PACT Act & Toxic Exposure
If you were exposed to burn pits, Agent Orange, radiation, or other toxic substances during your service, you may be owed VA health care and disability benefits under the PACT Act — and our office files the claim with you, at no cost.
What is the PACT Act?
The Sergeant First Class Heath Robinson Honoring our PACT Act (Public Law 117-168, signed 2022) is the largest expansion of VA benefits in a generation. It makes it easier for Veterans exposed to toxic substances to get care and compensation by adding new presumptive conditions — illnesses the VA automatically links to your service, so you don't have to prove the connection.
The VA has approved over one million PACT Act claims and continues to add presumptive conditions as new science emerges. The categories below are a guide — the VA maintains the official, current list (linked below).
Full Presumptive Conditions List
If you have a diagnosed condition below and you meet the service/exposure requirement for that group, the VA presumes it is connected to your service — you do not have to prove the link. Jump to a group:
Agent Orange & Herbicide Exposure
Who: Veterans who served where herbicides were used or stored — including the Republic of Vietnam and offshore waters, the Korean DMZ, U.S./Royal Thai bases in Thailand, Laos, certain Cambodia provinces, Guam/American Samoa, and Johnston Atoll, within the VA's qualifying date ranges.
Cancers- Bladder cancer
- Chronic B-cell leukemias (incl. CLL & hairy cell)
- Hodgkin's disease
- Multiple myeloma
- Non-Hodgkin's lymphoma
- Prostate cancer
- Respiratory cancers (lung, larynx, trachea, bronchus)
- Soft-tissue sarcomas (certain)
- AL amyloidosis
- Chloracne (within 1 year of exposure)
- Type 2 diabetes mellitus
- High blood pressure (hypertension) — added by the PACT Act
- Ischemic heart disease
- Monoclonal gammopathy of undetermined significance (MGUS) — added by the PACT Act
- Parkinsonism & Parkinson's disease
- Early-onset peripheral neuropathy
- Porphyria cutanea tarda
Burn Pits & Airborne Hazards (PACT Act — Gulf War & Post-9/11)
Who: Veterans who served in a qualifying location during the Gulf War era (on or after Aug 2, 1990) or post-9/11 era (on or after Sept 11, 2001), including Southwest Asia and later Afghanistan and other locations.
Respiratory (non-cancer)- Asthma (diagnosed after service)
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Chronic rhinitis
- Chronic sinusitis
- Constrictive / obliterative bronchiolitis
- Emphysema
- Granulomatous disease
- Interstitial lung disease
- Pleuritis
- Pulmonary fibrosis
- Sarcoidosis
- Brain cancer
- Gastrointestinal cancer (any type)
- Glioblastoma
- Head cancer (any type)
- Kidney cancer
- Lymphatic cancer (any type)
- Lymphoma (any type)
- Melanoma
- Neck cancer (any type)
- Pancreatic cancer
- Reproductive cancer (any type)
- Respiratory cancer (any type)
- Male breast cancer (added 2024)
- Urethral cancer (added 2024)
- Cancer of the paraurethral glands (added 2024)
- Certain leukemias (added Jan 2025)
- Certain male genitourinary cancers (added Jan 2025)
Gulf War Illness — Undiagnosed & Chronic Multisymptom Illness
Who: Veterans who served in the Southwest Asia theater (or Afghanistan for certain conditions) with qualifying chronic symptoms, generally rated 10% or more.
- Chronic fatigue syndrome
- Fibromyalgia
- Functional gastrointestinal disorders (e.g., IBS)
- Undiagnosed illness (fatigue, skin, headache, muscle/joint pain)
- Neurological & neuropsychological signs
- Respiratory & sleep disturbances
- Cardiovascular & weight-loss symptoms
- Brucellosis
- Campylobacter jejuni
- Coxiella burnetii (Q fever)
- Malaria
- Mycobacterium tuberculosis
- Nontyphoid Salmonella
- Shigella
- Visceral leishmaniasis
- West Nile virus
Radiation-Exposed (Atomic) Veterans
Who: Veterans who took part in a "radiation-risk activity" — e.g., atmospheric nuclear testing, the occupation of Hiroshima/Nagasaki, or certain other qualifying service.
- Leukemia (except chronic lymphocytic leukemia)
- Multiple myeloma
- Lymphomas (except Hodgkin's)
- Cancer of the thyroid
- Cancer of the breast
- Cancer of the pharynx
- Cancer of the esophagus
- Cancer of the stomach
- Cancer of the small intestine
- Cancer of the pancreas
- Cancer of the bile ducts
- Cancer of the gall bladder
- Cancer of the salivary gland
- Cancer of the urinary tract (kidney, renal pelvis, ureter, bladder, urethra)
- Primary liver cancer (non-cirrhotic)
- Cancer of the lung & bronchiolo-alveolar carcinoma
- Cancer of the bone
- Cancer of the brain
- Cancer of the colon
- Cancer of the ovary
Former Prisoners of War (POW)
Who: Veterans who were prisoners of war. Some conditions require at least 30 days of captivity; others apply regardless of length. Generally must be at least 10% disabling.
Any length of captivity- Psychosis
- Any of the anxiety states
- Dysthymic disorder (depressive neurosis)
- Organic residuals of frostbite
- Post-traumatic osteoarthritis
- Atherosclerotic heart disease / hypertensive vascular disease (& complications)
- Stroke and its residual effects
- Osteoporosis (when the Veteran has PTSD)
- Avitaminosis
- Beriberi (incl. beriberi heart disease)
- Chronic dysentery
- Helminthiasis
- Malnutrition (incl. optic atrophy)
- Pellagra & other nutritional deficiencies
- Irritable bowel syndrome
- Peptic ulcer disease
- Peripheral neuropathy (except where due to infectious cause)
- Cirrhosis of the liver
- Osteoporosis
Camp Lejeune Contaminated Water
Who: Veterans (and reservists/guardsmen) who served at Camp Lejeune, NC for at least 30 cumulative days between August 1, 1953 and December 31, 1987. The following are presumptive for disability compensation:
- Adult leukemia
- Aplastic anemia & other myelodysplastic syndromes
- Bladder cancer
- Kidney cancer
- Liver cancer
- Multiple myeloma
- Non-Hodgkin's lymphoma
- Parkinson's disease
Beyond the eight compensation conditions above, 16 conditions are covered for VA health care under the Caring for Camp Lejeune Families Act — our service officers will help you apply for Camp Lejeune health care — Contact us →.
Chronic Diseases Within One Year & ALS
Who: Any Veteran — no specific exposure required.
- A chronic disease (e.g., arthritis, diabetes, hypertension, peptic ulcers, certain cancers, psychosis, organic neurological disorders) diagnosed to at least 10% within one year of separation
- Amyotrophic lateral sclerosis (ALS) — presumptive any time after discharge for Veterans with 90+ days of continuous active service
- Certain tropical diseases diagnosed within the applicable presumptive period
Sources: U.S. Department of Veterans Affairs and 38 CFR §§ 3.307–3.309. Current as of June 2026. The VA adds presumptive conditions as new science emerges — if your condition isn't listed, you may still qualify, and we can help. Confirm your current eligibility with our office — an accredited VSO will review your case at no cost.
Combined Ratings Estimator (38 CFR § 4.25)
VA disability ratings do not simply add up. The VA uses the combined ratings table in 38 CFR § 4.25 to calculate your overall rating. Enter each individual condition's rating below to estimate the combined value. This is an unofficial estimate — your official rating is determined solely by the VA.
Calculation follows the VA method: ratings are combined in descending order using the formula in 38 CFR § 4.25, then the result is rounded to the nearest 10%. Bilateral factor and special monthly compensation are not included in this estimate.
How the VA combines ratings — a worked example
Ratings don’t add up. Each rating is applied to the remaining healthy percentage, in order from most to least disabling, and the final total is rounded to the nearest 10%. Example: a Veteran rated 50%, 30%, and 20%:
| Step | Combine | How it works | Running value |
|---|---|---|---|
| 1 | Start with the highest rating | — | 50% |
| 2 | Add the 30% | 50 + (30% of the 50% remaining = 15) | 65% |
| 3 | Add the 20% | 65 + (20% of the 35% remaining = 7) | 72% |
| 4 | Round to the nearest 10% | 72 → 70 | 70% |
That is why 50 + 30 + 20 does not equal 100% — it combines to 70%. (Per the regulation, 50% and 30% combine to 65%, which rounds up to 70%; 40% and 20% combine to 52%, which rounds to 50%.) The official table that governs every VA rating decision is 38 CFR § 4.25, the Combined Ratings Table.
View the official 38 CFR § 4.25 Combined Ratings Table (eCFR) →
Toxic Exposure Screening & TERA
Under the PACT Act, every Veteran enrolled in VA health care is offered a free Toxic Exposure Screening — a short set of questions about possible exposures during service. It takes only a few minutes, helps the VA connect you to informed, whole-health care, and you can ask for one at any VA health facility.
What is a TERA?
A Toxic Exposure Risk Activity (TERA) is any activity during your service that exposed you — or carried a real risk of exposing you — to a toxic substance, and that either required an entry in a military exposure-tracking record or that the VA determines qualifies. In plain terms, it is the VA's formal recognition that your service put you in harm's way from a hazardous substance. When the VA confirms it, the determination is recorded in a TERA memorandum in your file.
Exposures that can qualify as a TERA
- Airborne hazards — burn-pit smoke, sand & dust, oil-well fire smoke
- Chemicals — herbicides (Agent Orange), solvents, contaminated water
- Occupational hazards — asbestos, lead, fuels, industrial chemicals
- Radiation — nuclear testing, depleted uranium, radioactive materials
- Warfare agents — chemical & biological weapons
- Other hazards the VA recognizes case-by-case
What a TERA covers — and why it matters
- VA health care eligibility. Any Veteran who took part in a TERA — at home or abroad — is now eligible to enroll in VA health care under the PACT Act.
- Support for a claim, even for non-presumptive conditions. If you have a current diagnosis and evidence of a TERA, the VA must provide a medical exam and nexus opinion to decide whether your condition is connected to that exposure — opening the door to direct service connection when your condition isn't (yet) on a presumptive list.
- A permanent record. Once established, your TERA memorandum stays in your file and supports future claims and care.
Bring your service history, deployment locations and dates, your MOS/job duties, and anything involving smoke, fumes, chemicals, fuels, or radiation. We help document your TERA and file the claim with you.
How to File a PACT Act Claim — We Do It With You
- Contact our office. Call (217) 854-5249 or email macvac@macvac.org to set up a free appointment with an accredited VSO.
- Set up your federal VA online / Id.me account. It helps to have access before your appointment — we can help you create and verify it.
- Gather your records. DD-214(s), deployment locations and dates, and any medical records for the conditions you're claiming.
- We develop and file the claim. We identify every presumptive condition you may qualify for, gather the evidence, and submit the claim through the VA.
- We track it to a decision. We follow your claim, explain VA letters, and help with next steps — including appeals if needed.
Let the VAC Handle It For You
Content last reviewed: June 2026. Presumptive conditions are set and updated by the U.S. Department of Veterans Affairs; always confirm your current eligibility with our office — an accredited VSO will review your case and file with you at no cost.
Think you were exposed? Let's find out together.
An accredited Veterans Service Officer will review your service, screen for every PACT Act benefit you may be owed, and file the claim with you — free of charge.