Implementing the PACT Act is veterans’ next battle

Veterans clinched a victory after the Senate passed a bill that would expand medical coverage for former service members with toxic exposures.  

But after a long fought battle with no shortage of last-minute drama, their work is far from over.  

The Department of Veterans Affairs (VA) must now implement the legislation efficiently amid concerns of the department’s poor track record and existing backlogs. 

President Biden is expected to sign into law the Sgt. First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act on Wednesday, which will expand access to VA health care and benefits for veterans who were exposed to toxins during war. 

The VA is already encouraging veterans to apply for benefits. But moving forward, veterans service organizations and other experts say the department will have to buckle down if it wants to implement the legislation as smoothly as possible.  

“What this bill is authorizing is the core mission of what the Department of Veteran Affairs is there for and should be doing,” said David Shulkin, who served as VA secretary from March 2017 through February 2018. 

“That means that the VA should be prioritizing taking care of these particular veterans. And when the agency or any organization has finite resources — which every organization has, even the US government — it requires that you prioritize what you’re working on,” he continued. 

Shulkin said if he were still running the agency, he would personally take responsibility to ensure that it gets implemented smoothly. 

“In the agency as big as the VA, what I found was that one thing that leadership can do is be clear about its priorities, and when that happens, great things can happen in this organization,” he said. 

 “Now, there are a lot of competing priorities. But because this is a group of people that for whatever reason, we have been making wait — literally for decades, in many cases —I believe that gives them the right to be prioritized.” 

The PACT Act seeks to expand VA benefits eligibility to more than 3.5 million veterans who were exposed to toxins during their military service — including illnesses resulting from exposures to toxic burns and Agent Orange. 

It also adds 23 conditions to the department’s list of presumptive illnesses, meaning that veterans don’t have to prove that their illness was due to military service. 

But despite passage of the bill, some Republicans raised concerns with how the VA will go about implementing the legislation. 

Sen. Cynthia Lummis (R-Wyo.) tweeted that there were 168,000 veterans “waiting in line” for care, and that the number would spike to one million with the PACT Act.  

Patrick Murray, director of national legislative service at Veterans of Foreign Wars, said that while the department is dealing with a backlog of claims, this alone should not be a reason against the legislation. 

“Veterans would rather stand in line than not have a line at all,” Murray said. “And if they don’t want to do anything for veterans until we get rid of a backlog? Then we will never do anything for veterans, period.” 

Cory Titus, director of Veteran Benefits and Guard/Reserve Affairs for the Military Officers Association of America, noted that the measure would increase the VA’s workload, but the legislation is written in a way where certain provisions are phased in over time. 

“They slowly turn on the faucet and start off with smaller population groups that will allow VA to kind of build into it,” Titus said. “And while they’re doing that VA has a simultaneous track where they’re working on adding people to help with the claims process.” 

But there are other concerns with how the legislation will be implemented once it is signed into law. 

Sen. James Lankford (R-Okla.) said he was concerned the bill would limit access to outside physicians should veterans seek care outside the VA. 

John Berry, a veteran’s attorney based in Nebraska, said that some are concerned with how quickly claims will be processed. 

“The VA has done great things over the years to improve that speed. But a veteran will file a claim and sometimes they will not provide sufficient evidence and then they have to appeal the claim. And they can be in a cycle where it takes years to get the benefits that they’ve earned,” Berry said. 

“And usually that’s where we get involved where the veteran gets denied and the veteran doesn’t understand why the evidence that they submitted is not good enough,” he continued. 

The White House on Tuesday boasted that the VA has already granted 25,000 veterans and their survivors benefits for asthma, rhinitis and sinusitis based on presumptive exposure to particulate matter. 

The department has also launched VET-HOME, a network of providers who will conduct patient assessments on military exposures, and expects to have a fully operational call center by January to help veterans concerned about environmental exposures. 

The language of the PACT Act also aims to expand the VA’s capacity to handle the influx of claims.  For instance, it invests in VA claims processing, hiring more personnel to help the agency better handle the load, as well as investing in 31 major clinics and research facilities in 19 states. 

Moving forward, advocates say the most important thing the VA can do to implement the legislation smoothly is to communicate with veterans about the benefits they may qualify for and to set expectations. 

The agency has already established a webpage answering questions about who qualifies for benefits under the legislation.  

“There should be an immediate call to action for veterans to file their claims for the VA to process those claims expeditiously, and for the VA hospitals and benefits system to be ready for an influx of patients,” said Ret. Army Lt. Col. Beth Kubala, who serves as executive Director of the Betty and Michael D. Wohl Veterans Legal Clinic (VLC) at the Syracuse University College of Law 

“The VA is a large federal entity, and it handles medical care, benefits and a whole host of resources for our nation’s veterans. And I think implementation of the PACT is going to have to cause the VA to mobilize all the parts of its agency to support a smooth implementation of this,” she continued.  

Congressional oversight will also be critical to ensuring the bill is implemented as smoothly as possible, advocates say. This could take the form of public hearings and regular reporting. 

But Tom Porter, executive vice president of government affairs for Iraq and Afghanistan Veterans of America, says that veterans’ service organizations also play a role in oversight.  

“We don’t just wash our hands of it. We have a role where we have to partner essentially with the VA and with Congress to be advocates for what we just asked for,” Porter said. “When Congress moves too slow, and when the VA moves too slow, then we need to push them.”