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 stage 4 adenocarcinoma lung 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: hypertension and MGUS (monoclonal gammopathy of undetermined significance). Note: bladder cancer, parkinsonism, and hypothyroidism were added by the FY2021 NDAA, not the PACT Act
• 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, Djibouti
• 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
• Asthma (diagnosed after military service)
• Chronic bronchitis
• Emphysema
• Granulomatous disease
• Pleuritis

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 (FY2021 NDAA), 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 (FY2021 NDAA), MGUS (PACT Act), porphyria cutanea tarda

Neurological: Parkinson's disease, parkinsonism (FY2021 NDAA), 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. More than 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

16 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, Parkinson's disease (added November 2023), 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, 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)

21 Types of Cancer

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 of $100,000 to individuals — including civilians — who were exposed to radiation from nuclear weapons testing or uranium mining. (After the July 2025 reauthorization, all RECA categories now pay $100,000.)

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

TERA is a legal classification created by the PACT Act under 38 USC 1119. Unlike specific exposure categories (Agent Orange, burn pits, radiation), TERA is an umbrella classification that covers any qualifying toxic exposure during active duty, active duty for training, or inactive duty training — at home or abroad.

What Qualifies as a TERA

Under 38 USC 1710(e)(4)(C), a toxic exposure risk activity is any activity that requires a corresponding entry in an exposure tracking record system (such as the Individual Longitudinal Exposure Record, or ILER) or that the Secretary determines qualifies "when taking into account what is reasonably prudent to protect the health of veterans."

VA has determined that the following exposures during military service qualify as TERA:

• Air pollutants: Burn pits, sand/dust/particulates, oil well fires, sulfur fires
• Chemicals: Pesticides, herbicides, depleted uranium (with embedded shrapnel), contaminated water
• Occupational hazards: Asbestos, industrial solvents, lead, CARC paint, firefighting foams (AFFF/PFAS)
• Radiation: Nuclear weapons handling, radioactive materials, nuclear submarines/ships, X-ray exposure
• Warfare agents: Nerve agents, chemical and biological weapons

Concession of Toxic Exposure

Under 38 USC 1119(b), for covered veterans who served on or after August 2, 1990, in specified locations (Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, UAE) or after September 11, 2001, in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, or Uzbekistan, VA presumes they were exposed to listed toxic substances "unless there is affirmative evidence to establish that the covered veteran was not exposed." This shifts the burden — VA must disprove exposure rather than requiring the veteran to prove it.

TERA Healthcare Eligibility

Veterans who participated in a TERA are eligible for VA hospital care, medical services, mental health services, counseling, and nursing home care for any illness — not just presumptive conditions — under 38 USC 1710(a)(2)(F). Starting March 5, 2024, VA expanded PACT Act healthcare coverage ahead of the original schedule.

Toxic Exposure Screening

The PACT Act requires VA to provide a toxic exposure screening to every veteran enrolled in VA healthcare — an initial screening plus follow-up screening at least once every 5 years. The screening averages 5 to 10 minutes and covers burn pits, Gulf War exposures, Agent Orange, radiation, Camp Lejeune contamination, and other exposures. Screening is voluntary and is not required to file a PACT Act claim or receive benefits.

How to File a TERA-Based Claim

File on VA Form 21-526EZ online at VA.gov/PACT, by mail, in person, or with an accredited representative. If no exposure tracking record exists for your service, VA considers "the totality of the circumstances of the service of the veteran" under 38 USC 1119(a). Veterans whose claims were previously denied can file Supplemental Claims for reconsideration if their conditions are now presumptive under the PACT Act.

Between 1942 and 1975, the U.S. military tested mustard gas (nitrogen and sulfur mustard) and Lewisite on nearly 60,000 service members. Approximately 4,000 soldiers were subjected to severe, full-body exposures during field exercises. Many were sworn to secrecy. Under 38 CFR 3.316, certain conditions are presumptive for veterans with documented full-body exposure.

Presumptive Conditions (38 CFR 3.316)

All presumptive conditions require full-body exposure. There is no separate "limited exposure" presumptive category in the regulation. Veterans with limited exposure (such as patch tests) may still file claims but must establish service connection through direct evidence rather than the presumptive provisions.

Exceptions (38 CFR 3.316(b))

Service connection under this section will not be established if the claimed condition is due to the veteran's own willful misconduct or there is affirmative evidence that a nonservice-related supervening condition or event caused the claimed condition.

How to Establish Exposure

VA's Compensation and Pension Service contacts a Mustard Gas Manager who coordinates with DoD to verify exposure through the Chemical Biological Warfare Exposure System database. VA also reviews service treatment records, personnel records, and post-service treatment records. Contact mustardgas@vba.va.gov for mustard gas claims or the VA Special Issue Hotline at 1-800-749-8387 for Project 112/SHAD exposure inquiries.

Project 112/SHAD Connection

Project 112/SHAD (1962-1973) involved approximately 6,000 service members in biological and chemical warfare vulnerability testing, primarily using nerve agents and biological agents. SHAD does not have its own presumptive condition list — claims are evaluated individually. However, SHAD veterans who had mustard gas exposure specifically can use the 38 CFR 3.316 presumptive provisions. SHAD veterans are eligible for VA health care at no cost for any illness possibly related to the testing.

PFAS (per- and polyfluoroalkyl substances) are synthetic "forever chemicals" found in aqueous film-forming foam (AFFF) used to fight fuel fires at military installations since the 1970s. DoD has identified 718 military installations where PFAS was used or may have been released.

Who Was Exposed

• Military firefighters who used AFFF directly (highest exposure)
• Service members who trained with AFFF at fire training areas
• Anyone who drank contaminated water on affected bases
• Family members living on or near contaminated bases
• AFFF was used at military airfields, hangars, crash rescue operations, shipboard firefighting, and fuel storage facilities

Current VA Policy

There are no presumptive conditions for PFAS exposure as of April 2026. Veterans must file claims for direct service connection on a case-by-case basis. However, VA is actively reviewing the science:

• In September 2024, VA announced a scientific assessment of the relationship between PFAS exposure and kidney cancer
• VA published a Federal Register notice (September 26, 2024) soliciting public comment, received 42 comments, and published a response on December 18, 2025
• This review is being conducted under PACT Act authority to establish new presumptive conditions
• If sufficient evidence is found, kidney cancer could become the first PFAS-related presumptive condition

Known Health Effects

ATSDR has documented associations between PFAS exposure and elevated cholesterol, reduced antibody response to vaccines, altered liver enzymes, pregnancy complications, kidney cancer (PFOA), and testicular cancer (PFOA). The overall evidence is still considered "inconclusive" by VA Public Health, and research is ongoing. Additional health effects under investigation include thyroid disease, liver damage, immune system changes, and fertility issues.

How to File a PFAS Claim Now

Do not wait for presumptive conditions — you can file for direct service connection today. You will need: (1) a current medical diagnosis, (2) evidence of in-service PFAS exposure (duty station records at an affected installation, MOS records showing AFFF-related duties), and (3) a medical nexus opinion from a qualified physician linking your condition to PFAS exposure. Check DoD's list of PFAS-affected installations to confirm your base is on the list. File using VA Form 21-526EZ.

Pending Legislation

H.R. 3639 — VET PFAS Act would establish presumptive service connection for veterans who served at PFAS-contaminated installations. The bill has been introduced repeatedly since the 115th Congress without passing — it is currently in committee in the 119th Congress. A separate bill, H.R. 705, would create a DoD compensation fund specifically for military firefighters with PFAS-related illnesses.

COVID-19 is subject to presumptive service connection under a limited circumstance: if a veteran is diagnosed with COVID-19 within 14 days of separating from a qualifying period of active duty service, it is presumed to be service-connected. The veteran does not need to prove that service caused the infection.

What the 14-Day Presumptive Covers

• COVID-19 itself is the presumptive condition — diagnosed within 14 days of separation from active duty
• Falls under the chronic disease presumptive framework (38 CFR 3.307, 38 CFR 3.309)
• Adjudication guidance is in VA's M21-1 manual, Part VIII, Subpart iii, Chapter 10

What the Presumptive Does NOT Cover

As of April 2026, there is no broad presumptive for Long COVID (PASC), specific organ damage from COVID-19, COVID contracted during deployment, or COVID contracted by military healthcare workers. The absence of a broader presumptive does not mean veterans cannot get service connection — it means they must pursue direct service connection by showing evidence of in-service infection, a current disability, and a medical nexus linking the two.

How COVID-19 Residuals Are Rated

COVID-19 residuals are rated under the specific body system affected — respiratory conditions under the respiratory system codes, cardiac conditions under the cardiovascular system, neurological conditions under the neurological system, and so on. Each residual condition is evaluated separately and combined using VA math. Long COVID symptoms tracked by VA include fatigue, brain fog, shortness of breath, heart palpitations, joint and muscle pain, sleep disturbances, and anxiety or depression.

VA Long COVID Research

VA has 11 funded studies on Long COVID outcomes and has established 20+ Long COVID treatment programs across the VA system. The COPES Center conducts research on clinical phenotypes, health inequities, and management strategies for post-acute sequelae of SARS-CoV-2.

VA maintains six health registries that track and monitor the health of veterans exposed to environmental hazards during military service. Participation is free and voluntary. You do not need to be enrolled in VA health care to participate, and a registry evaluation does not affect your disability claims positively or negatively. Registry exams can identify health conditions you may not be aware of, and results become part of your VA medical record.

How to Access Any Registry

• In person: Find your local VA Environmental Health Coordinator at publichealth.va.gov/exposures/coordinators.asp
• Telehealth (nationwide): VET-HOME (Veterans Exposure Team — Health Outcomes Military Exposures) at 833-633-8846 — free telehealth evaluations for enrolled veterans from anywhere in the country
• Burn Pit Registry: Complete the online questionnaire at veteran.mobilehealth.va.gov/AHBurnPitRegistry

Combat veteran status provides specific advantages in VA claims and healthcare, but 38 USC 1154(b) is commonly misunderstood. It is not a true presumptive like Agent Orange or burn pit presumptives. Understanding the distinction is critical.

38 USC 1154(b) — What It Does and Does Not Do

Under 38 USC 1154(b), for veterans who "engaged in combat with the enemy," VA must accept satisfactory lay or other evidence of in-service incurrence of an injury or disease if consistent with the circumstances of combat service — even when there is no official record. Rebuttal requires "clear and convincing evidence to the contrary."

In practice: A combat veteran can say "I injured my knee in a firefight" and VA must accept that testimony as proof of the in-service event (if consistent with combat service). But the veteran still needs a current diagnosis of a knee condition and a medical opinion linking it to the in-service injury. This nexus requirement is where many combat veteran claims fail. The toxic exposure presumptives (Agent Orange, burn pits, radiation) are far more powerful because they presume both exposure and the link to the condition.

10-Year Enhanced Healthcare — 38 USC 1710(e)

Combat veterans who served in a theater of combat operations after November 11, 1998, and were discharged on or after September 11, 2001, receive 10 years of enhanced healthcare eligibility from date of discharge (expanded from 5 years by the PACT Act). During this period, veterans are placed in Priority Group 6 (unless eligible for a higher group), receive cost-free healthcare for any condition that may be related to combat service, and pay no copays for combat-related care.

After the enhanced period ends, the veteran remains enrolled in VA healthcare but is reassigned to the highest priority group they qualify for based on disability rating, income, and other factors, and may be required to make copayments.

Combat-Related Special Compensation (CRSC)

Under 10 USC 1413a, CRSC is a monthly payment to military retirees whose VA disability compensation causes a reduction in retired pay. CRSC restores the combat-related portion of that offset. "Combat-related" includes injuries from armed conflict, hazardous duty, duty simulating war, or caused by an instrument of war.

• Requires: military retiree entitled to retired pay + VA disability rating of at least 10% + retired pay currently reduced by VA offset
• Filed using DD Form 2860 with your service branch (NOT VA) — administered by DFAS
• 6-year statute of limitations from VA rating decision or retirement eligibility
• Cannot receive both CRSC and CRDP — must elect the one that pays more

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.

Forms for This Topic

The official VA forms relevant to this page, in one place. Select a form to view, download, or add it to your report.

• VA Form 21-526EZ — Application for Disability Compensation and Related Compensation BenefitsUse VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.
• VA Form 21-0966 — Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DICUse VA Form 21-0966 if you’re still gathering information to support your claim, and want to start the filing process.
• VA Form 21-10210 — Lay/Witness StatementUse VA Form 21-10210 to submit a formal statement to support your VA claim—or the claim of another Veteran or eligible family member.
• VA Form 20-0995 — Decision Review Request: Supplemental ClaimUse VA Form 20-0995 if you disagree with a VA decision and want to provide new evidence to support your claim.
• VA Form 20-0996 — Decision Review Request: Higher-Level ReviewUse this form to request a Higher-Level review of the decision you received by the Department of Veterans Affairs based on the evidence of record at the time VA issued of the prior decision.
• VA Form 10182 — VA Form 10182 ↗(opens VA.gov in a new tab)Board Appeal — the Notice of Disagreement that sends your case to a Veterans Law Judge
• VA Form 10-10EZ — Instrucciones y Solicitud de Beneficios MedicosPara que los Veteranos soliciten su afiliación al sistema de atención médica de VA.