CONGRESS ENACTS SERGEANT FIRST CLASS HEATH ROBINSON HONORING OUR PROMISE TO ADDRESS COMPREHENSIVE TOXICS (PACT) ACT OF 2022

President Biden signed into law the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022, a comprehensive bill which addresses a wide range of issues relevant to veterans exposed to toxic substances during their service. The PACT Act addresses health care, presumptions of service connection, research, resources, and other matters related to these exposures. Below is a summary of some of the key provisions.

New Presumptions of Service Connection for Toxic Exposed Gulf War and Post-9/11 Veterans

The PACT Act establishes a long list of new presumptions of service connection for veterans who served in certain locations in or near Southwest Asia during specific periods of time. Presumptions of service connection make it easier to win disability claims by eliminating the need for veterans diagnosed with specific disabilities to prove (for example, via a medical opinion) that the disability was caused by their service.

Veterans who qualify for the new presumptions of service connection under the PACT Act include (1) any veteran who served in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the United Arab Emirates, the neutral zone between Iraq and Saudi Arabia, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, or the Red Sea, on or after August 2, 1990; and (2) any veteran who served in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan on or after September 11, 2001. These veterans also do not need to prove exposure to a toxic substance. They are presumed exposed to a list of toxic substances to be developed by the VA.

According to President Biden and VA Secretary McDonough, all the new Gulf War and post-9/11 presumptions established under the PACT Act became effective on August 10, 2022. As such, below are the conditions that are now presumed service-connected under the PACT Act:

Medical Conditions Qualifying For Presumptive Service Connection

Under The PACT Act  (As of 8/2022)

New Groups of Veterans Considered to Have Participated in “Radiation Risk Activities”

Before the passage of the PACT Act, many veterans who participated in “radiation-risk activities” were entitled to presumptive service connection for certain cancers. Some of these “radiation-risk activities” include onsite participation in a nuclear test and participation in the occupation of Hiroshima or Nagasaki at any time from August 6, 1945 to July 1, 1946. The PACT Act adds several more “radiation-risk activities” to the list, including:

1. The cleanup of Enewetak Atoll during the period from January 1, 1977 to December 31, 1980;
2. Onsite participation in the response effort following the accidental release of four thermonuclear weapons near Palomares, Spain during the period from January 17, 1966 to March 31, 1967; and
3. Onsite participation in the response effort following the accidental release of four nuclear weapons near Thule Air Force Base, Greenland during the period from January 21, 1968 to September 25, 1968.

New Groups of Veterans Who Qualify for the Presumption of Exposure to Toxic Herbicides/Agent Orange

Before the passage of the PACT Act, the VA presumed that any veteran who served in certain designated areas was exposed to Agent Orange, without regard to whether or not the veteran could prove such exposure. For example, veterans who served in Vietnam have long been presumed by the VA to be exposed to Agent Orange. The PACT Act expands the areas of service which qualify for this presumption of exposure. They now include:

1. Vietnam during the period from January 9, 1962 to May 7, 1975 (which was previously recognized as qualifying for the presumption of exposure);
2. Thailand, at any US or Royal Thai base, during the period from January 9, 1962 to June 30, 1976.This does not include service in Thailand’s territorial waters, but does include service on a ship that called at a Thailand coastal base;
3. Laos, during the period from December 1, 1965 to September 30, 1969;
4. Cambodia at Mimot or Krek, Kampong Cham Province, during the period from April 16, 1969 to April 30, 1969;
5. Guam or American Samoa, or their territorial waters, during the period from January 9, 1962 to July 31, 1980; or
6. Johnston Atoll or a ship that called at Johnston Atoll during the period from January 1, 1972 to September 30, 1977

These presumptions of exposure go into effect for all veterans on August 10, 2022.

New Diseases That Qualify for Presumptive Service Connection Based on Their Association with Agent Orange Exposure

Before the PACT Act, the VA provided presumptions of service connection for many diseases experienced by veterans exposed to Agent Orange. These conditions included (1) bladder cancer, (2) hypothyroidism, (3) chloracne, (4) soft-tissue sarcomas, (5) non-Hodgkin’s lymphoma, (6) porphyria cutanea tarda, (7) Hodgkin’s disease, (8) respiratory cancers, (9) multiple myeloma, (10) prostate cancer, (11) type 2 diabetes, (12) chronic B-cell leukemias, including CLL and HCL, (13) AL amyloidosis, (14) ischemic heart disease, (15) Parkinson’s disease, (16) Parkinsonism, (17) early-onset peripheral neuropathy, (18) spina bifida in children of exposed veterans, and (19) certain birth defects in children of exposed female veterans.
The PACT Act adds two more conditions to that list: (1) hypertension and (2) monoclonal gammopathy of undetermined significance (MGUS). These presumptions went into effect immediately upon passage of the Act, on August 10, 2022.

Health Care Benefits

The PACT Act also expands VA health care benefits for specific categories of toxic-exposed veterans and veterans supporting certain overseas contingency operations.As of March 5, 2024, VA expanded access to healthcare (hospital care, medical service, and nursing home care) under Priority Group 6 for the following three categories of veterans:

1. Those who participated in a “toxic exposure risk activity” while serving on active duty, active duty for training, or inactive duty for training. A toxic exposure risk activity can be an activity which is recorded in an exposure tracking record system (such as the Individual Longitudinal Exposure Record (ILER)) for the veteran, or simply whatever the VA determines is a “toxic exposure risk activity.” 
2. Those who served in certain locations during specific periods of time, including, for instance, Iraq, Kuwait, Saudi Arabia, and Qatar on or after August 2, 1990, or Afghanistan, Djibouti, Egypt, or Jordan on or after September 11, 2001. 
3. Those who were deployed in support of a specific contingency operation. 

The PACT Act also expands the period of enhanced eligibility for VA health care for certain combat veterans. To be included in this expansion of benefits, a veteran must meet two criteria. First, he or she must have served on active duty in a theater of combat operations during a period of war after the Persian Gulf War, or in combat against a hostile force during a period of hostilities after November 11, 1998. Second, he or she must have a discharge/release date after September 11, 2001 (previously January 27, 2003). For these veterans, the Act expands the period of eligibility for hospital care, medical services, and nursing home care for any illness from five years following discharge to ten years following discharge. Furthermore, if the veteran was discharged/released from active service after September 11, 2001 but before October 1, 2013, and has not yet enrolled to receive these services, the PACT Act also creates a one-year eligibility period, from October 1, 2022 to September 30, 2023, during which such combat veterans can enroll to receive hospital care, medical services, or nursing home care for any illness.

Framework for Future Presumptions

The PACT Act also establishes a new framework for the VA to use to determine whether new presumptions of service connection related to toxic exposures should be established in the future. Under the framework, a VA working group will develop each year new recommendations as to whether any conditions should be added or subtracted from list of conditions that are presumptively service connected. The VA Secretary will then evaluate these recommendations and decide whether to establish to modify any presumption, and the public will be given an opportunity to comment on these decisions before they become final. DIC claimants will be entitled to an effective date for benefits retroactive to the date of their prior claim, or to the first day of the month in which the veteran’s death occurred, if the claimant had filed his or her claim within a year of the death.