How to File a PACT Act Claim in 2026: Step-by-Step Guide

What the PACT Act Does

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) fundamentally changed how VA handles toxic exposure claims by:

• Establishing presumptive service connection for dozens of conditions linked to burn pit exposure, Agent Orange, and other toxic substances — meaning veterans no longer need to prove their condition was caused by service if they have the exposure history and a qualifying diagnosis
• Mandating toxic exposure screening for all veterans during VA primary care visits
• Expanding the VA health care eligibility to veterans with hazardous exposure, even those who otherwise wouldn't have enrolled
• Requiring VA to automatically review previously denied claims that may now qualify under the new presumptives
• Extending the Gulf War period definition and adding new locations to Agent Orange exposure presumption

The law took effect on a rolling basis after August 10, 2022. By 2026, VA has processed millions of PACT Act claims — but many veterans who qualify have still not filed. If you served in a deployed environment after August 2, 1990, or served in Vietnam-era locations, you should review whether the PACT Act applies to your health conditions.

Who Qualifies for PACT Act Claims

Gulf War and Post-9/11 Veterans (Burn Pit Exposure)

Veterans who served in Southwest Asia, Central Asia, or certain other locations after August 2, 1990 are covered by the PACT Act's burn pit and airborne hazard presumptions. Covered locations include:

• Afghanistan, Iraq, Kuwait, Saudi Arabia, Bahrain, Oman, Qatar, United Arab Emirates, Jordan
• Egypt, Turkey, Syria, Uzbekistan, and surrounding airspace
• Somalia and Djibouti (after September 19, 2001)
• Other designated locations added by VA under the law

Vietnam Era Veterans (Expanded Agent Orange)

The PACT Act expanded the locations where Agent Orange exposure is presumed, adding:

• Veterans who served in or near the Korean Demilitarized Zone (DMZ) between 1967–1971
• Veterans who served in any country where Agent Orange was tested or stored (beyond the previous Vietnam/Korean DMZ list)
• Veterans aboard ships that operated in Vietnamese inland waterways ("Blue Water Navy" veterans already expanded under the Blue Water Navy Vietnam Veterans Act, now fully integrated into PACT Act framework)

Radiation-Exposed Veterans

Veterans exposed to ionizing radiation during nuclear tests, occupation of Hiroshima or Nagasaki, or other specific radiation events are covered with expanded presumptive conditions under the PACT Act.

No Nexus Letter Required for Presumptives

This is the critical distinction: for PACT Act presumptive conditions, you do NOT need a nexus letter proving that your condition was caused by service. VA presumes the connection if you have (1) the qualifying exposure history and (2) a current diagnosis of a covered condition. This fundamentally lowers the barrier to approval compared to standard direct service connection claims.

Presumptive Conditions Under the PACT Act

Burn Pit / Airborne Hazard Cancers (Post-9/11 & Gulf War Veterans)

The PACT Act created presumptive service connection for the following cancers in veterans with qualifying burn pit/airborne hazard exposure:

Gulf War Illness Presumptives

Gulf War illness (chronic multi-symptom illness) remains a separate presumptive category. Veterans who served in the Gulf War theater can claim undiagnosed illnesses or medically unexplained chronic multi-symptom conditions (including fatigue, skin conditions, headache, muscle pain, neurocognitive symptoms, and others) without a definitive diagnosis.

Expanded Agent Orange Presumptives (Vietnam Era)

All conditions previously listed under 38 CFR § 3.309(e) as Agent Orange presumptives continue, now expanded by the PACT Act to include:

• Hypertension (high blood pressure) — one of the most significant additions affecting millions of Vietnam veterans
• Monoclonal Gammopathy of Undetermined Significance (MGUS)
• All previously established Agent Orange presumptives: Type 2 diabetes, IHD, non-Hodgkin's lymphoma, Parkinson's disease, prostate cancer, respiratory cancers, soft tissue sarcoma, and others remain in force

Radiation Exposure Presumptives

Veterans who participated in atmospheric nuclear tests, occupied Hiroshima or Nagasaki post-WWII, or were assigned to certain other radiation-exposed duty locations have presumptive service connection for a specific list of radiogenic diseases including various cancers. The PACT Act added additional cancers to this list.

The Toxic Exposure Screening (TES)

One of the most important — and most underutilized — provisions of the PACT Act is the Toxic Exposure Screening (TES). Under the law, VA is required to offer a standardized screening questionnaire to every enrolled veteran during primary care appointments.

Why the TES Matters for Your Claim

Completing the TES creates a dated, official VA record of your toxic exposure history. If you later file a disability claim citing burn pit exposure or chemical exposure, having a TES record from your VA primary care visit corroborates your exposure history with documented evidence.

What the TES Asks

The screening asks about:

• Deployment locations and dates
• Proximity to burn pits and trash fires
• Exposure to chemicals, solvents, or industrial agents
• Radiation exposure history
• Agent Orange exposure (Vietnam-era veterans)
• Gulf War-related exposures
• Any other known toxic exposures during service

How to Complete the TES

The TES is administered at VA primary care visits — but many veterans report that it was not offered to them despite the mandate. If your primary care provider has not offered you the screening:

1. Ask your VA primary care provider explicitly: "I'd like to complete the Toxic Exposure Screening required by the PACT Act."
2. Contact your VA Patient Aligned Care Team (PACT) team through My HealtheVet secure messaging
3. You can also report your exposure history via VA's online environmental exposure submission tool

Step-by-Step: Filing VA Form 21-526EZ

Evidence to Gather Before Filing

Exposure Evidence

• Deployment orders: Document which locations you served in and when
• Unit records: If your unit deployed to a PACT Act-covered location, unit histories (often obtainable through the National Archives) corroborate your deployment
• Buddy statements: Written statements from servicemembers who can attest to shared exposure are powerful corroborating evidence
• Photographs: Photos taken during deployment showing burn pits or hazardous conditions have been accepted as corroborating evidence
• DoD Burn Pit Registry: If you registered with the Airborne Hazards and Open Burn Pit Registry, include that registration number in your claim

Medical Evidence

• Pathology reports: For cancer claims, the pathology or biopsy report confirming diagnosis is essential
• Physician letters: A letter from your treating oncologist or specialist confirming diagnosis, current status, and treatment
• VA medical records: If you're enrolled in VA health care, VA already has access to your VA records — but private medical records must be submitted separately
• Imaging reports: CT scans, PET scans, MRIs relevant to your condition

Adding PACT Act Conditions to an Existing Claim

If you already have an active pending claim with VA, you can add PACT Act conditions to it without filing a completely new application. The process depends on the status of your current claim:

If Your Claim Is Still Pending (Not Yet Decided)

1. Contact VA by phone (1-800-827-1000), online message, or through your VSO
2. Request to "add a new condition" to your existing pending claim
3. Provide the condition name and note "PACT Act presumptive"
4. VA will add the new condition to your pending claim and process it together

If Your Claim Was Recently Decided (Within 1 Year)

Within one year of a VA decision, you can file a Supplemental Claim (VA Form 20-0995) with new and relevant evidence. For PACT Act conditions not previously claimed, the PACT Act itself may constitute new and relevant evidence justifying a supplemental claim even if your exposure was the same.

Previously Denied Claims: The Supplemental Route

If you previously filed a claim that was denied because VA couldn't establish service connection for a condition that is now presumptive under the PACT Act, you have options:

VA's Automatic Review Obligation

Under the PACT Act, VA is required to automatically review certain previously denied claims that may now qualify under the new presumptives. Veterans who had claims denied for conditions now covered by PACT Act presumptives should have received or should receive a review notice from VA. If you haven't, contact VA or your VSO to inquire whether your denied claim has been flagged for automatic review.

File a Supplemental Claim (Form 20-0995)

If your previously denied claim has not been automatically reviewed, or if you want to proactively ensure it's reconsidered:

1. File VA Form 20-0995 (Decision Review Request: Supplemental Claim)
2. In the "New and Relevant Evidence" section, cite the PACT Act (Public Law 117-168) as establishing presumptive service connection for your condition
3. Include your current diagnosis documentation
4. Reference your deployment history establishing exposure in a covered location

The supplemental claim pathway is important because it can preserve an earlier effective date. If your original claim was filed before August 10, 2022 (the PACT Act enactment date) and your condition is now presumptive, winning on supplemental may result in retroactive pay back to your original claim date — potentially worth thousands or tens of thousands of dollars.

Effective Dates and Retroactive Pay

The effective date — the date from which VA pays disability compensation — is one of the most financially significant aspects of any PACT Act claim.

Standard Effective Date: Date of Claim

For new PACT Act claims, the effective date is the date VA receives your completed claim (or the date entitlement arose, whichever is later). This is why filing promptly matters: every month you delay filing is a month of retroactive pay you cannot recover.

PACT Act Retroactive Pay Window

The PACT Act created a special retroactivity window for veterans who filed claims within one year of the law's enactment (before August 10, 2023). Veterans who filed in that window and were granted benefits may have an effective date back to August 10, 2022, even if their claim wasn't decided until later. If you filed before August 10, 2023, check with your VSO or VA to ensure your effective date was applied correctly.

Previously Denied Claims: Supplemental Effective Dates

If VA's automatic PACT Act review grants you benefits, your effective date may trace back to your original claim date — potentially years before 2022. If you previously filed a claim that was denied and it's now being reviewed, the potential retroactive pay could be substantial.

PACT Act C&P Exam Tips

Not all PACT Act claims require a C&P exam. For clearly documented presumptive conditions, VA may grant the claim based on file review alone. But if you are scheduled for a C&P exam:

• Confirm the examiner knows this is a PACT Act claim. Remind the examiner that you're claiming under PACT Act presumptive — the exam should not require them to opine on causation for presumptive conditions.
• Provide your deployment records. Bring documentation of your deployment locations and dates to confirm your exposure history.
• Discuss all symptoms. Even if your primary diagnosis is established, the examiner should document the full extent of your condition and any secondary effects.
• Document current severity. The C&P exam is also used to rate the severity of your condition. Describe your worst days honestly, including functional limitations, pain levels, and any limitations on work or daily activities.
• For cancer claims: Bring pathology reports, treatment records, and a letter from your oncologist summarizing your diagnosis, treatment status, and prognosis.

Common Mistakes That Delay or Sink PACT Act Claims

• Not completing the toxic exposure section of 21-526EZ. The exposure section is what flags your claim as PACT Act-related. Skipping it or being vague can route your claim as a standard direct service connection claim — requiring more evidence than a presumptive.
• Filing without confirming your deployment location is covered. Verify that the specific country, base, or operation qualifies under the PACT Act covered locations list before citing it as your exposure basis.
• Not claiming secondary conditions. Many veterans with PACT Act cancers have secondary conditions — side effects of chemotherapy, radiation damage to adjacent organs, depression, PTSD from the cancer diagnosis and treatment. Claim these separately.
• Waiting for the "right time." There is no perfect time to file. Your effective date is locked to your filing date. Every month you wait is a month of retroactive pay lost.
• Not registering with the Airborne Hazards Registry. Registering with the DoD Airborne Hazards and Open Burn Pit Registry creates official documentation of your exposure. Do this whether or not you're currently filing a claim.
• Filing only the 21-526EZ without supporting statements. The personal statement (21-4138) describing your exposure in detail is important corroborating evidence, especially if your deployment records don't specifically note burn pit proximity.