VA's PACT Act Management Could Use Lessons from 9/11 First Responders Legislation, Rand Says
The Department of Veterans Affairs should be concerned about the lack of input from veterans and family members in decisions related to the PACT Act, as well as the absence of strong scientific processes to determine new presumptive conditions, analysts with a California-based think tank said Tuesday in a new report.
But the VA could find potential fixes in legislation passed to aid 9/11 responders and survivors who were exposed to environmental hazards after the terrorist attacks in 2001, Rand Corp. said in the report. Those earlier laws included beneficiaries in decisions and mandated robust research.
The PACT Act expanded VA health care benefits for millions of veterans who deployed overseas, and it designated nearly two dozen categories of illnesses as connected to military service, giving ill veterans expedited access to disability claims compensation.
The law also directed the VA to establish criteria for determining which conditions should automatically be considered linked to military service, and it funded new health and exposure research studies at the department.
It is those requirements that Rand researcher Ramya Chari and her colleagues say the VA should pay closer attention to. And to do that, VA officials should look to the legislative precedent set in the wake of the terrorist attacks on the World Trade Center.
Chari said the James Zadroga 9/11 Health and Compensation Act, which acknowledged links between medical conditions and environmental hazards at the site, as well as later legislation for 9/11 victims contained specific requirements for including survivors and family members in the decision-making process and establishing rigorous research and scientific collaboration on exposures.
The PACT Act, the Rand analysts said, does not include strategies for meaningful involvement in the process by veterans and others who have a stake in decisions. The VA's system for deciding new presumptive conditions also appears to lack the scientific research base needed moving forward, the report noted.
"It is unclear whether the [VA's] working groups have the necessary expertise to rigorously evaluate the scientific evidence on the range of conditions they are asked to consider," the analysts wrote, citing the National Academies of Sciences, Engineering and Medicine.
On the other hand, the World Trade Center Health Program was required to have responders and survivors on three key committees involved in governance and also had a broad research mandate to improve understanding and treatment of related medical conditions.
"VA has an opportunity to learn from prior initiatives, like the [World Trade Center Health Program initiatives], that have been contributing to the evidence base, fostering scientific collaboration, and engaging stakeholders in decision-making, prioritizing, and navigating the difficult trade-offs inherent in any program that relies on eligibility determinations," the report said.
The VA has received criticism this year for its ongoing deliberations over including a lung disease, constrictive bronchiolitis, thought to be caused by exposure to burn pits, to its list of presumptive conditions, and for its standards for awarding disability ratings to Vietnam veterans for high blood pressure linked to Agent Orange exposure.
Senate Democrats wrote VA Secretary Denis McDonough on April 15 urging the department to expedite changes to its regulations regarding the two illnesses.
"Toxic-exposed veterans have waited decades to receive the benefits and recognition the PACT Act provides, and we appreciate VA's efforts to implement the largest expansion of VA health care and benefits in decades," wrote 18 senators, including Senate Veterans Affairs Committee Chairman Sen. Jon Tester of Montana. "While more than 720,000 veterans and survivors have received PACT Act benefits, there are too many whose PACT Act claims have been wrongfully denied or underrated."
As of early April, the VA had processed nearly 1.2 million PACT Act-related claims and approved 896,899. It also has enrolled 284,000 veterans under PACT Act eligibility in VA health services and screened more than 5.38 million veterans for hazardous exposures.
The Rand report noted that the VA has not released data on the health outcomes or care received by screened veterans.
During a press conference in March, McDonough cited the data on PACT Act enrollment and claims approvals and said the legislation has allowed the department to help more veterans than ever.
"If there are veterans ... who feel like they're exposed and are now suffering those conditions, please come file a claim and let us do the work on establishing where you were," McDonough said.
Rand warned that the VA should act now to shore up its programs and prepare for future veteran claims as it shoulders the current demands of the PACT Act.
"Without a robust, sustainable strategy for determining eligibility for VA benefits, there is a risk that service members and veterans who are at risk of health consequences from currently unknown or understudied exposures could be left behind," the researchers wrote in the report.
