On August 10, President Biden signed the PACT Act into law, making a number of important changes to the VA system. The PACT Act aims to offer faster, more comprehensive benefits and health care for veterans and others who have been injured by toxin exposure related to military service.
In this article, we provide an easy guide to the new PACT Act provisions and help explain who is eligible for PACT Act VA benefits.
What is the PACT ACT?
In the past, veterans and others exposed to toxins on military bases or other contaminated areas found it nearly impossible to get financial compensation or health care benefits for illnesses caused by those toxins. Toxin exposure was hard to prove and proving that toxin exposure caused an illness was equally as difficult. Service connection for toxin exposure was rare.
But extensive scientific research and increased awareness have boosted the knowledge surrounding toxin exposure and illness, primarily toxins associated with burn pit smoke and fumes, Camp Lejeune drinking water, radiation exposure, and Agent Orange exposure.
On August 10, the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act (PACT Act) was signed into law to help veterans exposed to toxins get the funds and treatment they deserve. The PACT Act is named after Ohio National Guard Sergeant First Class Heath Robinson who died in 2020 at age 39 from an extremely rare form of lung cancer caused by prolonged exposure to toxins emitted from burn pits.
Through the PACT Act, veterans and others who meet certain criteria will automatically qualify for VA benefits and healthcare to help compensate and treat toxin exposure.
Who Qualifies for PACT Act VA Benefits?
The PACT Act introduces several changes to the VA claims process, presumptive disease lists, and eligible service dates and locations for Afghanistan, Iraq, and Vietnam-era veterans. Even if you already receive VA benefits, or have been denied benefits in the past, you may qualify for financial compensation and health care benefits under the PACT Act.
Four areas of coverage are included, each with its own data and location requirements and presumptive disease lists:
- Burn Pit Exposures
- Camp Lejeune
- Gulf War and SW Asia
- Vietnam Era
To receive PACT Act benefits, claimants in each area of coverage must meet two requirements:
- Date and location requirements, and
- Diagnosis with a disease on the presumptive list
I. Burn Pit Exposure PACT Act Criteria
Dates and Locations of Burn Pit Exposures:
- On or after September 11, 2001, in Yemen, Uzbekistan, Syria, Lebanon, Jordan, Egypt, Djibouti, Afghanistan, or the airspace above these locations
- On or after August 2, 1990, in United Arab Emirates, Somalia, Saudi Arabia, Qatar, Oman, Kuwait, Iraq, Bahrain, or the airspace above these locations
Under the PACT Act, there is no longer a 10-year limit on manifestation of symptoms.
Burn Pit Presumptive Diseases List:
- Respiratory cancer
- Reproductive cancer
- Pulmonary fibrosis
- Pancreatic cancer
- Neck cancer
- Lymphatic cancer
- Kidney cancer
- Interstitial lung disease
- Head cancer of any type
- Granulomatous disease
- Gastrointestinal cancer
- Constrictive bronchiolitis or obliterative bronchiolitis
- Chronic sinusitis
- Chronic rhinitis
- Chronic obstructive pulmonary disease
- Chronic bronchitis
- Brain cancer
- Asthma (diagnosed post-service)
II. Camp Lejeune PACT Act Criteria
Under the PACT Act Camp Lejeune Justice Act, you can file a Camp Lejeune lawsuit against the U.S. government if you meet the following requirements.
Dates and Locations of Camp Lejeune Toxic Water Exposure:
- Marine Corps Base Camp Lejeune for at least 30 consecutive days between August 1, 1953, and December 31, 1987
- North Carolina’s Marine Corps Air Station New River for at least 30 consecutive days between August 1, 1953, and December 31, 1987
Camp Lejeune Presumptive Diseases List:
- Systemic Sclerosis
- Renal Toxicity Scleroderma
- Parkinson’s Disease
- Neurobehavioral Disorders
- Non-Hodgkin’s Lymphoma
- Myelodysplastic Syndrome
- Multiple Myeloma
- Liver Cancer
- Lung Cancer
- Hepatic Steatosis
- Kidney Cancer
- Female Infertility
- Cardiac Defects
- Esophageal Cancer
- Breast Cancer
- Birth Defects
- Bladder Cancer
- Aplastic Anemia
III. Gulf War and Southwest Asia PACT Act Criteria
Dates and Locations of Gulf War and Southwest Asia Toxin Exposures:
- Active duty from August 2, 1990 to the present in Persian Gulf, Red Sea, Arabian Sea, Gulf of Oman, Gulf of Aden, United Arab Emirates, Saudi Arabia, Qatar, Oman, neutral zone between Iraq and Saudi Arabia, Kuwait, Iraq, Bahrain, or the airspace above these locations
- Cleanup teams or nuclear response teams at the Enewetak Atoll from January 1, 1977 to December 31, 1980
- Cleanup teams or nuclear response teams at the Palomares, Spain B-52 plane crash from January 17, 1966 to March 31, 1967
- Cleanup teams or nuclear response teams at the Greenland, Thule Air Force Base B-52 plane crash from January 21, 1968 to September 25, 1968
Gulf War & Southwest Asia Presumptive Diseases List:
- Myalgic Encephalomyelitis
- Chronic Fatigue Syndrome
- Gastrointestinal Disorders (functional)
- Cancers of the bile ducts, bone, breast, colon, esophagus, gall bladder, liver (primary site, but not if cirrhosis or hepatitis B is indicated), lung (including bronchio-alveolar cancer), pancreas, pharynx, ovary, salivary gland, small intestine, stomach, thyroid, urinary tract (kidney/renal, pelvis, urinary bladder, and urethra)
- Leukemia (except chronic lymphocytic leukemia)
- Lymphomas (except Hodgkin’s disease)
- Multiple myeloma (cancer of plasma cells)
IV. Vietnam Era PACT Act Criteria
Dates and Locations of Agent Orange Exposure:
- Thailand (all US and Royal Thai military bases) from January 9, 1962 to June 30, 1976
- American Samoa or Guam (and territorial waters) from January 9, 1962 to July 30, 1980
- Johnston Atoll (off or on ship) from January 1, 1972 to September 30, 1977
- Korean Demilitarized Zone from April 1, 1968 to Aug 31, 1971
- Laos from December 1. 1965 to September 30, 1969
- Cambodia (Kampong Cham Province, Krek, Mimot) from April 16, 1969 to April 30, 1969
- Vietnam and Blue Water Navy (within 12 mi) from January 9, 1962 to May 7, 1975
- C-123 Airplanes (ground maintenance, crew, flight of listed C-123’s) from 1969 to 1986
Agent Orange Presumptive Diseases List:
- Soft tissue sarcomas
- Respiratory cancers
- Prostate Cancer
- Porphyria Cutanea Tarda
- Peripheral neuropathy, early onset
- Parkinson’s Disease
- Non-Hodgkin’s lymphoma
- Multiple Myeloma
- Monoclonal gammopathy of undetermined significance (MGUS)
- Ischemic heart disease
- Hodgkin’s disease
- Diabetes Mellitus Type 2
- Chronic B cell leukemias
- Bladder cancer
- AL Amyloidosis
Did the PACT Act Fall Short?
The passing of the PACT Act is a momentous victory for veterans across the U.S., but its passage wasn’t immediate, and a number of amendments were made along the way. Once the PACT Act passed the House, the Senate proposed several amendments. Amendments from Senator Jon Tester and Senator Mike Lee proposed substantive changes to the PACT Act compared to previous proposals.
For example, a pair of amendments by Lee (SA 5048 and SA 5049) made it appear that Lee was looking to pump the brakes on some conditions proposed to be presumptively service connected by requiring a mandatory removal of presumption (versus permissive authorization).
One of Tester’s amendments is in the nature of a substitute (SA 5051):
- Removes references to certain benefits related to mammograms
- Keeps a requirement that DIC claims involving presumptions be re-evaluated
- Would still require a report on jet fuels, except there wouldn’t be a requirement that it be done on a biennial basis (like the House version does)
- Adds some provisions related to claims processing
- Adds a requirement for an epi study re: Ft. McLellan veterans
- Omits reference to PFAS/PFOS (the House version would otherwise require a registry)
- Removes a requirement that DOD introduce guidelines for active-duty personnel related to potential risks and prevention of toxic exposures
- Removes the Philippines from a list of countries related to presumption of specific toxic exposure members who served in certain locations
- Keeps in place that medical opinions should take into account total potential exposure through all applicable deployments and synergistic, combined effect of all toxic exposure risk activities
- Keeps in place the House version that Thailand, Laos, Cambodia, Guam, and American Samoa be included re: herbicide exposure
And, in the version that passed the Senate, it appears that a new effective date rule only applies to DIC.
Under the Honoring our PACT Act, the Secretary must perform outreach to veterans who previously filed claims and were denied for a condition that falls under the new presumptions. VA is not required to automatically readjudicate previously denied claims. However, if a veteran reapplies (i.e., files a Supplemental Claim) for a previously denied claim based on a newly established presumption, VA must assign an effective date as though the presumption was in effect on the date of the previously denied claim. This applies equally to claims for Dependency and Indemnity Compensation (DIC).
Perhaps the Senate quietly eliminated the broader earlier effective date rule as a cost-saving measure.
Either way, any veteran who previously claimed service connection for a condition that is presumed to be linked to Agent Orange, but got denied because they served in Thailand, Laos, Cambodia, Guam, American Samoa, or Johnston Island can file a Supplemental Claim and get many years’ worth of retroactive benefits.
Additional PACT Act Provisions
In addition to expanding eligibility for VA benefits and health care due to toxin exposure, the PACT Act includes many other provisions aimed at increasing VA efficiency.
Title I of the Honoring our PACT Act, known as the “Conceding Our Veterans’ Exposure Now and Necessitating Training Act of 2022” or the “COVENANT Act of 2022,” authorizes access to health care for all toxic-exposed veterans. This extends to hospital care (including mental health services and counseling), medical services, and nursing home care for any illness.
Title II, the “Toxic Exposure in the American Military Act of 2022” or “TEAM Act of 2022,” provides for a new, streamlined decision-making framework for VA to establish new presumptions for service-connection based on toxic exposures. The new decision process includes a Formal Advisory Committee, an Independent Science Review Board, and a Working Group.
The Formal Advisory Committee reviews data on potential toxic exposures and determines whether to commission additional research, advance a nomination to the Science Review Board, or recommend Secretarial action to expand a presumption.
The Independent Science Review Board, whose members must be selected from the general public, reviews available research and determines likelihood of association and impact of service.
The Toxic Exposure Working Group, which is comprised of VA employees, evaluates the Science Review Board’s conclusions and makes recommendations to the Secretary to establish a presumption of service-connection.
The Secretary of Veterans Affairs must then initiate a formal evaluation of the Working Group’s recommendation within 30-days. The element of the VA that conducts the formal evaluation then has 120-days to submit its recommendation to establish or modify a presumption of service connection for the toxic exposure or illness to the Secretary. The Secretary then has 160-days in which, in his discretion, to establish or modify the presumption of service connection, and if a presumption is established or modified, to commence drafting regulations.
Notably, if the Secretary removes a presumption of service connection, any claimant who was previously awarded compensation on the basis of the presumption continues to be entitled to receive compensation on that basis.
If a new presumption of service-connection is established, the Secretary must perform outreach to veterans who previously filed claims and were denied for a condition that falls under the new presumption. This outreach includes: (a) publishing on VA’s website that claimants may file Supplemental Claims; (b) notifying veteran service organization of the ability to file Supplemental Claims; and (c) contacting each claimant who was previously denied disability to which the new presumption would now apply.
While VA is not required to automatically readjudicate previously denied claims, if a veteran reapplies for a previously denied claim based on a newly established presumption, the effective date may not be earlier than the date on which the presumption of service connection was established. The exceptions are eligible survivors seeking Dependency and Indemnity (DIC) compensation. If an eligible survivor reapplies for a previously denied claim based on a newly established presumption, VA must assign an effective date as though the presumption was in effect on the date of the previously denied claim.
Title V of the Act designates VA as the coordinating authority for all research activities conducted by the federal government on the health consequences of military toxic exposures and requires VA to develop a Toxic Exposure Research Strategic Plan to ensure that the government’s research activities related to military toxic exposure are collaborative, transparent, and highly coordinated. More particularly, the Honoring our PACT Act requires research and analysis on matters including, but not limited to:
- An annual analysis and report on the treatment of veterans for medical conditions related to toxic exposure, which is likely to be scientifically useful in determining an association, if any, between medical conditions and toxic exposure
- An analysis relating to respiratory disease mortality of veterans who served in Southwest Asia
- An epidemiological study on the health trends of veterans who served after September 11, 2001
- A study on cancer rates among veterans
- A study on the health trends of veterans who participated in activities related to the Manhattan Project or resided at or near designated locations where waste arising from activities carried out in connection with the Manhattan Project was stored. Such locations include Coldwater Creek, Missouri, the St. Louis Airport Site, Missouri, the West Lake Landfill in the county of St. Louis, Missouri, Oak Ridge, Tennessee, Hanford, Washington, and any other location that is proximate to the Manhattan Project waste, as determined by the Secretary
- A study on toxic exposure and mental health outcomes, including chronic multi-symptom illness, traumatic brain injury, post-traumatic stress disorder, depression, episodes of psychosis, schizophrenia, bipolar disorder, suicide attempts, and suicide deaths
- A report on the health effects of jet fuels used by the Armed Forces
Title VI addresses resource allocation and training. It requires that VA publish a list of the benefits and healthcare resources available to veterans and survivors related to toxic exposure; directs VA to incorporate a toxic exposure questionnaire during primary care appointments; and requires improved standardized training for VA claims processors, we well as health care personnel conducting examinations to assist in the accurate adjudication of toxic exposure claims.
Title VII delves into resourcing, modernizing VA’s information technology systems, among other matters related to appropriation.
Title VIII requires, among other things, that VA conduct an epidemiological study on the health trends of veterans who served at Fort McClellan from January 1995 to May 1999; that VA and DoD to allow for service members and veterans to correct their military records as they pertain to toxic exposures; and permits VA to provide notice to claimants electronically so long as the claimant (or the claimant’s representative) consents to the receipt of electronic notice.
Title IX addresses methods to improve VA’s workforce.
The PACT Act is the most significant toxin exposure legislation passed in decades and will help millions of veterans pay for health care, and living costs who are suffering from illnesses caused by exposures to burn pit toxins, radiation, Agent Orange, and Camp Lejeune contaminated water.