Hematologic and lymphatic conditions including anemia, blood clotting disorders, and lymphatic conditions.
How Blood & Lymph conditions are rated
The hemic and lymphatic schedule at 38 CFR §4.117 covers conditions of the blood, bone marrow, spleen and lymph system, from anemias and platelet disorders to the leukemias, lymphomas and multiple myeloma. Diagnostic codes run 7702 through 7725.
Most codes in this group are rated on the treatment a condition requires and on measured laboratory values, rather than on symptoms described in general terms. The criteria name transfusions, intravenous iron infusions, phlebotomies, growth factors, immunosuppressive therapy, and specific platelet or neutrophil counts. That can make treatment records and lab results the central evidence here, more than a narrative of how you feel.
Many levels count events "per 12-month period." Polycythemia vera (DC 7704) moves from 10% for phlebotomy 3 or fewer times per 12-month period to 60% for 6 or more. Aplastic anemia (DC 7716) is rated in part on how often transfusions or infections recur "on average," and agranulocytosis (DC 7702) in part on how often infections recur. Iron deficiency anemia (DC 7720) runs 0%, 10% and 30% on intravenous iron infusions and oral supplementation, and its note sends anemia caused by blood loss to the criteria for the condition causing the blood loss. A dated record of each treatment can make those counts easy to verify.
For the cancers and for transplants, the schedule ties 100% to active disease, treatment, or the transplant itself, then sets the date of a mandatory VA examination. Leukemia (DC 7703) and Hodgkin's lymphoma (DC 7709) are rated 100% with active disease or during a treatment phase, and the rating continues beyond the end of treatment until an examination six months later. For non-Hodgkin's lymphoma (DC 7715) that examination comes two years after treatment ends. Symptomatic multiple myeloma (DC 7712) is rated 100% for five years after diagnosis. Where a code rates a bone marrow or stem cell transplant at 100%, the rating generally runs from hospital admission until an examination six months after discharge. Residuals are then rated under the appropriate codes. Some early or quiet stages are rated 0%, such as asymptomatic chronic lymphocytic leukemia at Rai Stage 0 and asymptomatic or smoldering myeloma.
These notes make any change based on that examination subject to §3.105(e). That section calls for a proposed rating setting out the reasons, notice to you, and 60 days to present additional evidence before a reduction becomes final. The multiple myeloma note also cites §3.344(a) and (b).
Several notes call for separate ratings. Splenectomy is rated 20% under DC 7706, with complications such as systemic infections with encapsulated bacteria rated separately, and the notes to immune thrombocytopenia (DC 7705) and acquired hemolytic anemia (DC 7723) direct that a splenectomy be rated and combined with them. Complications of polycythemia vera "such as hypertension, gout, stroke, or thrombotic disease" are rated separately. After the initial phase of pernicious anemia (DC 7722), the rating is 10% with neurologic or gastrointestinal residuals rated separately. Sickle cell trait alone, without a history of directly attributable pathological findings, "is not a ratable disability."