XVIII Airborne Corps Main Command Post at “Dragon City” near Dhahran, Eastern Province, Saudi Arabia. Photograph shows the corps historian at work in M-17A1 protective mask during an Iraqi SS-1B SCUD attack in January 1991. (XVIII Airborne Corps photograph DS-F-128-19 by PFC John F. Freund)
WASHINGTON, DC — The VA is experiencing less of a resource crunch this year due to the PACT Act-related surge than previously expected, according to VA Secretary Denis McDonough. He gave the credit to early planning and increased hiring.
McDonough warned, however, that the high point might be yet to come and that outreach efforts in 2024 could significantly increase enrollees before the end of the year.
When the PACT Act was passed in August 2022, significantly expanding benefits and healthcare eligibility for veterans exposed to toxic substances during their service, there was concern from both VA and Congress that the department would not be able to keep up with the expected deluge of new veterans into the system. To prepare the department, the milestone legislation included a number of new hiring provisions that allowed VA to more easily fill open positions in its healthcare facilities, as well as expand its benefits’ workforce, which has grown 25% since 2021.
“Claims are on the high end of what we had hoped,” McDonough said in testifying before the House Appropriations Committee. “Interestingly, the real question for us is when do we peak on the inventory, because the inventory is connected to backlog. … We’re actually beating our assessment on the backlog and the inventory. That’s because we think there was more aggressive enrollment and submission of claims last summer. So what we thought was going to be a series of claims spread out over the course of this calendar year actually got compressed. And because we’ve been able to hire, and hire more quickly, those numbers are coming down fast.”
According to VA, as of March 23, there have been 1.3 PACT Act-related claims. As of last month, there were about 900,000 total claims remaining in VA’s inventory, 330,000 of which were considered backlogged.
“[Backlogged means] they’re over 125 days,” McDonough explained. “Any individual claim will have multiple contentions, so it will not be considered completed until every contention is resolved. Even if a claim has five contentions, and we resolve three and are beginning to pay benefits on those three, we do not consider that closed until we resolve all five.”
At VA’s current rate, McDonough said he expects the backlog to be down to 50,000 by December 2025.
The bigger challenge, McDonough added, is on the medical side, where VA is seeing fewer new veterans enrolling for VA healthcare than expected. Since the legislation passed, VA has seen an estimated 500,000 new healthcare enrollees, about 100,000 of which are PACT Act-related.
“To be honest I think the enrollees are on the low side of what we might have expected,” he said. “We’ll see over the course of this year. Because we are biasing—and there’s some risk in this—toward aggressive outreach.”
In March, the VA opened PACT Act benefits up to all toxic-exposed veterans, compressing what had been a nine-year timeline into one year. This resulted in millions of new veterans who are eligible for healthcare and benefits, but might not know it. To address that, VA has 550 outreach events scheduled across the country during 2024 and McDonough said that number will likely grow.
“The risk there is that we over-enroll veterans,” he warned. “If that’s the case, we may be coming back here to talk about [an increased budget].”
Veterans’ individual experiences applying for service-connected benefits for their medical conditions through the Act have varied, McDonough pointed out. For example, the legislation included provisions for Vietnam veterans exposed to Agent Orange, many of whose claims are now being coming back rated at 0%.
“The PACT Act said if you were a Vietnam vet exposed to Agent Orange, and today you have hypertension, that is now connected to your service,” McDonough said. “The ratings are coming back lower. In many cases, 0% service connected. That’s not meaningless … but it’s surprising on the downside for veterans.”
On the other side of the equation, there has been a 17% increase in the number of veterans who are 100% service connected, he noted.
“This means things like increased access to dental care,” he said. “That’s a real challenge for us. Getting dental chairs and getting dentists.”
Overall, there have been 350,000 new veterans with a service connection added to VA’s roles through last year, McDonough told lawmakers.
“There’s a correlation between reduced suicidality and a relationship with VBA – that’s ultimately in the net interest of veterans as well,” he said. “The challenge as we get more vets into our care is are we in a position to take care of them? So far, the answer is yes, and we’re going to stay on top of that.”
