Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117
Aplastic anemia is a serious blood disorder where your bone marrow doesn't make enough red blood cells, white blood cells, and platelets. The VA rates this condition based on how severe your symptoms are and what treatments you need. Ratings range from 30% (needing at least one blood transfusion or having one infection per year) to 100% (needing a bone marrow transplant or frequent transfusions/infections every six weeks).
Rating levels
- 100% — You qualify for this rating if your aplastic anemia (a condition where your bone marrow doesn't make enough blood cells) is severe enough that you need a blood or bone marrow transplant, or you need blood transfusions at least every six weeks throughout the year. You also qualify if your low blood cell counts cause you to get serious infections at least every six weeks on average.
- 60% — You qualify for this rating if you need blood transfusions (platelets or red blood cells) at least once every three months, or if you get infections at least once every three months because your immune system is weakened. You also qualify if you must take daily medications that suppress your immune system (immunosuppressive drugs) or newer drugs that help your body make more platelets to prevent dangerous bleeding.
- 30% — You qualify if your aplastic anemia (a condition where your bone marrow doesn't make enough blood cells) is severe enough that you need blood transfusions at least once a year - either platelet transfusions (to help your blood clot) or red blood cell transfusions (to treat anemia). You also qualify if your low blood cell counts cause you to get infections that require medical treatment at least once per year on average.
- -1% — If aplastic anemia is treated with peripheral blood or bone marrow 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/immunosuppression (typically anti-thymocyte globulin + cyclophosphamide, or fludarabine-based regimens for matched-sibling-donor HSCT), 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 to continue 100% or step down to one of the lower transfusion / infection / hematologic-marker tiers 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 post-transplant residuals: acute and chronic graft-versus-host disease affecting skin, GI tract, liver, lungs (rate under affected body system), late infections from immunosuppression, secondary malignancy, infertility, cataracts from total body irradiation, and persistent cytopenias if engraftment is incomplete.