Service members deployed to the Middle East and Southwest Asia often worked near large, open-air burn pits used to incinerate massive amounts of waste. These pits disposed of everything from plastics, chemicals, and rubber to medical waste, releasing plumes of toxic smoke into the air. Many veterans later began to experience serious health problems, but establishing a direct link between their military service and these illnesses was complicated and often unsuccessful. The current framework acknowledges that the unique circumstances of military service in these regions created a widespread exposure to airborne hazards, paving the way for a simplified path to care and benefits.
Understanding Presumptive Service Connection
The concept of a “presumptive condition” fundamentally changes how a veteran’s illness is connected to their service. Historically, veterans were required to demonstrate a direct medical link, known as a nexus, between an event during service and their current diagnosis. This required gathering extensive documentation to prove that toxic exposure was the direct cause of their specific illness.
Presumptive status removes this heavy burden of proof. The Department of Veterans Affairs (VA) automatically presumes that certain diagnosed conditions were caused by the exposure, provided the veteran meets specific service location and date requirements. The focus shifts entirely to proving the diagnosis exists and that the service requirements were met, rather than litigating the scientific cause of the illness. This legal shift recognizes the evidence linking toxic exposure to chronic diseases.
The Recognized 23 Illnesses
The 23 conditions now recognized as presumptive cover a range of serious diagnoses, primarily affecting the respiratory system and various organs through the development of cancer. These illnesses are divided into two main categories: cancers and respiratory diseases. Presumed service connection acknowledges the danger posed by particulate matter and chemicals released from the open-air incineration of waste.
Cancers (12 Categories)
Twelve distinct categories of cancer are now considered presumptive for those who meet the service criteria for burn pit exposure. These cancers represent malignancies that researchers have linked to the exposure to carcinogens and other toxic materials, often being aggressive and difficult to treat.
The 12 presumptive cancer categories are:
- Brain cancer (including Glioblastoma)
- Gastrointestinal cancer of any type (stomach, colon, esophagus)
- Head cancer
- Neck cancer
- Kidney cancer
- Pancreatic cancer
- Lymphoma of any type
- Hematologic and lymphatic cancers
- Melanoma
- Reproductive cancer of any type (prostate, ovarian, testicular)
- Respiratory cancer of any type (lung, tracheal, laryngeal)
- Squamous cell carcinoma of the larynx and trachea
Respiratory and Other Illnesses (11 Conditions)
Eleven respiratory and other non-cancerous conditions are also presumed to be service-connected. These conditions are directly linked to the inhalation of fine particulate matter, which is a known product of open-air burning, causing chronic inflammation and damage to the lungs and airways. The presumption applies to Asthma if it was diagnosed after the veteran’s service in a qualifying location.
Chronic inflammatory conditions of the upper and lower airways are featured, including Chronic bronchitis, Chronic rhinitis, and Chronic sinusitis. More severe obstructive lung diseases, such as Chronic obstructive pulmonary disease (COPD) and Emphysema, involve progressive damage that restricts airflow.
The list encompasses serious lung conditions involving the small airways and lung tissue. This includes Constrictive bronchiolitis or obliterative bronchiolitis, which causes scarring and narrowing of the smallest airways. Interstitial lung diseases, like Pulmonary fibrosis and Interstitial lung disease (ILD), involve scarring that affects oxygen transfer.
Finally, the list includes systemic inflammatory conditions such as Sarcoidosis and Granulomatous disease. Pleuritis, which is inflammation of the lining surrounding the lungs, is also included.
The 11 presumptive respiratory and systemic conditions are:
- Asthma
- Chronic bronchitis
- Chronic rhinitis
- Chronic sinusitis
- Chronic obstructive pulmonary disease (COPD)
- Emphysema
- Constrictive bronchiolitis or obliterative bronchiolitis
- Pulmonary fibrosis
- Interstitial lung disease (ILD)
- Sarcoidosis and Granulomatous disease
- Pleuritis
Qualifying Service Locations and Dates
To benefit from presumptive status, a veteran must demonstrate service in specific geographic locations during designated time periods. The presumptive exposure applies to service in the Arabian Peninsula and the airspace above it, based on the widespread use of burn pits in these operational theaters.
Veterans who served on or after August 2, 1990, in countries that were part of the Gulf War operations qualify for the presumption of exposure. This includes Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the United Arab Emirates (UAE). The presumption also extends to service in the waters of the Persian Gulf, the Gulf of Oman, the Arabian Sea, the Red Sea, and the Gulf of Aden.
A separate list of locations applies to service on or after September 11, 2001, reflecting later deployments. This list includes Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen. Service in the airspace above any of these locations during the specified dates also qualifies a veteran for the presumptive status.
Steps to File a Presumptive Claim
Filing a claim for a presumptive condition begins by confirming the medical diagnosis and the qualifying service history. While the veteran does not need to prove the cause of the condition, they must provide medical evidence of the diagnosis itself, such as a doctor’s report or lab results. Official service records, like a DD-214, verify the veteran’s presence in a qualifying location during the necessary time frame.
The administrative process involves submitting a claim for disability compensation to the VA, typically using VA Form 21-526EZ. This form can be submitted online, by mail, or in person at a VA regional office. Veterans should file an “Intent to File” before submitting the formal application, as this preserves the earliest possible effective date for benefits.
Veterans can seek assistance from an accredited representative, such as a Veterans Service Officer (VSO), who can help gather documentation and navigate the process without charge. Even if a claim was previously denied, veterans should file a Supplemental Claim if their illness is now on the presumptive list. The VA will review existing medical records under the new, more favorable presumptive rules.