Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117
Chronic myelogenous leukemia (CML) is a type of blood cancer where your bone marrow makes too many white blood cells. The VA rates CML based on what treatment you need - 100% if you need a stem cell transplant or constant heavy-duty medications, 60% if you need intermittent treatment or targeted drugs when the cancer isn't in remission, and 30% if you're in remission but still need continuous targeted therapy. The ratings reflect how aggressive your treatment needs to be and how much the condition impacts your daily life.
Rating levels
- 100% — You qualify for this rating if your chronic myelogenous leukemia requires you to receive a stem cell transplant (where healthy blood-forming cells are put into your body to replace diseased ones) or if you need ongoing treatment with powerful medications that suppress your immune system or bone marrow function. These treatments are typically given continuously because your leukemia is severe enough to require constant medical intervention to keep it under control.
- 60% — You qualify for this rating if you need ongoing medical treatment for your chronic myelogenous leukemia that hasn't gone into complete remission (isn't fully controlled). This includes taking medications that suppress your bone marrow's ability to make blood cells (myelosuppressive therapy), targeted cancer drugs like tyrosine kinase inhibitors (TKIs such as Gleevec), or interferon treatments to keep the leukemia from progressing.
- 30% — You have chronic myelogenous leukemia that appears to be under control (in apparent remission) because you're taking specific cancer medications called tyrosine kinase inhibitors on an ongoing basis. These are targeted drugs like imatinib (Gleevec) or similar medications that you must take continuously to keep the leukemia from progressing. Your condition requires this daily medication regimen to maintain remission, but you're not currently experiencing active symptoms of the cancer.
- -1% — If CML is treated with peripheral blood or bone marrow stem cell transplant (still curative for select cases, mainly TKI-resistant or blast-phase disease), the 100% rating begins on the date of hospital admission and continues through transplant and recovery. If treatment is chemotherapy (myelosuppressants such as hydroxyurea or busulfan, used pre-TKI era or for cytoreduction in blast-phase disease), the 100% runs through the entire active chemotherapy period. Six months after hospital discharge (for transplant) or six months after the last dose of chemotherapy, VA must schedule a mandatory examination. That exam determines whether to continue 100% or step down to one of the lower TKI-based tiers (60% intermittent / 30% continuous TKI in remission). Note: this DC references § 3.105 generally (not just § 3.105(e)). § 3.105(e) covers the standard pre-reduction due-process (60-day notice + reasons + right to a hearing); § 3.105(a) addresses revision of a rating based on clear and unmistakable error (CUE); § 3.105(d) addresses severance of service connection. For most reductions following the mandatory exam, § 3.105(e) is the governing provision. Common CML residuals: TKI side effects (rash, GI symptoms, cardiotoxicity especially with nilotinib/ponatinib, fluid retention with imatinib), cytopenias, pleural effusions (especially dasatinib), pulmonary arterial hypertension (dasatinib), transformation to accelerated or blast phase (rerated as DC 7703 leukemia), graft-versus-host disease after transplant, and secondary malignancy.