The PACT Act of 2022

Update; 12/22/2022

Below is a .pdf with guidance from VA's Central Office (VACO) on all VBA offices regarding the processing of PACT Act claims;

8/10/2022:

From an Anonymous RVSR at VA;

PACT Act became law on 8/10/22. 
  
The PACT Act will bring these changes:
·         Expands and extends eligibility for VA health care for Veterans with toxic exposures and

          Veterans of the Vietnam, Gulf War, and post-9/11 era
·         Adds more than 20 new presumptive conditions for burn pits and other toxic exposures
·         Adds more presumptive-exposure locations for Agent Orange and radiation
·         Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health

          care
·         Helps us improve research, staff education, and treatment related to toxic exposures
 
Note website: https://www.va.gov/resources/the-pact-a ... -benefits/

Gulf War, Agent Orange and radiation exposure.

Gulf War and post 9/11;
20 burn pit and other toxic exposure presumptive conditions based on the PACT Act. This change expands benefits for Gulf War era and post-9/11 Veterans.

Presumptive exposure to burn pits;

On or after August 2, 1990, in any of these locations:
·         Bahrain
·         Iraq
·         Kuwait
·         Oman
·         Qatar
·         Saudi Arabia
·         Somalia
·         The United Arab Emirates (UAE)
·         The airspace above any of these locations

On or after September 11, 2001, in any of these locations (in addition to the above):
·         Afghanistan
·         Djibouti
·         Egypt
·         Jordan
·         Lebanon
·         Syria
·         Uzbekistan
·         Yemen
·         The airspace above any of these locations

These cancers are now presumptive if pre-requisite service from any of the above locations are established :
·         Brain cancer
·         Gastrointestinal cancer of any type
·         Glioblastoma
·         Head cancer of any type
·         Kidney cancer
·         Lymphatic cancer of any type
·         Lymphoma of any type
·         Melanoma
·         Neck cancer
·         Pancreatic cancer
·         Reproductive cancer of any type
·         Respiratory (breathing-related) cancer of any type

These illnesses are now presumptive if pre-requisite service from any of the above locations are established:
·         Asthma that was diagnosed after service
·         Chronic bronchitis
·         Chronic obstructive pulmonary disease (COPD)
·         Chronic rhinitis
·         Chronic sinusitis
·         Constrictive bronchiolitis or obliterative bronchiolitis
·         Emphysema
·         Granulomatous disease
·         Interstitial lung disease (ILD)
·         Pleuritis
·         Pulmonary fibrosis
·         Sarcoidosis

Agent Orange Exposure;
 
2 new conditions added to the list of presumptive conditions:
·         High blood pressure (also called hypertension)
·         Monoclonal gammopathy of undetermined significance (MGUS)
 
5 new locations to the list of presumptive locations:
·         Any U.S. or Royal Thai military base in Thailand from January 9, 1962,   through June

          30, 1976 
·         Laos from December 1, 1965, through September 30, 1969
·         Cambodia at Mimot or Krek, Kampong Cham Province from April 16, 1969, through April

          30, 1969
·         Guam or American Samoa or in the territorial waters off of Guam or American Samoa

          from January 9, 1962, through July 30, 1980
·         Johnston Atoll or on a ship that called at Johnston Atoll from January 1, 1972, through

          September 30, 1977
 
Radiation Exposure;

3 new response efforts to the list of presumptive locations:
·         Cleanup of Enewetak Atoll, from January 1, 1977, through December 31, 1980
·         Cleanup of the Air Force B-52 bomber carrying nuclear weapons off the coast

          of Palomares, Spain, from January 17, 1966, through March 31, 1967
·         Response to the fire onboard an Air Force B-52 bomber carrying nuclear weapons

          near Thule Air Force Base in Greenland from January 21, 1968, to September 25,

          1968

 
Claim processing notice to the field; as of August 10, 2022
 
Districts,
 
Please disseminate the guidance below to all ROs, including DROCs. OAR will release Higher Level Review guidance to the DROCs separately.
 
On August 10, 2022, the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022 was signed into law by President Biden.  VBA is already seeing an influx of claims associated with the Public Law.  Interim guidance regarding specifics of the Public Law and how it affects VBA claims processing, along with how to handle these claims in the Regional Offices, will be disseminated soon.  In the interim and effective immediately to ensure claims are not prematurely denied, any associated claims should be handled as follows:
 
1.    When a claim is received and it is related to one of the areas of the PACT Act, add VACO

       Special Issue 1 upon claims establishment or when the exposure contention is identified.
2.    Initiate development to include gathering records and/or ordering an examination for the

       specific exposure conditions under existing procedures.
3.    Once the claim is determined to be Ready for Decision, and the claim can be granted on

       any authority other than the PACT Act Public Law, grant the claim under current authority

       criteria (e.g., direct or secondary service connection).
4.    If the claim cannot be granted under any authority other than the PACT Act Public Law,

       process any additional contention(s) or issues unrelated to the exposure and continue the

       end product. Do not defer the entire claim and do not enter a deferral into VBMS for

       the unactionable contention(s).

·         If a claim cannot be decided without consideration of PACT Act guidance, use the claim

          status drop down to return the claim from RFD to open status. Do not use the deferral

          functionality. Proceed to Step 5.
·         If a partial rating can be completed, proceed with the decision(s) and insert a code sheet

          note to continue the end product at authorization. Do not enter a deferral for the

          unactionable PACT contentions. Proceed to Step 5 after authorization is completed on

          the partial rating. Failure to do so will prompt premature recall and hold by the National

          Work Queue (NWQ).

         Note:

•       If a partial rating would result in only denials, use the claim status drop down to    return the claim from RFD to open status. Do not issue the partial decision and do not use the deferral functionality.·         Claims for presumptive service connection for asthma, sinusitis, rhinitis under 38 CFR 3.320 regulatory provisions are currently being processed through the Claims Processing Automation model. If the claim cannot be granted under existing regulatory provisions, hold the claim using guidance provided above.

5.   Apply NWQ Review Project #4 to the exposure contention(s) or survivor claim if that is the

      only contention(s) remaining, and no additional action can be taken on the claim. VACO

      Special Issue 1 should remain on the claim.  This will facilitate automated recall to the NWQ

      to hold the claim pending further guidance.

Note: For claims for service-connected death benefits, VA claims processors should apply

          the above guidance for any claim where:
·         the Veteran’s service falls into one of the expanded exposure populations and there

          is evidence to indicate the Veteran’s death was caused by or is secondary to one of

          the existing or newly established presumptive conditions associated with that toxic

          exposure,
·         there is evidence indicating that the principal or contributory cause of the Veteran’s

          death is, or is secondary to one of the newly established presumptive

          conditions and the Veteran’s service meets the current or expanded exposure

          population criteria associated with the presumptive condition(s),
·         has a specific allegation of eligibility under the PACT Act, or
·         otherwise raises a question as to whether PACT Act may affect eligibility. 

6.   For DIC, reevaluation of previously denied claims must be elected, by the claimant, which

      can result in retroactivity. These unique claims must be identified separately from ‘new’

      PACT Act claims by adding VACO Special Issue 6 upon claims establishment or when

      otherwise identified.