PACT Act: Rutgers Research Helps Veterans Access Burn Pit Exposure Benefits

When Congress passed the Promise to Address Comprehensive Toxics (PACT) Act in 2022, it was a watershed moment for veterans who had been denied benefits due to a lack of conclusive scientific evidence linking exposure to burn pits and other toxins during military service to their illnesses. But the path to that landmark legislation wasn’t solely paved by political will; it was built on years of painstaking research, including critical work done at Rutgers University that helped establish a new framework for understanding and evaluating the complex health consequences of toxic exposures.

A New Method for Determining Service-Related Illnesses

In December 2024, the U.S. Department of Veterans Affairs (VA) adopted new rules to implement the PACT Act, incorporating a novel methodology for definitively determining whether specific respiratory illnesses are service-related. This method was, in part, developed by J. Scott Parrott, a professor at the Rutgers School of Health Professions, and his team. Their work, recently published in the Evidence-Based Toxicology journal, represents a significant shift in how the VA assesses claims related to environmental exposures during military service.

“Usually, you publish the research, and it changes policy,” Parrott explained. “This time, policy changed—and then the paper came out.” This unusual timeline underscores the urgency surrounding the issue and the immediate need for a robust, scientifically grounded approach to addressing the health concerns of veterans.

The Rising Concern Over Burn Pits and Toxic Exposures

The concerns surrounding airborne hazards began to surface during the 1990 Gulf War and intensified following the conflicts in Iraq and Afghanistan after the 9/11 attacks. While environmental monitoring documented widespread dust and pollution, open-air burn pits emerged as a particularly alarming source of exposure. According to the published paper, these pits were used at up to 86% of military bases, especially between 2005 and 2012, as a primary method for waste disposal.

The practice involved igniting a wide range of materials – medical waste, plastics, batteries, vehicles, insecticide containers, and even human waste – with jet fuel. The resulting smoke released a complex mixture of toxins, which veterans inhaled, leading to a growing number of reports of chronic respiratory conditions, rare lung diseases, and other serious health problems. However, establishing a direct causal link between these exposures and the illnesses proved to be a significant challenge.

In 2020, the National Academies of Sciences, Engineering, and Medicine reviewed the VA’s presumptive-injury policies and concluded that the evidence connecting deployment in Southwest Asia to respiratory diseases, cancers, and autoimmune disorders was inconclusive. This finding highlighted the need for a new approach to evaluating the health risks associated with military exposures.

Reframing the Evidence: An Abductive Approach

Parrott and his team recognized that conventional research frameworks, which often demand a level of proof akin to a randomized clinical trial, were ill-suited to the realities of war-zone conditions. “We were asked to develop a different and innovative methodology,” Parrott said. “These events occurred decades ago, when exposures weren’t being measured as people are firing bullets and lobbing bombs at you. You can’t go back and gather more data.”

Instead of attempting to prove a direct causal link through traditional means, they reframed the question: If definitive experimental proof is unattainable, can the totality of preclinical, clinical, environmental, and epidemiological evidence point to the most plausible explanation? They examined whether clinical patterns, biological findings, and deployment histories aligned in ways consistent with inhalational injury.

“You can’t prove it in the strictest sense,” Parrott explained. “But you can determine whether there is any other plausible explanation. And if there isn’t, that’s strong enough to guide policy.” This approach, known as abductive inference, focuses on identifying the most likely explanation based on the available evidence, even in the absence of absolute certainty.

VA Policy Shifts Based on Rutgers’ Findings

The conclusions of the Rutgers team’s research are direct. The authors wrote in their February 1st publication, “The sum total of the evidence indicates that deployment to the Southwest Asia theater of operations increases the risk of developing a subset of interstitial lung diseases and constrictive bronchiolitis.”

This methodology assigns graded levels of confidence rather than demanding unattainable certainty. This shift provided the VA with a new pathway for evaluating service-related illnesses and ultimately led to the implementation of the PACT Act. The PACT Act expands and extends eligibility for VA health care for Veterans with toxic exposures, adds more presumptive conditions for burn pits and Agent Orange, and requires toxic exposure screenings for all enrolled Veterans. More information about the PACT Act and its benefits can be found on the VA website.

A Personal Connection to the Research

The work holds a deeply personal significance for Parrott. His son-in-law, James Petty, a veteran of multiple tours in Iraq and Afghanistan and later a military contractor in Kuwait, developed a rare lung condition after deployment and now suffers from chronic respiratory and cardiopulmonary disorders.

Parrott shared that seeing his work shape federal policy is rewarding, but as well profoundly personal. The PACT Act, spurred by research like his, offers a measure of justice and care to veterans like Petty who have long suffered the consequences of their service.

Expanding Tools for Future Decisions and Ongoing Research

The work at Rutgers is far from over. The university is now hosting the evidence synthesis platform previously used by the U.S. Agency for Healthcare Research and Quality, which was decommissioned in November. Parrott and his team have cloned and rebuilt the platform at Rutgers, creating a continuously updated, open-source repository of research and data on military exposures accessible to policymakers, clinicians, and veterans.

the team is exploring how large-language models – the technology powering artificial intelligence – can assist in analyzing complex epidemiological and preclinical studies, potentially accelerating evidence reviews without compromising rigor. This ongoing research aims to refine the methodology for evaluating toxic exposures and ensure that veterans receive the care and benefits they deserve.

By changing how evidence is evaluated, Parrott’s work reshapes how uncertainty is weighed in public policy—and how veterans can gain recognition and disability benefits for illnesses tied to their service. For those still waiting for answers, this shift could prove transformative. The Honoring our PACT Act of 2022 represents a significant step forward, but continued research and vigilance are essential to ensure that all veterans receive the care they need.