PACT Act Respiratory Conditions: A Guide to Medical Evidence (2026) 

The PACT Act has significantly changed how the U.S. Department of Veterans Affairs (VA) reviews respiratory conditions for veterans. This law was created to help those who were exposed to burn pits, smoke, and other airborne hazards while serving. 

For many veterans, certain illnesses may now be considered “presumptive.” This means the VA may assume the condition was caused by your service without you needing to provide a separate medical letter (a “nexus”) linking the two.  

However, having a presumptive condition does not guarantee a specific result.  

This guide explains how medical evidence may support a respiratory evaluation. Remember, our focus is on the documentation of your health, not on the outcome of any specific case. 

Who Is Covered: Qualifying Service and Locations 

The PACT Act covers 23 categories of illnesses and over 330 specific conditions. To see if these rules might apply to you, the VA looks at where and when you served. 

Southwest Asia (August 2, 1990, to present) 

This includes service in: 

• Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates (UAE), Oman, and the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, and the Red Sea. 

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

The list of locations for newer veterans is extensive. It includes: 

• Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen. 

• The airspace above these locations is also included. 

If you served in these areas, certain respiratory conditions might be reviewed under the presumptive guidelines. This means you only need to show you have a current diagnosis of the condition.

Tracking Your Exposure: The ILER Record 

A key tool in your benefits journey is the Individual Longitudinal Exposure Record (ILER). This is a digital file that tracks where you were stationed and what chemicals or hazards you may have been near. 

Important Update for 2026: As of March 23, 2026, active-duty service members can now access their ILER record directly using a Common Access Card (CAC). For veterans, the VA is expected to offer direct access to these records starting in the fall of 2026. In the meantime, your VA healthcare providers can access this data for you to help document your exposure history. 

Common PACT Act Respiratory Conditions 

Several breathing and sinus issues are commonly linked to toxic exposure. The VA uses a rulebook called 38 CFR § 4.97 (VA Disability for Respiratory Conditions) to decide how to evaluate these conditions based on medical evidence. 

Chronic Rhinitis and Sinusitis 

• Chronic Rhinitis: This is long-term swelling in the nose. It often causes a stuffy nose or a “runny” nose that won’t go away. 

• Chronic Sinusitis: This affects the cavities around your nose. It often causes facial pain, pressure, and repeated infections that require antibiotics. 

For these, the VA looks for specific evidence like CT scans or notes from an Ear, Nose, and Throat (ENT) doctor. They look for things like nasal polyps or how much your breathing is blocked. 

Asthma and COPD

• Asthma: A condition that makes it hard to breathe because your airways narrow and swell. 

• COPD: This includes chronic bronchitis and emphysema. These conditions cause long-term breathing problems and poor airflow. 

These conditions are usually evaluated using objective tests. This means the VA relies on machines to measure how well your lungs work, rather than just how you feel. 

Types of Evidence Used in Evaluations 

When the VA reviews your health, they look for a “longitudinal history.” This is just a fancy way of saying they want to see your medical story over a long period, not just one doctor’s visit. 

Objective Testing 

Objective tests are the most important part of a respiratory record because they provide hard numbers. 

• Spirometry (Pulmonary Function Test or PFT): This is a breathing test. It measures two main things: 

• FEV-1: How much air you can blow out in one second. 

• FVC: The total amount of air you can breathe out after taking a deep breath. 

• Imaging: X-rays or CT scans can show if there is physical damage or blockage in the lungs or sinuses. 

Treatment and Medication Logs 

Your records should show how you manage your condition. This includes: 

• Prescriptions: Using inhalers, steroids, or nebulizers regularly shows that your condition is persistent. 

• Antibiotics: For sinusitis, the VA may count how many times a year you had to take antibiotics for an infection. 

• Incapacitating Episodes: These are times when your condition is so bad that a doctor tells you to stay in bed or you cannot perform daily tasks. 

Evidence by Condition 

Secondary Conditions: Sleep Apnea 

Sleep apnea is a condition where you stop breathing for short times while you sleep. It is not currently listed as a presumptive condition under the PACT Act. 

However, medical evidence could show that sleep apnea is “secondary” to a PACT Act condition. For example, if you have severe chronic rhinitis that blocks your nose, a doctor might find that it makes your sleep apnea worse. To document this, you would usually need a sleep study and a medical opinion explaining how the two conditions are connected. 

Common Gaps in Medical Records 

Sometimes, a veteran’s medical file is missing information that could help the VA understand their health. Common gaps include: 

• No Formal Diagnosis: You might have symptoms, but a doctor hasn’t officially named the condition in your records. 

• Old Data: Having a breathing test from five years ago might not show how you are doing today. 

• Gaps in Care: If you don’t see a doctor for two years, it might look like your condition went away, even if it didn’t.

Disclaimer: This article is for informational purposes only. It is not legal or medical advice. Trajector Medical provides medical evidence consulting only. We do not file claims, represent clients in legal matters, or determine eligibility for benefits.