What Is the PACT Act? Presumptive Conditions and Your VA Rating

Presumptive conditions lists are established by law and regulation, and Congress and VA have both added to them over time, most recently through the PACT Act itself. The conditions, exposure locations, and dates below were confirmed directly against VA's official PACT Act pages and the text of Public Law 117-168. They are not guaranteed to remain current indefinitely. Before relying on any of this for a claim, confirm the current, authoritative list directly at VA's official PACT Act page: https://www.va.gov/pact.

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, known as the PACT Act (Public Law 117-168), is a federal law that expanded VA health care and disability benefits eligibility for veterans exposed to burn pits, Agent Orange, and other toxic substances during military service. Among other provisions, it created new presumptive conditions and expanded qualifying service locations and dates for existing presumptive categories.

VA describes a presumptive condition this way: for some conditions, VA automatically assumes, or presumes, that military service caused the condition, rather than requiring the veteran to separately prove a medical link. VA calls these presumptive conditions, and a condition is presumptive when it is established by law or regulation. This is a distinct legal question from how severely a condition is rated once service connection exists. Whether a condition is presumed connected to service, and what percentage a service-connected condition is rated at, are two separate questions answered by two separate parts of VA's rules.

PACT Act Section 406 (38 U.S.C. 1120, 38 CFR 3.320) establishes presumptive service connection for veterans in qualifying locations diagnosed with qualifying cancers or respiratory illnesses. Presumptive cancers include brain, gastrointestinal, glioblastoma, genitourinary, head, neck, lymphoma, melanoma, pancreatic, reproductive, and respiratory cancers. Presumptive respiratory conditions include post-service asthma, chronic bronchitis, COPD, rhinitis, sinusitis, bronchiolitis, emphysema, interstitial lung disease, pleuritis, pulmonary fibrosis, and sarcoidosis.

Under 38 CFR 3.320, a veteran qualifies for the burn pit presumption of exposure by serving on or after September 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, or the airspace above these locations, or by serving on or after August 2, 1990 in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates, or the airspace above these locations.

Agent Orange presumptive service connection existed before the PACT Act. The PACT Act added to it. Section 404 amended 38 U.S.C. 1116, implemented at 38 CFR 3.309(e), to add hypertension (high blood pressure) and monoclonal gammopathy of undetermined significance (MGUS) to the list of conditions presumed connected to Agent Orange exposure. Section 403 amended 38 U.S.C. 1116 to add new qualifying service locations and dates: any U.S. or Royal Thai military base in Thailand from January 9, 1962 through June 30, 1976; Laos from December 1, 1965 through September 30, 1969; Cambodia at Mimot or Krek, Kampong Cham Province from April 16, 1969 through April 30, 1969; Guam or American Samoa, or the territorial waters off either, from January 9, 1962 through July 31, 1980; and Johnston Atoll, or a ship that called at Johnston Atoll, from January 1, 1972 through September 30, 1977.

Camp Lejeune water contamination presumptive service connection is commonly associated with the PACT Act, but it is a separate legal provision that predates it. The presumption itself is a VA regulation, 38 CFR 3.309(f), finalized in January 2017 and effective March 14, 2017, tracing back to the Caring for Camp Lejeune Families Act of 2012 (Public Law 112-154), which first established VA health care eligibility for those affected. VA's own guidance states plainly that the PACT Act does not affect VA disability benefits related to Camp Lejeune; the PACT Act's only Camp Lejeune provision, the Camp Lejeune Justice Act (Title VIII), created a separate legal claims process for personal-injury lawsuits, not a change to this disability presumption. Under 38 CFR 3.309(f), a veteran, reservist, or National Guard member who served at Camp Lejeune or MCAS New River, North Carolina, for at least 30 days total, consecutive or not, between August 1, 1953 and December 31, 1987, and who is diagnosed with one of eight listed diseases (adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin's lymphoma, or Parkinson's disease) qualifies for this presumption. See VA's official Camp Lejeune page for the current, authoritative version: https://www.va.gov/disability/eligibility/hazardous-materials-exposure/camp-lejeune-water-contamination/.

Presumption establishes service connection; it does not assign a rating percentage. Once service connection is granted under the PACT Act, the disability is rated according to standard 38 CFR Part 4 criteria based on documented functional impairment, treatment, or frequency of symptoms.