The PACT Act
When the exact listed diagnosis and covered service requirements are met, the presumption can supply the causal link to service. You still need evidence of the diagnosis and qualifying service, and VA still decides the evaluation and effective date.
The Honoring our PACT Act of 2022 added more than 20 presumptive conditions for veterans exposed to burn pits and other toxic hazards. Current regulation also includes fine-particulate-matter presumptions at 38 CFR § 3.320, with additional bladder, ureter, and related genitourinary-cancer presumptions at 38 CFR § 3.320a. The law also expanded Agent Orange and radiation exposure presumptions.
Quick eligibility check
Three questions about the burn-pit and toxic-exposure list. This does not screen Agent Orange, Camp Lejeune, radiation, or every direct toxic-exposure theory.
Burn-pit and toxic-exposure presumptive list
The current conditions VA lists for this framework. The diagnosis and covered location-and-date requirements must both match. DC links are educational rating-schedule references.
Cancers12 conditions
Current VA.gov PACT Act cancer list for veterans with the required covered service. Section 3.320 separately lists certain rare cancers; it is not the complete PACT list.
Brain cancer
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Gastrointestinal cancer (any type)
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Glioblastoma
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Genitourinary cancer
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Head cancer (any type)
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Hematologic and lymphatic cancers
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Lymphoma (any type)
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Melanoma
DC 7833 →Service: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Neck cancer (any type)
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Pancreatic cancer
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Reproductive cancer (any type)
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Respiratory (breathing-related) cancer (any type)
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Non-cancer respiratory12 conditions
Current VA.gov non-cancer illness list. Asthma must have been diagnosed after service. Asbestosis is not on this PACT presumptive list and requires its own evidence analysis.
Asthma (diagnosed after service)
DC 6602 →Service: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Chronic bronchitis
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Chronic Obstructive Pulmonary Disease (COPD)
DC 6604 →Service: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Chronic rhinitis
DC 6522 →Service: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Chronic sinusitis
DC 6510 →Service: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Constrictive / obliterative bronchiolitis
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Emphysema
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Granulomatous disease
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Interstitial lung disease (ILD)
DC 6825 →Service: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Pleuritis
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Pulmonary fibrosis
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Sarcoidosis
No DC guideService: Covered service on or after Sep 11, 2001, or Aug 2, 1990, depending on location
PACT Act / current VA presumptive guidance
Agent Orange (Vietnam-era, § 3.309(e))
The Agent Orange presumptive list predates PACT but was expanded by it. Selected presumptives (not exhaustive):
- Type 2 Diabetes Mellitus
- Ischemic heart disease
- Parkinson's disease (and Parkinsonism)
- Hypertension (PACT-era addition)
- Monoclonal gammopathy of undetermined significance — MGUS (PACT-era addition)
- Bladder cancer (PACT-era addition)
- Hypothyroidism (PACT-era addition)
- Prostate cancer, respiratory cancers, soft-tissue sarcomas, chronic B-cell leukemias
Camp Lejeune (1953–1987, § 3.307(a)(7))
Veterans stationed at Camp Lejeune for 30+ days between August 1953 and December 1987 get a presumption for these conditions:
- Kidney cancer
- Liver cancer
- Non-Hodgkin's Lymphoma
- Adult leukemia
- Multiple Myeloma
- Parkinson's disease
- Aplastic anemia / myelodysplastic syndromes
- Bladder cancer
PACT-covered service locations
Post-9/11 burn pit / toxic exposure
Service on or after September 11, 2001:
- • Afghanistan
- • Djibouti
- • Egypt
- • Jordan
- • Lebanon
- • Syria
- • Uzbekistan
- • Yemen
- + airspace above these locations
Gulf War locations (on or after Aug 2, 1990)
- • Bahrain
- • Iraq
- • Kuwait
- • Oman
- • Qatar
- • Saudi Arabia
- • Somalia
- • UAE
- • Arabian Sea
- • Gulf of Aden
- • Gulf of Oman
- • Neutral zone between Iraq and Saudi Arabia
- • Persian Gulf
- • Red Sea
- + airspace above these locations
Earlier eras (some PACT-expanded)
- • Vietnam (Jan 9, 1962 – May 7, 1975)
- • Thailand military bases (Jan 9, 1962 – Jun 30, 1976)
- • Korean DMZ (Sep 1, 1967 – Aug 31, 1971)
- • Camp Lejeune (Aug 1953 – Dec 1987)
- • Atmospheric nuclear testing sites
- • Laos, Cambodia, Guam (Agent Orange-related)
How to file
- 1
Get your evidence in order
- DD-214 showing service dates and locations
- Current medical records confirming the condition
- Service treatment records (if available)
- Deployment orders or unit records if the DD-214 lacks specifics
- 2
File VA Form 21-526EZ
Submit online or by mail. Form 21-526EZ on VA.gov →
- 3
Identify the exact theory and service
Name the diagnosed condition and identify the covered location and dates in your application or supporting statement. Do not assume the condition label alone establishes the presumption.
- 4
Nexus statement
When the exact presumption requirements are established, a separate private nexus letter is generally unnecessary because the presumption supplies the causal link. A medical opinion may still matter if the diagnosis is disputed, an exception is raised, or the claimed condition is not actually on the applicable list.
- 5
C&P exam
Attend any scheduled exam and answer accurately. The examiner may address diagnosis, severity, onset, medical history, or whether an exception or different theory applies. Do not script answers or argue with the examiner; provide the records VA requested. C&P Exam Prep Generator →
- 6
Decision
Processing time varies with the evidence needed, the number of claimed issues, and whether VA must obtain records or examinations. A presumption does not guarantee a faster decision.
Was your claim denied as “not presumptive”?
A denial may turn on missing service records, a diagnosis mismatch, an exception, or a legal error. The appropriate review lane depends on what is missing:
VA didn’t have your service location records
Request DD-214 corrections and line-of-duty documentation. Submit any deployment orders, performance reports, or unit awards naming the location.
VA misinterpreted your service dates
Pull deployment orders, travel vouchers, evaluations, and TDY records showing the precise location and dates. Different exposure programs have different service requirements.
VA didn’t apply liberalizing law to a pre-Aug 2022 claim
A Supplemental Claim requires new and relevant evidence. Identify the current presumptive rule and submit the service or medical evidence that was missing from the prior record.
Need an independent legal review?
File a Higher-Level Review (HLR) — a senior reviewer reexamines the existing record and no new evidence may be submitted. It may fit when you allege an error based on evidence VA already had. A Supplemental Claim may fit when new and relevant evidence is needed; an accredited representative can help compare lanes.
Save this guide
Continue with the free public condition catalog or review the official VA exposure page.
Caveats
Data validated against current VA.gov and eCFR sources on August 16, 2026.
Educational only — not legal advice. Talk to a VSO or VA-accredited attorney before filing. Presumptive lists change with new legislation and VA rulemaking; verify against the latest 38 CFR § 3.320 , § 3.320a, and VA.gov PACT Act page before relying on any condition or location listed here.