PACT Act: Presumptive Conditions

Tw0 veterans in front of a table where women take information from them
Veterans check in to a PACT Act informational event put on by the VA Long Beach Healthcare System. (VA Long Beach Healthcare System via Facebook)

The Department of Veterans Affairs estimates that "potentially millions" more veterans or their survivors could be eligible to receive health care or financial compensation for toxic exposure-related medical conditions newly considered presumptive under the PACT Act, said Steve Miska, PACT Act transitional executive director.

The law's presumptive aspect "gives us the opportunity to automatically assume that, by virtue of a veteran having this condition, it must be due to their service," Miska told "That is a game changer in terms of how veterans historically have had to file a claim" for conditions now covered by the PACT Act: "Not only did they have to prove that those conditions were manifesting, but they also had to prove the service connection."

The law added what Miska described as 23 new "buckets of conditions," amounting to more than 330 medical conditions altogether. Some of the buckets contain, for example, a number of related types of cancers.

Whereas in the past, the VA approved about 25% of claims related to burn pit exposures, the rate was about 78.6% for PACT Act claims in the first year, Miska said.

The PACT Act presumes a service connection -- provided the veteran served in a certain place at a certain time -- for the following conditions related to toxic exposures from burn pits, contaminated water at Marine Corps bases in North Carolina, radiation, and the Vietnam-era chemical defoliant, Agent Orange.

Burn Pit Presumptive Conditions

To be eligible for PACT Act compensation for exposure to burn pits or other toxins, veterans must have served at some point since Aug. 2, 1990, on the ground or in the airspace above Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, United Arab Emirates, the Arabian Sea, the Gulf of Aden, the Gulf of Oman, the neutral zone between Iraq and Saudi Arabia, the Persian Gulf or the Red Sea; or since Sept. 11, 2001, on the ground or in the airspace above Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan or Yemen.

If the eligible veteran has, or has had, one of the following conditions, the PACT Act assumes it is connected to burn pits. (The VA says the following are not complete lists of cancers considered presumptive under the PACT Act.)

Brain, head, neck and nervous system cancers

Brain cancers

  • Primary glioblastoma
  • Secondary glioblastoma
  • Anaplastic astrocytoma
  • Brain stem glioma
  • Diffuse astrocytoma
  • Pilocytic astrocytoma
  • Pineal astrocytic tumors
  • Subependymal giant cell astrocytoma
  • Ependymomas (cellular, clear cell, papillary, RELA fusion-positive, and tanycytic)
  • Malignant pineal gland
  • Mixed gliomas (Oligoastrocytoma)
  • Oligodendrogliomas
  • Pituitary carcinoma

Ear and eye cancers

  • Ceruminous adenoma
  • Rhabdomyosarcoma
  • Carcinoid tumors of the orbit and ocular adnexa
  • Eye and ocular adnexa cancers (ciliary body, eyelid, iris, optic disc, retina, vitreous and orbit tumors)
  • Melanomas of the eye (choroidal melanoma, conjunctival melanoma and iris melanoma)
  • Neuroendocrine tumors of the orbit

Mouth, neck and throat cancers

  • Hypopharyngeal cancer (including adenoid cystic carcinoma, lymphoma, mucoepidermoid carcinoma, and squamous cell carcinoma)
  • Jaw cancer (including ameloblastic carcinoma, clear cell odontogenic carcinoma, ghost cell odontogenic carcinoma, multiple myeloma, odontogenic carcinosarcoma, odontogenic sarcoma, osteosarcoma, primary intraosseous carcinoma, and squamous cell carcinoma)
  • Laryngeal cancer (including adenocarcinoma, chondrosarcoma, lymphoma, plasmacytoma, sarcoma, and squamous cell carcinoma)
  • Oral cavity squamous cell carcinoma
  • Oropharyngeal cancer (including lymphoepithelioma, lymphoma, minor salivary gland tumors, salivary gland cancer, squamous cell carcinoma, and tonsillar cancer)
  • Pharyngeal cancer (including basaloid squamous cell carcinoma, keratinizing squamous cell carcinoma, and non-keratinizing squamous cell carcinoma)
  • Salivary gland cancer (including acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma not otherwise specified or “NOS,” mucoepidermoid carcinoma, polymorphous adenocarcinoma, and secretory carcinoma)
  • Thyroid cancer (including anaplastic, follicular, medullary, and papillary)
  • Tongue cancer (including adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low-grade carcinoma)
  • Basal cell carcinoma of the skin
  • Melanoma
  • Squamous cell carcinoma of the skin

Nose cancers

  • Keratinizing undifferentiated carcinoma
  • Non-keratinizing undifferentiated carcinoma
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Adenoid cystic cancer
  • Lymphoma
  • Neuroendocrine carcinoma
  • Olfactory neuroblastoma
  • Plasmacytoma
  • Squamous cell carcinoma
  • Melanoma
  • Fibrosarcoma
  • Leiomyosarcoma
  • Rhabdomyosarcoma
  • Undifferentiated pleomorphic sarcoma


  • Fibromatosis
  • Liposarcoma
  • Malignant ganglioma, mesenchymoma, and schwannoma
  • Osteosarcoma
  • Dermatofibrosarcoma
  • Ectomesenchymoma
  • Ewing sarcoma (endocrine)
  • Fibrosarcoma
  • Leiomyosarcoma
  • Low-grade fibromyxoid sarcoma
  • Rhabdomyosarcoma
  • Angiosarcoma
  • Hemangioendothelioma and hemangiopericytoma
  • Solitary fibrous tumor
  • Vascular sarcoma

Spinal cord cancers

  • Lymphoma
  • Malignant schwannoma
  • Multiple myeloma
  • Osteosarcoma
  • Solitary plasmacytoma
  • Chondrosarcoma
  • Chordoma
  • Ewing’s sarcoma
  • Malignant peripheral nerve sheath tumor

Gastrointestinal cancers

  • Anal cancer (including adenocarcinoma, basal cell cancer, carcinoma in situ or “Bowen’s disease,” melanoma, and squamous cell cancer) 
  • Colorectal cancer or colon cancer (including adenocarcinoma, carcinoid, gastrointestinal stromal tumor, and lymphoma)
  • Esophageal cancer (including adenocarcinoma and squamous cell carcinoma)
  • Liver cancer (including hepatocellular carcinoma of the liver and intrahepatic tract)
  • Pancreatic cancer (including adenocarcinoma of the pancreas)
  • Salivary gland cancers (including acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma not otherwise specified or “NOS,” mucoepidermoid carcinoma, polymorphous adenocarcinoma, and secretory carcinoma)
  • Small intestine cancers (including adenocarcinoma, carcinoid tumor, gastrointestinal stromal tumor, lymphoma, and sarcoma)
  • Spleen cancers (including primary tumors of the spleen)
  • Stomach cancers (including carcinoid tumors, diffuse adenocarcinoma, gastrointestinal stromal tumor, intestinal carcinoma, and lymphoma)
  • Tongue cancer (including adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low-grade carcinoma)

Kidney cancers

  • Renal cell carcinoma (including chromophobe, clear cell, clear cell papillary, collecting duct, medullary, papillary, and unclassified types)
  • Non-renal cell carcinoma (including renal sarcoma and Wilms tumor) 


  • B-cell lymphoma (including diffuse B-cell lymphoma, follicular B-cell lymphoma, other non-Hodgkin mature B-cell lymphoma, and small cell B-cell lymphoma)
  • Hodgkin’s lymphoma
  • Anaplastic large cell lymphoma
  • Burkitt lymphoma
  • Lymphoblastic lymphoma
  • Mantle-cell lymphoma
  • Mycosis fungoides
  • Non-Hodgkin’s lymphoma
  • T-cell lymphoma


  • Melanomas of the eye (including choroidal melanoma, conjunctival melanoma, and iris melanoma)
  • Melanomas of the skin (including acral lentiginous melanoma, lentigo maligna melanoma, nodular melanoma, and superficial spreading melanoma)
  • Mucosal melanoma (melanomas that originate in tissues that line internal areas of the body)

Pancreatic cancers

  • Exocrine pancreatic cancers (including adenocarcinoma, adenosquamous carcinoma, colloid carcinoma, and squamous cell carcinoma)
  • Neuroendocrine pancreatic cancer

Reproductive cancers

Female reproductive cancers

  • Breast cancer
  • Cervical cancer
  • Ovarian cancer
  • Paraurethral gland cancer
  • Uterine cancer
  • Vaginal cancer
  • Vulvar cancer

Male reproductive cancers

  • Male breast cancer
  • Penile cancer
  • Prostate cancer
  • Testicular cancer

Other reproductive cancers

  • Urethral cancer

Respiratory cancers

Bronchial cancers

  • Adenocarcinoma
  • Large-cell carcinoma
  • Squamous cell carcinoma

Laryngeal cancers

  • Adenocarcinoma
  • Chondrosarcoma
  • Glottis, laryngeal neuroendocrine, subglottis, or supraglottis neoplasm
  • Lymphoma
  • Plasmacytoma
  • Sarcoma
  • Squamous cell carcinoma

Lung cancers

  • Adenocarcinoma
  • Carcinoid tumor
  • Large cell carcinoma
  • Pleomorphic carcinoma
  • Salivary gland carcinoma
  • Squamous cell carcinoma (epidermoid carcinoma)
  • Unclassified carcinoma
  • Combined small cell carcinoma
  • Small cell carcinoma (oat cell cancer)
  • Adenosquamous carcinoma of the lung
  • Sarcomatoid carcinoma of the lung
  • Sarcomoid carcinoma of the lung
  • Typical and atypical carcinoid of the lung

Nasopharyngeal cancers

  • Keratinizing undifferentiated carcinoma
  • Non-keratinizing undifferentiated carcinoma
  • Squamous cell carcinoma

Paranasal sinus and nasal cavity cancers

  • Lymphoma
  • Melanoma
  • Neuroendocrine carcinoma
  • Plasmacytoma
  • Squamous cell carcinomaAdenocarcinoma
  • Adenoid cystic cancer
  • Fibrosarcoma undifferentiated pleomorphic sarcoma
  • Leiomyosarcoma
  • Olfactory neuroblastoma
  • Rhabdomyosarcoma

Pharyngeal cancers

  • Basaloid squamous cell carcinoma
  • Keratinizing squamous cell carcinoma
  • Non-keratinizing squamous cell carcinoma

Throat (oropharyngeal) cancers

  • Lymphoepithelioma
  • Lymphoma
  • Minor salivary gland tumors
  • Salivary gland cancer
  • Squamous cell carcinoma
  • Tonsillar cancer

Trachea cancers

  • Adenocarcinoma of the trachea
  • Squamous cell carcinoma of the trachea

Non-cancer conditions

  • Asthma that was diagnosed after service
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic rhinitis
  • Chronic sinusitis
  • Constrictive bronchiolitis or obliterative bronchiolitis
  • Emphysema
  • Granulomatous disease
  • Interstitial lung disease (ILD)
  • Pleuritis
  • Pulmonary fibrosis
  • Sarcoidosis

Contaminated Water Presumptive Conditions

To be eligible for PACT Act benefits for exposure to contaminated water in North Carolina, veterans must have served at either Marine Corps Base Camp Lejeune or Marine Corps Air Station New River between Aug. 1, 1953, and Dec. 31, 1987.

If the veteran has, or has had, one of these conditions, the PACT Act assumes it is connected to contaminated water:

  • Adult leukemia
  • Aplastic anemia and other myelodysplastic syndromes
  • Bladder cancer
  • Kidney cancer
  • Liver cancer
  • Multiple myeloma
  • Non-Hodgkin lymphoma
  • Parkinson's disease

Agent Orange Presumptive Conditions

The PACT Act added five new locations where it presumes conditions are related to exposure to the defoliant Agent Orange: military bases in Thailand, Jan. 9, 1962-June 30, 1976; Laos, Dec. 1, 1965-Sept. 30, 1969; locations in Cambodia, April 16-30, 1969; Guam or American Samoa or territorial waters off either location, Jan. 6, 1962-July 31, 1980; and Johnston Atoll or on a ship that called there, Jan. 1, 1972, through Sept. 30, 1977.

If the veteran has, or has had, one of these conditions, the PACT Act assumes it is connected to Agent Orange:

  • High blood pressure (also called hypertension)
  • Monoclonal gammopathy of undetermined significance (MGUS)

The VA already presumed a service connection to Agent Orange for a number of other conditions at additional locations.

More Exposure-Related Presumptive Conditions

The PACT Act only added new presumptive service connections. The VA already covered conditions presumed to be from exposure to asbestos, mustard gas, chemical testing and more circumstances of military service.

Just because the PACT Act hasn't declared a condition presumptive yet doesn't mean it never will, Miska said. The law requires the VA to examine evidence of service connection to "future potential conditions" to recommend for inclusion.

-- Amanda Miller can be reached at

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