Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117
Acquired agranulocytosis is a serious blood disorder where your bone marrow doesn't make enough white blood cells (specifically neutrophils) to fight infections, making you extremely vulnerable to getting sick. The VA rates this condition from 10% to 100% based on how severe your symptoms are and what treatments you need to stay healthy. Higher ratings go to veterans who need stronger treatments like bone marrow transplants or growth factor injections, or who get infections very frequently.
Rating levels
- 100% — You qualify for this rating if you need a bone marrow transplant (a procedure where healthy bone marrow cells are put into your body to replace damaged ones), or if you get infections very frequently - at least once every six weeks throughout a 12-month period. Agranulocytosis means your body doesn't make enough of certain white blood cells that fight infections, so you get sick much more often than normal people.
- 60% — You qualify for this rating if you need regular injections of special medications (called growth factors like G-CSF or GM-CSF) or must take daily immune-suppressing drugs (like cyclosporine) to keep your infection-fighting white blood cells at a low but safer level. You also qualify if you get infections at least once every three months because your body can't make enough of these protective blood cells on its own.
- 30% — You qualify for this rating if you need regular injections of special medications called myeloid growth factors to keep your infection-fighting white blood cells (ANC or absolute neutrophil count) above 1000 per microliter of blood. You also qualify if you get infections that come back on a regular basis - at least once per year but less than once every three months.
- 10% — You qualify for this rating if you need to take medication like antibiotics every day to keep your condition under control, or if you need periodic injections of special growth factor medicines to keep your infection-fighting white blood cells at safe levels (1500 or higher per microliter of blood). This applies when your body doesn't make enough of the white blood cells called neutrophils, which normally protect you from infections.
- -1% — If your acquired agranulocytosis is severe enough to require a bone marrow transplant (BMT, also called hematopoietic stem cell transplant), the 100% rating begins on the date you are admitted to the hospital for the transplant. The 100% continues through hospitalization, conditioning chemotherapy/radiation, the transplant itself, and the engraftment / recovery period. Six months after you are discharged from the hospital, VA must schedule a mandatory examination. That exam decides whether you still have impairment justifying continued 100% or whether to reduce based on residuals (graft-versus-host disease, infections, hematologic function, secondary malignancy, post-transplant fatigue/deconditioning). If VA proposes to reduce the rating after that exam, the protection of 38 CFR § 3.105(e) applies — VA must notify you 60 days before reduction with reasons and your right to a hearing. The same exam rule applies to any subsequent reduction.