Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117DBQ: DBQ HEM Hematologic and Lymphatic Conditions, Including Leukemia
Multiple myeloma is a cancer of the blood that affects plasma cells (infection-fighting cells) in your bone marrow. The VA has a simple two-tier rating system for this condition: if you have any symptoms from the multiple myeloma, you get 100%. If your multiple myeloma isn't causing symptoms yet (called asymptomatic or smoldering), or if you have MGUS (a precancerous condition that may lead to multiple myeloma), you get 0%.
Rating levels
- 100% — You qualify for this rating if you have multiple myeloma (a type of blood cancer that affects plasma cells in your bone marrow) and are experiencing symptoms from the disease. The symptoms can include things like bone pain, fatigue, frequent infections, anemia (low red blood cell count), or other problems caused by the cancer affecting your blood and immune system.
- 0% — You qualify for this rating level when you have multiple myeloma that isn't causing any noticeable symptoms yet. This includes "smoldering" multiple myeloma (cancer cells are present but growing very slowly), asymptomatic cases (no symptoms you can feel), or MGUS (abnormal proteins in your blood that may or may not develop into full multiple myeloma). At this stage, you're not experiencing pain, fatigue, infections, or other problems from the condition.
- -1% — Multiple myeloma is unusual among VA cancer ratings — instead of running 100% during treatment and six months afterward, the 100% rating runs for FIVE YEARS from the date symptomatic multiple myeloma is diagnosed (CRAB criteria: hypercalcemia, renal insufficiency, anemia, or bone lesions; OR myeloma-defining biomarkers — 60% clonal plasma cells, free-light-chain ratio ≥100, or >1 focal MRI lesion). The longer window reflects that myeloma is incurable with frequent relapse cycles even when initial response is good. At the five-year mark, VA must schedule a mandatory examination. Any reduction is protected by BOTH 38 CFR § 3.105(e) (60-day pre-reduction notice with reasons and right to a hearing) AND § 3.344(a) and (b) (stabilization-of-disability rule — ratings that have been continuous for 5+ years cannot be reduced unless the medical evidence demonstrates sustained material improvement that is reasonably certain to continue under the ordinary conditions of life and work). This is a stronger protection than § 3.105(e) alone — VA must affirmatively prove the improvement is durable, not merely show a snapshot of better lab values. Common residuals to consider at the five-year exam: skeletal damage from lytic lesions (rate under affected bones / DC 5252-5275 depending on site), renal insufficiency (DC 7530 / 7541 / renal dysfunction ladder), peripheral neuropathy from bortezomib (DCs 8520-8540), cardiomyopathy if doxorubicin used (DC 7020), amyloid deposition (DC 7539 if renal involvement), and secondary malignancy (especially MDS/AML from prior alkylators). If the myeloma is no longer in stable response or has progressed, the 100% rating continues or resumes.