The PACT Act was a historic victory for Veterans, but for many, the results have been bittersweet. A common trend in 2026 is the “approval-but-no-pay” scenario. Veterans are seeing their service connection approved, but they are receiving 0% or 10% ratings.
These low numbers often don’t reflect the daily struggle of living with breathing issues.
When PACT Act respiratory benefits are denied or underrated, it is rarely because the Veteran is healthy. Instead, it is usually because the medical record did not use the specific clinical language the VA requires. In 2026, simply having a “presumptive condition” is only the first step.
The “0% Trap”: Connection Without Compensation
Receiving a 0% rating can feel like a hollow victory. It means the VA agrees that your military service, specifically your exposure to burn pits or toxins, caused your rhinitis or asthma. However, they are essentially saying the condition isn’t severe enough to impact your life financially.
To move past this “trap,” you must document what the VA calls “functional loss.” This means showing how the condition limits your ability to work or perform daily tasks. For example, if you have chronic sinusitis, the difference between 0% and 30% often comes down to the number of “incapacitating episodes” you have each year.
An episode counts if it requires bed rest and a doctor’s care. If your medical records don’t mention bed rest, the VA may default to a 0% rating.
Five Common Reasons Your Evaluation Might Be Underrated
Understanding why a record is seen as “weak” can help you identify the gaps in your own medical history. Here are the most frequent roadblocks:
- No Clear Symptom Timeline
The VA looks for “chronicity.” If your medical records only show doctor visits from the last few months, the VA might view your condition as a temporary illness rather than a long-term disability. - Missing Objective Evidence
A doctor’s note saying you “feel congested” is considered subjective. While important, the VA prioritizes objective evidence, things that can be measured or seen. For asthma, this means a Pulmonary Function Test (PFT). For rhinitis or sinusitis, this often requires a CT scan or a report from a Nasal Endoscopy. - Functional Impact is Not Documented
Doctors often write notes like “patient is stable” or “doing well” if a medication is working. However, if you are only “doing well” because you have to stay indoors or avoid physical activity, that is a limitation. You must ensure your records reflect what you cannot do, not just how the medication helps.
- Inconsistent Reporting Across Providers
If you tell your VA doctor your breathing is “fine” but tell a private specialist it is “terrible,” these conflicting records can lead to an underrated evaluation. Consistency is vital. Every medical professional you see should receive the same detailed description of your symptoms.
- Missing Nexus for Secondary Conditions
This is the primary reason why PACT Act respiratory benefits are denied when a Veteran tries to link a new condition to a respiratory one. For example, the PACT Act does not “presume” sleep apnea is related to burn pits.
To connect them, you need a Medical Nexus Opinion, a letter where a doctor explains exactly how your service-connected rhinitis or asthma caused or worsened the sleep apnea.
Advanced Testing: Speaking the VA’s Language
In 2026, the VA became more reliant on specific diagnostic codes. If your medical evidence doesn’t use the specific measurements found in these codes, you may be underrated.
For conditions like COPD or asthma, the VA looks at your FEV-1 and FVC scores from your lung tests. If your scores are on the border between a 30% and 60% rating, having a fresh test from early 2026 can be the deciding factor. Similarly, for sinus issues, the VA looks for “purulent discharge” (infection) or “crusting.”
If your doctor sees these things but doesn’t write them down using those specific words, the VA examiner might miss them.
Building a Stronger Record: The 2026 Action Plan
The most effective time to organize your medical history is before you attend a Compensation & Pension (C&P) exam. Once an examiner writes their report, it becomes the “official” version of your health in the VA’s eyes.
Step 1: Visit a Specialist While a general doctor is helpful, the notes from an Ear, Nose, and Throat (ENT) specialist or a Pulmonologist carry more weight for respiratory issues. Their specialized equipment can provide the objective proof the VA needs.
Step 2: Start a Symptom Log Keep a 30-day log of your symptoms. Note every time you have a “flare-up,” every time you lose sleep, and every time you have to miss work. Share this log with your doctor so they can include these details in your clinical notes.
Step 3: Check Your Test Currency Are your lung function tests more than a year old? In 2026, the VA prefers data that is current. Requesting a new PFT or CT scan can ensure the VA is looking at your health as it is right now, not as it was years ago.
Step 4: The Nexus Check If you are pursuing benefits for a secondary condition like GERD or sleep apnea, check your records for a “Nexus.” This statement must use the phrase “at least as likely as not” to connect the two conditions. Without this bridge, the VA is likely to deny the connection.
About Medical Evidence Consulting
Medical evidence consulting focuses on reviewing and organizing health records to ensure they are complete and clearly reflect clinical history. This process does not include filing paperwork, providing legal representation, or directing decisions in a benefits evaluation.
Trajector Medical does not handle claims, file paperwork, or determine benefit eligibility.
Disclaimer: This content is for informational purposes only and does not constitute medical or legal advice. Always consult with a qualified professional for specific medical or legal concerns. Trajector Medical is a private consulting firm and is not affiliated with the Department of Veterans Affairs.
References
- U.S. Department of Veterans Affairs (2026). PACT Act Performance Dashboard and Rating Schedule.
- 38 CFR § 4.97. Schedule of Ratings: Respiratory System.
- National Academies of Sciences (2025). Long-Term Health Effects of Airborne Hazards in Post-9/11 Veterans.
- Journal of Occupational and Environmental Medicine (2026). Respiratory Symptom Progression in Deployed Personnel.
