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TERA / Toxic Exposure / PACT Act
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TERA / Toxic Exposure / PACT Act

The largest expansion of VA benefits in decades — and the door is open now for burn pit, Agent Orange, Camp Lejeune, and radiation exposure claims

The PACT Act Changed Everything

The PACT Act (Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act), signed into law on August 10, 2022, is the most significant expansion of VA toxic exposure benefits since Agent Orange legislation. It established new presumptive conditions for burn pit exposure, expanded Agent Orange presumptives, created the Toxic Exposure Risk Activity (TERA) framework, and extended eligibility for Gulf War and post-9/11 veterans.

For veterans who were previously denied toxic exposure claims, the PACT Act reopens the door. Conditions that required a difficult-to-obtain nexus letter are now presumptive — meaning the VA presumes they were caused by service if you served in a qualifying location. No nexus letter needed.

If you were denied before the PACT Act for a condition that is now presumptive, file a Supplemental Claim immediately. The new law is the "new and relevant evidence" that reopens your claim.

Burn Pit / Airborne Hazards Presumptives

Post-9/11 veterans who served in Southwest Asia, Afghanistan, or other covered locations after August 2, 1990:

Constrictive bronchiolitisConstrictive pericarditisAny cancer diagnosed after August 2, 1990Sinusitis, rhinitis, laryngitis, rhinosinusitisGastric reflux (GERD)Sleep apneaReproductive and urinary conditions

Agent Orange / Herbicide Presumptives

Vietnam-era, Korea DMZ, Thailand, and other covered locations (see FAQ for full location list):

Type 2 DiabetesIschemic heart diseaseParkinson’s diseaseNon-Hodgkin’s lymphomaProstate cancerRespiratory cancersChloracneAL amyloidosisPeripheral neuropathy (early-onset)Bladder cancer (added under PACT)Hypothyroidism (added under PACT)

Agent Orange presumptives are among the most powerful in the VA system. A single grant of Type 2 diabetes can unlock an entire secondary condition chain: peripheral neuropathy, retinopathy, kidney disease, erectile dysfunction, and hypertension.

All Exposure Categories

Burn Pit / Airborne Hazards

PACT Act §3.320

Iraq, Afghanistan, Southwest Asia (post-9/11, after August 2, 1990)

Conditions: Constrictive bronchiolitis, Constrictive pericarditis, Any cancer diagnosed after August 2, 1990, Sinusitis, rhinitis, laryngitis, rhinosinusitis, Gastric reflux (GERD), Sleep apnea, Reproductive and urinary conditions

Agent Orange / Herbicides

38 CFR §3.309(e)

Vietnam, Thailand, Korea DMZ, C-123 aircraft

Conditions: Type 2 Diabetes, Ischemic heart disease, Parkinson’s disease, Non-Hodgkin’s lymphoma, Prostate cancer, Respiratory cancers, Chloracne, AL amyloidosis, Peripheral neuropathy (early-onset), Bladder cancer (added under PACT), Hypothyroidism (added under PACT)

Camp Lejeune Water

Camp Lejeune Justice Act

Camp Lejeune, NC (1953-1987)

Conditions: Kidney cancer, liver cancer, leukemia, multiple myeloma, bladder cancer, Parkinson’s

Gulf War Illness

38 CFR §3.317

Southwest Asia (1990-present)

Conditions: Chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders (IBS), undiagnosed illnesses with objective indications

Radiation Exposure

38 CFR §3.309(d), §3.311

Nuclear test sites, Hiroshima/Nagasaki cleanup, uranium processing

Conditions: Multiple cancers, leukemia, thyroid disease

Case Snapshot — Sinusitis (Burn Pit)

Denied → 30% via PACT Act / TERA

The veteran was previously denied for chronic sinusitis due to the lack of a medical nexus connecting the condition to military service. The veteran served in a covered burn pit location in Southwest Asia.

After the PACT Act (Public Law 117-168) made sinusitis a presumptive condition under the toxic exposure framework, we filed under TERA with the verified deployment record. No nexus letter was needed — the law now presumes the connection.

Result: service connection granted at 30%. (Anonymized; individual results depend on the specific file and evidence.)

Accuracy Safeguard

PACT Act presumptives depend on verified deployment locations, dates of service, and specific diagnoses. A veteran who served in a covered location but does not have a covered diagnosis, or vice versa, may not qualify under the presumptive pathway. An accredited records review is the only way to determine which pathway applies to your specific file.

Time-Sensitive: PACT Act Filing Windows

Some PACT Act provisions have filing deadlines that affect your effective date. Veterans who file within one year of a condition being added to the presumptive list may receive an effective date back to the date the provision took effect. Filing after that window means the effective date is the date of the new claim.

Earlier filing = more back pay. If you suspect you qualify, file an Intent to File (VA Form 21-0966) today to lock in your date while you gather documentation.

The Advocate's Take

The PACT Act is the biggest opportunity for toxic-exposed veterans in a generation. Conditions that were routinely denied for decades are now presumptive. But the VA is not going to call you and tell you to file — you have to act.

If you served in a burn pit zone, Vietnam, Thailand, Camp Lejeune, or any other toxic exposure location, and you have a condition on the presumptive list, file now. If you were previously denied, file a Supplemental Claim with the PACT Act as your new evidence. And do not stop at the presumptive condition — look at the secondary condition chains that flow from it. The door is open. Walk through it.

Frequently Asked Questions

What is the PACT Act?
The PACT Act (Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022) is the largest expansion of VA benefits in decades. It established new presumptive service connections for conditions related to toxic exposures — primarily burn pits, Agent Orange, and radiation. It also created the Toxic Exposure Risk Activity (TERA) framework and expanded eligibility for Vietnam-era and Gulf War veterans.
What does "presumptive" mean?
A presumptive condition means the VA presumes it was caused by military service if you served in a qualifying location during a qualifying period. You do not need to provide a nexus letter proving the connection — the law presumes it. You still need a current diagnosis, but the burden of proving the link to service is eliminated.
Do I need a nexus letter for a PACT Act claim?
For conditions on the presumptive list: no. If your condition is presumptive and you served in the qualifying location during the qualifying period, the VA must presume service connection. For conditions not on the presumptive list but related to toxic exposure, you may still qualify through the TERA framework, but you will need medical evidence linking the condition to the exposure.
I was previously denied for a condition that is now presumptive. What do I do?
File a Supplemental Claim immediately. The PACT Act creating a new presumptive condition is "new and relevant evidence" for purposes of reopening a previously denied claim. If you file within one year of the PACT Act effective date for your condition, you may receive an effective date as early as August 10, 2022 (the date the PACT Act was signed).
What is the TERA framework?
TERA (Toxic Exposure Risk Activity) is a framework within the PACT Act that allows veterans to claim service connection for conditions related to toxic exposures that are not on the presumptive list. TERA establishes a concession of exposure based on service location and dates, which simplifies the evidence burden even for non-presumptive conditions. The VA is required to complete a TERA assessment for every veteran filing a claim.
What are the Agent Orange service locations?
Agent Orange / herbicide exposure is conceded for veterans who served in: Vietnam (in-country, offshore, or in airspace, 1962-1975), Thailand (certain Royal Thai Air Force Bases, 1962-1975), Korea DMZ (1968-1971), and on C-123 aircraft previously used to spray Agent Orange. The VA also recognizes certain test and storage sites within the United States.
Can PACT Act conditions lead to secondary claims?
Absolutely. This is a critical strategy. For example, Agent Orange-presumptive Type 2 diabetes can establish secondary service connection for peripheral neuropathy, retinopathy, kidney disease, erectile dysfunction, and hypertension — all under 38 CFR §3.310. A single PACT Act grant can unlock an entire secondary condition chain. See our Secondary Conditions page for the full analysis.
Interactive Tool

Toxic Exposure Map — Find Your Exposure Category

Select your exposure type to see qualifying service locations, conditions, and the governing regulation. If you served in one of these areas, you may have presumptive eligibility.

PACT Act 2022 — Presumptive Exposure

Toxic Exposure: What the VA Now Presumes

If you served in these places and times, the VA presumes exposure — you don’t have to prove it happened, only that you were there.

Burn Pits & Airborne Hazards

Qualifying Service

Gulf War & Post-9/11 (on or after Aug 2, 1990 / Sep 11, 2001)

Example Presumptive Conditions

Asthma, rhinitis, sinusitis, many cancers, COPD

Agent Orange (Herbicides)

Qualifying Service

Vietnam (1962–1975), Thailand, Korean DMZ + Blue Water Navy

Example Presumptive Conditions

Diabetes II, ischemic heart disease, Parkinson’s, prostate cancer

Camp Lejeune Water

Qualifying Service

Aug 1953 – Dec 1987 (30+ cumulative days)

Example Presumptive Conditions

Kidney/liver cancer, Parkinson’s, bladder cancer, leukemia

Radiation & Gulf War Illness

Qualifying Service

Atomic veterans; Gulf War undiagnosed illnesses

Example Presumptive Conditions

Certain cancers, chronic fatigue, fibromyalgia, GI issues

Presumption is powerful — but not automatic. You still must file, get a current diagnosis, and be rated. We build the exposure record the VA expects to see.

The Veterans We Fight For

Real Veterans. Real Claims. Real Outcomes.

Every case on this desk belongs to someone who served. These are the veterans this practice represents — across every era, branch, and condition.

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Official VA Video Library · Government Produced

Know What the C&P Exam Should Look Like

Even presumptive claims may require a C&P exam to confirm the diagnosis and assign a rating percentage.

Your VA Claim Exam: What to Expect

Your VA Claim Exam: What to Expect

Tips to Prepare for Your VA Claim Exam

Tips to Prepare for Your VA Claim Exam

Open A Channel

Three Ways to Put an Accredited Agent on TERA / Toxic Exposure / PACT Act

No fee unless you win. An accredited agent #45147 personally reviews every request — we respond within 48 hours.