If you served in a qualifying place and have a listed diagnosis, the 2022 PACT Act may provide a legal presumption for your claim. The law — formally the Sergeant First Class Heath Robinson Honoring our PACT Act — added more than twenty conditions to the VA’s presumptive list for burn-pit and airborne-hazard exposure. For those conditions, you do not have to prove that your service caused them. The VA presumes it.
A presumption can supply the service-connection link when every requirement is met. This guide covers qualifying locations and periods, the VA-listed conditions checked on August 12, 2026, the evidence still required, and what to review if VA denies the claim. Verify the live VA list before filing.
Why this matters so much
In an ordinary claim you have to prove three things: a current diagnosis, an in-service event, and a medical link between them. The link — the nexus — is where most claims die. A qualifying presumption generally means the veteran does not need a separate medical opinion to prove that link. VA still verifies the diagnosis, service facts, and every applicable requirement.
Who qualifies: location + time period
Burn-pit presumptions turn on where and when you served. There are two main eligibility groups.
Gulf War era (on or after August 2, 1990)
Service in the Southwest Asia theater of operations on or after August 2, 1990. That theater includes:
- Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the United Arab Emirates
- The neighboring waters and the airspace above these locations
Post-9/11 era (on or after September 11, 2001)
Service on or after September 11, 2001 in the above locations or in:
- Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen
If your DD-214, deployment orders, or travel/pay records put you in one of these places during the relevant window, the VA presumes you were exposed to fine particulate matter and burn-pit emissions. You do not have to prove you stood next to a specific pit.
Current VA-listed presumptive conditions
The PACT Act presumptive list splits into cancers and other illnesses. The list below was checked against VA Public Health on August 12, 2026. A listed diagnosis plus qualifying service identifies a presumptive theory for VA to verify; it is not a guarantee of an award.
Presumptive cancers
- Acute and chronic leukemias
- Brain cancer
- Gastrointestinal cancer of any type
- Glioblastoma
- Head cancer of any type
- Kidney cancer
- Lymphatic cancer of any type
- Lymphoma of any type
- Melanoma
- Multiple myelomas
- Myelodysplastic syndromes
- Myelofibrosis
- Neck cancer of any type
- Pancreatic cancer
- Reproductive cancer of any type
- Respiratory (breathing-related) cancer of any type
- Urinary bladder, ureter, and related genitourinary cancers
Presumptive illnesses
- Asthma (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
Several of these have their own rating guides
The respiratory conditions on this list are rated under 38 CFR § 4.97 and the airway codes. If your presumptive condition is asthma, rhinitis, sinusitis, or sleep-related, walk the rating schedule on the asthma, rhinitis, and sinusitis condition guides so you know which tier your diagnosis supports.
Why you don’t need a nexus letter
The VA codified the burn-pit presumptions in the particulate-matter regulation, 38 CFR § 3.320, alongside the broader presumptive framework in § 3.309. For a qualifying presumptive condition, the regulation can supply two parts of the service-connection analysis:
- It concedes the exposure. Qualifying service in a covered location during the covered period = presumed exposure to fine airborne particulate matter. No exposure proof required.
- It presumes the connection. If you have a listed condition and the qualifying service, the condition is presumed to be related to that exposure — the nexus is built into the law.
That is the difference between a presumptive and direct theory. A direct claim generally needs evidence connecting the current disability to service. A qualifying presumption supplies that link, subject to VA verification and the complete record. For the bigger picture of how presumptive service connection fits next to the other routes, see the four paths to service connection.
How to file a PACT Act claim
- Get the diagnosis documented. A current diagnosis of the listed condition from a VA or private provider. Make sure the diagnosis language matches a listed condition.
- Pull your service records. DD-214, deployment orders, or any record showing you were in a covered location during the covered window. This is what triggers the presumption.
- File VA Form 21-526EZ. List the presumptive condition by name. You can note in a short statement that you are claiming under the PACT Act / burn-pit presumption and 38 CFR § 3.320.
- Attend the C&P exam if scheduled. The VA may still examine you to confirm the current diagnosis and rate the severity — not to re-litigate service connection. Walk in prepared with the C&P Exam Prep tool.
Common mistakes that bounce PACT Act claims
- Service couldn’t be confirmed. If your records don’t clearly show the covered location and dates, the presumption doesn’t trigger. Submit the orders, not just the DD-214 summary.
- Diagnosis doesn’t match a listed term. “Breathing problems” isn’t a listed condition; “chronic obstructive pulmonary disease” is. Get the precise diagnosis on paper.
- Filed as direct, not presumptive. Say you’re claiming under the burn-pit presumption so the rater applies the right framework.
What to do if you’re denied
Start with the reasons and bases in the decision letter. Identify whether VA disputed the diagnosis, qualifying service, application of the presumption, severity, or another issue before choosing a review lane:
- Missing or wrong evidence? File a Supplemental Claim with the new service records or a corrected diagnosis.
- Do you believe VA made an error using the evidence already in the file? Higher-Level Review asks a senior reviewer to take a new look without adding new evidence.
The full appeals decision tree — which lane, the one-year window, and how to protect your effective date — is in the VA appeals guide. And the full PACT Act walkthrough, including the secondary conditions that often follow a respiratory diagnosis, lives on the PACT Act resource hub. If you want a guided, step-by-step path from diagnosis to filing, the Claim Coach runs the whole sequence.
Quick answers
What is a presumptive condition under the PACT Act?
A legal presumption can supply the medical link when the veteran has a listed diagnosis and meets the applicable service requirements. VA still verifies the condition, location, dates, character of service, and any other requirements before granting the claim.
Who qualifies for burn pit presumptions?
Two broad groups. Gulf War era veterans who served on or after August 2, 1990 in the Southwest Asia theater of operations (including Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the UAE), and post-9/11 veterans who served on or after September 11, 2001 in additional locations including Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen. If you served in those places during those windows, exposure to burn pits and fine airborne particulate matter is presumed.
Do I need a nexus letter for a PACT Act presumptive condition?
When the diagnosed condition and qualifying service meet the applicable presumption, a separate private nexus letter is generally not needed for that presumptive theory. You still need evidence of the current condition and qualifying location and dates, and VA must verify that all legal requirements are met. A different or non-presumptive theory may require additional medical evidence.
What conditions are presumptive under the PACT Act?
VA’s current burn-pit and toxic-exposure list includes acute and chronic leukemias; brain, gastrointestinal, head, kidney, lymphatic, neck, pancreatic, reproductive, respiratory, and urinary-bladder/ureter/related genitourinary cancers; glioblastoma; lymphoma; melanoma; multiple myelomas; myelodysplastic syndromes; and myelofibrosis. It also includes asthma diagnosed after service, chronic bronchitis, COPD, chronic rhinitis, chronic sinusitis, constrictive or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, and sarcoidosis. This answer was checked against VA Public Health on August 12, 2026; verify the live VA list before filing.
How do I file a PACT Act claim?
File VA Form 21-526EZ listing the diagnosed condition and identify the applicable PACT Act presumption. Submit or identify medical evidence and service records showing the qualifying location and dates. When every requirement for the presumption is met, a separate private nexus opinion is generally not needed for that theory. VA may still develop evidence or schedule an exam.
What if my PACT Act claim is denied?
Read the reasons and bases in the decision letter before choosing a review option. Missing evidence may support a Supplemental Claim, while an asserted error based on the existing record may fit Higher-Level Review. A Board Appeal is another option. The correct lane depends on the record, the claimed error, and applicable deadlines; consider a VA-accredited representative.
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Educational content only. This is not legal, medical, or financial advice. Always consult an accredited VSO or VA-accredited attorney for claim-specific guidance. Authority: PACT Act of 2022 (Public Law 117-168); current 38 CFR Part 3 presumptive provisions, including §§ 3.309, 3.320, 3.320a, and 3.320b as applicable. Condition list checked against VA Public Health on August 12, 2026. Form: VA Form 21-526EZ. Always verify the current VA list and your specific dates and locations before filing.