VA Diagnostic Code 7704Polycythemia vera:
Rated from 10% to 100% under § 4.117. Here is what the VA requires at each level.
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What each rating requires
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- 100%
Requiring peripheral blood or bone marrow stem-cell transplant or chemotherapy (including myelosuppressants) for the purpose of ameliorating the symptom burden
- 60%
Requiring phlebotomy 6 or more times per 12-month period or molecularly targeted therapy for the purpose of controlling RBC count
- 30%
Requiring phlebotomy 4-5 times per 12-month period, or if requiring continuous biologic therapy or myelosuppressive agents, to include interferon, to maintain platelets <200,000 or white blood cells (WBC) <12,000
- 10%
Requiring phlebotomy 3 or fewer times per 12-month period or if requiring biologic therapy or interferon on an intermittent basis as needed to maintain all blood values at reference range levels
Notes on this code
These notes are part of the regulation. They change how the levels above are applied.
- Note (1): Rate complications such as hypertension, gout, stroke, or thrombotic disease separately
- Note (2): If the condition undergoes leukemic transformation, evaluate as leukemia under diagnostic code 7703
- Note (3): A 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant; or during the period of treatment with chemotherapy (including myelosuppressants). Six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter
Polycythemia Vera (VA Diagnostic Code 7704)
Hemic and Lymphatic Systems — 38 CFR § 4.117
Understanding Polycythemia Vera
Polycythemia vera is a condition of the blood-forming (hemic) system. Under the VA rating schedule, it is rated based on the type and frequency of treatment required to manage it — such as phlebotomy, targeted or biologic therapy, chemotherapy (including myelosuppressants), or a blood/bone marrow stem-cell transplant.
The VA assigns a disability rating according to how the condition is being treated and the intensity of that treatment. Below are the rating levels defined for this diagnostic code.
Available Rating Levels
100%
Requiring peripheral blood or bone marrow stem-cell transplant, or chemotherapy (including myelosuppressants) for the purpose of ameliorating the symptom burden.
60%
Requiring phlebotomy 6 or more times per 12-month period, or molecularly targeted therapy for the purpose of controlling RBC (red blood cell) count.
30%
Requiring phlebotomy 4–5 times per 12-month period, or requiring continuous biologic therapy or myelosuppressive agents (to include interferon) to maintain platelets below 200,000 or white blood cells (WBC) below 12,000.
10%
Requiring phlebotomy 3 or fewer times per 12-month period, or requiring biologic therapy or interferon on an intermittent basis as needed to maintain all blood values at reference range levels.
What the VA Looks For
When rating polycythemia vera, the VA focuses on the treatment being used and how often it is required, matching that to the levels above. Key considerations from the rating schedule include:
- Separate rating for complications. Complications such as hypertension, gout, stroke, or thrombotic disease are rated separately.
- Leukemic transformation. If the condition undergoes leukemic transformation, it is evaluated as leukemia under Diagnostic Code 7703.
- 100% during active treatment. A 100 percent evaluation is assigned as of the date of hospital admission for a peripheral blood or bone marrow stem-cell transplant, or during the period of treatment with chemotherapy (including myelosuppressants).
- Mandatory re-examination after treatment. Six months following hospital discharge — or, in the case of chemotherapy, six months after completion of treatment — the appropriate disability rating is determined by a mandatory VA examination. Any reduction in evaluation based on that or any subsequent examination is subject to the provisions of § 3.105(e).
These criteria are a rendering of § 4.117, diagnostic code 7704. The official version is the one that governs your rating.
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