The PACT Act

The PACT Act is named for Sergeant First Class Heath Robinson, an Ohio National Guard soldier who served in Kosovo and Iraq and was exposed to burn pits. He developed a rare autoimmune condition and bile duct cancer, and died on May 6, 2020, at age 39. His widow, Danielle Robinson, was a leading advocate for the legislation.

Before the PACT Act, many veterans who were exposed to toxic substances during military service had to prove — on their own — that their health problems were directly caused by those exposures. This was extremely difficult, and the VA denied the majority of these claims. The PACT Act changes that by making dozens of conditions presumptive, which means the VA assumes your service caused the condition if you served in a qualifying location during a qualifying time period. You do not need to prove the connection yourself.

What the PACT Act Does

• Adds 20+ new presumptive conditions for burn pit and airborne hazard exposure (cancers, respiratory diseases)
• Expands Agent Orange presumptive locations to include Thailand military bases, Guam, American Samoa, Johnston Atoll, Laos, and Cambodia
• Adds new Agent Orange presumptive conditions: bladder cancer, hypertension, MGUS (monoclonal gammopathy of undetermined significance), parkinsonism, and hypothyroidism
• Strengthens radiation exposure benefits for atomic veterans, including Enewetak Atoll cleanup crews, Palomares responders, and Thule AFB responders
• Includes the Camp Lejeune Justice Act, allowing lawsuits for water contamination harm
• Extends combat veteran healthcare from 5 years to 10 years after separation
• Requires Toxic Exposure Screening at every VA healthcare visit
• Concedes toxic exposure — if you served in a qualifying location during a qualifying period, the VA accepts that you were exposed without requiring individual proof

Implementation Timeline

Open burn pits were used at military sites in Iraq, Afghanistan, and other locations to dispose of waste — including chemicals, paint, medical waste, munitions, plastics, and petroleum products. The toxic smoke exposed hundreds of thousands of service members. The PACT Act makes more than 20 cancers and respiratory conditions presumptive for veterans who served in qualifying locations.

Qualifying Service Locations

Southwest Asia Theater (on or after August 2, 1990):

• Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, UAE, Oman
• The neutral zone between Iraq and Saudi Arabia
• Persian Gulf, Gulf of Aden, Gulf of Oman, Arabian Sea, Red Sea
• Airspace above all listed locations

Post-9/11 Locations (on or after September 11, 2001):

• Afghanistan, Syria, Jordan, Egypt, Lebanon, Yemen, Uzbekistan
• Any other location determined by the Department of Defense to have involved toxic exposure risk activities

Presumptive Cancers

Presumptive Respiratory & Other Conditions

• Constrictive bronchiolitis (obliterative bronchiolitis)
• Chronic obstructive pulmonary disease (COPD)
• Pulmonary fibrosis
• Interstitial lung disease
• Sarcoidosis
• Chronic sinusitis, chronic rhinitis, chronic laryngitis
• Pulmonary alveolar proteinosis

Key point: There is no minimum length of service required in the qualifying location. If you served there at all during the qualifying period, you are covered. If you were previously denied a burn pit claim before the PACT Act, you can refile — the new presumptive conditions may change the outcome.

Airborne Hazards & Open Burn Pit Registry

The Airborne Hazards and Open Burn Pit Registry is a voluntary health registry for veterans exposed to burn pits, sandstorms, or other airborne hazards. You can enroll through VA.gov by completing an online questionnaire. Enrolling is not required to file a disability claim, and it does not automatically file a claim for you — but it documents your reported exposure and may help support your case.

Agent Orange is a tactical herbicide the U.S. military used to clear vegetation during the Vietnam War. It contained the chemical dioxin (2,3,7,8-TCDD), which has been linked to serious long-term health conditions. The name comes from the orange stripe on the barrels it was stored in. The PACT Act expanded both the list of presumptive conditions and the locations that qualify.

Presumptive Conditions (21+)

Cancers: Bladder cancer (PACT Act), chronic B-cell leukemias, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, prostate cancer, respiratory cancers (lung, bronchus, larynx, trachea), some soft tissue sarcomas

Systemic/Metabolic: AL amyloidosis, diabetes mellitus type 2, hypertension (PACT Act), hypothyroidism (PACT Act), MGUS (PACT Act), porphyria cutanea tarda

Neurological: Parkinson's disease, parkinsonism (PACT Act), early-onset peripheral neuropathy

Other: Chloracne, myelodysplastic syndromes, ischemic heart disease

Qualifying Locations & Dates

Herbicide Test & Storage Sites

Agent Orange and other tactical herbicides were also tested or stored at locations in the U.S. and abroad, including Camp Gruber (Oklahoma), Eglin Air Force Base (Florida), Fort Drum (New York), Gulfport (Mississippi), the Panama Canal Zone, and Puerto Rico. Veterans who participated in testing or were exposed at storage sites may also qualify. The DoD maintains the full list at VA Public Health — Herbicide Tests and Storage.

For presumptive conditions: You only need proof of qualifying service (DD-214 showing location and dates) plus a current diagnosis. No nexus letter or proof of causation is required.

From 1953 through 1987, drinking water at U.S. Marine Corps Base Camp Lejeune in Jacksonville, North Carolina was contaminated with toxic chemicals including trichloroethylene (TCE), perchloroethylene (PCE), benzene, and vinyl chloride. Between 500,000 and 1 million people — service members, their families, and civilian workers — were exposed.

Who Qualifies

• Served on active duty or resided at Camp Lejeune or MCAS New River, North Carolina
• For at least 30 cumulative days between August 1, 1953, and December 31, 1987
• Includes active-duty members, reservists, National Guard who trained there, family members, and civilian workers

8 VA Presumptive Conditions

• Adult leukemia
• Aplastic anemia and other myelodysplastic syndromes
• Bladder cancer
• Kidney cancer
• Liver cancer
• Multiple myeloma
• Non-Hodgkin's lymphoma
• Parkinson's disease

15 Conditions Covered for Healthcare (No Copays)

Under the 2012 Camp Lejeune Families Act, veterans and family members who meet the service/residence requirements can receive VA healthcare with no copays for: bladder cancer, breast cancer, esophageal cancer, female infertility, hepatic steatosis (fatty liver disease), kidney cancer, leukemia, lung cancer, miscarriage, multiple myeloma, myelodysplastic syndromes, neurobehavioral effects, non-Hodgkin's lymphoma, renal toxicity, and scleroderma.

Camp Lejeune Justice Act (CLJA) — Lawsuits

Title VIII of the PACT Act includes the Camp Lejeune Justice Act of 2022, which allows veterans and family members to file federal lawsuits against the U.S. government for harm caused by the contaminated water. This is separate from VA disability compensation — you can pursue both.

Elective Option — Faster Settlement Path

The DOJ and Department of the Navy offer a streamlined settlement alternative to full litigation. Tier 1 injuries (kidney cancer, liver cancer, non-Hodgkin's lymphoma, leukemia, bladder cancer) may receive approximately $150,000 to $450,000 depending on exposure duration. Tier 2 injuries (multiple myeloma, Parkinson's disease, kidney disease, systemic scleroderma) receive lower amounts. An additional $100,000 is available if the qualifying injury resulted in death. Elective Option payments are not offset by VA disability payments.

Since January 2025, DOJ has paid more than $421 million in Elective Option settlements. For more information, visit DOJ Camp Lejeune Justice Act Claims or contact the Navy CLJA Portal at clclaims.jag.navy.mil.

"Gulf War Syndrome" — now formally called Medically Unexplained Chronic Multisymptom Illness (MUCMI) — refers to a cluster of chronic symptoms experienced by veterans who served in the Southwest Asia theater. An estimated one-third of Gulf War veterans experience some form of Gulf War illness. The VA recognizes these conditions on a presumptive basis.

Qualifying Service

Service in the Southwest Asia theater on or after August 2, 1990 (ongoing — no end date). Locations include: Afghanistan, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, Syria, Turkey, UAE, and associated waters (Arabian Sea, Gulf of Aden, Gulf of Oman, Persian Gulf, Red Sea).

Presumptive Conditions

Chronic Multisymptom Illnesses (must persist 6+ months):

• Chronic Fatigue Syndrome (ME/CFS) — Long-term, severe fatigue not relieved by rest
• Fibromyalgia — Widespread muscle pain with insomnia, stiffness, headaches, memory problems
• Functional Gastrointestinal Disorders — Including irritable bowel syndrome (IBS), functional dyspepsia, functional abdominal pain

Undiagnosed Illnesses (symptoms lasting 6+ months that cannot be attributed to a specific diagnosis):

• Fatigue, headaches, joint pain, muscle pain, indigestion
• Insomnia, dizziness, respiratory issues, memory problems
• Cardiovascular symptoms, abnormal weight loss, skin conditions

Infectious Diseases:

• Within 1 year of separation: Brucellosis, campylobacter jejuni, Q fever, malaria, nontyphoid salmonella, shigella, West Nile virus
• At any time after separation: Tuberculosis, visceral leishmaniasis

ALS (amyotrophic lateral sclerosis) is presumptive for all veterans who had 90+ days of continuous active service, regardless of where they served.

"Atomic veterans" are service members who were exposed to ionizing radiation during military service — through nuclear weapons testing, occupation of Hiroshima and Nagasaki, or cleanup of contaminated sites. The PACT Act expanded the list of qualifying activities and codified presumptive cancers.

Qualifying Radiation Exposure Activities

• Atmospheric nuclear weapons testing — Over 200 tests between 1945 and 1962 (Nevada Test Site, Marshall Islands, Pacific)
• Hiroshima & Nagasaki occupation — Post-WWII occupation forces and POWs near the atomic bombings
• Enewetak Atoll cleanup (1977–1980) — ~6,000 service members cleaned up radioactive contamination from 43 nuclear tests (expanded by PACT Act)
• Palomares, Spain (1966) — Responders to B-52 bomber accident involving four hydrogen bombs (added by PACT Act)
• Thule Air Force Base, Greenland (1968) — Responders to B-52 crash that spread radioactive contamination (added by PACT Act)
• Gaseous diffusion plants — Paducah (KY), Portsmouth (OH), Oak Ridge (TN)
• Amchitka Island, Alaska — Underground nuclear tests (1965, 1969, 1971)

20 Presumptive Cancers

Bile duct, bone, brain, breast, colon, esophageal, gall bladder, leukemia (except chronic lymphocytic), liver (primary), lung, lymphomas (except Hodgkin's), multiple myeloma, ovarian, pancreatic, pharynx, salivary gland, small intestine, stomach, thyroid, and urinary tract cancers (kidney, renal pelvis, ureter, bladder, urethra).

RECA — Radiation Exposure Compensation Act

RECA is a separate federal program from VA disability benefits, administered by the Department of Justice. It provides one-time lump-sum payments ($50,000–$100,000) to individuals — including civilians — who were exposed to radiation from nuclear weapons testing or uranium mining.

RECA was reauthorized and expanded in July 2025. Key changes include expanded coverage for New Mexico residents (present at least 1 year between September 24, 1944, and November 6, 1962) and a new Manhattan Project waste category covering individuals exposed at contamination sites in Missouri, Tennessee, Alaska, and Kentucky.

Veterans should file for both VA benefits and RECA if they qualify — they are separate programs. RECA claims can be filed at justice.gov/civil/reca or by calling 1-800-729-7327. The deadline is December 31, 2027.

Depleted Uranium (DU)

Depleted uranium is used in tank armor and armor-piercing projectiles. Veterans may have been exposed through inhalation, ingestion, embedded fragments, or skin contact during the Gulf War, Bosnia, Afghanistan, or Iraq. The VA offers free DU urine testing through the Metal Exposures and Depleted Uranium (MEDU) Surveillance Center at the Baltimore VA Medical Center. Contact your VA Environmental Health Coordinator to schedule.

Project 112 / Project SHAD (1962–1973)

From 1962 to 1973, the Department of Defense conducted classified biological and chemical warfare vulnerability tests. Project 112 covered land-based tests and Project SHAD (Shipboard Hazard and Defense) covered sea-based tests. Service members who participated were often not told what they were exposed to. Claims are evaluated case-by-case. More information is available at VA.gov — Project 112/SHAD.

Mustard Gas Testing (1940s)

During World War II, the military tested mustard gas and lewisite on approximately 60,000 service members. Many participants were sworn to secrecy and never told what they were exposed to. The VA recognizes mustard gas exposure as a basis for disability claims, and certain related conditions may receive favorable consideration.

Fort McClellan, Alabama (1917–1999)

Fort McClellan was home to the U.S. Army Chemical Corps School and other training units for 82 years. Veterans may have been exposed to radioactive compounds (cesium-137, cobalt-60), chemical warfare agents (mustard gas, nerve agents), fog oil and hexachloroethane smoke, and PCBs from a nearby Monsanto plant. There are no presumptive conditions yet — claims are evaluated case-by-case. The PACT Act mandated an epidemiological study of veterans who served there, which could lead to future presumptive conditions.

Karshi-Khanabad (K2) Air Base, Uzbekistan (2001–2005)

K-2 veterans were exposed to jet fuel contamination, depleted uranium, asbestos, and burn pit smoke at this former Soviet air base. K-2 veterans are fully covered under the PACT Act — all burn pit/airborne hazard presumptive conditions apply, and asthma, rhinitis, and sinusitis are presumptive due to fine particulate matter exposure.

PFAS ("Forever Chemicals") at Military Bases

PFAS are synthetic chemicals found in firefighting foam (AFFF) used at virtually every military installation with an airfield. The DoD has identified hundreds of bases with known or suspected PFAS contamination. There are no VA presumptive conditions for PFAS yet, but the PACT Act directed VA and DoD to study the exposure. This is an emerging area — claims are currently evaluated case-by-case. Veterans concerned about PFAS exposure should mention it during their Toxic Exposure Screening.

Summary

Step 1: Create a VA.gov Account

Go to VA.gov and click "Sign in." You can sign in with Login.gov (recommended) or ID.me. You will need a government-issued photo ID and your Social Security number to verify your identity. Note: DS Logon was removed in November 2025 — only Login.gov and ID.me are available.

Step 2: File an Intent to File (ITF)

This is one of the most important steps. An Intent to File protects your effective date — the date your benefits will start if your claim is approved. It gives you up to 1 year to submit your completed claim. File your ITF even if you are still gathering evidence.

• Online: Starting a claim on VA.gov automatically creates an ITF
• By phone: Call 1-800-827-1000
• By mail: Submit VA Form 21-0966

Step 3: Gather Your Evidence

For presumptive conditions (burn pit, Agent Orange, radiation, Camp Lejeune, Gulf War illness):

• DD-214 or military records showing qualifying service location and dates
• Current medical diagnosis of a presumptive condition
• That is it — no nexus letter, buddy statements, or additional proof of causation required

For non-presumptive conditions (direct service connection):

• DD-214 or military records showing qualifying service
• Current medical diagnosis
• Medical nexus — a doctor's opinion stating your condition is "at least as likely as not" caused by in-service toxic exposure
• In-service evidence: medical records, buddy statements (VA Form 21-10210), incident reports

Step 4: File VA Form 21-526EZ

• Online (recommended): VA.gov disability claim form
• By mail: Download the form and mail to VA Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444
• In person: Visit your local VA regional office

Tips: Claim each condition separately. Be specific about your exposure type and location. If you served in multiple qualifying locations, list all of them. Upload all supporting evidence with your claim.

Step 5: Attend the C&P Exam (If Scheduled)

VA may schedule a Compensation and Pension exam to evaluate your condition. Not all claims require one, especially well-documented presumptive claims. Be honest and thorough about your symptoms, including your worst days. Do not miss your exam — it can result in denial. If you cannot attend, call to reschedule immediately.

Step 6: Wait for a Decision

After filing, your claim goes through: receipt, initial review, evidence gathering, rating decision, and notification. PACT Act presumptive claims have been processed faster than typical claims. You can check your claim status at VA.gov.

If Your Claim Is Denied

You have three options within 1 year of the decision:

• Supplemental Claim (VA Form 20-0995) — Submit new and relevant evidence
• Higher-Level Review (VA Form 20-0996) — A senior reviewer re-examines the same evidence
• Board of Veterans' Appeals (VA Form 10182) — Appeal to the Board for a new decision

Previously denied claims: If you filed a toxic exposure claim before the PACT Act and it was denied, the new presumptive status counts as "new and relevant evidence." File a Supplemental Claim — you may be able to get retroactive benefits back to your original claim date.

Before the PACT Act, combat veterans could enroll in VA healthcare for 5 years after separation without needing to demonstrate a service-connected disability. The PACT Act extended this to 10 years.

• Combat veterans can enroll in VA healthcare and receive care without needing a service-connected disability for up to 10 years after leaving service
• Veterans who served in a toxic exposure risk activity (TERA) also qualify for this enhanced enrollment period
• VA implemented a phased enrollment expansion to manage the influx of new enrollees
• If you previously lost eligibility under the old 5-year window, you may now be eligible again under the 10-year window

To enroll, complete VA Form 10-10EZ online at VA.gov health care application or call the VA Health Care Enrollment line at 877-222-8387.

The PACT Act requires VA healthcare providers to screen every veteran for potential toxic exposures at every VA healthcare visit. This is one of the most important provisions of the law because it ensures that exposures are identified and documented — even if the veteran has not filed a claim.

How It Works

• The screening is a conversation, not a medical test — your provider asks about your service locations and potential exposures
• Results are documented in your VA health record
• Screening results can support your disability claim
• You can also request a TES at any time — you do not have to wait for your provider to initiate it
• Be honest and thorough about every location you served and every potential exposure you experienced

In addition to the TES, the VA offers free registry health exams for specific exposure categories — including Agent Orange, Gulf War, and ionizing radiation. These exams do not determine benefits eligibility but document your health for the record. Contact your local VA Environmental Health Coordinator to schedule.

For more information, visit VA.gov — The PACT Act and Your VA Benefits.