Presumptive service connection means the VA accepts that a condition is related to your military service without requiring you to prove a direct link. Normally, establishing service connection requires a medical nexus opinion — a doctor confirming your condition is "at least as likely as not" connected to service. For presumptive conditions, that step is legally skipped: if you served in a qualifying location and have a qualifying condition, the connection is presumed.
The PACT Act (Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act), signed August 10, 2022, was the largest expansion of presumptive eligibility in VA history. It added hundreds of conditions across multiple exposure categories and reached back to cover Veterans who had been denied for years.
Which Category Applies to Me?
Select your primary era of service to see which presumptive categories likely apply.
PACT Act — Burn Pits & Toxic Exposure
38 CFR §3.320 · Signed August 10, 2022
Who Qualifies
Veterans who served in a covered location on or after August 2, 1990, or who were exposed to a specific covered substance regardless of location. The VA must presume you were exposed to toxic substances — you no longer need to prove you were near a burn pit specifically.
Covered Locations
- ▸Bahrain, Djibouti, Egypt, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, United Arab Emirates, Yemen
- ▸Afghanistan, Iraq, Syria — service on or after September 11, 2001
- ▸Kosovo and other former Yugoslavia locations — service after November 11, 1998
- ▸Philippines — service after July 1, 2003 in support of military operations
- ▸Any vessel in the Persian Gulf, Red Sea, Arabian Sea, Gulf of Oman, or Gulf of Aden
Any Cancer
The PACT Act presumes exposure to toxic substances for Veterans who served in covered locations. Cancer of any type — including those not specifically listed — may be service-connected if you can show a nexus to toxic exposure. The VA must now give the benefit of the doubt on the exposure question itself.
Specific Cancers with Full Presumption
Head cancer, neck cancer, respiratory cancers (lung, trachea, bronchus, larynx), gastrointestinal cancers, reproductive cancers, urinary cancers, lymphatic cancers (including non-Hodgkin's lymphoma), kidney cancer, melanoma, pancreatic cancer, any cancer of the endocrine system, glioblastoma, and any cancer that the VA designates as a rare cancer.
Respiratory / Non-Cancer
Constrictive bronchiolitis, obliterative bronchiolitis, constrictive pericarditis, hypersensitivity pneumonitis. These conditions, previously very difficult to connect to service, are now presumptive for covered Veterans.
Agent Orange
38 CFR §3.307(a)(6), §3.309(e) · Expanded by PACT Act 2022
Who Qualifies
Veterans who served in a qualifying location where Agent Orange or other herbicides were used. Foot soldiers, pilots, Navy "Blue Water" Veterans (service in offshore waters, added 2020), and others who came into contact with tactical herbicides during the qualifying period.
Qualifying Locations & Periods
Bladder cancer, hypertension, and hypothyroidism were added by the PACT Act in 2022. Veterans previously denied for these conditions should file a Supplemental Claim.
Gulf War Illness
38 CFR §3.317 · Service on or after August 2, 1990
Who Qualifies
Veterans who served on active duty in the Southwest Asia theater of operations on or after August 2, 1990 — even if they never deployed to combat. The Gulf War Illness presumption covers a wide range of chronic, poorly understood conditions that remain undiagnosed or lack a clear etiology.
Covered Locations
Undiagnosed Illness
A combination of symptoms with no identifiable diagnosis — fatigue, skin rash, headache, muscle pain, neurological signs, respiratory symptoms, sleep disturbances, GI symptoms, menstrual disorders, or other chronic disabilities that appeared or worsened after service.
Medically Unexplained Chronic Multisymptom Illness (MUCMI)
Including fibromyalgia, irritable bowel syndrome (IBS), and functional gastrointestinal disorders. These are among the most common qualifying conditions for Gulf War Veterans.
Infectious Diseases
Brucellosis, campylobacter jejuni, coxiella burnetii (Q fever), malaria, mycobacterium tuberculosis, nontyphoid salmonella, shigella, visceral leishmaniasis, West Nile virus.
Any Presumptive Condition
Under §3.317, the VA presumes service connection for any diagnosed or undiagnosed chronic disability that appears to a degree of 10% or more during the presumptive period (by December 31, 2026).
Camp Lejeune Water Contamination
38 CFR §3.307(a)(7) · Service August 1953 – December 1987
Who Qualifies
Veterans (and family members who resided on base) who spent at least 30 days cumulative at Camp Lejeune or Marine Corps Air Station (MCAS) New River, North Carolina, between August 1, 1953 and December 31, 1987. The water supply during that period was contaminated with volatile organic compounds (VOCs) including trichloroethylene, perchloroethylene, benzene, and vinyl chloride.
Radiation Exposure (Atomic Veterans)
38 CFR §3.309(d) · Nuclear testing and occupation service
Who Qualifies
Veterans who participated in atmospheric nuclear testing, served in the occupation of Hiroshima or Nagasaki before July 1, 1946, were held as prisoners of war in Japan (within 35 miles of Hiroshima or Nagasaki), or served in certain other radiation-risk activities as defined under 38 CFR §3.309(d).
Key Qualifying Activities
- ▸On-site participant in atmospheric nuclear weapons testing (any U.S.-conducted test site)
- ▸Occupation of Hiroshima or Nagasaki between August 6, 1945 and July 1, 1946
- ▸POW in Japan and within 35 miles of Hiroshima or Nagasaki
- ▸Service at Enewetak Atoll during cleanup operations (1977–1980)
- ▸Service at Palomares, Spain (1966) or Thule Air Force Base (1968) — weapons accidents
- ▸Participation in underground nuclear testing at Amchitka Island, Alaska (before January 1, 1974)
For radiation claims not covered by these presumptives, Veterans can request a dose estimate from the Defense Threat Reduction Agency (DTRA) via the Nuclear Test Personnel Review (NTPR) program. An individual dose assessment may support a non-presumptive claim.
How to File a Presumptive Claim
File VA Form 21-526EZ (Application for Disability Compensation). Identify the specific presumptive condition and note your qualifying service (location and dates). Explicitly state that you are claiming under the relevant presumptive regulation (e.g., "PACT Act burn pit presumptive" or "Agent Orange §3.309(e)").
Provide evidence of qualifying service — DD-214 or service records showing dates and locations. For Agent Orange, the VA will often confirm service in qualifying locations from service records. For PACT Act claims, the VA should accept location based on your DD-214.
Provide a current medical diagnosis of the qualifying condition. For presumptive claims, you generally do NOT need a nexus letter — the nexus is presumed by law. A diagnosis from your treating physician or VA clinician is sufficient.
If you were previously denied for the same condition under the old rules, file a Supplemental Claim (VA Form 20-0995) and cite the PACT Act or applicable expansion as new and relevant evidence. You may be entitled to an earlier effective date.
Work with a VSO (Veterans Service Organization) — VSOs provide free claims assistance and can significantly improve the speed and quality of your claim. Contact your local American Legion, VFW, DAV, or state Veterans affairs office.
Were You Previously Denied?
Thousands of Veterans were denied claims for conditions that are now presumptive under the PACT Act. If you were denied before August 2022, your claim does not reopen automatically — you must take action. File a Supplemental Claim citing the PACT Act as new and relevant evidence. If granted, your effective date may reach back to your original claim date.
The VA has a PACT Act review initiative for claims denied between 2017 and 2022 — check VA.gov or contact a VSO to see if your claim is in the review queue. If not, file proactively. See the Effective Date Reference for how retroactive benefits work.
Registry & Toxic-Exposure Screening
Separate from the presumptions above, two VA programs are open to toxic-exposed and enrolled Veterans. Neither is part of the claims process, and neither affects your eligibility for VA care or benefits.
Airborne Hazards & Open Burn Pit Registry
A VA environmental-health registry that documents possible airborne-hazard and burn-pit exposures. Since the August 2024 redesign, eligible Veterans and service members are included automatically from DoD records; participation is voluntary. You can review your participation, add health information, or opt out through the official page.
VA burn pit registry ↗Toxic-exposure screening (PACT Act)
Every Veteran enrolled in VA health care can get a free toxic-exposure screening — an initial screening plus a repeat at least every five years. It takes about 5–10 minutes and simply records any exposures you report. Ask for it at your next VA appointment, or contact your local VA health facility’s toxic-exposure screening navigator.
VA PACT Act & screening ↗Sources: 38 C.F.R. §3.307 (presumptive service connection), §3.309 (specific diseases), §3.317 (Gulf War undiagnosed illness), §3.320 (PACT Act toxic exposure). For the full conditions list and current regulations, see VA.gov Hazardous Exposures ↗ and pactact.va.gov ↗.