What this means
m21-1:VIII.ii.2.C explains rating claims based on exposure to burn pits and other toxins, including fine particulate matter (bpot). In plain terms, the official guidance says establish presumptive service connection (SC) due to fine particulate matter exposure if the evidence establishes It also addresses if awarding or denying a claim for presumptive SC based on BPOT exposure, apply the following guidelines:
How this may help with a claim
Use m21-1:VIII.ii.2.C when organizing evidence or checking VA's handling of rating claims based on exposure to burn pits and other toxins, including fine particulate matter (bpot). Compare your application, supporting records, and notice with this source-specific point: Establish presumptive service connection (SC) due to fine particulate matter exposure if the evidence establishes If awarding or denying a claim for presumptive SC based on BPOT exposure, apply the following guidelines: Save proof of submission and identify the exact condition, exception, or missing development step before requesting correction or choosing a review option.
What to review in your file
- Check the file against this official condition: Establish presumptive service connection (SC) due to fine particulate matter exposure if the evidence establishes
- Confirm that the record or notice addresses this source point: Under current rules, the presumption of SC does not require the disability to manifest within any time frame after service nor to any degree of disability.
- Document how this stated step or exception applies: Presumptive SC for cancer associated with exposure to burn pits and other toxins, including fine particulate matter (BPOT) may only be established if the cancer in consideration is the primary or originating site of the cancer.
Important limits
m21-1:VIII.ii.2.C explains VA guidance for rating claims based on exposure to burn pits and other toxins, including fine particulate matter (bpot); it does not guarantee an award or replace the statutes, regulations, binding decisions, and review instructions that control an individual claim. Conditions and exceptions still matter, including this source point: Establish presumptive service connection (SC) due to fine particulate matter exposure if the evidence establishes As discussed in M21-1, Part VIII, Subpart ii, 2.A.1.d, SC cannot be established on a presumptive basis if
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Rating Claims Based on Exposure to Burn Pits and Other Toxins, Including Fine Particulate Matter (BPOT)
- m21-1:VIII.ii.2.C
- Rating Claims Based
- Exposure Burn Pits
- Presumptive Disabilities Associated BPOT
- establishing qualifying presumptive disability
- date disabilities became subject
- presumptive asthma
Original VA guidance
The official VA text of this section
Overview
In This Section
This section contains the following topics:
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| Topic | Topic Name |
| 1 | Presumptive Service Connection (SC) for Disabilities Associated With BPOT Exposure |
| 2 | Denying SC for Disabilities Associated With BPOT Exposure |
| 3 | Additional Rating Considerations |
1. Presumptive SC for Disabilities Associated With BPOT Exposure
Introduction
This topic contains information about presumptive SC for disabilities associated with BPOT exposure, including
- establishing SC for a qualifying presumptive disability
- date disabilities became subject to presumptive SC based on BPOT exposure
- presumptive SC for asthma
- BPOT general rating decision requirements, and
- establishing an effective date for qualifying disabilities due to BPOT exposure.
Change Date
June 6, 2025
VIII.ii.2.C.1.a. Establishing SC for a Qualifying Presumptive Disability
Establish presumptive service connection (SC) due to fine particulate matter exposure if the evidence establishes
- service in a qualifying location as described in M21-1, Part VIII, Subpart ii, 2.A.1.e, and
- the Veteran has been diagnosed with a condition listed in
- 38 U.S.C. 1120
- 38 CFR 3.320a, or
- 38 CFR 3.320b.
Important:
- Presumptive SC for the conditions listed in 38 U.S.C. 1120 became effective August 10, 2022, based on Public Law 117-168, Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022.
- Under current rules, the presumption of SC does not require the disability to manifest within any time frame after service nor to any degree of disability.
- Presumptive SC for cancer associated with exposure to burn pits and other toxins, including fine particulate matter (BPOT) may only be established if the cancer in consideration is the primary or originating site of the cancer.
References: For more information on
- the history of BPOT exposure policies, see M21-1, Part VIII, Subpart ii, 2.A.1.a
- which diagnoses qualify as a presumptive under 38 U.S.C. 1120, see
- VBA Letter 20-24-06, Updated Guidance on Processing Claims Involving PACT Act, and
- M21-1, Part VIII, Subpart ii, 2.A.1.f
- presumptive SC for metastatic cancer, see M21-1, Part V, Subpart ii, 2.B.1.b, and
- presumptive BPOT disabilities, see M21-1, Part VIII, Subpart ii, 2.A.1.f-h.
VIII.ii.2.C.1.b. Date Disabilities Became Subject to Presumptive SC Based on BPOT Exposure
The table below shows the dates on which the BPOT disabilities became subject to presumptive SC.
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| Disability | Effective Date |
|---|---|
| Chronic respiratory illnesses: asthma rhinitis, and sinusitis, to include rhinosinusitis. Important: Under historical 38 CFR 3.320, these conditions were required to have manifested within 10 years of separation from a period of active duty. Historical 38 CFR 3.320 was superseded by the PACT Act on August 10, 2022. | August 5, 2021 |
| Specific rare respiratory cancers: squamous cell carcinoma (SCC) of the larynx SCC of the trachea adenocarcinoma of the trachea salivary gland-type tumors of the trachea adenosquamous carcinoma of the lung large cell carcinoma of the lung salivary gland-type tumors of the lung sarcomatoid carcinoma of the lung, and typical and atypical carcinoid of the lung. Important: This historical provision in 38 CFR 3.320 was superseded by the PACT Act on August 10, 2022. | April 26, 2022 |
| Disabilities listed in 38 U.S.C. 1120: head cancer of any type neck cancer of any type respiratory cancer of any type gastrointestinal cancer of any type reproductive cancer of any type lymphoma cancer of any type kidney cancer brain cancer melanoma pancreatic cancer chronic bronchitis chronic obstructive pulmonary disease constrictive bronchiolitis or obliterative bronchiolitis emphysema granulomatous disease interstitial lung disease pleuritis pulmonary fibrosis sarcoidosis glioblastoma asthma diagnosed after service chronic sinusitis, and chronic rhinitis. | August 10, 2022 |
| Under 38 CFR 3.320a: urinary bladder cancer, including over-lapping sites of the bladder, and ureter cancer, including the ureteric orifice, and urachus. | January 2, 2025 |
| Under 38 CFR 3.320b: acute leukemias chronic leukemias multiple myelomas, including monoclonal gammopathy of undetermined significance myelodysplastic syndromes, and myelofibrosis. | January 10, 2025 |
VIII.ii.2.C.1.c. Presumptive SC for Asthma
The PACT Act provided for presumptive SC for, “asthma that was diagnosed after service of the covered Veteran.” This means the presumption only applies when asthma is diagnosed after service. Asthma is also a presumptive condition presumed to be associated with exposure to fine particulate matter per 38 CFR 3.320.
The Department of Veterans Affairs has implemented the PACT Act presumption for asthma as shown in the table below for all decisions made.
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| If asthma was first diagnosed … | Then … |
|---|---|
| prior to, or during service | SC must be considered under other theories of entitlement (i.e., direct, aggravation). |
| after service | the presumption of SC under 38 CFR 3.320 and 38 U.S.C. 1120 applies. |
VIII.ii.2.C.1.d. BPOT General Rating Decision Requirements
In order to properly document decisions based on BPOT exposure in Veterans Benefits Management System-Rating (VBMS-R), claims processors must use a combination of applicable system-generated language, analysis fragments, and glossary text fragments to adequately explain the basis of all decisions.
If awarding or denying a claim for presumptive SC based on BPOT exposure, apply the following guidelines:
- cite the applicable regulatory or statutory authority for the decision, when applicable
- list favorable findings, if applicable, specific to the facts of the case, and
- assign the appropriate special issue and special issue basis to each decided issue.
References: For more information on
- completing the rating decision, see
- M21-1, Part V, Subpart iv, 1.A, and
- the VBMS Rating User Guide, and
- historical rating requirements for particulate matter claims, see the attachment, Historical_M21-1VIII_ii_2_SecC_5-4-22.docx.
VIII.ii.2.C.1.e. Establishing an Effective Date for Disabilities Due to BPOT Exposure
When assigning an effective date, follow the guidance in M21-1, Part V, Subpart ii, 4.A relevant to the facts of the claim.
In addition to the general principles governing the assignment of effective dates, consider the following relevant factors when awarding presumptive SC based on BPOT exposure:
- When did the disability become subject to presumptive SC?
- Did the Veteran’s service qualify under 38 CFR 3.320 or under a location added in 38 U.S.C. 1119?
- Did the qualifying disability manifest within any applicable manifestation period?
Use the table below when assigning an effective date based on presumptive BPOT SC requirements being met.
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| If the award involves a … | And the condition … | Then the effective date cannot be prior to … |
|---|---|---|
| current 38 CFR 3.320(a)(2) condition (sinusitis, rhinitis, or asthma), and 38 CFR 3.320 location | manifested outside the 10-year manifestation period | August 10, 2022, the date the law was changed to allow for the award of benefits under 38 U.S.C. 1120. |
| manifested within the 10-year manifestation period | August 5, 2021, the date the regulation went into effect to allow for presumptive SC. | |
| historical 38 CFR 3.320(a)(3) condition (rare respiratory cancer), and 38 CFR 3.320 location | N/A | April 26, 2022, the date the regulation went into effect to allow for presumptive SC. |
| location added in 38 U.S.C. 1119, or presumptive condition added by 38 U.S.C. 1120 | N/A | August 10, 2022, the date the law was changed to allow for the award of benefits under 38 U.S.C. 1120. |
| 38 CFR 3.320a disability | N/A | January 2, 2025, the date the regulation went into effect to allow for presumptive SC. |
| 38 CFR 3.320b disability | N/A | January 10, 2025, the date the regulation went into effect to allow for presumptive SC. |
Note: If warranted by the facts of the case, award retroactive benefits under 38 CFR 3.114(a).
Reference: For more information on assigning effective dates, see
- 38 CFR 3.400
- 38 CFR 3.114, and
- 38 CFR 3.156(c).
2. Denying SC for Disabilities Associated With BPOT Exposure
Introduction
This topic contains information about denying SC for disabilities associated with BPOT exposure, including
- when presumptive SC cannot be established, and
- requirement to provide adequate explanation of decisions to deny.
Change Date
December 7, 2023
VIII.ii.2.C.2.a. When Presumptive SC Cannot Be Established
As discussed in M21-1, Part VIII, Subpart ii, 2.A.1.d, SC cannot be established on a presumptive basis if
- the Veteran
- did not serve in a qualifying location as listed in M21-1, Part VIII, Subpart ii, 2.A.1.e, or
- is not diagnosed with a presumptive BPOT disability
- there is affirmative evidence that the BPOT disability
- was caused by another condition or event that occurred between the Veteran’s qualifying service and the onset of the disability, or
- was the result of the Veteran’s own willful misconduct or the abuse of alcohol or drugs.
Reference: For more information on establishing SC under 38 U.S.C. 1120, see
- M21-1, Part VIII, Subpart ii, 2.A, and
- VBA Letter 20-24-06.
VIII.ii.2.C.2.b. Requirement to Provide Adequate Explanation of Decisions to Deny
When denying SC for a condition based on BPOT exposure, the decision and decision notice must provide adequate reasons for the decision. Decision makers must include a discussion of the specific provisions that were not met under the relevant presumptive provisions, as well as any other avenue of SC raised by the claimant or evidence.
In order to properly document decisions to deny benefits based on BPOT exposure in VBMS-R, claims processors must:
- use a combination of any applicable system-generated language, glossary text fragments, and free text to ensure the decision and decision notice adequately explain why the claim could not be granted under all applicable provisions, and
- apply the appropriate special issue and special issue basis for each decided contention.
Important: If the system-generated text options do not adequately cover the reason a claim is being denied, decision makers must use glossary text or free text to supplement the explanation of the decision.
References: For more information on
- BPOT general rating decision requirements, see M21-1, Part VIII, Subpart ii, 2.C.1.d
- system-generated text and glossary fragments, see the VBMS Rating User Guide
- considering unclaimed theories of SC, see M21-1, Part II, Subpart iii, 1.A.2.e, and
- decision notification requirements, see 38 CFR 3.103(f).
3. Additional Rating Considerations
Change Date
December 7, 2023
VIII.ii.2.C.3.a. Special Provisions Regarding the Evaluation of Respiratory Conditions
The rating activity must consider the provisions of 38 CFR 4.96 when granting entitlement to SC for certain respiratory disabilities. These provisions include
- prohibitions for separately evaluating certain coexisting respiratory conditions
- entitlement to special monthly compensation in specific cases, and
- requirements for pulmonary function tests.
Reference: For more information on evaluating respiratory disabilities, see
- 38 CFR 4.97, and
- M21-1, Part V, Subpart iii, 4.A.