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PACT Act Exposure Questionnaire

Complete this questionnaire to determine if you are eligible for PACT Act presumptive benefits Learn More
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Presumptive PACT Act Benefits

One of the most significant aspects of the PACT Act is the introduction of presumptive conditions related to toxic exposure. A presumptive condition means that the VA automatically assumes a veteran’s illness is connected to their service without requiring them to provide extensive proof.

  • Previously Denied Claims May Now Be Approved – If a veteran was denied benefits for a condition now covered under the PACT Act, they should reapply immediately to secure their rightful compensation.
  • Even 0% Disability Ratings Can Help – While a 0% rating means no compensation for that disability (e.g. hypertension), it still allows the veteran to access VA healthcare and use that rating to establish secondary service connection for other conditions that may qualify for compensation.
  • Increase in Partial VA Disability Rating – Veterans with an existing disability rating may qualify for an increase, which can lead to higher monthly compensation and additional benefits for dependents.
  • Veterans at Maximum Disability Rating – Even those receiving the maximum disability benefits should file a claim if they have a newly covered condition under the PACT Act, as it may provide additional financial support or benefits.
01
1.
Did you serve in any of the locations below?
Vietnam Theater
Vietnam Theater
Gulf Region
Gulf Region
Europe
Europe
United States
United States
Greenland
Greenland
Marshall Islands
Marshall Islands
None of the above
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If You Served In The United States
Use our Toxic Exposure Map to search by base, exposure, or condition and find what service-related exposures and conditions were caused by your service.
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02
2.
Did you perform active military, naval, air, or space service while assigned in:
Thailand from Jan 9, 1962 - Jun 30, 1976
Thailand from Jan 9, 1962 – Jun 30, 1976
Service at any U.S. or Royal Thai military base regardless of duty location or military occupational specialty
Laos from Dec 1, 1965 - Sep 30, 1969
Laos from Dec 1, 1965 – Sep 30, 1969
Republic of Vietnam from Jan 9, 1962 - May 7, 1975
Republic of Vietnam from Jan 9, 1962 – May 7, 1975
Or on a U.S. military vessel that operated on inland waterways of Vietnam or within 12 nautical miles seaward of the demarcation line of waters of Vietnam and Cambodia
Cambodia from Apr 16, 1969 - Apr 30, 1969
Cambodia from Apr 16, 1969 – Apr 30, 1969
At Mimot or Krek, Kampong Cham Province
Guam or American Somoa from Jan 9, 1962 - May 7, 1975
Guam or American Somoa from Jan 9, 1962 – May 7, 1975
Or in the territorial waters thereof
Johnston Atoll from Jan 9, 1962 - Jul 31, 1980
Johnston Atoll from Jan 9, 1962 – Jul 31, 1980
Or on a ship that called at Johnston Atoll
C123 Aircraft
C123 Aircraft
Performed service in the Air Force/Air Force Reserve involving regular and repeated operation, maintenance, or service onboard a C–123 known to have been used to spray an herbicide agent during the Vietnam era
Korean Demilitarized Zone (DMZ) from Sep 1, 1967 – Aug 31, 1971+
Korean Demilitarized Zone (DMZ) from Sep 1, 1967 – Aug 31, 1971+
Yes
No
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03
3.
Have you been diagnosed with any of the conditions below?
  • AL amyloidosis
  • All chronic B-cell leukemias
  • Bladder cancer
  • Chloracne or other acne form disease consistent with chloracne (manifesting within one year of exposure)
  • DMII (Type 2 Diabetes Mellitus)
  • Early-onset peripheral neuropathy (manifesting within one year of exposure)
  • Hodgkin’s disease
  • Hypertension
  • Hypothyroidism
  • Ischemic heart disease
  • Monoclonal gammopathy
  • Multiple myeloma
  • Non-Hodgkin’s lymphoma
  • Parkinson’s disease or Parkinsonism
  • Porphyria cutanea tarda (manifesting within one year of exposure)
  • Prostate cancer
  • Respiratory cancers
  • Some soft-tissue sarcomas
Yes
No
*Note: Under VA regulations, this condition must manifest within 1 year of herbicide exposure.
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02
2.
Did you perform active military, naval, air, or space service while assigned:
On or after August 2, 1990
On or after August 2, 1990
On or after September 11, 2001
On or after September 11, 2001
Not at either time
Not at either time
*Note: VA considers these locations in the definition of “Covered Veteran” for the purpose of eligibility for the presumptions related to burn pits and other toxins (BPOT) established in the PACT Act under 38 U.S.C. 1120. See M21-1 VIII.ii.2.A.1.e: Neutral Zone between Iraq and Saudi Arabia, Arabian Sea, Gulf of Aden, Gulf of Oman, Persian Gulf, Red Sea
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03
3.
Did your service on or after August 2, 1990 take place in any of these countries:
Bahrain on or after Aug 2, 1990
Bahrain on or after Aug 2, 1990
Iraq on or after Aug 2, 1990
Iraq on or after Aug 2, 1990
Kuwait on or after Aug 2, 1990
Kuwait on or after Aug 2, 1990
Oman on or after Aug 2, 1990
Oman on or after Aug 2, 1990
Qatar on or after Aug 2, 1990
Qatar on or after Aug 2, 1990
Saudi Arabia on or after Aug 2, 1990
Saudi Arabia on or after Aug 2, 1990
Somalia on or after Aug 2, 1990
Somalia on or after Aug 2, 1990
United Arab Emirates on or after Aug 2, 1990
United Arab Emirates on or after Aug 2, 1990
While performing military, naval, air or space service in these countries, you may have been exposed to:
  • Burn Pits
  • Depleted Uranium
  • Oil Well Fires
  • Carc Paint
  • Hazardous Chemicals & Materials
  • Pesticides
  • Chemical & Biological Weapons
  • Jet Fuel
  • Sand, Dust, and Particulates
Yes
No
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04
4.
Have you been diagnosed with any of the conditions below?
Cancers
  • Brain Cancer
  • Gastrointestinal cancer (any type)
  • Glioblastoma
  • Head cancer (any type)
  • Kidney cancer
  • Lymphoma (any type)
  • Melanoma
  • Neck cancer (any type)
  • Pancreatic cancer
  • Reproductive cancer (any type)
  • Respiratory cancer (any type)
Conditions
  • Asthma
  • Constrictive bronchiolitis
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease
  • Chronic Rhinitis
  • Chronic Sinusitis
  • Emphysema
  • Granulomatous disease
  • Interstitial lung disease
  • Obliterative bronchiolitis
  • Pleuritis
  • Pulmonary fibrosis
  • Sarcoidosis
Yes
No
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03
3.
Did your service on or after September 11, 2001 take place in any of these countries:
Afghanistan on or after Sep 11, 2001
Afghanistan on or after Sep 11, 2001
Djibouti on or after Sep 11, 2001
Djibouti on or after Sep 11, 2001
Egypt on or after Sep 11, 2001
Egypt on or after Sep 11, 2001
Jordan on or after Sep 11, 2001
Jordan on or after Sep 11, 2001
Lebanon on or after Sep 11, 2001
Lebanon on or after Sep 11, 2001
Syria on or after Sep 11, 2001
Syria on or after Sep 11, 2001
Yemen on or after Sep 11, 2001
Yemen on or after Sep 11, 2001
Uzbekistan on or after Sep 11, 2001
Uzbekistan on or after Sep 11, 2001
While performing military, naval, air or space service in these countries, you may have been exposed to:
  • Burn Pits
  • Depleted Uranium
  • Oil Well Fires
  • Carc Paint
  • Hazardous Chemicals & Materials
  • Pesticides
  • Chemical & Biological Weapons
  • Jet Fuel
  • Sand, Dust, and Particulates
Yes
No
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04
4.
If you served in the Persian Gulf, were you stationed in any of the countries below?
Afghanistan
Afghanistan
Turkey
Turkey
Syria
Syria
Jordan
Jordan
Israel
Israel
Egypt
Egypt
While performing military, naval, air or space service in these countries, you may have been exposed to:
  • Burn Pits
  • Depleted Uranium
  • Oil Well Fires
  • Carc Paint
  • Hazardous Chemicals & Materials
  • Pesticides
  • Chemical & Biological Weapons
  • Jet Fuel
  • Sand, Dust, and Particulates
Yes
No
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05
5.
Do you have any symptoms of Gulf War Illness listed below, that have lasted at least 6 months?*
  • Fatigue
  • Muscle and joint pain
  • Cognitive difficulty (trouble thinking clearly)
  • Skin rashes
  • Abdominal (belly) discomfort or bowel changes
  • Headaches
  • Shortness of breath
  • Trouble sleeping
Yes
No
*Gulf War Illness (GWI) is a chronic condition affecting many Veterans of Operation Desert Storm and Desert Shield (1990–1991). It falls under Chronic Multi-Symptom Illness (CMI) and involves varied, unexplained symptoms that differ by person. There’s no standard definition, but studies show 25–45% of Gulf War Veterans are affected. A VA survey found over 40% of deployed Veterans reported symptoms, compared to lower rates in non-deployed Veterans.
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If You Did Not Serve In the US, Vietnam Theater, Gulf Region, or Europe…
While you may not qualify for compensation under the PACT Act, you may still qualify for compensation under other statutes.
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If you did not serve in any of the locations listed…
While you may not qualify for compensation under the PACT Act, you may still qualify for compensation under other statutes.
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If you don’t have any of the conditions listed…
While you may not qualify for compensation under the PACT Act based on presumption, you may still qualify for compensation under other authorities.
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If you didn’t serve during the required dates…
While you may not qualify for compensation under the PACT Act, you may still qualify for compensation under other statutes.
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Results
You may be able to claim new presumptive conditions related to herbicides
You may be able to claim new presumptive conditions related to potential exposures
Get A free Case Evaluation – Absolutely No Obligation
Hill & Ponton is ready to help you fight to get the compensation your deserve! Complete this brief form and our team will contact you within 30 minutes during normal business hours to discuss your claim.

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Name*
Have you filed a claim for VA benefits AND have a decision that is current or has been appealed within the last 12 months?*
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02
2.
Did you perform active military, naval, air, or space service, OR
active duty for training or inactive duty for training while participating in the following radiation risk activity?
Greenland

Nuclear response near Thule Air Force Base, Greenland from Jan 21, 1968, to Sep 25, 1968

Onsite participation in the response effort following the on-board fire and crash of a United States Air Force B-52 bomber that caused the release of four thermonuclear weapons in the vicinity of Thule Air Force Base, Greenland, during the period beginning January 21, 1968, and ending September 25, 1968

While performing military, naval, air or space service in these countries, you may have been exposed to:
Radiation
Yes
No
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03
3.
Have you been diagnosed with any of the conditions below?
Presumptive Conditions
  • Bile Duct Cancer
  • Bone Cancer
  • Brain Cancer
  • Breast Cancer
  • Bronchiolo-alveolar carcinoma
  • Colon cancer
  • Esophageal cancer
  • Gallbladder cancer
  • Leukemia, other than chronic lymphocytic leukemia (CLL)
  • Lung cancer
  • Lymphomas, except Hodgkin’s disease
  • Multiple myeloma
  • Ovarian cancer
  • Pancreatic cancer
  • Pharyngeal cancer
  • Primary liver cancer
  • Salivary gland cancer
  • Small intestine cancer
  • Stomach cancer
  • Thyroid cancer
  • Urinary tract cancer (including kidneys, renal pelves, ureters, urinary bladder, and urethra)
Non-presumptive Radiogenic Conditions
  • Ovarian cancer
  • Parathyroid adenoma
  • Prostate cancer
  • Rectal cancer
  • Skin cancer
  • Tumors of the brain and central nervous system
  • Any other cancer
Yes
No
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02
2.
Did you perform active military, naval, air, or space service, OR
active duty for training or inactive duty for training while participating in the following radiation risk activity?
Palomares, Spain

Nuclear response near Palomares, Spain Jan 17, 1966, to Mar 31, 1967

Onsite participation in the response effort following the collision of a United States Air Force B-52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967.

While performing military, naval, air or space service in these countries, you may have been exposed to:
Radiation
Yes
No
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02
2.
Did you perform active military, naval, air, or space service, OR
active duty for training or inactive duty for training while participating in the following radiation risk activity?
Enewetak Atoll

Clean up of Enewetak Atoll Jan 1, 1977, through Dec 31, 1980

Clean up of Enewetak Atoll during the period beginning on January 1,1977, and ending on December 31, 1980

While performing military, naval, air or space service in these countries, you may have been exposed to:
Radiation
Yes
No
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04
5.
Do you have any symptoms of Gulf War Illness listed below, that have lasted at least 6 months?*
  • Fatigue
  • Muscle and joint pain
  • Cognitive difficulty (trouble thinking clearly)
  • Skin rashes
  • Abdominal (belly) discomfort or bowel changes
  • Headaches
  • Shortness of breath
  • Trouble sleeping
Yes
No
*Gulf War Illness (GWI) is a chronic condition affecting many Veterans of Operation Desert Storm and Desert Shield (1990–1991). It falls under Chronic Multi-Symptom Illness (CMI) and involves varied, unexplained symptoms that differ by person. There’s no standard definition, but studies show 25–45% of Gulf War Veterans are affected. A VA survey found over 40% of deployed Veterans reported symptoms, compared to lower rates in non-deployed Veterans.