For veterans filing a VA disability claim under the PACT Act, the Compensation & Pension (C&P) exam remains one of the most important steps in the entire process.
While the PACT Act significantly simplifies how veterans establish service connection for toxic-exposure conditions, it does not eliminate the VA’s need to evaluate the severity of your condition. That’s where the C&P exam comes in.
Many veterans assume that because their condition is presumptive, approval and compensation are automatic. Unfortunately, that misunderstanding often leads to underrated claims or preventable denials.
“The PACT Act removes the nexus requirement, but the C&P exam still determines how much compensation you receive,” explains Brian Reese.
What Is the PACT Act?
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, signed into law in August 2022, represents the largest expansion of VA healthcare and disability benefits in modern history.
The law was designed to address long-standing gaps in care for veterans exposed to toxic substances during military service, including:
- Burn pits used in Iraq, Afghanistan, and Southwest Asia
- Agent Orange exposure in Vietnam and other locations
- Industrial chemicals, fuels, and airborne hazards
- Contaminated water sources
The PACT Act presumes that certain medical conditions are caused by these exposures, removing the long-standing requirement for veterans to prove how their service caused their illness.
“This law finally shifted the burden away from veterans who were being asked to prove the unprovable,” says Brian Reese.
What Is a Presumptive Condition for VA Disability?
A presumptive condition is a medical condition the VA automatically recognizes as service-connected based on:
- Where you served?
- When you served?
- What condition you’re diagnosed with?
If you meet those criteria, the VA must presume service connection.
This means:
- No nexus letter is required
- No proof of exposure is required
- No in-service medical documentation is required
“Presumptive doesn’t mean optional it means the VA is legally required to grant service connection when eligibility is met,” notes Brian Reese.
How Presumptive VA Disability Works?
To qualify for presumptive service connection under the PACT Act, veterans must meet three core requirements:
| Requirement | What the VA Reviews |
|---|---|
| Qualifying Location | Iraq, Afghanistan, Vietnam, Southwest Asia, etc. |
| Qualifying Timeframe | Specific exposure windows set by law |
| Medical Diagnosis | Condition listed under PACT Act presumptives |
Once these are confirmed, service connection is legally established. However, the rating percentage is still undecided and that’s where the C&P exam becomes critical.
What Is a PACT Act C&P Exam?
A PACT Act C&P exam is a medical evaluation performed by a VA-contracted examiner to:
- Confirm the diagnosis
- Measure symptom severity
- Document functional impact on work and daily life
- Complete a condition-specific Disability Benefits Questionnaire (DBQ)
The examiner does not approve or deny your claim. Their role is to provide medical evidence used by the VA rater to assign a percentage.
“Think of the C&P exam as the evidence-building phase the rater relies heavily on what the examiner documents,” explains Brian Reese.
Three Types of PACT Act C&P Exams
1. Burn Pit Exposure Exams
Often evaluate:
- Asthma
- Chronic sinusitis
- Rhinitis
- Bronchitis
- Sleep-related breathing disorders
Exams may include pulmonary function testing or imaging.
2. Toxic Exposure Risk Activity (TERA) Exams
Focus on veterans who handled or worked around hazardous materials.
Conditions evaluated may include:
- Skin disorders
- Neurological symptoms
- Endocrine and autoimmune conditions
3. Agent Orange Exposure Exams
Frequently assess:
- Hypertension
- Ischemic heart disease
- Diabetes mellitus
- Presumptive cancers
What to Expect During a PACT Act C&P Exam?
During the exam, the examiner will typically:
- Review your service and medical history
- Confirm your diagnosis
- Perform a targeted physical examination
- Order diagnostic tests if necessary
- Ask how the condition affects work and daily life
- Complete the DBQ
“VA ratings are based on functional loss how the condition impacts your ability to live and work,” says Brian Reese.
How to Prepare for Your PACT Act C&P Exam?
Bring Relevant Records
Bring copies of:
- Service records (DD-214 if available)
- VA and private medical records
Document Your Symptoms
Track:
- Frequency
- Severity
- Duration
- Functional limitations
Describe Your Worst Days
The VA rates disabilities based on maximum impairment, not occasional good days.
“Veterans lose ratings when they minimize symptoms talk about your worst days, not your best,” explains Brian Reese.
PACT Act Presumptive Claim Example
A veteran deployed to Iraq and Afghanistan in 2004 and 2007 with documented burn pit exposure later developed chronic sinusitis.
After filing a claim under the PACT Act, the VA scheduled a C&P exam. The examiner:
- Confirmed qualifying service
- Verified diagnosis
- Documented frequent infections and functional impact
The VA granted 30% under 38 CFR § 4.97, DC 6513.
“This is exactly how the PACT Act was designed to work less red tape and faster recognition,” says Brian Reese.
Final Thought
The PACT Act removes the hardest hurdle proving service connection but it does not eliminate the need to prove severity.
Your C&P exam determines:
- Whether you’re underrated
- Whether your compensation reflects reality
- Whether secondary conditions are recognized
“Presumptive gets you in the door the C&P exam determines what you walk away with,” explains Brian Reese.
Preparation is not optional. It’s the difference between a fair rating and years of appeals.
FAQs
Do I still need a C&P exam if my condition is presumptive?
Yes. Presumptive status establishes service connection, but the C&P exam determines severity and rating percentage.
Do I need a nexus letter for a PACT Act claim?
No. Presumptive conditions eliminate the nexus requirement.
What happens if I miss my C&P exam?
Missing an exam without good cause can result in denial or a lower rating under 38 C.F.R. § 3.655.
Can the VA deny a presumptive claim?
Yes, if eligibility requirements or diagnosis are not confirmed.
Can I submit evidence after the C&P exam?
Yes. You can submit additional medical or lay evidence if the exam was incomplete or inaccurate.
