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 described by VA as perhaps the largest health care and benefit expansion in VA history. 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 adds more than 20 presumptive conditions — meaning VA assumes your service caused these conditions if you meet the service requirements for the presumption.

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:

• Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates (UAE), or the airspace above any of these locations

On or after September 11, 2001:

• Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, or the airspace above any of these locations

Agent Orange exposure

If you served in:

• Republic of Vietnam between January 9, 1962, and May 7, 1975

The PACT Act added these presumptive locations:

• Thailand at any U.S. or Royal Thai military base, January 9, 1962, through June 30, 1976
• Laos, December 1, 1965, through September 30, 1969
• Cambodia at Mimot or Krek, Kampong Cham Province, April 16, 1969, through April 30, 1969
• Guam or American Samoa (or their territorial waters), January 9, 1962, through July 31, 1980
• Johnston Atoll (or a ship that called there), January 1, 1972, through September 30, 1977

VA notes this isn’t the full list of Agent Orange presumptive locations; check VA’s Agent Orange eligibility page for others.

Radiation exposure

Radiation-risk activities under 38 CFR § 3.309(d) include:

• Onsite participation in atmospheric (including underwater) nuclear tests
• Occupation of Hiroshima or Nagasaki (August 6, 1945–July 1, 1946), or POW internment in Japan with comparable exposure
• At least 250 days before February 1, 1992, at the Paducah, Portsmouth, or Oak Ridge K25 gaseous diffusion plants, with badge-monitored (or comparable) exposure
• Underground nuclear tests (Long Shot, Milrow, or Cannikin) on Amchitka Island, Alaska, before January 1, 1974, if your test-related duties exposed you to radiation
• Service that would qualify a Department of Energy employee for the Special Exposure Cohort under the Energy Employees Occupational Illness Compensation Program Act
• PACT Act additions: cleanup of Enewetak Atoll (1977–1980), response to the B-52 collision near Palomares, Spain (January 17, 1966–March 31, 1967), and response to the B-52 fire near Thule Air Force Base, Greenland (January 21–September 25, 1968)

Other radiation exposure can still be service connected directly, with evidence.

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 VA assumes your service caused the condition. You don’t need to prove the connection — you need to meet the service requirements for the presumption and have medical evidence of the condition.

Burn pit / airborne hazard presumptives

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

Cancers:

• Brain cancer
• Gastrointestinal cancer of any type
• Glioblastoma
• Head cancer of any type
• Kidney cancer
• Lymphoma of any type
• Melanoma
• Neck cancer of any type
• Pancreatic cancer
• Reproductive cancer of any type
• Respiratory (breathing-related) cancer of any type

Illnesses:

• Asthma that was diagnosed after service
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Chronic rhinitis
• Chronic sinusitis
• Constrictive bronchiolitis or obliterative bronchiolitis
• Emphysema
• Granulomatous disease
• Interstitial lung disease (ILD)
• Pleuritis
• Pulmonary fibrosis
• Sarcoidosis

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 if you’re eligible
• Request a toxic exposure screening at your next VA healthcare appointment (VA provides one to every enrolled veteran, with a follow-up at least once every 5 years)
• The screening records your exposure history and points you to benefits, registry exams, and clinical resources

Step 2: File an Intent to File

Before gathering evidence, consider submitting an Intent to File. It can reserve a potential earlier effective date if you submit a complete claim within one year and VA approves it. Starting the disability claim online with an identity-verified account does this automatically. You can also call 1-800-827-1000 or mail VA Form 21-0966.

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
• No nexus needed — You don’t need to prove the connection between exposure and condition. VA presumes it once the service requirements are met.

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
• By mail to Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444
• In person at a VA regional office
• With help from an accredited VSO representative, attorney, or claims agent

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

VA may schedule a C&P exam to evaluate the current severity of your condition. Even when service connection is presumptive, exam findings help VA evaluate the severity of your condition. VA assigns your rating percentage using the exam report and other evidence in your claim file; that rating helps determine 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) based on the change in law. VA says a Supplemental Claim can be based on a change in law such as the PACT Act instead of new evidence, but you’ll still need to submit or identify medical evidence of the diagnosis and severity. VA also says that if it thinks you may be eligible now, it will try to contact you — but you don’t need to wait.

Effective date considerations

If your claim is granted based on the PACT Act:

• Under 38 CFR § 3.114, an award under a liberalizing law generally can’t have an effective date earlier than the law’s effective date, and retroactive payment requires that you met the eligibility criteria continuously from that date
• The specific effective date rules are complex — an accredited VSO representative can review your file

PACT Act healthcare expansion

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

• Veterans who served in the Vietnam War, the Gulf War, Iraq, Afghanistan, or another combat zone after 9/11, who deployed in support of the Global War on Terror, or who were exposed to toxins or other hazards during service can enroll without applying for disability benefits first (if they meet basic service and discharge requirements)
• VA says it began this expansion on March 5, 2024, years earlier than the law required
• Every veteran enrolled in VA health care gets a toxic exposure screening

Timeline expectations

VA doesn’t publish a separate processing time for PACT Act claims. It reported an average of 68.4 days to complete disability-related claims in August 2026 — a national average, not an estimate for any one claim. VA says timing depends on the type of claim, how many conditions you claimed and how complex they are, and how long it takes to collect evidence. See VA’s after-you-file page for the latest figure.

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. Presumptions of exposure are based on where and when you served, so check the location lists even if you don’t recall a specific exposure.

2. File for all qualifying conditions

Review the full list of presumptive conditions and file for each diagnosed condition that qualifies. Separate evaluations are combined only when applicable rating and anti-pyramiding rules permit; the same manifestations cannot be compensated twice. Certain coexisting respiratory conditions receive a single evaluation under the predominant-disability code, with elevation when overall severity warrants, under 38 CFR § 4.96(a). A grant of service connection does not always add a separate percentage. 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, a related condition may be claimed as secondary if the evidence supports it. 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 help you file correctly. 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 records your exposure history in your VA health record.

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

Correction — October 21, 2026: Clarified that the chart’s airspace qualifier applies only to burn-pit and airborne-hazard locations, and listed the radiation-risk activities as 38 CFR § 3.309(d) defines them (underground tests count only for qualifying Amchitka service). Also clarified that separate ratings follow VA’s rule against rating the same symptoms twice, including limits for certain coexisting respiratory conditions.

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.

Correction — October 31, 2026: Clarified that VA assigns the disability rating using the exam report and other evidence; the exam itself does not decide the percentage.