What is the PACT Act?

The PACT Act is named in honor of Sergeant First Class Heath Robinson, an Army National Guard member who died in 2020 from a rare cancer linked to toxic exposure during his deployment. This act responds to decades of advocacy from veterans who suffered illnesses related to exposure to burn pits, Agent Orange, and other hazardous substances. It is a comprehensive effort to ensure that veterans receive the healthcare and compensation they deserve.

Key Provisions of the PACT Act

The PACT Act aims to make the Department of Veterans Affairs (VA) more accessible and responsive to veterans affected by toxic exposure. Its key provisions include:

1. Expanded Healthcare Eligibility

The act expands VA healthcare eligibility to cover post-9/11 combat veterans, including those who were previously ineligible due to enrollment deadlines. This includes approximately 3.5 million veterans who were exposed to burn pits and other toxins.

2. Presumptive Conditions for Toxic Exposure

One of the most significant aspects of the PACT Act is the establishment of a presumptive service connection for certain conditions. Veterans diagnosed with any of the conditions listed under the act no longer need to prove their illness is directly linked to their military service.

For burn pit exposure, the act recognizes 23 specific conditions, including respiratory issues like asthma and chronic bronchitis, as well as cancers such as brain, kidney, and pancreatic cancer. It also expands the list of presumptive conditions related to Agent Orange, including hypertension and monoclonal gammopathy.

3. Enhanced Toxic Exposure Screening

The VA will conduct regular toxic exposure screenings for all enrolled veterans. This proactive measure ensures early identification of illnesses and a streamlined process for addressing health concerns.

4. Improved VA Resources and Accountability

The act allocates funds to modernize VA facilities, hire additional staff, and improve claims processing times. It also mandates an annual report to Congress to ensure transparency and accountability in how the VA addresses toxic exposure claims.

5. Broader Geographic Coverage

The PACT Act expands the list of locations presumed to have exposed veterans to harmful chemicals, including countries in the Middle East, Southeast Asia, and Africa. This change acknowledges the widespread nature of toxic exposure in modern military operations.

Why is the PACT Act Important?

The PACT Act addresses a systemic issue that has impacted generations of veterans. Burn pits, used extensively during operations in Iraq and Afghanistan, exposed service members to a toxic mix of chemicals from burning waste. Similarly, veterans of the Vietnam War were exposed to Agent Orange, a herbicide later linked to severe health conditions.

Historically, many veterans faced significant barriers in proving their illnesses were service-connected, leading to delays or denials of benefits. The PACT Act removes much of this burden by presuming a link between service and specific conditions. This change ensures faster access to healthcare and financial support for veterans and their families.

What Does This Mean for You?

For millions of veterans, the PACT Act guarantees access to healthcare for those who have suffered silently from the effects of toxic exposure. In theory, it makes the claims process for exposed veterans easier.

The act also benefits surviving family members of veterans who died from presumptive conditions. Spouses, children, and dependents can now receive benefits previously denied due to the lack of a service connection.

What to do to make sure you are eligible for PACT Act related benefits?

If you have never filed a claim for one of the presumptive conditions, but you believe you are eligible, the next steps are:

1. Fill out VA Form 21-526EZ and upload to VA via Quick Submit.
2. Make sure you include any documents showing your diagnosis and current treatment

If you’ve been denied for one of these conditions, please reach out with copies of your denial letters from VA by filling out my intake form. I’ll review them, and if I think you have a case I can represent, I’ll be in touch.

What happens if you become a client?

For each of my clients, I do a comprehensive review of the entire c-file, including service treatment records, VA medical records, VA decisions and more. This is a page by page review (for many veterans the file is thousands of pages long) so it can take a little time.

Once the review is complete, I develop a strategy for your case, then we meet to go over it. While my main work is appeals, if I offer representation I will also represent you on new claims. 

Once the strategy is ready, I write a detailed legal brief with an overview of the medical evidence and submit to VA, then keep you updated on a regular basis on the progress of your claim. Sometimes this includes reaching out to VA raters and other personnel through VA’s internal systems. As an accredited agent, I have access to VA systems and can keep a close eye on your claim and address issues before decisions are finalized.

VA claims can be really complicated. Thousands of pages of regulations. Lots of headaches. But there are steps you can take to make it easier and quicker to get to the right answer with your claim. Here are ten tips on how to make you claim successful. 

• Each issue is separate. Make sure you understand that when VA rates your claim, they generally aren’t looking at you as an overall human being. Instead, they are deciding each “issue” separately. The left ankle is different than the right ankle, even if you have the same symptoms of the same condition on each (there are exceptions to this). 

• Get a copy of your C-File. If you’ve ever filed a VA claim, then VA has a file on you called the “C-File.” That document contains every document that the Veterans Benefits Administration uses to process your VA claim. You can get a copy by filing VA Form 10206. It’s important to know what’s in your C-File – and what isn’t.

• Know the different between the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA).  VHA operates hospitals and clinics and their job is to make sure veterans get the health care they need. VBA, on the other hand, has the job of processing benefits claims. The two entities don’t always talk with each other and don’t always have access to the same data. 

• The “Caluza Triangle.” Make sure you understand what are the three things every VA claim must prove – current condition, an event in service, and the nexus between them. See “The basics of VA Service Connection” for more information.

• Make a plan for each issue. I keep a spreadsheet for each client, where I track: the health condition. Do we have diagnosis/current condition, event in service and nexus? Have a filed for this issue in the past and if so, what is the current status? By tracking each issue separately, it helps keep clear track of what is happening with the claim.

• Notes. For each condition, write down clear notes about what the condition is and how it effects your daily life. It’s important to communicate with VA what it’s like during flareups … when things are at their worst. 

• Know how your condition is rated. For each condition, find out the VA Diagnostic Code and look up how it is rated. Start by getting the diagnostic code (for instance, if you Google “VA Diagnostic Code IBS” the first answer will tell you the diagnostic code is 7319. You can then get the rating criteria by Googling “VA Schedule of Ratings 7319”. This will give you a decent idea, based on your conditions, where your rating might land. It will also tell you clearly if you end up under-rated when you claim is decided.

• Consider all health issues—even the ones without an obvious link to service. Let’s say, for example, you suffer from service-connected PTSD, shoulder impingement and erectile dysfunction. The ED is not service connected. It’s worth asking, however, how your PTSD effects it. Are you taking antidepressant medications that can cause ED? If so, then the erectile disfunction can be service connected secondary to the PTSD.

• Don’t submit appeals without a strategy. Something I see all the time in various Facebook groups for veterans. One vet posts something like “My claim got denied, what should I do?” With no more information than that, other people respond, “Get a buddy statement. File an HLR. File a supplemental. Pay thousands of dollars for a nexus.”  None of those responses make any sense without knowing exactly why the claim was denied. The reason it was denied will be in the rating decision that you get in the mail, and in almost all cases it ties back to the three things you have to prove for every VA claim. 

• Make it easy for the rater to grant your claim. Keep your claim organized and when you submit a new claim, include a separate statement for each issue on that claim.  Because each issue is processed separately, it makes it easier on the rater if you claim is organized and each issue is treated separely. A separate one page statement describing your foot pain, for example, is a lot easier to understand and work with then a 20 page statement describing a lot of different health issues. Make it easier for the rater to find and understand the information they need to grant your claim.

Finally, if you can do it, get a good representative. If it’s your initial claim you can work with any county veterans service officer or service officer from DAV, American Legion, VFW and others. They’re free, and can help guide you through pitfalls that can break your claim.

Not long after the 1991 Gulf War and later Iraq War began, veterans began returning home with a number of mysterious the difficult to treat illnesses. Veterans struggled with fatigue, joint pain, mysterious skin rashes, respiratory issues and high numbers of extremely rare diseases like ALS (better known as Lou Gehrig’s Disease).

Congress passed laws as early as 1994 to ensure that Gulf War veterans received the medical care and compensation they earned. Despite those laws, VA continues to deny Gulf War claims as much as 90{af6e83512be7e3b4cecc791bda27e84cdebe7671cbbd222b753a29df54d2caa8} of the time.  Before you file a Gulf War illnesses claim, it’s important to understand what you are filing. VA doesn’t consider “Gulf War Syndrome” as a term that you can file for – but there are many specific conditions that are presumptive for Gulf War veterans.

Who is considered a Gulf War veteran?

VA defines a Gulf War veteran as:

• Served in active service in Southwest Asia theater of operations after August 2, 1990
• Includes these areas:
  • Iraq
  • Kuwait
  • Saudi Arabia
  • Neutral Zone between Iraq and Saudi Arabia
  • Bahrain
  • Qatar
  • United Arab Ermirates
  • Oman
  • Gulf of Aden
  • Gulf of Oman
  • Persian Gulf
  • Arabian Sea
  • Red Sea
  • Air spaces above these locations

What conditions are presumptive for Gulf War veterans?

There are four main types of health conditions that are considered presumptive for Gulf War veterans. Each of these has their own special requirements. They are:

• Particulate matter exposure conditions (rhinitis, asthma and sinusitis)
• Chronic Multisymptom Illnesses such as Fibromyalgia, chronic fatigue, functional gastrointestinal disorders
• Undiagnosed chronic illnesses
• Endemic disease

Particulate Matter/Burn Pit Exposures

I intend to do another post specifically about burn pit and particulate matter exposures, however the basics are pretty clear. To qualify for service connection for these conditions (as of April 2022) you must have:

• A diagnosis of chronic athsma, rhinitis or sinusitis
• The symptoms or “manifestation” of the illness must have first appeared within 10 years of service
• Served in the Gulf War theater as described above, or in Afghanistan or Djibouti after September 11, 2001.

Note that the House recently passed legislation which will expand benefits for veterans with particulate matter exposure. The Senate has yet to take up a vote. I’ll be sure to post about it when this passes in to law.

Medically Unexplained Chronic Multisymptom Illnesses (MUCMI)

This category of Gulf War related illnesses includes a group of primarily autoimmune type disorders which are diagnosed but have no clear medical explanation. They include:

• Fibromyalgia
• Myalgic Encaphalomyeltis / Chronic Fatigue Syndrome
• Functional Gastrointestinal Disorders including Irritable Bowel Syndrome (IBS), functional dyspepsia, vomiting, constipation, boating, abdominal pain syndrome and dyphagia

For these conditions, they must be a) A minimum of 10{af6e83512be7e3b4cecc791bda27e84cdebe7671cbbd222b753a29df54d2caa8} disabling, and b) must manifest before December 31, 2026.

Undiagnosed Illnesses

Gulf War veterans suffer from a significant number of symptoms which cannot be paired with a clear diagnosis. These can include:

• Fatigue
• Unexplained rashes
• Headaches
• Muscle Pain
• Joint pain
• Neurological Symptoms
• Respiratory Symptoms
• Sleep Disturbance
• Gastrointestinal symptoms
• Cardiovascular symptoms
• Abnormal weight loss
• Menstrual disorders

In order to service connect these conditions, they must be chronic (which means existed for 6 months or more), and the veteran must not have a diagnosis for the condition.

Endemic Diseases

Endemic diseases include certain chronic diseases that are common in Southwest Asia. Most of these conditions must have been manifested or diagnoses within one year of service, but not all. These can include:

• Brucellosis
• Campylobacter jejuni
• Coxiella burnetiid (Q fever)
• Malaria
• Mycobacterium Tuberculosis (no time limit)
• Nontyphoid Salmonella
• Shigella
• Leishmaniasis (no time limit)
• West Nile virus

Statistics show that Gulf War veterans claims are some of the most difficult to get approved, and that VA continues to deny as many as ninety percent of all Gulf War claims. If you have been unjustly denied, please consider requesting a case evaluation to determine if an appeal might help you win your claim.

VA claims can sometimes seem confusing and intimidating – and often are. But for service connection itself, the rules are actually simpler than you would think. 

Service connection simply means that a veteran’s disability was incurred during or aggravated by their military service. In order to prove it, you have to show three things:

1. A current diagnosed disability. Sounds simple? Bottom line is you need to show that you have a current condition that is effecting you today. For example, you might have broken your arm in the military five years ago. But that broken arm isn’t a current disability. A current disability would be arthritis that happened because of the broken arm, or restricted range of motion due to scar tissue. So that’s the first thing. You need a current condition.
2. Event in service. The second thing you need to prove your claim is an event in service. That could be an injury (such as the broken arm I mentioned earlier), an illness, or something else that happened such as a traumatic incident, a hazardous exposure, etc. 
3. Connection (or nexus) between 1 and 2. A nexus is medical evidence (such as a doctors opinion) that the event caused the current disability.

Where it gets tricky is the exceptions or when you have difficulty obtaining evidence or getting recognition–or when VA makes a mistake. For example, when I injured my feet, that was the event in service. But when VA lost my records, there was no evidence of that event.

Except.. there was. What I didn’t know way back in the early 1990s is that my journal and letters home from basic training could also have proven my case. A buddy statement from someone I went through training with could have done the same.

Sometimes the nexus is “presumed.” That can happen, for example, if you a condition is diagnosed while you are still in the military. You didn’t have it when you went in (that’s the “presumption of soundness”, and you did have it on the way out? No nexus needed. It can also be presumed for certain conditions. For example, if you served in Vietnam, it is presumed by law that you were exposed to Agent Orange. If you later get prostate cancer, then (in theory) service connection should be an automatic grant.

If you don’t have a presumed nexus, VA will almost always schedule you for an exam as part of their duty to assist. In most cases these days, that means they’ll send you to an outside contractor such as QTC, LHI or VES, and they will in turn send you to a doctor, nurse practitioner or other medical professional who will conduct your exam on a subcontracting basis. Be prepared for anything here: sometimes you’ll get a quality exam, and sometimes it’ll seem like a nightmare, and you never know what to expect.

In most cases, if your claim is denied it will be because you are missing one or more of those three elements. If you need help with the next steps, feel free to call or request a case evaluation.