Blood and Lymphatic Conditions Rating Guide

The Rules That Decide Every Blood and Lymphatic Claim

The hemic and lymphatic system covers the blood, bone marrow, spleen, and lymph nodes. Conditions here split into two broad groups, and the group decides how the rating works. Anemias and clotting disorders are rated on how well the blood is working and how sick it makes you. Blood and lymphatic cancers are rated on a fixed schedule tied to treatment. A handful of shared rules under 38 CFR § 4.117 sit on top of both groups.

1. Anemia is rated on hemoglobin plus symptoms

Anemia is rated on the hemoglobin level in your blood together with the symptoms it causes, such as weakness, dizziness, shortness of breath, and fatigue. Lower hemoglobin combined with more symptoms means a higher rating. A lab number alone does not tell the whole story; the rating pairs the number with what the condition does to your daily function.

2. Blood cancers rate 100 percent during active treatment

Blood and lymphatic cancers, including leukemia, lymphoma, Hodgkin's disease, and multiple myeloma, are rated 100 percent while the disease is active and during treatment, and for a set period afterward. During the active phase the VA does not weigh individual symptoms; the diagnosis and active treatment carry the total rating on their own.

3. When treatment ends, a review exam re-rates on residuals

The automatic 100 percent does not last forever. When active treatment ends, the VA schedules a mandatory review examination. At that exam the condition is re-rated on its residuals, the lasting effects on the body, rather than keeping the automatic total rating. If there are no residuals, the rating can drop; if lasting damage remains, that damage is rated on its own under the matching part of the schedule.

4. Ongoing treatment and transfusion dependence factor in

Some conditions are transfusion-dependent or require continuous treatment to keep the blood counts stable. That ongoing need is part of the disability picture and factors into the rating. Documenting how often you need transfusions or infusions, and what happens without them, matters to how the condition is scored.

5. Several blood cancers are presumptive

A number of blood and lymphatic cancers are Agent Orange or other exposure presumptives. Certain leukemias, lymphomas, and multiple myeloma are on the presumptive lists, which means a covered veteran with qualifying service often does not have to prove the link between the exposure and the disease. See the PACT Act and presumptives guide to check whether your service and condition qualify.

Find the Guide for Your Condition

This system does not yet have a dedicated per-condition guide for every code. For the exact rating levels, the treatment timeline, and the Board data on the conditions that are covered, start here:

For anemia and other specific blood conditions, open the condition lookup page for the rating levels and Board data.

Common Secondary Conditions

Blood and lymphatic conditions rarely stand alone. Because they affect the whole body and because treatment leaves its own mark, one service-connected condition often opens the door to several secondary claims:

• Anemia secondary to another disease. A chronic illness or ongoing gastrointestinal bleeding can cause anemia. When the underlying condition is service-connected, the resulting anemia can be claimed as secondary.
• Blood cancers tied to exposure. Certain leukemias, lymphomas, and myeloma are linked to Agent Orange or burn-pit exposure, which is why the presumptive lists matter so much here.
• Mental health from a serious diagnosis. The fatigue and strain of a blood disorder or a cancer diagnosis can drive depression and anxiety, which may be claimed as secondary to the physical condition.
• Organ or immune residuals after treatment. Chemotherapy, radiation, and stem-cell treatment can leave lasting organ damage or a weakened immune system that is rated separately. See secondary conditions.

Evidence That Wins

• A complete blood count showing your hemoglobin and platelet levels, the objective backbone of an anemia or clotting claim.
• A bone-marrow biopsy or pathology report confirming a blood cancer and its type, the record that establishes the diagnosis.
• Treatment records that date the active phase, showing when chemotherapy, radiation, or other active treatment started and stopped. This timeline drives the 100-percent period and the review exam.
• Documentation of transfusion dependence or ongoing infusions, showing how often you need treatment to keep your counts stable.
• The matching DBQ for the condition, which prompts the examiner to capture the labs, symptoms, and residuals the rating depends on. See the DBQ guide.

Common Mistakes

Frequently Asked Questions