This study examines the long-term health impacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, focusing on post-acute sequelae of COVID-19 (PASC) in a cohort of 135,161 individuals with SARS-CoV-2 infection and 5,206,835 controls from the US Department of Veterans Affairs. The follow-up period was 3 years, extending beyond previous 2-year studies. The results show that among non-hospitalized individuals, the increased risk of death and PASC declined over the 3 years, with 9.6 disability-adjusted life years (DALYs) per 1,000 persons in the third year. Among hospitalized individuals, the risk of death remained elevated in the third year, contributing 8.16 DALYs per 1,000 persons, and the risk of PASC was still significant, leading to 90.0 DALYs per 1,000 persons. The study highlights the persistent health burden, particularly among hospitalized individuals, and underscores the importance of early recognition and care for PASC to reduce chronic health loss.This study examines the long-term health impacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, focusing on post-acute sequelae of COVID-19 (PASC) in a cohort of 135,161 individuals with SARS-CoV-2 infection and 5,206,835 controls from the US Department of Veterans Affairs. The follow-up period was 3 years, extending beyond previous 2-year studies. The results show that among non-hospitalized individuals, the increased risk of death and PASC declined over the 3 years, with 9.6 disability-adjusted life years (DALYs) per 1,000 persons in the third year. Among hospitalized individuals, the risk of death remained elevated in the third year, contributing 8.16 DALYs per 1,000 persons, and the risk of PASC was still significant, leading to 90.0 DALYs per 1,000 persons. The study highlights the persistent health burden, particularly among hospitalized individuals, and underscores the importance of early recognition and care for PASC to reduce chronic health loss.