PACT Act Toxic Exposure Conditions (Burn Pits, Airborne Hazards)

1. What This Condition Is

If you deployed after August 2, 1990 and spent time near open burn pits, you breathed in a toxic mix of chemicals, heavy metals, and particulates that no filter was designed to handle. The same goes for airborne hazards including sand, dust, oil well fires, and sulfur fires across Southwest Asia and other PACT Act-covered locations.

For years, VA denied these claims because veterans couldn't prove a direct link between burning trash and their chronic illness. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022, Public Law 117-168, changed that. Signed into law on August 10, 2022, it removed the nexus requirement for covered veterans by making dozens of conditions presumptive.

Presumptive means VA accepts that your service caused the condition without requiring you to prove it. You served in a qualifying location. You have the diagnosis. VA owes you the benefit of the doubt under 38 CFR 3.102.

2. VA Rating Criteria

The PACT Act does not assign one blanket rating. Each underlying condition has its own diagnostic code (DC) under 38 CFR Part 4. Your rating depends on the diagnosis, not just the exposure.

Common presumptive conditions and the rating schedules they fall under:

Active malignancies are generally rated at 100% while under active treatment (such as chemotherapy, radiation, or surgical management), with a mandatory VA reexamination six months after treatment ends to evaluate residual disability. The specific provision authorizing the 100% active-treatment rating appears within the rating notes for each body-system schedule under 38 CFR Part 4 (for example, 38 CFR 4.97 for respiratory cancers, 38 CFR 4.124a for neurological cancers). Note: 38 CFR 4.115(b) applies specifically to genitourinary malignancies and is not the universal authority for all cancer ratings.

Nine rare respiratory cancers were added to the presumptive list by Federal Register update in January 2025, including squamous cell carcinoma of the head and neck and other specified malignancies. If you were previously denied for one of these, you have grounds for a Supplemental Claim under VA Form 20-0995.

3. What to Expect at Your C&P Exam

For most PACT Act presumptive claims, VA should not require you to prove the nexus. The exam is there to document your current diagnosis and severity, not to question whether your service caused it.

That said, examiners sometimes still probe whether you were actually exposed. Know your service history and deployment locations cold. If you were stationed in a PACT Act-covered location during a qualifying period, state that clearly.

Bring documentation of your qualifying service location and your current diagnosis to the exam. If your examiner questions exposure when it should be presumed, that is grounds to challenge the exam as inadequate under 38 CFR 3.159(c)(4).

For respiratory conditions, expect pulmonary function testing. Bring your most recent imaging and specialist notes. For cancers, bring oncology records and treatment summaries.

4. Evidence You Need to Win

1. Proof of service in a qualifying location. The PACT Act covers veterans who served in the Southwest Asia theater of operations on or after August 2, 1990, as well as veterans who served in covered locations after September 11, 2001. Covered post-9/11 locations include Afghanistan, Iraq, Syria, Djibouti, Kuwait, Bahrain, Qatar, the UAE, Saudi Arabia, Oman, Jordan, Egypt, Turkey, Israel, Lebanon, Yemen, Somalia, and Uzbekistan (Karshi Kanabad), among others.

2. A current diagnosis. You need a confirmed diagnosis from a licensed physician. Generic symptoms are not enough. The diagnosis must match a condition VA recognizes as presumptive, or you will need to pursue a direct service connection claim with a nexus opinion.

3. Airborne Hazards and Open Burn Pit Registry enrollment. Enrollment is not required but strengthens your record. Access it through VA's public health website.

4. Deployment records, orders, or DD-214 with location data. These confirm qualifying service.

5. Medical records documenting the progression of symptoms from service forward. Continuity of symptomatology under 38 CFR 3.303(a) matters even for presumptive claims.

For conditions that are not on the presumptive list, you still have a path. Under the PACT Act, VA must consider a toxic exposure finding for any veteran with documented qualifying service. A private independent medical opinion (IMO) connecting your specific condition to burn pit or airborne hazard exposure can satisfy the nexus requirement under the standard in 38 CFR 3.102.

5. Secondary Conditions to Consider

File secondary conditions under 38 CFR 3.310. You need your toxic exposure condition service connected first, then a medical opinion linking the secondary condition to that primary condition.

6. Common Mistakes That Kill Claims

Not knowing which conditions are presumptive. Veterans file general toxic exposure claims without specifying a diagnosis. VA cannot grant what you do not claim. Get a diagnosis, match it to the presumptive list, and file that specific condition.

Not knowing the qualifying service locations. If your deployment location is not clearly listed on your DD-214, you need orders or other records confirming where you served. VA will not presume a location — only a condition.

Filing too late or not at all after a prior denial. If VA denied a PACT Act-eligible condition before August 10, 2022, you can refile under VA Form 20-0995 as a Supplemental Claim using the new law as the basis. You are not time-barred.

Ignoring residual disability after cancer treatment ends. When active cancer reaches remission, VA drops the 100% rating after six months unless you document ongoing residual disability. File for those residuals immediately: nerve damage, organ loss, treatment side effects, and secondary conditions all have ratable severity.

Not claiming secondary conditions. Respiratory conditions, cardiovascular disease, and mental health conditions frequently develop downstream from PACT Act exposures and primary cancers. Each one is a separate claim opportunity.

7. FWD Assist Resources

The FWD Assist HQ book catalog covers several conditions closely tied to PACT Act claims:

• PACT Act Guide — step-by-step PACT Act claims framework, qualifying locations, and the full presumptive list
• C&P Exam Preparation Guide — how to prepare for your exam, what examiners look for, and how to challenge a bad exam
• Secondary Conditions Guide — how to build secondary claims off a primary PACT Act condition
• Nexus Letters Guide — how to get a private IMO for conditions outside the presumptive list
• Cancer and Toxic Exposure — specific guidance on active cancer ratings, residual ratings, and the six-month reexamination process
• TDIU Guide — if toxic exposure conditions prevent you from working, this covers the Individual Unemployability pathway under 38 CFR 4.16

Visit fwdassisthq.com for the full catalog.

8. Get Help Without a Claim Shark

Free, accredited help is available at no cost to you. Veterans Service Organizations including the DAV, VFW, American Legion, and AMVETS provide accredited VSO representation. Your county veterans service officer can help locally. VA-accredited agents and attorneys are also an option.

Federal law under 38 USC 5905 prohibits anyone from charging you an upfront fee before VA issues an initial decision on your claim. Any representative who asks for money before that point is breaking the law. After an initial decision, accredited attorneys and agents may charge up to 20% of past-due benefits — no more.

Verify accreditation before working with any paid representative at va.gov/ogc/accreditation.asp.