WASHINGTON, DC — Now that the first major provisions of the PACT Act went into effect at the beginning of last month, what happens next?
The new law expands VA healthcare eligibility to potentially hundreds of thousands of veterans who have conditions linked to toxic exposure. On Oct. 1, VA began accepting benefits claims for the presumptive conditions included in the bill.
While the bill includes language that phases some of these presumptive conditions in over a number of years, spreading out what VA expects to be a deluge of claims, President Joe Biden ordered VA to speed up the process.
Biden directed VA to accept all presumptive conditions in the bill immediately, including making hypertension a presumptive condition for Agent Orange exposure for Vietnam veterans, which by itself could result in half a million new claims. This will not only accelerate the growing backlog of claims, but put additional pressure on VA to get new claims processors in place as quickly as possible.
Estimates prior to the legislation’s passage put the number of veterans potentially impacted by the bill in the millions. Those eligible include post-9/11 veterans who served in a combat zone after the 1991 Persian Gulf War; served against a hostile force after Nov. 11, 1998 and were discharged between Sept. 11, 2001, and Oct.r 1, 2013; and certain groups of Vietnam-era and Gulf War-era veterans.
Starting Oct. 1, those veterans have a one-year window to enroll in VA healthcare. And on Jan. 1, 2023, VA will begin processing benefits claims.
The department began seeing the impact of the legislation almost immediately after it was signed into law on Aug. 11. The following day, VA experienced the largest number of online disability claims ever filed in a single day. By Sept. 28, there had been over 200,000 total claims—a 21% jump over the previous year. Of those, 70,000 were specifically related to conditions named in the PACT Act.
The new presumptive conditions included in the bill are equally split between cancers and respiratory illnesses linked to toxins that veterans came into contact with during their service. The bill also adds hypertension and monoclonal gammopathy to the list of presumptives for Agent Orange exposure.
There has been conversation at VA about adding hypertension to the list of Agent Orange presumptives since at least 2009, when a federal advisory panel recommended it be included. VA leaders chose not to. The decision came up again several times in the following years as additional evidence strengthened the link between hypertension and exposure to the herbicide. Each time, VA chose not to add the condition to the presumptive list.
When questioned, VA leaders said that the evidence was not as compelling as with other conditions. However, veterans’ advocates were quick to blame cost as the real culprit.
What About Hypertension?
Hypertension is the most common medical condition affecting VA patients and the most common condition affecting older adults. Estimates have placed the cost of paying benefits to Vietnam veterans with hypertension at up to $15 billion over the first 10 years.
In early discussions about what would eventually become the PACT Act, it was unclear whether hypertension for Vietnam veterans would make the cut. When it finally did, the bill’s language had it being phased in on Oct. 1, 2026.
Biden’s decision to include all presumptive conditions immediately means VA might be getting those estimated 500,000 hypertension claims much sooner than expected.
VA officials have admitted that the PACT Act will enlarge the existing claims backlog, putting more stress on an already strained system. But VA Secretary Denis McDonough has assured Congress on numerous occasions that the department has been preparing for this.
“We started, as soon as I got in the chair over a year and a half ago, preparing for something like the PACT Act,” McDonough said at a meeting of the Defense Writers Group last month. “I wouldn’t say that we were preparing precisely for the PACT Act. There were a bunch of different proposals out there at the time. But the president made it very clear to me from the beginning that he thought this issue … was a large piece of unconfronted work.”
VA began intensifying its efforts to automate the claims process and has recently been focused specifically on the newly added presumptive conditions.
“We are still on track to, by the end of this calendar year, have tested and proven automated processes for all of the conditions listed in the PACT Act,” McDonough said.
VA also began hiring claims personnel, approaching Congress in September 2021 about using excess funds from the fiscal year 2021 budget to hire new staff.
“They gave us the go-ahead, and we began that process,” McDonough said. “We’ve hired about 2,094 people now, [but] there’s about a 2-year tail on getting somebody hired, then getting them fully trained, then having them be a fully operational claims reviewer.”
One difficulty VA has encountered during the hiring process–not only for benefits personnel but for its medical facilities, as well—are vacancies in its human resources departments. “We have the lowest ratio of HR professionals per employee in the federal government by a long shot,” McDonough admitted. “[And] the responsibilities our HR professionals have are among the most complicated—Title 5, Title 38 and then hybrid Title 38. We need HR experts who are conversant in, fluent in, all three of those hiring structures. That also, by the way, makes our personnel very desirable for other members of the federal family once they’re up and trained. So one of the reason we have a low ratio of HR professionals per employee is that a lot of our people end up hired away to other federal agencies.”
The PACT Act’s authors included a provision in the bill that requires VA to develop a plan to recruit and retain HR personnel and present it to Congress no later than one year after the bill’s signing.
