--- title: "Part VIII, Subpart ii, Chapter 2, Section C Rating Claims Based on Particulate Matter Exposure Under 38 CFR 3.320" document: "M-21-1" section: "Part VIII, Subpart ii, Chapter 2, Section C" canonical: "https://veteranai.co/va-regulations/m21-1/viii.ii.2.c-rating-claims-based-on-particulate-matter-exposure-under-38" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177443/M21-1-Part-VIII-Subpart-ii-Chapter-2-Section-C-Rating-Claims-Based-on-Exposure-to-Burn-Pits-and-Other-Toxins-Including-Fine-Particulate-Matter-BPOT" updated: "2026-09-06T14:37:11.737134Z" --- 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.| **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.| **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.| **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 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. 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 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]().