On Aug. 10, 2022, President Joe Biden signed into law one of the largest healthcare and benefits expansions in American history: the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, or the PACT Act. In response to military members’ exposure to toxic burn pits and other environmental hazards during their service, the law expands Veterans Affairs Department healthcare eligibility and benefits to a significant number of veterans of the Vietnam War, Gulf War and post-9/11 eras.
Private-sector health systems also play a critical role in caring for and engaging with the more than 18 million veterans of the U.S. armed forces. Under the law, hospitals, health systems, other provider organizations and the VA can provide more care to more veterans than ever before.
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In the Vietnam and post-Vietnam eras, service members have been exposed to toxic substances in many locations. For years, the VA, the Defense Department, Congress and others have worked to understand the downstream health consequences of agents of biological warfare and toxic burn pits.
In Iraq, Afghanistan and other parts of the Southwest Asia theater of military operations, open-air combustion of trash and other waste in burn pits was a common practice. Products burned in these toxic landfills included plastics, paints, solvents, munitions, jet fuel, medical and human waste, without the use of protective equipment designed for these operations. In 2007, some military installations reported burning up to 200 tons of such waste daily. While determining the health impact of aerosolized waste is challenging, an influential 2011 report from the National Academies of Sciences, Engineering, and Medicine suggested links between burn pits and various respiratory and neoplastic diseases. Since then, the VA has focused extensive resources on research aimed at better understanding these connections.
The PACT Act expands access to VA healthcare coverage to veterans exposed to these toxic substances. First, it extends the window for certain combat veterans to apply for benefits. It provides what are known as presumptions of service connection to more than 20 categories of respiratory and neoplastic diseases for veterans who served in certain locations. By presuming service connection, veterans who served in these locations will be eligible for expanded healthcare access regardless of whether they have one of the conditions.
To ensure the VA identifies every veteran who may have been exposed to toxic substances, the law requires that all those enrolled in the VA healthcare system are offered screening for toxic exposures. Of the millions of screenings performed to date across the VA system, over 40% of veterans reported having a possible toxic exposure during their military service. The PACT Act also gives the VA broader authority regarding staff hiring, recruitment and retention, as well as allowing the department to expand its brick-and-mortar clinical footprint.
As the VA looks toward the future of caring for veterans, myriad opportunities exist for clinicians and healthcare leaders in the academic and private sectors to support the agency’s efforts to maximize the benefits of the PACT Act. Some examples:
- Ask patients if they served in the military. If they did, tell them about the PACT Act. Veterans are a unique population, often with specific healthcare needs due to their service time. Determining if they served in the military can provide needed context for their care, especially regarding risks related to environmental exposures and mental health issues. Private-sector health systems and other providers can play a vital role in improving veterans’ access to services by referring them to their local VA medical center or regional benefits office. Staff at these offices can then determine any additional services veterans may qualify for or require. Assistance is also available by referring veterans to va.gov/PACT for more information.
- Participate in research involving veterans’ toxic exposures. The VA’s research enterprise offers opportunities for collaboration with academic affiliates on the risks of environmental hazards. One example is the Million Veteran Program, a national research initiative that aims to understand how genetics, lifestyle and military toxic exposures can affect health and lead to illness over time. The VA also manages large registries that examine the relationship between toxic exposures and clinical outcomes among hundreds of thousands of veterans—a rich data set that will inform care for veterans and the general population for generations to come. Private organizations can encourage veterans to participate in research studies. The VA is also interested in partnering with nongovernmental and academic organizations to conduct high-impact research.
- Take advantage of expanded leasing authority for academic affiliates. Under the PACT Act, the VA has broader authority to enter into non-competitive leasing agreements with academic partners for the provision of healthcare to veterans. These agreements allow the VA to share space with academic medical centers and create collaborative work environments. The department seeks opportunities to work with leading academic institutions on research, clinical care and training the next generation of clinicians. Multidisciplinary care, in collaboration with academic affiliates, will only broaden the choices available to veterans.
- Serve veterans by working at VA facilities. VA staff members are committed to meeting the healthcare needs of millions of veterans. The PACT Act strengthens the department’s ability to recruit and retain top clinical and nonclinical talent. The VA has greater flexibility than ever to offer more competitive wages, bonuses and far-reaching student loan repayment. It also is investing in infrastructure expansions to add more services in many parts of the country.
We have all benefited from the service and sacrifice of our veterans. The PACT Act provides a once-in-a-generation opportunity for the healthcare community to help those who have served this country. The law expands access to healthcare coverage for more than 20 broad categories of health conditions that are associated with toxic exposures, of which more than 400 individual diseases are now covered. Through the dramatic increase in covered conditions, expansion of the VA’s workforce and infrastructure, and ongoing research involving toxic exposures, the PACT Act will improve and save lives for decades to come.
