The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 - the PACT Act - is the largest expansion of VA benefits in decades. Its core mechanism is the presumption of service connection: if you served in a covered location during a covered period and later developed a listed condition, the VA assumes your service caused it. You do not have to prove the link with a medical opinion.
That changes the entire claims calculus. Conditions that were routinely denied for lack of a nexus - cancers, respiratory disease, hypertension - now require only three things: a current diagnosis, qualifying service, and a discharge that is not dishonorable.
Burn Pit and Toxic Exposure Presumptive Conditions
These apply to veterans who served on or after September 11, 2001 (or August 2, 1990 for Gulf War-era service) in covered locations including Iraq, Afghanistan, Kuwait, Saudi Arabia, Bahrain, Qatar, the UAE, Oman, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, Somalia, and the airspace above them.
Cancers
- 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
- Neck cancer of any type
- Pancreatic cancer
- Reproductive cancer of any type
- Respiratory (lung-related) cancer of any type
Respiratory and Other Conditions
- 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
Agent Orange Presumptive Conditions Added by the PACT Act
The PACT Act added hypertension (high blood pressure) and monoclonal gammopathy of undetermined significance (MGUS) to the Agent Orange presumptive list. It also added new qualifying locations beyond Vietnam:
- Any U.S. or Royal Thai military base in Thailand, January 9, 1962 - June 30, 1976
- Laos, December 1, 1965 - September 30, 1969
- Cambodia at Mimot or Krek, Kampong Cham Province, April 16 - April 30, 1969
- Guam or American Samoa (or their territorial waters), January 9, 1962 - July 31, 1980
- Johnston Atoll or ships that called there, January 1, 1972 - September 30, 1977
Hypertension is the biggest practical addition. Thailand veterans with high blood pressure - previously denied for decades - now qualify presumptively. Hypertension is commonly rated 10% to 60% under diagnostic code 7101, and it often anchors secondary claims for heart disease and kidney disease.
Radiation Exposure Presumptive Conditions
The PACT Act also expanded presumptive service connection for radiation-exposed veterans (nuclear test participants, occupation of Hiroshima and Nagasaki, cleanup at Palomares, Enewetak Atoll, and others). The presumptive list includes leukemias, lymphomas, and cancers of the thyroid, breast, lung, bone, liver, skin, esophagus, stomach, colon, pancreas, kidney, bladder, salivary gland, brain, and more.
How to File a PACT Act Claim
- Get a current diagnosis. Presumption removes the nexus requirement, not the diagnosis requirement.
- Confirm your service location and dates. Your DD-214 or personnel records must place you in a covered location during the covered period.
- File VA Form 21-526EZ and reference the PACT Act. If you previously filed and were denied, file a supplemental claim (VA Form 20-0995) - the PACT Act is new law that can reopen old denials.
- Watch for your C&P exam. Even presumptive conditions get rated, so the severity exam still determines your percentage.
Previously denied? That denial is not the end. The PACT Act created new presumptions that did not exist when your claim was decided, which qualifies as a reason to file a supplemental claim with a potentially earlier effective date.
What Presumptive Conditions Pay
A presumptive grant is rated on severity like any other condition. Examples using 2026 rates for a veteran with no dependents:
- Chronic sinusitis at 50% (radical surgery or near-constant symptoms): $1,132.90/month
- COPD at 60% (FEV-1 of 40-55% predicted): $1,435.02/month
- Hypertension at 10% (diastolic 100+ or medication required): $180.42/month
- Asthma at 30% (daily inhalational bronchodilator): $552.47/month - see our asthma rating guide
Multiple presumptive conditions combine under the whole-person method like any others. Two respiratory conditions, though, are usually rated as one disability under 38 CFR 4.96 - the VA assigns the higher of the two rather than combining them. How combined ratings work →