Cross & York Editorial
VA TERA Presumptive Conditions: What Veterans Need to Know
By Rick Gregory, Legal Specialist
TL;DR
- TERA stands for Toxic Exposure Risk Activity. It is a VA screening and documentation process created under the PACT Act to capture a veteran's full toxic exposure history.
- Every veteran receiving VA care from June 2022 onward should have been offered a TERA screening. The results become part of your medical record.
- The PACT Act (Public Law 117-168, signed August 10, 2022) created dozens of presumptive conditions tied to burn pit exposure, Agent Orange, ionizing radiation, and Gulf War illness.
- In January 2025, VA added new presumptive conditions including hypertension, MGUS, additional genitourinary cancers, and additional leukemia conditions.
- A completed TERA screening is not required to file a claim, but it is strong supporting evidence. Contact us or call (202) 934-2954 for a free case evaluation.
If you served in Vietnam, the Gulf War, Iraq, Afghanistan, or any number of other locations where toxic exposures were common, you have probably heard the term "presumptive condition." What you may not have heard is the term "TERA." VA TERA presumptive conditions connect the two concepts: TERA is the documentation process, and presumptive conditions are the diagnoses VA automatically covers as a result.
TERA is the VA's formal process for documenting your exposure history. VA TERA presumptive conditions are the diagnoses that VA presumes were caused by that exposure -- meaning you do not need to prove a direct link between your service and your illness. Understanding how TERA works, which presumptive conditions it covers, and how to use it in a claim can make a real difference in whether your disability claim succeeds.
What is TERA in the VA context?
TERA stands for Toxic Exposure Risk Activity. It is a structured screening and documentation process the VA put in place after the PACT Act became law in August 2022.
When you go in for VA health care, a provider is supposed to ask you a set of standardized questions about any toxic exposures you may have faced during military service. That includes burn pit smoke, Agent Orange, contaminated water, radiation, and other hazards. Your answers are recorded in your VA electronic health record.
The screening is not a one-time checkbox. It is meant to build a documented exposure history that follows you through the VA system. Every veteran receiving VA care from June 2022 onward should have been offered a TERA screening. If you have not had one, you can ask for it at your next VA appointment.
Critically, a TERA screening does not by itself grant benefits. What it does is create an official record that can support a disability claim. When a claims examiner reviews your file, documented TERA findings can help establish the service connection that VA looks for.
What are VA TERA presumptive conditions under the PACT Act?
A presumptive condition is a diagnosis that VA automatically assumes was caused by a specific exposure, as long as you meet the service and exposure requirements. You do not need to submit independent medical evidence proving that your condition came from your service. The presumption does that work for you.
Before the PACT Act, veterans with burn pit-related illnesses had almost no presumptive pathway. They had to submit nexus letters, medical opinions, and extensive records to prove what should have been obvious. The PACT Act changed that by creating presumptive categories for burn pit and airborne hazards, extending existing Agent Orange presumptions, expanding radiation-related coverage, and reinforcing Gulf War illness protections.
VA TERA presumptive conditions are the specific diagnoses that fall under those categories. If you have been diagnosed with one of them and you meet the service requirements, your claim starts with the presumption working in your favor rather than against you.
The service requirements vary by category. For burn pit and airborne hazards, you generally need to have served in Southwest Asia, Afghanistan, or other covered locations after August 2, 1990. For Agent Orange, the primary qualifying service is Vietnam or the Korean DMZ during the Vietnam era, though other locations have also been added. Radiation exposure covers a specific list of nuclear-related assignments.
Full list of PACT Act presumptive conditions by exposure type
The table below covers the main presumptive conditions currently recognized under the PACT Act, organized by exposure category. This is not legal advice, and eligibility depends on your individual service history.
Burn pit and airborne hazard cancers
| Condition | Notes |
|---|---|
| Brain cancer | Any type |
| 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 | Includes lung cancer |
| Acute leukemia | |
| Chronic leukemia | |
| Myelodysplastic syndromes | |
| Multiple myeloma | |
| Adenocarcinoma of the trachea | |
| Adenosquamous carcinoma of the lung |
Burn pit and airborne hazard respiratory illnesses
| Condition | Notes |
|---|---|
| Asthma | Diagnosed after service |
| Chronic bronchitis | |
| COPD | |
| Chronic rhinitis | |
| Chronic sinusitis | |
| Constrictive or obliterative bronchiolitis | |
| Emphysema | |
| Granulomatous disease | |
| Interstitial lung disease (ILD) | |
| Pleuritis | |
| Pulmonary fibrosis | |
| Sarcoidosis |
Agent Orange presumptive conditions
| Condition | Category |
|---|---|
| Bladder cancer | Cancer |
| Chronic B-cell leukemia | Cancer |
| Hodgkin's disease | Cancer |
| Multiple myeloma | Cancer |
| Non-Hodgkin's lymphoma | Cancer |
| Prostate cancer | Cancer |
| Respiratory cancers including lung cancer | Cancer |
| Soft tissue sarcomas (certain types) | Cancer |
| AL amyloidosis | Other illness |
| Chloracne | Other illness |
| Diabetes mellitus type 2 | Other illness |
| High blood pressure (hypertension) | Other illness -- added January 2025 |
| Hypothyroidism | Other illness |
| Ischemic heart disease | Other illness |
| Monoclonal gammopathy of undetermined significance (MGUS) | Other illness -- added January 2025 |
| Parkinsonism | Other illness |
| Parkinson's disease | Other illness |
| Peripheral neuropathy, early onset | Other illness |
| Porphyria cutanea tarda | Other illness |
Ionizing radiation
Radiation-related presumptive conditions are listed in 38 CFR 3.311. The PACT Act added new qualifying exposure locations including the Enewetak Atoll cleanup (1977-1980), Palomares Spain B-52 cleanup (1966-1967), and the Thule Air Force Base Greenland incident response (1968).
What new presumptive conditions were added in January 2025?
In January 2025, VA expanded the list of presumptive conditions under the PACT Act. The most significant additions were:
Hypertension (high blood pressure) linked to Agent Orange. Veterans with qualifying Vietnam-era service who have a diagnosis of hypertension can now claim it as a presumptive condition. This affects a large number of veterans who may have been denied in the past or never filed because they did not know it was covered.
MGUS (monoclonal gammopathy of undetermined significance) linked to Agent Orange. MGUS is a blood condition that can precede more serious disorders. Its addition as a presumptive condition opens a new pathway for veterans with Vietnam-era service.
Additional genitourinary cancers. VA expanded the range of covered reproductive and urinary tract cancers in the burn pit category.
Additional leukemia conditions. More specific leukemia subtypes were added to the burn pit and airborne hazards presumptive list.
If you filed a claim for any of these conditions before January 2025 and were denied, you may be eligible to reopen your claim based on the changed regulations. An accredited VA attorney can review your prior denial and advise on whether a new claim or supplemental claim makes sense.
How does a TERA screening help your VA claim?
A TERA screening creates a formal, dated record of your exposure history inside the VA system. That matters for several reasons.
First, it removes one of the most common sticking points in PACT Act claims: proving that exposure actually occurred. The PACT Act created presumptions of exposure for many service locations, but a TERA record provides an additional layer of documentation. It is contemporaneous evidence from a VA provider, which carries more weight than a veteran's after-the-fact statement alone.
Second, a TERA screening is part of your VA medical record. That means it flows automatically to claims examiners who review your file. You do not have to submit it separately or track it down. It is already there.
Third, if you have a condition that is not on the current presumptive list, TERA documentation can still help. A nexus opinion from a private physician that references your documented TERA exposure history is stronger than one that has to rely solely on service records that may be incomplete or missing.
Fourth, TERA screenings are cumulative. If you update your screening as new conditions develop or as you remember additional exposures, each update adds to your documented record.
Does a TERA screening affect your VA disability rating?
The TERA screening itself does not change your rating. It is an exposure documentation tool, not a rating decision.
What it does is support the underlying claim that leads to a rating. A rating decision starts with a determination of service connection. If that connection is established, the VA then rates the severity of the condition using its Schedule for Rating Disabilities. TERA helps establish the service connection step. Once that is in place, the rating is determined by the severity of your diagnosis and its functional impact.
Veterans sometimes skip the TERA screening because they think it is just a formality. It is not. If your exposure history is not in your VA record, there is less for a claims examiner to work with. Getting screened, or asking your provider to update an existing screening, takes very little time and can have a meaningful impact on your claim.
Check your VA eligibility if you are unsure whether your service qualifies for PACT Act coverage.
How to use TERA documentation to file a PACT Act claim
Step 1: Confirm your TERA screening is on file
Request a copy of your VA medical records or log in to MyHealtheVet to review your file. Look for any documentation related to toxic exposure screening. If no screening has been completed, contact your VA primary care provider and ask to complete a TERA screening at your next appointment. Do not wait for the VA to offer it proactively.
Step 2: Gather your service records and diagnosis documentation
You will need evidence connecting your service to the exposure and your exposure to your current condition. For presumptive conditions, the diagnosis and qualifying service are typically enough. Gather your DD-214 or other discharge papers, any deployment orders showing service in a covered location, and all medical records related to your diagnosed condition. If you have been diagnosed recently, make sure the diagnosis is documented by a VA or private physician in writing.
Step 3: File a claim using VA Form 21-526EZ
Submit your disability compensation claim through VA.gov, by mail, or in person at a VA regional office. On the form, identify the condition you are claiming and note that you are claiming it as a PACT Act presumptive condition. Include your TERA screening records, service documentation, and any medical evidence you have gathered. If your condition is not currently on the presumptive list, a private nexus opinion from a physician who references your TERA history can strengthen the claim significantly.
You do not need to hire anyone to file a claim. Veterans Service Organizations (VSOs) provide free claims assistance. If your claim involves a denied condition, a reopen, or a complex exposure history, an accredited VA attorney works on a contingency basis with no fee unless you are awarded past-due benefits.
Frequently asked questions
What does TERA mean in the VA?
TERA stands for Toxic Exposure Risk Activity. It is the VA's standardized screening and documentation process for recording a veteran's toxic exposure history during military service. VA providers use TERA to capture information about burn pit exposure, Agent Orange, contaminated water, radiation, and other hazards. The results are stored in your VA electronic health record and can support a VA disability claim.
Is a TERA screening required to file a PACT Act claim?
No. A TERA screening is not required to file a PACT Act disability claim. You can file based on your service records, diagnosis documentation, and the qualifying service locations defined under the PACT Act. However, having a completed TERA screening on file is useful evidence that can help a claims examiner verify your exposure history, especially for conditions that require more documentation.
What conditions are presumptive under the PACT Act for burn pit exposure?
Burn pit and airborne hazard presumptive conditions include a wide range of cancers (brain, head and neck, kidney, lung, lymphoma, pancreatic, reproductive, and others) as well as respiratory illnesses such as COPD, chronic bronchitis, constrictive bronchiolitis, interstitial lung disease, and pulmonary fibrosis. The full list appears in the table above. Qualifying service generally includes deployment to Southwest Asia, Afghanistan, or other covered locations after August 2, 1990.
Can I reopen a denied VA claim if my condition is now presumptive?
Yes. If VA denied your claim for a condition that was later added to the PACT Act presumptive list, you can file a supplemental claim. A supplemental claim requires new and relevant evidence, and a change in law -- such as a condition being added to the presumptive list -- qualifies. If your denial was issued after August 10, 2022 and VA failed to apply the PACT Act correctly, you may also have grounds for a higher-level review or appeal. An accredited VA attorney can review your situation at no charge.
Does hypertension qualify as a VA presumptive condition?
Yes. As of January 2025, hypertension qualifies as a presumptive condition for veterans with Agent Orange exposure and qualifying Vietnam-era service. This includes service in the Republic of Vietnam, service along the Korean DMZ during the Vietnam era, and other recognized locations. If you have a hypertension diagnosis and qualifying service, you can file a new claim or reopen a prior denial.
VA TERA presumptive conditions represent one of the most significant expansions of veterans' benefits in decades. The PACT Act created new pathways for veterans who spent years being denied because they could not prove what was already well documented in military history.
If you have a diagnosis and qualifying service, you do not need to navigate the claims process alone. Cross and York is a VA-accredited law firm in Washington DC. We take VA disability cases on a contingency basis -- there is no fee unless you recover past-due benefits, and the fee is capped at 20% of any past-due amount. There is no charge on future benefits.
Call us at (202) 934-2954 or visit our free case evaluation page to find out whether your condition qualifies.
Cross & York is a VA-accredited law firm authorized to represent veterans before the Department of Veterans Affairs under 38 CFR § 14.629. Contingent fees apply only to past-due benefits awarded on appeal and are capped at 20% in accordance with 38 CFR § 14.636. No fee is charged for representing veterans on initial claims. Address: 1050 Connecticut Ave NW, Washington, DC 20008.