PACT Act 2022: Complete Presumptive Conditions List

By Shirley Chia. Published 2026-05-27. Source: Pub. L. 117-168, 38 CFR 3.320, 38 CFR 3.309.

What the PACT Act did, in one paragraph

The PACT Act, signed by President Biden on August 10, 2022, took roughly 3.5 million post-9/11 veterans plus several million Gulf War and Vietnam-era veterans whose toxic-exposure conditions had been individually hard to prove and granted them presumptive service connection. Presumptive means the VA presumes the link to service if the qualifying location and dates are met; the veteran does not need a nexus letter. The Act codified this through new regulation at 38 CFR 3.320 (burn pit + airborne hazards) and amendments to 38 CFR 3.309(e) (Agent Orange) and 38 CFR 3.309(d) (radiation). It also expanded Camp Lejeune coverage through the companion Camp Lejeune Justice Act of 2022 included in the same legislation.

Pathway 1: Burn-pit and airborne hazards (38 CFR 3.320)

Qualifying service

Veterans who served on active duty, active duty for training, or inactive duty training in any of the qualifying locations during the qualifying periods. The locations and periods are at 38 CFR 3.320(a)(1).

Persian Gulf War era (August 2, 1990 to present)

• Bahrain
• Iraq
• Kuwait
• Oman
• Qatar
• Saudi Arabia
• Somalia
• United Arab Emirates
• The waters above (the Persian Gulf, Gulf of Aden, Gulf of Oman, Red Sea, and Arabian Sea)
• The airspace above any of the above

Post-9/11 era (September 11, 2001 to present)

All locations above plus:

• Afghanistan
• Syria
• Yemen
• Djibouti
• Egypt
• Jordan
• Lebanon
• Uzbekistan
• The airspace above any of the above

Presumptive conditions under 38 CFR 3.320(b)

Twenty-four conditions are presumptive. Diagnosis at any time after qualifying service triggers the presumption (no latency or one-year window applies).

Cancers

1. Brain cancer (any type)
2. Gastrointestinal cancer of any type
3. Glioblastoma
4. Head cancer of any type
5. Kidney cancer
6. Lymphatic cancer of any type
7. Lymphoma of any type
8. Melanoma
9. Neck cancer of any type
10. Pancreatic cancer
11. Reproductive cancer of any type
12. Respiratory (breathing-related) cancer of any type

Respiratory and immune-system conditions

13. Asthma diagnosed after service
14. Chronic bronchitis
15. Chronic obstructive pulmonary disease (COPD)
16. Chronic rhinitis
17. Chronic sinusitis
18. Constrictive bronchiolitis or obliterative bronchiolitis
19. Emphysema
20. Granulomatous disease
21. Interstitial lung disease (ILD)
22. Pleuritis
23. Pulmonary fibrosis
24. Sarcoidosis

Skin / immunological

25. Chronic urticaria (chronic hives)

The asthma category specifically requires diagnosis after service; pre-existing asthma is excluded from the presumption under 38 CFR 3.320(b)(13).

Pathway 2: Expanded Agent Orange (38 CFR 3.309(e))

Qualifying service (unchanged)

• Vietnam in-country January 9, 1962 through May 7, 1975 (including Blue Water Navy under the 2019 BWNVAA, defined as service within 12 nautical miles of the Vietnam coast)
• Korean DMZ September 1, 1967 through August 31, 1971
• Thailand base perimeter service January 9, 1962 through May 7, 1975 (Royal Thai Air Force Bases at U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, Don Muang)
• C-123 aircrew 1969-1986 (per VA regulations following the 2015 NAS report)
• Other named locations including specific Department of Defense pesticide test sites

Presumptive conditions added by PACT Act

The PACT Act amended 38 CFR 3.309(e) effective August 10, 2022 to add two conditions to the Agent Orange list:

1. Hypertension
2. Monoclonal gammopathy of undetermined significance (MGUS)

Hypertension is the most consequential addition. Prior to the PACT Act, hypertension was the most-denied condition under Agent Orange claims because the Veterans Affairs and Rehabilitation Committee found the medical evidence linking it to herbicide exposure was suggestive but not definitive. The PACT Act resolved this in favor of veterans.

Pre-existing Agent Orange list (still presumptive)

These conditions were already on 38 CFR 3.309(e) before the PACT Act and remain presumptive:

• AL amyloidosis
• Bladder cancer
• Chloracne (must appear within one year of last exposure)
• Chronic B-cell leukemias
• Diabetes mellitus Type 2
• Hodgkin's disease
• Hypothyroidism
• Ischemic heart disease (including coronary artery disease, MI, angina)
• Multiple myeloma
• Non-Hodgkin's lymphoma
• Parkinson's disease (and as of 2021, parkinsonism)
• Peripheral neuropathy (early onset within one year)
• Porphyria cutanea tarda (within one year)
• Prostate cancer
• Respiratory cancers (lung, bronchus, larynx, trachea)
• Soft tissue sarcomas (with exclusions)

Pathway 3: Camp Lejeune water contamination

Qualifying service

• Active duty, reserve, or National Guard service at Camp Lejeune or MCAS New River, North Carolina
• For at least 30 cumulative days (not necessarily consecutive)
• Between August 1, 1953 and December 31, 1987
• Civilian employees who worked on base during that period are also covered for healthcare; the disability presumption applies to veterans

Presumptive conditions under 38 CFR 3.307(a)(7)

1. Adult leukemia
2. Aplastic anemia and other myelodysplastic syndromes
3. Bladder cancer
4. Kidney cancer
5. Liver cancer
6. Multiple myeloma
7. Non-Hodgkin's lymphoma
8. Parkinson's disease

The Camp Lejeune Justice Act of 2022, included in the PACT Act, also allows civil claims against the federal government for harms not covered by the disability presumption. This is a separate cause of action with its own statute of limitations (two years from August 10, 2022, so closed as of August 9, 2024).

Pathway 4: Radiation-exposed veterans (38 CFR 3.309(d))

Qualifying service

• Onsite participation in U.S. atmospheric nuclear weapons tests
• Occupation forces in Hiroshima or Nagasaki between August 6, 1945 and July 1, 1946
• Internment as a POW in Japan during the relevant period
• Participation in underground nuclear tests at Amchitka Island
• Specified service at Department of Energy gaseous diffusion plants in Paducah, Portsmouth, or K-25 (Oak Ridge)

Presumptive cancers (any of 21 listed radiogenic cancers)

Cancers of the bile ducts, bone, brain, breast, colon, esophagus, gall bladder, liver (except cirrhosis or hepatitis B), lung (including bronchiolo-alveolar carcinoma), pancreas, pharynx, ovary, salivary gland, small intestine, stomach, thyroid, urinary tract; leukemia (except chronic lymphocytic); lymphomas (except Hodgkin's); multiple myeloma; primary cancers other than the above.

How to file a PACT Act claim, step by step

Step 1: Confirm your eligibility

Cross-reference your service against the qualifying locations and periods above. Your DD-214 documents your overall service; deployment records (Personnel File / Service Treatment Records / DD-2796 post-deployment health assessments) document specific in-theater periods. If your condition is on a presumptive list AND your service matches the location and dates, you are eligible without needing a nexus letter.

If your condition is NOT on a presumptive list but you have qualifying service and believe the condition is linked to exposure, you can file an individual (direct) claim citing the in-theater exposure as the in-service event. The individual claim requires a nexus letter under the standard Hickson framework.

Step 2: Get a current diagnosis

You need a current diagnosis of the presumptive condition documented in your medical records. The VA will not grant service connection for a condition you do not currently have. If you suspect you have a condition (cancer, COPD, ILD) but have not been diagnosed, the PACT Act gives you free toxic exposure screening at VA — request it via your VA primary care or by calling 1-800-MyVA411.

Step 3: File VA Form 21-526EZ

The standard initial claim form. The full filing process is covered in our filing guide. PACT Act specifics:

• Section IV (claimed conditions): list each PACT Act presumptive condition you have.
• Section X (additional remarks): cite PACT Act / 38 CFR 3.320 by name. Example: "Claim for service connection for [condition] as a presumptive condition under PACT Act 38 CFR 3.320(b) based on qualifying service in [location] from [date] to [date]."
• Supporting documents: DD-214, deployment orders showing the qualifying location/period, current medical records showing the diagnosis. No nexus letter needed if presumptive.

Step 4: Free representation (recommended)

Use a VA-accredited Veterans Service Organization (VSO) representative. They are free. Recognized VSOs include the American Legion, Disabled American Veterans (DAV), Veterans of Foreign Wars (VFW), Vietnam Veterans of America (VVA), Iraq and Afghanistan Veterans of America (IAVA), and many others. Find one through the VA OGC accreditation directory.

Step 5: Track the claim

Sign in to VA.gov claim status to monitor progress. PACT Act claims have historically been adjudicated faster than the overall VA average because the presumption removes nexus disputes, but processing times still average 150-200 days for an initial decision.

Refiling a previously-denied claim

If you were denied for a condition that is now presumptive under the PACT Act:

1. File VA Form 20-0995 (Supplemental Claim).
2. Cite the PACT Act as new and relevant evidence — specifically the regulatory addition at 38 CFR 3.320 or amendment at 38 CFR 3.309(e).
3. Include a brief statement: "Reopening per PACT Act presumption. Condition X is now presumptive under [38 CFR section]. Qualifying service: [location/dates]."

The effective date for a granted supplemental claim is governed by 38 USC 5110(a). For PACT Act refilings filed within one year of August 10, 2022 (so by August 9, 2023), the effective date reverted to the original claim date. That window has now closed. For filings after August 9, 2023, the effective date is generally the date of the supplemental claim. The grant itself is still available, just with a less favorable effective date.

Worked examples

What the PACT Act does NOT do

• It does not retroactively pay benefits for conditions you did not have at the time of original denial. A condition that develops post-PACT-Act gets the new filing date as effective date.
• It does not eliminate the diagnosis requirement. You still need a current diagnosis of the presumptive condition documented in medical records.
• It does not grant service connection for conditions not on the presumptive lists. A non-listed condition still requires a nexus letter for direct service connection.
• It does not extend to family members for VA disability. The Camp Lejeune Justice Act civil pathway is the only family-member compensation route, and that window closed August 9, 2024.
• It does not change the rating schedule. Once service-connected, the condition is rated under the existing 38 CFR Part 4 schedule — same percentages, same criteria.

Sources cited in this article

• Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, Pub. L. 117-168, August 10, 2022
• 38 CFR 3.320 — Burn pit and other airborne hazard exposures
• 38 CFR 3.309 — Disease subject to presumptive service connection
• 38 CFR 3.307 — Presumptive service connection for chronic, tropical, or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents
• 38 USC 5110 — Effective dates of awards
• Camp Lejeune Justice Act of 2022, Pub. L. 117-168, Title VIII.

VetDisabilityCalc is an independent reference site. We are not VA-accredited and we do not prepare or present VA claims. This guide is reference material based on the cited regulations and is not legal or medical advice. For VA-accredited representation, use the official VA OGC accreditation directory.