PACT Act Presumptive Conditions: What Changed and Where the Rules Live

Public Law 117-168 was signed on August 10, 2022. VA describes it as perhaps the largest health care and benefit expansion in its history. It expanded and extended VA health care eligibility for veterans with toxic exposure. It added more than 20 new presumptive conditions. It added presumed-exposure locations for Agent Orange and for ionizing radiation. It also required a toxic exposure screening for every veteran enrolled in VA health care, with a follow-up screening at least once every five years.

The compensation side phased in on a schedule written into the statute itself. October 1, 2023 covered asthma, chronic sinusitis, chronic rhinitis, and most of the named cancers. October 1, 2024 covered chronic bronchitis and chronic obstructive pulmonary disease. October 1, 2025 covered kidney cancer and respiratory cancer. All three dates have passed. The phase-in is finished and is now a historical detail rather than a gate on anyone's claim.

There is no filing deadline. VA's own page states that the PACT Act is here to stay and that veterans and survivors can file for benefits anytime. The separate one-year window that backdated PACT Act claims to August 10, 2022 closed on August 14, 2023, after a short extension. Ordinary effective-date rules apply now.

Most writing on this subject cites 38 CFR 3.307 and 3.309. For burn pits that citation is wrong, and the error is easy to check. Paragraph (a) of 38 CFR 3.307 has seven subparagraphs and stops at (a)(7), which covers Camp Lejeune. There is no (a)(8) and no (a)(9). The section says nothing about burn pits, airborne hazards, fine particulate matter, or Southwest Asia.

The burn pit condition list is statutory. 38 USC 1120(b) names asthma diagnosed after service, ten categories of cancer, chronic bronchitis, chronic obstructive pulmonary disease, constrictive or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, sarcoidosis, chronic sinusitis, chronic rhinitis, and glioblastoma. The presumption of exposure, along with the country and date lists that drive it, sits at 38 USC 1119. Neither list was ever folded into the Code of Federal Regulations.

A proposed rule published October 1, 2024 would have done exactly that. It would retitle 38 CFR 3.320 and rebuild it around the statutory disease list. Its comment period closed December 2, 2024. No final rule has replaced the section. As of August 21, 2026 the current text of 3.320 still carries its 2023 heading, 'Claims based on exposure to fine particulate matter,' and its shorter list.

Three regulations do carry particulate-matter presumptions, and they are narrower than the statute. 38 CFR 3.320 covers asthma, rhinitis, and sinusitis, plus nine rare cancers of the larynx, trachea, and lung. 38 CFR 3.320a covers urinary bladder cancer and ureter cancer, effective January 2, 2025. 38 CFR 3.320b covers acute and chronic leukemias, multiple myelomas including MGUS, myelodysplastic syndromes, and myelofibrosis, effective January 10, 2025.

VA's presumptive system is not one list. It is five separate bodies of law that grew at different times, use different triggers, and sit in different places.

Burn pits and fine particulate matter run on 38 USC 1119 and 1120, with three narrower regulations at 38 CFR 3.320, 3.320a, and 3.320b. Herbicides run on 38 USC 1116, 1116A, and 1116B, and on 38 CFR 3.307(a)(6) and 3.309(e). Camp Lejeune water contamination runs on 38 CFR 3.307(a)(7) and 3.309(f), which are regulatory rather than statutory. Ionizing radiation runs on 38 USC 1112(c) and 38 CFR 3.309(d), with a second and completely different path at 38 CFR 3.311. Gulf War undiagnosed illness runs on 38 USC 1117 and 1118, and on 38 CFR 3.317.

The differences between the five are not cosmetic. One family needs 30 days of cumulative presence at a named base. Another needs one day at a duty station in a listed country. One has a manifestation deadline of December 31, 2026. Three have no deadline at all. The per-family pages linked below carry the specifics.

38 CFR 3.309(e) lists 14 diseases associated with herbicide exposure. Hypertension is not one of them. Neither is monoclonal gammopathy of undetermined significance, bladder cancer, hypothyroidism, or parkinsonism as distinct from Parkinson's disease. All five sit in the statute at 38 USC 1116(a)(2). The regulation was last amended March 13, 2023 and still carries the older list.

VA administers the statute. Its public Agent Orange eligibility page names 19 conditions, which matches 38 USC 1116(a)(2) rather than the regulation. A proposed rule published February 12, 2024 under RIN 2900-AR10 would add those five diseases to 3.309(e), and would add regulatory paragraphs for Thailand, Laos, Cambodia, Guam and American Samoa, and Johnston Atoll. As of August 21, 2026 no final rule has been published.

This gap explains a common piece of confusion. A veteran reads 38 CFR 3.309(e), does not find their condition, and concludes there is no presumption. The controlling text for those five diseases is the statute, and the statute has them.

A presumption removes the burden of proving why a condition happened. Where a presumption applies, VA treats the condition as incurred in service without the veteran producing evidence of cause.

It does not remove the need for a current diagnosis. It does not remove the need for the severity to be documented. Those are two different requirements, and they are the ones that actually decide the percentage. The presumption answers the cause question and stops there.

Presumptions can also be rebutted. 38 USC 1113 and 38 CFR 3.307(d) allow affirmative evidence to defeat one. The particulate-matter regulations at 3.320(b) name their own exceptions: a condition not incurred during or aggravated by qualifying service, a supervening condition or event after the most recent departure from service, and the veteran's own willful misconduct.

Two dates are currently operative and worth stating plainly.

Agent Orange hypertension. 38 USC 1116(a)(2)(M) added hypertension to the herbicide disease list. Under section 404(d) of Public Law 117-168 it applied from August 10, 2022 to dependency and indemnity compensation claimants under chapter 13, and to veterans who are terminally ill, homeless, under extreme financial hardship, more than 85 years old, or able to show other sufficient cause. For all other veterans the statutory date is October 1, 2026.

Gulf War undiagnosed illness. 38 CFR 3.317(a)(1)(i) requires a qualifying chronic disability to become manifest during qualifying service, or to a degree of 10 percent or more not later than December 31, 2026. That text was set by a final rule effective February 3, 2022, and the section's amendment note still ends at 86 FR 51001, September 14, 2021, which means no later amendment has been codified. The date applies only to the undiagnosed illness and multisymptom illness presumption in 3.317(a). It does not touch the nine infectious diseases in 3.317(c), the burn pit presumptions at 38 USC 1120, or direct service connection.

The burn pit, Camp Lejeune, and radiation presumptions carry no manifestation deadline at all.

A VA-accredited Veterans Service Organization representative can prepare and file an exposure claim with a veteran and does not charge for it. That is the free option, and it exists for every one of the five families on this page.

The records side is often the real work. Presumptions turn on where a person was and when, so the file usually needs orders, a personnel record, or a campaign medal rather than a medical argument. The page on proving presence, linked below, covers which record shows what.