PACT Act & Toxic Exposure Claims

What Is the PACT Act?

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act — mercifully shortened to the PACT Act — was signed into law on August 10, 2022. It's named after SFC Heath Robinson, an Ohio National Guard soldier who developed a rare cancer after exposure to burn pits in Iraq and Kosovo. He died in 2020. He was 39.

The law does three big things. First, it adds 23+ conditions to the VA's presumptive list for veterans exposed to burn pits and other toxins. Second, it expands Agent Orange presumptions to cover Thailand, Guam, American Samoa, Johnston Atoll, and several test/storage sites. Third, it created the Camp Lejeune Justice Act, giving a legal pathway for veterans and families harmed by contaminated water at Camp Lejeune between 1953 and 1987.

Before the PACT Act, veterans who got sick from burn pits had to prove — condition by condition — that their illness was connected to service. That meant nexus letters, independent medical opinions, and years of appeals. Most got denied. The PACT Act flipped that. If you have a qualifying condition and served in a qualifying location, the VA now concedes the connection.

Who Qualifies

The PACT Act covers four main groups of veterans. You don't need to fall into all of them — just one.

Burn Pit / Airborne Hazard Exposure (Post-9/11)

If you served in Southwest Asia, the Middle East, or certain other locations after August 2, 1990, you're covered. This includes Iraq, Afghanistan, Syria, Jordan, Egypt, Lebanon, Yemen, Uzbekistan, and more. The VA now concedes that you were exposed to airborne hazards — including burn pits — if you served in these areas. You don't have to prove you stood next to a burn pit. Service in the theater is enough.

Agent Orange Exposure (Vietnam Era + Expanded Locations)

Vietnam veterans have had presumptive conditions for Agent Orange since the early 1990s. But the PACT Act expanded this to include veterans who served in Thailand (1962–1975), Guam, American Samoa, Johnston Atoll, and Wake Island, plus those involved in testing, transporting, or storing Agent Orange. Blue Water Navy veterans — those who served on ships offshore Vietnam — are also included under the Blue Water Navy Vietnam Veterans Act of 2019, which the PACT Act reinforced.

Radiation Exposure

Veterans who participated in nuclear weapons testing, served in Hiroshima/Nagasaki occupation forces, or were exposed to radiation during service at specific sites. The PACT Act expanded the list of radiation-risk activities under 38 CFR § 3.309(d) and added Palomares, Spain and Enewetak Atoll cleanup veterans.

Camp Lejeune Water Contamination

If you served at Camp Lejeune for at least 30 days between August 1, 1953 and December 31, 1987, you were exposed to contaminated drinking water containing TCE, PCE, benzene, and vinyl chloride. The PACT Act created an entirely new legal pathway for these claims. More on this below.

Presumptive Conditions

"Presumptive" means the VA assumes your condition is connected to your service. You don't need a nexus letter. You don't need an independent medical opinion. You need two things: a current diagnosis and qualifying service (right place, right time). That's it.

Under 38 CFR § 3.320, the PACT Act added these conditions as presumptive for veterans with toxic exposure:

Cancers (Burn Pit / Airborne Hazard Exposure)

• Bladder cancer
• Head cancer of any type
• Body cancer of any type
• Neck cancer of any type
• Respiratory cancer of any type (includes lung)
• Gastrointestinal cancer of any type
• Reproductive cancer of any type
• Lymphatic cancer of any type (includes non-Hodgkin's lymphoma)
• Kidney cancer (renal cell carcinoma)
• Melanoma
• Pancreatic cancer
• Lymphomatic cancer of any type
• Any type of cancer for which DOD has established a link to burn pit or airborne hazard exposure

Other Presumptive Conditions

• Constrictive bronchiolitis
• Constrictive pericarditis
• Chronic sinusitis
• Chronic rhinitis
• Chronic laryngitis
• Glioblastoma
• Chronic obstructive pulmonary disease (COPD)
• Chronic bronchitis
• Pulmonary fibrosis
• Sarcoidosis
• Interstitial lung disease
• Desquamative interstitial pneumonia
• Hypersensitivity pneumonitis
• Organizing pneumonia
• Pulmonary alveolar proteinosis
• Chronic obliterative bronchiolitis
• Diffuse alveolar damage
• Pleuritis and/or pleurisy
• Pulmonary granuloma
• Lung disease (other than cancer) not otherwise specified
• Squamous cell carcinoma of the head or neck

Burn Pit Exposure

Burn pits were open-air waste disposal sites used on military bases across Southwest Asia and the Middle East. They burned everything — medical waste, plastics, electronics, human waste, munitions, paint, petroleum products. Sometimes 24 hours a day. Sometimes yards from where you slept.

The VA estimated that 3.5 million veterans were exposed to burn pit smoke during post-9/11 service. And for years, the VA denied most of those claims.

Concession of Exposure

This is the game-changer. Under the PACT Act, if you served in any of these locations on or after August 2, 1990, the VA now concedes your exposure to airborne hazards and open burn pits:

• Afghanistan
• Iraq
• Syria
• Jordan
• Egypt
• Lebanon
• Yemen
• Uzbekistan
• Southwest Asia theater of operations (as defined under 38 CFR § 3.317)
• Any location where the DoD has identified burn pit use

You don't have to prove you were near a burn pit. You don't need buddy statements about smoke. Your service records showing deployment to one of these locations is sufficient. The VA will concede exposure and move on to evaluating your condition.

Toxic Exposure Screening

The PACT Act also requires the VA to screen every veteran enrolled in VA healthcare for toxic exposures. This is a simple questionnaire during your appointment. But it does something important — it creates a documented record of your exposure in your VA medical file. If you develop a condition later, that screening is evidence. Get screened even if you feel fine right now.

Agent Orange Updates

Agent Orange presumptive conditions have been around since the Agent Orange Act of 1991. But the PACT Act significantly expanded who qualifies and where exposure is recognized.

Expanded Locations

The VA now recognizes Agent Orange exposure for veterans who served at:

• Thailand military bases (1962–1975) — specifically Royal Thai Air Force Bases at U-Tapao, Korat, Nakhon Phanom, Udon Thani, Takhli, Don Muang, and Camp Friendship in Korat
• Guam — Agent Orange testing and storage
• American Samoa
• Johnston Atoll — herbicide destruction operations
• Wake Island
• Specific test and storage sites in the United States, including Fort Drum (NY), Gulfport (MS), and Eglin Air Force Base (FL)

Blue Water Navy Veterans

The Blue Water Navy Vietnam Veterans Act of 2019 extended Agent Orange presumptions to veterans who served on ships in the offshore waters of Vietnam. The PACT Act reinforced and expanded this. If you served aboard a vessel in the waters surrounding Vietnam — even if you never set foot on land — you're covered. The VA maintains a list of ships at va.gov/disability/eligibility/hazardous-materials-exposure/agent-orange/navy-coast-guard-702-702-ships-background.

C-123 Aircraft Veterans

Veterans who served on C-123 aircraft that were previously used to spray Agent Orange in Vietnam are also covered. These planes retained herbicide residue for decades. Reserve and Guard members who flew or maintained these aircraft at Westover Air Reserve Base (MA), Rickenbacker Air National Guard Base (OH), and Pittsburgh Air Reserve Station (PA) between 1969 and 1986 are eligible.

Agent Orange Presumptive Conditions

The PACT Act added hypertension and monoclonal gammopathy of undetermined significance (MGUS) to the existing Agent Orange presumptive list. The full list now includes:

• AL amyloidosis
• Bladder cancer
• Chronic B-cell leukemias
• Chloracne
• Diabetes mellitus type 2
• Hodgkin's disease
• Hypertension
• Ischemic heart disease
• Monoclonal gammopathy of undetermined significance (MGUS)
• Non-Hodgkin's lymphoma
• Parkinsonism
• Parkinson's disease
• Peripheral neuropathy, early-onset
• Porphyria cutanea tarda
• Prostate cancer
• Respiratory cancers
• Soft tissue sarcomas

Camp Lejeune Justice Act

The Camp Lejeune Justice Act is embedded within the PACT Act, but it works differently from everything else on this page. It's not a VA disability claim — it's a federal tort claim. That means it's a lawsuit, filed in the U.S. District Court for the Eastern District of North Carolina.

From 1953 to 1987, the drinking water at Marine Corps Base Camp Lejeune was contaminated with industrial solvents, benzene, and other chemicals — some at levels 240 to 3,400 times above safety standards. An estimated 1 million people were exposed, including service members, their families, and civilian workers.

Who Qualifies

Anyone — veteran, family member, or civilian — who lived or worked at Camp Lejeune for at least 30 cumulative days between August 1, 1953 and December 31, 1987. This includes:

• Active-duty Marines and sailors
• Reserve and Guard members on active duty at Lejeune
• Family members who lived on base
• Civilian employees
• Children born to mothers who were at Camp Lejeune while pregnant

Conditions Linked to Camp Lejeune Water

• Kidney cancer
• Liver cancer
• Non-Hodgkin's lymphoma
• Leukemia
• Bladder cancer
• Multiple myeloma
• Parkinson's disease
• Kidney disease (end stage renal disease)
• Systemic sclerosis/scleroderma
• Cardiac birth defects (in children born to exposed parents)
• Esophageal cancer
• Breast cancer
• Lung cancer
• Miscarriages
• Hepatic steatosis (fatty liver disease)
• Female infertility
• Neurobehavioral effects
• Aplastic anemia and other myelodysplastic syndromes

The Claims Process

Camp Lejeune claims go through a two-track process. First, you file an administrative claim with the Department of the Navy's Judge Advocate General (JAG). They have six months to respond. If they deny or don't respond, you can then file a lawsuit in federal court. Many veterans are pursuing both the tort claim and a VA disability claim simultaneously — they're not mutually exclusive.

How to File a PACT Act Claim

Filing a PACT Act claim uses the same form as any other VA disability claim — VA Form 21-526EZ. You can file online at va.gov, by mail, or in person at your regional office. But the evidence requirements are lighter than you think.

Step 1: File an Intent to File (ITF)

Before you do anything else, file an Intent to File using VA Form 21-0966. This locks in your effective date — the date from which your benefits will be calculated if approved. You then have one year to submit your full claim. Filing an ITF takes five minutes and can be worth thousands of dollars in back pay.

You can file an ITF online, by phone (1-800-827-1000), or in person. Do it today. Seriously.

Step 2: Gather Your Evidence

For a PACT Act presumptive claim, you need less evidence than a standard claim. Here's what matters:

• DD-214 or service records showing you served in a qualifying location during a qualifying period
• Current medical diagnosis of a presumptive condition (VA medical records, private doctor records, or C&P exam)
• That's it for presumptive conditions. No nexus letter. No buddy statements about exposure. No independent medical opinion.

If your condition isn't on the presumptive list but you believe it's related to toxic exposure, you can still file — you'll just need to follow the standard direct service connection route with a nexus letter.

Step 3: Submit Your Claim

File VA Form 21-526EZ online at va.gov. Select "new claim" for conditions you haven't claimed before, or "increase" if your existing condition has worsened. Under the condition description, reference your toxic exposure and the PACT Act. Be specific — name the condition, name the exposure, reference the location and dates.

Step 4: Attend Your C&P Exam

The VA will likely schedule a Compensation and Pension (C&P) exam. Show up. Be honest. Describe your worst days, not your best. The examiner is assessing the current severity of your condition and confirming the diagnosis. For presumptive claims, they're not there to debate whether burn pits caused your COPD — that's already conceded. They're confirming you have COPD and how bad it is.

Effective Dates

This is where money enters the picture. Your effective date determines how far back the VA will pay you. And the PACT Act has specific rules about this.

The Phased Rollout

The PACT Act didn't activate all at once. It rolled out in phases:

• August 10, 2022: Law signed. Burn pit registry enrollment, toxic exposure screenings begin.
• January 1, 2023: First round of new presumptive conditions take effect.
• October 1, 2023: All remaining PACT Act presumptive conditions take effect.
• August 10, 2023: One-year anniversary — special effective date rules for early filers.

Why Filing Date Matters

For PACT Act presumptive conditions, your effective date is generally the date you file your claim (or your Intent to File date). But there's a special provision: if you filed within one year of the PACT Act's signing — between August 10, 2022 and August 9, 2023 — your effective date can go back to August 10, 2022, regardless of when you actually filed during that window.

That ship has sailed for new filers. But if you filed during that window and haven't received a decision yet, make sure the VA is applying the correct effective date.

Back Pay and Retroactive Benefits

If you're approved, the VA owes you back pay from your effective date to the date of the decision. At higher disability ratings, this can add up to tens of thousands of dollars. This is why filing an Intent to File immediately — even before you have all your evidence — is so important. Every month you wait is a month of benefits you can't recover.

If You Were Previously Denied

This section might be the most important one on this page.

If the VA denied your toxic exposure claim before the PACT Act — and a lot of them did — you can reopen it. The PACT Act itself qualifies as "new and relevant evidence" because it changed the legal framework. Here's how.

File a Supplemental Claim

Use VA Form 20-0995 (Supplemental Claim). In the "new and relevant evidence" section, cite the PACT Act — Public Law 117-168 — as the basis for reopening. The VA has issued guidance that the PACT Act's changes to presumptive conditions and concession of exposure constitute new and relevant evidence sufficient to reopen previously denied claims.

And here's the part that matters: if your supplemental claim is granted, your effective date may go back to your original claim date. If you first filed for burn pit exposure in 2018, got denied, and now reopen under the PACT Act — your effective date could be 2018. That's years of back pay.

What About Higher-Level Review?

A Higher-Level Review (VA Form 20-0996) asks a senior reviewer to look at the same evidence and find an error. For PACT Act cases, a Supplemental Claim is almost always the better path because you're introducing new evidence (the law change), not arguing the old evidence was misread. But if your denial was recent and you believe there was a clear and unmistakable error, HLR is an option.

Don't Assume Your Old Denial Is Final

A lot of veterans think "denied means denied." It doesn't. The VA's appeals system is designed to let you reopen claims when circumstances change. The PACT Act is one of the biggest circumstance changes in VA history. If you have a prior denial for a condition that's now presumptive — file that supplemental claim.

Frequently Asked Questions