No, the PACT Act does not cover Kosovo veterans through its presumptive conditions framework. Kosovo is not on the list of designated locations, so a veteran who developed a toxic-exposure illness after serving there cannot skip the evidence burden the way a veteran who deployed to Iraq or Afghanistan can. Benefits are still available, but you have to build the case yourself through a direct service connection claim, and you can access VA health care through combat zone and toxic exposure pathways regardless of whether a disability claim is ever filed.
Why Kosovo Sits Outside the Presumptive List
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 expanded VA health care and benefits for veterans exposed to burn pits and other toxic substances. Its central feature is the presumptive conditions list: if you served in a designated location during a specified period and later develop a listed condition, the VA assumes a service connection without requiring you to prove the link.
The designated locations cover post-9/11 service in countries such as Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, and Yemen, Gulf War-era service in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, and the United Arab Emirates, and Agent Orange locations including Vietnam, Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll. Kosovo does not appear on any of them.1Veterans Affairs. The PACT Act and Your VA Benefits
The consequence is practical. A veteran with respiratory illness after Bagram Airfield can point to a presumptive condition. A veteran with the same illness after Camp Bondsteel has to prove the connection.
Kosovo has, however, been a designated combat zone since March 24, 1999, under Executive Order 13119. That designation covers the former Federal Republic of Yugoslavia, Albania, Kosovo, the Adriatic Sea, and the Ionian Sea north of the 39th parallel, and it remains in force today.2IRS. Combat Zones Approved for Tax Benefits Combat zone status opens doors to VA health care and certain tax benefits. It does not change the evidence burden for a disability claim. Many veterans confuse the two.
The Exposures a Kosovo Claim Is Built On
A direct service connection claim starts with what you were actually exposed to. Kosovo had a distinctive mix of hazards.
Depleted Uranium
NATO used approximately 31,000 rounds of depleted uranium ammunition during Operation Allied Force, primarily fired by A-10 aircraft during roughly 100 missions across Kosovo.3UN Meetings Coverage and Press Releases. NATO Confirms to United Nations Use of Depleted Uranium During Kosovo Conflict DU is a dense metal used in armor-piercing munitions. On impact it creates fine particles and fragments that persist in soil and structures for years. Service members who handled contaminated equipment, worked near strike sites, or breathed dust in affected areas faced potential exposure.
The VA identifies two health concerns with DU: radiation and heavy metal toxicity. Because DU is less radioactive than naturally occurring uranium, the VA considers radiation the lesser concern. The larger worry is heavy metal toxicity, particularly kidney damage. Research into effects on bone mineral density is ongoing. Embedded DU fragments may remain in the body for many years; inhaled particles are generally cleared from the lungs over several years.4Public Health. Depleted Uranium
Industrial Contamination
The 1999 conflict damaged industrial infrastructure across Kosovo. The Trepça mining and smelting complex in Mitrovica released large amounts of lead, zinc, arsenic, and other heavy metals into the surrounding land, and the contamination was severe enough that peacekeeping soldiers received protective measures against lead exposure as early as 2000.5Ej Atlas. The UN Resettled 600 Roma to a Mining/Smelting Complex Exposing Them to Lead Poisoning, Kosovo KFOR personnel also encountered hazardous chemical storage at energy plants and factories throughout Kosovo, where improperly stored industrial chemicals created ongoing exposure risks.6EUCOM. Oregon Army National Guard Chemical Officer Contributes to Safe Environment in Kosovo
Burn Pits and Airborne Hazards
Burn pits operated near military installations in Kosovo, exposing personnel to smoke containing a mixture of chemicals, metals, and fine particulate matter. Burn pit use in Kosovo was more localized than in Iraq or Afghanistan, but the health effects of inhaling the smoke do not depend on how large the operation was.
How to File a Direct Service Connection Claim
Because Kosovo lacks presumptive status, every Kosovo-related disability claim runs on direct service connection. The quality of your evidence tends to matter more than the underlying merits. The VA requires three things.7Veterans Affairs. Evidence Needed For Your Disability Claim
A Current Diagnosed Condition
You need medical records showing a current diagnosis from a qualified provider. A general complaint of symptoms is not enough. If you suspect kidney problems from DU exposure or respiratory issues from burn pit smoke, get the condition formally diagnosed and documented before filing. VA treatment records work. Private medical records do too.
An In-Service Event or Exposure
You need evidence that something happened during your Kosovo deployment that could have caused your condition. Deployment orders and service records establishing your presence in Kosovo are the foundation. Beyond that, any documentation of specific exposure events strengthens the claim: records showing your unit operated near DU strike sites, documentation of burn pit proximity, or evidence that you served near the Trepça complex or another contaminated industrial site.
When official records do not capture your specific exposure, lay evidence fills the gap. A buddy statement from a fellow service member who witnessed the same conditions carries real weight. The VA accepts these on VA Form 21-10210, where the witness describes what they personally observed. Each witness submits a separate form, checks a box indicating their relationship to you, and signs it.8Veterans Benefits Administration. Lay/Witness Statement VA Form 21-10210 A statement from someone who served alongside you at the same base, describing the same burn pit or the same contaminated area, is exactly the kind of corroboration that moves a claim forward.
A Medical Nexus
This is the element that separates presumptive claims from direct service connection claims, and it is where Kosovo veterans carry the heaviest burden. You need a medical opinion stating that your condition is connected to your in-service exposure. The VA’s standard is “at least as likely as not,” meaning the doctor must conclude there is at least a 50 percent probability the condition resulted from your service.
The opinion usually comes as a nexus letter from a qualified medical professional. It has to do more than state a conclusion. It must include a clinical rationale explaining why the doctor believes the specific exposure led to the specific condition. A letter that says “the veteran’s kidney disease is at least as likely as not related to depleted uranium exposure during service in Kosovo” without explaining the reasoning gives the VA grounds to discount it. The strongest nexus letters reference your service records, your medical history, and the relevant medical literature on the exposure in question.
File an Intent to File First
Before you start assembling evidence, file an Intent to File using VA Form 21-0966. This one-page form does nothing except tell the VA you plan to submit a claim. But if the claim is eventually approved, the VA may pay retroactive benefits dating back to when it processed the Intent to File rather than when you submitted the completed claim.9Veterans Affairs. Submit An Intent To File
You have one year from the date of the Intent to File to submit the full claim. Miss that window and the potential effective date expires. For Kosovo veterans who need time to gather nexus letters, buddy statements, and medical records, that one-year runway is valuable.
If the VA Denies Your Claim
Non-presumptive claims get denied more often than presumptive ones. A denial is not the end. The VA offers three paths forward.10Veterans Affairs. VA Decision Reviews And Appeals
- A Supplemental Claim, where you submit new and relevant evidence the VA did not have before. For Kosovo veterans this often means a stronger nexus letter, additional buddy statements, or newly available medical research linking the condition to the exposure. A Supplemental Claim can also be filed based on a change in law, including any future addition of Kosovo to the presumptive list.11Veterans Affairs. Supplemental Claims
- A Higher-Level Review, where a more senior VA reviewer examines the same evidence. You cannot submit new evidence. Choose this when you believe the original decision misapplied the law or overlooked evidence already in your file.
- An appeal to the Board of Veterans’ Appeals, where a Veterans Law Judge reviews your case. This is the most formal option and typically takes the longest, but it provides review outside the regional office that denied the claim.
For Kosovo veterans denied on the nexus element, the Supplemental Claim route is usually the most productive. If the VA said the medical link was insufficient, a more detailed nexus letter from a specialist with a thorough clinical rationale addresses the weakness directly.
VA Health Care You Can Access Now
Health care eligibility and disability compensation run on separate tracks. You can enroll in VA health care even if you never file a disability claim, and even if a claim is denied.
Kosovo veterans qualify for enrollment through multiple routes. Veterans who served in any combat zone after September 11, 2001, can enroll if they meet basic service and discharge requirements.1Veterans Affairs. The PACT Act and Your VA Benefits Because Kosovo has been a designated combat zone since March 24, 1999, this covers most KFOR deployments.
Veterans whose Kosovo service predates the post-9/11 window may qualify under the Toxic Exposure Risk Activity (TERA) pathway. The VA defines TERA participation broadly to include exposure to air pollutants like burn pits and dust, chemicals including depleted uranium, occupational hazards like asbestos and lead, radiation, and warfare agents.12VA.gov. All Things PACT Act 101 A Kosovo veteran exposed to DU, lead contamination from industrial sites, or burn pit smoke would likely meet this definition. Veterans who qualify through TERA or toxic exposure pathways are generally placed in Priority Group 6 for enrollment purposes.13Veterans Affairs – VA.gov. VA Priority Groups
Once enrolled, the VA provides a toxic exposure screening as part of your care. It is a brief conversation with a member of your care team, usually 5 to 10 minutes during a regular appointment. The main question is whether you believe you experienced toxic exposures during service. If you say yes, the care team documents the exposure and connects you with additional resources and registry exams. The screening repeats at least once every five years.14VA.gov. Toxic Exposure Screening Fast Facts The screening itself is not a physical exam or diagnostic workup. Think of it as a documentation event that creates a record of your exposure in the VA system, which can support future claims.
Registries That Build Your Record
The VA maintains registries that track veterans with specific environmental exposures. Participation is voluntary, free, and does not require enrollment in VA health care. A registry evaluation is a medical assessment, not a claim for benefits, but the results become part of your record and can support a future claim.
Veterans who served during the 1990s or 2000s to the present are eligible for the Depleted Uranium Follow-up Program. To get an evaluation, contact your local VA Environmental Health Coordinator. The evaluation assesses potential long-term health effects from DU exposure and can flag problems before symptoms appear.15Public Health. Environmental Health Registry Evaluation for Veterans
Kosovo is not among the operations or locations that automatically qualify veterans for the Airborne Hazards and Open Burn Pit Registry based on Department of Defense records. Veterans who deployed to an eligible area but are not listed in the system can request a manual eligibility review by submitting a request and selecting “Registry Eligibility” as the topic.16Public Health. Airborne Hazards and Open Burn Pit Registry If you were exposed to burn pit smoke in Kosovo, pursue the review.