PACT Act Presumptive Conditions: Burn Pits, Agent Orange, and Who Qualifies

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The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, Pub. L. 117-168, signed Aug. 10, 2022, added presumptive conditions and locations for toxic exposure. Primary source: VA.gov – The PACT Act and your VA benefits. "Presumptive" means VA assumes service caused the condition if you meet the service requirements — you do not need a nexus opinion for that condition.

Burn pits and other airborne hazards (Gulf War & post-9/11 eras)

Cancers: brain, gastrointestinal (any type), glioblastoma, head (any type), kidney, lymphoma (any type), melanoma, neck (any type), pancreatic, reproductive (any type), respiratory (any type). Other illnesses: asthma diagnosed after service, chronic bronchitis, COPD, chronic rhinitis, chronic sinusitis, constrictive or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, sarcoidosis. Qualifying service (examples from VA): on/after Aug 2, 1990 in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or the UAE; or on/after Sept 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, or Yemen (includes airspace). Check the VA page for the full list. Regulation: VA's 2023 fine-particulate-matter rule, 38 CFR § 3.320, separately lists asthma, rhinitis, sinusitis (including rhinosinusitis), and nine rare respiratory cancers for Southwest Asia theater service (Aug 2, 1990 on) and Afghanistan, Syria, Djibouti, or Uzbekistan (on or after Sept 19, 2001). Gulf War undiagnosed / medically unexplained chronic multisymptom illness is covered by 38 CFR § 3.317.

Agent Orange

PACT added high blood pressure (hypertension) and monoclonal gammopathy of undetermined significance (MGUS) as Agent Orange presumptive conditions, and added presumptive locations: Thailand (any U.S. or Royal Thai base, Jan 9, 1962–June 30, 1976), Laos (Dec 1, 1965–Sept 30, 1969), Cambodia at Mimot or Krek, Kampong Cham Province (Apr 16–30, 1969), Guam/American Samoa territorial waters (Jan 9, 1962–July 31, 1980), and Johnston Atoll (Jan 1, 1972–Sept 30, 1977). These are listed on VA.gov; the longstanding Agent Orange disease list is at 38 CFR § 3.309(e), and the general herbicide-exposure rules (including Vietnam service, Jan 9, 1962–May 7, 1975) are at 38 CFR § 3.307(a)(6).

Other provisions

• Toxic exposure screening for every Veteran enrolled in VA health care (initial screening and a follow-up at least once every 5 years).
• New radiation presumptive locations: Enewetak Atoll cleanup (Jan 1, 1977–Dec 31, 1980), Palomares, Spain cleanup (Jan 17, 1966–Mar 31, 1967), and the Thule Air Force Base, Greenland B-52 response (Jan 21–Sept 25, 1968).

How to file

File a claim on VA Form 21-526EZ; an Intent to File (VA Form 21-0966) can preserve an earlier effective date (38 CFR § 3.155). If you were denied a now-presumptive condition before, file a supplemental claim (VA Form 20-0995).

Lists verified against VA.gov on Oct 29, 2026. VA can add conditions by rule, so check the VA page for updates.