Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117
Polycythemia vera is a blood disorder where your bone marrow produces too many red blood cells, making your blood thicker than normal. The VA rates this condition from 10% to 100% based on how often you need treatments like phlebotomy (blood draws to reduce your red blood cell count) or whether you need more intensive treatments like chemotherapy. Higher ratings reflect more frequent treatments and more severe symptoms that significantly impact your daily life.
Rating levels
- 100% — You qualify for this rating if your polycythemia vera is severe enough that you need a peripheral blood transplant, bone marrow stem-cell transplant, or chemotherapy treatments to help manage your symptoms. Chemotherapy in this case includes myelosuppressants (medications that slow down your bone marrow's production of blood cells). These are major medical interventions used when the condition significantly impacts your health and quality of life.
- 60% — To qualify for this rating level, you must need phlebotomy (a medical procedure where blood is drawn from your body to reduce the number of red blood cells) at least 6 times in a 12-month period, or you must be taking molecularly targeted therapy (specialized medications that work at the cellular level) to keep your red blood cell count under control. This rating recognizes that your polycythemia vera requires frequent medical interventions to manage dangerously high levels of red blood cells in your system.
- 30% — You qualify for this rating if you need to have blood drawn and removed (phlebotomy) 4-5 times per year to manage your condition. You also qualify if you need to take ongoing medications like interferon or other drugs that suppress your bone marrow to keep your platelet count below 200,000 or your white blood cell count below 12,000.
- 10% — You qualify for this rating if your polycythemia vera (a blood disorder that causes your body to make too many red blood cells) is mild enough that you need blood removal treatments (phlebotomy) three times or less per year. You also qualify if you need certain medications like biologic therapy or interferon only occasionally to keep your blood cell counts in the normal range.
- -1% — If polycythemia vera requires peripheral blood or bone marrow stem cell transplant, the 100% rating begins on the date you are admitted to the hospital for the transplant. If chemotherapy (including myelosuppressants such as hydroxyurea, busulfan, interferon, or ruxolitinib used as cytoreduction) is the treatment, the 100% rating runs through the entire period of active chemotherapy. Six months after hospital discharge (for transplant) or six months after the last dose of chemotherapy, VA must schedule a mandatory examination. That exam determines whether the 100% should continue or whether to drop to one of the lower phlebotomy/therapy-based tiers (60% / 30% / 10%) based on current treatment requirements and residuals. 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 rule applies to any subsequent reduction. Common residuals include thrombotic events (DVT, stroke, MI — rate under affected body system), bleeding complications, hematologic transformation to myelofibrosis or acute leukemia (rerated under DC 7703 / DC 7716 as applicable), and graft-versus-host disease after allogeneic transplant.