PACT Act: Toxic Exposure and VA Disability Benefits

What is the PACT Act?

The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act (PACT Act) is the most significant expansion of VA healthcare and disability benefits for toxic-exposed veterans in over 30 years. Signed into law on August 10, 2022, it fundamentally changed how the VA handles claims related to toxic exposure.

Before the PACT Act, veterans exposed to burn pits, Agent Orange, contaminated water, and other toxins often struggled to prove their conditions were connected to military service. The PACT Act establishes dozens of presumptive conditions — meaning the VA now assumes these conditions are service-connected if you served in qualifying locations during qualifying time periods.

Who qualifies?

The PACT Act covers veterans exposed to toxins in several categories:

Burn pit and airborne hazard exposure

If you served in any of these locations during the qualifying time periods:

On or after August 2, 1990:

• Southwest Asia — Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, UAE (and the airspace and waters surrounding these locations)

On or after September 11, 2001:

• Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen

• Any location where the Department of Defense identifies burn pit or airborne hazard exposure

Agent Orange exposure

If you served in:

• Vietnam (including in-country, offshore, or in the airspace) between January 9, 1962 and May 7, 1975
• Thailand at specific Royal Thai Air Force Bases during the Vietnam era
• Guam, American Samoa, Johnston Atoll, Wake Island — locations where Agent Orange was tested or stored
• C-123 aircraft that were previously used to spray Agent Orange

Radiation exposure

If you participated in:

• Nuclear weapons testing (atmospheric or underground)
• Occupation of Hiroshima or Nagasaki
• Service at specific nuclear facilities
• Cleanup of Enewetak Atoll or Palomares, Spain

Other toxic exposures

• Camp Lejeune contaminated water (1953-1987)
• Gulf War service with unexplained chronic multi-symptom illness
• Specific hazardous materials encountered during military duties

Presumptive conditions under the PACT Act

Presumptive conditions mean the VA assumes the condition is connected to your service if you served in a qualifying location. You don’t need to prove the connection — just that you have the condition.

Burn pit / airborne hazard presumptives

The PACT Act added these conditions as presumptive for veterans with qualifying service:

Cancers:

• Bladder cancer
• Head cancer of any type
• Neck cancer of any type
• Respiratory cancer of any type (larynx, bronchus, lung, trachea)
• Reproductive cancer of any type
• Glioblastoma
• Lymphatic cancer of any type
• Kidney cancer (renal cell carcinoma)
• Melanoma
• Pancreatic cancer
• Any cancer for which DOD establishes a link to burn pit/airborne hazard exposure

Respiratory conditions:

• Constrictive bronchiolitis or obliterative bronchiolitis
• Diffuse interstitial pneumonitis (interstitial lung disease)
• Desquamative interstitial pneumonitis
• Pulmonary fibrosis
• Sarcoidosis
• Chronic sinusitis
• Chronic rhinitis
• Chronic bronchitis
• Emphysema
• Chronic obstructive pulmonary disease (COPD)
• Asthma (diagnosed after service)
• Pleuritis
• Pulmonary granuloma

Agent Orange presumptives

The PACT Act added these conditions to the existing Agent Orange presumptive list:

• High blood pressure (hypertension)
• Monoclonal gammopathy of undetermined significance (MGUS)

These are in addition to the long-standing presumptive conditions including:

• AL amyloidosis
• Chloracne (or similar acneform disease)
• Chronic B-cell leukemias
• Hodgkin’s disease
• Hypothyroidism
• Ischemic heart disease
• Multiple myeloma
• Non-Hodgkin’s lymphoma
• Parkinsonism
• Parkinson’s disease
• Peripheral neuropathy, early-onset
• Porphyria cutanea tarda
• Soft tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
• Type 2 diabetes
• Various cancers (bladder, prostate, lung, and others)
• And others listed in 38 CFR § 3.309(e)

How to file a PACT Act claim

Step 1: Complete your toxic exposure screening

The PACT Act expanded VA healthcare eligibility for toxic-exposed veterans. Even before filing a disability claim, you can:

• Enroll in VA healthcare at VA.gov
• Request a toxic exposure screening at your next VA healthcare appointment
• The screening helps document your exposure history, which supports future claims

Step 2: File an Intent to File

Before gathering evidence, submit an Intent to File to establish your effective date. This preserves your right to back pay from this date if your claim is approved. You can do this online at VA.gov or by calling 1-800-827-1000.

Step 3: Gather your evidence

For presumptive conditions, you need:

• Proof of qualifying service — DD-214, deployment orders, or service records showing you served in a qualifying location during a qualifying time period
• Current diagnosis — Medical records confirming you have the presumptive condition
• That’s it — You don’t need to prove the connection between exposure and condition. The VA presumes it.

For non-presumptive conditions related to toxic exposure, you’ll also need:

• Evidence of exposure — Documentation of specific toxins encountered
• Nexus letter — A medical opinion linking your condition to the toxic exposure
• Medical literature — Supporting studies if available

Step 4: File your claim

File using VA Form 21-526EZ through:

• Online at VA.gov (recommended)
• In person at your VA Regional Office
• With a VSO representative

When filing, specifically note:

• The condition you’re claiming
• That it’s related to toxic exposure
• Your service in qualifying locations and dates
• Reference the PACT Act if filing for a newly presumptive condition

For detailed filing instructions, see our complete how to file a VA disability claim guide.

Step 5: Attend your C&P exam

The VA will likely schedule a C&P exam to evaluate the current severity of your condition. Even though the service connection is presumptive, the exam determines your rating percentage, which sets your monthly compensation.

Previously denied claims

If you filed a claim for a condition that’s now presumptive under the PACT Act and were denied, you have options:

File a Supplemental Claim

Submit VA Form 20-0995 (Supplemental Claim) citing the PACT Act as new and relevant evidence. The VA’s change in law establishing your condition as presumptive counts as “new and relevant” evidence.

Effective date considerations

If your Supplemental Claim is granted:

• If you file within one year of the PACT Act’s effective date for your condition, you may receive back pay to your original claim date
• The specific effective date rules are complex — work with a VSO to maximize your back pay

PACT Act healthcare expansion

Beyond disability compensation, the PACT Act expanded VA healthcare eligibility:

• Post-9/11 combat veterans now have a 10-year enrollment window after discharge (expanded from 5 years)
• Toxic-exposed veterans can enroll in VA healthcare regardless of disability rating
• Veterans who served near burn pits are eligible for VA healthcare even without a diagnosed condition

Timeline expectations

Presumptive claims under the PACT Act are often processed faster than standard claims because the VA doesn’t need to establish the service connection — it’s presumed.

Tips for PACT Act claims

1. Don’t assume you’re not eligible

The PACT Act covers a wide range of service locations and time periods. Even if you weren’t directly exposed to burn pits, you may qualify based on your service location.

2. File for all qualifying conditions

Review the full list of presumptive conditions and file for every condition you have that qualifies. Each condition adds to your combined rating. Use our calculator to see how additional ratings affect your monthly payment.

3. Consider secondary conditions

Toxic exposure conditions can lead to secondary conditions. For example, if you’re service-connected for a respiratory condition under the PACT Act, sleep apnea may be secondary to that condition. See our secondary conditions guide for more information.

4. Work with a VSO

PACT Act claims involve specific eligibility criteria and effective date rules. A VSO can ensure you file correctly and maximize your benefits. Find one at VA.gov.

5. Get your toxic exposure screening

Even if you’re not filing a claim immediately, get your toxic exposure screening documented in your VA health records. This creates a paper trail that supports future claims.

Use our VA disability calculator to estimate your monthly compensation based on your expected ratings.

Disclaimer: This content is for informational purposes only and does not constitute legal or medical advice. For personalized guidance on your VA disability claim, consult a VA-accredited Veterans Service Organization (VSO), attorney, or claims agent. You can find accredited representatives at VA.gov.