The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) marks a significant milestone in provid­ing health care access and funding for military personnel and Veterans exposed to toxic substances, including burn pits, during their service. Chemicals, plastics, human waste, health care waste, and tires are among the items disposed of in burn pits.1 SFC Robinson served in the Ohio Army National Guard where he was exposed to burn pits while serving in Kosovo and Iraq. His exposure to burn pits is believed to have led to him developing lung cancer and a rare autoimmune disorder. He later died in 2020.2 This article aims to shed light on the key provisions of the PACT Act and its importance to both medical clinicians and legis­lative policymakers.

The PACT Act aims to address the health care needs of millions of Veterans who may have been affected by toxic exposures during their military service. The PACT Act allo­cates $797 billion for this purpose.3 Representative Mark Takano (California), Chair of the House Committee on Veterans’ Affairs, introduced the PACT Act, which was later signed into law by President Joe Biden on August 10, 2022.1,4 It brings substantial expansions in health care research, services, and benefits for Veterans exposed to burn pits and other toxic substances.5

In the past, the US Department of Veterans Affairs (VA) has denied nearly 70% of burn pit exposure disability claims.1 The PACT Act has provisions to improve health care access for Veterans exposed to toxic substances by ending the requirement for Veterans to prove that burn pits caused their illnesses and streamlining the claims process.1,5 Retroactive pay may also be available for those who did not receive care after initially claiming disability caused by burn pits.6 Access to VA health care services will be expanded for post-9/11 combat Veterans, extending their enrollment period from 5 to 10 years post-discharge from service.6 The legislation also recognized a connection between US military use of Agent Orange during the Vietnam War and the development of hypertension.7 The PACT Act rec­ognizes Agent Orange exposure for Veterans who served in Johnston Atoll, Guam, Cambodia, Laos, Thailand, and American Samoa during the Vietnam War era.8

Medical clinicians play a crucial role in the implemen­tation of the PACT Act. The act requires regular screening of enrolled Veterans for toxic-exposure-related concerns, enabling early detection and prompt intervention and ulti­mately improving the health and well-being of military personnel and Veterans in North Carolina and beyond.2 Clinicians need to be aware of the presumption of exposure and its connection to service for various chronic conditions based on military environmental exposure.9 This new pro­cess is evidence-based and transparent, allowing for faster policy decisions on crucial exposure issues and enhancing the care Veterans receive.10 Furthermore, the PACT Act emphasizes the need for toxic-exposure-related education and training for VA and non-VA clinicians.5

Veterans Exposure Team-Health Outcomes of Military Exposures (VET-HOME), which is comprised of health pro­fessionals specialized in assessing health effects related to military exposures, was created under the PACT Act.5 Clinicians can collaborate with this team to ensure com­prehensive evaluation and management of Veterans who have concerns about environmental exposure. VET-HOME provides an accessible hub for Veterans as well as VA and non-VA clinicians to obtain information about toxic expo­sures and connect with eligible VA services.9 Through the establishment of VET-HOME and the implementation of regular toxic exposure screenings, the PACT Act will contribute to early detection and intervention for exposure-related health conditions.

Policymakers should recognize the significant impact of the PACT Act in addressing the health care needs of North Carolina military personnel and Veterans. Fort Liberty (for­merly Bragg), Camp Lejeune, Marine Corps Air Stations New River and Cherry Point, and Seymour Johnson Air Force Base are among the major military bases found in North Carolina. While the total US adult population is made up of 6.4% Veterans, North Carolina’s adult population is comprised of nearly 8% Veterans.11 The PACT Act mandates conduct­ing new studies of Veterans who served in Southwest Asia during the Gulf War and analyses of post-9/11 Veterans’ health trends. This research will provide valuable insights into the health effects of toxic exposures, guiding future policy decisions related to Veterans’ health care, which will affect a substantial portion of North Carolina residents.

For North Carolina residents who served on active duty and in the Reserves and National Guard, the PACT Act holds immense significance. Its funding to enhance claims pro­cessing and increase the workforce will contribute to more efficient and accessible health care services for Veterans living in North Carolina. The authorization of 31 new major medical and research facilities across 19 states, with one proposed in North Carolina, will improve the availability of specialized care.10

The PACT Act is a significant step toward honoring the commitment to care for those who have served our country. By providing comprehensive health care access and benefits to Veterans exposed to toxic substances, the act ensures that these brave individuals receive the support they need and deserve. The PACT Act acknowledges the sacrifices made by military personnel and is a crucial measure in deliv­ering prompt help to those affected by toxic exposures dur­ing their service.

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) marks a momentous achievement in delivering critical health care and benefits to military personnel and Veterans exposed to toxic substances during their service. The Act’s provisions enhance health care access, streamline claims processes, and prioritize early detection and inter­vention for affected individuals. As legislative policymakers and medical clinicians, understanding the significance of the PACT Act in improving the lives of Veterans is paramount to its successful implementation. By working together, we can ensure that those who have served our nation receive the support and care they deserve.

Disclosure of interests

The author has no interests to disclose.