The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, or PACT Act, was signed into law in August 2022. The Act, which is considered the largest healthcare and benefit expansion in VA history, expands VA healthcare and benefits for Veterans who were exposed to burn pits, Agent Orange, and other toxic exposures, and it applies to Veterans of the Vietnam era, the Gulf War, and post-9/11. It is named for Heath Robinson, a Veteran who was deployed to Kosovo and Iraq and passed away in 2020 from cancer resulting from toxic exposure during his service.
According to the VA, exposure to burn pits was common among service members overseas.1 Burn pits are areas made for open-air combustion, and they are a common waste disposal practice in military sites outside of the U.S. The smoke from burn pits contains substances that can have short and long-term health effects, especially for people who were exposed for long periods of time. Those who have preexisting health conditions are also more susceptible to health effects from burn pit smoke.
Other toxins Veterans may have been exposed to during service include chemical warfare agents, nerve gases, asbestos, lead, and more. Veterans who were called to respond to cleanup efforts in Enewetak Atoll; Palomares, Spain; and the Pituffik Space Base in Greenland may also be eligible for radiation exposure presumptives under the act.
The Path to the PACT Act
The PACT Act was the culmination of years of advocacy from Veterans, including the VFW (Veterans of Foreign Wars). 2 Several previous toxic exposure bills have already provided some relief, but, in 2021, Veterans started working toward legislation that would cover multiple exposures at once. Not only that, but the law included reforms such as recognizing troops exposed to Agent Orange in Thailand and reforms for Veterans suffering from Gulf War illness.3 For three decades, researchers were unsure what caused the illness. The symptoms include joint pain, muscle aches, dizziness, and memory lapses. It was recently discovered that the illness is caused by exposure to sarin, an extremely toxic nerve agent.
"Over the past 20 years, you've heard in the news of Veterans exposed to toxins since September 11, talking about discrete cancers and the effects of those exposures," said Kurt Page, Army veteran, general manager, and vice president for the federal healthcare solutions team at GE HealthCare. "What the PACT Act does, in its very essence, is that it looks back at Veterans who served all the way back to Vietnam and every conflict since, and presumes that they were exposed to contaminants and toxins."
Rumblings of what became the PACT Act first began 15 years ago, but legislation often takes several sessions to get over the threshold. In addition to pressure from Veteran organizations, more stories started coming out about Veterans' health issues, which helped the act gain momentum.
Key Components of the Act
One of the major components of the act is that every enrolled Veteran will receive an initial screening for toxic exposure and a follow-up screening every five years. The act also adds a long list of 23 conditions that are presumed to be connected to service, including brain cancer, head cancer of any type, interstitial lung disease, and pulmonary fibrosis.
“VA medical centers are conducting extensive outreach to screen all Veterans for any toxin exposures and assess for symptoms. This screening will hopefully identify individuals that might need further testing for any chronic conditions and develop monitoring and treatment plans as early as possible.” Says Dr. Anil Vachani, MD, MSCE, Attending Physician, Philadelphia Veterans Administration Medical Center.
If the VA denied one of the new presumptive conditions in the past, but the Veteran is now eligible for benefits, the VA will try to contact them. The VA is also prioritizing the claims of Veterans with cancer to ensure they get timely access to care and benefits. The act also authorizes 31 new facilities across the country to provide greater access to VA healthcare.
Veterans who may have been exposed to certain environmental hazards during military service can register at either the VA's Environmental Health Registry Evaluations page or the Airborne Hazards and Open Burn Pit Registry.
“There are many aspects of burn pit exposure and its role in causing long-term health effects that are unknown says Dr. Vachani, the PACT Act will allow a broad range of research to help advance our knowledge in this area which will in turn improve how we care for Veterans with this type of exposure.”
Female Veterans also began coming forward about health issues related to their service, said Betsy Tower, senior director of political advocacy and government affairs at GE HealthCare.
"One of the things that comes out of the PACT Act is a five-year strategic plan on toxic exposure research," Tower said. "Women Veterans may be at serious risk of breast cancer detection based on their exposure to burn pits." Although women often start getting mammograms at age 40, if they were exposed to burn pits, they can go into the VA and get screenings no matter how old they are. This is a result of the Dr. Kate Hendricks Thomas Supporting Expanded Review for Veterans In Combat Environments (SERVICE) Act, signed into law on June 7, 2022, which expands toxic-exposure eligibility for Veterans who served overseas. The bill was named after Marine Corps veteran Dr. Kate Hendricks Thomas, a tireless veterans' advocate who passed away from breast cancer on April 5, 2022, at the age of 42. She was relentless in helping her fellow veterans, many of whom, like her, were exposed to burn pits during their military service. The SERVICE Act expands eligibility for clinically appropriate mammography screening to Veterans of any age who served in several locations including Iraq, Afghanistan, and parts of Southwest Asia.
Additionally, under the PACT Act, Veterans will be able to receive care quicker. Prior to the act, a significant number of Veterans were going to the VA to have their condition evaluated for disability, Page said. Now, however, they will be able to go for treatment instead of evaluation.
"You've got a generation of young men and women, some who are as young as 25, who have served and who are going to experience chronic problems from their service," Page said. "Although the need for healthcare today may not be pervasive, we know these cancers are coming. And it's just amazing that our government said, 'We gotcha. We're going to start screening you now, and we're going to put money behind it.''
A Tremendous Opportunity to Serve Veterans Well
On August 10, 2022, when President Biden signed the PACT Act into law, the Senate Veterans' Affairs Committee Chairman, Senator Jon Tester (D-MT) shared, "This is a historic moment that has been months—even decades—in the making. For generations, toxic-exposed veterans have been left to fight our government to get the health care and benefits they have earned. I'm proud to say after today, this fight is over. We are keeping our end of the bargain for promises made to our men and women who served in uniform." Senate Veterans' Affairs Committee Ranking Member, Senator Jerry Moran (R-KS) added, "The PACT Act delivers on a promise made to our veterans that if someone serves in our military, we will take care of them and provide them with the benefits they have earned through their service."
Since the passage of the act, the VA and other Veteran organizations have been reaching out to Veterans with information about the legislation. In January, the VA marked 1 million screenings for military exposures.4 "There is a tremendous opportunity and obligation to serve Veterans well, and to get ahead of the curve of the influx of Veterans coming for care," said Kerry Hurff, marketing director for GE HealthCare.
The VA requested $325 billion for its operating budget for FY2024, an increase of 5.4% from FY2023. "When I see that, what I see is a whole continuum of care for the Veteran," Page said. "I think about cancer research and partnerships with private organizations and industries on one end, all the way through the continuum of buying more mammographies so our wounded Veterans in remote areas can have more breast cancer screening."
Some of the funding would also go toward investing in technology, Page said. Technology investments would allow providers to reach Veterans who can't come into large VA medical centers. Increased funding could allow the VA to invest more to deliver world-class care; it could bring in new technologies which could also attract more physicians, nurses, and other healthcare providers—all with the goal of providing the best possible care for Veterans.
So what are the next steps for the PACT act? Moving forward, the VA will explore a possible link between acute leukemia, chronic leukemia, and multiple myeloma as they pertain to service in Iraq, Afghanistan, Somalia, Djibouti, Egypt, Jordan, Syria, Yemen, Uzbekistan, and all of the Southwest Asia operational theater.
Resources
1. 10 things to know about burn pits. U.S. Department of Veterans Affairs. March 2016. https://www.publichealth.va.gov/docs/exposures/ten-things-to-know-fact-sheet.pdf. Accessed August 1, 2023.
2. Spiva D. The most significant piece of veterans legislation in history. Veterans of Foreign Wars. February 22, 2023. https://www.vfw.org/media-and-events/latest-releases/archives/2023/2/the-most-significant-piece-of-veterans-legislation-in-history. Accessed August 1, 2023.
3. Saintsing M. Gulf War illness symptoms baffled scientists. Until now. Disabled American Veterans. September 29, 2022. https://www.dav.org/learn-more/news/2022/gulf- war-illness-has-baffled-scientists-until-now/#:~:text=While%20combat%20lasted%2043%20days,%2C%20headaches%2C%20fatigue%20and%20insomnia. Accessed August 1, 2023.
4. Department of Veterans Affairs. VA reaches 1 million in military exposure screenings. American Legion. January 4, 2023. https://www.legion.org/veteranshealthcare/257852/va-reaches-1-million-military-exposure-screenings. Accessed August 1, 2023.
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