PACT Act Presumptive Conditions: The Complete List

A presumptive condition is one where the VA accepts service connection without requiring you to prove your disease was caused by your military service. Under the PACT Act, signed August 10, 2022, the VA added more than 20 new conditions to that list, covering cancers, respiratory diseases, and blood disorders linked to burn pit exposure and other toxins.

Public Law 117-168^[1]

What a presumptive condition means under the PACT Act

Normally, to get service connection for a disability, you need three things: a current diagnosis, evidence of an in-service event or exposure, and a medical nexus opinion linking the two. That third element, the nexus, is where claims fall apart. Doctors often refuse to write opinions, and VA-contracted examiners sometimes produce inadequate ones.

With a presumptive condition, the nexus requirement disappears. The VA presumes the connection exists if you have the diagnosis and you qualify as a covered veteran. No opinion needed linking your lung disease to a specific burn pit.

The VA still needs two things from you: proof of your qualifying service (already in your records) and a current diagnosis from a medical provider. The presumption does not eliminate those requirements. It eliminates the hardest one.

38 CFR § 3.320^[2]

Who qualifies: covered veterans and covered locations

The PACT Act created 38 U.S.C. § 1119, which defines a "covered veteran" based on where and when you served.

Southwest Asia theater from August 2, 1990 onward. This covers service in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the United Arab Emirates on or after August 2, 1990.

Post-9/11 locations from September 11, 2001 onward. This covers service in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan on or after September 11, 2001.

If you served in any of those locations during those periods, the VA presumes you were exposed to burn pits, fine particulate matter, and other toxins. You do not have to prove you stood near a burn pit or breathed smoke on a particular date. Affirmative evidence can rebut the presumption, but the VA cannot deny it simply because your records don't document a specific exposure event.

38 USC § 1119^[3] 38 CFR § 3.320^[2]

Burn pit and toxic exposure presumptive conditions

Under 38 U.S.C. § 1120 and proposed 38 CFR § 3.320, the VA listed 23 conditions presumptively associated with fine particulate matter exposure for covered veterans:

Cancers:

• Head cancer
• Neck cancer
• Respiratory cancer
• Gastrointestinal cancer
• Reproductive cancer
• Lymphoma cancer
• Kidney cancer
• Brain cancer
• Melanoma
• Pancreatic cancer
• Glioblastoma

Respiratory conditions:

• Asthma (when diagnosed after service)
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Constrictive bronchiolitis
• Emphysema
• Granulomatous disease
• Interstitial lung disease
• Pleuritis
• Pulmonary fibrosis
• Sarcoidosis

Sinus conditions:

• Chronic rhinitis
• Chronic sinusitis

These conditions appear in the VA's proposed rulemaking published October 1, 2024. The categories cover a wide range of diagnoses. If your cancer falls under "reproductive cancer" or "gastrointestinal cancer," the VA interprets those categories broadly. Ask your VA regional office or an accredited claims agent to confirm your specific diagnosis fits a listed category.

38 USC § 1120^[4] 89 Fed. Reg. 80,178 (Oct. 1, 2024)^[5]

Cancers added in 2025: bladder, ureter, leukemias, and blood disorders

Two separate rules took effect in early 2025 and added conditions beyond the original 23.

Bladder and ureter cancers (effective January 2, 2025)

The VA published a final rule adding urinary bladder cancer and ureter cancer as presumptive conditions under a new regulation, 38 CFR § 3.320a. Covered veterans with either diagnosis qualify for service connection without proving causation.

38 CFR § 3.320a^[6]

Blood disorders and leukemias (effective January 10, 2025)

Eight days later, a second rule added five more conditions under 38 CFR § 3.320b:

• Acute leukemias
• Chronic leukemias
• Multiple myeloma
• Myelodysplastic syndromes
• Myelofibrosis

These are serious blood and bone marrow cancers. Multiple myeloma was already presumptive for Agent Orange veterans. The 2025 rule extends that presumption to covered burn pit veterans, meaning Gulf War and post-9/11 veterans with those diagnoses no longer need to establish a connection through the Agent Orange pathway.

38 CFR § 3.320b^[7]

Agent Orange presumptive conditions and new locations

The PACT Act also changed the rules for Agent Orange veterans by adding two new conditions and five new locations.

Two new presumptive conditions

The PACT Act added hypertension (high blood pressure) and monoclonal gammopathy of undetermined significance (MGUS) to the existing Agent Orange presumptive list. Veterans with these diagnoses who served in a covered Agent Orange location no longer need a nexus opinion.

38 USC § 1116^[8]

Five new presumptive locations

Before the PACT Act, the presumptive location list for Agent Orange was relatively narrow. The law added:

• Any U.S. or Royal Thai military base in Thailand from January 9, 1962, through June 30, 1976
• Laos from December 1, 1965, through September 30, 1969
• Cambodia at Mimot or Krek, Kampong Cham Province, from April 16, 1969, through April 30, 1969
• Guam or American Samoa (or their territorial waters) from January 9, 1962, through July 31, 1980
• Johnston Atoll or on a ship that called at Johnston Atoll from January 1, 1972, through September 30, 1977

If you served in any of those locations during those periods, the VA presumes you were exposed to Agent Orange. Combined with the existing presumptive conditions list, which includes ischemic heart disease, Parkinson's disease, several cancers, and Type 2 diabetes, this expansion covers a large number of veterans who previously had no path to a presumption.

38 USC § 1116^[8]

How to file a claim based on PACT Act presumptive conditions

The claim process is the same as any other VA disability claim. File VA Form 21-526EZ. You can do that online at VA.gov, by mail, or in person at a VA regional office.

What matters in your submission:

Your diagnosis. Get a statement or records from your treating physician showing your current diagnosis and its name. The VA needs to match your condition against the presumptive list. "Lung cancer" is fine. The more specific the diagnosis, the easier the match.

Your service records. The VA pulls these from the National Personnel Records Center. If your records are missing or incomplete, include any documentation you have: deployment orders, unit history, DD-214 with theater of service marked. The VA is required to assist in developing your file, but gaps in records cause delays.

No nexus letter required. You do not need a doctor to write that your condition was caused by burn pit exposure. The regulation removes that requirement. If a VA examiner requests a nexus opinion anyway, that is an error. You can object to that development and cite 38 CFR § 3.320 as the basis.

38 CFR § 3.320^[2]

The VA is also required to conduct a toxic exposure screening for every enrolled veteran under the PACT Act. That screening is not a substitute for filing a claim, but it creates a record of your reported exposure in the VA system.

Public Law 117-168^[9]

If the VA denies your claim despite a qualifying diagnosis and qualifying service, the most common errors are: the rater did not recognize the condition as presumptive, the rater required nexus evidence the regulation doesn't actually require, or the VA did not credit your service in a covered location. Each of those is a clear factual or legal error you can raise in a Supplemental Claim with a statement identifying the specific regulation and the specific error.