WASHINGTON — It wasn't a bullet or roadside bomb that felled Lance Cpl. Josef Lopez three years ago after nine days in Iraq.
It was an injection into his arm before his unit left the states.
The then 20-year-old Marine from Springfield, Mo., suffered a rare adverse reaction to the smallpox vaccine. While the vaccine isn't mandatory, the military strongly encourages troops to take it.
However, it left Lopez in a coma, unable for a time to breathe on his own and paralyzed for weeks. Now he can walk, but with a limp. He has to wear a urine bag constantly, has short-term memory loss and must swallow 15 pills daily to control leg spasms and other ailments.
And even though his medical problems wouldn't have occurred if he hadn't been deployed, Lopez doesn't qualify for a special government benefit of as much as $100,000 for troops who suffer traumatic injuries.
The hangup? His injuries were caused by the vaccine.
"I could have easily died, or not been able to walk because of that," Lopez said. "It destroyed my world. It was pretty traumatic to me."
Officials at the Department of Veterans Affairs, which oversees the benefit program, said they're following what the agency has determined to be Congress' intent.
"It's for traumatic injury, not disease; not illness; not preventive medicine," said Stephen Wurtz, deputy assistant director for insurance at the VA. "It has nothing to do with not believing these people deserve some compensation for their losses."
The VA was unable to say how many claims have been rejected because of vaccine-related injuries. Wurtz and others familiar with the program said it probably wasn't a large amount.
As of July 1, the traumatic injury program has granted nearly 6,700 claims, a 63 percent approval rate, and paid $394 million in compensation, Wurtz said.
A representative for the Military Vaccine Agency, which oversees the vaccination of troops for smallpox, anthrax and other diseases, couldn't be reached for comment, despite repeated attempts.
Sen. Claire McCaskill, a Missouri Democrat and a member of the Armed Services Committee, drafted a bill named after Lopez to widen the program to include vaccine-related injuries.
She became aware of his plight when he and his mother stopped in her Senate office last year looking for help. Lopez had come to Washington to compete in the wheelchair portion of the Marine Corps Marathon.
"The program was created with a broad mandate to provide financial assistance to folks with serious injuries and given to VA to determine the outlines," said Stephen Hedger, McCaskill's legislative director and an Army veteran of Iraq. The VA "took a narrower approach and defined in greater detail what injuries and illnesses qualified for payment. Our view is it was way too narrow."
Lopez's health insurance through the military has covered all his medical expenses. The VA has paid for his medical costs since he was discharged in June.
What he didn't get were benefits from a program called TSGLI, or Traumatic Servicemember Group Life Insurance. Congress created it in 2005 to provide short-term financial help to severely injured service members until their disability benefits could kick in. The compensation is retroactive to injuries suffered since Oct. 1, 2001.
It's intended to cover expenses such as the costs of having a family member temporarily relocate while an injured service member receives treatment at a military hospital. Another might be the costs of retrofitting a service member's home to accommodate a wheelchair or other medical equipment.
The injuries don't have be the result of combat, however. Service members could be eligible because of a car accident on the way to the grocery store. The fee is an additional $1 each month on top of their regular military life insurance premium.
Lopez seemed to fit the profile. His injuries affected his normal daily activities, one of the criteria to obtain coverage. His family also met another: financial hardship.
His mother, Barbara Lopez, took a leave from her job as a high school secretary to move to Maryland to be with him while he spent six weeks at the National Naval Medical Center at Bethesda. She also had to give up her second job, a part-time position as a cashier.
They'd to build a ramp and widen a door to accommodate his wheelchair at her home in Springfield, where he spent his recovery.
Barbara Lopez said she heard about TSGLI from families of other injured troops at Bethesda. Yet unlike many of them, whose wounds were obvious, her son's application was turned down. She still can't fathom it.
"In his spinal column, he has quite a bit of permanent scarring," Barbara Lopez said. "He takes medication to help his legs. He can walk unassisted, but never far, and he can't stand for very long. I kind of feel Joe was out there fighting the same fight they were. He should be just as eligible."
The military began the smallpox vaccination program in 2003 because of post-9/11 fears that terrorists might attack the U.S. with germ warfare. Plans for the invasion of Iraq were also under way. The military was concerned that Saddam Hussein might use biological weapons against American troops.
Smallpox is contagious and can be fatal. It has no known cure. However, on rare occasions, as in Lopez's case, the vaccine can be as dangerous as the disease. Side effects can range from a simple rash to swelling around the brain and heart, and even death.
Like the inoculation for anthrax, another pre-combat injection, troops are supposed to be informed of the side effects and told that taking the vaccine was optional. Many have said that it was made abundantly clear that refusing wasn't a good idea.
"No one said 'No,'" Lopez said. "I had no qualms. I had no reason not to."