On Veterans Day 2021, the Biden Administration announced new actions to address health effects of military exposures on veterans. The White House provided a fact sheet outlining new initiatives to address health impacts of military service:

Exposure to contaminants and environmental hazards poses a major health concern for veterans of all generations. There are also gaps and delays in the scientific evidence demonstrating conclusive links between known exposures and health impacts, leaving many veterans without access to Department of Veterans Affairs (VA) benefits and high-quality treatment to address significant health conditions. For example, it took decades to provide access to compensatory benefits and health care to many Vietnam era veterans for conditions presumed to be related to Agent Orange exposure. For the newest generation of veterans, concerns about burn pits and other exposures continue to mount. While the federal government has taken some steps to address these issues, including implementing registries to track veterans exposed to potentially hazardous substances, the Biden-Harris Administration is committed to doing more to enable timely access to services and benefits for those potentially exposed to hazardous materials.

As we mark Veterans Day and honor those who have worn the uniform of the United States, the Administration is moving forward to support our service members and veterans who may have encountered environmental hazards by:

Developing and testing a model for establishing service connection. It can be difficult for veterans to prove connection for disabilities resulting from environmental hazards. To mitigate this difficulty, VA may create presumptions of exposure in order to establish service connection for various chronic conditions when the evidence of an environmental exposure and the associated health risks are strong in the aggregate but hard to prove on an individual basis. In order to deliver benefits more quickly to veterans who developed disabilities due to exposure to environmental hazards and to lower the evidentiary burden on such veterans, VA developed a new model to accelerate the decision-making process to consider adding new presumptive conditions. This new model takes into consideration not only consensus reports from the National Academy of Sciences, Engineering, and Medicine, but also includes analyses of data from other sources as well, including data from the Veterans Benefits Administration and the Veterans Health Administration. The new model relies upon a multi-faceted scale to evaluate the strength of scientific and other evidence and allow VA to make faster policy decisions on key exposures. VA successfully applied this model to examine the association between exposures to particulate matter and three respiratory conditions, as announced last May.

Adding new presumptive conditions. In August, VA began processing disability claims for asthma, rhinitis, and sinusitis based on presumed exposure to particulate matter. Veterans who served in the Southwest Asia theater of operations and other areas and who developed these conditions within 10 years of military service are now eligible to apply for disability benefits and access to VA health care. This rulemaking was based upon application of the new presumptive model and involved careful review of a study conducted by the National Academies of Science, Engineering, and Medicine, as well as other evidence assessed by VA subject matter experts.

Applying new model to review evidence of service connection for rare respiratory cancers and constrictive bronchiolitis. VA will further test the new presumptive model to assess potential associations between military environmental exposures and constrictive bronchiolitis, lung cancers, and rare respiratory cancers such as squamous cell carcinoma of the larynx or trachea and salivary gland-type tumors of the trachea. The President has directed VA to complete the review of rare cancers and provide recommendations about new presumptions of service connection within 90 days. Based on the results of this review, the Administration will consider initiating additional rulemaking. Once the process is complete, the Administration will continue to test this model on additional health conditions and exposures to ensure more timely review and consideration of potential service connection.

Improving data on individual exposures. The Individual Longitudinal Exposure Record (ILER) is the primary Department of Defense and VA application to track, record, and assess environmental and occupational exposure to potentially hazardous substances. Currently, ILER is not scheduled to reach full operating capability until September 2023. To ensure full capability of the ILER, DoD plans to expand and accelerate the development schedule—and add additional data—enabling more comprehensive information on health risks of potential exposures to be more rapidly incorporated into service member and veterans medical care and benefit decisions.

Raising awareness of VA benefits related to military exposures. Many veterans are unaware of their eligibility for benefits and services related to potential military exposures. In addition, some claims adjudicators may not have up-to-date awareness of recent policies related to conditions newly presumed to be service-connected. In October 2021, VA launched an outreach campaign to inform service members and veterans about eligibility and benefits related to chronic disabilities that may be due to military exposures while in service. This includes efforts to embed educational and outreach materials into the Transition Assistance Programs (TAP) and as part of the Solid Start program, which reaches out to transitioning service members at regular intervals during the first year following their military separation. VA will also initiate new public service announcements and live events to encourage early and regular engagement with VA and other federal agencies for benefits, health care, and other services. VA also plans to provide refresher trainings for all claims processors, share information related to military exposures, and host a series of Q&A sessions related to implementation of the new presumptive disabilities that were implemented this summer. VA will also revise Frequently Asked Question materials and call scripts to ensure that front line employees are able to better assist veterans through the claims process. 

Expanding training for VA and non-VA providers. Veterans often find that their providers and compensation and pension examiners are not well-trained to understand or treat veterans’ exposure concerns. To address this issue, VA has completed a contract with the American College of Preventive Medicine (ACPM) to provide a five-module certificate training program in military environmental exposures. This will provide a basic level of competence for all VA- and non-VA providers across the nation that will help better treat veterans with concerns about toxic exposures. VA will require all providers to complete the first module of this training for an entry-level understanding of the health outcomes of military exposures and encourage the remaining four modules for certification.

Establishing network of specialized providers and call center. Veterans with concerns about the health outcomes of military exposures experience inconsistent care to address these specific issues, especially outside of VA. Beginning in 2022, VA will launch VET-HOME, The Veterans Exposure Team-Health Outcomes of Military Exposures. VET-HOME will consist of two interconnected parts: a call center for veterans and providers, and a nationwide network of specialists. Veterans with questions about environmental exposures will call into a central location and be guided through the registry exam or environmental exposure process. They would then be referred to one of 40 environmental health providers across the United States who would use a telemedicine platform to assess and if necessary refer the veteran to a VA facility to complete any specialty testing, like a pulmonary function test or other lab work. Providers with questions on military exposures would be referred to one the 40 military environmental heath subject matter experts. The results of the consultation would be shared with the veteran’s primary care doctor, helping to deliver better care to the veteran.

Extending Eligibility Period for VA Health Care. Some Veterans do not have concerns about their health until several years after deployment or leaving service. At present, VA allows veterans to receive free VA health care for up to 5 years after discharge or release for any condition related to service in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF) or Operation New Dawn (OND) in Iraq. This is called an “enhanced eligibility period.” To ensure that veterans who served in these conflicts have access to health care from VA, the Administration will call upon Congress to implement a change to the statute to enable a longer enhanced enrollment period for the 3 million veterans who deployed to support recent combat operations.

Taken together, these actions will improve our understanding of the health effects of military-related exposures, educate providers and veterans about these exposures, and provide timelier access to health services and benefits for individuals who were exposed. The Administration will continue to prioritize efforts to support veterans who were exposed to environmental hazards during their military service. At the same time, the Administration will work with Congress on its encouraging ongoing efforts to ensure we are able to quickly and fairly recognize additional presumptions of service-connected disabilities, in order to live up to our sacred obligation to provide veterans the care they have earned.