PACT Act Conditions
The PACT Act added more than 20 burn pit and toxic exposure conditions to the VA presumptive list, which means the VA accepts the service connection without a nexus letter. Chronic sinusitis, one of the most claimed of them, pays $552.47/month at the 30 percent level in 2026.
Rating Criteria by Level
The PACT Act is an exposure law, not a diagnostic code, so there is no single rating scale for it. Each presumptive condition is rated on its own criteria under 38 CFR Part 4. The scale below is for chronic sinusitis, rated under the general rating formula for sinusitis in 38 CFR 4.97, which is one of the most frequently granted burn pit presumptives.
Who Qualifies for PACT Act Presumptives
The presumption turns on where and when you served. If your record places you in a covered location during a covered window, the VA presumes toxic exposure and you never have to prove proximity to a burn pit.
- Gulf War era, on or after August 2, 1990: Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the United Arab Emirates
- Post-9/11 era, on or after September 11, 2001: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen
- The airspace above any of the locations listed above
- Camp Lejeune, at least 30 cumulative days between August 1, 1953 and December 31, 1987, under the Camp Lejeune Justice Act
- Radiation cleanup at Enewetak Atoll, Palomares in Spain, and Thule Air Base in Greenland, all added to the radiation-exposed veteran definition
- Agent Orange locations added in 2022: Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll, covered on the Agent Orange presumptives page
The VA also offers a free toxic exposure screening at every VA medical center. It does not replace a claim, but the screening note becomes part of your medical record and helps establish the exposure history.
Presumptive Respiratory Conditions
These are the airway and lung diagnoses the PACT Act made presumptive for burn pit and particulate matter exposure. Most are rated on pulmonary function testing values, so recent PFT results carry more weight than symptom reports.
DC 6602, rated 10 to 100 percent on FEV-1 results and medication requirements. Daily inhaled bronchodilator therapy alone meets the 30 percent level.
Rated 0 to 50 percent under the general rating formula for sinusitis. The count of incapacitating episodes per year drives the level.
Rated 10 or 30 percent depending on polyps and the degree of nasal passage obstruction. Frequently claimed alongside sinusitis.
DC 6600, rated 10 to 100 percent on pulmonary function testing values including FEV-1 and DLCO.
Chronic obstructive pulmonary disease, rated on the same pulmonary function scale as bronchitis and emphysema, from 10 to 100 percent.
Rated on FEV-1, the FEV-1/FVC ratio, and DLCO. Advanced disease requiring oxygen therapy reaches the 100 percent level.
A small airways disease strongly associated with deployment exposure. Often requires a lung biopsy to confirm, and is rated on restrictive lung disease criteria.
Rated on DLCO, FVC, and whether the veteran requires supplemental oxygen. Progressive cases reach 100 percent.
Scarring of lung tissue rated on pulmonary function values and oxygen requirement. Commonly claimed with interstitial lung disease.
A granulomatous disease rated 0 to 100 percent on pulmonary involvement and whether systemic corticosteroid therapy is required.
Any chronic granulomatous condition of the lungs. Rated on the residual pulmonary impairment it produces.
Inflammation of the lung lining. Rated on restrictive impairment and any residual pleural thickening.
Presumptive Cancers
The PACT Act cancer categories are written broadly, using the phrase "of any type" for most organ systems. Malignancies are rated 100 percent while active and through the treatment period, then re-examined and rated on residual impairment.
Rated 100 percent while active and through the treatment period, then re-evaluated on residuals such as speech, swallowing, or cognitive impairment.
100 percent during active disease and for six months after treatment ends, then rated on functional residuals.
Lung, bronchus, trachea, and larynx. Rated 100 percent while active, then on residual lung function measured by pulmonary function testing.
Esophageal, stomach, colon, rectal, and related malignancies. 100 percent during treatment, then rated on digestive residuals.
Includes prostate, testicular, and gynecologic malignancies. Prostate cancer steps down to voiding dysfunction or erectile dysfunction residuals after treatment.
Covers Hodgkin and non-Hodgkin lymphoma. Rated 100 percent while active and for six months following the end of treatment.
Rated 100 percent during active disease. Residuals are rated on the genitourinary schedule, including any loss of a kidney.
Includes glioblastoma, which was one of the earliest burn pit presumptives. Residuals are rated on cognitive, motor, and seizure impairment.
Rated 100 percent while active. Residual scarring and any lymph node involvement are rated separately afterward.
Rated 100 percent during active disease. Digestive and endocrine residuals, including secondary diabetes, are rated on their own criteria.
How to File a PACT Act Claim
A presumptive removes the nexus requirement, but the other two elements still apply. You need qualifying service and a current diagnosis. There are three practical routes:
Show the qualifying location and date range on your DD-214 or deployment orders, and show a current diagnosis on the list published under 38 CFR 3.320. The VA then presumes both exposure and causation, and no nexus letter is needed.
If the VA denied a respiratory or cancer claim before August 2022, file a supplemental claim rather than an appeal. The PACT Act counts as a liberalizing law change, and a grant can carry an effective date reaching back to the original claim, which produces retroactive back pay.
Diagnoses that are not listed can still be won directly. That path requires documenting actual exposure (deployment records, base air quality reports, buddy statements) plus a medical nexus opinion. It is harder, but it is open to any condition, including sleep apnea and GERD claims tied to deployment.
What Happens at Your C&P Exam
For a presumptive claim the exam is about severity, not causation. The examiner is not deciding whether burn pits caused your condition, because the regulation already settled that question. Expect the examiner to:
- Confirm the diagnosis and review imaging, pathology reports, and pulmonary function testing
- Order or review PFT values including FEV-1, the FEV-1/FVC ratio, and DLCO for any respiratory claim
- Count incapacitating and non-incapacitating episodes over the previous 12 months for sinusitis and rhinitis
- Document your exact medication regimen, including inhaled bronchodilators, corticosteroids, and any oxygen requirement
- Record surgical history, since repeated sinus surgery is the gate for the 50 percent level
- Screen for separately ratable conditions such as sleep apnea, GERD, and hypertension
Bring proof of the qualifying deployment, a current medication list, and every record of a treated flare-up. Episode counts decide sinusitis and rhinitis ratings, and flare-ups treated at home without a provider visit are invisible to the rater.
Secondary Conditions to PACT Act Presumptives
The presumptive is often only the starting point. Conditions caused or aggravated by a service-connected PACT Act diagnosis are rated separately and combine into your total.
Chronic nasal obstruction from sinusitis and rhinitis is a recognized contributor to obstructive sleep apnea. A CPAP prescription rates 50 percent on its own.
Chronic sinus pressure and headaches frequently support a separate headache claim. Prostrating attacks are rated 0 to 50 percent.
Living with chronic respiratory disease or a cancer diagnosis routinely supports a secondary mental health claim. Rated 0 to 100 percent on the mental disorders scale.
Breathlessness and cancer surveillance drive anxiety claims in this population. Rated on the same general formula as depression.
Chronic hypoxia and long-term corticosteroid therapy both raise blood pressure. Rated 10 to 60 percent under DC 7101.
Steroid inhalers and chronic cough aggravate acid reflux. Rated on symptom severity and its effect on health.