The Playbook › Toxic exposure guides
The PACT Act, signed in August 2022, is the largest expansion of VA benefits in a generation. Its central change is simple. For veterans exposed to burn pits, Agent Orange, and other toxic substances, it added a long list of conditions that VA now presumes were caused by service.
Presumptive means you do not have to prove the link. If you served in a covered place and time, and you have a listed condition, the connection is assumed.
The short version
- If you have a presumptive condition and qualifying service, you do not need a nexus letter.
- Covers post-9/11 and Gulf War veterans exposed to burn pits and airborne hazards, and expands Agent Orange and radiation coverage.
- There is no deadline to file a PACT Act claim.
- If you were denied before for a condition that is now presumptive, file a Supplemental Claim.
- Survivors may qualify for benefits based on a veteran’s presumptive condition.
On this page
Who is covered for burn pits and airborne hazards
VA presumes exposure if you served in any of these places during these periods.
| Period | Locations, including the airspace above |
|---|---|
| On or after September 11, 2001 | Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen |
| On or after August 2, 1990 | Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates |
You do not have to prove you were near a specific burn pit. Service in the location is enough.
Presumptive conditions for burn pit exposure
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 cancer of any type
Illnesses
- Asthma diagnosed after service
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Chronic rhinitis
- Chronic sinusitis
- Constrictive or obliterative bronchiolitis
- Emphysema
- Granulomatous disease
- Interstitial lung disease
- Pleuritis
- Pulmonary fibrosis
- Sarcoidosis
VA has continued to add conditions since the PACT Act passed, including certain blood cancers and genitourinary cancers. Always check the current list on VA.gov, linked below, before assuming a condition is not covered.
Agent Orange changes
The PACT Act added two presumptive conditions for Agent Orange exposure:
- High blood pressure (hypertension)
- Monoclonal gammopathy of undetermined significance (MGUS)
It also added new locations where exposure is presumed, including bases in Thailand, and parts of Laos, Cambodia, Guam, American Samoa, and Johnston Atoll. Full details are in the Agent Orange guide.
Radiation changes
Three response and cleanup missions were added as presumptive radiation exposure:
- Cleanup of Enewetak Atoll, January 1, 1977, to December 31, 1980
- Cleanup after the B-52 accident at Palomares, Spain, January 17 to March 31, 1967
- Response to the B-52 fire near Thule Air Force Base, Greenland, January 21 to September 25, 1968
What “presumptive” does and does not do
| It does | It does not |
|---|---|
| Remove the need to prove the condition was caused by service | Remove the need for a current diagnosis |
| Remove the need to prove you were exposed, if you served in a covered location | Set your rating. Severity still decides the percentage. |
| Apply to veterans previously denied | Apply automatically. You must file. |
Not on the PACT Act list?
You can still file. For a condition that is not presumptive, VA must consider your exposure and, in most cases, get a medical opinion on whether it is linked. The PACT Act requires a toxic exposure risk activity review when you claim a condition and your records show exposure. A private nexus opinion citing research on the exposure strengthens these claims.
For how the two most common ones are rated, see sinusitis and rhinitis ratings and, for Agent Orange veterans, hypertension ratings.
Conditions on the list can also lead to others. Sleep apnea secondary to presumptive rhinitis or sinusitis is a common example. See secondary conditions.
How to file a PACT Act claim
- Submit an Intent to File today if you are not ready.
- Get a current diagnosis in your medical records.
- File VA Form 21-526EZ at VA.gov and answer the toxic exposure questions. See the filing guide.
- Upload your diagnosis and treatment records. Your DD214 and service records establish where you served.
- Attend any exam. VA needs to assess severity even when the link is presumed.
If you were denied before
If VA denied a condition that is now presumptive, file a Supplemental Claim on VA Form 20-0995. The change in law is treated as a basis for a new review. See Supplemental Claims.
On effective dates: when a claim is granted because of a new law, the effective date generally cannot be earlier than the date the PACT Act took effect, and special rules can allow up to one year of retroactive pay in some cases. See VA back pay.
Health care and screening
The PACT Act also expanded VA health care. Veterans exposed to toxins during service, at home or abroad, can enroll without first applying for disability benefits. Every veteran enrolled in VA care is offered a toxic exposure screening. It takes a few minutes and puts your exposure history on record.
Survivors
If a veteran died from a condition that is now presumptive, the surviving spouse, children, or parents may be eligible for monthly compensation, even if an earlier claim was denied. See DIC survivor benefits.
Free printable checklist. Everything to gather before you file, what to bring to your C&P exam, and what to check in your decision, on two pages.
Last reviewed October 2026. This guide is general educational information, not legal or medical advice, and this site is not affiliated with the Department of Veterans Affairs. Rules and rates change. Confirm details on VA.gov or with an accredited representative. See our disclaimer and editorial policy.