PACT Act Presumptive Conditions: What the Statutes Actually List

What a presumption does — and why there are two

The catch: presumptive doesn't mean automatic. It means the law fills in something you would otherwise have to prove. For burn pits and other airborne hazards, the provisions added in 2022 by the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act — the PACT Act, as §1116(b) names it in full — fill in two things.

• Exposure. 38 U.S.C. §1119(b)(1) requires VA to presume that any covered veteran was exposed to the substances, chemicals and airborne hazards on a list VA maintains, “unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service.”
• Service connection. Under §1120(a), a listed disease becoming manifest in a covered veteran “shall be considered to have been incurred in or aggravated during active military, naval, air, or space service, notwithstanding that there is no record of evidence of such disease during the period of such service.” That presumption is made subject to §1113, which this guide doesn't cover.

You still need the disease, the qualifying service, and a claim. What the presumptions remove is the need for a service record showing the disease, or proof of the specific exposure.

Who is a covered veteran for burn pits and airborne hazards

§1119(c)(1) defines a covered veteran by where and when you served — in active service “while assigned to a duty station in, including airspace above” one of these countries:

Three details that matter in practice:

• Records help, but aren't the only route. In deciding a claim, VA may consider any record of yours in an exposure tracking record system — which §1119(c)(2) says includes the Individual Longitudinal Exposure Record — and, if no such record shows a toxic exposure, the totality of the circumstances of your service (§1119(a)).
• The substance list is VA's. Under §1119(b)(2)(A), VA establishes and maintains the list of substances, chemicals and airborne hazards, in collaboration with the Secretary of Defense. The statute doesn't print it.
• Any end date has a floor. VA must determine whether to set an end date for these presumptions, but never earlier than the last day of the Persian Gulf War period in §101(33) (§1119(b)(2)(B)). §101(33) defines that period as beginning August 2, 1990 and ending on a date to be prescribed by Presidential proclamation or by law.

The §1120 disease list, as the statute prints it

§1120(b) specifies these, in this order:

1. Asthma that was diagnosed after the covered veteran's qualifying service.
2. These cancers: head cancer of any type; neck cancer of any type; respiratory cancer of any type; gastrointestinal cancer of any type; reproductive cancer of any type; lymphoma cancer of any type; kidney cancer; brain cancer; melanoma; pancreatic cancer.
3. Chronic bronchitis.
4. Chronic obstructive pulmonary disease.
5. Constrictive bronchiolitis or obliterative bronchiolitis.
6. Emphysema.
7. Granulomatous disease.
8. Interstitial lung disease.
9. Pleuritis.
10. Pulmonary fibrosis.
11. Sarcoidosis.
12. Chronic sinusitis.
13. Chronic rhinitis.
14. Glioblastoma.
15. Any other disease VA determines, by regulation under subchapter VII, warrants a presumption based on a positive association with a substance, chemical or airborne hazard on the §1119(b)(2) list.

Watch item 1. Asthma qualifies when it was diagnosed after the covered service — that condition is in the statute itself. And item 15 means the list can grow by regulation. This guide lists only what the statute names, so check VA's current list before concluding a condition isn't covered.

WheelsUp's VA Disability tool (a Pro tool) includes an exposure screener: tick the places you served and it shows whether the §1119 burn-pit presumptions or the §1117 Gulf War illness rules apply to that service, with the §1120 diseases listed — screening against the statutes, not a diagnosis, with a prompt to check your own ILER record before you file.

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Gulf War illness: no manifestation deadline

38 U.S.C. §1117 covers a different kind of condition — a qualifying chronic disability, which §1117(a)(2) defines as a chronic disability resulting from an undiagnosed illness, a medically unexplained chronic multisymptom illness, or a diagnosed illness VA determines by regulation warrants a presumption. Its opening provision, in its current text, lets VA pay compensation “to a Persian Gulf veteran with a qualifying chronic disability that became manifest to any degree at any time.”

⚠ At any time. If you read a manifestation deadline for Gulf War illness somewhere else, the statute's current words control.

Read the verb, too: the statute says VA may pay compensation, and §1117(c) has VA prescribe regulations describing the periods and places of service, the illnesses, and any relevant medical characteristics.

What counts as a qualifying chronic disability

Under §1117(a)(2), a chronic disability resulting from any of these, or any combination of them:

• an undiagnosed illness;
• “A medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms.”
• any diagnosed illness VA determines, in regulations, warrants a presumption of service connection.

§1117(g) lists thirteen signs or symptoms that may be a manifestation of an undiagnosed or chronic multisymptom illness: fatigue; unexplained rashes or other dermatological signs or symptoms; headache; muscle pain; joint pain; neurological signs and symptoms; neuropsychological signs or symptoms; signs or symptoms involving the upper or lower respiratory system; sleep disturbances; gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual disorders.

Who is a Persian Gulf veteran

§1117(f): a veteran who served on active duty in the Southwest Asia theater of operations, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan during the Persian Gulf War — the period §101(33) says began August 2, 1990 and ends on a date to be prescribed by Presidential proclamation or by law.

The statute doesn't define the Southwest Asia theater; 38 CFR §3.317(e)(2) does: Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations.

Two more provisions worth knowing. A disability for which compensation under the subchapter is payable is considered service connected for all other laws of the United States (§1117(e)). And if a Persian Gulf veteran presents at a VA medical facility with any one symptom associated with Gulf War Illness, VA must ensure its health care personnel use a disability benefits questionnaire designed to identify it (§1117(d)).

Agent Orange and other herbicides (§1116)

§1116 is the older presumption, and every one of its covered-service windows closed by July 31, 1980. It matters to veterans of that era, and to their families, rather than to anyone separating now.

A veteran with that service is presumed to have been exposed to an herbicide agent containing dioxin or 2,4-dichlorophenoxyacetic acid, unless affirmative evidence establishes otherwise (§1116(c)). The diseases §1116(a)(2) lists:

• Non-Hodgkin's lymphoma, Hodgkin's disease, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) and multiple myeloma — each becoming manifest to a degree of disability of 10 percent or more;
• each soft-tissue sarcoma other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma — 10 percent or more;
• chloracne or another acneform disease consistent with chloracne, and porphyria cutanea tarda — 10 percent or more within a year after the last date of covered service;
• diabetes mellitus (type 2), parkinsonism, bladder cancer, hypothyroidism, monoclonal gammopathy of undetermined significance, and hypertension;
• and, separately under §1116(a)(1)(B), any additional disease VA determines by regulation to warrant a presumption, if it becomes manifest within any period those regulations set.

Health care runs on a separate track

Service connection is one question; VA health care is another. 38 U.S.C. §1710(e)(1)(H) makes a covered veteran, as §1119(c) defines the term, eligible for VA hospital care (including mental health services and counseling), medical services and nursing home care for any illness — beginning not later than the dates §1710(e)(6)(A) sets for four discharge periods running from August 2, 1990 through December 31, 2018 (VA may move them earlier; the paragraph lists no date for later discharges), and subject to the limits in §1710(e)(2).

Ask VA which date applies to you, and see our priority groups guide for how enrollment works.

The short checklist

1. Check your duty stations against both §1119(c)(1) lists — airspace above those countries counts.
2. Look at your ILER record before you file, and gather what else shows where you served.
3. Match your condition to §1120(b) — then check VA's current list for anything added by regulation.
4. Asthma? Note when it was diagnosed; the statute requires after the covered service.
5. Gulf War service? There is no manifestation deadline; describe symptoms in the §1117(g) categories.
6. Apply for VA health care as its own step (§1710(e)(1)(H)).

Sources

• 38 U.S.C. §1119 — (a) exposure tracking records and the totality of the circumstances; (b)(1) presumption of exposure; (b)(2) VA's list and the end-date floor; (c)(1)(A)–(B) covered veterans; (c)(2) exposure tracking record system, including the Individual Longitudinal Exposure Record
• 38 U.S.C. §1120 — (a) presumption of service connection; (b)(1)–(15) the diseases specified; (c) covered veteran as defined in §1119(c)
• 38 U.S.C. §1117 — (a)(1) manifest to any degree at any time; (a)(2) qualifying chronic disability; (c) regulations; (d) the Gulf War Illness questionnaire; (e) service connected for all other laws; (f) Persian Gulf veteran; (g) the thirteen signs or symptoms
• 38 U.S.C. §101(33) — the Persian Gulf War period · 38 CFR §3.317(e)(2) — the Southwest Asia theater of operations (used for that definition only)
• 38 U.S.C. §1116 — (a)(1)–(2) the presumptions and listed diseases; (c) presumption of exposure; (d)(1)–(5) covered service locations and periods
• 38 U.S.C. §1710(e)(1)(H), (e)(2), (e)(6) — health-care eligibility for covered veterans

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