The PACT Act
If you served post-9/11 in a covered location and have one of these conditions, the VA presumes service connection. No nexus letter needed.
The Honoring our PACT Act of 2022 added 23 presumptive conditions for veterans exposed to burn pits and other airborne hazards, codified at 38 CFR § 3.320. It also expanded Agent Orange (Vietnam) and Camp Lejeune presumptives.
Quick eligibility check
Three questions. Not a legal determination — a fast read on whether a presumptive framework probably applies to you.
The full presumptive list
Conditions where the VA presumes service connection if the service history lines up. DC links go to the rating-criteria page on this site.
Cancers16 conditions
PACT Act presumptives under 38 CFR § 3.320 for veterans with qualifying post-9/11 or Gulf War service.
Brain cancer
No DC guideService: Post-9/11/2001 or Gulf War (Aug 2, 1990+)
38 CFR § 3.320
Gastrointestinal cancer (any type)
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Glioblastoma
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Head cancer (any type)
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Kidney cancer
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Lymphatic cancer (any type)
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Non-Hodgkin's Lymphoma
DC 7715 →Service: Post-9/11/2001 or Gulf War (also Agent Orange / Vietnam)
38 CFR § 3.320 & § 3.309(e)
Hodgkin's Lymphoma
DC 7709 →Service: Post-9/11/2001 or Gulf War (also Agent Orange / Vietnam)
38 CFR § 3.320 & § 3.309(e)
Malignant Skin Neoplasms (non-melanoma)
DC 7818 →Service: Post-9/11/2001 or Gulf War (melanoma lane)
38 CFR § 3.320
Neck cancer (any type)
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Pancreatic cancer
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Reproductive cancer (any type)
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Respiratory cancer (any type)
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
AL Amyloidosis
DC 7717 →Service: Agent Orange (since 2009); also covered for post-9/11 / Gulf War
38 CFR § 3.309(e) & § 3.320
Multiple Myeloma
DC 7712 →Service: Agent Orange (since 1996); also covered for post-9/11 / Gulf War
38 CFR § 3.309(e) & § 3.320
Non-cancer respiratory12 conditions
PACT Act respiratory presumptives. Asthma must be diagnosed after service. Asbestosis (DC 6833) is rated under the same code as IPF but is NOT a PACT presumptive — it uses the older M21-1 asbestos framework.
Chronic bronchitis
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Chronic Obstructive Pulmonary Disease (COPD)
DC 6604 →Service: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Constrictive / obliterative bronchiolitis
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Emphysema
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Granulomatous disease
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Interstitial lung disease / Idiopathic Pulmonary Fibrosis
DC 6825 →Service: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Pleuritis
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Pulmonary fibrosis
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Sarcoidosis
No DC guideService: Post-9/11/2001 or Gulf War
38 CFR § 3.320
Agent Orange (Vietnam-era, § 3.309(e))
The Agent Orange presumptive list predates PACT but was expanded by it. Selected presumptives (not exhaustive):
- Type 2 Diabetes Mellitus
- Ischemic heart disease
- Parkinson's disease (and Parkinsonism)
- Hypertension (PACT-era addition)
- Monoclonal gammopathy of undetermined significance — MGUS (PACT-era addition)
- Bladder cancer (PACT-era addition)
- Hypothyroidism (PACT-era addition)
- Prostate cancer, respiratory cancers, soft-tissue sarcomas, chronic B-cell leukemias
Camp Lejeune (1953–1987, § 3.307(a)(7))
Veterans stationed at Camp Lejeune for 30+ days between August 1953 and December 1987 get a presumption for these conditions:
- Kidney cancer
- Liver cancer
- Non-Hodgkin's Lymphoma
- Adult leukemia
- Multiple Myeloma
- Parkinson's disease
- Aplastic anemia / myelodysplastic syndromes
- Bladder cancer
PACT-covered service locations
Post-9/11 burn pit / toxic exposure
Service on or after September 11, 2001:
- • Afghanistan
- • Djibouti
- • Egypt
- • Jordan
- • Lebanon
- • Syria
- • Uzbekistan
- • Yemen
- + airspace above these locations
Gulf War (Aug 2, 1990 onwards)
- • Bahrain
- • Iraq
- • Kuwait
- • Oman
- • Qatar
- • Saudi Arabia
- • Somalia
- • UAE
- + airspace above these locations
Earlier eras (some PACT-expanded)
- • Vietnam (Jan 9, 1962 – May 7, 1975)
- • Thailand military bases (Jan 9, 1962 – Jun 30, 1976)
- • Korean DMZ (Sep 1, 1967 – Aug 31, 1971)
- • Camp Lejeune (Aug 1953 – Dec 1987)
- • Atmospheric nuclear testing sites
- • Laos, Cambodia, Guam (Agent Orange-related)
How to file
- 1
Get your evidence in order
- DD-214 showing service dates and locations
- Current medical records confirming the condition
- Service treatment records (if available)
- Deployment orders or unit records if the DD-214 lacks specifics
- 2
File VA Form 21-526EZ
Submit online or by mail. Form 21-526EZ on VA.gov →
- 3
Check the box for presumptive service connection
This is what tells VA to apply the PACT framework instead of requiring you to prove nexus from scratch.
- 4
Nexus statement
You do NOT need a nexus letter for a presumptive condition — that’s the whole point. Spending money on a private nexus opinion for a § 3.320 / § 3.309(e) claim is usually wasted.
- 5
C&P exam
The exam should focus on diagnosing and severity-rating the condition — not proving service connection. If the examiner pushes on nexus, redirect: presumptives don’t require it. C&P Exam Prep Generator →
- 6
Decision
Typical timeline 3–6 months. PACT claims are usually processed faster than non-presumptive direct claims because the legal question is settled.
Was your claim denied as “not presumptive”?
Wrongful denials happen, especially right after a liberalizing-law change. Common reasons and how to challenge them:
VA didn’t have your service location records
Request DD-214 corrections and line-of-duty documentation. Submit any deployment orders, performance reports, or unit awards naming the location.
VA misinterpreted your service dates
Pull deployment orders and TDY records. Even a few days in a covered location triggers the location presumption.
VA didn’t apply liberalizing law to a pre-Aug 2022 claim
File a Supplemental Claim citing the PACT Act as new and material evidence. A claim previously denied for lack of nexus may now succeed under presumption.
Need an independent legal review?
File a Higher-Level Review (HLR) — a senior reviewer takes a fresh look. No new evidence allowed; this is the right path if the legal analysis was wrong, not the facts.
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Caveats
Educational only — not legal advice. Talk to a VSO or VA-accredited attorney before filing. Presumptive lists change with new legislation and VA rulemaking; verify against the latest 38 CFR § 3.320 and VA.gov PACT Act page before relying on any condition or location listed here.