The PACT Act of 2022 is the largest expansion of VA benefits in decades. Presumptive service connection means the VA cannot require you to prove nexus. Your service in the right location, at the right time, is enough. This guide covers every era — GWOT, Gulf War, Vietnam, Lejeune, radiation.
In a standard VA claim, you must prove three things: a current diagnosis, an in-service event or condition, and a nexus — a medical link connecting the two. Nexus letters are expensive, C&P examiners are hostile, and the burden sits on the veteran.
Presumptive service connection removes the nexus requirement entirely. Congress has looked at the evidence, declared that certain exposures in certain locations cause certain conditions, and written that into federal law. If you have the diagnosis and you had the qualifying service, the VA must grant service connection. Period. The VA cannot require a private nexus letter. The VA cannot use a C&P exam to deny service connection on these conditions.
38 CFR 3.307 — Presumptive service connection for chronic, tropical, and prisoner-of-war-related disabilities. Covers the framework under which presumptives operate and includes Gulf War illness.
38 CFR 3.309 — Specific lists of conditions that are presumptively service-connected: chronic diseases, tropical diseases, Agent Orange/herbicide conditions, Camp Lejeune, and radiation-related conditions.
38 CFR 3.320 — Added by the PACT Act for burn pit / airborne hazard presumptives. Covers covered veterans with qualifying service in Southwest Asia and other locations on or after August 2, 1990 (Gulf War) and on or after September 19, 2001 (post-9/11 theaters).
Official VA reference: VA's PACT Act resource page at VA.gov →
One critical nuance: presumptive service connection determines whether you're service-connected. It does not determine your rating. You will still receive a C&P exam — but the exam is to measure how severe the condition is, not to dispute the connection. Know this going in: the examiner rating your lung function cannot deny service connection for your COPD if you have qualifying Gulf War service. They can only assess severity.
Coverage depends on when and where you served. The PACT Act has two main buckets: Gulf War / post-9/11 veterans (burn pits and airborne hazards) and legacy expansions for Vietnam, Korean DMZ, Thailand, and others. Use the table to find your era.
| Program | Dates | Covered Locations | CFR |
|---|---|---|---|
| Gulf War / GWOT Burn Pits | Aug 2, 1990 – present | Iraq, Kuwait, Saudi Arabia, Afghanistan, Syria, Djibouti, Egypt, Jordan, Lebanon, Uzbekistan, Yemen, waters offshore | 38 CFR 3.320 |
| Post-9/11 Expanded (PACT) | Sep 19, 2001 – present | Same SW Asia locations + Somalia, anywhere on active orders in combat zone | 38 CFR 3.320 |
| Agent Orange — Vietnam | Jan 9, 1962 – May 7, 1975 | Vietnam (in-country), waters offshore (Blue Water Navy), Thailand RTAF bases | 38 CFR 3.309(e) |
| Agent Orange — Korea | Sep 1, 1967 – Aug 31, 1971 | Korean Demilitarized Zone (DMZ) | 38 CFR 3.309(e) |
| Camp Lejeune Water | Aug 1, 1953 – Dec 31, 1987 | Camp Lejeune and MCAS New River, North Carolina (≥30 days) | 38 CFR 3.307(a)(7) |
| Radiation — Atmospheric Tests | 1945 – 1962 | Test sites: Nevada, Pacific (Bikini, Enewetak, Johnston Atoll, etc.) | 38 CFR 3.309(d) |
| Radiation — Occupation / POW | Aug 6 – Sep 2, 1945 | Hiroshima, Nagasaki (occupation forces, POWs) | 38 CFR 3.309(d) |
If your service era and location are in the table, your next step is confirming a covered diagnosis — not proving nexus. The VA must service-connect any covered condition from the relevant list if your service is documented.
These conditions are presumptively service-connected under 38 CFR 3.320 for veterans with qualifying Southwest Asia or post-9/11 service. If you have a current diagnosis and qualifying service, you do not need a nexus letter.
The VA Secretary has authority under the PACT Act to add conditions by rulemaking without requiring an Act of Congress. New conditions are regularly added as evidence accumulates. Check VA's official PACT Act page for the current full list — the conditions listed here reflect the statute as of mid-2026 but are not exhaustive.
Veterans and their families who lived or worked at Camp Lejeune or MCAS New River for at least 30 days between August 1, 1953, and December 31, 1987, were exposed to contaminated drinking water containing volatile organic compounds — including trichloroethylene (TCE), perchloroethylene (PCE), benzene, and vinyl chloride. The VA recognizes a specific presumptive list under 38 CFR 3.307(a)(7).
VA disability claim (under 38 CFR 3.307) — Monthly compensation for rated conditions. Tax-free. Available to veterans and qualifying family members. File VA Form 21-526EZ if you're a veteran, or VA Form 21P-534EZ for surviving family members. No attorney needed.
Camp Lejeune Justice Act of 2022 tort claim — A federal tort lawsuit filed in the Eastern District of North Carolina against the government for harm from contaminated water. Available to veterans AND their family members who were present at Lejeune for ≥30 days during the covered period. This is a civil damages claim — think settlement, not monthly benefits. Most Camp Lejeune tort claimants use an attorney. The two-year statute of limitations runs from August 10, 2022 (the law's enactment date) or two years from when you knew or should have known of the connection.
You can pursue both. Filing for VA disability does not waive your right to a tort claim. Veterans are filing both simultaneously through VSOs and attorneys. The VA claim is faster and provides immediate monthly compensation; the tort claim may result in a larger lump-sum settlement if liability is established. Consult a Camp Lejeune attorney before the tort deadline if you haven't already.
You must document at least 30 cumulative days of presence at Camp Lejeune or MCAS New River during the covered period. Military records, housing records, pay records, and unit assignment records can all document this. Request your complete military records through the National Archives if your service record doesn't clearly show the assignment.
Agent Orange presumptives under 38 CFR 3.309(e) cover the largest presumptive population in VA history. If you served in Vietnam between January 9, 1962, and May 7, 1975, you have presumptive exposure. The PACT Act and pre-PACT legislation expanded the covered population and the condition list significantly.
Hypertension (high blood pressure) was added to the Agent Orange presumptive list effective January 19, 2022. This is potentially the largest group of Vietnam-era veterans to be affected by any single presumptive addition. If you're a Vietnam veteran with hypertension that was previously denied because you couldn't prove service connection — or if you never filed because you assumed it wouldn't qualify — file now. The condition is on the list, and you have a potential effective date argument if you previously filed and were denied.
Veterans who had a hypertension claim previously denied should consider filing a Supplemental Claim with the updated regulation as new and relevant evidence.
Veterans exposed to ionizing radiation during service are covered for presumptive service connection for radiogenic cancers under 38 CFR 3.309(d) and 38 CFR 3.311. The covered exposure events and covered conditions are both broad.
| Covered Event | Description |
|---|---|
| Atmospheric nuclear tests | Participation in above-ground nuclear weapons tests in U.S., Pacific, or other locations (1945–1962) |
| Japan occupation forces | Service in Hiroshima or Nagasaki between August 6 and September 2, 1945 |
| POWs in Japan (WWII) | Prisoners of war held by Japan who were exposed to nuclear fallout |
| Amchitka Island | Service on Amchitka Island, Alaska before January 1, 1974 (underground test site) |
| Gaseous diffusion plants | Exposure while working at a gaseous diffusion plant (Paducah, Portsmouth, or Oak Ridge) |
| Enewetak Atoll cleanup | Service at Enewetak Atoll in the Pacific during cleanup operations (January 1, 1977 – December 31, 1980) |
Unlike other presumptive lists (where specific conditions are listed), radiation-exposed veterans may file any cancer claim. The VA evaluates whether your specific cancer is "radiogenic" — meaning science supports a relationship between radiation and your cancer type. Cancers with strong radiogenic evidence include: leukemia (except CLL), thyroid cancer, breast cancer, esophageal cancer, stomach cancer, pharynx cancer, small intestine cancer, pancreatic cancer, bile duct cancer, gall bladder cancer, salivary gland cancer, urinary tract cancers, and multiple myeloma.
If your cancer is not on the established radiogenic list, you may still file — the VA must consider the claim under 38 CFR 3.311(b)(2) if there is "credible scientific evidence" of a relationship. The dose-reconstruction process can support claims for cancer types not specifically listed.
PACT Act claims intersect with intent to file, C&P exams, and appeals. Use these guides to cover every angle:
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