The VA's list of presumptive conditions has grown significantly since the PACT Act became law in August 2022, and 2025 brought another wave of additions. As of mid-2026, the VA recognizes over 330 specific conditions across more than 23 exposure categories. Veterans who served in qualifying locations no longer need to prove their illness was caused by service, which used to be the biggest barrier to approval. They just need to show qualifying service and a current diagnosis.
This guide covers every major category of new and existing presumptive conditions, explains who qualifies, and walks through the steps to file a claim.
What "Presumptive" Means for Your Claim
When the VA designates a condition as presumptive, it accepts that the condition is connected to military service without requiring you to prove how. The burden of proof shifts. Instead of submitting a detailed nexus letter or medical evidence linking your illness to a specific exposure, you provide two things: evidence of qualifying service and a diagnosis from a licensed medical provider.
This matters for claim approval rates. Before the PACT Act, the VA approved roughly 25% of burn pit-related claims. Since the law took effect, that rate climbed to approximately 78%. The presumptive designation is the single biggest factor in that change.
Newly Added Presumptive Conditions (2024 to 2025)
The following conditions were added to the VA's presumptive list in the 24 months leading into 2026:
Added in January 2025
| Condition | Category |
|---|
| Acute leukemia | Cancer |
| Chronic leukemia | Cancer |
| Multiple myeloma | Cancer |
| Myelodysplastic syndromes | Cancer |
| Myelofibrosis | Cancer |
| Urinary bladder cancer | Cancer |
| Ureter cancer | Cancer |
| Additional genitourinary cancers | Cancer |
Added in Summer 2024
| Condition | Category |
|---|
| Male breast cancer | Cancer |
| Urethral cancer | Cancer |
| Cancer of the paraurethral glands | Cancer |
Agent Orange Additions (Recent)
| Condition | Category |
|---|
| Hypertension (high blood pressure) | Cardiovascular |
| Monoclonal gammopathy of undetermined significance (MGUS) | Blood disorder |
Full Burn Pit and Toxic Exposure Presumptive List
The PACT Act created presumptive status for veterans exposed to airborne hazards including burn pits, particulate matter, and industrial pollutants during qualifying deployments.
Burn Pit Cancers
| Cancer Type | Notes |
|---|
| Brain cancer | Including glioblastoma |
| Gastrointestinal cancers | Colorectal, esophageal, stomach, pancreatic |
| Respiratory cancers | Lung, bronchial, laryngeal, tracheal |
| Lymphomas | Including non-Hodgkin's lymphoma |
| Melanoma | Skin cancer |
| Head and neck cancers | Ear, eye, nose, throat, salivary gland |
| Kidney cancers | |
| Sarcomas | Soft tissue |
| Reproductive cancers | |
| Genitourinary cancers | Bladder, ureter, urethral, paraurethral |
Burn Pit Respiratory Conditions
| Condition | Notes |
|---|
| Asthma | Diagnosed after service |
| COPD | Chronic obstructive pulmonary disease |
| Chronic bronchitis | |
| Emphysema | |
| Interstitial lung disease | |
| Pulmonary fibrosis | |
| Constrictive or obliterative bronchiolitis | |
| Granulomatous disease | |
| Pleuritis | |
| Sarcoidosis | |
| Chronic rhinitis | |
| Chronic sinusitis | |
Qualifying Service for Burn Pit Presumptives
To qualify under the burn pit and airborne hazard category, you must have served:
- 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 Persian Gulf, or the Red Sea on or after August 2, 1990
- On the ground or in the airspace above Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, or Yemen on or after September 11, 2001
Agent Orange Presumptive Conditions
Vietnam-era veterans and others exposed to herbicides have a separate presumptive list. These conditions do not require proof of direct Agent Orange contact if you served in a qualifying location.
Agent Orange Cancers
| Cancer | Notes |
|---|
| Bladder cancer | |
| Chronic B-cell leukemia | |
| Hodgkin's disease | |
| Multiple myeloma | |
| Non-Hodgkin's lymphoma | |
| Prostate cancer | |
| Respiratory cancers | Including lung cancer |
| Soft tissue sarcomas | With certain exclusions |
Agent Orange Other Conditions
| Condition | Notes |
|---|
| AL amyloidosis | Rare blood protein disorder |
| Chloracne | Skin disorder caused by chlorine compounds |
| Diabetes mellitus type 2 | |
| High blood pressure (hypertension) | Added recently |
| Hypothyroidism | |
| Ischemic heart disease | |
| MGUS | Monoclonal gammopathy of undetermined significance |
| Parkinson's disease | |
| Parkinsonism | |
| Peripheral neuropathy, early onset | |
| Porphyria cutanea tarda | Liver condition |
Agent Orange Qualifying Locations (Expanded in 2022)
The PACT Act added five new locations where Agent Orange service is now recognized:
- Thailand (at certain perimeters and bases)
- Laos
- Cambodia
- Guam and American Samoa
- Johnston Atoll
Previously these locations were not covered. Veterans who served in these areas and have an Agent Orange condition can now file or refile.
Camp Lejeune Contaminated Water Conditions
Veterans who lived or worked at Marine Corps Base Camp Lejeune in North Carolina for at least 30 days between August 1, 1953 and December 31, 1987 are covered under a separate presumptive category tied to contaminated water exposure.
| Condition | Notes |
|---|
| Bladder cancer | |
| Kidney cancer | |
| Leukemia | |
| Multiple myeloma | |
| Non-Hodgkin's lymphoma | |
| Parkinson's disease | |
| Neurobehavioral effects | |
| Renal toxicity | |
| Hepatic steatosis | |
| Female infertility | |
| Miscarriage | |
| Scleroderma | |
Family members who lived on base during the qualifying period may also be eligible for health care through the VA.
Gulf War Illness Presumptive Conditions
Gulf War veterans who served in Southwest Asia on or after August 2, 1990, can receive disability compensation for certain chronic, unexplained conditions under the Gulf War illness presumptive. This category covers conditions that may not have a confirmed medical diagnosis but are linked to undiagnosed illness.
| Condition | Notes |
|---|
| Chronic fatigue syndrome | |
| Fibromyalgia | |
| Functional gastrointestinal disorders | Including IBS |
| Undiagnosed illnesses | With objective signs of reduced function |
These conditions must be present for at least six months and rated at least 10% disabling to qualify. The presumptive period extends through December 31, 2026 and has been renewed repeatedly.
Radiation Exposure Presumptive Conditions
Veterans exposed to ionizing radiation during service at specific nuclear test sites, cleanup operations, or through prisoner of war situations may qualify under a radiation-based presumptive.
Qualifying locations and events include:
- Nuclear atmospheric testing sites (including Marshall Islands)
- Cleanup at Enewetak Atoll
- Palomares, Spain (1966 B-52 crash)
- Thule Air Force Base, Greenland (1968)
Radiation-associated cancers include all malignancies except chronic lymphocytic leukemia. Veterans must have participated in a qualifying radiation risk activity and developed a covered cancer.
What the 2026 PACT Act Review Could Add
Under Section 902 of the PACT Act, the VA is required to review scientific evidence on a two-year cycle and formally consider adding new presumptive conditions. August 2026 marks four years since the law passed, triggering another mandatory review.
The VA Advisory Committee on Toxic Exposures has reportedly examined approximately 47 potential new conditions in this review cycle. Areas under consideration include:
- Additional Camp Lejeune illnesses beyond the original eight covered conditions
- New respiratory diseases linked to burn pit research published since 2022
- Additional Agent Orange health outcomes
Until the VA formally publishes a rule, these conditions are not yet presumptive. Veterans with conditions under review can still file a traditional claim with supporting medical evidence and should not wait for the review cycle to conclude.
How to File a Presumptive Conditions Claim
Filing a PACT Act or presumptive conditions claim follows the same process as any VA disability claim, but you do not need a nexus letter or medical opinion linking the condition to service.
Step 1: Gather your service records.
Pull your DD-214 and any deployment records that confirm service in a qualifying location and timeframe. If you served in Iraq, Afghanistan, or Southwest Asia, your service dates and duty locations establish the exposure tie.
Step 2: Get a current diagnosis.
You need a diagnosis from a licensed physician. This can be from a VA provider, a private doctor, or a community care provider. The diagnosis must be on the presumptive conditions list.
Step 3: File online through VA.gov.
Go to va.gov and use the online claims system to submit VA Form 21-526EZ. Select "toxic exposure" as the basis for your claim and identify the specific presumptive condition. The online system is the fastest filing method.
Step 4: File by mail or in person if preferred.
You can mail your completed form to the VA Claims Intake Center or visit a VA regional office. Bring copies of your DD-214 and medical records.
Step 5: Connect with a Veterans Service Officer (VSO).
VSOs from organizations like the American Legion, DAV, or VFW provide free claims assistance. They can review your paperwork before submission, catch missing documentation, and help refile denied claims. This costs nothing.
Step 6: Track your claim.
After filing, you can check claim status at va.gov/track-claims or call 1-800-827-1000.
What to Do if Your Claim Was Previously Denied
If the VA denied a claim for a condition that later became presumptive, you may be able to reopen or refile without starting from scratch. The key issue is your effective date, which determines how far back your payments go.
If you file a supplemental claim for a newly presumptive condition within one year of the VA's rule change adding that condition, your effective date goes back to your original claim filing date. File as soon as possible after a new condition is added to preserve the earliest possible effective date.
Veterans whose conditions were denied before the PACT Act should file a supplemental claim citing the new presumptive status rather than waiting for the VA to act automatically.
Frequently Asked Questions
What are the newest presumptive conditions added to the VA list?
The most recent additions came in January 2025. They include acute and chronic leukemias, multiple myeloma, myelodysplastic syndromes, myelofibrosis, urinary bladder cancer, ureter cancer, and other genitourinary cancers. Before that, in summer 2024, the VA added male breast cancer, urethral cancer, and cancer of the paraurethral glands. Hypertension and MGUS were added to the Agent Orange list.
Do I need a nexus letter for a presumptive conditions claim?
No. A nexus letter is not required for VA presumptive conditions claims under the PACT Act. You need a diagnosis and proof of qualifying service, but you do not need a medical opinion connecting your condition to service exposure.
Can I get back pay if my condition is newly added to the presumptive list?
Potentially yes. If you had a prior denied claim and file a supplemental claim within one year of the new presumptive rule taking effect, the VA can restore your original effective date. Back pay would cover the period from that original date. Acting quickly after any new addition is added is important.
What service qualifies for burn pit presumptives?
Service in Iraq, Afghanistan, and 13 other countries in the Gulf and Middle East regions on or after August 2, 1990 (Gulf region) or September 11, 2001 (Afghanistan and other specified locations). You do not need to have worked directly at a burn pit; presence in the qualifying area is sufficient.
How long does a PACT Act claim take to process?
Processing times vary but PACT Act claims are processed faster than traditional disability claims. The VA has reported that veterans filing these claims in 2026 receive decisions about 65% faster than non-PACT claims. Using the online filing system and submitting complete documentation upfront reduces delays.
What happens if I have a condition that is under review but not yet presumptive?
You can file a traditional disability claim now and include supporting medical evidence showing the connection between your service and your condition. Filing early preserves your potential effective date. If the condition is later made presumptive, your existing claim could benefit from the retroactive review process.
What is the difference between presumptive and non-presumptive VA claims?
For a presumptive condition, the VA assumes service connection once you prove qualifying service and have a diagnosis. For a non-presumptive condition, you must prove the condition is related to service through medical evidence and a nexus letter from a physician. Presumptive claims are faster and have a higher approval rate.
If you are unsure what VA benefits you may qualify for based on your service history, run a free screening at benefitsusa.org/screener. The tool checks multiple federal and state programs at once and shows your estimated benefits in under five minutes.
