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In December 2024, the Department of Veterans Affairs acknowledged that numerous PACT Act disability claims were handled incorrectly. According to a VA Office of Inspector General (OIG) report, claims processors required unnecessary exams, exam results went unchecked or unexplored, and processing staff sought medical opinions for conditions already presumed by the PACT Act, causing delayed awards, increased costs, and erroneous denials.
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) is the most sweeping expansion of VA health care and disability benefits in decades.
The PACT ACT opens doors for veterans exposed to burn pits, Agent Orange, and other toxic hazards, recognizing over 20 new presumptive conditions and extending access to health care and presumptions of exposure across eras from Vietnam to post-9/11 conflicts.
For many veterans, the PACT Act means not just dollars, but a simplified claims process, rapid results, and improved access to medical care. Instead of having to prove a link between military service and disability, veterans only need to show qualifying service, and the VA presumes service-connection.
Such automatic approval is a big advantage for those fighting obscure or complex illnesses. The PACT Act also pushes VA to improve toxic-exposure screenings and recognize areas of contamination and associated health risks.
PACT Act VA Processing Errors
The (OIG) report, Staff Incorrectly Processed Claims When Denying Veterans’ Benefits for Presumptive Disabilities Under the PACT Act, lays out troubling missteps:
- Unneeded medical exams: Processors demanded exams that weren’t required under the law or manual, leading to delays, added veteran stress, and cost overruns totaling about $1.4 million in just six months.
- Failure to follow up: When exam reports were incomplete or contradictory, staff didn’t always request clarification. Instead, they moved to decide, often wrongly, before gathering the full picture.
- Medical opinions where none were needed: Claims were denied for presumptive conditions even when medical opinions weren’t legally required, adding both cost and unnecessary complexity.
- Wrong decisions and underpayments: Although some denials were technically correct, processing mistakes resulted in two veterans being denied $56,700 in benefits.
- Widespread error: The OIG estimated a minimum of 870 potential errors that could affect veterans’ benefits.
Impact of VA Mistakes on Veterans’ Well-Being
Even a small mistake in processing a disability benefits claim can mean months of delay for health care or compensation. The consequences are real. Denied or delayed benefits can cause severe financial strain, forcing veterans to struggle with basic needs like housing, food, and healthcare, leading to increased stress and mental health issues.
Errors in claims processing can delay or deny access to necessary medical and mental health treatments, worsening existing conditions and creating new ones. The constant battle to correct errors and the uncertainty of benefits can significantly worsen conditions like anxiety and depression.
The administrative burden and financial strain associated with incorrect claims have been linked to the worsening of conditions such as PTSD. Overall, inadequate or delayed benefits negatively impact veterans’ quality of life, affecting their ability to work, maintain relationships, and engage in daily activities.
Why Did These Errors Happen?
Several root causes emerged from OIG findings:
- Training gaps: Staff weren’t fully prepared to navigate the complex rules around presumptive conditions or proper exam use.
- Tool unreliability: Automated tools meant to guide effective date calculations or exam needs were incomplete or inaccurate, and VA continued relying on them.
- Manuals lacking detail: The adjudication manual had unclear instructions, so processors defaulted to worst-case assumptions.
- Caseload pressure: With a surge of claims since the PACT Act took effect, processors faced volume and speed pressures. Inattention to detail becomes easier under strain.
The OIG recommended, and VA committed to, several fixes. First, to update adjudication guidelines to clearly define when exams and medical opinions are needed for presumptive conditions. Second, to build reliable tools and actively test their effectiveness in guiding exam requests, effective date decisions, and presumptive determinations. Third, to create evaluation reports for all levels of PACT Act training, including deadlines and feedback for trainers to address identified gaps.
Finally, the OIG concluded that the VA must revisit claims identified by the OIG, correct mistakes, and make the affected veterans whole.
How Veterans Can Protect Their PACT Act Benefits
Veterans don’t have to accept an incorrect decision. Here’s what you can do:
- Track your claim or intent to file using VA.gov or the VA Health and Benefits app to know where things stand.
- File a Supplemental Claim right away if you were denied for a presumptive condition you qualify for. Don’t wait for the VA to reach out.
- Keep complete documentation: Copies of all exam reports, letters, and decisions are gold if something goes wrong.
- Watch your effective date: If your benefits didn’t go back to the earliest allowable date, appeal it.
- Request reconsideration or appeal: The VA appeals process exists for correcting errors. If you’ve been denied or underpaid, appeal the decision.
- Get help from accredited representatives: Only use experienced VA disability legal support to help with your claim or appeal.
The PACT Act delivered a powerful expansion of veteran health care and disability benefits, but only if claims are handled correctly.
If you’re a veteran navigating the PACT Act claims process and need assistance with your claim or appeal, we can help. Our VA disability lawyers work to pursue your full benefits and ensure your claim gets proper attention.
Contact a Gang & Associates VA disability lawyer today to advance your rights under the PACT Act. Call 888.878.9350 or Connect Online.