PACT Act GI Cancers & MGUS Mission Brief

Launch Your Presumptive Cancer Claim Strategy

GI cancers of any type and monoclonal gammopathy of undetermined significance (MGUS) are now presumptive if you meet the PACT Act exposure criteria. Use this mission brief to confirm eligibility, assemble evidence, and file or reopen in time to protect your back pay.

  1. Verify exposure lanes: Match your service dates and locations to the burn pit or Agent Orange presumption so VA must concede exposure.
  2. Stage the medical core: Gather pathology, oncology treatment summaries, and toxic exposure screening notes that prove the diagnosis and presumptive route.
  3. File decisively: Choose between a new claim or Supplemental Claim, cite the PACT Act change-in-law, and monitor development deadlines.

What’s covered on this page

Presumptive conditions snapshot

  • GI cancers of any type: Colorectal, pancreatic, stomach, esophageal, liver, bile duct, and small intestine cancers qualify when the claimant served in covered airborne-hazard deployments.1
  • Reproductive cancers: Ovarian cancer (within VA’s “reproductive cancers of any type”) is presumptive for the same toxic exposure cohorts, so document gynecological oncology records alongside GI proof.1
  • MGUS & related hematologic conditions: MGUS appears on both the burn pit cancer list and the Agent Orange presumptive list—veterans can win under either exposure lane when the records match service criteria.12
  • Timeline reminder: VA began full PACT Act health care enrollment for all eligible toxic-exposed veterans on March 5, 2024, and continues to expand screening capacity for cancers flagged in the law.3

Who qualifies under the PACT Act

  • Post-9/11 and Southwest Asia deployments: VA concedes airborne hazard exposure for service in Iraq, Afghanistan, Syria, Djibouti, Somalia, or other covered locations on or after September 11, 2001, and for Southwest Asia service dating back to August 2, 1990.1
  • Other toxic-exposure cohorts: Veterans assigned to the Kosovo, Horn of Africa, or other PACT Act “location-based” lists qualify even without direct burn pit documentation—cite the location and dates on VA Form 21-526EZ.
  • Agent Orange pathway for MGUS: Vietnam, certain Thailand air bases, Laos, Cambodia, Blue Water Navy (within 12 nautical miles), Guam, American Samoa, and other PACT Act–added AO sites automatically satisfy the MGUS exposure requirement.2
  • Survivor eligibility: DIC and accrued benefits flow to survivors when the veteran died from a presumptive cancer tied to these exposure rules—preserve deployment evidence and oncology records in the claim packet.

Evidence you need before you file

  • Diagnosis proof: Full pathology reports, staging summaries, oncology treatment plans, and hematology labs (include serum protein electrophoresis for MGUS).
  • Exposure confirmation: Toxic exposure screening note, deployment orders, performance reports, or DD 214 remarks that confirm you were in a presumptive location—pair them with a PACT Act mission brief to show the exposure chain.4
  • Continuity of care: VA and private treatment notes that show ongoing symptoms, chemotherapy/radiation cycles, or MGUS monitoring intervals—these support rating percentages and expedite requests.
  • Lay or caregiver statements: Use the lay statement templates and the VA Form 21-10210 guide to document daily limitations, treatment side effects, or caregiver burdens linked to the cancer.
  • Change-in-law memo: Draft a short cover letter that cites the PACT Act presumption, tags each exhibit, and references the Supplemental Claim playbook so the rater matches the cancer to the approved exposure lane.

Filing playbook: new vs. supplemental

  1. Protect your effective date: File an Intent to File (VA Form 21-0966) if you need time to chase records, then complete VA Form 21-526EZ as soon as the packet is ready.
  2. Note the presumption: In Part IV, cite “PACT Act airborne hazards presumptive” or “Agent Orange MGUS presumptive” so VBMS tags the correct exposure lane—mirror the language from your PACT Act Pathfinder output.
  3. Reopen with a Supplemental Claim: If VA denied the cancer before March 2024, submit VA Form 20-0995, select “change in law,” and include the updated VA guidance plus any missing medical evidence.
  4. Upload with discipline: Label files YYYY-MM-DD_Veteran-Name_RecordType.pdf, keep each exhibit under VA’s size limit, and mirror the order used in your cover memo.
  5. Track development: Monitor VA.gov claim status weekly, respond immediately to evidence requests, and document every call or upload in your Claim Prep Checklist.

Common pitfalls and pro tips

  • Forgetting to tie each exhibit to the presumptive rule—call out the exact deployment or AO site and the qualifying condition in every narrative section.
  • Submitting only summary pages. Upload the full pathology or MGUS laboratory series so raters can confirm diagnostic criteria.
  • Missing the one-year AMA window after a denial. Continuous pursuit preserves back pay, even when you need to add new treatment records.
  • Skipping hardship notes. Terminal diagnoses, ongoing chemo, or severe financial distress can justify an expedite—include supporting physician letters and bills.
  • Underusing survivor benefits. If the veteran passed away from a covered cancer, survivors should file DIC with the same presumptive citations and medical records.

Care & Support Moves

  • Book VA toxic exposure screening (takes minutes) and upload the note—it documents exposure acceptance and flags you for follow-up care.4
  • Ask oncology teams about VA’s Close-to-Me Cancer Care and National TeleOncology options, which expanded after the March 2024 cancer access initiative.3
  • Coordinate with social work for travel reimbursement, lodging, or caregiver resources while treatments are ongoing.

FAQ

Usually no—the presumption replaces the medical nexus. Focus on proving your qualifying service, diagnosis, and current severity. A nexus opinion can still help when secondary issues (like neuropathy from chemo) are part of your claim or when you are building secondary chains.
Presumptives cover conditions that manifest after service, but direct service connection is still possible. Submit service treatment records, line-of-duty notes, and medical opinions that link in-service symptoms to the cancer, and mirror the steps in the Start Here pathfinder if you need a refresher on direct service-connection lanes.
File VA Form 20-0995, select “change in law,” and attach the VA guidance showing the cancer is now presumptive along with any evidence VA did not see the first time.

Related Resources & References

Get Toxic Exposure Intel Before the VA Sends a Letter

We send veteran-written briefings when PACT Act rules shift—new presumptives, evidence drills, and cover-memo scripts—so you can act before the claims backlog moves.