When retired Command Sgt. Maj. Jim Richardson first deployed to Afghanistan in 2009, he had to register for burn pit exposure. 

Burn pits, the open air trash disposals used in U.S. military sites throughout the Middle East, can cause a variety of respiratory illnesses, including cancers. (The military has not banned the practice but uses them much more rarely now.) But Richardson, who retired after 35 years in the Nevada Army National Guard and now lives in Reno, said nothing ever came of the registry, even though he later developed respiratory issues including chronic obstructive pulmonary disease (COPD) and mild asthmatic symptoms.

But that changed this year, when he was able to claim health care benefits under the Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022, a bill considered to be the largest expansion of veterans’ health care and benefits in a generation.

The bill extends health care coverage to veterans who were exposed to Agent Orange, burn pits and other forms of toxic exposures during their military service and makes over 20 conditions associated with toxic exposure “presumptive,” meaning veterans don’t have to spend time proving their disability is a result of their service when applying for Department of Veterans Affairs benefits or health care. 

Rather, a diagnosis of these conditions — which include more than a dozen types of cancers and illnesses such as asthma, chronic bronchitis and sinusitis — are now automatically assumed to be due to a veteran’s military service, qualifying them for free VA health care and medications to treat those conditions.

Before the PACT Act, the VA denied 70 percent of disability claims related to burn pit exposure, according to the Associated Press. 

From the bill’s passage on Aug. 10, 2022, through October 13, 2023, the VA received 15,125 PACT Act claims from veterans in Nevada, representing 42 percent of all claims in the state over that time period. More than 5,000 veterans have enrolled in VA care in Nevada since passage.

[See the list of presumptive conditions and which service locations and time periods they correspond to here.]

Richardson learned that his respiratory conditions were now covered under the PACT Act. All veterans who served in Afghanistan after 9/11 or a host of other Middle Eastern nations after the Gulf War were now designated as having presumptive exposure to burn pits — making them eligible for coverage of the types of respiratory conditions that Richardson is managing. Having served in Afghanistan, Kuwait, Iraq, Qatar and other eligible nations, Richardson filed a new claim.

After a processing time that he described as “pretty quick” compared with other filings, he learned the VA would cover treatment related to his COPD and asthmatic symptoms. Between the VA hospital in Reno and a secondary community provider, he’s been able to receive regular examinations and coverage. 

“The VA gets a bad rap sometimes, but the VA here in Reno is fantastic,” he said. “All I’ve ever asked is for them to take care of me, because I took care of them for so long.”

How the PACT Act works

The PACT Act, which veterans’ groups fought hard for on Capitol Hill (including sleeping on the Capitol steps until the bill passed), is streamlining care for veterans including Richardson, saving them money and frustrating odysseys through bureaucracy. It was a priority for President Joe Biden, whose son Beau died of brain cancer in 2015 — a fate Biden believes might be due to burn pit exposure during his service in Iraq.

The bill passed in August 2022, giving veterans a year to file PACT Act claims. It passed with strong bipartisan majorities in both chambers after initially failing to win Republican support in the Senate.

Sen. Jacky Rosen (D-NV) sits on the Senate Armed Services Committee and has held a number of veteran-focused events in Nevada this year, encouraging veterans to claim their benefits. She said the number one issue she hears about from veterans is their health care.

“They’re proud [of their service],” she said in an interview. “And they just want to transfer that pride and the skills that they used to the workforce and of course get the care that they need.”

Nationally, the VA has received more than 1.1 million PACT Act claims, and completed more than 600,000. It has conducted more than 4.6 million toxic exposure screenings. 

Denise Estes, a department service officer at the Reno branch of Veterans of Foreign Wars, said the act has “worked wonderfully” for veterans of the Vietnam War who were exposed to Agent Orange and who now suffer from hypertension (now a presumptive condition) and veterans who served in the Gulf, Afghanistan and Iraq who had burn pit exposure and now face a number of related cancers, lung and sinus problems. 

Many Vietnam veterans have had high blood pressure “forever,” Estes said, meaning its inclusion as a presumptive condition now means those veterans can get their medication covered. Hypertensive vascular disease has been the most frequently claimed condition under the PACT Act nationally, with the VA granting benefits to 77 percent of those claims.

The next three most frequently claimed conditions are all respiratory — allergic rhinitis, maxillary sinusitis and bronchial asthma — and are now presumptive for veterans of Middle Eastern wars with burn pit exposures. 

“Before, they had to have been in a certain place for burn pits [to apply],” Estes said. “Now they realize everyone in the Gulf was exposed.”

To receive VA coverage without a co-pay for a condition connected to a veteran’s military service, their “disability rating” must be at least 50 percent. Estes said for many veterans whose rating was at 40 percent, the conditions outlined in the PACT Act pushed them up to the 50 percent threshold, qualifying them for free health care. 

Because the benefits are also backdated to Aug. 10, 2022, veterans who filed PACT Act claims could get compensated for health care they had paid for over the year between passage and the claim deadline, tax-free.

Richardson was able to get compensation for his asthma and COPD-related health care costs between August 2022 and 2023.

Veterans enrolled in VA health care can also receive a toxic exposure screening, and are encouraged to receive follow-up ones every five years. 

Outreach efforts

Dr. Monica Rawlinson-Maynor, the chief of administrative medicine at the VA of Southern Nevada Health Care System, has been leading PACT Act outreach efforts in Southern Nevada.

The VA offers weekly classes at the North Las Vegas VA Medical Center to go over PACT Act conditions and walks veterans through how to file additional claims. 

The VA is also trying to actively reach veterans who don’t come into the medical center for care but are in the Southern Nevada enrollment area, calling veterans to sign them up for toxic exposure screenings to identify potential toxins and refer them to resources. And they’ve also reached out to social workers and homeless veterans’ groups.

Rawlinson-Maynor said the department is also working with VA hospital units that she suspects have patients that will qualify for PACT Act benefits.

“We are looking at specific areas that are pulmonary, because we know that a lot of people may be presenting with asthma symptoms,” she said. “We want to look at our oncology areas, because we have veterans that may be diagnosed with cancers, and we have some presumptive cancers associated with toxic exposure.”

Estes said in Reno, the VA regional office has been “stellar.” 

“I have guys come up and tell me all the time tell me how easy the process was,” she said.

Next steps

Moving forward, Richardson wants to see more engagement with rural veterans, who tend to be older and often served in Vietnam. 

And Rep. Dina Titus (D-NV) wants to ensure that veterans exposed to radiation at the Nevada Test Site can also receive presumptive benefits. 

Having served at the Nevada Test Site is not considered a presumptive location; veterans must prove they were exposed to a certain dose of radiation to receive presumptive benefits for various cancers or other illnesses that may have come from their service.

Titus introduced a bill in July to make the Nevada Test Site a presumptive location for associated pulmonary issues and provide compensation for care to those veterans, though it has not received a vote.

Rosen said moving forward, she’s hoping to expand telehealth options for rural veterans and ensure no groups seeking care are left behind.

“We’re going to be sure that every veteran gets the care they need,” she said.