The PACT Act: Presumptive Conditions and Presumed Exposure

The Sergeant First Class Heath Robinson Honoring our PACT Act became law on August 10, 2022. VA calls it perhaps the largest expansion of benefits in its history. The part that matters most for a claim is the word presumptive.

The conditions and locations below were verified against VA’s PACT Act and burn-pit presumptive pages on July 9, 2026. The presumptive list continues to expand, so check the linked VA pages for the current version before you file.

What “presumptive” means

Normally a service-connection claim needs a medical nexus: proof that your service caused your condition. For a presumptive condition, VA presumes that link automatically as long as you meet the service requirements. You still have to show a current diagnosis and qualifying service, but you do not have to prove the toxic exposure caused the disease. That removes the single hardest piece of a burn-pit claim.

The burn-pit and toxic-exposure presumptive conditions

For Gulf War era and post-9/11 veterans with qualifying service, VA now presumes these conditions are related to toxic exposure. The burn-pit presumptive list groups them as follows.

Cancers: brain, gastrointestinal (any type), glioblastoma, genitourinary (which includes kidney), head cancer of any type, hematologic and lymphatic, lymphoma of any type, melanoma, neck cancer of any type, pancreatic, reproductive cancer of any type, and respiratory (breathing-related) cancer of any type.

Chronic illnesses: asthma diagnosed after service, chronic bronchitis, chronic obstructive pulmonary disease (COPD), chronic rhinitis, chronic sinusitis, constrictive or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, and sarcoidosis.

The PACT Act also added two conditions for Vietnam-era (Agent Orange) veterans: high blood pressure (hypertension) and monoclonal gammopathy of undetermined significance (MGUS). Those, and the full herbicide list, are covered in the Agent Orange presumptives guide.

Presumed exposure: where and when

If you served in the right place during the right window, VA presumes you were exposed. For burn pits and other post-9/11 hazards, presumed exposure covers service on or after September 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, or the airspace above them. For Gulf War era hazards, it covers service on or after August 2, 1990 in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates, or the surrounding waters and airspace (the Arabian Sea, Gulf of Aden, Gulf of Oman, the neutral zone between Iraq and Saudi Arabia, the Persian Gulf, and the Red Sea).

The toxic exposure screening

The PACT Act requires VA to give a toxic exposure screening to every veteran enrolled in VA health care, with a follow-up at least once every five years. It is a short set of questions about burn pits, Gulf War hazards, Agent Orange, radiation, Camp Lejeune water, and other exposures. The screening does not file a claim for you, but it puts your exposure history in the record and can point you toward conditions worth claiming.

How to file or refile

File a new disability claim on VA Form 21-526EZ the same way you would for any condition. If VA previously denied a condition that is now presumptive, do not treat that old denial as final. File a Supplemental Claim (VA Form 20-0995); the change in law that made your condition presumptive is itself a basis to have the claim readjudicated.

One timing point worth knowing. During the first year after the law, claims or intents to file submitted by August 9, 2023 could have their effective date backdated to the date of enactment, August 10, 2022. That special window has closed. Filing now still works, and there is no final deadline to file a PACT Act claim, but the effective date follows the standard rules: file an intent to file (VA Form 21-0966) first to lock in the earliest date you can.

Next steps

A granted presumptive is rated no differently from a condition you had to prove the hard way: it drops onto the rating schedule and folds into your combined percentage, where a 30 and a 20 come out to 40, not 50. The combined-rating calculator does that arithmetic for you. Before you file, it is worth having a free VA-accredited representative or VSO check that your service dates and diagnosis land inside a presumptive category, and flag whether an old denial is now worth refiling as a Supplemental Claim. VA’s own overview is on the PACT Act page.