WASHINGTON - John Thomas Doody was in a coma and on a ventilator, but his mom refused to follow a doctor's advice and put the Iraq war veteran in a nursing home.
Chris Ott quit her job, moved the family to Tampa, Fla., so her son, known as J.T., could be near the Veterans Affairs hospital. She spends most of her waking hours trying to meet his many needs.
He was shot while serving with the Marines in Fallujah and suffered an infection and series of strokes during his recovery. She says he's paralyzed and nearly blind but has made dramatic improvement over the years.
To ease the financial burden, Ott relies on a relatively new federal program that pays her a stipend of about $2,000 per month, trains her on how to care for J.T. and provides at least 30 days of respite care each year.
Once every three months, a VA inspector comes by her house to check on her and J.T.
"Now, I can still love him and hug him and kiss him and talk to him and laugh with him. Oh yeah, I still have my son," she said.
The extra help has eased one family's financial hardship. Yet there's a question of fairness. For every family receiving the caregiver benefit, many more make do without.
For example, Pauline King of Anna, Ill., is not eligible for the stipend even though her husband, Jerry, a Vietnam veteran, needs help with bathing, dressing and going to the bathroom as a result of multiple sclerosis.
When lawmakers created the program in 2010, it limited participation to veterans who had served since the Sept. 11 terrorist attacks.
King said the move to exclude Vietnam veterans shows "they're still not paying attention" in Congress.
Cost was a factor on Capitol Hill. The caregivers for veterans from earlier wars can get some help from the VA, such as counseling and a lesser amount of respite care, but no monthly stipend.
Ordered by Congress to study the feasibility of expanding the program, the Department of Veterans Affairs expressed reservations in a report Wednesday, projecting the cost at between $1.8 billion and $3.8 billion in the first year alone. The VA estimated that an additional 2,000 full-time workers would need to be in place to handle the workload of an expanded program.
"VA believes the expansion of benefits to caregivers of eligible veterans of all eras would make the program more equitable," the agency said in a statement. "Unfortunately, core health care services to veterans would be negatively impacted without the additional resources necessary to fund the expansion."
Given tight budget times, with most federal agencies already forced to make cuts and furlough workers, the prospects of adding billions of dollars to the VA budget seems unlikely. The VA thus far has been exempted from the mandatory cuts, known as sequestration.
Still, in July, the Senate Veterans' Affairs Committee passed a bill that would expand the program to veterans from all eras. The bill also increased the types of injuries and illnesses that would qualify a veteran's caregiver for extra assistance. Any veteran with a "serious-service connected disability" who needed help with basic activities of daily living would qualify.
But concerns about cost will be difficult to overcome. Currently, about 11,000 caregivers are enrolled in the program. The Congressional Budget Office estimated that an additional 70,000 caregivers would participate by 2016 if the bill, sponsored by Sen. Bernie Sanders, I-Vt., becomes law.
Rep. Jeff Miller, R-Fla., chairman of the House Veterans' Affairs Committee, said the intent of the Senate legislation is admirable but that Congress has an obligation not to expand existing programs without first ensuring they work correctly. He said he was also concerned that the Senate legislation does not identify how to pay for an expansion.
"The VA's cost estimate for the caregiver expansion presents a serious obstacle in an enormously constrained fiscal climate," Miller said.
The Wounded Warrior Project agrees with Miller about holding off on an expansion.
The advocacy group was instrumental in pushing Congress for the enhanced benefit for Iraq and Afghanistan veterans. The group says improvements for are needed before the VA expands the caregiver benefit. For example, it says the VA set what it called unduly strict participation criteria for veterans with mental health conditions. The appeals process is inadequate, the group adds.
The VA needs to resolve "these long-standing concerns as a pre-condition to extending the promise of this law to caregivers of pre-9/11 veterans," the group said in testimony on Sanders' bill.
But other groups say it's simply not right to treat one generation of veterans differently from others.
"It's a matter of fairness. It's a matter of principal," said Adrian Atizado, assistant legislative director for Disabled American Veterans. "We leave no one behind in the military. That is no one, no matter when they served or what branch of service."
Organizations such as Vietnam Veterans of America and Disabled American Veterans were instrumental in securing the study released Wednesday.
In the low range of the VA's projections, 32,000 veterans serving prior to 9/11 would enroll for an enhanced caregiver benefit in the coming fiscal year. In the high range, 88,000 would join the program. The VA estimated that it would spend between $25,000 and $36,770 per year for each participant.
Jerry King is one pre-Sept. 11 veteran who could use the extra help.
He was diagnosed with multiple sclerosis in 1978. The VA determined that the disease, which results in the loss of muscle control and balance, was service-connected.
"The care is a lot. When you're taking care of a home, when you're taking care of your family, that's your day. You do not sit down and watch TV. You do not sit down and read a magazine," his wife said.
The Kings rely on his disability payments from the VA and Social Security to make ends meet. She said she pays a local couple $10,000 a year to help with such things as moving her husband from his bed to his wheelchair and with the ironing of his clothes. She said there's not much money left over after that and that a monthly stipend would "be a big step for us."
"As the years advance and as these things are in their systems, they are going to start showing their head, and the ones who can't run away from it are the caregivers, the loved ones. The government doesn't see what these loved ones are going through," Pauline King said.
But Ott has concerns about what an expansion of the program would mean for her son. "I believe they should have the same opportunities, but not to the detriment of the ones already in the program," she said.