VA Secretary Denis McDonough discusses compensation for veterans affected by burn pits

Amna Nawaz:

One year ago this week, President Biden signed the PACT Act, fundamentally changing how veterans could receive disability compensation for war-related illnesses.

Before that, they had to prove their sickness was related to military service, an often impossible bar. Under the PACT Act, veterans have to prove deployment to one of the included countries, like Iraq or Afghanistan and others. They also must suffer from one of 23 listed medical conditions, such as brain cancer, asthma, or chronic bronchitis.

More than 801,000 veterans and their survivors have filed claims since the act was signed. The VA posts online data for one condition covered by the new law, asthma. There were 36,000 claims for asthma. Half were approved and half were denied.

So, overall, how is the implementation of this act proceeding?

Denis McDonough is the secretary of Veterans Affairs, and he joins me now.

Welcome back to the "NewsHour."

Denis McDonough, U.S. Secretary of Veterans Affairs: Thanks for having me, Amna. Happy to be here.

Amna Nawaz:

So, let's start with that question. How is the implementation going overall?

Denis McDonough:

Well, look, I mean, I think we're out of the gate strong. But, so far, we're doing a lot of outreach.

In fact, we have just conducted and we are conducting the biggest outreach campaign in the history of VA, so that veterans, no matter where they are, know what they qualify for. And they come in and file a claim to try to make sure that we get them everything that they have earned.

So that 800,000 number feels decent. We have a long way to go. And we're going to stay on top of this until every veteran knows what's available to him or her, files a claim, then we fulfill that claim for them.

And I think we're out of the gate strong, but we got a long way to go, and we're not going to let up.

Amna Nawaz:

Where do you think that number could end up?

Denis McDonough:

Well, look, I mean, the numbers, let's just take one half of the law.

The first half of the law addresses Vietnam vets, but let's set that aside for a second. The other half of the law covers anybody who was in Central Command for the 30 years of war there starting in 1991 and Kuwait and Saudi Arabia, going all the way through the summer of 2021, and when the activities in Afghanistan ceased.

So that's 30 years of war. We think there's probably four million veterans who qualify, having been in that geography. So we want to make sure that everybody knows that they have an opportunity gets that claim filed, and we get to work for them.

Amna Nawaz:

So you mentioned the one condition you have listed, claims files and rejections online.

Denis McDonough:

Yes.

Amna Nawaz:

We have requested from the DA — the VA, rather, data on claims and denials for all of the 23 medical conditions.

Denis McDonough:

Yes.

Amna Nawaz:

We were told we have to file a Freedom of Information Act to receive that information.

Do you have that data? Are you tracking it?

Denis McDonough:

I don't have that information at my fingertips. I was really gratified to see that you cited our data in your lead-in.

We made a decision early in this process that we'd put out the data we have every two weeks, so that you and then obviously veterans and their families, Congress, everybody can see exactly what we're doing. So…

Amna Nawaz:

But for the other medical conditions as well?

Denis McDonough:

Again, we have what — we have we have published what we have.

If you have — you all have a request, all right, we will go to work on it. But what we're working through right now is actually getting those claims filed, processing those claims, and getting the benefits paid to our veterans.

Amna Nawaz:

Last year, I know you and I spoke about one particular lung condition that was very hard, is still very hard to diagnose.

I just want to play a clip from that exchange we had last year in September.

Denis McDonough:

Sure. Sure.

Amna Nawaz:

There's a condition called constrictive bronchiolitis, which basically destroys the small airways. There's no treatment, there's no cure.

Denis McDonough:

Right.

Amna Nawaz:

Under the metrics that the VA currently uses, you have to establish what's called the disability rating. And that then can help grant some benefits to the veterans.

Denis McDonough:

Right.

Amna Nawaz:

People who have this do not qualify for anything. They have to appeal to get something. And I believe, back in July, you said you were looking into this.

Denis McDonough:

Yes.

Amna Nawaz:

So have you closed the loophole?

Denis McDonough:

So we have been working on this issue of constrictive bronchiolitis.

One of the issues is the test to prove existence of chronic constrictive bronchiolitis is actually as intrusive in many cases as the disease itself.

Amna Nawaz:

Right.

Denis McDonough:

And so I don't have news on that yet.

Amna Nawaz:

So, Mr. Secretary, many months later now, almost a year later, have you been able to close that loophole?

Denis McDonough:

We don't have specific process yet established on how to test for constrictive bronchiolitis.

But a lot of times, it manifests in other challenges too. Those are conditions that we have very straightforward tests for, so asthma being one of them.

So, I don't have news for you on that at the moment, but we will stay on top of it. This is one of the things that our troopers really wrestle with. It's something that we need a straightforward definition for and an even more straightforward test, so that we can establish the connection — or establish the existence of the condition, so that people who were in that geography and have that condition get their benefit.

Amna Nawaz:

There have been some questions, though, about the tests, the kind of tests, pulmonary function tests and the like that are used for things like asthma and emphysema…

Denis McDonough:

Yes.

Amna Nawaz:

… don't necessarily work correct for this particular illness.

Denis McDonough:

Correct. Right.

Amna Nawaz:

And I just I want to play for you another bite. We spoke with a doctor who has been treating a number of these patients. His name is Robert Miller.

He's at Vanderbilt Medical Center. He says he has seen 300 patients with constrictive bronchiolitis since the U.S. invasion of Iraq. He says none of them so far, none of them have benefited from the PACT Act. This is just a little bit of what he had to say.

Denis McDonough:

Sure.

Dr. Robert Miller, Vanderbilt University Medical Center:

When it comes to the respiratory patients that I take care of, it has not come through in a way that has helped as many as I would have liked.

The PACT Act says that constrictive bronchiolitis and other respiratory disorders should be considered presumptive diagnoses. These presumptive diagnoses for respiratory disease are not getting rated for disability. The VA actually hasn't created a code for disability for constrictive bronchiolitis.

Amna Nawaz:

So you have said there's not a test. There's not a code that's been created for it. We spoke about it last year. And you said you were working on it.

Denis McDonough:

Yes.

Amna Nawaz:

I guess, for the hundreds of those veterans who suffer from this…

Denis McDonough:

Totally.

Amna Nawaz:

… when can they access those benefits?

Denis McDonough:

Look, I mean, it's really hard for me to know. I'm really glad. We will make sure that we track down the doctor that you're working with there and make sure that we understand what that timeline is for those 300.

I don't know if those 300 since the president signed the law into — signed the bill into law a year ago, but we will get to the bottom of it and we will figure it out. I think what we have been trying to say to veterans is, we want you in our care. We want you to get the benefits that you have earned and so richly deserve.

That's what this outreach campaign has been about. Believe me, nobody's more frustrated about how we can diagnose — make some of these diagnoses than I am. But we will keep working at it.

Amna Nawaz:

There are recommendations, though, right?

There was a working group that's been focusing just on this issue for the VA.

Denis McDonough:

A VA working group, correct.

Amna Nawaz:

They put forward recommendations last September, I believe.

Denis McDonough:

Correct. Yes.

Amna Nawaz:

I don't think those have been adopted.

Denis McDonough:

Those are being worked through at our — what's called our War Related Illness and Injury Study Center of Excellence, which is up at East Orange, New Jersey, and our VA center there.

This is some of the best science that we have on these conditions. I guess I want to just underscore to you, Amna, I'm not happy about where this stands. I want to make sure every veteran gets the care and the benefits that they have earned.

Amna Nawaz:

So help us understand why it's taking so long.

Denis McDonough:

Look, we're — because we're working through the science to get to it. And that's — and let's be clear. That's on one condition, constrictive bronchiolitis, that we're working through, 800,000 claims.

About 450,000 of them have now been completed. We're granting in those 450,000 at about 80 percent. It's — I think the last number I saw is 78.6 percent. That's substantially higher. And that's the importance and the strength of the new law, which establishes a presumption of connection.

So we just need the existence of the condition and the fact of presence in Central Command. Those two things make sure that we get the rating, get the benefits and get the care.

Amna Nawaz:

We look forward to keeping in touch with you about this issue.

Before I let you go, I need to ask you about another issue we have spoken about previously, which was the decision the VA made to provide abortion services and counseling in cases of incest, rape, or when the life of the woman was at risk.

Denis McDonough:

Life or health.

Amna Nawaz:

Life or health. Thank you.

Do you know how many people have accessed those services?

Denis McDonough:

I think the most recent numbers I have seen are in 50 range.

This is going back to the period when we started providing the services in September. So, I don't know that that's the most recent number. That's the number that sticks out to me as being the one we have most recently provided to Congress.

Amna Nawaz:

I appreciate you providing that to us today.

Secretary of Veterans Affairs Denis McDonough, always good to have you here. Thank you.

Denis McDonough:

Thank you so much.