The PACT Act was signed into law by President Joe Biden in August 2022, instituting the largest expansion of healthcare benefits for veterans in a generation. An estimated 3.5 million veterans have been exposed to burn pits — open-air pits often used to burn chemical waste — and other harmful substances since the 9/11 attacks. Symptoms can include chronic headaches, fatigue, throat burning, difficulty breathing, skin rashes, and in severe cases, can lead to various cancers and other illnesses.
The legislation was an important step in right-sizing healthcare benefits for former service members impacted by toxic exposure, especially as more research points to connections between chemicals in military environments and a variety of illnesses.
Now, one year since the law was passed, we take a look at the progress, highlight ongoing needs in veterans’ healthcare, and answer the following common questions:
The brave women and men who honorably served deserve access to sufficient benefits, proper treatment, and providers specializing in caring for the wounds they bear as a result. The PACT Act was a major step in the right direction; now it’s up to lawmakers and the VA to see that it's implemented properly and all veterans exposed to toxic substances are made aware of the benefits available to them.
What is the PACT Act?
The PACT Act — short for “Promise to Address Comprehensive Toxics” – was signed into law on August 10, 2022, by President Joe Biden. It expands VA healthcare and benefits for veterans exposed to Agent Orange, burn pits, and other toxic substances. The bill is considered the largest healthcare and benefits expansion in VA history. Since its passage, more than 3 million veterans have received VA’s new toxic exposure screenings with about 42% (1.3 million) reporting a “concern of exposure.” Specifically, the law does the following:
expands and extends eligibility for VA healthcare-enrolled veterans of the Vietnam, Gulf War, and post-9/11 eras who have experienced toxic exposure;
requires the VA to provide a toxic exposure screening to all veterans enrolled in VA healthcare;
increases the number of presumptive conditions for burn pits, Agent Orange, and other toxic exposures with more than 20 additional conditions;
includes more “presumptive-exposure” locations for radiation and Agent Orange; and
aims to improve research, education, and treatment related to toxic exposures.
The objectives of the PACT Act are crucial to the well-being of so many of our former service members. Biden, whose eldest passed away from cancer years after deploying to Iraq, stated to veterans upon signing the bill: “We owe you. You’re the backbone. You’re the steel. You’re the sinew. You’re the very fiber that makes this country what it is.” Indeed, so many that have worked to secure our nation at home and abroad were inadvertently exposed to toxins that could negatively impact their health. And unlike the threats of combat, chemical exposure can easily be overlooked. For example, many veterans of the Global War on Terror who served in Iraq and Afghanistan were exposed to toxic fumes from burn pits. These open-air pits would be used to discard chemical waste, human waste, medical equipment, tires, and plastics on military bases. Some only discovered later that there were airborne substances that could be harmful to their health.
According to a 2022 survey of post-9/11 veterans by Iraq and Afghanistan Veterans of America ( IAVA), 82% of respondents reported being exposed to burn pits or airborne toxic materials during their service, and among those exposed, 49% believe that they have symptoms associated with burn pits or toxic exposure.
Moreover, a 2022 Mission Roll Call poll found only 12% of veterans with exposure to toxic substances had completed the VA's Airborne Hazards and Open Burn Pit Registry, suggesting there may be gaps in the agency’s estimates and related research. Promisingly, though, 72% of respondents reported an intention to submit a disability claim for toxic exposure, which can help them get appropriate care. Veterans with toxic exposure can experience a number of immediate and long-term health problems, including chronic fatigue, headaches, sudden skin rashes, and cancer. Certain conditions can go undetected without proper screening, and those who are unaware of the chemicals present in their environment may be less likely to connect health symptoms to their service experiences. Therefore it’s imperative that the VA and lawmakers build awareness around the expansions to VA health benefits via the PACT Act and the importance of veterans taking part in the free screenings.
How can veterans get PACT Act benefits?
Veterans enrolled in VA healthcare can file a disability claim to apply for PACT Act benefits, including treatment coverage and compensation in some cases. There is no deadline to apply for related benefits, but veterans who apply or submit an “Intent to File” by August 9, 2023, can have their benefits backdated to August 10, 2022 — the day President Biden signed the PACT Act into law. The VA is even hosting a nationwide “Summer VetFest” to encourage veterans to apply. The outreach initiative will include over 50 events across the country to “inform veterans, their families, caregivers, and survivors about the PACT Act.”
In the past, proving that toxin exposure caused an illness was difficult, and veterans often found it extremely challenging to get proper healthcare benefits for illnesses caused by those toxins. For instance, prior to the passage of the PACT Act, around 70% of disability claims related to burn pit exposure were denied by the VA. Thankfully, more scientific research and awareness are increasing understanding of the connections between toxin exposure and illness, particularly from burn pit fumes, radiation exposure, and Agent Orange exposure.
Chemical and toxic substance exposure varies by service era, and the list of contaminants includes smoke from burn pits used throughout Afghanistan and Iraq, Agent Orange residue near work sites in Vietnam, and elevated radiation levels and contaminated water at military bases. Some common symptoms of toxic substance exposure are chronic fatigue, headaches, skin rashes, throat irritation, or trouble breathing.
Disabilities Covered Under the PACT Act
Over 20 "presumptive conditions" connected to exposure to burn pits and other toxic substances have been added through the PACT Act, expanding VA benefits for Gulf War era and post-9/11 veterans. Presumptive conditions are diagnosed disabilities that are presumably caused by a veteran’s military service.
Presumptive cancers include: Gastrointestinal cancers, lymphoma, head cancers, neck cancers, reproductive cancers, respiratory cancers, brain cancers, kidney cancers, pancreatic cancers, melanoma, and glioblastoma.
Presumptive illnesses include: Chronic obstructive pulmonary disease (COPD), asthma diagnosed after service, chronic bronchitis, chronic rhinitis, chronic sinusitis, constrictive bronchiolitis or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease (ILD), pulmonary fibrosis, pleuritis, and sarcoidosis.
Presumptive conditions from Agent Orange include: High blood pressure (hypertension), diabetes mellitus type 2, ischemic heart disease, monoclonal gammopathy of undetermined significance (MGUS), hypothyroidism, parkinsonism, and Parkinson’s disease.
Additionally, Vietnam-era veterans along with nuclear/radiation-exposed veterans and military families exposed to contaminated water at Camp Lejeune are also eligible. And though eligibility depends on service history and other factors, veterans are encouraged to apply no matter their separation date.
Through the PACT Act, many veterans can get free VA healthcare for any condition related to service for up to 10 years from the date of their most recent discharge or separation. Veterans can also enroll at any time during this period and get care, but may owe a copay for some care. Those enrolled will receive an initial screening and a follow-up screening at least once every five years.
As of May 2023, the VA had processed 252,000 of the 546,000 PACT Act claims filed by veterans, approving nearly 80% for one or more conditions. And of 14,000 survivors of veterans who have filed claims for disability compensation, 6,000 cases have been reviewed, resulting in benefits to 3,600 survivors — reflecting increased efficiency and notable effort from the agency.
How can we support veterans who have been exposed to toxins?
Even though PACT Act benefits have rolled out over the last year, there is still time to inform veterans of what they may be eligible for. As individuals, we can play a role in helping ensure former service members with toxic exposure get the care and support they need. If you know veterans of any of the aforementioned service eras, point them to the latest news via the VA on PACT Act benefits and encourage them to get a free toxic exposure screening at a local VA facility.
As of 2021, there were a reported 16.5 million former service members across the country, and nearly half are unaffiliated with VA. Part of the issue is that veterans can easily become overwhelmed navigating the complex system of VA benefits. The Veterans Health Administration (VHA) — a branch of the VA led by the Under Secretary for Health of Veterans Affairs — oversees and carries out the healthcare program of the VA. As the largest integrated healthcare system in the U.S., it provides care to over 9 million veterans at 1,298 healthcare facilities across the country.
Even with the expansion of benefits based on the PACT Act, we should urge the VA to develop initiatives to better explain VA benefits prior to service members’ military separation. We must also call on Congress to prioritize ongoing oversight of the VA’s implementation of the PACT Act along with policies like the MISSION Act, which is aimed at strengthening comprehensive healthcare for veterans. Ensuring the VA adheres to the standards and objectives outlined in each law is key to successful outcomes in the long term.
Mission Roll Call continues to advocate for each of these measures with the goal of ensuring all veterans have access to quality care. The passage of the PACT Act was a great development, and it has already impacted millions of veterans with toxic exposure. The wounds of service members are not always apparent, and it’s vital to make as many veterans as possible aware of the ways chemical toxins could be affecting their health. To keep up the momentum, share this blog post with veterans in your community and use your voice on social media to help spread awareness.