The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act — the PACT Act — is the most significant expansion of VA health care and benefits for toxic-exposed veterans in decades. Signed into law in August 2022, it fundamentally changed how the VA handles claims related to burn pit exposure, Agent Orange, radiation, and other military toxic exposures.
What Changed
Before the PACT Act, veterans exposed to burn pits and other toxic substances had to individually prove that their specific condition was caused by their specific exposure — a nearly impossible burden for many conditions with long latency periods. The PACT Act changed this by:
- Conceding toxic exposure. Veterans who served in covered locations during covered time periods are now presumed to have been exposed to toxic substances. No individual proof of exposure is required.
- Adding presumptive conditions. A significant list of cancers, respiratory conditions, and other diseases are now presumptively service-connected for eligible veterans.
- Expanding eligibility. The Act extended the period for filing claims and broadened the geographic and temporal criteria for qualifying service.
- Expanding VA health care. Veterans exposed to toxins during service gained expanded eligibility for VA health care, even without a disability rating.
Who Qualifies
The PACT Act covers veterans who served in:
- Southwest Asia (Iraq, Kuwait, Saudi Arabia, and surrounding areas) from August 1990 to present.
- Afghanistan from September 2001 to present.
- Countries and locations where burn pits were used, as determined by the DoD.
- Vietnam, Thailand, and other locations for Agent Orange and tactical herbicide exposure (existing presumptives expanded).
- Locations associated with radiation exposure (nuclear weapons testing, cleanup operations).
When a Nexus Letter Still Helps
For conditions on the presumptive list, a nexus letter is not strictly required. However, a nexus opinion can be valuable when:
- The veteran's diagnosis is ambiguous or contested.
- The qualifying service period is borderline or disputed.
- The condition is not on the presumptive list but is still related to toxic exposure.
- A prior claim was denied and the veteran is refiling with new evidence.
- The veteran has multiple conditions and wants to establish the connections between them.
The Key Point
The PACT Act removed the biggest barrier to toxic exposure claims — the requirement to individually prove the connection between a specific exposure and a specific condition. If you served in a covered location and have a covered condition, the path to service connection is more direct than it has ever been. If you were previously denied, the PACT Act may be the new evidence you need to refile.
Continue Reading: PACT Act Details and Presumptive Conditions
Burn Pit Exposure: Presumptive Conditions
The PACT Act added the following conditions as presumptive for veterans with qualifying toxic exposure (burn pits, particulate matter, and other airborne hazards):
Cancers
- Bladder cancer
- Head cancer of any type
- Body cancer of any type
- Neck cancer of any type
- Respiratory cancer of any type (larynx, bronchus, lung, trachea)
- Gastrointestinal cancer of any type (esophagus, stomach, small intestine, colon, rectum)
- Reproductive cancer of any type
- Glioblastoma
- Kidney cancer (renal cell carcinoma)
- Lymphatic cancer of any type
- Lymphomatic cancer of any type
- Melanoma
- Pancreatic cancer
- Any cancer for which the VA Secretary determines a service connection is warranted
Other Conditions
- Constrictive bronchiolitis
- Constrictive pericarditis
- Other respiratory and pulmonary conditions as determined by the VA Secretary
Agent Orange Presumptive Conditions
The PACT Act also codified and expanded the list of conditions presumptive for veterans exposed to Agent Orange and other tactical herbicides:
- AL amyloidosis
- Bladder cancer
- Chronic B-cell leukemias
- Chloracne
- Diabetes mellitus type 2
- Hodgkin's disease
- Hypertension
- Ischemic heart disease
- Monoclonal gammopathy of undetermined significance (MGUS)
- Multiple myeloma
- Non-Hodgkin's lymphoma
- Parkinsonism
- Parkinson's disease
- Peripheral neuropathy, early-onset
- Porphyria cutanea tarda
- Prostate cancer
- Respiratory cancers
- Soft tissue sarcomas
Camp Lejeune Water Contamination
The PACT Act includes the Camp Lejeune Justice Act, which provides a federal cause of action for individuals who were exposed to contaminated water at Camp Lejeune, North Carolina, for at least 30 days between August 1953 and December 1987. Conditions associated with Camp Lejeune water contamination include:
- Adult leukemia
- Aplastic anemia and myelodysplastic syndromes
- Bladder cancer
- Kidney cancer
- Liver cancer
- Multiple myeloma
- Non-Hodgkin's lymphoma
- Parkinson's disease
How to File Under the PACT Act
If you have a condition on the presumptive list and qualifying service:
- New claims: File a standard claim for disability compensation (VA Form 21-526EZ). Provide evidence of qualifying service (DD-214, deployment orders) and current diagnosis (medical records, physician documentation).
- Previously denied claims: File a Supplemental Claim (VA Form 20-0995) citing the PACT Act as new and relevant evidence. The PACT Act itself constitutes a change in law that allows previously denied claims to be reconsidered.
- Non-presumptive conditions: If your condition is not on the presumptive list but you believe it is related to toxic exposure, you can still file a claim. The PACT Act's concession of toxic exposure simplifies one element of the nexus argument. A nexus letter from a physician who can connect your specific exposure to your specific condition strengthens these claims significantly.
The Role of the Nexus Letter in PACT Act Claims
While presumptive conditions do not strictly require a nexus opinion, there are several scenarios where a nexus letter adds significant value:
- Diagnostic clarity. The veteran's medical records may not clearly state the diagnosis in the terms used by the presumptive list. A nexus letter can confirm the diagnosis and map it to the correct presumptive category.
- Secondary conditions. A veteran with a presumptive primary condition (e.g., diabetes from Agent Orange) may have secondary conditions (peripheral neuropathy, erectile dysfunction, kidney disease) that require a nexus opinion to establish the secondary connection.
- Non-presumptive conditions in toxic-exposed veterans. For conditions not on the list, the PACT Act's concession of exposure helps, but a medical opinion is still needed to connect the exposure to the specific condition.
- Increased ratings. A nexus letter that documents the severity and functional impact of a condition can support a higher initial rating or a claim for increased rating.