Blood and Lymphatic Conditions Rating Guide

If you're a veteran trying to file a claim for a blood or lymphatic condition, most often anemia (low iron or low red blood cells), but also conditions like myelodysplastic syndrome, leukemia, lymphoma, multiple myeloma, and low platelets (thrombocytopenia), this guide walks the whole path: how service connection works, how these conditions get connected to your service (directly, through a presumptive, or secondary to another condition), what evidence wins, why these claims get denied, a checklist before you file, what the claims process looks like step by step, how to read your decision letter, and what to do whether you win or you're denied. Blood and lymphatic conditions share one framework in the rating schedule, 38 CFR § 4.117: anemia is scored on your hemoglobin level and the symptoms it causes, while blood cancers follow a 100-percent-then-residuals pattern that surprises many veterans when the automatic rating ends. A blood condition is also often a downstream problem, caused by something else, so how you explain the cause matters as much as the diagnosis itself.

Last updated: July 2026 · Educational use only. Not legal advice. Verify current rules at VA.gov or eCFR.

The Rules That Decide Every Blood and Lymphatic Claim

The hemic and lymphatic system covers the blood, bone marrow, spleen, and lymph nodes. Conditions here split into two broad groups, and the group decides how the rating works. Anemias and clotting disorders are rated on how well the blood is working and how sick it makes you. Blood and lymphatic cancers are rated on a fixed schedule tied to treatment. A handful of shared rules under 38 CFR § 4.117 sit on top of both groups. This guide is built in part from real Board of Veterans' Appeals decisions on blood and lymph conditions, plain-language patterns drawn from what actually won and what actually lost, not a prediction about any one veteran's claim.

1. Anemia is rated on hemoglobin plus symptoms

Anemia is rated on the hemoglobin level in your blood together with the symptoms it causes, such as weakness, dizziness, shortness of breath, and fatigue. Lower hemoglobin combined with more symptoms means a higher rating. A lab number alone does not tell the whole story; the rating pairs the number with what the condition does to your daily function.

2. Blood cancers rate 100 percent during active treatment

Blood and lymphatic cancers, including leukemia, lymphoma, Hodgkin's disease, and multiple myeloma, are rated 100 percent while the disease is active and during treatment, and for a set period afterward. During the active phase the VA does not weigh individual symptoms; the diagnosis and active treatment carry the total rating on their own.

3. When treatment ends, a review exam re-rates on residuals

The automatic 100 percent does not last forever. When active treatment ends, the VA schedules a mandatory review examination. At that exam the condition is re-rated on its residuals, the lasting effects on the body, rather than keeping the automatic total rating. If there are no residuals, the rating can drop; if lasting damage remains, that damage is rated on its own under the matching part of the schedule.

4. Ongoing treatment and transfusion dependence factor in

Some conditions are transfusion-dependent or require continuous treatment to keep the blood counts stable. That ongoing need is part of the disability picture and factors into the rating. Documenting how often you need transfusions or infusions, and what happens without them, matters to how the condition is scored.

5. Several blood cancers are presumptive

A number of blood and lymphatic cancers are Agent Orange or other exposure presumptives. Certain leukemias, lymphomas, and multiple myeloma are on the presumptive lists, which means a covered veteran with qualifying service often does not have to prove the link between the exposure and the disease. See the PACT Act and presumptives guide to check whether your service and condition qualify.

The review exam is not a punishment. When the mandatory review comes up after treatment ends, it is the normal path, not a threat to your benefits. If lasting effects remain, from organ damage to fatigue to a weakened immune system, those residuals are rated on their own. Keep every treatment record so the residuals are documented. See the cancer claims guide.

Find the Guide for Your Condition

This system does not yet have a dedicated per-condition guide for every code. For the exact rating levels, the treatment timeline, and the Board data on the conditions that are covered, start here:

Area	Guide	Conditions
Blood and lymphatic cancers	Cancer Claims Guide	leukemia, lymphoma, myeloma
Anemia (the most-claimed condition in this group)	DC 7720 breakdown	iron deficiency anemia and related anemias

For anemia and other specific blood conditions, open the condition lookup page for the rating levels and Board data.

How Service Connection Works, At a High Level

Before getting into the specific pathways below, it helps to understand the three things every blood or lymphatic claim ultimately has to show under 38 CFR § 3.303. This is the same basic test that applies to any VA disability claim, just applied to this condition.

A current diagnosis. You must actually have the condition now, confirmed by lab testing such as a complete blood count. This is the single most common reason blood claims fail, because a condition like anemia can resolve: claims are denied where recent blood work came back normal and no anemia was found, even though the veteran had a documented diagnosis years earlier.
An in-service cause, or a service-connected cause. The records must show an event, injury, illness, or exposure in service, or a service-connected condition that led to the blood problem. An in-service blood transfusion after a surgery, documented in service records, has supported a grant on its own.
A medical link (nexus). A qualified provider must connect the current condition to service, and explain why. A private opinion that explained its reasoning has tipped the balance in a veteran's favor, while a bare claim of exposure with no medical link connecting it to the diagnosis has lost.

Ties go to the veteran. If the evidence for and against your claim is roughly equal, the law requires VA to decide in your favor. This is called the benefit of the doubt (38 CFR § 3.102; 38 U.S.C. § 5107(b)). See the Service Connection Guide for how this test works generally.

What VA Looks For: Tests, Records, and Diagnostic Codes

Whether you are filing directly, through a presumptive, or secondary to another condition, the record VA actually reviews centers on a small set of documents and data points.

A complete blood count (CBC): showing your hemoglobin and platelet levels, the objective backbone of an anemia or clotting claim, and the document that answers whether you have a current diagnosis.
A bone-marrow biopsy or pathology report: confirming a blood cancer and its specific type, the record that establishes the diagnosis for leukemia, lymphoma, myelodysplastic syndrome, or myeloma.
Treatment records that date the active phase: showing when chemotherapy, radiation, or other active treatment started and stopped. This timeline drives the 100-percent period and the mandatory review exam.
Documentation of transfusion dependence or ongoing infusions: how often you need treatment to keep your counts stable, including the frequency of oral iron supplementation versus intravenous iron infusions.
The diagnostic codes involved: DC 7720 for iron deficiency anemia, plus whatever code applies to the underlying condition you're connecting it to, or the cancer-specific code covered in the Cancer Claims Guide for leukemia, lymphoma, and myeloma.
The matching Disability Benefits Questionnaire (DBQ): the form that prompts the examiner to capture the labs, symptoms, and residuals the rating depends on, discussed in more detail later in this guide.

Service Connection Pathways: Direct, Presumptive, and Secondary

Blood and lymphatic conditions can reach service connection through several different pathways, and not every claim needs a from-scratch nexus opinion. These are the established routes.

Direct Service Connection

A veteran demonstrates that the condition began during or was caused by active military service. Primary anemia is treated as a chronic disease, so an in-service diagnosis plus continuous symptoms since service can carry the claim on its own (38 CFR § 3.303(b), 3.309(a)). An in-service blood transfusion documented in service records, paired with service records showing continuous anemia afterward, has supported a grant on this theory, as has an in-service diagnosis with continued treatment ever since.

Camp Lejeune presumptive

Aplastic anemia and myelodysplastic syndromes are on the list of conditions presumed related to the contaminated water at Camp Lejeune (August 1953 to December 1987, at least 30 days of service there), under 38 CFR § 3.309(f). A veteran with myelodysplastic syndrome and anemia has won service connection on this basis alone, without needing to separately prove the exposure caused the disease.

Gulf War and toxic exposure (TERA)

Veterans who served in Southwest Asia may qualify through presumptive or toxic-exposure rules under 38 CFR § 3.317 (undiagnosed illness and chronic multi-symptom illness) and 38 U.S.C. § 1117 and 1119, and VA often concedes the exposure itself. This has supported grants tied to burn-pit and particulate exposure, though this pathway is more fact-dependent than the Camp Lejeune presumptive and should be paired with a medical opinion where possible.

Secondary Service Connection (38 CFR § 3.310)

A veteran demonstrates that the blood or lymphatic condition was caused or chronically aggravated by an already service-connected condition. If a condition VA already covers is causing your anemia, claim it as secondary. Anemia has been granted as secondary to a service-connected condition causing heavy internal bleeding (for example, uterine fibroids), and a separate anemia rating has been granted where a service-connected blood disorder was found to be the likely cause. See our Secondary Service Connection Guide.

A secondary claim only works if the underlying condition is service connected. Anemia claimed as secondary to another condition has been denied as a matter of law once that underlying condition's own service-connection claim was denied. The secondary theory cannot succeed on a primary condition that was never granted.

Service Connection by Aggravation

Where military service significantly worsened a documented pre-service blood or lymphatic condition beyond its natural progression, aggravation-based service connection is available. This is distinct from a congenital condition, discussed below, which cannot be directly service connected even on a worsening theory.

Congenital conditions are not directly service connectable. A condition you were born with is a congenital defect, and cannot be directly service connected, even on a worsening theory (38 CFR § 3.303(c), 4.9). Service connection for a congenital blood disorder such as Fanconi anemia can be denied on this basis even where a related condition it led to, such as leukemia or low platelets caused with the help of service exposures, is separately granted.

Rating Criteria Under 38 CFR § 4.117

The two groups of conditions in this guide are rated on two different structures.

Anemia (DC 7720)

Anemia is rated on how it is treated.

30%Frequent IV iron infusions

The maximum schedular rating under DC 7720 is supported where a veteran needs intravenous iron infusions four or more times in a year. Requesting more than 10 percent without proof of frequent IV infusions has failed; oral iron alone does not support this tier.

10%Continuous oral iron supplements

Continuous oral iron supplementation to manage the anemia has repeatedly supported a 10 percent rating. This is the most common anemia rating tier.

Iron deficiency anemia caused by blood loss is rated differently. When the anemia is caused by bleeding, VA has rated it under whatever condition is causing the bleeding, not under the anemia diagnostic code itself. Trace the bleeding source and make sure that underlying condition, not just the anemia, is part of the claim.

Blood and Lymphatic Cancers

100%Active disease and treatment

Leukemia, lymphoma, Hodgkin's disease, and multiple myeloma are rated 100 percent while the disease is active and during treatment, and for a set period afterward. During this phase VA does not weigh individual symptoms separately; the diagnosis and active treatment carry the rating.

Re-ratedResiduals after treatment ends

When active treatment ends, a mandatory review examination re-rates the condition on its residuals, the lasting effects on the body, rather than keeping the automatic total rating. Lasting organ damage, a weakened immune system, or ongoing fatigue are rated on their own under the matching part of the schedule; if no residuals remain, the rating can be reduced.

See the full walkthrough in the Cancer Claims Guide, including the exact treatment-timeline rules and the Board data behind them.

The effective date can reach back to your original claim. Where an earlier appeal was still open, a later grant has preserved the chance at an earlier effective date rather than the later one initially assigned. Do not assume a favorable rating decided years after your original claim locks you into the later date; check whether an earlier appeal was still pending.

Go deeper: open the full DC 7720 (anemia) breakdown

What the VA measures at your C&P exam
Evidence that has won at the Board
Inside the rater's playbook: grant, denial, and remand rates

See the full DC 7720 breakdown →

Evidence That Wins

A complete blood count showing your hemoglobin and platelet levels, the objective backbone of an anemia or clotting claim, and current enough to establish the diagnosis exists today, not just in the past.
A bone-marrow biopsy or pathology report confirming a blood cancer and its type, the record that establishes the diagnosis.
Treatment records that date the active phase, showing when chemotherapy, radiation, or other active treatment started and stopped. This timeline drives the 100-percent period and the review exam.
Documentation of transfusion dependence or ongoing infusions, showing how often you need treatment to keep your counts stable.
A nexus opinion that gives its reasons, not just a conclusion. A medical opinion wins when it explains the why. A detailed private opinion has put the evidence in balance against a negative VA opinion and led to a grant, and an opinion with a thorough rationale has been given high weight where a bare conclusion would not be.
The matching DBQ for the condition, which prompts the examiner to capture the labs, symptoms, and residuals the rating depends on. See the DBQ guide.

Why These Claims Get Denied

Beyond the general "no current diagnosis" and "no nexus" reasons covered above, a few specific denial patterns show up often enough in the Board's decisions to call out on their own.

A past diagnosis that no longer holds up. Anemia can resolve, and VA rates the present, not your history. Claims have been denied where current labs came back normal even though the veteran had been diagnosed years earlier. A daily multivitamin with iron has not been accepted as proof of ongoing anemia.
Toxic exposure argued without a medical link. Even a conceded exposure is not enough by itself. A claim has been denied where the veteran had a documented toxic-exposure finding for solvents and gear oils but no medical evidence tied the anemia to that exposure; another claim has failed where there was neither a documented exposure nor a current disease.
Service that cannot be documented. Unverified service sinks the in-service element. Claims have failed where records could not confirm the specific overseas service claimed, and National Guard training time that was never federalized has not counted as qualifying active duty.
A congenital condition, claimed as if it were directly service connectable. A condition present from birth is a congenital defect, and cannot be directly service connected even on a worsening theory.
A secondary claim resting on a primary condition that was itself denied. A secondary claim only works if the underlying condition is service connected; once that underlying claim is denied, the secondary theory fails as a matter of law.
An obvious non-service cause left unaddressed. Where the record points to a clear cause unrelated to service, such as a later-diagnosed cancer and its chemotherapy, a primary anemia claim has been denied when nothing in the file explained why service, rather than that obvious cause, was the more likely source.

Common Mistakes

Procedural and strategic missteps, distinct from the denial patterns above, that repeatedly cost veterans ground on these claims.

Not knowing the 100-percent rule. Blood and lymphatic cancers rate 100 percent during active treatment. Some veterans do not realize the total rating is automatic during that phase and undersell the claim.
Being caught off guard by the review exam. When treatment ends, a mandatory review re-rates the condition on its residuals. Expect it, and keep your records so any lasting effects are documented and rated.
Not tracing anemia to its cause. Anemia is often a symptom of something else, such as a gastrointestinal bleed. Missing the underlying service-connected cause leaves a valid secondary claim on the table.
Missing the Agent Orange presumptive. Certain leukemias and lymphomas are presumptive for exposed veterans. Not checking the presumptive lists can mean proving a link you never had to prove.
Asking for a higher anemia rating without the matching evidence. A request for more than 10 percent has been denied where the veteran took oral iron but had no record of IV infusions. The rating tier you're asking for has to match the treatment documented in the file.
Not challenging a VA opinion that ignores your history. A negative opinion can be set aside if it is built on gaps rather than facts. The Board has rejected opinions that relied on a lack of records or failed to address the veteran's full history. If an examiner missed your records, say so in writing rather than letting the opinion stand unchallenged.

Do's and Don'ts

A condensed version of everything above, in the order it actually matters when you sit down to build your file.

Get recent blood work, a complete blood count, close to when you file, and make sure it's in your file.
Get a nexus opinion that explains its reasoning, not just a yes or no.
Connect anemia to another service-connected illness if one is causing it, such as a bleeding condition.
Check presumptive paths like Camp Lejeune or Gulf War service before you file.
Point to in-service records and continuous symptoms if your condition is chronic.
Save proof of ongoing treatment, oral iron dates or IV iron infusion dates, for the rating.
Challenge a VA opinion that ignored your records or history, in writing.
Keep every treatment record dating the active phase if you have a blood cancer, for the eventual review exam.

Don't

Don't assume a past diagnosis still counts, VA rates the present.
Don't rely on toxic exposure alone without a medical opinion tying it to your specific diagnosis.
Don't claim service you cannot document, unverified deployments or unfederalized Guard time will not carry the in-service element.
Don't expect a congenital condition to be service connected, even on a worsening theory.
Don't lean on a secondary claim when the underlying primary condition was denied.
Don't ignore an obvious non-service cause of your anemia, address it directly in your evidence.
Don't ask for a higher anemia rating without the matching treatment evidence, oral iron alone will not support the 30% tier.

Secondary Conditions

Blood and lymphatic conditions rarely stand alone. Because they affect the whole body, and because treatment leaves its own mark, one service-connected condition often opens the door to several secondary claims, in both directions.

Ways to connect via another condition (this condition as the secondary)

Conditions that can cause or worsen a blood or lymphatic condition, when that other condition is already service connected:

A bleeding condition causing anemia. A chronic illness or ongoing gastrointestinal bleeding can cause anemia. When the underlying condition is service-connected, the resulting anemia can be claimed as secondary. Anemia has been granted as secondary to a service-connected condition causing heavy internal bleeding.
Another service-connected blood disorder. A separate anemia rating has been granted where a service-connected blood disorder was found to be the likely cause of the anemia.
Exposure-linked blood cancers. Certain leukemias, lymphomas, and myeloma are linked to Agent Orange or burn-pit exposure, which is why the presumptive lists matter so much here, even outside a strict secondary theory.

Conditions this condition can cause (this condition as the primary)

Once a blood or lymphatic condition, or its treatment, is itself service connected, it can be the primary condition behind other secondary claims:

Mental health from a serious diagnosis. The fatigue and strain of a blood disorder or a cancer diagnosis can drive depression and anxiety, which may be claimed as secondary to the physical condition.
Organ or immune residuals after treatment. Chemotherapy, radiation, and stem-cell treatment can leave lasting organ damage or a weakened immune system that is rated separately. See secondary conditions.

This system does not yet have enough published Board data specific to these diagnostic codes to show grant-rate widgets for this condition group the way it does for higher-volume conditions; the pathways above reflect the documented case patterns instead.

Quick Checklist Before You File

Bring these together before you submit anything.

Recent blood work (a complete blood count) confirming you have the condition now.
Service records showing the in-service event, illness, or exposure you are relying on.
A nexus opinion from a provider that explains the reasoning, not just a yes or no.
A secondary theory, if a service-connected condition is causing your anemia.
Presumptive paths checked, such as Camp Lejeune or Gulf War service, before filing.
Proof of ongoing treatment, oral iron or dates of IV iron infusions, for the rating.
Written notes if a VA opinion ignored your records or history.

For the mechanics of actually submitting the claim, see the Standard Claim Guide and the Fully Developed Claim Guide (filing with all your evidence up front can speed up the decision).

The Claims Process, Step by Step

Once you file, your claim moves through a series of hand-offs. Understanding who does what helps you know who to contact, and what to expect, at each stage.

You file the claim. Directly with VA, through VA.gov, or with the help of an accredited representative.
VA acknowledges the claim and assigns it for development. A Veteran Service Representative (VSR) is assigned to gather your service treatment records, VA and private medical records, and any other evidence needed.
The VSR orders a Compensation & Pension (C&P) exam if one is needed. Not every claim requires one, but most blood and lymphatic claims do, especially where lab results, biopsy findings, or a nexus opinion are needed.
The C&P exam is conducted. By a VA clinician or a contracted examiner, who completes a Disability Benefits Questionnaire (DBQ) documenting the diagnosis, current labs, severity, and, where relevant, a nexus opinion.
The file goes to a Rating Veteran Service Representative (RVSR), the "rater." The rater reviews the complete file, including the exam results, and decides whether service connection is warranted and at what percentage.
A senior reviewer may review the decision before it's finalized, depending on the complexity of the claim.
VA issues the decision letter. This states whether the claim is granted or denied, the rating percentage if granted, and the reasons behind the decision.
If you disagree, you choose an appeal lane. Higher-Level Review, Supplemental Claim, or a Board appeal, covered later in this guide.

Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner

Your VSO

An accredited representative from a veterans service organization, or an accredited attorney or claims agent. Not a VA employee. Helps you prepare, gather evidence, and file, and can represent you through an appeal. Has no authority to decide your claim.

VSR (Veteran Service Representative)

VA staff who "develops" your claim: requests records, schedules the C&P exam, and assembles the file. Does not decide the rating.

Rater (RVSR)

VA staff who reviews the completed file and makes the actual decision, service connection or denial, and the percentage. This is the person whose judgment the decision letter reflects.

C&P Examiner

A VA clinician or a contracted medical examiner who conducts the exam and completes the DBQ. Documents findings and, where asked, a nexus opinion. Does not decide the claim.

For the full walkthrough of every stage with more detail, see Inside Your Claim and Claim Stages.

DBQs and Your C&P Exam

A Disability Benefits Questionnaire (DBQ) is the standardized form an examiner completes for your condition, it structures the exam findings into the specific data points VA's rating schedule requires (for blood and lymphatic conditions, that includes current lab values, treatment dates, and, for cancers, the status of active treatment). See the DBQ Guide for how these forms work, including whether a private DBQ completed by your own doctor can be submitted instead of relying solely on a VA exam.

Before your C&P exam, bring your most recent lab work, a clear timeline of when treatment started and stopped, and a specific account of your symptoms and how they affect daily function. Be consistent with what's already in your medical records and prior statements. For a full walkthrough of what to expect and how to prepare, see the C&P Exam Prep Guide.

Reading Your Decision Letter, and What to Do If Denied

Your decision letter has two parts: a narrative section explaining the reasoning (often called "reasons and bases"), and a codesheet showing the actual rating percentage, the effective date, and the diagnostic code used. See the Reading Your Decision Letter Guide for how to find and interpret each part, or use the Letter Interpreter tool to upload your own letter and get a plain-English breakdown.

If your claim is denied, or the rating is lower than you expected, you have three main lanes:

Supplemental Claim: refile with new and relevant evidence, such as a new nexus opinion or updated lab work. See Supplemental Claim Guide.
Higher-Level Review (HLR): a senior reviewer looks at the same evidence again for a difference of opinion, no new evidence is added. See HLR Guide.
Board Appeal: your case goes to a Veterans Law Judge at the Board of Veterans' Appeals, with options for a direct review, an evidence docket, or a hearing. See Board Appeal Guide.

Not sure which lane fits your situation? See the Appeals decision guide for a side-by-side comparison of all three.

After You Win: Maintaining Your Rating

A grant is not always the end of the story. Keep your treatment consistent, continued follow-up with your treating provider, and records of ongoing labs, transfusions, or infusions, protects you if VA schedules a future reexamination. This matters even more for a blood cancer grant, where the mandatory review exam after active treatment ends is expected, not optional. Not every rating gets reexamined; understand when a rating becomes protected from future review (including Permanent and Total status) and what to do if VA proposes to reduce it. See Protect Your Rating and Future Reexaminations for the specifics.

If your condition worsens after the initial grant, for example needing more frequent iron infusions, or a cancer recurring, you can file for an increased rating. See the Rating Increase Guide.

Quick Reference Tables

Service Connection Pathways

Pathway	Applies To	Evidence Needed
Direct / chronic disease	Anemia diagnosed in service with continuous symptoms since	Service records + continuity of treatment
Camp Lejeune presumptive	Aplastic anemia, myelodysplastic syndromes	30+ days at Camp Lejeune, Aug. 1953-Dec. 1987
Gulf War / toxic exposure (TERA)	Blood and lymphatic conditions tied to burn-pit or particulate exposure	Qualifying Southwest Asia service + supporting medical opinion where possible
Secondary (38 CFR § 3.310)	Anemia caused by a service-connected bleeding condition or blood disorder	Nexus opinion connecting the service-connected condition to the blood condition
Aggravation (38 CFR § 3.306)	Pre-service condition worsened beyond natural progression by service	Baseline severity + evidence of the in-service worsening

Anemia Rating (DC 7720)

Rating	Treatment Shown
30%	Intravenous iron infusions 4 or more times a year
10%	Continuous oral iron supplementation

From Filing to Decision: Who Does What

Role	Does	Decides your rating?
VSO / accredited representative	Helps prepare, gather evidence, and file; represents you on appeal	No
VSR	Develops the claim: orders records and the C&P exam	No
C&P Examiner	Conducts the exam, completes the DBQ, may give a nexus opinion	No / but has a strong impact
Rater (RVSR)	Reviews the full file and decides service connection and percentage	Yes

Frequently Asked Questions

How does the VA rate blood disorders?

Blood and lymphatic conditions are rated under 38 CFR 4.117. Anemia and clotting disorders are rated on how the blood is working and the symptoms it causes, for example anemia is scored on the hemoglobin level together with weakness, dizziness, shortness of breath, and fatigue. Blood and lymphatic cancers follow a separate rule: 100 percent during active treatment, then a re-rating on residuals.

Do blood cancers get 100 percent?

Yes, during the active phase. Leukemia, lymphoma, Hodgkin's disease, and multiple myeloma are rated 100 percent while the disease is active and during treatment, and for a set period afterward. When active treatment ends, a mandatory review exam re-rates the condition on whatever lasting effects remain.

How is anemia rated?

Anemia is rated on the hemoglobin level in your blood together with the symptoms it causes, such as weakness, dizziness, shortness of breath, and fatigue. Lower hemoglobin with more symptoms means a higher rating. Under DC 7720, continuous oral iron supplements support a 10 percent rating, and needing IV iron infusions 4 or more times a year supports the maximum 30 percent rating. For the exact rating levels, open the condition lookup page for your specific code.

What happens at the mandatory review exam?

After active treatment for a blood cancer ends, the VA schedules a review examination. At that exam the condition is re-rated on its residuals, the lasting effects on the body, rather than keeping the automatic 100 percent. If lasting damage remains, that damage is rated on its own; if there are no residuals, the rating can be reduced.

Are blood cancers presumptive?

Several are. Certain leukemias, lymphomas, and multiple myeloma are Agent Orange or other exposure presumptives, so a covered veteran with qualifying service often does not have to prove the link between the exposure and the disease. Aplastic anemia and myelodysplastic syndromes are also presumptive for Camp Lejeune water exposure. Check the PACT Act and presumptives guide to see whether your service and condition qualify.

Can a congenital blood condition be service connected?

Not directly. A condition present from birth is a congenital defect and cannot be directly service connected, even on a worsening theory. That said, a related condition it leads to, such as a cancer or blood disorder caused with the help of service exposures, can still be separately service connected on its own facts.

Disclaimer. This guide is written for educational purposes and describes how the VA's rules and regulations work in general. It is not legal advice, and it does not constitute representation or create any attorney relationship. It is based in part on a small sample of Board of Veterans' Appeals decisions that are binding only on the case decided and are not precedential, so it shows patterns, not promises. Individual claims have unique facts, and outcomes depend on the specific evidence presented. Veterans seeking help with their claims should work with a VA-accredited VSO representative, claims agent, or attorney; you do not have to do this alone, and you should not pay for basic help. The laws, regulations, and benefit rates referenced in this guide are current as of July 2026. Verify current rules at VA.gov or eCFR or through your VSO. Find an accredited representative →

Sources

38 CFR § 4.117, Schedule of Ratings, Hemic and Lymphatic Systems, including DC 7720 (iron deficiency anemia)
38 CFR § 3.303, basic rules for service connection, including §3.303(b) (chronic disease and continuity of symptoms), §3.303(c) (congenital defects, with 4.9), and §3.303(d) (disease diagnosed after service)
38 CFR § 3.310, Secondary Service Connection
38 CFR § 3.306, Aggravation of Pre-Service Disability
38 CFR § 3.102 and 38 U.S.C. § 5107(b), benefit of the doubt
38 CFR § 3.307 and 3.309, presumptive service connection and chronic diseases, including §3.309(f) (Camp Lejeune contaminated water diseases)
38 CFR § 3.317, Gulf War undiagnosed and chronic multi-symptom illness
38 CFR § 3.104(c), binding favorable findings
38 U.S.C. § 1110 and 1131, service connection for wartime and peacetime service
38 U.S.C. § 1117 and 1119, Gulf War and toxic exposure

Related Tools and Guides

Service Connection Guide

The three-element test that underlies every VA disability claim.

Secondary Service Connection

How a service-connected condition can cause or worsen anemia.

Cancer Claims Guide

The 100-percent-then-residuals pattern for blood and other cancers.

PACT Act and Presumptives

Which leukemias, lymphomas, and myeloma are presumptive.

Secondary Conditions

Anemia from another disease, and treatment residuals.

Digestive Guide

Gastrointestinal bleeding, a common cause of anemia.

Immune and Nutritional Guide

Immune-system effects that overlap with blood disorders.

Nexus Letters

The medical link a secondary blood-condition claim usually needs to be granted.

DBQ Guide

The exam forms that capture labs, symptoms, and residuals.

C&P Exam Prep

What to expect at the exam and how to prepare.

Inside Your Claim

Who handles your claim at each stage, from VSR to rater.

Reading Your Decision Letter

How to find the rating, the effective date, and the reasoning in your letter.

Letter Interpreter Tool

Upload your decision letter for a plain-English breakdown.

Appeals Guide

Supplemental Claim vs Higher-Level Review vs Board appeal, side by side.

Protect Your Rating

Permanent and Total status, reexaminations, and reduction defense.