Complete List of PACT Act Presumptive Conditions

Burn Pit and Airborne Hazard Presumptive Respiratory Conditions

Veterans deployed to the Middle East, Central Asia, and East Africa encountered intense particulate matter, open burn pits that consumed plastics, munitions, and chemical waste, and industrial pollutants. The PACT Act established presumptive service connection for the following chronic respiratory disorders:

• Asthma: Diagnosed after discharge from active duty. Under 38 CFR 4.97, Diagnostic Code 6602, asthma ratings depend on spirometry results (FEV-1 or FEV-1/FVC) or the frequency of bronchodilator or systemic corticosteroid therapy.
• Chronic Bronchitis: Rated under Diagnostic Code 6600 from 10 percent to 100 percent based on pulmonary function test metrics (FEV-1, FEV-1/FVC, or DLCO), maximum exercise capacity, or complications such as cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, or outpatient oxygen therapy.
• Chronic Obstructive Pulmonary Disease (COPD): Rated under Diagnostic Code 6604, evaluated using pulmonary function tests measuring forced expiratory volume (FEV-1), forced vital capacity (FVC), or diffusing capacity of the lung for carbon monoxide (DLCO).
• Chronic Rhinitis: Rated under Diagnostic Code 6522, based on the percentage of nasal obstruction or the presence of rhinitis with nasal polyps.
• Chronic Sinusitis: Rated under Diagnostic Code 6510 through 6514, evaluated based on radical surgery, chronic osteomyelitis, or annual episodes of sinusitis manifesting with headaches, pain, and purulent discharge or crusting.
• Constrictive Bronchiolitis or Obliterative Bronchiolitis: A severe, irreversible narrowing of the smallest airways that frequently requires specialized high-resolution computed tomography (HRCT) or lung biopsy to identify.
• Emphysema: Evaluated under Diagnostic Code 6603 according to objective pulmonary impairment.
• Granulomatous Disease: Inflammatory nodular formations within pulmonary tissue.
• Interstitial Lung Disease (ILD): A broad group of disorders causing progressive scarring of pulmonary tissue, evaluated under the General Rating Formula for Interstitial Lung Disease (Diagnostic Codes 6825 through 6833).
• Pleuritis: Chronic inflammation of the pleural linings surrounding the lungs.
• Pulmonary Fibrosis (including Idiopathic Pulmonary Fibrosis): Diffuse interstitial fibrosis of the lungs, rated under Diagnostic Code 6825 based on forced vital capacity (FVC), diffusing capacity (DLCO), maximum exercise capacity, cor pulmonale, pulmonary hypertension, or outpatient oxygen therapy.
• Sarcoidosis: Systemic inflammatory granulomas evaluated under Diagnostic Code 6846 based on persistent active disease, steroid therapy requirements, or thoracic functional impairment.

PACT Act Presumptive Cancers

The legislation established presumptive status under 38 U.S.C. 1120(b) and VA regulatory notices for a comprehensive range of malignant neoplasms. Any veteran with qualifying deployment service who receives a diagnosis of the following cancers is eligible for presumptive service connection:

• Brain Cancer: Primary malignant tumors of the brain tissue.
• Glioblastoma: An aggressive form of malignant brain cancer.
• Gastrointestinal Cancer of Any Type: Includes stomach, colon, rectal, esophageal, small intestine, gallbladder, and liver cancers.
• Head Cancer of Any Type: Encompasses cancers of the mouth, tongue, pharynx, larynx, and salivary glands.
• Neck Cancer of Any Type: Encompasses thyroid cancer and other cervical soft tissue malignancies.
• Kidney Cancer: Renal cell carcinoma and related kidney tumors.
• Lymphoma of Any Type: Includes Hodgkin’s lymphoma and non-Hodgkin’s lymphoma variants (note that Public Law 117-263 removed the redundant statutory phrase “lymphomatic cancer of any type” because all lymphatic malignancies are covered under lymphoma of any type).
• Melanoma: Malignant skin cancer arising from melanocytes.
• Pancreatic Cancer: Malignant tumors of the endocrine or exocrine pancreas.
• Reproductive Cancer of Any Type: Includes testicular, ovarian, prostate, cervical, uterine, and penile cancers.
• Respiratory Cancer of Any Type: Includes lung cancer, bronchial tumors, tracheal cancer, laryngeal cancer, and rare respiratory cancers (squamous cell carcinoma of the larynx or trachea, adenocarcinoma of the trachea, salivary gland-type tumors of the trachea or lung, adenosquamous carcinoma of the lung, large cell carcinoma of the lung, sarcomatoid carcinoma of the lung, and typical and atypical carcinoid of the lung).
• Additional Hematologic and Genitourinary Cancers: For Gulf War and post-9/11 veterans, the VA also recognizes acute and chronic leukemias, multiple myeloma, myelodysplastic syndromes, and bladder, ureter, and related genitourinary cancers as presumptive.

Under 38 CFR 4.115b and corresponding oncological rating codes, active malignancies are rated at 100 percent while undergoing treatment and during a mandatory six-month convalescent period following completion of surgical resection, chemotherapy, antineoplastic, or radiation treatment. Once the cancer is in remission, the VA conducts a mandatory examination to rate any permanent residual impairments.

Expanded Agent Orange Presumptive Conditions

The PACT Act addressed long-standing scientific recommendations from the National Academies of Sciences, Engineering, and Medicine by adding two major health conditions to the presumptive tactical herbicide schedule under agent orange presumptive conditions:

• High Blood Pressure (Hypertension): Rated under 38 CFR 4.104, Diagnostic Code 7101. A 10 percent rating requires diastolic blood pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. A 20 percent rating requires diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more (with 40 percent for diastolic 120 or more and 60 percent for diastolic 130 or more).
• Monoclonal Gammopathy of Undetermined Significance (MGUS): Rated under 38 CFR 4.117, Diagnostic Code 7712, which assigns a 0 percent evaluation to asymptomatic MGUS while establishing service connection should it progress to symptomatic multiple myeloma.

These conditions complement existing Agent Orange presumptions, including type 2 diabetes, hypothyroidism, bladder cancer, ischemic heart disease, Parkinson’s disease, parkinsonism, early-onset peripheral neuropathy, and prostate cancer.

Qualifying Locations and Statutory Service Dates

Presumptive entitlement requires documented physical service within designated geographic boundaries. Military records such as orders, evaluations, or medals must confirm deployment during the following parameters:

Gulf War and Southwest Asia Theater (August 2, 1990, to Present)

• Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, United Arab Emirates (UAE).
• The airspace above these sovereign nations.
• Surrounding waters: Persian Gulf, Arabian Sea, Red Sea, Gulf of Oman, and Gulf of Aden.

Post-9/11 Operational Locations (September 11, 2001, to Present)

• Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen.
• The airspace above these nations.

Expanded Tactical Herbicide Locations

• Thailand: Any United States or Royal Thai military base from January 9, 1962, through June 30, 1976.
• Laos: Entire territory from December 1, 1965, through September 30, 1969.
• Cambodia: Mimot or Krek in Kampong Cham Province from April 16, 1969, through April 30, 1969.
• Guam and American Samoa: Territorial land and adjacent waters from January 9, 1962, through July 31, 1980.
• Johnston Atoll: Island landmass or vessels calling at the atoll from January 1, 1972, through September 30, 1977.

Secondary Service Connection for PACT Act Conditions

When a primary presumptive condition is granted, secondary physical or psychological complications can also be connected under 38 CFR 3.310. A secondary condition is an impairment that is caused or aggravated by a service-connected disability.

Common secondary claims linked to PACT Act respiratory conditions include:

• Obstructive Sleep Apnea: Chronic sinus inflammation, rhinitis with nasal polyps, or severe asthma can obstruct upper airway anatomy, resulting in secondary sleep apnea.
• Secondary Gastroesophageal Reflux Disease (GERD): High-dose bronchodilators or oral corticosteroid regimens prescribed for asthma or COPD can relax the lower esophageal sphincter, causing severe acid reflux.
• Cardiovascular Complications: Chronic lung diseases that reduce systemic oxygen levels can place compensatory strain on the right ventricle, causing cor pulmonale or pulmonary hypertension.
• Secondary Mental Health Conditions: Enduring the physical limitations, chronic pain, or terminal prognosis of a presumptive cancer can lead to secondary major depressive disorder or generalized anxiety.

Secondary conditions are rated independently under their respective diagnostic codes. Adjudicators calculate your total combined percentage using 38 CFR 4.25 whole-person efficiency math, which you can estimate using the va combined rating calculator.

Filing Evidence and Compensation Scale

To file a claim for a presumptive condition, submit VA Form 21-526EZ accompanied by:

1. DD Form 214 or service personnel records establishing qualifying dates and locations.
2. Clinical records confirming an active medical diagnosis.
3. Relevant pharmacy records or diagnostic test results (such as spirometry or pathology reports).

The VA will schedule a Compensation and Pension (C&P) exam to evaluate the functional severity of your disability. Ratings follow the schedule established in Title 38 of the Code of Federal Regulations. For a veteran with no qualifying dependents, monthly disability pay starts at $180.42 for a 10 percent rating, increasing with symptom severity up to $3,938.58 for a 100 percent rating, effective 2025-12-01. You can view all tier levels on our va disability pay chart. For claims involving back pay, calculate your retroactive payout using our va back pay calculator.

While participation in the burn pit registry is helpful for long-term health monitoring, remember that registry enrollment is not a substitute for submitting a formal compensation claim.

Getting Accredited Representation for Your Claim

Filing a presumptive claim requires assembling detailed medical evidence and service records. Working with an accredited advocate ensures your claim is completed accurately and prevents administrative delays.

Federal regulations authorize specific individuals to represent veterans before the Department of Veterans Affairs:

• Veterans Service Officers (VSOs): Accredited representatives from organizations such as the VFW, DAV, American Legion, or state veterans agencies provide free representation.
• Accredited Claims Agents and Attorneys: Licensed advocates accredited by the VA Office of General Counsel can assist with complex claims, secondary connections, and formal appeals.

You can verify the credentials of any representative by searching the official VA Office of General Counsel Accreditation Search. Never pay an unaccredited company to file a VA claim on your behalf.