110 Iowa L. Rev. 571 (2025)

DOWNLOAD PDF

Abstract

Sick veterans have long disproportionately borne the costs of scientific uncertainty as to whether military toxic exposures cause cancers and more. The relaxed evidentiary standards that make the “uniquely pro-claimant” veterans benefits system work for traditional battlefield injuries do not achieve the same results for toxic exposures, where causal relationships to disease require population-level data and years of study. This Article argues that, given this structure, core veterans’ policy objectives are only fairly and efficiently vindicated by creating generous evidentiary presumptions for toxic-exposed veterans. 2022’s blockbuster PACT Act is rightly celebrated for its momentous expansion of evidentiary presumptions for post-9/11 veterans. PACT is already delivering critical income and healthcare benefits for tens of thousands of sick veterans and their families. Yet its mechanism for creating new presumptions by rulemaking risks years of delay in benefits access for sick veterans left out of the Act, as has been the case for past generations of toxic-exposed veterans. PACT leaves the Secretary of the Department of Veterans Affairs the discretion to consider and create new presumptions, as guided by scientific study, but gives affected veterans little say as to what exposures and conditions should be considered. This Article provides a principled basis for the Secretary to exercise his authority to create new presumptions generously, even as the PACT Act’s price tag over its first decade is projected to hit $737 billion. The Article then proposes mechanisms to allow smaller groups of toxic-exposed veterans to force timely consideration of the presumptions that have been historically secured only by the most politically organized.