What the PACT Act actually changed
The Honoring our PACT Act of 2022 (Public Law 117-168), signed August 10, 2022, is the largest expansion of VA presumptive service connection in decades. It does three things:
- Adds 23 new presumptive conditions (11 cancers + 12 respiratory illnesses) for veterans exposed to burn pits and other toxic substances during Gulf War and post-9/11 service.
- Adds 2 conditions (hypertension and MGUS) to the Vietnam-era Agent Orange presumptive list, and expands location coverage to include Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll.
- Establishes a permanent presumption of toxic exposure for all veterans who served in qualifying locations during qualifying periods — meaning you do not have to prove specific exposure events, only that you served in the listed time and place.
Why presumptive service connection matters
VA Disability Compensation requires a service connection — meaning the condition must be linked to military service. For most claims, the veteran (or representative) must produce medical and lay evidence connecting current disability to a service event. That can take years of nexus letters, medical opinions, and appeals.
A presumptive service connection inverts the burden: if you have a listed condition AND served in a listed location during a listed period, VA presumes the connection. You only need to document:
- Diagnosis of the condition (medical records)
- Proof of qualifying service (DD-214 / NGB-22 / service personnel record showing the time and location)
That dramatically shortens approval time and increases approval rate. PACT Act claims have historically approved at substantially higher rates than non-presumptive claims for the same condition.
How to file a PACT Act claim
- Get a recent diagnosis from a treating physician (VA or civilian). A printout of your diagnosis with ICD-10 code is sufficient.
- Pull your DD-214 / NGB-22 and any military personnel records showing the dates and locations of your qualifying service.
- File VA Form 21-526EZ online at va.gov, by mail, or through a VA-accredited Veteran Service Organization (VSO) — American Legion, VFW, DAV, MOAA. VSO filing is free and increases approval rate.
- Attend any C&P (Compensation and Pension) examination VA schedules — these are how the rating percentage gets assigned.
- Receive a rating decision. Typical PACT Act claim processing: 130–250 days. Faster for terminally ill, financially distressed, or homeless veterans.
Once approved, retroactive pay flows back to the claim filing date. If you filed shortly after PACT Act passage (Aug 2022), retroactive pay could cover multiple years.
Other presumptive lists (not PACT Act)
The existing presumptive lists remain in effect and may apply to your situation:
- Existing Agent Orange presumptives (38 CFR § 3.309(e)): diabetes mellitus type 2, ischemic heart disease, Parkinson's disease, prostate cancer, soft-tissue sarcomas, multiple myeloma, non-Hodgkin's lymphoma, hairy cell leukemia, chloracne, peripheral neuropathy, AL amyloidosis, and others.
- Camp Lejeune contaminated water (38 CFR § 3.309(f)): bladder cancer, kidney cancer, liver cancer, non-Hodgkin lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, kidney disease.
- Atomic veterans / ionizing radiation (38 CFR § 3.309(d)): various cancers and conditions linked to specific qualifying nuclear-test or occupation participation.
- Gulf War Syndrome / undiagnosed chronic multi-symptom illness (38 CFR § 3.317): chronic fatigue, fibromyalgia, IBS, and undiagnosed chronic illnesses for Gulf War service.
- Tropical diseases and POW-specific presumptives at 38 CFR §§ 3.307(a)(4), 3.309(c) for specific service profiles.
If your condition is not PACT Act presumptive, check these other lists with a VSO before assuming direct service connection is your only path.