The Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022 is a landmark piece of legislation that expands access to VA healthcare and benefits for veterans exposed to toxic substances, including burn pits, Agent Orange, and radiation, during their military service. As of 2025, the PACT Act continues to evolve through implementation phases, providing life-changing support for countless veterans affected by these exposures.
This guide breaks down the latest PACT Act updates, details newly added presumptive conditions, clarifies eligibility requirements, and highlights the essential role of expert medical documentation in securing the benefits you are medically, legally, and ethically eligible for.
Understanding the PACT Act: A Landmark for Veterans
Signed into law in August 2022, the PACT Act is designed to address decades of overlooked toxic exposure cases by removing barriers to VA healthcare and disability compensation.
The Act provides:
- Expanded Healthcare Access: More veterans are now eligible to enroll in VA healthcare, regardless of income or current health status. This includes mandatory toxic exposure screenings during VA appointments to help identify potential service-connected conditions early.
- Presumptive Conditions: Veterans diagnosed with certain illnesses no longer need to prove direct service connection if they served in a qualifying location during a designated period.
- Presumptive Locations & Timeframes: Specific regions and eras of service automatically trigger eligibility under the Act. Beyond Vietnam, new presumptive exposure locations for Agent Orange now include certain U.S. or Royal Thai military bases in Thailand, Laos, Cambodia, American Samoa, Guam, and Johnston Atoll.
The PACT Act is being rolled out in phases through 2025, with new conditions and clarified service criteria added as medical and scientific research progresses. Staying informed and ensuring your medical documentation is complete and up to date is essential.
New Presumptive Conditions Under the PACT Act
A presumptive condition means the VA assumes your illness is service connected if you served in certain locations and timeframes. While this simplifies the claims process, you still need a formal diagnosis from a healthcare provider, supported by thorough medical documentation.
The PACT Act categorizes presumptive conditions into three major exposure groups:
1. Burn Pit and Other Toxic Exposure (Post-1990 Conflicts)
Veterans who served in Iraq, Afghanistan, Kuwait, Saudi Arabia, Oman, Qatar, UAE, and nearby areas from August 2, 1990, to the present are covered.
Key conditions include:
Respiratory Conditions:
- Asthma (diagnosed after service)
- Chronic Bronchitis COPD
- Emphysema Chronic
- Rhinitis/Sinusitis
- Constrictive Bronchiolitis
- Granulomatous Disease
- Interstitial Lung Disease
- Pleurisy Pulmonary
- Fibrosis Sarcoidosis
Cancers:
- Brain cancer (including glioblastoma)
- Kidney cancer
- Lymphatic cancers (e.g., Hodgkin’s lymphoma)
- Multiple Myeloma
- Neck cancer
- Pancreatic cancer
- Reproductive organ cancers (e.g., ovarian, prostate, testicular, uterine)
- Respiratory cancers (e.g., lung cancer)
- Gastrointestinal and other head, neck, or lymphatic cancers
As of January 2025, the VA specifically added acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, myelofibrosis, and urinary bladder, ureter, and related genitourinary cancers as presumptive conditions for Gulf War and Post-9/11 veterans exposed to burn pits.
Other: Hypertension Monoclonal Gammopathy of Undetermined Significance (MGUS)
2. Agent Orange Exposure (Vietnam War Era)
The Act expanded presumptive Agent Orange exposure locations beyond Vietnam to include Thailand, Laos, Cambodia, American Samoa, and more.
Covered conditions include:
- Parkinson’s Disease
- Ischemic Heart Disease
- Type 2 Diabetes
- Various cancers (e.g., bladder, prostate, leukemia)
It’s important to note that Hypertension and Monoclonal Gammopathy of Undetermined Significance (MGUS) were specifically added as presumptive conditions for Agent Orange exposure.
3. Radiation Exposure
The PACT Act expands benefits for veterans exposed to radiation, including those involved in nuclear testing, weapons handling, or cleanup. The types of radiation exposure relevant to the PACT Act include ionizing radiation (alpha, beta, gamma, neutrons) and exposure to radioactive materials. The PACT Act does not cover illnesses from non-ionizing radiation, such as electromagnetic radiation from communications equipment.
Types of Radiation and their relevance to the PACT Act:
- Ionizing Radiation: This is the type of radiation covered by the PACT Act. It has enough energy to damage DNA and includes:
- Alpha Particles: Relatively heavy and short-ranged, easily stopped by a sheet of paper or the outer layer of skin.
- Beta Particles: Lighter and more penetrating than alpha particles, may require a layer of clothing or a thin sheet of metal to stop.
- Gamma Rays: High-energy electromagnetic radiation, requiring thick shielding like concrete or lead to stop.
- Neutrons: Penetrating particles that can be slowed down by materials like water or concrete.
- Radioactive Materials: Exposure can occur through inhalation, ingestion, or skin contact with radioactive substances.
Radiation Exposure in the Context of the PACT Act: The PACT Act acknowledges that veterans may have been exposed to ionizing radiation during their service, especially those involved in specific activities. The VA provides toxic exposure screenings to identify potential radiation exposure, and the PACT Act expands the list of locations where veterans may have been exposed and are eligible for presumptive service connection for related illnesses.
Examples of radiation exposure scenarios include veterans involved in nuclear weapons testing, handling radioactive materials, or participating in cleanup activities. The VA uses military records and other evidence to verify radiation exposure.
Other Toxic Exposures: The PACT Act also addresses other toxic exposures that veterans may have experienced during their service, including:
- Burn pits and other airborne hazards: Open burning of waste on military bases created air pollution.
- Gulf War-related exposures: Includes exposure to various airborne hazards, oil well fires, and other environmental contaminants.
- Agent Orange: A herbicide used during the Vietnam War, linked to various health conditions.
- Camp Lejeune water contamination: Contamination of drinking water at the Marine Corps Base Camp Lejeune.
Presumptive conditions include various leukemias, thyroid cancer, and other radiation-related illnesses.
Eligibility Criteria: Who Qualifies Under the PACT Act?
To qualify for presumptive service connection, you generally must meet three requirements:
1. Qualifying Service
You must have served in:
- Southwest Asia Theater of Operations (Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, etc.) from August 2, 1990, onward
- Afghanistan, Syria, Djibouti, or Uzbekistan post-9/11
- Vietnam, Thailand, Laos, Cambodia, or American Samoa during the Vietnam War era
- Designated radiation-exposure sites or nuclear cleanup assignments
2. Diagnosed Condition
You must have a formal diagnosis from a licensed healthcare provider for one of the PACT Act’s presumptive conditions.
3. Service Timeframes
Some conditions require diagnosis within a particular time after service (e.g., asthma must be diagnosed after service).
Important: Even with a presumptive condition, benefits are not automatic. You must still file a claim and provide evidence of:
- Qualifying service (e.g., DD-214 or service records)
- Medical diagnosis
- Detailed documentation about the condition’s severity and impact
If your condition isn’t on the presumptive list, you may still qualify through a direct service connection by submitting a nexus letter linking your illness to your military service.
Why Medical Evidence Still Matters (Even for Presumptive Claims)
The PACT Act removes the need to prove the condition was caused by service, but you must still prove you have the condition and that it is disabling.
Here’s what the VA still requires:
- Official Medical Diagnosis: Verified by a healthcare provider and supported by lab tests, imaging, or clinical evaluations.
- Severity & Functional Impact: The VA uses this to determine your disability rating, which directly affects your compensation.
- Symptom frequency and intensity
- Functional limitations (e.g., work, mobility, cognition)
- Treatment history and responses
Many veterans have symptoms they assume are minor or unrelated, but may be linked to toxic exposure. Trajector Medical helps uncover these overlooked or undiagnosed conditions, ensuring your whole health picture is represented.
PACT Act Eligibility & Medical Evidence Checklist
Use this checklist to assess your readiness to file or strengthen your claim:
Service History
- I served in a qualifying location (e.g., Iraq, Afghanistan, Vietnam, nuclear test site)
- My service occurred during the VA’s designated time period
- I may have been exposed to burn pits, Agent Orange, or radiation
Diagnosed Conditions
- I have a formal diagnosis for a condition now considered presumptive
- I experience symptoms that align with presumptive conditions, but haven’t yet been diagnosed
- My condition significantly impacts my daily life or ability to work
Medical Documentation
- My medical records (VA and private) reflect my diagnosis, symptoms, and treatment history
- I have discussed my exposure and symptoms with my doctor
- I have relevant diagnostic test results (e.g., MRI, pulmonary tests, biopsies)
- My treatment history (e.g., medications, therapies) is well documented
Next Steps
- I understand that strong medical evidence is still needed, even for presumptive claims
The PACT Act offers hope and opportunity, especially for those previously denied. But the path to successful benefits still hinges on quality medical evidence, confirming your diagnosis, showing the severity, and linking it clearly to your service when needed.
Trajector Medical specializes in developing that evidence. We:
- Review your medical records for gaps and missed conditions
- Guide you through what symptoms may be service-connected
- Help you gather documentation that supports a stronger, more confident case
We work closely with veterans to ensure their claims reflect the full impact of their service-related conditions. If your health issues are affecting your quality of life and you believe they may be related to your military service, don’t wait.
