Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117
Immune thrombocytopenia (ITP) is a condition where your immune system attacks your own platelets - the blood cells that help you clot when you're injured. This leads to dangerously low platelet counts and bleeding problems. The VA rates ITP from 0% to 100% based mainly on your platelet count numbers and what treatments you need to manage the condition. Higher ratings go to veterans who need stronger treatments like chemotherapy or have very low platelet counts despite treatment.
Rating levels
- 100% — You qualify if your immune thrombocytopenia (low platelet count due to immune system problems) is so severe that you need chemotherapy treatment because other treatments haven't worked. You also qualify if your platelet count (blood cells that help with clotting) stays at 30,000 or below even with medical treatment, which puts you at serious risk for dangerous bleeding.
- 70% — You qualify for this rating if you need to take medications that suppress your immune system to manage your condition. You also qualify if your platelet count (blood cells that help clotting) is between 30,000 and 50,000, and you've been hospitalized for severe bleeding that required IV immune globulin (antibody treatment), high-dose steroid injections, and platelet transfusions to save your life.
- 30% — You qualify for this rating if your blood test shows platelet counts between 30,000 and 50,000 (platelets are blood cells that help with clotting), and you have either an autoimmune condition destroying your platelets or mild bleeding from your gums, nose, or mouth. You must also need treatment with either steroid pills taken by mouth or special antibody treatments given through an IV to manage your condition.
- 10% — Your platelet count (blood cells that help with clotting) is between 30,000 and 50,000, which is below the normal range of 150,000-400,000. Despite having low platelets, your condition is stable enough that you don't need medical treatment like medications or blood transfusions to manage it.
- 0% — Your platelet count (blood cells that help with clotting) is above 50,000 and you're not experiencing any symptoms from your immune thrombocytopenia. This also applies if your immune thrombocytopenia is in remission, meaning the condition is currently inactive or controlled.
- -1% — If immune thrombocytopenia required chemotherapy (e.g., rituximab, cyclophosphamide, vincristine, or other cytotoxic agents used for refractory disease), the 100% rating continues for six months after the last dose of chemotherapy. At the six-month mark, VA must schedule a mandatory examination. That exam determines whether the 100% should continue or whether to step down to one of the lower platelet-count / treatment-based tiers (70% / 30% / 10% / 0%). 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 chemotherapy residuals to consider at the exam: cytopenias, infection susceptibility, neuropathy (from vincristine), cardiomyopathy (from anthracyclines if used), and secondary malignancy.