial process for determining the sliding fee discount and catastrophic fee waiver, using the Federal Poverty Guidelines. Those whose annual household income is at or below 100% of that year’s Federal Poverty Guidelines may receive a full discount on their bill; others receive discounts based on the sliding scale. Those federal guidelines are based on annual household income and family size.

For example, for those in the U.S., except for Alaska and Hawaii, a household of four people with an annual income of $32,150 would be at 100% of the federal poverty level in 2026.

Instructions for applying for financial relief are also available at the MPWP web page. Patients can also contact the Defense Health Agency’s Debt Adjudication office for assistance, Monday through Friday, 8 a.m. to 5 p.m. Central Standard Time at 210-295-3344, or by email at DHA-MPWP-Inquiries@health.mil.

According to an advanced Federal Register notice, the rescission will be effective immediately on publication, expected early Friday morning.

In the notice, VA officials said that while the rule was meant to clarify existing policy, “stakeholders have expressed uncertainty” about its impact on claims and leaving the rule in place during the codification process “could undermine confidence in the benefits system.”

“VA always takes veterans’ concerns seriously and recognizes that many commenters construed the interim final rule as something that could result in adverse consequences,” the notice read.

The rule, published Feb. 17, generated significant backlash from veterans, advocacy groups and lawmakers who said the proposal could have financially penalized veterans who adhere to medical treatment or encourage those seeking a disability rating to forego medications prior to a compensation and pension exam, putting their health at risk.

The VA said the regulation simply formalized a practice that has been in place since 1958. Officials said it was needed because a 2025 court ruling, Ingram v. Collins, decided the VA must discount the positive impact of medication when issuing a disability rating.

The rule stated that the methodology dictated by the courts set a standard that was “unquantifiable, hypothetical [and] unwarranted.”

The major veterans groups, including Disabled American Veterans, the Veterans of Foreign Wars and American Legion strongly objected to ruling, which they said was crafted without any input from veterans outside the VA.

Nearly 20,000 veterans and advocates have flooded the Federal Register’s comment section on the rule, saying it would hurt veterans.

“As a former Army nurse, it seems this rule change could have unforeseen and harmful downstream effects for veterans, which is why it demands serious public scrutiny and possible legislative clarification from Capitol Hill,” VFW National Commander Carol Whitmore said in a statement shortly after the rule was published. “While VA has authority to amend the rating schedule, it must do so without adversely affecting veterans.”

Collins announced two days after publication that the rule would not be enforced. But it remained on the books, raising concerns among veterans.

At least one lawsuit was filed against the VA seeking to stop implementation and on Tuesday, 20 Democrat and independent lawmakers from the House and Senate wrote Collins asking the rule be revoked.

They said that leaving the rule on the books was causing veterans to “confront the unnecessary dilemma of continuing life-improving treatment for their conditions.”

“This rule forces veterans into an impossible choice: follow their prescribed treatment plan or risk losing their benefits,” wrote the lawmakers, including the ranking Democrats on the House and Senate Veterans Affairs Committees, Rep. Mark Takano of California and Sen. Richard Blumenthal of Connecticut.

In letter, the lawmakers said enforcement of the rule could have resulted in an estimated $23 billion in savings and objected to what they said was a “political maneuver aimed at cutting costs.”

The VA has filed an appeal to the Ingram v. Collins ruling, and the rescission does not resolve that court case which continues.

In the notice to be published Friday, officials said the department is “committed to its mission of ensuring that every claimant applying for benefits — especially veterans who have earned disability compensation through their honorable service to the Nation — receives all benefits to which they are entitled under the law as expeditiously as possible.”

The conflict is the latest chapter in the ongoing story of VA’s federal workforce, and what it will look like in coming years. After President Joe Biden’s administration heavily emphasized building up the department’s employee base in response to higher demands for health care and benefits, President Donald Trump’s White House has reversed that course, pushing for significant cuts and less aggressive recruiting efforts.

On Monday, the House finalized legislation to prohibit payments from the department’s Critical Skill Incentive programs from being awarded to Senior Executive Service employees, in reaction to improper cash awards handed out during the last presidential administration. The measure is expected to be signed into law by President Donald Trump in coming days.

The bill comes in response to still ongoing criticism of Biden-era appointees improperly using the cash awards for senior officials rather than hard-to-fill specialists.

Bill sponsor Sen. Jerry Moran, R-Kansas and chairman of the Senate Veterans’ Affairs Committee, called the past awards an “abuse of taxpayer dollars” and said the move is needed to ensure integrity and transparency in the department’s bonus programming.

In a related move, House Veterans’ Affairs Committee leaders on Tuesday held a hearing reviewing the department’s recruitment, relocation and retention incentive payment practices, better known as 3R bonuses.

VA leaders awarded about $1.2 billion in those incentives to roughly 134,000 employees from the start of fiscal 2020 to the end of fiscal 2023, according to the VA Inspector General’s office. Officials estimated that about $341 million in bonuses were not properly documented or justified, and about $5 million in awards were improperly handed out to ineligible individuals.

Republican lawmakers said that program is in need of significant reforms too.

“When someone receives a relocation incentive and never actually relocates, that is wrong and a clear waste of taxpayer dollars,” said Rep. Jennifer Kiggans, R-Va., chairwoman of the House Veterans’ Affairs Committee’s panel on oversight. “These are taxpayer dollars set aside for veterans, and for far too long they have been carelessly handled.”

Trump administration supporters praised recent efforts to cut waste and inefficiency within the department. Tracey Therit, VA’s chief human capital officer, said the bonus programs are a critical tool in filling in-demand specialties, but also promised continued reforms within the human resources and financial oversight offices to improve bonus decisions.

“We are confident that the steps we have already taken and continue to take will strengthen our incentive program governance and oversight, leading to more effective outcomes and better service to the nation’s veterans,” she said.

But Democratic lawmakers said the work is less focused on efficiency and more focused on shedding government workers through active cuts and passive messaging.

Rep. Delia Ramirez, D-Ill., noted that VA leaders awarded recruiting incentives more than 20,000 times in 2024. Halfway through this year, that total is about 7,000. Recruitment incentives were awarded more than 6,000 times in 2024 but have been used about 1,000 times this year.

“It’s not that VA employees are less meritorious than they were [last year],” Ramirez noted. “No matter what VA employees do, they will never receive 3R awards, because the Trump Administration wants them to leave. They want every employee to be pushed out so they can decimate VA’s workforce and destroy it in order to justify privatizing the VA.”

VA officials expect to reduce the department’s workforce by roughly 30,000 employees this fiscal year, a move that has drawn the ire of union leaders and administration critics.

Union officials testified at the hearing that they are already seeing shortfalls in key areas like nursing and appointment scheduling, areas that will hurt veterans benefits.

VA leaders have disputed those assertions in recent months, insisting that cuts to the department bureaucracy can be done without impacting customer service. They said they are continuing to recruit for critical health care and benefits processing posts, and have dismissed concerns from critics regarding perceived emerging gaps in the workforce.

Senate leaders this week are expected to advance their plans for a $435 billion VA budget next fiscal year. The appropriations bill represents an $83 billion boost from Congress’ approved spending plan for VA in fiscal 2025, even with the planned staffing reductions.

Officials from the Senior Citizens League — an affiliate of TREA: The Enlisted Association — last week announced their latest projection for Social Security COLA rates for the upcoming year, estimating the figure will be less than 2.6%.

In a statement, the group said that figure is “substantially lower” than the 3.2% adjustment that was implemented at the start of 2024. The cost-of-living adjustment rate hasn’t been below 3% since early 2020, when it was down to 1.3%.

Social Security officials typically announce their cost-of-living calculations for the coming calendar year in early October.

In recent years, estimates unveiled by the Senior Citizens League’s in late summer have come within a percentage point of the official adjustment mark.

The Social Security announcement is of particular interest to veterans because Congress annually ties the increase in veterans payouts to the Social Security Administration’s calculations.

About 5 million veterans and 2 million military retirees receive benefits checks each month through the Department of Veterans Affairs. The COLA-increase would apply to payouts for disability compensation, clothing allowances, and dependency and indemnity benefits, as well as some other Veterans Affairs assistance programs.

For a veteran receiving $1,500 a month in disability payouts, a cost-of-living adjustment of 2.6% would mean an extra $39 each month. In 2023, that figure soared to 8.7%, or about $130 a month for that same veteran.

Social Security officials calculate the annual cost-of-living adjustment based on the Consumer Price Index for Urban Wage Earners and Clerical Workers. If those laborers don’t see a rise in their annual salaries, federal planners can determine that no adjustment is needed.

However, Senior Citizens League officials said the government’s “failure to return inflation to pre-pandemic levels” has put additional pressure on seniors and veterans benefits recipients, making the size of the adjustment crucial for many the financial health of many households.

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Is the Medicare Part B late enrollment penalty statutory or regulatory?”

Kevin’s response:

The Part B late enrollment penalty can be found in the general and permanent laws of the United States, found here.

The specific location is Title 42 – The Public Health And Welfare, Chapter 7 – Social Security, Subchapter XVIII – Health Insurance For Aged and Disabled, Part B – Supplementary Medical Insurance Benefits for Aged and Disabled, Sec 1395r – Amount of Premiums for Individuals Enrolled Under This Part.

”…the monthly premium…shall be increased by 10 percent of the monthly premium so determined for each full 12 months (in the same continuous period of eligibility) in which he could have been but was not enrolled.”

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Are three two separate payments or two payments in one? I know there is a Part B payment, but didn’t know they attached a payment called IRMAA to the Part B payment.

Boy, this is rough on a retiree’s fixed income.”

Kevin’s response:

If you’re an individual tax filer and your modified adjusted gross income is above $103,000 or if you’re a joint tax filer with modified adjusted gross income above $206,000, you’ll be subject to an income related monthly adjustment amount, or IRMAA. In the first income tier of IRMAA, you’ll pay an additional $69.90/month for Part B and an additional $12.90/month for Part D. If you’re subject to IRMAA it will be added to the Part B premium.

Your choice of plans can help mitigate the additional Part B premium. Many, but not all, FEHB plans will eliminate out-of-pocket costs for doctor and outpatient services, and there are a couple of FEHB plans that offer a partial Part B premium reimbursement. Also, some MA plans offered by FEHB plans have $0 out-of-pocket costs for approved medical services from providers that accept Medicare and the plan, besides prescription drugs. Most of the MA plans offered by FEHB plans also include generous Part B premium reimbursement. The combination of $0 out-of-pocket costs (besides prescription drugs) and Part B premium reimbursement, help make MA plans offered by FEHB plans the lowest cost plan type for most federal annuitants.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“I have gotten conflicting and complicated information regarding does FEHB include/offer a Medicare Advantage option as a FEHB plan?

I have called OPM three times. Their advice is to call Medicare.

Medicare has no information on what plans are available to FEHB. Their advice is to call the plan. The plan says they do offer Medicare Advantage coordination, but it is offered with any plan, not a specific Medicare advantage plan (Aetna and BCBS), with some rebate of Part B premium and hoops regarding retiree services, etc., in an endless loop of ‘not my problem.’ Yet I see online where, since 2021, this has been an option.

It seems to be more clear cut for the Postal Service people, which I am not. I am on disability retirement and SSDI. Do you have any information regarding Medicare Advantage coordination with FEHB?”

Kevin’s response:

There are some FEHB plans that offer a Medicare Advantage plan to their Medicare eligible enrollees.

National plans include Aetna Advantage, APWU High, GEHA High and Standard, MHBP Standard, NALC High, and SAMBA High and Standard.

In addition, depending on where you live, you might have access to Kaiser or United Healthcare options.

To learn more about Medicare Advantage plans offered by FEHB plans, go to section 9 of the official FEHB plan brochure or to the carrier website.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

A Fed Times reader asks:

“My wife is covered on my “self+1″ Blue Cross FEHB plan. She will turn 65 this summer and will be going on Medicare Parts A and B. I am still 62 and will need to remain on the FEHB plan.

Is there some way I can change my FEHB enrollment to a “self only” plan at that time, or will I have to wait until open season in the fall?

Do I need to suspend her coverage as a spouse of an annuitant in order to preserve her ability to return to an FEHB plan if her new gap insurance doesn’t work for her needs?”

Reg’s response:

There is no provision in law or regulation that would allow you to suspend your wife’s FEHB coverage.

You could, of course switch to Self Only coverage; however, if you were to die before you were able to switch back, your wife would only be covered by Medicare A and B.

Got a question for the Federal Times expert? Send inquiries to: fedexperts@federaltimes.com.