PACT Act Presumptive Conditions — The Complete 2026 List
The PACT Act — the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, signed in August 2022 — rewrote the presumptive rules for toxic-exposed veterans. Here's why that word matters: a presumptive condition means the VA concedes the nexus. You only have to prove (1) qualifying service and (2) a current diagnosis. No nexus letter. No medical opinion connecting your condition to service.
That removes the hardest part of most claims. But the lists are scattered across burn pit, Agent Orange, and radiation rules. This is the master list — every exposure type, plus what to do if you were already denied or your condition isn't on it.
What "Presumptive" Actually Means
A normal claim requires three elements: a current diagnosis, an in-service event or exposure, and a medical nexus between them. The nexus is where most claims die.
A presumption deletes that third element — the connection is already decided. Your claim reduces to proof of qualifying service and proof of a current diagnosis.
There is no time limit on filing a presumptive claim. A condition diagnosed decades after service still qualifies. If you haven't filed yet, lock in your effective date with an Intent to File while you gather records.
Burn Pit & Airborne Hazard Conditions (38 CFR 3.320)
The burn pit and airborne-hazard presumptions — codified at 38 CFR § 3.320 — cover Gulf War and post-9/11 veterans. Two groups of conditions:
| Respiratory Conditions | Cancers |
|---|---|
| Asthma diagnosed after separation | Brain cancer |
| Chronic bronchitis | Glioblastoma |
| COPD | Gastrointestinal cancer of any type |
| Chronic rhinitis | Head cancer of any type |
| Chronic sinusitis | Neck cancer of any type |
| Constrictive or obliterative bronchiolitis | Kidney cancer |
| Emphysema | Lymphoma of any type |
| Granulomatous disease | Lymphatic cancer of any type |
| Interstitial lung disease | Melanoma |
| Pleuritis | Pancreatic cancer |
| Pulmonary fibrosis | Reproductive cancer of any type |
| Sarcoidosis | Respiratory cancer of any type |
The "of any type" entries cover whole categories, not single diagnoses. For how these claims are filed and rated, see the burn pit deep dive.
Qualifying Service Locations and Dates
For the burn pit conditions above, qualifying service is either:
- On or after August 2, 1990: the Southwest Asia theater — Iraq, Kuwait, Saudi Arabia, Bahrain, Oman, Qatar, Somalia, the UAE, and the surrounding waters and airspace
- On or after September 11, 2001: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, or Yemen
Deployed to any of these? You may also fall under the separate Gulf War illness presumptive framework.
Not sure which presumptive path fits your service?
VetAid reads your decision letter and records against the full PACT Act presumptive framework — every burn pit condition, Agent Orange addition, and radiation site — and flags the path the VA should have conceded. Free, in under 2 hours.
Check My PACT Act Eligibility FreeAgent Orange: New Conditions and New Locations
The PACT Act added two conditions to the Agent Orange presumptive list:
- Hypertension (high blood pressure)
- MGUS (monoclonal gammopathy of undetermined significance)
It also expanded where qualifying herbicide exposure is conceded:
| Location | Qualifying Window |
|---|---|
| Thailand — any U.S. or Royal Thai base | Jan 9, 1962 – Jun 30, 1976 |
| Laos | Dec 1, 1965 – Sep 30, 1969 |
| Cambodia — Mimot or Krek, Kampong Cham Province | Apr 16, 1969 – Apr 30, 1969 |
| Guam or American Samoa and territorial waters | Jan 9, 1962 – Jul 31, 1980 |
| Johnston Atoll | Jan 1, 1972 – Sep 30, 1977 |
The Thailand expansion is huge: any service at a U.S. or Royal Thai base in the window now qualifies. If you were denied under the older, narrower rules, that denial is ripe for a supplemental claim.
Radiation-Risk Activity Expansion
The PACT Act also added three cleanup and response operations to the list of radiation-risk activities:
- Cleanup of Enewetak Atoll — Jan 1, 1977 to Dec 31, 1980
- Cleanup of the Air Force B-52 accident near Palomares, Spain — Jan 17, 1966 to Mar 31, 1967
- Response to the fire aboard the B-52 near Thule Air Force Base, Greenland — Jan 21, 1968 to Sep 25, 1968
Service in these operations now counts as a radiation-risk activity for the radiation presumptive framework.
Denied Before the PACT Act? File a Supplemental Claim
If you were denied for a condition that is now presumptive, the fix is a supplemental claim. The new presumption itself counts as new and relevant evidence — you don't need anything else. The VA re-decides under the presumptive rules, nexus conceded.
Don't refile as a brand-new initial claim, and don't assume the VA will re-review your old denial on its own. File the supplemental claim yourself and cite the new presumption. And use your free VA toxic exposure screening — every enrolled veteran gets one at least every 5 years.
Not on the List? You Can Still Win
The presumptive list is a shortcut, not a gate. If your condition isn't on it, you can still win direct service connection the traditional way — with a nexus letter linking your diagnosis to your exposure.
The PACT Act helps here too: the VA must now consider whether a toxic exposure risk activity (TERA) during your service contributed to your condition, even in non-presumptive claims. And the list itself is not frozen — the VA continues to review and add conditions.
Denied for a condition the VA should have presumed?
VetAid reads your decision letter and records against 38 CFR 3.320, the Agent Orange list, and the radiation-risk rules — and drafts the supplemental-claim argument the presumption supports. Free, in under 2 hours.
Analyze My Denial FreeFrequently Asked Questions
No. Presumptive service connection means the VA concedes the nexus — the link between your service and your condition — as a matter of law. You prove only two things: qualifying service in a covered location and time window, and a current diagnosis of a listed condition. That is the entire point of the presumptive framework at 38 CFR 3.320. A nexus letter only comes back into play if your condition is not on a presumptive list and you file for direct service connection instead.
File a supplemental claim. When a condition you were denied for later becomes presumptive, the new presumption itself is new and relevant evidence — you do not need to dig up anything else to reopen. The VA then decides your claim under the presumptive framework, where you no longer have to prove nexus. You are not starting over, and there is no penalty for having been denied before. Do not file the same evidence as a brand-new initial claim; the supplemental lane exists for exactly this situation.
Yes. The PACT Act added hypertension (high blood pressure) and MGUS (monoclonal gammopathy of undetermined significance) to the Agent Orange presumptive list. If you have qualifying herbicide exposure — Vietnam service or one of the expanded PACT Act locations such as Thailand base service (Jan 9, 1962 - Jun 30, 1976), Laos, Cambodia at Mimot or Krek, Guam or American Samoa, or Johnston Atoll — and a current hypertension diagnosis, the VA concedes the nexus. Veterans denied for hypertension before the PACT Act should file a supplemental claim.
Yes. The presumptive list is a shortcut, not a gate. You can still win direct service connection for any condition with a current diagnosis, an in-service event or exposure, and a nexus letter connecting the two. The PACT Act also requires the VA to consider whether a toxic exposure risk activity (TERA) during your service contributed to your condition, even in non-presumptive claims. And the list is not frozen — the VA continues to review and add conditions, so a denial today is not necessarily the last word.
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