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VA Expands Health Care Eligibility for Veterans under the PACT Act, Native Veterans Encouraged to Check Eligibility for Benefits

On September 28, 2022, the Department of Veterans Affairs (VA) announced that it will expand and extend eligibility for VA health care for certain Veterans of the Vietnam, Gulf War, and post-9/11 eras pursuant to the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act (S. 3373). As a result of the PACT Act, generations of Veterans will now have access to VA health care and benefits they earned and deserve, including American Indian/Alaska Native (AI/AN) Veterans who serve in the military at a higher rate than any other population. For more information on how to apply for health care or learn more about what the PACT Act means for Veterans or their families visit: VA.gov/PACT.

Expansion Details:

Beginning on October 1, 2022, post-9/11 Veterans who did not previously enroll in VA health care will have a 1-year window to enroll if they:

  • Served on active duty in a theater of combat operations during a period of war after the Persian Gulf War, or
  • Served in combat against a hostile force during a period of hostilities after Nov. 11, 1998, and
  • Were discharged or released from active service between Sept. 11, 2001, and Oct. 1, 2013.

The following groups of Veterans will also be eligible for care beginning October 1:

  • Gulf War Veterans who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War. This includes Veterans who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary Medal, Combat Era Specific Expeditionary Medal, Campaign Specific Medal, or any other combat theater award established by federal statute or executive order.
  • Vietnam-era Veterans who served in the following locations and time periods : The Republic of Vietnam between Jan. 9, 1962, and May 7, 1975 Thailand at any U.S. or Royal Thai base between Jan. 9, 1962, and June 30, 1976; Laos between Dec. 1, 1965, and Sept. 30, 1969; Certain provinces in Cambodia between April 16, 1969, and April 30, 1969; Guam or American Samoa (or their territorial waters) between Jan. 9, 1962, and July 31, 1980 ; Johnston Atoll (or on a ship that called there) between Jan. 1, 1972, and Sept. 30, 1977

Background on the PACT ACT

On August 10, 2022, President Biden signed the bipartisan PACT Act into law, authorizing one of the largest expansions of VA health care and benefits in U.S. history.  Before the PACT Act’s passage, many Veterans’ claims for healthcare services and other benefits were denied by VA because Veteran claimants had difficulty proving a connection between their ailment and their service. The PACT Act is intended to remove barriers to Veterans getting care, expanding the number of Veterans who are eligible for care and streamlining the process for proving a service connection for certain conditions related to toxic exposure.

The PACT Act will bring the following changes:

  • Expands and extends eligibility for VA health care for Veterans with toxic exposures and Veterans of the Vietnam, Gulf War, and post-9/11 eras
  • Adds more than 20 new presumptive conditions for burn pits and other toxic exposures
  • Adds more presumptive-exposure locations for Agent Orange and radiation
  • Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health care
  • Helps VA improve research, staff education, and treatment related to toxic exposures

AI/AN Veterans

There is an urgent need to ensure that all AI/AN Veterans have access to the benefits they earned through their service.  According to a 2020 VA Report, AI/AN Veterans served in the Pre-9/11 period at a higher percentage than other Veteran populations.  Despite a distinguished record of service, VA’s statistics also show that AI/AN Veterans were more likely to be unemployed, were more likely to lack health insurance, and were more likely to have a service-connected disability when compared to Veterans of other races.  In addition, in Fiscal Year 2017, AI/AN Veterans used Veterans Benefits Administration benefits or services at a lower percentage than veterans of other races.

NCUIH and the VA

The National Council of Urban Indian Health (NCUIH) has continued to advocate on behalf of AI/AN veterans living in urban areas and to strengthen its partnership with VA. Thanks to NCUIH’s work with VA, urban Indian organizations (UIOs) are now eligible to enter the VA Indian Health Service/Tribal Health Program (THP)/UIO Reimbursement Agreements Program, which provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible AI/AN Veterans. In October 2021, Sonya Tetnowski, President of NCUIH and CEO of the Indian Health Center of Santa Clara Valley, Army Veteran, and member of the Makah Tribe was appointed to the VA’s first-ever Advisory Committee on Tribal and Indian Affairs to represent the voice of urban Indians.

NCUIH Submits Comments to VA on Tribal Representation Expansion Project

On March 30, 2022, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Department of Veteran Affairs (VA) on the Tribal Representation Expansion Project (T.REP). The comments were submitted in response to VA’s notice of Tribal consultation and request for comment. In the comments, NCUIH requested that VA include urban Indian organizations (UIOs) in T. REP or establish a similar program for UIOs.  In addition, NCUIH recommended that VA consult with UIOs to gain a better understanding of the needs of American Indian/Alaska Native (AI/AN) veterans living in urban areas.

The Tribal Representation Expansion Project

VA’s T.REP represents VA’s most recent effort to ensure that AI/AN veterans and their families have access to appropriate representation in the preparation, presentation, and prosecution of their VA benefit claims. The aim of this program is to “ensure that Native American Veterans have access to responsible, qualified representation in the preparation, presentation, and prosecution of their benefit claims before VA.”  VA hopes to build on its work from 2017, when it revised its regulations to permit Tribal veterans’ service offices affiliated be recognized by VA as Tribal organizations in a manner similar to State organizations.

In addition to seeking information regarding the availability of representation for veterans’ claims in Tribal communities, VA is also planning to provide further options for representation.  According to VA, they plan to collaborate with Tribal governments to identify “an individual who is affiliated with their government, is of good character and reputation, and, who, after proper training on VA benefits, would be fit to be authorized by the VA General Counsel to represent on VA benefit claims.”  If a tribal government identifies such a person “[t]he General Counsel then plans to use his discretionary authority, pursuant to 38 CFR 14.630, to specially authorize such individuals to prepare, present, and prosecute VA benefit claims before VA.”

About AI/AN Veterans

AI/ANs have a proud legacy of service in the armed forces of the United States.  This includes at least 12,000 AI/AN men who served the United States in World War One, who suffered a casualty rate five times that of other American forces before this country granted universal citizenship to American Indians; 42,000 AI/ANs who served in the Vietnam War, representing 25% of the total AI/AN population at the time; and at least 33,538 AI/ANs who have served following September 11, 2001.

There are at least 140,000 living AI/AN veterans nationwide.  NCUIH estimates that 67% percent of the veteran population identifying as AI/AN alone lives in metropolitan areas.  UIOs currently serve six of the ten urban counties with the largest veteran AI/AN alone populations, including Maricopa County, Arizona; Los Angeles County, California; San Diego County, California; Bernalillo County, New Mexico; Oklahoma County, Oklahoma; and Tulsa County, Oklahoma.  AI/AN veterans regularly prefer to see UIOs over other health care providers thanks to the provision of culturally competent care (including traditional healing services), community and familial relationships, shorter wait times, and shorter distance to travel.

Unfortunately, despite a distinguished record of service, VA’s statistics show that AI/AN veterans were more likely to be unemployed, were more likely to lack health insurance, and were more likely to have a service-connected disability when compared to veterans of other races.  In addition, in Fiscal Year 2017, AI/AN veterans used Veterans Benefits Administration (VBA) benefits or services at a lower percentage than veterans of other races.  It is important to note that AI/AN veterans living in urban areas face many of the same barriers to accessing competent representation in VA claims that AI/AN veterans face on reservations.  For example, AI/AN veterans living in urban areas face significant barriers to accessing representation on VA benefit claims based on their location, they deal with the same language barriers that AI/AN veterans living in rural areas face, and they must overcome cultural barriers to representation as well.

NCUIH’s Role

NCUIH has consistently advocated for UIO inclusion with VA-led initiatives and played a critical role in getting legislation passed in 2020 which established the VA Advisory Committee on Tribal and Indian Affairs and in the subsequent nomination and selection of NCUIH President-Elect Sonya Tetnowski as a UIO representative on the Committee.  Given the large portion of the AI/AN veteran population living in urban areas and UIOs’ ability to reach AI/AN veterans, inclusion of UIOs in T.REP would help VA accomplish its goal of “ensur[ing] that Native American Veterans and their families have access to responsible, qualified representation in the preparation, presentation, and prosecution of their benefit claims before VA.”  Accordingly, NCUIH made the following specific comments, requests, and recommendations to VA in response to the notice:

  • NCUIH recommends that VA expand T. REP to provide accreditation opportunities for staff at UIOs.
    • In the alternative, NCUIH requests that VA establish a similar accreditation program for staff at UIOs.
  • NCUIH requests that VA consult with UIOs to better understand the needs of AI/AN veterans living in urban areas.
    • NCUIH recommends that VA establish an Urban Confer policy to set the necessary policies and procedures for direct and clear communication with UIOs.

NCUIH appreciates the VA for its commitment to ensuring that AI/AN veterans “have access to responsible, qualified representation in the preparation, presentation, and prosecution of their benefit claims before VA.” NCUIH will continue to monitor this program and engage with VA to support greater provision of benefits to AI/AN veterans living in urban areas.