The PACT Act (Sergeant First Class Heath Robinson Honoring our PACT Act, Public Law 117-168) signed August 2022 is the biggest expansion of VA benefits since the post-Vietnam reforms of the 1970s. It rewrote presumptive service connection for toxic exposure, opened VA healthcare to millions of post-9/11 combat vets, and accelerated the eligibility phase-in that was supposed to take a decade.
If you served in any combat zone after Aug 2, 1990, you're affected. If you served in Vietnam, the Korea DMZ 1967-71, Thailand RTAFB perimeter, or were on a C-123 anywhere 1969-86, you're affected. If you were stationed at Camp Lejeune between 1953 and 1987, you and your family are affected.
This guide explains what each presumption covers, who qualifies, and what 2024-2025 expansions most vets haven't been told about.
A note before we start: this guide is information only. We don't file claims or advise you on what to claim. Claims are filed through the VA, and a VA-accredited Veterans Service Officer (VSO) can prepare and submit a claim for you at no cost. You can find one through the VA Office of General Counsel accreditation search.
The big picture: what "presumptive" means
A presumptive condition is one VA presumes was caused by your service, so you don't have to prove the nexus. You still have to show:
- You have the condition (current diagnosis), and
- You served in a qualifying location/period (exposure presumption applies)
That's it. No medical opinion required to link the two. VA does that work via the presumption.
The traditional 3-prong service connection test (current diagnosis + in-service event + medical nexus) gets collapsed to 2 prongs. Massive evidentiary advantage.
Burn pit presumptives (post-9/11 + Gulf War)
If you served in the Southwest Asia theater of operations any time after Aug 2, 1990, OR in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, or Yemen any time after Sept 11, 2001, AND were exposed to burn pits or airborne hazards, the following are now presumptive:
Respiratory conditions:
- Asthma diagnosed after service
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Chronic rhinitis
- Chronic sinusitis
- Constrictive bronchiolitis or obliterative bronchiolitis (added 2024 clinical guidance)
- Emphysema
- Granulomatous disease
- Interstitial lung disease
- Pleuritis
- Pulmonary fibrosis
- Sarcoidosis
Cancers (any of the following):
- Brain cancer including glioblastoma
- Gastrointestinal cancer of any type
- Head and neck cancer of any type
- Kidney cancer
- Lymphatic cancer of any type
- Lymphoma of any type
- Melanoma
- Pancreatic cancer
- Reproductive cancer of any type
- Respiratory (breathing-related) cancer of any type
Agent Orange, the hypertension + MGUS additions
If you served in Vietnam (January 9, 1962 through May 7, 1975), at the Korea DMZ (September 1, 1967 through August 31, 1971), at Thailand Royal Thai Air Force bases (January 9, 1962 through June 30, 1976), or on a C-123 aircraft (1969-1986), you're presumed Agent Orange exposed. The PACT Act also added boots-on-ground service in Laos (December 1, 1965 through September 30, 1969), specific Cambodian provinces (April 16 through April 30, 1969), and Guam, American Samoa, and Johnston Atoll Agent Orange test/storage sites.
The full 38 CFR §3.309(e) presumptive list is long. The major conditions:
- Ischemic heart disease
- Parkinson's disease + parkinsonism (the latter added 2021)
- Bladder cancer (added 2021)
- Hypothyroidism (added 2021)
- Hypertension (added under the 2022 PACT Act; VA began deciding these claims in early 2025)
- MGUS / Monoclonal Gammopathy of Undetermined Significance (added 2024)
- Type 2 diabetes mellitus
- Prostate cancer
- Multiple myeloma
- AL amyloidosis
- Hodgkin's and non-Hodgkin's lymphoma
- Chronic B-cell leukemias (including CLL and hairy cell)
- Soft tissue sarcomas
- Respiratory cancers (lung, larynx, trachea, bronchus)
- Porphyria cutanea tarda
- Early-onset peripheral neuropathy
- Chloracne
- Spina bifida (in biological children of Vietnam Veterans, §1805)
The hypertension addition matters enormously. Hypertension is common in older Veterans and was excluded from AO presumptives for decades. The 2022 PACT Act changed that, and VA began deciding these claims in early 2025. If you're a Vietnam-era, Agent Orange-exposed vet with high blood pressure, this presumption may now apply to you.
Service-connected hypertension can also be associated with related conditions such as kidney disease, congestive heart failure, and stroke. How any of these are rated is determined by the VA on the facts of each case.
Camp Lejeune Family Member Program
If you or a family member lived at Marine Corps Base Camp Lejeune or MCAS New River between Aug 1, 1953 and Dec 31, 1987 for at least 30 cumulative days, you're presumed exposed to contaminated drinking water (TCE, PCE, vinyl chloride, benzene).
Veterans get VA disability presumptive SC for:
- Adult leukemia
- Aplastic anemia and other myelodysplastic syndromes
- Bladder cancer
- Kidney cancer
- Liver cancer
- Multiple myeloma
- Non-Hodgkin's lymphoma
- Parkinson's disease
Family members (not just Veterans) get VA-paid health care for 15 conditions tied to that water under the Camp Lejeune Family Member Program. Spouses, kids, in-utero exposures, all covered. This is one of the most under-utilized programs in VA.
Separate from VA disability: the Camp Lejeune Justice Act civil claim path (PACT Act §804) allowed civil suits in federal court. Filing window closed August 10, 2024, only pending suits proceed. Anyone exposed who didn't file by the deadline cannot file a new CLJA civil claim, but the VA presumptive disability path and Family Member Program remain open indefinitely.
Atomic radiation cohorts
If you participated in atmospheric nuclear weapons testing (1945-1962), occupation of Hiroshima or Nagasaki (Aug 6, 1945 to Jul 1, 1946), were a POW interned in Japan near those cities, served at DOE gaseous diffusion plants (Paducah KY, Portsmouth OH, Oak Ridge K-25 TN), Amchitka AK underground tests before 1974, or were part of the 1977-80 Enewetak Atoll cleanup (added via FY2023 NDAA), you qualify as a radiation-exposed Veteran.
21 radiogenic cancers are presumptive under 38 CFR §3.309(d)(2): leukemia (except CLL), thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, multiple myeloma, lymphomas (except Hodgkin's disease), bile ducts, gall bladder, primary liver cancer, salivary gland, urinary tract (which includes the kidneys), bronchiolo-alveolar carcinoma, bone, brain, colon, lung, and ovary.
Beyond presumptive: 38 CFR §3.311 lets VA grant SC for additional radiogenic diseases on a case-by-case basis using dose reconstruction.
Separate DOJ pathway: RECA (Radiation Exposure Compensation Act) is a one-time lump-sum payment of $100,000 for downwinders, on-site nuclear-test participants, and uranium workers (millers, miners, ore transporters). RECA was reauthorized on July 4, 2025 (Public Law 119-21) after its 2024 lapse. The program reopened, set a flat $100,000 award, expanded downwind eligibility to the entire states of Idaho, Utah, and New Mexico (plus additional areas and covered periods), and added more compensable cancers. Claims must be filed by December 31, 2027 (the Trust Fund is authorized through December 31, 2028, but the filing window closes a year earlier). File electronically through the DOJ RECA Claims Portal. Note: onsite-participant awards are offset by any VA payment received for the same illness.
Gulf War undiagnosed illness + medically unexplained chronic multisymptom illness
If you served in the Southwest Asia theater after Aug 2, 1990, you can get presumptive SC for "medically unexplained chronic multisymptom illness" under 38 CFR §3.317. The named conditions:
- Chronic fatigue syndrome
- Fibromyalgia
- IBS, functional dyspepsia, functional constipation, functional abdominal pain syndrome
Plus 9 named infectious diseases: brucellosis, campylobacter jejuni, Q fever, malaria, mycobacterium tuberculosis, nontyphoid salmonella, shigella, visceral leishmaniasis, West Nile virus.
These conditions don't require you to prove burn pit exposure specifically. Gulf War service alone triggers the presumption. Under current regulation, the medically-unexplained category requires the condition to manifest to 10%+ by December 31, 2026 for the presumption to apply.
How PACT Act claims work
A presumptive condition is established through the VA disability compensation claim process. Because the exposure connection is presumed, the VA does not require you to prove a medical nexus, it relies on the presumption tied to your qualifying service location and period.
Claims are filed through the VA. A VA-accredited Veterans Service Officer (VSO) can prepare and submit a claim for you at no cost, that is specifically what VSOs are accredited to do. You can find one through the VA Office of General Counsel accreditation search. Benefitry does not file claims or advise on what to claim.
When the VA rates multiple service-connected conditions, it combines them under 38 CFR §4.25 rather than simply adding the percentages. See our combined ratings guide for how that math works.
The PACT Act §103 PG6 universal eligibility expansion
Separate from disability claims: the PACT Act opened VA healthcare to a much wider population.
March 5, 2024 acceleration eliminated the original 2032 phase-in. ANY toxic-exposed combat Veteran is now eligible for VA health enrollment regardless of separation year. Eight years early.
If you're a post-9/11 vet who's never enrolled in VA healthcare because you thought you didn't qualify or weren't sure, you almost certainly qualify now. VA health care enrollment is handled directly through the VA at va.gov/health-care/apply.
Also: every enrolled Veteran is offered a Toxic Exposure Screening (TES) at every VA primary care visit and at least once every 5 years (PACT Act §603). This is the proactive triage that should identify exposure-related conditions for you. If your VA team hasn't offered you a TES, ask.
Newly added 2024 conditions worth surfacing
- Hypertension as an Agent Orange presumptive (2022 PACT Act; VA began deciding claims in early 2025)
- MGUS (monoclonal gammopathy of undetermined significance) as an Agent Orange presumptive
- Constrictive bronchiolitis as a burn-pit presumptive
- Glioblastoma as burn-pit brain cancer presumptive
- Enewetak Atoll cleanup (1977-80) added to radiation-exposed cohorts (FY2023 NDAA, fully effective 2024)
If your prior VA claim was denied before any of these were added, the VA has a supplemental claim process for reviewing a decision when new and relevant evidence exists, and a newly added presumption can be relevant. A VA-accredited VSO can advise on whether this applies to your situation and handle the process for you at no cost (find one here).
What this guide is not
This guide is informational. It explains what the PACT Act presumptions cover and who qualifies. It does not file claims, complete VA forms, or advise you on what to claim or how to claim it.
Claims are filed through the VA. A VA-accredited Veterans Service Officer (VSO) can prepare and submit a claim for you at no cost, that is specifically what VSOs do. Find one through the VA Office of General Counsel accreditation search.
The PACT Act is the biggest VA reform in decades and the largest single expansion of presumptive conditions ever. If you served in any qualifying area and have a covered condition, the presumptions are designed to do most of the connection work for you. To see the dollar value at a given rating, run it through our disability calculator.