How the PACT Act Can Help You Pursue VA Benefits for Respiratory Conditions
If you served our country after September 11, 2001, especially in places like Iraq, Afghanistan, or other parts of the Southwest Asia theater of operations, you may have been exposed to toxic materials. Sadly, this has caused a lot of veterans to develop serious lung and breathing problems.
The air in these deployed areas often contained a dangerous mix of smoke from open burn pits, fine desert dust and sand, and other pollutants.
The PACT Act (formally the Honoring our Promise to Address Comprehensive Toxics Act of 2022) is a historic law that changed how the VA looks at these cases. It directly connects military service in certain areas to many respiratory issues, making the process of pursuing VA benefits simpler for thousands of veterans.
The PACT Act’s Big Change: Presumptive Conditions
The most important part of the PACT Act for respiratory conditions is the creation of presumptive conditions.
What is a Presumptive Condition?
Think of “presumptive” as the VA automatically agreeing that your military service caused your illness.
If your condition is on the presumptive list, you do not have to prove the medical link (called a “nexus“) between your service and your diagnosis. The VA presumes the connection, as long as you can show two things:
- You have a current medical diagnosis of the condition.
- You have evidence of qualifying service in a designated location during a specific timeframe.
Key Respiratory Conditions Now Presumptive
If you were in a qualifying location (like Afghanistan, Iraq, Syria, or other designated areas) on or after September 11, 2001, and you have a current diagnosis, the VA may presume service connection for the following:
- Asthma (diagnosed after your service ended)
- Chronic Bronchitis
- Chronic Rhinitis (a lasting inflammation inside your nose)
- Chronic Sinusitis (a lasting inflammation of your sinuses)
- Chronic Obstructive Pulmonary Disease (COPD)
- Constrictive or Obliterative Bronchiolitis (a rare and severe lung disease)
- Emphysema
- Granulomatous Disease (like Sarcoidosis, if it affects your lungs)
- Interstitial Lung Disease (ILD)
- Pleuritis
- Pulmonary Fibrosis
- Any type of Respiratory Cancer (like lung or throat cancer)
This is a major step forward. For example, as of January 1, 2024, the VA had approved more than 30,000 claims for asthma and over 7,000 for COPD.
How to Establish Service Connection
Whether your condition is presumptive or not, gathering the right medical evidence is the most important step in your benefits pursuit. We focus on helping you document the medical evidence needed for your evaluation. We do not file claims, handle paperwork, or provide legal representation.
1. For Presumptive Conditions (The Simplified Path)
For these conditions, your focus is on proving the two key things:
- Current Diagnosis: Comprehensive medical records that clearly show you have one of the presumptive conditions.
- Service Records: Documents (like your DD214 or military orders) that confirm you were deployed to a qualifying location during the right time period.
2. For Non-Presumptive Conditions (The Traditional Path)
If your breathing problem is not on the presumptive list, you can still pursue benefits by proving a direct service connection. This requires three main pieces of evidence:
- Current Diagnosis: A clear diagnosis from a medical professional.
- In-Service Event/Exposure: Evidence, such as your lay statement or unit histories, showing you were exposed to burn pits or other toxins during your service.
- Medical Nexus (Link): A formal medical opinion, sometimes called a nexus letter, from a doctor that states your condition is at least as likely as not caused or aggravated by your military exposure.
Crucial Medical Evidence for Your Evaluation
The VA relies on medical documentation to understand your illness and its severity. The stronger your medical evidence, the more clearly your case can be supported.
Getting the Right Tests
Medical records are essential. For respiratory conditions, this includes:
- Pulmonary Function Tests (PFTs): These are vital. They measure how well your lungs are working. Key results include:
- FEV-1 (Forced Expiratory Volume in one second)
- FVC (Forced Vital Capacity)
- Specialist Reports: Reports from doctors who specialize in the lungs (Pulmonologists) or ear, nose, and throat (ENT Specialists) carry a lot of weight.
- Imaging: X-rays or CT scans that show any damage or change in your lungs.
Documenting Your Exposure
It is important to document where and when you were exposed:
- Airborne Hazards and Open Burn Pit Registry: Registering with this VA registry helps document your exposure history. Over 4.3 million veterans and service members have participated as of early 2025, which helps the VA research these issues.
- Lay/Buddy Statements: Your own statement, and statements from people you served with (“buddy statements“), are crucial. They can describe your personal experience near burn pits or when your symptoms first started.
Understanding How the VA Rates Severity
The VA assigns a disability rating based on how severe your symptoms are and how much your breathing problem affects your daily life and ability to work. Ratings typically range from 0% to 100%.
The VA often uses the objective results from your Pulmonary Function Tests (PFTs) to determine the rating. For example, for Asthma, the rating criteria focuses on the FEV-1 score or the need for strong medication:
| Rating | FEV-1 (Forced Expiratory Volume) Symptoms/Treatment |
|
100% |
Less than 40% of the predicted value OR Requires daily high-dose systemic steroids or has more than one attack per week with respiratory failure. |
|
60% |
40% to 55% of the predicted value OR Requires monthly doctor visits for flare-ups or needs intermittent courses of systemic steroids (at least three per year). |
|
30% |
56% to 70% of the predicted value OR Requires daily inhalers or anti-inflammatory medication. |
|
10% |
71% to 80% of the predicted value OR Requires an inhaler (bronchodilator) sometimes. |
Ratings for other conditions like Sinusitis and Rhinitis are based on the frequency and severity of episodes, such as how often you need antibiotics or if you have nasal polyps.
The C&P Exam: What to Expect
The VA will likely require you to attend a Compensation & Pension (C&P) exam for your respiratory evaluation. This is not a time to be tough or downplay your problems. Our role is to educate you about this process. We do not provide C&P exam preparation.
Here’s how to ensure the examiner gets an accurate picture of your condition:
- Be Thorough: Fully explain all of your symptoms—shortness of breath, coughing, wheezing, and fatigue—even if they seem minor on that particular day.
- Explain Daily Impact: Describe how your condition limits your daily life. Focus on what you can’t do now that you could before service (e.g., “I can only walk half a block before I have to stop and catch my breath,” or “My chronic cough wakes me up multiple times a night”).
- Bring Your Records: While the examiner should have your file, it can potentially be helpful to have your own copies of your civilian medical records, PFT results, and personal statement on hand.
The Domino Effect: Secondary Service Connection
Sometimes, a service-connected respiratory condition can lead to another health problem. We call this the Domino Effect.
For example, a severe respiratory condition like COPD can cause strain on your heart, possibly leading to a heart condition like Cor Pulmonale (right-sided heart enlargement). When one service-connected condition causes or makes worse a second, new condition, that second condition may qualify for secondary service connection.
You would need a medical opinion (a nexus letter) that clearly states the link—for example, that your service-connected COPD is the cause of your new heart condition.
Total Disability Individual Unemployability (TDIU)
If your respiratory problems (especially severe ones like constrictive bronchiolitis or severe COPD) are so bad that they prevent you from getting or keeping a regular job, you may be able to pursue Total Disability Individual Unemployability (TDIU).
TDIU allows the VA to pay you at the 100% disability rate, even if your combined schedular rating is lower than 100%. This is an important potential option if your breathing issues cause chronic fatigue, frequent serious flare-ups, or necessitate so many medical appointments that consistent work is impossible.
The PACT Act is an important tool that has helped many post-9/11 veterans pursue the benefits they earned. By focusing on detailed medical evidence, understanding the new presumptive rules, and clearly documenting the full impact of your respiratory condition, you can build a strong foundation for your benefits evaluation.
Disclaimer: We provide medical evidence consulting services to assist veterans in documenting the severity and origins of their conditions. We are not a legal firm, claims agent, or VSO. We do not provide legal advice, file claims, or act as representatives in the VA process. The decision on how to use the medical evidence we help you secure is always yours.
