Hodgkin's lymphoma (DC 7709)

Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117DBQ: DBQ HEM Hematologic and Lymphatic Conditions, Including Leukemia

DC 7709 covers Hodgkin's lymphoma — a B-cell lymphoma characterized by Reed-Sternberg cells, including classical Hodgkin's (nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte-depleted) and nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL). The VA assigns a flat 100% rating during active disease and active treatment (chemotherapy such as ABVD or escalated BEACOPP, radiation, immunotherapy with brentuximab or checkpoint inhibitors, targeted therapy, autologous or allogeneic stem-cell transplant). The 100% continues for six months after all treatment ends, then a mandatory VA examination determines whether to continue 100% or rate on residuals. If there has been no local recurrence or metastasis, chronic residuals are rated separately — common late effects include cardiotoxicity (anthracycline cardiomyopathy, mediastinal-radiation valvular and coronary disease), bleomycin or radiation pulmonary fibrosis, vincristine-induced peripheral neuropathy, hypothyroidism from neck radiation, secondary malignancy in radiation field, and infertility. Residuals are combined under 38 CFR § 4.25 subject to anti-pyramiding rules of § 4.14. Any reduction in the 100% rating is protected by the due-process requirements of 38 CFR § 3.105(e). Recurrence or metastasis restores 100% from the date of recurrence.

Rating levels

  • 100% — You qualify for 100% during any period of active Hodgkin's lymphoma or active treatment for it. Treatment phases include chemotherapy (ABVD, escalated BEACOPP, BV-AVD), radiation therapy (involved-site or extended-field), immunotherapy (brentuximab vedotin, checkpoint inhibitors such as nivolumab/pembrolizumab), targeted therapy, and autologous or allogeneic stem-cell transplant. The 100% rating continues without interruption during the entire active-treatment phase. See the CFR Note below for what happens after treatment ends.
  • -1% — The 100% rating continues for six months after all Hodgkin's lymphoma treatment ends. At the six-month mark, VA must schedule a mandatory examination. If the lymphoma has not locally recurred and has not metastasized, the rating is based on residuals under the diagnostic codes that match each chronic complication. Common residuals from Hodgkin's treatment: cardiotoxicity from doxorubicin or mediastinal radiation (DCs 7000 series — cardiomyopathy, valvular disease, accelerated coronary artery disease), pulmonary fibrosis from bleomycin or chest radiation (DC 6825), peripheral neuropathy from vincristine (DCs 8520-8540 by nerve), hypothyroidism from neck radiation (DC 7903), secondary malignancy in radiation field (rated under primary site), infertility (no separate DC, may support SMC-K if loss of use of creative organ), psychiatric residuals (DCs 9411-9434), and chronic fatigue (functional component). If VA proposes to reduce the rating after the six-month 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. If the lymphoma recurs or metastasizes, the 100% rating resumes from the date of recurrence and the six-month clock resets after treatment ends again.

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