Rachel Sauer, writing for the University of Colorado Cancer Center at the UC School of Medicine / Anschutz Medical Campus, reports that the PACT Act which went into effect at the beginning of 2023 enables many U.S. veterans to access benefits for an expanded list of health conditions presumed to be caused by exposure to toxic substances. This is particularly true for several head and neck cancers.

The PACT Act is the short name for The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act. Among the “toxics” PACT addresses are exposures to airborne hazards resulting from burn pits, but it is not limited to those. Under the Act, a number of conditions and cancers are presumed to be a result of military service. With PACT, says Sauer, “any type of head cancer and any type of neck cancer now is considered presumptive, as well as several other types of cancer.” She notes that in some cases, veterans are being seen with multiple different cancers at once.

VA must provide screening for Colorado Military Veterans

The PACT Act greatly expanded Veterans Administration (VA) benefits for veterans who experienced toxic exposures in Vietnam, the Gulf War, and the post-9/11 military campaigns. Sauer says the Act requires the VA to provide a toxic exposure screening to every veteran enrolled in VA health care, and adds more than 20 presumptive conditions for burn pits, Agent Orange, and other toxic exposures.

Jessica McDermott, MD, an assistant professor of medical oncology in the CU School of Medicine whose practice includes the Rocky Mountain Regional Veterans Administration Medical Center, is quoted as saying: “A question we get fairly regularly is what it means to have a presumptive condition for a toxic exposure. For some conditions . . . a patient and their provider would have to prove that their military service caused the condition, and for a lot of cancers direct causation can be very difficult to prove. [But] under PACT, for the conditions it covers, it’s now automatically assumed that a veteran’s military service led to the condition.”

She adds that contrary to a common perception, patients do not have to prove they breathed a certain amount of airborne toxins. Instead, if they served in certain areas during certain times, there is an expanded list of conditions that are presumed to have been caused by their service and the exposures they had. To ensure veterans, their families, and survivors receive the benefits they have earned, VA is considering all conditions established in the PACT Act to be presumptive as of August 10, 2022, the date President Joe Biden signed the bill into law.

Understanding PACT-related exposures

McDermott goes on to note that the head and neck cancers included in the expanded list of presumptive conditions are important for many reasons, including the fact that there often is less awareness of these cancers. “People will first associate lung cancer with breathing-in exposures,” she says, “but when you’re inhaling something it has to bypass the nose, the thyroid, the larynx, the oropharynx and they’re all at risk for exposures. Head and neck cancers do have quite a few overlapping risk factors with lung cancer, but the general public just tends to know less about them.”

She adds that the average age for presentation with head and neck cancers is late 50s to 60s, although younger veterans are also presenting with them. And while many factors can influence a head and neck cancer diagnosis (such as smoking, access to other medical care, and exposure to certain viruses), “burn pit exposures are presenting a growing challenge for patients, clinicians, and researchers.” Because these exposures happened on a wider basis in recent wars in Iraq and Afghanistan, McDermott says, “we’re really trying to catch up in terms of what we know about risk and outcomes.”

McDermott offers this general advisory: “For veterans or anybody else, if you have any unexplained neck nodules or neck nodes, any trouble swallowing, any new hoarseness that doesn’t go away, any unexplained weight loss, all those are things to pay attention to.” Your own self-awareness is key, she adds, because screening for head and neck cancers is not as advanced or reliable as with other cancer screenings at this time. Another potential avenue for cancer detection is through dentists who might catch it. But the drawback there is that veteran populations are not always consistent in accessing dental care.

Colorado veterans show interest in PACT benefits

Colorado is home to nearly 400,000 veterans. Several locales are seeing a rise in demand from veterans interested in PACT benefits. Applications for benefits first began being accepted at the start of 2023. Wait times for appointments are growing longer. Assistant Veterans Service Officer Charles Graves, with El Paso County, has been quoted as saying about 10% of the state’s veterans likely experienced toxic exposure and qualify for benefits, but far fewer have applied. He strongly urged veterans to apply before the one-year mark of the PACT signing, which means by August 10, 2023. Because if your claim for benefits is approved, your payments will have an effective date of August 10, 2022 and be backdated accordingly.

A federal bill that would grant $50 million every year for five years to improve outreach to veterans across the country and staff up local VA offices could help meet the growing demand. In El Paso County, an area with a high veteran population, in the first quarter of 2023 just over 250 claims had been filed for benefits. Graves said at the time that of the claims that had actually been adjudicated, the VA granted about 80% of them. “Our phones should be blowing off the hook,” Graves said, “which they are, but they should be blowing off the hook even more.”

The El Paso County VA office stated it would attempt to reach as many veterans as possible in order to spur getting applications in by the August 10th date. Similarly, Michael Rohrbach, a U.S. Marine Corps veteran and the director of the Denver VA Regional Office, said: “I encourage all my fellow veterans and their survivors who believe they may be entitled to benefits, to not wait and apply right away. This is the single greatest expansion of benefits in VA history.”

To learn more about the PACT Act, the new presumptive conditions, and the new qualifying service locations/dates, visit www.VA.gov/PACT, or call 1-800-myVA41. Locations and contact points for VA offices in Colorado can be found at https://www.va.gov/directory/guide/state.asp?STATE=CO&dnum=ALL.