Just moments after the Senate finalized a military toxic exposure bill that could benefit millions of veterans, activist John Feal issued a warning to the crowd of advocates celebrating outside the Capitol about the moment they had been lobbying for and dreaming about for years:

“The hard part hasn’t begun.”

Feal — who spent years as one of the lead advocates to award federal benefits to Sept. 11 victims, first responders and their families — said work to make sure those payouts and resources are properly funded and administered continues to this day. He cautioned that even well-written bills don’t always mean an easy transition to getting people the help they need.

“Getting a bill passed is easy, you just have to beat up the Senate and the House,” Feal said. “These people behind me, they have to take that and make sure Congress and the VA now do the right thing.”

The Promise to Address Comprehensive Toxics Act — better known as the PACT Act — is set to be signed into law by President Joe Biden on Aug. 8.

When that happens, it will mark a key moment in the 13-year-old fight to expand benefits for burn pit victims sickened in Iraq and Afghanistan, and the decades-old quest to fully compensate Vietnam veterans for their exposure to chemical defoliants.

But, advocates say it won’t be the end of their work on the issue. The next step is delivering the benefits to veterans and their families, estimated to cost around $300 billion over the next 10 years.

White House and Veterans Affairs officials promise they have been preparing for that task for months.

“Veterans who were exposed to toxic fumes while fighting for our country are American heroes, and they deserve world-class care and benefits for their selfless service,” VA Secretary Denis McDonough said in a statement minutes after Feal’s speech.

“Once the president signs this bill into law, we at VA will implement it quickly and effectively, delivering the care these veterans need and the benefits they deserve.”

When will benefits arrive

Separate from the congressional work, VA last year began revamping how it approaches illnesses believed linked to burn pit smoke in places like Iraq and Afghanistan.

In the past, the department stuck to strict scientific evidence before granting presumptive status for illnesses believed linked to military service. Now, the department uses a wider set of metrics to evaluate the claims, which has led to adding 12 respiratory illnesses and cancers to the list of conditions presumed caused by burn pits (a designation that greatly speeds up the process of veterans receiving disability payouts).

Once the PACT Act is signed into law, those new processes will be codified, a move that veterans advocates say will be key in coming years to preventing long waits for department recognition of military injuries.

Other parts of the sweeping toxic exposure legislation will also go into effect immediately. Veterans currently get five years of medical coverage through VA after leaving the service, but will see that expanded to 10 years under the new law.

All veterans who left the ranks in summer 2017 or later will have their eligibility automatically extended. Veterans who left between summer 2014 and summer 2017 will be able to apply for additional years of health care coverage, ending at 10 years after the date they separated.

The benefits for individual illnesses will take longer to process. The law calls for VA to add 23 new conditions to the list of burn pit presumptive illnesses — including asthma, chronic bronchitis and brain cancer — but those will be phased in over the next three years.

For Vietnam veterans exposed to Agent Orange, presumptive status for monoclonal gammopathy of undetermined significance (MGUS) goes into effect immediately.

But new benefits for Vietnam veterans suffering from high-blood pressure (a group estimated to be around 500,000 individuals) aren’t set to go into effect until late 2026.

There are provisions in the bill to speed up benefits for individuals with deteriorating health conditions, or age 80 and older. However, as the bill is written, some veterans expecting to benefit from the PACT Act won’t see any checks in the mail for another four years.

Changing the timeline

White House officials said they are hoping to speed that up.

“The law does provide discretion to the VA secretary to move more quickly than some of the dates, so we’re going to be working collaboratively to see how much we can get done as quickly as possible so that veterans can get the services they need,” said Terri Tanielian, special assistant to the president for Veterans Affairs.

“The department is focused on making sure that they can hire the staff that they need, that they have the resources in the right places. We’re mindful of needing to make sure that the workforce and the infrastructure is ready.”

Lawmakers included funding in the measure for the new hires, aware that sending millions of new benefits claims to VA in coming years has the potential to overwhelm their current systems.

Biden called on Congress to pass comprehensive burn pit legislation in his State of the Union speech last spring. Tanielian said now that it has been done, the administration is focused on making sure it meets its responsibilities to implement the measure.

“This is a major victory for veterans, their families and survivors and those that have cared for them over the years,” she said. “We’re looking forward to the President signing it and then being able to implement it effectively so that we can deliver the health care benefits that we know veterans have earned and that they deserve.”

Veterans advocates said they’ll be lobbying for quicker responses, too. The provisions regarding deteriorating health conditions are written broadly, and some veterans groups said they see opportunities to force VA to respond immediately to certain claims even if the law seems to give them more time.

But much of that will depend on VA’s ability to hire new staff to process claims and respond to veterans’ questions.

The department has hired several hundred claims processors in recent months to deal with the glut of overdue disability claims (cases pending for more than four months). The figure was as high as 264,000 last fall, but now sits at about 165,000, roughly half what it was before the coronavirus pandemic.

Apply now

The Department of Defense has estimated nearly 3.5 million troops from recent wars may have suffered enough exposure to the smoke to cause health problems. Only a small portion of that group has signed up for VA’s official burn pit registry, designed to help track health issues in that population.

In his statement on the PACT Act passage, McDonough encouraged eligible veterans to apply for benefits as soon as possible, rather than waiting on the legislation’s official start date. Depending on the case, veterans may eventually be eligible for retroactive pay if they file earlier.

Veterans can visit the department’s online page regarding PACT information or call 1-800-MyVA411 (800-698-2411).

“The PACT Act is perhaps the largest health care and benefit expansion in VA history,” the VA’s benefits site states. “If you’re a veteran or survivor, you can file claims now to apply for PACT Act-related benefits.”

In his statement, McDonough said that department officials “will be communicating with you every step of the way to make sure that you and your loved ones get the benefits you’ve earned.”

As Feal delivered his speech to the celebrating advocates, Senate Veterans’ Affairs Committee Chairman Jon Tester, D-Mont., received a text from McDonough offering his congratulations on the legislative victory and promising that “we will execute this.”

Tester said he’ll hold the secretary to that promise.

“We’ll be watching,” he said. “I know they’re committed, and I know the president said we’re going to get this done. But we’ve got to watch them to make sure.”

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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