PACT Act Presumptives

What the PACT Act changed

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, signed in August 2022, is the largest expansion of VA benefits for toxic-exposed veterans in decades. It established new presumptive conditions, expanded eligible service locations and dates, and created a presumption of toxic exposure for many post-9/11 veterans.

Under a presumption, the VA accepts that a qualifying condition is service-connected without requiring the veteran to prove the connection with a nexus opinion. The veteran still must prove they have the diagnosed condition and qualifying service.

Covered service periods and locations

• Post-9/11 era — service on or after August 2, 1990 in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, UAE, or the airspace above; or on or after September 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, or other listed locations.
• Vietnam era — expanded Agent Orange presumptive locations including Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll.
• Atomic veterans, Camp Lejeune water contamination, and other historic exposure groups also gained expanded coverage.

PACT Act presumptive conditions (post-9/11 exposure)

• Cancers — brain, gastrointestinal (any type), genitourinary (any type), head and neck (any type), kidney, lymphatic (any type), lymphoma, melanoma, pancreatic, reproductive (any type), respiratory (any type).
• Respiratory — 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.
• Other — glioblastoma, hypertension and monoclonal gammopathy of undetermined significance (MGUS) added for Vietnam-era and select other groups.

How PACT Act claims are processed

1. Confirm your service location and dates qualify under the PACT Act expansion.
2. Confirm you have a current diagnosis of a covered presumptive condition.
3. VA Form 21-526EZ is the form generally filed for this purpose. The VA's online claim flow now flags PACT-eligible conditions automatically.
4. Submit current medical records confirming diagnosis. A nexus opinion is NOT required when the presumption applies.
5. Attend any C&P exams. The exam will focus on diagnosis and severity, not causation.

Where these claims break down

• ×Assuming PACT Act applies only to post-9/11 service — Vietnam, Korea DMZ, and other groups also benefit.
• ×Failing to file because of a previous denial — PACT Act denials before 2022 can be reopened with Supplemental Claims.
• ×Not getting screened — VA offers a free Toxic Exposure Screening every five years.
• ×Submitting unnecessary nexus opinions when the presumption removes that requirement.
• ×Missing related secondaries — many presumptive conditions cause secondary conditions that should also be claimed.

Frequently Asked Questions