Body system: Hemic and Lymphatic SystemsRegulation: 38 CFR § 4.117
Pernicious anemia and Vitamin B12 deficiency anemia happen when your body can't properly absorb or use Vitamin B12, leading to problems making healthy red blood cells. The VA rates this condition at either 10% or 100% - there's nothing in between. You'll get 10% if you need ongoing B12 treatment like injections or high-dose supplements, but you'll jump to 100% if your condition is severe enough to need blood transfusions or if it's affecting your nervous system with symptoms like brain fog, spinal cord problems, or severe nerve damage.
Rating levels
- 100% — You qualify for this rating if your pernicious anemia or B12 deficiency is so severe when first diagnosed that you need blood transfusions, or if the condition has damaged your nervous system. The nervous system damage must be serious enough to cause brain problems (encephalopathy), spinal cord issues (myelopathy), or severe nerve damage in your arms and legs (peripheral neuropathy), and you need B12 shots or IV treatments to manage it.
- 10% — You qualify for this rating if you have pernicious anemia (your body can't absorb vitamin B12 properly) or vitamin B12 deficiency anemia (low red blood cell count due to lack of B12) and need ongoing treatment to manage it. The treatment must be continuous and involve regular B12 injections, high-dose B12 pills or tablets that dissolve under your tongue, or B12 nasal sprays or gels. This covers cases where your condition requires consistent medical intervention to prevent symptoms like fatigue, weakness, and nerve problems from returning.
- -1% — The 100% rating begins on the date pernicious anemia or B12 deficiency is initially diagnosed if either: (1) the anemia is severe enough to require blood transfusion, OR (2) treatment requires parenteral (injection) B12 therapy. The 100% continues through hospitalization and the parenteral therapy course. Six months after hospital discharge or six months after parenteral B12 therapy is stopped, VA must schedule a mandatory examination. After that exam, the rating drops to 10% (the maintenance tier for ongoing B12 replacement). Crucially, any neurologic or GI residuals are then rated SEPARATELY and combined with the 10% under 38 CFR § 4.25 — examples include peripheral neuropathy (DCs 8520-8540 by nerve, subacute combined degeneration of the spinal cord), myelopathy (DC 8011 or under appropriate spinal-cord injury code), dementia or cognitive impairment from B12-deficient encephalopathy (DC 9326 or 9304), and GI residuals such as atrophic gastritis from autoimmune destruction of parietal cells (DC 7307) or malabsorption (DC 7319). Some residuals (especially neurologic) may be permanent even with adequate B12 replacement, which is why separate evaluation is required by the regulation. If VA proposes to reduce the 100% 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.