PACT Act implementation

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, known as the PACT Act, rewrote how VA handles toxic exposure. It created a presumption of exposure for veterans who served in covered locations during covered periods, added more than twenty conditions, mostly respiratory illnesses and cancers, to the presumptive list for burn pit and airborne hazard exposure, and added hypertension and monoclonal gammopathy of undetermined significance to the Agent Orange presumptive list.

It also expanded the map. Agent Orange presumptive locations grew to include Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll for covered periods, and radiation risk activity locations expanded as well. The law required VA to give every enrolled veteran a toxic exposure screening and expanded healthcare eligibility for post-9/11 combat veterans.

The statute allowed VA to phase the new presumptives in over several years. VA instead announced that it would make all PACT Act presumptive conditions effective immediately and began deciding claims under all of them. In January 2025, VA added further cancers, including acute and chronic leukemias, multiple myeloma, myelodysplastic syndromes, myelofibrosis, and urinary bladder, ureter, and related genitourinary cancers, to the toxic exposure presumptive list in 38 CFR 3.320.

For decades, veterans exposed to burn pits and other airborne hazards during the Gulf War and post-9/11 eras had to individually prove that their illnesses were caused by service, a nearly impossible evidentiary burden for exposures that were common but poorly documented. The presumptive framework removes that burden: if the veteran served in a covered place and time and has a listed condition, VA presumes the connection.