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PACT Act Presumptive Conditions: Full List and Covered Locations

The PACT Act, signed August 10, 2022, lets the VA presume that certain cancers and breathing illnesses came from burn pits and other toxic exposures, if you served in a covered location. For Gulf War and post-9/11 veterans, that covers 11 types of cancer, 12 illnesses such as asthma, COPD and chronic sinusitis, and blood and bladder cancers added in 2025. It also added hypertension and MGUS for Agent Orange and five new Agent Orange locations. Here is the full list and how to file.

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TL;DR

A presumptive condition means you do not need a medical opinion linking it to service. You need a diagnosis and qualifying service (38 U.S.C. 1120).
Gulf War locations count on or after August 2, 1990. Post-9/11 locations (Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen) count on or after September 11, 2001, including the airspace above them.
Since 2025, the VA also presumes bladder and ureter cancers (38 CFR 3.320a) and acute and chronic leukemias, multiple myelomas including MGUS, myelodysplastic syndromes and myelofibrosis (38 CFR 3.320b) for these veterans.
Agent Orange now covers hypertension and MGUS, plus Thailand, Laos, Cambodia, Guam, American Samoa and Johnston Atoll for set dates.
The special window to backdate PACT Act benefits to August 10, 2022 closed August 14, 2023. Today, file an Intent to File to protect your start date for one year.

What is a PACT Act presumptive condition?

Normally, to service connect a condition you need three things: a diagnosis, an event in service, and a medical opinion linking them. A presumptive condition removes the hardest part. If you have a listed condition and a qualifying period of service, the VA presumes the link.

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act became law on August 10, 2022. It wrote a new list of burn pit and toxic exposure presumptives into 38 U.S.C. 1120 and expanded the Agent Orange rules in 38 U.S.C. 1116. Some parts phased in over time. The last phase took effect October 1, 2025, so the full list now applies to everyone.

Which locations and dates qualify for burn pit presumptives?

You must have served in one of these places on or after the date shown. The airspace above each location counts too.

Service era	Start date	Covered locations
Gulf War era	On or after August 2, 1990	Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, United Arab Emirates (and the rest of the Southwest Asia theater, including the Persian Gulf, Gulf of Aden, Gulf of Oman, Arabian Sea and Red Sea)
Post-9/11	On or after September 11, 2001	Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen

The water areas come from the VA's definition of the Southwest Asia theater of operations in 38 CFR 3.317(e)(2). Your DD-214, deployment orders, or personnel records usually show where you served.

Which cancers are presumptive under the PACT Act?

These cancers are listed in 38 U.S.C. 1120(b) for covered veterans:

Brain cancer
Gastrointestinal cancer of any type
Glioblastoma
Head cancer of any type
Kidney cancer
Lymphoma of any type
Melanoma
Neck cancer of any type
Pancreatic cancer
Reproductive cancer of any type
Respiratory (breathing-related) cancer of any type

Which illnesses are presumptive under the PACT Act?

Asthma diagnosed after service
Chronic bronchitis
Chronic obstructive pulmonary disease (COPD)
Chronic rhinitis
Chronic sinusitis
Constrictive bronchiolitis or obliterative bronchiolitis
Emphysema
Granulomatous disease
Interstitial lung disease (ILD)
Pleuritis
Pulmonary fibrosis
Sarcoidosis

What conditions were added after 2022?

The PACT Act let the VA add conditions by regulation. In January 2025 it did:

Regulation	Added conditions	Effective
38 CFR 3.320a	Urinary bladder cancer; ureter cancer (including the ureteric orifice and urachus)	January 2, 2025
38 CFR 3.320b	Acute leukemias; chronic leukemias; multiple myelomas, including monoclonal gammopathy of undetermined significance (MGUS); myelodysplastic syndromes (MDS); myelofibrosis	January 10, 2025 (interim final rule)

Both rules cover the same Gulf War and post-9/11 locations listed above. An older rule, 38 CFR 3.320, also presumes asthma, rhinitis, sinusitis, and nine rare respiratory cancers for these veterans. The VA can still rebut a presumption with affirmative evidence, for example evidence that a condition came from something after service.

Gulf War veterans should also know about 38 CFR 3.317. It covers undiagnosed illnesses and chronic multisymptom illnesses such as chronic fatigue syndrome, fibromyalgia and functional GI disorders. The regulation currently requires them to show up to 10% or more by December 31, 2026, unless they began during service in the theater.

What changed for Agent Orange?

The PACT Act added two conditions to the Agent Orange list:

High blood pressure (hypertension)
Monoclonal gammopathy of undetermined significance (MGUS)

It also added these locations and dates, per the VA:

Location	Dates
Any U.S. or Royal Thai military base in Thailand	January 9, 1962, to June 30, 1976
Laos	December 1, 1965, to September 30, 1969
Cambodia (Mimot or Krek, Kampong Cham Province)	April 16, 1969, to April 30, 1969
Guam or American Samoa, or their territorial waters	January 9, 1962, to July 31, 1980
Johnston Atoll, or a ship that called there	January 1, 1972, to September 30, 1977

These add to the long-standing Agent Orange presumptives in 38 CFR 3.309(e), such as type 2 diabetes, ischemic heart disease, Parkinson's disease, prostate cancer and respiratory cancers.

What is the toxic exposure screening?

The VA says every veteran enrolled in VA health care will get an initial toxic exposure screening and a follow-up at least once every 5 years. The screening asks about exposures in service. It is not a claim and does not decide benefits, but it puts your exposure history in your VA record. The VA also expanded health care eligibility to toxic-exposed veterans starting March 5, 2024.

Can PACT Act benefits still be backdated to August 2022?

No, not through the special window. Veterans who filed a claim or an Intent to File by August 14, 2023 could have benefits backdated to August 10, 2022. The VA extended the original August 9 deadline to August 14 after technical problems on VA.gov. That window is closed.

What still protects you today is the Intent to File. Submitting VA Form 21-0966, or starting a claim online, sets a possible start date. You then have one year to file the full claim (38 CFR 3.155). If you think you have a PACT Act condition, file the Intent to File now, even if you are still gathering records.

How do you file a PACT Act claim?

Confirm your service location and dates. Pull your DD-214 and any deployment records.
Confirm the diagnosis. The condition must be diagnosed by a medical provider. For asthma, it must be diagnosed after service.
Submit an Intent to File to lock in a possible start date.
File VA Form 21-526EZ online or by mail. Name the condition and say you are claiming it under the PACT Act based on your service location.
Previously denied? The VA says to file a Supplemental Claim so it can review your case again under the new law.

Presumptive conditions can also lead to secondary claims. For example, service-connected diabetes can support claims for neuropathy. See our secondary conditions guide. If you have a C&P exam, read the C&P exam tips. To see how a new rating changes your total, use the VA disability calculator, and check what each rating level unlocks in the VA benefits guide.

Need help putting your statement into words? Get the Statement Template Pack ($97) for personal and buddy statement templates you fill in with your own experience.

Frequently asked questions

Do I need a nexus letter for a PACT Act condition?

Not if the condition is on the presumptive list and you served in a covered location during the covered dates. The presumption replaces the nexus. You still need a current diagnosis.

Does the PACT Act cover veterans who were never near a burn pit?

The presumption is based on location and dates, not on proving you stood near a burn pit. If you served in a covered location during the covered period, exposure is presumed unless there is affirmative evidence you were not exposed.

Is hypertension a PACT Act condition for burn pit veterans?

Hypertension was added for Agent Orange exposure, not for burn pit exposure. A Gulf War or post-9/11 veteran can still claim hypertension on a direct or secondary basis with medical evidence.

Is it too late to file a PACT Act claim?

No. There is no deadline to file. Only the special backdating window to August 10, 2022 has passed. Your effective date is generally the date of your Intent to File or claim.

My claim was denied before 2022. Can I try again?

Yes. If the condition is now presumptive, file a Supplemental Claim (VA Form 20-0995). The VA says it will review the case again.