DISABILITYVA program

PACT Act: Burn Pit and Toxic Exposure Presumptives

The Sergeant First Class Heath Robinson PACT Act (2022) added more than 20 presumptive conditions, including cancers and respiratory conditions, for veterans exposed to burn pits and other toxins, and added presumptive-exposure locations for Agent Orange and radiation.

Available to veterans who served in a location and period VA lists, such as on or after 8/2/1990 or 9/11/2001 for burn pits, or an added Agent Orange location from 1/9/1962

View on VA.gov

Step-by-step guide

What VA looks for in a burn pit claim

A condition on the burn pit listA diagnosis of a listed cancer or breathing condition, such as asthma diagnosed after service, COPD, chronic sinusitis, or a respiratory cancer. A cancer counts where it started, not where it spread.
Service in a covered place on or after its start dateDuty in a listed country or body of water, or the airspace above it. From August 2, 1990: Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates, the neutral zone between Iraq and Saudi Arabia, the Arabian Sea, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, and the Red Sea. From September 11, 2001: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen.
A discharge that is not dishonorableService that ended under conditions other than dishonorable. A discharge under honorable conditions settles this; for other discharges, VA applies its character of discharge rules.

Source: 38 CFR 3.320 (opens in new tab); 38 CFR 3.320a (opens in new tab); 38 CFR 3.320b (opens in new tab); M21-1 VIII.ii.2.A (opens in new tab); M21-1 VIII.ii.2.C (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab); 38 CFR 3.12 (opens in new tab)

Which part of the PACT Act are you looking at?

Burn pits and other airborne hazards
For service in certain places on or after August 2, 1990, or September 11, 2001, VA presumes exposure to burn pits and other toxins, and presumes that a listed condition is connected to service. You do not need to show how service caused it, and any length of service there counts. VA does not apply the presumption when specific evidence shows the condition did not start in or get worse from that service. The same is true when something after that service caused it, or when it came from your own willful misconduct or alcohol or drug abuse.
Source: 38 CFR 3.320 (opens in new tab); 38 CFR 3.320a (opens in new tab); 38 CFR 3.320b (opens in new tab); 38 CFR 3.12 (opens in new tab); M21-1 VIII.ii.2.A (opens in new tab); M21-1 VIII.ii.2.C (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab); VA.gov: the PACT Act and your VA benefits (opens in new tab)
Agent Orange: places and conditions the Act added
The PACT Act added high blood pressure (hypertension) and monoclonal gammopathy of undetermined significance (MGUS) to the Agent Orange list. It also added five places, each with its own dates. Thailand: any US or Royal Thai base, January 9, 1962 to June 30, 1976. Laos: December 1, 1965 to September 30, 1969. Cambodia: Mimot or Krek in Kampong Cham Province, April 16 to 30, 1969. Guam or American Samoa, or their waters: January 9, 1962 to July 31, 1980. Johnston Atoll, or a ship that called there: January 1, 1972 to September 30, 1977. The Agent Orange card covers the full lists.
1. A condition on the Agent Orange listA diagnosis on the list, which now includes high blood pressure and MGUS. Chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy count only if they reached 10 percent within 1 year after your last exposure.
2. Service in a listed place during its datesService at a place on the Agent Orange list during its dates, such as Vietnam and its inland and nearby offshore waters, a unit in or near the Korean DMZ from September 1, 1967 to August 31, 1971, or one of the five places the Act added. In Thailand, it counts anywhere on a US or Royal Thai base, whatever your job.
Source: 38 CFR 3.309(e) (opens in new tab); M21-1 VIII.i.1.A (opens in new tab); M21-1 VIII.i.1.C (opens in new tab); VA.gov: Agent Orange exposure and disability compensation (opens in new tab); VA.gov: the PACT Act and your VA benefits (opens in new tab); 38 CFR 3.307(a)(6) (opens in new tab)
Other toxic exposures, or a condition not on a list
A condition that is not on a presumptive list, or an exposure outside the listed places and dates, can still be service connected. VA decides it as a direct claim using its toxic exposure risk activity (TERA) procedures, in place since August 10, 2022, and the exam VA orders can include a medical opinion on the exposure.
1. A condition you have nowA diagnosis from a medical provider, VA or private, showing you have the condition today.
2. A toxic exposure during serviceRecords or statements that show what you were exposed to, where, and when, such as burn pits, sand and dust, oil well or sulfur fires, chemicals, or other job hazards.
3. A medical link to the exposureA medical opinion that the condition is at least as likely as not related to the exposure. It can come from your own provider or from a VA claim exam.
Source: 38 CFR 3.303 (opens in new tab); M21-1 VIII.ii.2.B (opens in new tab); M21-1 VIII.i.1.B (opens in new tab); M21-1 VIII.i.1.C (opens in new tab); M21-1 IV.i.2.A (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab); VA Form 21-526EZ (opens in new tab); VA.gov: the PACT Act and your VA benefits (opens in new tab); 38 CFR 3.159(c)(4) (opens in new tab)
A condition VA denied before
If VA denied a condition that is now presumptive, you can file a Supplemental Claim on VA Form 20-0995. A Supplemental Claim based on a change in law, such as the PACT Act, does not need new evidence, but VA still needs medical evidence of the diagnosis and how severe it is. VA may contact you about a past denial, but you do not need to wait for that.
1. A past VA decision on the conditionThe decision letter that denied the condition. A Supplemental Claim can be filed at any time after a decision, unless that issue is already in another review or on appeal in court.
2. Medical evidence of the diagnosis and its severityRecords that show the diagnosis and how severe it is now. You can send copies, or name the records so VA can request them.
Source: 38 CFR 3.2501 (opens in new tab); 38 CFR 3.2500(a) (opens in new tab); VA.gov: Supplemental Claims (opens in new tab); VA.gov: the PACT Act and your VA benefits (opens in new tab); VA Form 20-0995 (opens in new tab); M21-1 VIII.i.1.A (opens in new tab); 38 CFR 3.2500(b) (opens in new tab)
VA health care and the toxic exposure screening
The PACT Act expanded VA health care for veterans with toxic exposures. For enrollment without a disability claim first, VA looks at two things: its basic service and discharge rules, and service in a listed place or operation, or exposure to toxins or other hazards in service. VA offers every enrolled veteran a toxic exposure screening, then a follow-up at least once every 5 years.
1. Covered service or an exposure, plus the basic service rulesService in a PACT Act place or operation, or an exposure to toxins or other hazards during service, along with VA's basic service and discharge rules for health care.
2. Enrollment in VA health careThe screening is for veterans enrolled in VA health care. It is part of your care, and it is not a claim for compensation.
Source: VA.gov: the PACT Act and your VA benefits (opens in new tab); VA.gov: how to apply for VA health care (opens in new tab); VA Form 10-10EZ (opens in new tab); 38 CFR 3.151(a) (opens in new tab)

Time limits

You can file a PACT Act claim at any time. An intent to file holds your start date for 1 year. VA does not pay a PACT Act presumption for any time before it took effect, which is August 10, 2022 for the conditions and places the law itself added.

What to gather, and what it shows VA

Documents for this benefit: what each is, what it shows VA, and how VA gets it
Document	What it shows	How VA gets it	Have it?
Separation papers (DD214) The record of your service dates, branch, and character of discharge. It may also show where you served.	When and where you served, and your discharge	VA will request this for you once you file. You can also get your own copy through eVetRecs, SF180, or milConnect for more recent discharges.	Yes
Service personnel records Records of deployments, duty stations, and job duties, with dates.	Where you served and what you did there	VA will request these for you once you file. VA also checks Defense Department deployment records, such as the Individual Longitudinal Exposure Record (ILER), and for Agent Orange service on a ship, a VA team researches the ship records. You can also get your own copy through eVetRecs or SF180.
VA medical records Records of care at VA medical centers and clinics, and of care VA paid for in the community.	The diagnosis and how severe it is	VA will request these for you once you file. You can review your own VA records on VA.gov.
Private medical records Records from doctors and hospitals outside VA, including pathology or biopsy reports for a cancer.	The diagnosis, where a cancer started, and how severe it is	Send copies to VA yourself, or complete VA Form 21-4142 and VA Form 21-4142a so VA can request them. The provider details go on the VA forms, not into BeneVets.
Toxic exposure answers on VA Form 21-526EZ Section IV of the claim form. It asks whether you claim conditions from toxic exposures, whether and when you served in Gulf War hazard places or Agent Orange places, and about other exposures, such as asbestos or a toxin tied to your military job.	Which places, dates, and exposures VA checks	You answer on VA's form. The form asks for approximate months and years.
Statements about an exposure Your own written account, or one from someone who served with you, of what you were exposed to, where, and when.	The exposure, from people who were there	Your statement goes on VA Form 21-4138, and a witness completes VA Form 21-10210. Both go to VA with the claim.
Medical opinion on the link A written opinion from a health care provider that a condition is at least as likely as not related to an exposure in service.	The connection between the exposure and the condition	Not needed for a condition on a list. For a condition not on a list, your provider can write one and submit it to VA, and VA can request its own opinion with a claim exam. For conditions VA has found to have no positive association with Agent Orange, such as many cancers and hearing loss, its TERA procedures make an exception, so VA may not request an opinion of its own.
VA claim exam, including a TERA opinion An exam VA schedules when it needs more medical evidence. For a toxic exposure claim, VA can ask the examiner whether the exposure caused the condition.	The diagnosis, how severe it is, and any link to an exposure	VA schedules it, and you do not need to bring anything. For burn pit conditions, VA does not ask you to have a biopsy or other invasive test for the exam.
The earlier decision letter The VA letter that denied the condition, with its date.	What VA decided before, and when	VA mailed it after the decision. You can download decision letters for certain claims, reviews, and appeals on VA.gov. The issue and its decision date go on VA Form 20-0995.	Yes
Health care application (VA Form 10-10EZ) The form to enroll in VA health care. It asks about your service and any exposure to toxins or other hazards.	Your service and exposures, for enrollment	Apply online, by phone, by mail, or in person at a VA medical center or clinic. The BeneVets fill flow can prefill identity, contact, and service fields.

Records and statements go to VA. BeneVets never asks you to upload or type them here.

Steps, in order

Check the lists
Compare your diagnosis and your service with the lists in this chapter and on VA.gov. VA's examples for the burn pit cancer groups include thyroid, colon, breast, and prostate cancer. A cancer counts where it started. Asthma counts when it was first diagnosed after service; asthma first diagnosed before or during service is decided as a direct or aggravation claim.
Source: M21-1 VIII.ii.2.A (opens in new tab); M21-1 VIII.ii.2.C (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab); VA.gov: presumptive cancers related to burn pit exposure (opens in new tab); VA.gov: Agent Orange exposure and disability compensation (opens in new tab); VA.gov: the PACT Act and your VA benefits (opens in new tab)
Confirm where and when you served
Check your DD214 and personnel records for the places and dates. VA will request your service records for you once you file, and it checks Defense Department deployment records too. For your own copies, use eVetRecs or SF180.
Source: 38 CFR 3.159(c)(3) (opens in new tab); M21-1 VIII.ii.2.B (opens in new tab); VA.gov: request your military service records (opens in new tab); Standard Form 180 (SF180) (opens in new tab)
Get free help from a VSO
Free help: an accredited VSO can file this with you. Find one near you in the BeneVets VSO directory at Find an accredited VSO near you. VA also accredits attorneys and claims agents, who can charge fees only for work done after VA issues its initial decision on the claim.
Source: VA.gov: accredited representatives (opens in new tab); 38 CFR 14.636(c) (opens in new tab)
Set your start date
Submit an intent to file on VA Form 21-0966, by phone, or by starting the online application while signed in to a verified VA.gov account. You then have 1 year to file, and it works for a new claim or a Supplemental Claim for disability compensation. Once you file, that intent to file is used up and does not hold a date for later claims. If you left service less than 1 year ago, a claim filed within that year can start from the date you first met every requirement.
Source: M21-1 II.iii.2.A (opens in new tab); VA.gov: your intent to file (opens in new tab); VA Form 21-0966 (opens in new tab); 38 CFR 3.400(b)(2)(ii) (opens in new tab)
Point VA to your medical records
VA will request your VA treatment records once you file. For each private doctor, send copies to VA or complete VA Form 21-4142 and VA Form 21-4142a so VA can request them.
Source: 38 CFR 3.159(c)(1) (opens in new tab); 38 CFR 3.159(c)(2) (opens in new tab); VA Form 21-4142 (opens in new tab); VA Form 21-4142a (opens in new tab)
For a new claim, file VA Form 21-526EZ
List each condition or symptom, and answer the toxic exposure questions in Section IV with approximate months and years. With service in a covered burn pit place, you do not need to name the exposure for a listed condition, but naming only an exposure, with no condition, is not a complete claim. The BeneVets fill flow can prefill identity, contact, and service fields; the conditions and exposure sections are completed on VA's form.
Source: VA Form 21-526EZ (opens in new tab); M21-1 VIII.ii.2.B (opens in new tab); M21-1 VIII.i.1.A (opens in new tab); 38 CFR 3.155(b) (opens in new tab)
For a past denial, file VA Form 20-0995
List each condition and the date of the decision that denied it. For a claim based on the PACT Act change in law, new evidence is not required, but VA needs medical evidence of the diagnosis and its severity, sent or named so VA can get it. You can file online for disability compensation.
Source: 38 CFR 3.2501 (opens in new tab); VA.gov: Supplemental Claims (opens in new tab); VA Form 20-0995 (opens in new tab); M21-1 VIII.i.1.A (opens in new tab)
For other exposures, show the exposure and the link
Gather records of your duties and locations, and statements from you or from people who served with you on VA Form 21-4138 or VA Form 21-10210. For a condition not on a list, an opinion from your own provider can show the link. VA can also request one with a claim exam, except for some conditions VA has found to have no positive association with Agent Orange.
Source: M21-1 V.ii.1.B (opens in new tab); VA Form 21-4138 (opens in new tab); VA Form 21-10210 (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab); M21-1 IV.i.2.A (opens in new tab); M21-1 VIII.i.1.B (opens in new tab)
Go to any claim exam VA schedules
VA asks for a claim exam only when it needs more information to decide. For a toxic exposure claim, VA can ask the examiner for a TERA opinion on whether the exposure caused the condition. Missing an exam can delay the claim, and VA may then decide on the evidence it already has.
Source: 38 CFR 3.159(c)(4) (opens in new tab); M21-1 IV.i.2.A (opens in new tab); VA.gov: VA claim exam (opens in new tab)
Enroll in VA health care
Apply on VA Form 10-10EZ online, by phone, by mail, or in person at a VA medical center or clinic. Have your DD214 and details about any toxic exposures ready. The BeneVets fill flow can prefill identity, contact, and service fields.
Source: VA Form 10-10EZ (opens in new tab); VA.gov: how to apply for VA health care (opens in new tab); VA.gov: the PACT Act and your VA benefits (opens in new tab)
Ask for the toxic exposure screening
Ask at your next VA health care appointment, or contact your VA facility and ask for the toxic exposure screening navigator. The screening points you to benefits, registry exams, and care. Compensation still needs its own claim.
Source: VA.gov: the PACT Act and your VA benefits (opens in new tab); 38 CFR 3.151(a) (opens in new tab)
Track your claim
Track the claim on VA.gov. You do not need to do anything while you wait unless VA sends a letter asking for more information.
Source: M21-1 III.i.2.D (opens in new tab); VA.gov: how to file a VA disability claim (opens in new tab); VA.gov: check your claim, decision review, or appeal status (opens in new tab)
Read the decision
For a burn pit claim, a denial explains which rule was not met. You can choose a Supplemental Claim (VA Form 20-0995), a Higher-Level Review (VA Form 20-0996), or a Board Appeal (VA Form 10182). A review filed within 1 year of the date on the decision letter keeps the original effective date (the date your payments start).
Source: M21-1 VIII.ii.2.C (opens in new tab); 38 CFR 3.2500(h) (opens in new tab); VA.gov: decision reviews and appeals (opens in new tab); VA Form 20-0995 (opens in new tab); VA Form 20-0996 (opens in new tab); VA Form 10182 (opens in new tab)

Good to know

No link evidence for a listed condition

With covered service and a listed condition, VA presumes the connection, so you do not need to show that service caused it. If VA added your condition while your claim was pending, VA still treats it as presumptive.

Source: VA.gov: the PACT Act and your VA benefits (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab); 38 CFR 3.320a (opens in new tab)

The burn pit list

Cancers: brain cancer and glioblastoma; head, neck, respiratory, gastrointestinal, or reproductive cancer of any type; lymphoma of any type; kidney cancer; melanoma; and pancreatic cancer. In 2025, VA added bladder and ureter cancers and blood cancers: leukemias, multiple myeloma including MGUS, myelodysplastic syndromes, and myelofibrosis. Other illnesses: asthma diagnosed after service, chronic bronchitis, COPD, chronic rhinitis, chronic sinusitis, constrictive or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, and sarcoidosis.

Source: M21-1 VIII.ii.2.A (opens in new tab); 38 CFR 3.320 (opens in new tab); 38 CFR 3.320a (opens in new tab); 38 CFR 3.320b (opens in new tab); VA.gov: burn pits and other specific environmental hazards (opens in new tab)

No pay before a presumption took effect

VA does not pay a PACT Act presumption for any time before it took effect. For the burn pit and Agent Orange conditions and places the law added, that date is August 10, 2022. It is January 2, 2025 for bladder and ureter cancers and January 10, 2025 for the blood cancers. Asthma, rhinitis, sinusitis, and some rare respiratory cancers were presumptive earlier for some places, so their date can be earlier. VA does not apply the Nehmer court order to Agent Orange claims granted under the PACT Act's additions.

Source: M21-1 VIII.ii.2.C (opens in new tab); M21-1 VIII.i.1.C (opens in new tab); M21-1 VIII.i.1.A (opens in new tab)

How far back pay can reach

In general, pay starts from the later of two dates: the date VA receives your claim or intent to file, and the date you first met every requirement. A claim VA receives within 1 year after you leave service can start from the date you first met every requirement. If you file more than 1 year after a presumption took effect, VA can pay from up to 1 year before it received your claim or intent to file, when the record shows you met every requirement from that day onward.

Source: 38 CFR 3.400(b)(2)(ii) (opens in new tab); 38 CFR 3.114(a) (opens in new tab); 38 CFR 3.155(b) (opens in new tab); M21-1 VIII.ii.2.C (opens in new tab)

The burn pit registry is voluntary

The Airborne Hazards and Open Burn Pit Registry and its exam are voluntary. Joining a registry is not a claim and does not hold a start date for pay; only a claim or an intent to file does. The registry exam is not a compensation exam, and you do not need it to file a claim or to get other VA benefits. The same is true of the Agent Orange Registry exam.

Source: VA.gov: toxic exposure screening and your VA benefits (Lovell FHCC) (opens in new tab); VA.gov: Agent Orange exposure and disability compensation (opens in new tab); 38 CFR 3.151(a) (opens in new tab); 38 CFR 3.155(b) (opens in new tab)

Radiation response efforts the Act added

The Act added three radiation response efforts where VA presumes radiation exposure. One is the cleanup of Enewetak Atoll, January 1, 1977 to December 31, 1980. Another is the cleanup of a B-52 bomber carrying nuclear weapons off the coast of Palomares, Spain, January 17, 1966 to March 31, 1967. The third is the response to a fire on a B-52 bomber carrying nuclear weapons near Thule Air Force Base, Greenland, January 21, 1968 to September 25, 1968. The radiation card covers those claims.

Source: VA.gov: the PACT Act and your VA benefits (opens in new tab)

Survivors can apply too

If a veteran's death came from a condition that is now presumptive, a surviving spouse, dependent child, or parent can apply for DIC. If VA denied a survivor claim before, VA may contact you, but you do not need to wait to reapply.

Source: VA.gov: the PACT Act and your VA benefits (opens in new tab); VA.gov: DIC for spouses, children, and parents (opens in new tab)

BeneVets is informational and is not an accredited representative. Free help: an accredited VSO can work through VA benefits with you at no cost. Find an accredited VSO near you