Better Controls Needed to Accurately Determine Decisions for Veterans’ Nonpresumptive Conditions Involving Toxic Exposure Under the PACT Act

In August 2022, the PACT Act significantly expanded veterans’ eligibility for benefits and services for conditions related to toxic exposure. The expansion added further complexity to VBA’s claims determination process, particularly given the voluminous guidance issued for nonpresumptive conditions—those conditions for which service connection cannot be granted on a presumptive basis. Notably, the law opened a new path for service connection for veterans with nonpresumptive conditions related to toxic exposure risk activity (TERA). The VA OIG conducted this review from October 2023 through May 2025 to determine whether VBA staff processed decisions in compliance with TERA procedures under the PACT Act that denied nonpresumptive conditions. The OIG focused on denials because of the potential impact of incorrect decisions on benefits received by veterans.

The review found VBA’s oversight lagged in ensuring accurate processing of nonpresumptive conditions under the PACT Act. While VBA took steps to improve PACT Act claims processing, these efforts have not remedied the problem of various inaccuracies related to nonpresumptive conditions. An OIG statistical analysis estimated 61 percent of all nonpresumptive, TERA-related decisions under the PACT Act that VBA denied from May 1 through August 31, 2023, had processing errors—some of which could have affected veterans’ benefits. For example, some errors showed that claims processors did not accurately identify toxic exposure claims, research and verify veterans’ participation in a TERA, request a medical exam and opinion regarding toxic exposure, or appropriately include key information in decisions for nonpresumptive conditions. Furthermore, PACT Act guidance is difficult for staff to navigate because it is frequently updated and spread among several different sources. VBA needs to improve its oversight to mitigate and prevent inconsistencies and errors. VBA concurred with the OIG’s three recommendations to correct processing errors, consolidate guidance, and evaluate controls.