Acquired hemolytic anemia (DC 7723)

Rating levels

• 100% — To qualify for this rating level, you must need either a bone marrow transplant (a procedure where healthy bone marrow is transplanted to replace diseased marrow) or ongoing treatment with medications given through an IV or drugs that suppress your immune system like prednisone, Cytoxan, azathioprine, or rituximab. This represents the most severe level of acquired hemolytic anemia (a condition where your immune system destroys your red blood cells faster than your body can make new ones) that requires the most intensive medical interventions to keep you stable.
• 60% — You qualify for this rating if your acquired hemolytic anemia (a condition where your body destroys its own red blood cells) is severe enough that you need to take immunosuppressive drugs (medications that suppress your immune system) at least 4 times during a 12-month period. These medications are typically needed when your immune system is attacking your red blood cells and needs to be controlled to prevent further damage.
• 30% — You qualify at this level if your acquired hemolytic anemia (a condition where your immune system destroys your red blood cells faster than your body can make them) requires treatment with immunosuppressive drugs (medications that calm down your overactive immune system) at least 2 times per year but fewer than 4 times per year. Each treatment course typically lasts several weeks or months, so this means you need this specialized medication therapy multiple times annually to manage your condition.
• 10% — You qualify for this rating if your acquired hemolytic anemia (a condition where your immune system destroys your red blood cells faster than your body can make them) requires treatment with immunosuppressive medications (drugs that calm down your overactive immune system) once during a 12-month period. This means your condition is serious enough to need medical treatment that suppresses your immune system to stop it from attacking your red blood cells, but you only need this treatment once per year.
• 0% — You have acquired hemolytic anemia (a condition where your body destroys red blood cells faster than it can make new ones) but you're not experiencing any symptoms from it. Your condition doesn't cause you any noticeable problems like fatigue, weakness, shortness of breath, or other health issues in your daily life.
• -1% — If acquired hemolytic anemia requires bone marrow transplant (an uncommon but recognized treatment for refractory autoimmune hemolytic anemia or paroxysmal nocturnal hemoglobinuria with bone-marrow failure), the 100% rating begins on the date you are admitted to the hospital. The 100% continues through hospitalization, conditioning chemotherapy/immunosuppression, the transplant itself, engraftment, and for six months after hospital discharge. At the six-month-post-discharge mark, VA must schedule a mandatory examination. That exam decides whether the 100% should continue or whether to step down to one of the lower immunosuppressive-therapy tiers (60% / 30% / 10% / 0%) 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 to consider: acute and chronic graft-versus-host disease (rated under affected body system), persistent hemolysis or cytopenias if engraftment is incomplete, late infections from immunosuppression, secondary malignancy, infertility, and cataracts if total body irradiation was used.