Midway through Matt Keil's second deployment in Iraq, he came home and married his fiancee, Tracy, in 2007.
He had two weeks R&R; no time for a honeymoon.
Before he went back to war the couple had the sort of conversation unique to newlyweds in the military. "I told her if you get a phone call that I'm injured, I'm probably fine," Matt says. "But if they come to the apartment or to your work in person, then I'm dead."
Six weeks later the news came — a phone call, thankfully. Matt had been shot in the shoulder. It wasn't until Tracy got to Walter Reed Army Medical Center that she got the full story. The sniper's bullet had nicked Matt's spine.
"The doctor came in and told me he was paralyzed from the neck down, and he said it was a 'Christopher Reeve'-type injury," says Tracy.
Questions overwhelmed them about the future, including whether they'd ever be able to have children. It seemed like something they could figure out later.
"They were kinda telling us we're putting the cart before the horse," Matt recalls. "You guys got to get through a whole hell of a lot of rehab."
Time was running out, though, and the Keils didn't realize it.
To have children they'd need help: in vitro fertilization. But IVF is expensive, costing, on average, at least $12,000 per cycle of treatment, according to the American Society for Reproductive Medicine.
The Pentagon's health care system for active-duty troops covers IVF for wounded soldiers like Matt Keil. The Department of Veterans Affairs for veterans doesn't. By the time the Keils learned about the difference, it was too late.
"We were just swallowing the fact that he was never going to go back to work," Tracy says. "But finding out that IVF wouldn't be covered because we agreed to retire out so quickly, that was hard, because nobody told me that."
A law passed in 1992 made it illegal for the VA to pay for IVF, which some people oppose because embryos are often destroyed in the process.
The only option for the Keils would have been to get the procedure done immediately after Matt's injury. They had missed the window.
Matt was just starting to accept that with the limits of current science he might never walk again. But the limit on his ability to pay for IVF was put in his way by Congress.
"This is a direct result of a combat injury," says Tracy. "Don't tell me that his service wasn't good enough for us to have a chance at a family. Because we've already lost so much. I just want to have a family with the man that I love and please don't make this any worse than it already has to be."
In the decades since Congress banned IVF for the VA, the procedure has become much more common. And about 1,400 troops came back from Iraq and Afghanistan with severe injuries to their reproductive organs. Thousands more have head injuries, paralysis or other conditions that make IVF their best option.
Bills to change the law come up periodically, only to be blocked at the last minute, says Sen. Patty Murray, a Democrat from Washington. "They don't come out and say that directly, but there continues to be a backroom concern about the practice of IVF," Murray says. Murray's bipartisan IVF bill nearly passed last summer.
Republican Sen. Thom Tillis of North Carolina, who is staunchly against abortion rights, effectively blocked it. Tillis declined requests for comment, but said at the time that he opposed the bill because other problems at the VA need to be fixed first.
The Congressional Budget Office estimates a change in VA policy to pay for fertility treatment could cost more than $500 million over four years.
Murray says vets should get the same options as active-duty troops. "It's really ridiculous that Congress would deny a widely used medical procedure to our veterans just because of their own ... beliefs," she says.
Rep. Jeff Miller, the Republican chairman of the House Committee on Veterans' Affairs, said he's working toward a compromise that "meets the needs of this special group of severely injured veterans while being sensitive to concerns surrounding IVF procedures."
In the meantime, many fertility clinics across the country offer discounted rates for veterans who are paying out of their own pockets for IVF.
For the Keils, who spent the year after Matt's injury figuring out how their new life could work, offers like that came too late.
"We weren't at a good spot in our marriage at the time, and thought that if we're going to bring kids into this world they need to be brought into a healthy relationship," says Matt.
"What if we didn't even end up staying together?" Tracy adds.
They took a year to work it out, and then decided it was for sure — their marriage would survive. They also wanted a family.
"We were ready, and it didn't matter what it was going to take," Tracy says.
The VA told them what they already knew — no coverage for IVF. The decision still seemed crazy to them, considering how much medical care VA would pay for.
"I served my country. I was injured," Matt says. "All my medical supplies are paid for, but the one thing they won't facilitate [by] paying — that I lost the ability to have — was a family."
Paying for IVF on their own seemed impossible to Matt and Tracy.
Matt's condition meant that IVF would be even more of a financial strain than usual. Among other things, Tracy was her husband's full-time caregiver, and they would need to hire help while she was getting treatments.
Their savings weren't going to cut it.
But then a veterans charity paid for the Keils' wheelchair accessible house, so they could target their money toward IVF. The local VFW held a fundraiser to help. Kids all around Denver and then Colorado set up lemonade stands and collected donations, too.
The couple's twins, Faith and Matthew, were born in November 2010. They ride on the back of their dad's motorized wheelchair. When he wants to lift them high in the air they jump on his feet and he reclines the chair until he's upside down.
This winter the kids are outside building igloos and snowmen.
Thousands of vets have injuries that make IVF their only option for having a family. Matt and Tracy Keil say they want them all to get that chance.
ARI SHAPIRO, HOST:
Hundreds of U.S. troops came home from the wars in Iraq and Afghanistan with injuries that make it difficult to have children. Some are able to conceive through in vitro fertilization, or IVF, but there's a catch. Military health care for active troops covers IVF. The health care veterans get through the VA does not. This is something people don't talk about much, but one couple did open up to NPR. And listeners should be aware we will hear discussions about sex and reproduction here. Here's NPR's Quil Lawrence.
QUIL LAWRENCE, BYLINE: This is a story about love and the cost of war.
MATT KEIL: My name is Matt Keil.
TRACY KEIL: My name is Tracy Keil. August 2005, we lived in the same apartment complex in Colorado Springs, and we met at the pool. He had just gotten home from his first deployment.
M. KEIL: My first tour was August '04 to July of 2005.
T. KEIL: I think I had called in sick 'cause it was such a beautiful day (laughter).
M. KEIL: And my second tour was October of 2006.
T. KEIL: And he had proposed before he deployed...
M. KEIL: Yeah. We were...
T. KEIL: ...At his going-away party at the pool (laughter). He proposed where we met.
LAWRENCE: Halfway through Matt's second deployment, he flew home on leave, and they got married.
M. KEIL: January 12 of 2007.
T. KEIL: Six weeks to the day before his injury.
LAWRENCE: Then he was back to Iraq in the city of Ramadi during maybe the worst year of the war.
M. KEIL: Early in the morning, O-dark-thirty at February 24, I was shot in the right side of the neck by an enemy sniper. I was loaded in the last spot on the helicopter in the upper-left (unintelligible) position, and that's always reserved for the most urgent surgical.
T. KEIL: Yeah. The doctor came in and told me that he was paralyzed from the neck down. And he said he had a Christopher-Reeve-type injury. But I had no idea what we had in store for us and what was ahead.
LAWRENCE: In store for them was months of surgery and rehab at Walter Reed Hospital. Matt got one reprieve. A little life came back to his left hand.
M. KEIL: Tracy - she had dropped one of the physical therapy aids on the ground - floor next to my hospital bed, and she reached down to pick it up. And I just kind of looked over at her, you know, at her butt as she was bent over, and I just though, hey, I'm going to give her a little tap on the butt. And we all freaked out, like, out of nowhere. I mean, yesterday, this didn't work. Now it does.
LAWRENCE: That little bit of movement in one hand meant Matt could use all sorts of adaptive equipment, and the Keils were trying to adapt all the aspects of their young marriage. Lots of questions - some made people uncomfortable.
T. KEIL: You know, a lot of people don't want to talk about sex and what that is like for somebody that's paralyzed.
M. KEIL: Having the genitalia makes you a man. If you don't have it or doesn't work properly, then you're somehow less of a man - lot of guys see that.
T. KEIL: Men, in general, don't want to talk about it.
M. KEIL: One of the biggest questions everybody asks me is, like, can you get an erection? Yeah, I can get an erection, but I - you know, I can't ejaculate like a normal guy can - just can't do it.
T. KEIL: You know, we were, like - we were just married. I mean, I think as a married couple, we've only had sex a couple of time as a married couple. So it was like, yeah, we were curious. We were definitely wanting to know what this was going to look like for our life. Am I going to get pregnant randomly?
LAWRENCE: In some ways, Matt was lucky. Many Afghanistan vets stepped on landmines that caused devastating injuries to the genital area. But no, the Keils would probably never get pregnant without expensive medical help, something they thought they'd figure out later.
M. KEIL: They were kind of telling us we were putting the cart before the horse, really. And you know, you guys got to get through a whole hell of a lot of rehab before.
LAWRENCE: It turns out, though, that a window was closing, and they didn't realize. Active duty troops can get in vitro fertilization paid for by the Pentagon's health plan, not veterans. A law passed in 1992 made it illegal for the VA to pay for IVF, which some people oppose because embryos are often destroyed in the process. So the Keils would have had to get the procedure done immediately in the short months before Matt's medical retirement from the Army. It was too late.
T. KEIL: I mean, we just were, like, swallowing the fact that he was never going to go back to work, but finding out that IVF wouldn't be covered because we agreed to retire out so quickly - that was hard because nobody told me that.
LAWRENCE: Even if they had known, doing IVF during all that rehab seemed crazy, and it was too soon to make big decisions with the shock of Matt's injuries still sinking in.
T. KEIL: Like, wait a minute. Let us figure out what our new life is going to look like. What if we didn't even end up staying together?
M. KEIL: We weren't in a good spot in our marriage at the time, and I thought that if we're going to bring kids into this world, then they need to be brought into a healthy relationship.
T. KEIL: And I can say this now, I guess, nine years into this. It is a strange dynamic that changes in the house when you have the man of the house in a wheelchair. And we needed to figure some of that out.
LAWRENCE: They took a year to consider and then decide it was for sure. Their marriage would survive this, and they wanted a family.
T. KEIL: We were ready, and it didn't matter what it was going to take.
LAWRENCE: Doctors said what it would take was lots of hormone shots, some really uncomfortable medical procedures for both of them and $32,000. And they just didn't have that kind of money.
M. KEIL: I served my country. I was injured. All of my medical supplies are paid for, but the one thing that they won't facilitate paying for that I lost the ability to have was a family.
LAWRENCE: Matt had accepted the limits of current science and medicine meant he'd probably never walk again, but this was a limit imposed by Congress. Tracy Keil says it felt like a broken promise.
T. KEIL: This is a direct result of a combat injury. And don't tell me that his service was not good enough for us to have a chance at a family because we've already lost much. I just want to have a family with the man that I love. And please don't make this any worse than in already has to be.
LAWRENCE: The Keils emptied their savings account, but it wasn't going to be enough until a vet's charity paid for their fully wheelchair-accessible house so they could put all their money toward IVF. Then the local VFW did a fundraiser, and kids all around Denver and then all around Colorado started setting up lemonade stands and collecting donations. That was five years ago.
M. KEIL: The one on the left is strawberry, watermelon.
UNIDENTIFIED CHILD #1: How about squeeze, squeeze, squeeze?
LAWRENCE: The twins Faith and Matthew were born in November of 2010. They ride on the back of their dad's motorized wheelchair. When he wants to lift them high in the air, they jump on his feet, and he reclines the chair until he's upside down. This winter, they're out building igloos and snowmen.
UNIDENTIFIED CHILD #2: We're going to finish that...
M. KEIL: No.
UNIDENTIFIED CHILD #2: igloo and build a snowman.
M. KEIL: I don't know.
LAWRENCE: Several times since the kids were born, Congress has come close to supporting IVF for vets, which would cost about $500 million over four years. The bills always have bipartisan support, and they always get blocked at the last minute, says Senator Patty Murray.
PATTY MURRAY: They don't come out and say that directly, but there continues to be a backroom concern about the practice of IVF.
LAWRENCE: Murray's a Democrat. Her IVF bill nearly passed last summer. Republican Senator Tom Tillis, who staunchly antiabortion, effectively blocked it. Tillis declined request for comment. Murray says vets should get the same options as active-duty troops.
MURRAY: It's really ridiculous that Congress would deny a widely used medical procedure to our veterans just because of their own politicians' beliefs.
LAWRENCE: The Republican chairman of the House Veterans Affairs Committee, Jeff Miller, said he's working for a compromise that, quote, "meets the needs of this special group of severely injured veterans while being sensitive to concerns surrounding IVF procedures."
In the meantime, many fertility clinics across the country have advertised discounted rates for veterans who are paying for their own IVF.
T. KEIL: Come on, babe. Yes, she can drive you down. Get your shoes on.
LAWRENCE: Thousands of vets have injuries that make IVF their only option. Matt and Tracy Keil say they want them all to get a chance to have a family.
T. KEIL: This one's my favorite. Tell him about the fishing pole.
LAWRENCE: Even if that's not always easy.
M. KEIL: So my kids are in T-ball, you know? And we figured out a way to - with a fishing pole and a piece of Velcro on the end of the fishing line, we put a tennis ball there. And I can do batting practice with my kids. They teach me just as much as I teach them.
[POST-BROADCAST CORRECTION: In the audio of this story we say that military health care for active troops covers the costs of in vitro fertilization. But the costs are only covered for active-duty troops who suffer combat injuries and need IVF in order to conceive a child. We should have said, as is written in our Shots post, that "the Pentagon's health care system for active-duty troops covers IVF for wounded soldiers like Matt Keil."]
LAWRENCE: Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.