PACT Act Explained: Every New Presumptive Condition Added in 2022

What the PACT Act Is — and Why It Matters

The PACT Act's full name is the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022. It was named in honor of SFC Heath Robinson, an Ohio National Guard veteran who died of a rare cancer believed to be caused by burn pit exposure during his deployments in Kosovo and Iraq.

Before the PACT Act, veterans suffering from conditions linked to toxic exposures faced an impossible burden: they had to prove, on their own, that their specific illness was caused by their specific exposure during service. VA routinely denied these claims because the scientific evidence linking individual exposures to individual cancers was difficult to document at the individual level — even when the epidemiological data was overwhelming.

The PACT Act changed this fundamentally. Under a presumptive service connection, VA presumes that your condition is related to your service — you don't have to prove the nexus yourself. The legal authority for these presumptives is codified at 38 C.F.R. § 3.309, which lists diseases associated with specific toxic exposures.

Burn Pit & Airborne Hazard Presumptives

Open burn pits were used at military bases throughout Southwest Asia, Afghanistan, and other post-9/11 theater locations. These open-air waste disposal sites burned everything — ammunition, human waste, chemicals, medical waste, and electronics — 24 hours a day. The smoke contained benzene, heavy metals, dioxins, furans, polycyclic aromatic hydrocarbons, and a cocktail of other carcinogens.

The PACT Act created a presumption of exposure to airborne hazards and open burn pits for veterans who served in covered locations during covered time periods. This means the VA no longer requires veterans to prove they were personally exposed to a burn pit — if you served in a covered location during a covered period, exposure is presumed.

Covered Locations — Post-9/11

Veterans who served on or after August 2, 1990, in the following locations are presumed to have been exposed to airborne hazards including burn pit smoke:

• Afghanistan — after September 11, 2001
• Iraq — after August 2, 1990
• Kuwait — after August 2, 1990
• Saudi Arabia — after August 2, 1990
• Djibouti — after September 11, 2001
• Egypt, Jordan, Lebanon, Philippines, Somalia, Syria, Uzbekistan, Yemen — after September 11, 2001
• Any Southwest Asia theater location as defined under 38 C.F.R. § 3.317

Additionally, the PACT Act covers veterans who served in any other location the VA determines warrants a presumption of exposure, including future determinations under the Secretary's authority.

The 38 Presumptive Cancers — Full List

The PACT Act added 38 specific cancers to the list of presumptive conditions under 38 C.F.R. § 3.309(f)(2) for veterans with toxic exposure history. This is the complete list:

Head & Neck Cancers

Gastrointestinal Cancers

Respiratory & Thoracic Cancers

Reproductive Cancers

Lymphatic, Hematopoietic & Other Cancers

Authority: 38 C.F.R. § 3.309(f)(2); Public Law 117-168 (PACT Act of 2022), Section 3113

Agent Orange Expansion: New Locations Now Covered

The PACT Act significantly expanded the list of locations where veterans are presumed to have been exposed to Agent Orange — beyond the original Vietnam locations covered under 38 C.F.R. § 3.307(a)(6). Veterans who served in these newly added locations are now entitled to the same Agent Orange presumptives as Vietnam veterans.

Newly Added Agent Orange Locations

• Thailand — at RTAFB Ubon, Nakhon Phanom RTAFB, Udorn RTAFB, or other Thai bases where tactical herbicides were used
• Guam and American Samoa — veterans who served at military installations where Agent Orange or other herbicides were stored or tested
• Johnston Atoll — veterans who were assigned to Johnston Atoll or on ships calling there between 1972 and 1977
• Cambodia — at Mimot or Krek, Kampong Cham Province
• Laos — at specific border locations where tactical herbicide spraying operations occurred
• Korea — along the Korean Demilitarized Zone (DMZ) between September 1, 1967 and August 31, 1971 (previously covered, now reinforced)

Veterans with qualifying service at these locations who develop any of the Agent Orange presumptive conditions listed at 38 C.F.R. § 3.309(e) — including ischemic heart disease, Type 2 diabetes, Parkinson's disease, non-Hodgkin's lymphoma, and all soft-tissue sarcomas — are now presumptively service-connected.

Blue Water Navy Veterans

The PACT Act formally confirmed and expanded benefits for Blue Water Navy veterans — those who served offshore in the waters of Vietnam without going ashore. Prior to the Blue Water Navy Vietnam Veterans Act of 2019 (which was reinforced by the PACT Act), these veterans were excluded from Agent Orange presumptives despite documented evidence that Agent Orange contaminated the ships' water supplies through evaporation and distillation systems.

Under current law (38 C.F.R. § 3.307(a)(6)(iii)), Blue Water Navy veterans who served in the territorial seas and inland waterways of the Republic of Vietnam between January 9, 1962 and May 7, 1975 are presumed to have been exposed to Agent Orange. This covers veterans who never set foot on Vietnamese soil.

What Qualifies as Blue Water Navy Service

• Service aboard a Navy or Coast Guard vessel that operated in the territorial sea (within 12 nautical miles of Vietnam's coast) between the qualifying dates
• The veteran's unit must have operated in the area — personal shore leave is not required
• VA maintains a list of ships with confirmed service in qualifying waters (the "Blue Water Navy Ship List")

Expanded Radiation Presumptives

The PACT Act expanded the list of "radiation-risk activities" under 38 C.F.R. § 3.309(d) and added new locations where veterans are presumed to have been exposed to ionizing radiation during service. This expansion covers:

• Atmospheric nuclear weapons testing participants — at Bikini Atoll, Eniwetok Atoll, and various continental test sites
• Occupation forces in Hiroshima and Nagasaki — veterans who entered these cities between August 6, 1945 and July 1, 1946
• POWs in Japan — who were held within 75 miles of Hiroshima or Nagasaki during atomic bombing
• Enewetak Atoll cleanup workers — between January 1, 1977 and December 31, 1980
• Additional test site participants — at various locations added under the PACT Act's expanded definitions

Radiation-risk veterans who develop any of the 21 radiogenic diseases listed at 38 C.F.R. § 3.309(d)(2) — including all cancers of the blood, bone, thyroid, and major organs — are entitled to presumptive service connection.

Era-Based Coverage: Who Qualifies by Service Period

Post-9/11 Veterans (September 11, 2001 — Present)

Veterans who served in covered Southwest Asia and post-9/11 theater locations are presumed exposed to airborne hazards and burn pit smoke. This is the largest group covered by the PACT Act's new burn pit presumptives. The 38 cancer presumptives apply to qualifying post-9/11 veterans.

Gulf War Era Veterans (August 2, 1990 — August 31, 2021)

Gulf War veterans who served in Southwest Asia — including Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, UAE, Oman, and other locations — already had Gulf War Illness presumptives under 38 C.F.R. § 3.317. The PACT Act expanded these to include additional burn pit presumptives and applied the cancer list to Gulf War veterans who served in covered locations.

Vietnam Era Veterans (1962 — 1975)

Vietnam-era veterans benefit primarily from the Agent Orange location expansions described above. Veterans with qualifying service in Thailand, Guam, Cambodia, Laos, Johnston Atoll, and American Samoa can now access the full suite of Agent Orange presumptive conditions, including the 14 conditions listed at 38 C.F.R. § 3.309(e).

How to File a PACT Act Claim in 2025

Filing a PACT Act claim follows the same process as any VA disability claim, but there are specific elements you'll want to include to take advantage of the new presumptives.

1. File VA Form 21-526EZ — "Application for Disability Compensation and Related Compensation Benefits." This is the standard disability claim form available at va.gov or through an accredited VSO.
2. Indicate toxic exposure on Section IV — Mark the box for "Hazardous Materials Exposure" and specify the type (burn pit/airborne hazards, Agent Orange, radiation) and your service location and dates.
3. List your covered service locations — Include every location where you served in the Southwest Asia theater or other covered areas, with approximate dates.
4. Identify your claimed conditions — List each condition separately. For presumptive cancers, name the specific cancer and indicate that you are claiming under the PACT Act presumptive provisions.
5. Submit your current medical diagnosis — You still need a current diagnosis. Include medical records from your VA physician, private oncologist, or specialist showing the diagnosis.
6. Attach service records — DD-214, deployment orders, or any documentation confirming your service in covered locations. If you lack records, VA must assist you in obtaining them under the duty to assist (38 C.F.R. § 3.159).

If You Were Previously Denied

One of the most important provisions of the PACT Act is its retroactive reach. If you previously filed a claim for a condition now covered under the PACT Act's new presumptives and were denied — you can reopen that claim as a Supplemental Claim under 38 C.F.R. § 3.2501.

The PACT Act also directed VA to automatically reprocess certain previously denied claims under the new law, but this automatic review does not cover all denials. To protect your effective date, file your own Supplemental Claim now rather than waiting for VA's automatic review.

What Counts as "New and Relevant Evidence" for a Supplemental Claim

• The new presumptive law itself — citing the PACT Act and the applicable CFR section is sufficient
• A new or updated diagnosis of a qualifying condition
• Service records not previously submitted confirming service in a covered location
• A medical nexus opinion from a specialist (for non-presumptive conditions)

Effective Date Rules Under PACT Act

Your effective date — the date from which VA calculates your monthly payment — is critical because it determines your back pay. Under 38 C.F.R. § 3.400, effective dates work as follows for PACT Act claims:

• New claims filed after August 10, 2022: Effective date is the date VA receives your claim (or your Intent to File date, if you filed one earlier under 38 C.F.R. § 3.155(b)).
• Supplemental claims based on PACT Act: The effective date is the later of the date of the Supplemental Claim or the date the condition became disabling — but certain grandfathering provisions apply for claimants who filed prior claims that were denied on the merits.
• Automatic reprocessing by VA: If VA automatically reviews and approves your previously denied claim, the effective date may go back to your original claim date — this is a significant potential benefit for veterans with decades-old denials.