Gulf War Exposure and Presumptive Conditions (PACT Act)

Gulf War Exposure and Presumptive Conditions (PACT Act)

What is the PACT Act?

PACT Act Accomplishes:

  • Expands locations for radiation.
  • Expands presumptive conditions for herbicide exposure.
  • Expands locations for herbicide exposure.
  • Establishes presumptive conditions for toxic exposures.
  • Provides avenue for reevaluation of denied DIC claims that may result in retroactive effective dates.

Covered Veteran/Gulf War

Covered Veteran: Veteran who was AD (military, naval, air or space service) assigned to any of the following:

    • On/after Aug. 2, 1990
      • Bahrain
      • Iraq
      • Kuwait
      • Oman
      • Qatar
      • Saudi Arabia
      • Somalia
      • United Arab Emirates
    • On/after Sept. 11, 2001
      • Afghanistan
      • Djibouti
      • Egypt
      • Jordan
      • Lebanon
      • Syria
      • Yemen
      • Uzbekistan
      • Any other country determined relevant by the Secretary of the VA

Gulf War Presumptive Conditions – Burn Pits and Other Toxins:

      • Asthma
      • Chronic bronchitis
      • Constrictive bronchiolitis, obliterative bronchiolitis
      • Chronic obstructive pulmonary disease
      • Emphysema
      • Granulomatous disease
      • Interstitial lung disease
      • Pleuritis
      • Pulmonary fibrosis
      • Sarcoidosis
      • Chronic rhinitis
      • Chronic sinusitis
      • Head cancers
      • Neck cancers
      • Respiratory cancers
      • Gastrointestinal cancers
      • Reproductive cancers
      • lymphoma/lymphoma cancers
      • Kidney cancer
      • Brain cancer
      • Melanoma
      • Pancreatic cancer
      • Glioblastoma

Presumptive Cancers

If you have a cancer claim that involve presumptive conditions due to burn pits and other toxins under the PACT Act you should note that:

      • Only malignant tumors qualify for presumptive service connection for the established cancers.
      • Benign neoplasm or any other non-malignant disease processes do not qualify under these presumptive diseases.
      • Skin cancers and other melanoma only qualify for presumptive service connection if the location of the malignancy is the head or neck.
      • All melanomas qualify for presumptive service connection regardless of location.
      • Sarcomas may only be considered for presumptive service connection if located in the head or neck areas or located within a presumptive body system.
      • Only primary cancer may be considered a presumptive disease. Metastatic or secondary cancers would not warrant service connection on a presumptive basis.

Defining Different Types of Cancer

How Does the VA Define Head Cancer?

Malignancies found in the locations of the scalp, face, mouth, aural areas, lips, and hard or soft palate.

Below are some examples of head cancers:

  • Malignant ear tumors
  • Malignant tumors of the eye and adnexa
  • Neuroendocrine tumors of the orbit
  • Carcinoid tumors of the orbit and ocular adnexa
  • Pituitary carcinoma
  • Melanoma
  • Basal cell carcinoma of the skin
  • Squamous cell carcinoma of the skin
  • Oral cavity squamous cell carcinoma
  • Pharyngeal cancer – keratinizing squamous cell carcinoma, non-keratinizing squamous cell carcinoma, basaloid squamous cell carcinoma
  • Jaw cancer – squamous cell carcinoma, osteosarcoma, ameloblastic carcinoma, primary intraosseous carcinoma, clear cell odontogenic carcinoma, ghost cell odontogenic carcinoma, odontogenic carcinosarcoma, odontogenic sarcoma, multiple myeloma
  • Tongue cancer – adenoid cystic carcinoma, mucoepidermoid carcinoma, polymorphous low-grade carcinoma
  • Oropharyngeal cancer – squamous cell carcinoma, salivary gland cancer, lymphoma, minor salivary gland tumors, lymphoepithelioma
  • Nasopharyngeal cancer – squamous cell carcinoma, keratinizing undifferentiated carcinoma, non-keratinizing undifferentiated carcinoma
  • Paranasal sinus and nasal cavity cancer – squamous cell carcinoma, adenocarcinoma, adenoid cystic cancer, lymphoma, plasmacytoma, melanoma, olfactory neuroblastoma, neuroendocrine carcinoma, fibrosarcoma, undifferentiated pleomorphic sarcoma, leiomyosarcoma, rhabdomyosarcoma
  • Salivary gland cancer – mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, polymorphous adenocarcinoma, adenocarcinoma not otherwise specified, secretory carcinoma.
  • Sarcoma – osteosarcoma, fibrosarcoma, dermatofibrosarcoma, low grade fibromyxoid sarcoma, fibromatosis, liposarcoma, leiomyosarcoma, ectomesenchymoma, malignant schwannoma, malignant mesenchymoma, malignant ganglioma
  • Sarcoma in blood vessels – angiosarcoma, hemangioendothelioma, hemangiopericytoma, solitary fibrous tumor, vascular sarcoma
  • Ewing sarcoma (endocrine)
  • Malignant Pineal Gland

How Does the VA Define Neck Cancer?

Neck cancers include malignancies found in the locations of the neck, pharynx and larynx.
Below are some examples of neck cancers:

  • Melanoma
  • Basal cell carcinoma of the skin
  • Squamous cell carcinoma of the skin
  • Oral cavity squamous cell carcinoma
  • Pharyngeal cancer – keratinizing squamous cell carcinoma, non-keratinizing squamous cell carcinoma, basaloid squamous cell carcinoma
  • Tongue cancer – adenoid cystic carcinoma, mucoepidermoid carcinoma, polymorphous low-grade carcinoma
  • Oropharyngeal cancer – tonsillar cancer, squamous cell carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, lymphoma
  • Laryngeal cancer – squamous cell carcinoma, adenocarcinoma, sarcoma, chondrosarcoma, lymphoma, plasmacytoma
  • Thyroid cancer – anaplastic thyroid cancer, papillary, follicular, medullary
  • Sarcoma – osteosarcoma, fibrosarcoma, dermatofibrosarcoma, low grade fibromyxoid sarcoma, fibromatosis, liposarcoma, leiomyosarcoma, rhabdomyosarcoma, leiomyosarcoma, ectomesenchymoma, malignant schwannoma, malignant mesenchymoma, malignant ganglioma
  • Sarcoma in blood vessels – angiosarcoma, hemangioendothelioma, hemangiopericytoma, solitary fibrous tumor, vascular sarcoma Ewing sarcoma (endocrine)
  • Spinal cord malignant tumors – malignant peripheral nerve sheath tumor, malignant schwannoma, solitary plasmacytoma, osteosarcoma, chondrosarcoma, Ewing’s sarcoma, chordoma, lymphoma, multiple myeloma

How does the VA define Respiratory Cancer?

Respiratory cancers consist of any malignancies located in the nose to the pleural space.
Some examples of respiratory cancer are:

  • Non-small lung cancer – squamous cell carcinoma (epidermoid carcinoma), large cell carcinoma, adenocarcinoma, pleomorphic carcinoma, carcinoid tumor, salivary gland carcinoma, unclassified carcinoma
  • Small cell lung cancer – small cell carcinoma (oat cell cancer), combined small cell carcinoma
  • Sarcomoid carcinoma of the lung
  • Sarcomatoid carcinoma of the lung
  • Adenosquamous carcinoma of the lung
  • Typical and atypical carcinoid of the lung
  • Squamous cell carcinoma of the trachea, adenocarcinoma of the trachea
  • Laryngeal cancer – glottis neoplasm, laryngeal neuroendocrine neoplasm, subglottis neoplasm, supraglottis neoplasm
  • Cancer of the bronchus – adenocarcinoma, squamous cell carcinoma, large cell carcinoma
  • Pharyngeal cancer – keratinizing squamous cell carcinoma, non-keratinizing squamous cell carcinoma, basaloid squamous cell carcinoma
  • Oropharyngeal cancer – squamous cell carcinoma, salivary gland cancer, lymphoma, minor salivary gland tumors, lymphoepithelioma
  • Nasopharyngeal cancer – squamous cell carcinoma, keratinizing undifferentiated carcinoma, non-keratinizing undifferentiated carcinoma
  • Paranasal sinus and nasal cavity cancer – squamous cell carcinoma, adenocarcinoma, adenoid cystic cancer, lymphoma, plasmacytoma, melanoma, olfactory neuroblastoma, neuroendocrine carcinoma, fibrosarcoma undifferentiated pleomorphic sarcoma, leiomyosarcoma, rhabdomyosarcoma
  • Laryngeal cancer – squamous cell carcinoma, adenocarcinoma, sarcoma, chondrosarcoma, lymphoma, plasmacytoma

How Does the VA Define Gastrointestinal Cancer?

Gastrointestinal cancers include any malignancy found in the gastrointestinal system from the tongue to the anus.
Below are some examples of gastrointestinal cancer:

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

What does the VA Consider to be Reproductive Cancer?

Below are some examples of reproductive cancers that the VA has given:

  • Female reproductive cancer – cervical cancer, ovarian cancer, uterine cancer, vaginal cancer, vulvar cancer, breast cancer
  • Male reproductive cancer – testicular cancer, penile cancer, prostate cancer

What does the VA Consider to be a Lymphoma or a Lymphomatic Cancer?

Lymphoma cancers of any type are medically unrecognized as a discrete category, the VA determined they fall under the lymphoma diagnosis.
Below are some examples of lymphomas and lymphomatic cancers:

  • Non-Hodgkin’s lymphoma
  • Hodgkin’s lymphoma
  • Diffuse B-cell lymphoma, other non-hodgkin mature B-cell lymphoma, follicular B-cell lymphoma, small cell B-cell lymphoma
  • T-cell lymphoma
  • Mantle-cell lymphoma
  • Burkitt lymphoma
  • Anaplastic large cell lymphoma
  • Mycosis fungoides
  • Lymphoblastic lymphoma

What Does the VA Consider to be Kidney Cancer?

Below are some examples of kidney cancer:

  • Renal cell carcinoma – clear cell, papillary, chromophobe, clear cell papillary, collecting duct, medullary, unclassified
  • Non-renal cell carcinoma – Wilms tumor, renal sarcoma

What Does the VA Consider to be Brain Cancer?

Below are some examples of brain cancer:

  • Astrocytoma – glioblastoma, anaplastic astrocytoma, diffuse astrocytoma, pineal astrocytic tumors, brain stem glioma, pilocytic astrocytoma, subependymal giant cell astrocytoma
  • Oligodendrogliomas
  • Ependymomas – cellular, papillary, tanycytic, RELA fusion-positive, clear cell
  • Mixed gliomas (oligoastrocytoma)
  • Pituitary carcinoma

What Does the VA Consider to be a Melanoma Diagnosis?

Below are some examples of melanoma:

  • Skin – superficial spreading melanoma, nodular melanoma, lentigo malignant melanoma, acral lentiginous melanoma
  • Eye – choroidal melanoma, conjunctival melanoma, iris melanoma
  • Mucosal melanoma (originate in tissues that line internal areas of the body)

What Does the VA Consider to be Pancreatic Cancer?

Below are some examples of pancreatic cancer:

  • Exocrine – adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, colloid carcinoma
  • Neuroendocrine pancreatic cancer