Federal Register / Vol. 89, No. 44 / Tuesday, March 5, 2024 / Rules and Regulations 15753 

■ b. Section 546.204(b); 

■ c. Section 546.408; and 

■ d. Section 546.703. 

§§ 546.203, 546.204, 546.406, 546.408, 

546.409, 546.504, and 546.506. [Amended] 

■ 41. In addition to the amendments set 

forth above, in 31 CFR part 546, remove 

the words ‘‘546.201(a)’’ and add, in their 

place, the words ‘‘546.201’’ in the 

following places: 

■ a. Section 546.203(a), (c), (d), and (f); 

■ b. Section 546.204(a) and (b); 

■ c. Section 546.406; 

■ d. Section 546.408; 

■ e. Section 546.409; 

■ f. Section 546.504; and 

■ g. Section 546.506. 

Bradley T. Smith, 

Director, Office of Foreign Assets Control. 

[FR Doc. 2024–04500 Filed 3–1–24; 8:45 am] 

BILLING CODE 4810–AL–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 3 

Processing Applications for Health 

Care, Sergeant First Class Heath 

Robinson Honoring Our Promise To 

Address Comprehensive Toxics Act of 

2022, or the Honoring Our PACT Act of 

2022 

AGENCY: Department of Veterans Affairs. 

ACTION: Notification of sub-regulatory 

guidance. 

SUMMARY: This notice informs the public 

of the Department of Veterans Affairs 

(VA) implementation of the Honoring 

our PACT Act of 2022, which expands 

health care to three new cohorts of 

toxic-exposed veterans. 

DATES: The guidance is effective upon 

publication. VA invites comments on 

this notice and its plan for 

implementation. To ensure VA 

considers your comment, comments are 

to be submitted on or before April 4, 

2024. 

ADDRESSES: Comments must be 

submitted through www.regulations.gov. 

Except as provided below, comments 

received before the close of the 

comment period will be available at 

www.regulations.gov for public viewing, 

inspection, or copying, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post the comments 

received before the close of the 

comment period on 

www.regulations.gov as soon as possible 

after they have been received. VA will 

not post on www.regulations.gov public 

comments that make threats to 

individuals or institutions or suggest 

that the commenter will take actions to 

harm an individual. VA encourages 

individuals not to submit duplicative 

comments; however, we will post 

comments from multiple unique 

commenters even if the content is 

identical or nearly identical to other 

comments. Any public comment 

received after the comment period’s 

closing date is considered late and will 

not be considered. 

FOR FURTHER INFORMATION CONTACT: 

Ralph Weishaar, Director, Business 

Support Office, VHA Member Services 

(15MEM) Business Policy, Department 

of Veterans Affairs, 810 Vermont 

Avenue NW, Washington, DC 20420, 

202–461–9700 (this is not a toll-free 

number). 

SUPPLEMENTARY INFORMATION: On August 

10, 2022, the President signed into law 

the Honoring our PACT Act of 2022 (the 

PACT Act), Public Law 117–168. 

Section 103(a)(1) of the PACT Act 

amended section 1710(e)(1) of title 38, 

United States Code (U.S.C.) to establish 

eligibility for hospital care, medical 

services, and nursing home care for 

three new cohorts of toxic-exposed 

veterans. Sections 1710(e)(1)(G) through 

(I) describe these three new cohorts of 

toxic-exposed veterans as follows: 

• Cohort 1: Veterans who participated 

in a toxic exposure risk activity while 

serving on active duty, active duty for 

training, or inactive duty training. (See 

38 U.S.C. 1710(e)(1)(G)). 

• Cohort 2: Covered veterans as 

defined in 38 U.S.C. 1119(c). (See 38 

U.S.C. 1710(e)(1)(H)). Covered veterans 

are those veterans who: 

Æ Performed active military, naval, 

air, or space service on or after August 

2, 1990, while assigned to a duty station 

in (including airspace above): Bahrain, 

Iraq, Kuwait, Oman, Qatar, Saudi 

Arabia, Somalia, or the United Arab 

Emirates; or 

Æ Performed active military, naval, 

air, or space service on or after 

September 11, 2001, while assigned to 

a duty station in (including airspace 

above) Afghanistan, Djibouti, Egypt, 

Jordan, Lebanon, Syria, Yemen, 

Uzbekistan, or any other country 

determined relevant by VA (note: VA 

has not determined any other country 

relevant at this time). 

• Cohort 3: Veterans who deployed in 

support of Operation Enduring 

Freedom, Operation Freedom’s Sentinel, 

Operation Iraqi Freedom, Operation 

New Dawn, Operation Inherent Resolve, 

and Resolute Support Mission. (See 38 

U.S.C. 1710(e)(1)(I)). 

Section 1710(e)(6)(A), as added by 

section 103(a) of the PACT Act, 

established a specific schedule for 

eligibility for these veterans depending 

upon their cohort and their date of 

discharge or release from the Armed 

Forces. However, section 

1710(e)(6)(B)(i) authorizes VA to 

modify, to an earlier date, the start dates 

of VA health care eligibility for the three 

new cohorts of toxic-exposed veterans. 

The Secretary has determined 

modifying these dates is appropriate 

based on the number of veterans 

receiving hospital care, medical 

services, and nursing home care under 

section 1710(e)(1)(G) through (I) and the 

resources available to VA. 

Consequently, VA is announcing that, 

effective March 5, 2024, veterans in the 

three cohorts described above, 

corresponding to section 1710(e)(1)(G) 

through (I), are eligible to enroll in VA 

health care on this basis. Modifying the 

phased-in schedule to an earlier single 

eligibility expansion date will provide 

an all-at-once approach for newly 

eligible veterans based on the 

amendments made by section 103(a) of 

the PACT Act. 

To help expedite the VA health care 

Priority Group upgrade process, VA is 

developing and will implement system 

enhancements to VHA’s Enrollment 

System (VES) to assess the enrollment 

records of veterans who VA enrolled in 

Priority Group 6 based on their status as 

a combat veteran (as described in 38 

U.S.C. 1710(e)(1)(D)) to determine their 

eligibility for continued assignment to 

Priority Group 6 based on their 

qualification in Cohort 2 or 3. 

Additionally, VES will assess the 

enrollment records of veterans enrolled 

in Priority Groups 7 and 8 to determine 

their eligibility for assignment to 

Priority Group 6 under Cohort 2 or 3. By 

the end of fiscal year 2024, VA will 

begin conducting targeted outreach to 

veterans currently enrolled in Priority 

Groups 7 and 8 whom VA could not 

determine eligibility for assignment to 

Priority Group 6 based on being in 

Cohorts 1, 2, or 3. VA will provide 

guidance to these veterans on the new 

authorities, along with instructions on 

how to submit a VA Form 10–10EZR, 

Health Benefits Update Form, for 

consideration of an upgrade to their 

enrollment Priority Group. 

Eligibility Based on Toxic Exposure 

Risk Activity (TERA) 

Background: Cohort 1 veterans are 

those who participated in a toxic 

exposure risk activity (TERA) while 

serving on active duty, active duty for 

training, or inactive duty training. If the 

veteran only participated in a TERA 


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15754 Federal Register / Vol. 89, No. 44 / Tuesday, March 5, 2024 / Rules and Regulations 

outside of one of these service periods 

(e.g., as a civilian or private contractor), 

the veteran is not eligible as a Cohort 1 

veteran. 38 U.S.C. 1710(e)(4)(C) defines 

TERA as any activity that requires a 

corresponding entry in an exposure 

tracking record system (as defined in 38 

U.S.C. 1119(c)) or that the Secretary 

determines qualifies for purposes of this 

subsection when taking into account 

what is reasonably prudent to protect 

the health of veterans. 38 U.S.C. 1119(c) 

defines the term ‘‘exposure tracking 

record system’’ as any system, program, 

or pilot program used by VA or the 

Department of Defense to track how 

veterans or members of the Armed 

Forces have been exposed to various 

occupational or environmental hazards; 

this includes the Individual 

Longitudinal Exposure Record (ILER) or 

successor system. 

Description of TERA: VA has 

determined under 38 U.S.C. 

1710(e)(4)(C)(ii) that veterans who were 

exposed to one or more of the following 

hazards or conditions during active 

duty, active duty for training, or inactive 

duty training participated in a TERA: air 

pollutants (burn pits, sand, dust, 

particulates, oil well fires, sulfur fires), 

chemicals (pesticides, herbicides, 

depleted uranium with embedded 

shrapnel, contaminated water), 

occupational hazards (asbestos, 

industrial solvents, lead, paints 

including chemical agent resistant 

coating, firefighting foams), radiation 

(nuclear weapons handling, 

maintenance and detonation, 

radioactive material, calibration and 

measurement sources, X-rays, radiation 

from military occupational exposure), 

and warfare agents (nerve agents, 

chemical and biological weapons). This 

list is not comprehensive; if veterans 

believe they participated in other 

activities that constitute a TERA, they 

should identify the TERA in their 

application so VA can determine 

whether they qualify. Veterans can 

locate additional military exposure 

categories on VA’s Public Health 

website at https://www.publichealth.

va.gov/exposures/. 

Process: Veterans must apply (either 

as a new enrollee on VA Form 10–10EZ, 

Application for Health Benefits, or as an 

existing enrollee on VA Form 10– 

10EZR, Health Benefits Update Form) 

for VA to determine whether they 

participated in a TERA and are eligible 

for enrollment in Priority Group 6 on 

that basis. If VA has already determined 

that a veteran participated in a TERA in 

the context of a disability claim, that 

decision will be binding for health care 

enrollment purposes. If VA has not 

determined a veteran participated in a 

TERA, VA will consider required entries 

in the veteran’s ILER, the veteran’s 

Service personnel records, and other 

sources as necessary, including the 

veteran’s military service record, which 

may include the veteran’s Military 

Occupational Specialty, and any active 

military, naval, air, or space service or 

active duty for training or inactive duty 

for training to determine whether the 

veteran participated in a TERA, as 

described above. 

Covered Veterans and Veterans Who 

Deployed in Support of Certain 

Contingency Operations 

Background: As described above, 

veterans in Cohorts 2 and 3 served in 

certain locations during certain time 

periods (generally, during or after the 

Persian Gulf War) or in support of 

certain contingency operations 

(generally after September 11, 2001). 

Process: For current enrollees, VA 

will review its existing records to 

determine if the enrollee is a covered 

veteran or deployed in support of an 

identified contingency operation. If the 

veteran’s service qualifies, VA will 

place the veteran in Priority Group 6 

unless the veteran qualifies for a higher 

Priority Group. VA will review new 

applications for enrollment to determine 

whether the veteran is eligible for 

enrollment in Priority Group 6 as a 

Cohort 2 or Cohort 3 veteran based on 

qualifying service. 

Conclusion and Next Steps 

VA is currently drafting a proposed 

rule to codify in regulation the statutory 

changes made by section 103(a) of the 

PACT Act. Due to the time required to 

promulgate regulations, VA will 

implement the law and begin processing 

applications for VA health care 

pursuant to the amendments made by 

section 103(a) of the PACT Act on 

March 5, 2024, based on the subregulatory guidance contained in the 

Under Secretary for Health (USH) 

Memorandum associated with this 

Notice. To ensure the enrollment of all 

veterans eligible under this authority, 

VA will also begin targeted outreach to 

current enrollees who may benefit from 

these changes to provide further 

information on the amendments made 

by section 103 of the PACT Act and how 

to request a Priority Group upgrade. VA 

will also engage in outreach to 

unenrolled veterans to encourage them 

to apply. VA will evaluate the records 

of veterans applying for VA health care 

for the first time, if they meet the basic 

threshold eligibility requirements for 

VA health care, to determine eligibility 

under Cohorts 1 through 3 as added by 

section 103 of the PACT Act (as well as 

any other bases for eligibility). Issuing 

the USH Memorandum will allow VA to 

implement 38 U.S.C. 1710(e)(1)(G) 

through (I) and deliver health care to 

veterans as quickly as possible while 

simultaneously continuing efforts to 

promulgate the implementing 

regulations. VA will provide the USH 

Memorandum to VHA Enrollment and 

Eligibility staff and VA medical facility 

directors. This USH Memorandum is a 

supporting document and is located at 

http://www.regulations.gov. 

How to Apply: Any veteran who 

wants to apply for new VA health care 

enrollment can do so by submitting a 

VA Form 10–10EZ: (1) in-person or by 

mail to a VA medical facility; (2) by 

mail to the Health Eligibility Center, 

2957 Clairmont Rd., Suite 200, Atlanta, 

GA 30329; (3) online at https://

www.va.gov/health-care/how-to-apply/; 

or (4) by calling 1–877–222–VETS 

(8387). Veterans enrolled in VA health 

care who want to apply for an upgrade 

to their current Priority Group can do so 

by submitting a VA Form 10–10EZR 

using any of the four methods described 

above. Should a veteran receive an 

enrollment decision with which they 

disagree, they can appeal the decision 

with VA. 

For more information about the PACT 

Act and your benefits, access https://

www.va.gov/resources/the-pact-act-andyour-va-benefits/ or contact 1–877–222– 

VETS (8387). 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved and signed 

this document on February 23, 2024, 

and authorized the undersigned to sign 

and submit the document to the Office 

of the Federal Register for publication 

electronically as an official document of 

the Department of Veterans Affairs. 

Michael P. Shores, 

Director, Office of Regulation Policy & 

Management, Office of General Counsel, 

Department of Veterans Affairs. 

[FR Doc. 2024–04202 Filed 3–4–24; 8:45 am] 

BILLING CODE 8320–01–P 


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