Essential thrombocythemia and primary myelofibrosis (DC 7718)

Rating levels

• 100% — You qualify for this rating if you need ongoing myelosuppressive therapy (medications that suppress your bone marrow to control blood cell production) without breaks, or if you're within six months of being hospitalized for major treatments like a stem cell or bone marrow transplant, chemotherapy, or interferon treatment. These treatments are intensive therapies used to manage serious blood disorders that affect how your body makes blood cells.
• 70% — You qualify for this rating level if you need ongoing medical treatment with special medications to keep your blood platelet count (the cells that help your blood clot) below a certain dangerous level. The required treatments include myelosuppressive drugs (medicines that slow down bone marrow production of blood cells), chemotherapy, or interferon therapy, and you must take these either continuously or on and off as needed to control your condition.
• 30% — You qualify for this rating if you need ongoing medical treatment with special medications to keep your blood cell counts in the normal range. This includes taking myelosuppressive drugs (medicines that slow down bone marrow activity), chemotherapy, or interferon to maintain your platelet count (blood clotting cells) between 200,000-400,000 or your white blood cell count between 4,000-10,000. The key factor is that you require continuous or periodic treatment with these medications to prevent your blood counts from becoming dangerously high or low.
• 0% — You have been diagnosed with essential thrombocythemia or primary myelofibrosis (blood disorders that affect your bone marrow's ability to produce blood cells normally), but you are not experiencing any noticeable symptoms from these conditions. Your blood disorders are not causing you any physical problems, fatigue, pain, or other issues that interfere with your daily activities or work.
• -1% — If essential thrombocythemia or primary myelofibrosis requires peripheral blood or bone marrow stem cell transplant (the only known curative therapy for myelofibrosis), the 100% rating begins on the date you are admitted to the hospital for the transplant. If treatment is chemotherapy (myelosuppressants such as hydroxyurea, busulfan, anagrelide, or JAK inhibitors such as ruxolitinib or fedratinib) or interferon (pegylated interferon alfa-2a), the 100% runs through the entire active-treatment period. Six months after hospital discharge (for transplant) or six months after the last dose of chemotherapy / interferon, VA must schedule a mandatory examination. That exam decides whether to continue 100% or step down to one of the lower platelet-based / treatment-based tiers (70% / 30% / 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 residuals to consider at the six-month exam: thrombotic events (DVT, stroke, MI — rate under affected body system), bleeding complications, transformation to acute leukemia (rerated under DC 7703), hematologic complications from JAK inhibitors, graft-versus-host disease after allogeneic transplant, and constitutional symptoms (night sweats, fatigue, weight loss) that may persist.