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August 10, 2022

PACT Act Adds New Presumptive Conditions for Burn Pit, Agent Orange, and Radiation Exposure

Last updated on April 25, 2024

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In 2022, President Biden signed the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022 into law. Known as the PACT Act, this is the most comprehensive toxic exposure legislation ever signed into law.

This is a huge deal, as the new law will help many veterans who have been impacted by burn pits, Agent Orange, and radiation exposure finally get the compensation they deserve.

The VA PACT ACT will have a big impact on people’s lives, similar to when the original GI Bill was passed. This new law has the potential to benefit more than 5 million veterans.

If you’re a veteran who has been impacted by toxic exposure and you meet the new criteria, don’t hesitate to file a claim! You may be eligible for VA health care and benefits that were previously unavailable to you. 


What is the PACT Act?

The Veterans PACT Act of 2022 is a law designed to care for veterans exposed to toxic substances during their military service. The law provides expanded health care and disability benefits for veterans and their families. It will be phased into practice from the effective date (August 10, 2022) to October 2026. 

The VA PACT Act has three main functions:

  • Expanded VA health care eligibility and disability benefits to veterans and families exposed to toxic substances. The law reforms the VA’s presumptive decision-making process and addresses three main types of toxic exposure: burn pits, Agent Orange, and radiation.
  • Reforms the VA’s process for adding and removing presumptive conditions to the VA’s list. This includes giving a timeline of 160 days to the Secretary of the VA to begin to add a condition to the list after receiving a recommendation.
  • Increases resources to the VA to bolster VA claims processing, the VA’s workforce, and VA health care facilities to make sure the VA can take on the added responsibility of caring for veterans with toxic exposure.

Who is a toxic exposed veteran?

You’re considered a toxic-exposed veteran if you participated in a toxic exposure risk activity while serving active duty, active duty for training, inactive duty training, or are a veteran who deployed in support of one of these operations:

  • Operation Enduring Freedom
  • Operation Freedom’s Sentinel
  • Operation Iraqi Freedom
  • Operation New Dawn
  • Operation Inherent Resolve
  • Resolute Support Mission

This increased eligibility for veterans expands care for the nearly 5 million post-9/11 veterans exposed to toxic substances.

Generation after generation of veterans have experienced toxic exposure throughout their service and are dealing with debilitating conditions to this day.

Now, Congress has created a path for veterans to get the help they need.

The PACT Act and Presumptive Disabilities

The new law greatly expands the number of presumptive disabilities the VA recognizes. 

A presumptive disability for toxic exposure is one that the VA “presumes” to be service-connected, even if there’s no specific Nexus (“link” or “connection”) for service connection.

When you qualify for a presumptive service connection disability, your claim is MUCH easier to win.

In essence, Congress has made it much easier for the 20% of veterans impacted by toxic exposure to win their VA claims.

see also:
Maximizing Your PACT Act Compensation
What are VA Presumptive Conditions?
23 Burn Pit Presumptive Conditions Added by the VA PACT Act

What does this mean for impacted veterans?

Instead of having to prove a service-connected disability, in most cases, you only need to show with your DD 214 that you were deployed to an eligible location for the different types of toxic exposure during a specific period, and that you developed a qualifying condition as a result.

The PACT Act also provides veterans with a medical examination to link a disability and toxic exposure risk activity, if a veteran submits a disability compensation claim for a service-connected disability without enough evidence.

Below we break out the different types of toxic exposure and what veterans are impacted.


Which veterans are impacted by the PACT Act?

Of the three main toxic exposures in this new law, the veterans PACT Act has different criteria on who is eligible for each presumptive, based on when and where veterans served.

New Toxic Exposure Presumptive Conditions

In 2021, Congress created the first list of presumptive disabilities for veterans with burn pit exposure. However, this list only had four conditions (sinusitis, rhinitis, rhinosinusitis, and asthma) and none related to cancer.

With the PACT Act, 13 respiratory illnesses and 11 categories of cancers have been added to the list, “Airborne Hazards and Burn Pit Exposures.”  

These conditions include:

  • Chronic bronchitis
  • Chronic OPD
  • Constrictive bronchiolitis or obliterative bronchiolitis
  • Emphysema
  • Granulomatous disease
  • Interstitial lung disease
  • Pleuritis
  • Pulmonary fibrosis
  • Sarcoidosis
  • Glioblastoma
  • Chronic sinusitis
  • Chronic rhinitis
  • Asthma that developed and was diagnosed after qualifying service

The 11 categories of cancers added to the toxic exposure presumptive list include:

  • Head cancer of any type
  • Neck cancer of any type
  • Respiratory cancer of any type
  • Gastrointestinal cancer of any type
  • Reproductive cancer of any type
  • Lymphoma cancer of any type
  • Lymphomatic cancer of any type
  • Kidney cancer
  • Brain cancer
  • Melanoma
  • Pancreatic cancer

Although there are only 11 cancers mentioned, when “of any type” is added as a qualifier, hundreds of types of cancers can now be considered presumptively service-connected.

Service Areas to Qualify for Toxic Exposure Presumption

If you served on active duty in any of these countries during the time frames listed below, you’re covered under the new law. You must have performed active military, naval, air, or space service, while assigned to a duty station, including the airspace above.

Your service does not have to be limited to boots on the ground in-country. If you served in the waters nearby or the airspace above these countries, you’re covered.

You’re eligible for toxic exposure presumptive conditions if you served on or after August 2, 1990, in these countries:

  • Bahrain
  • Iraq
  • Kuwait
  • Oman
  • Qatar
  • Saudi Arabia
  • Somalia
  • United Arab Emirates

Or if you served on or after September 11, 2001, you’re covered for service in all of the above countries plus:

  • Afghanistan
  • Djibouti
  • Egypt
  • Jordan
  • Lebanon
  • Syria
  • Yemen
  • Uzbekistan
  • Or any other country determined relevant by the Secretary

In order to qualify for a toxic exposure presumptive, you must:

  • Prove you served in one of the eligible areas listed below
  • Have evidence of a disability related to toxic exposure (listed above)

You don’t have to have a record of any of these conditions in your military medical records to qualify for presumptive service connection. 

Toxic Exposure Presumptives Effective Dates

For toxic exposure presumptive claims, the effective dates are listed below. If a veteran is terminally ill, homeless, in severe financial difficulty, aged 85 or older, or can demonstrate other acceptable cause, August 10, 2022, is the effective date for claims. This also applies to Dependency and Indemnity Compensation.

Effective immediately:

  • Asthma
  • Respiratory cancer of any type
  • Brain cancer
  • Constrictive bronchiolitis or obliterative bronchiolitis
  • Emphysema
  • Granulomatous disease
  • Interstitial lung disease
  • Pleuritis
  • Pulmonary fibrosis
  • Sarcoidosis
  • Chronic sinusitis
  • Chronic rhinitis
  • Glioblastoma

Effective October 1, 2023:

  • Chronic bronchitis
  • COPD

Effective October 1, 2024:

  • head cancer, neck cancer, gastrointestinal cancer, reproductive cancer, lymphoma, lymphomatic cancer, and pancreatic cancer

Effective October 1, 2025:

  • Kidney cancer
  • Melanoma

To learn more, read our article on filing a VA claim for a burn pit presumptive disability.


Gulf War Syndrome Updates

The PACT Act also expanded the number of veterans eligible to be granted presumptive service connection for Gulf War Illness, or Gulf War Syndrome.

Thousands of veterans who served in the Persian Gulf during their military careers suffer from Gulf War Syndrome. The phrase “Gulf War Syndrome” refers to long-term unexplained chronic symptoms that are typically lifelong in origin.

Possible causes include exposure to burning oil-well fires, pollution, pesticides, depleted uranium, vaccinations, and anti-nerve gas tablets, to name a few.

Congress added these locations to the list of areas linked to long-term health problems:

  • Israel
  • Egypt
  • Turkey
  • Syria
  • Jordan

The old locations already considered before the PACT Act are also still eligible:

  • Iraq, Kuwait, Saudi Arabia
  • Afghanistan
  • The neutral zone between Iraq and Saudi Arabia
  • Bahrain, Qatar, and the United Arab Emirates (UAE)
  • Oman
  • The Gulf of Aden and the Gulf of Oman
  • The waters of the Persian Gulf, the Arabian Sea, and the Red Sea
  • The airspace above these locations

Any veteran who served from Aug. 2, 1990, onward in these areas meets the criteria to be considered eligible for a Gulf War Syndrome presumptive disability, as long as their disabilities qualify under the VA’s definition of Gulf War Syndrome.

You can learn more about what disabilities and symptoms qualify for Gulf War Illness in our article about Gulf War Syndrome.


Agent Orange Presumptive Service Connection

Agent Orange is a dangerous herbicide used in the Vietnam War. It’s been linked to serious health issues for both our veterans and the civilian populations who were exposed to it. These disabilities may take years to manifest themselves.

Now, veterans who served in Thailand, Cambodia, Laos, Guam, American Samoa, and Johnston Atoll during Vietnam are covered for the first time under the same Agent Orange presumptive policies already extended to Vietnam Veterans. Many more Vietnam War-era veterans are now covered, and in some cases the presumption extends past the war’s end. 

Just like for the toxic exposure presumption, active military, naval, air, or space service qualify as covered service (including in the airspace above an area).

Covered countries for Agent Orange presumption now include:

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

Vietnam service and Korean Demilitarized Zone service are still included on the presumptive list.

However, in addition to this list, the new law includes hospital care and medical services for any veteran who was exposed to dioxin or another toxic substance found in a herbicide or defoliant during the Vietnam era, regardless of where they served

The PACT Act for veterans added two conditions to the Agent Orange presumptive service connection list:

  • Monoclonal gammopathy (a condition with abnormal proteins found in the blood)
  • High blood pressure (hypertension)

Agent Orange Presumptive Conditions Effective Dates

All new Agent Orange presumptive condition claims are effective October 1, 2022. DIC claimant, terminally ill veterans, homeless veterans, those with financial harship, and veterans over the age of 85 will be given effective dates of August 10, 2022. 

To learn more, read our article about filing a claim for an Agent Orange presumptive disability.

Radiation Exposure and the PACT Act

The PACT Act 2022 extends presumptive service connection to veterans involved in specific incidents involving radiation cleanup.

Any veteran involved in the nuclear cleanup of Enewetak Atoll from January 1, 1977 to December 31, 1980.

Any veteran involved in the nuclear cleanup of two separate B-52 crash sites:

  • Palomores, Spain – from January 17, 1966 to March 31, 1967
  • Thule Air Force Base, Greenland – from January 21, 1968 to September 25, 1968

How to Win A VA Claim for Exposure to a Toxic Substance

There are a few different actions you can take as a veteran to make winning your VA claim for toxic exposure easier.

Agent Orange

The Agent Orange registry health exam is a free comprehensive exam available at local VA locations that cover your exposure history, medical history, includes a physical exam and tests if required, and will go over your results with a VA physician. You don’t have to be enrolled in VA health care to qualify. You can learn how register for the exam here

When filing a VA claim, show you meet the duty station and time conditions. Submit your military duty records along with your VA claim to show you meet the requirements. These records, along with a medical diagnosis of one of the conditions on the Agent Orange presumptive list, will qualify you for VA disability compensation.

If you weren’t deployed to one of the areas that normally qualifies for an Agent Orange presumptive rating, you will still be covered if you can prove you were exposed during or involved in testing, storage, or disposal in the U.S. or abroad. Including records of deployment from these facilities, or the use or storage of these chemicals can help you win your claim. 

Burn Pits and Other Toxins

If you were exposed to one or more burn pits, self-register immediately. The VA maintains the Airborne Hazards and Open Burn Pit Registry, which can help you document and track your symptoms. There are two parts, a questionnaire and an optional VA health evaluation. 

When filing, in order to establish presumptive service connection for one of the conditions related to toxic exposure, your evidence must show qualifying service at one of the specified duty locations, and manifestation of the qualifying diagnosed disability(ies). 

With those conditions met, the nexus between the condition and your exposure to toxic substances in your duty location is presumed, and you will be service-connected for that condition.

What happens if my VA claim was already denied?

If you filed for a condition added to one of the presumptive lists within the PACT Act, you’re eligible to submit a Supplemental Claim.

While the VA is supposed to go back and evaluate claims to determine all veterans who are eligible, don’t wait for this to happen. You can submit a supplemental claim for your condition (that has been added to the presumptive list) without receiving notice from the VA.

You can file a supplemental claim without the VA telling you you are eligible using VA Form 20-0995. If a Supplemental Claim is filed for any conditions in this new law, the effective date will be the date the Supplemental Claim was filed


Changes to the VA with the PACT Act

When new sweeping legislation is passed, and major changes are made to the VA claims process, it takes a while for the VA to catch up.

The PACT Act created 31 new VA outpatient clinics across the U.S. and extended the VA’s budget to hire high-quality private-sector employees.

With all the new facilities and processes, it will take some time for the VA to hire and train new employees and train all the existing employees on the updated procedures. It takes, on average, 95 days to hire new employees.

Aside from the updates to toxic substances presumptive lists, VA employees will now focus health care on toxic exposure. During all VA appointments, new screening questions will be introduced to find out if veterans could have toxic exposure.

This is why it’s critical to understand how the new presumptive process works if the PACT Act applies to you to advocate for yourself. VA Claims Insider is here to support you by educating you throughout your entire VA claim process.

The veterans PACT Act is a major step in the right direction for Congress, as it shows they are truly committed to caring for our veterans.

Military Base Toxic Exposure

Military Burn Pit Locations


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About the Author

Brian Reese
Brian Reese

Brian Reese

Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).

Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start. 

As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.

He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).

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