DC 7706 · 38 CFR 4.117
Polycythemia Vera C&P Exam Prep
To evaluate the current severity of Polycythemia Vera (PV) based on treatment requirements, laboratory values, and symptom burden in order to assign an accurate VA disability rating under 38 CFR - 4.117, DC 7704/7706.
- Format:
- Interview + Physical
- Typical duration:
- 30-45 minutes
- DBQ form:
- Hematologic_and_Lymphatic_Conditions_Including_Leukemia (Hematologic_and_Lymphatic_Conditions_Including_Leukemia)
- Examiner:
- Hematologist or Oncologist
What the examiner evaluates
- Frequency of therapeutic phlebotomy required in the past 12-month period
- Whether molecularly targeted therapy (e.g., ruxolitinib/JAK inhibitors) is required to control RBC count
- Whether continuous biologic therapy or myelosuppressive agents (including interferon) are required to maintain platelets below 200,000 or WBC below 12,000
- Whether intermittent biologic therapy or interferon is required to maintain all blood values at reference range levels
- Whether peripheral blood or bone marrow stem-cell transplant or chemotherapy (including myelosuppressants) has been required to ameliorate symptom burden
- Current complete blood count (CBC) laboratory values including hemoglobin, hematocrit, RBC count, WBC count, WBC differential, and platelet count
- Presence and severity of symptoms: fatigue, headache, dizziness, pruritus, sweating, bleeding, thrombotic events
- Active vs. remission disease status
- Complications such as hypertension, gout, stroke, or thrombotic disease (rated separately)
- Whether leukemic transformation has occurred (rated separately under applicable leukemia diagnostic code)
- Impact of condition on occupational and daily functioning
Examination is typically conducted in person by a hematologist or oncologist. The examiner will review your medical records, conduct a clinical interview about your symptom history and treatment, and may perform a brief physical examination. Bring all relevant hematology laboratory reports, medication lists, and treatment records. You have the right to request the examination be recorded in most states.
Measurements and tests
Complete Blood Count (CBC) with Differential
What it measures: Hemoglobin (gm/100mL), hematocrit (%), RBC count, WBC count, WBC differential, and platelet count - the core laboratory markers used to determine PV disease activity and treatment necessity
What to expect: The examiner will review your most recent CBC laboratory results. Bring printed copies of your last several CBCs, especially those from the past 12 months, to show trends. If values are borderline, trends over time matter more than a single snapshot.
Critical thresholds
- Platelets < 200,000 or WBC < 12,000 maintained by continuous biologic/myelosuppressive therapy Supports 30% rating if requiring continuous biologic therapy or myelosuppressive agents including interferon to maintain these values
- Phlebotomy required 3 or fewer times per 12-month period or intermittent biologic/interferon to maintain all values at reference range Supports 10% rating
- Phlebotomy required 4-5 times per 12-month period or continuous biologic/myelosuppressive therapy to maintain platelets <200,000 or WBC <12,000 Supports 30% rating
- Phlebotomy required 6 or more times per 12-month period or molecularly targeted therapy to control RBC count Supports 60% rating
- Requires peripheral blood/bone marrow stem-cell transplant or chemotherapy (including myelosuppressants) to ameliorate symptom burden Supports 100% rating
Tips
- Bring printed copies of all CBC results from the past 12-24 months - highlight dates and values
- Note the date each phlebotomy was performed; the examiner needs exact frequency per 12-month period
- If labs were done at multiple facilities (VA and private), consolidate them into a single timeline
- Ask your treating hematologist to write a letter documenting the frequency and clinical necessity of each phlebotomy or medication adjustment
- If your CBC values fluctuate, provide labs showing both typical and worst-case values
Pain considerations: Although PV is not primarily a pain condition, note any bone pain, joint pain (gout flares), or headache severity during laboratory value discussions, as these may support separately ratable complications.
Phlebotomy Frequency Documentation
What it measures: The number of therapeutic phlebotomies performed within a rolling 12-month period - the primary treatment-intensity metric directly tied to rating thresholds under DC 7704
What to expect: The examiner will ask how many times you required phlebotomy in the past year. They will document this on the DBQ. Your answer must reflect the medically required frequency, not elective or missed sessions.
Critical thresholds
- 3 or fewer phlebotomies per 12 months 10% rating criterion
- 4-5 phlebotomies per 12 months 30% rating criterion
- 6 or more phlebotomies per 12 months 60% rating criterion
Tips
- Count phlebotomies performed in a rolling 12-month window ending on or near the exam date
- Bring a written log of phlebotomy dates from your hematologist's office or VA records
- If phlebotomy frequency has varied year to year, document multiple years to show the typical course of your disease
- If phlebotomy was reduced due to addition of cytoreductive medications (hydroxyurea, ruxolitinib, interferon), clarify that medications are required because phlebotomy alone was insufficient
- Do not underreport missed phlebotomies if they were clinically indicated but logistically missed - report what was medically required
Pain considerations: Note any post-phlebotomy symptoms (fatigue, lightheadedness, iron-deficiency symptoms) that affect your daily functioning and ability to work.
Medication and Treatment Therapy Review
What it measures: Whether treatment requires continuous vs. intermittent biologic therapy, myelosuppressive agents, molecularly targeted therapy (e.g., JAK2 inhibitors such as ruxolitinib), interferon, or chemotherapy - critical to rating differentiation
What to expect: The examiner will ask about all current and recent medications. They will categorize each as continuous, intermittent, biologic, myelosuppressive, or molecularly targeted. Be precise about whether each medication is taken daily (continuous) or as needed (intermittent).
Critical thresholds
- Intermittent biologic/interferon to maintain all blood values at reference range 10% rating
- Continuous biologic therapy or myelosuppressive agents (including interferon) to maintain platelets <200,000 or WBC <12,000 30% rating
- Molecularly targeted therapy (e.g., ruxolitinib) to control RBC count 60% rating
- Chemotherapy including myelosuppressants to ameliorate symptom burden 100% rating
Tips
- Bring a complete medication list with drug name, dose, and frequency - note the start date for each medication
- Know the classification of each drug: hydroxyurea is a myelosuppressive agent; ruxolitinib is a molecularly targeted JAK inhibitor; pegylated interferon-alpha is a biologic/interferon
- If your hematologist adjusted your medication because phlebotomy alone was not controlling your disease, ask them to document this in a clinical note before your exam
- Distinguish between 'continuous' (daily or scheduled regular dosing) and 'intermittent' (as-needed or periodic) medication use - this distinction directly affects your rating level
- Include any past chemotherapy courses (e.g., busulfan, chlorambucil) even if no longer ongoing
Pain considerations: Document any medication side effects (fatigue, bone pain, nausea, immune suppression, increased infection risk) and how they affect your work capacity and daily life.
Rating criteria by percentage
100%
Polycythemia Vera requiring peripheral blood or bone marrow stem-cell transplant OR chemotherapy (including myelosuppressants) for the purpose of ameliorating the symptom burden.
Key symptoms
- Requires stem-cell or bone marrow transplant
- Requires chemotherapy or myelosuppressant drugs to reduce symptom burden
- Severe constitutional symptoms: profound fatigue, weight loss, night sweats
- Transformation to myelofibrosis or leukemia requiring aggressive treatment
- Unable to maintain basic activities of daily living or employment
From 38 CFR: Per 38 CFR - 4.117, DC 7704: chemotherapy including myelosuppressants (e.g., hydroxyurea at high doses, busulfan, or similar agents used for cytoreduction to control symptom burden, distinct from use to merely maintain blood counts) or peripheral blood/bone marrow stem-cell transplant.
60%
Polycythemia Vera requiring phlebotomy 6 or more times per 12-month period OR molecularly targeted therapy (e.g., ruxolitinib/JAK2 inhibitors) for the purpose of controlling RBC count.
Key symptoms
- Frequent phlebotomy (6+ per year) required to prevent hyperviscosity
- On molecularly targeted therapy (ruxolitinib/Jakafi) for RBC count control
- Persistent fatigue, headaches, visual changes from hyperviscosity
- Uncontrolled erythrocytosis despite other treatments
- Splenomegaly causing abdominal discomfort
- Pruritus (especially aquagenic itch) significantly limiting activities
From 38 CFR: Per 38 CFR - 4.117, DC 7704: phlebotomy -6 times per 12-month period to maintain hematocrit at goal, or daily ruxolitinib (Jakafi) or equivalent JAK inhibitor prescribed specifically to control elevated RBC/hematocrit.
30%
Polycythemia Vera requiring phlebotomy 4-5 times per 12-month period, OR if requiring continuous biologic therapy or myelosuppressive agents (including interferon) to maintain platelets below 200,000 or WBC below 12,000.
Key symptoms
- Moderate phlebotomy frequency (4-5 per year)
- On continuous hydroxyurea or pegylated interferon-alpha daily
- Requiring continuous medication to keep platelets or WBC in acceptable range
- Moderate fatigue affecting work and daily activities
- Recurring headaches, dizziness, or visual disturbances
- Iron deficiency symptoms from repeated phlebotomy
From 38 CFR: Per 38 CFR - 4.117, DC 7704: phlebotomy 4-5 times per 12-month period; or daily hydroxyurea, busulfan, or pegylated interferon used continuously (not as-needed) to maintain platelets <200,000 or WBC <12,000.
10%
Polycythemia Vera requiring phlebotomy 3 or fewer times per 12-month period, OR requiring biologic therapy or interferon on an intermittent (as-needed) basis to maintain all blood values at reference range levels.
Key symptoms
- Infrequent phlebotomy (1-3 per year)
- On intermittent/as-needed low-dose interferon or biologic therapy
- Mild, intermittent symptoms: occasional fatigue, mild pruritus
- Blood counts generally maintained at or near reference range with minimal intervention
- Condition is well-controlled but still requires active medical management and monitoring
From 38 CFR: Per 38 CFR - 4.117, DC 7704: 1-3 phlebotomies per 12-month period or as-needed (intermittent) interferon/biologic therapy to keep all values within normal reference ranges.
Describing your symptoms accurately
Fatigue and Energy Limitation
How to describe it: Accurately describe how fatigue affects your ability to perform sustained physical or mental work. Specify how many hours per day you can be active before fatigue sets in, whether fatigue is constant or episodic, and whether it worsens after phlebotomy or medication side effects. Connect fatigue directly to your PV diagnosis and treatment.
Example: On my worst days - often within 24-48 hours after a phlebotomy - I cannot get out of bed for more than a few hours. I feel lightheaded when standing, cannot concentrate at work, and need to rest multiple times throughout the day. This level of fatigue occurs approximately 3-4 days per month.
Examiner listens for: Frequency of severe fatigue episodes, impact on ability to maintain employment or complete daily tasks, whether fatigue is treatment-related or disease-related, and whether it limits work to light or sedentary activity only.
Avoid: Saying 'I get tired sometimes' - instead, quantify: 'I have debilitating fatigue for 3-5 days after each phlebotomy, occurring every 6-8 weeks, which prevents me from working on those days.'
Headaches, Dizziness, and Neurological Symptoms
How to describe it: Describe the frequency, severity (1-10 scale), duration, and character of headaches. Note whether headaches are associated with elevated hematocrit/hyperviscosity and whether they resolve after phlebotomy. Mention any visual disturbances, ringing in ears, or cognitive difficulties (brain fog).
Example: When my hematocrit climbs before my next scheduled phlebotomy, I develop severe throbbing headaches rated 8/10 that last the entire day, accompanied by blurred vision and difficulty concentrating. This occurs 1-2 weeks before each phlebotomy is due and prevents me from driving or working safely.
Examiner listens for: Relationship between symptoms and disease activity (pre-phlebotomy vs. post-phlebotomy), frequency of neurological symptoms, whether they have caused any safety incidents, and whether imaging or neurology referral has been required.
Avoid: Failing to connect headaches and dizziness to your PV - the examiner may not make this connection unless you explicitly state it. Do not say 'I just get headaches' without explaining the pattern linked to your hematocrit levels.
Pruritus (Skin Itching)
How to describe it: Aquagenic pruritus - intense itching triggered by water contact (showering, bathing, rain) - is a hallmark PV symptom. Describe its frequency, severity, triggers, duration, and impact on hygiene and sleep. Note whether antihistamines or other treatments have been required.
Example: Every time I shower or come into contact with water, I experience intense burning and itching across my entire body that lasts 20-30 minutes. This happens daily, forces me to take very short cold showers, prevents me from swimming or exercising, and frequently disrupts my sleep when it occurs at night.
Examiner listens for: Whether the itch is aquagenic (water-triggered), its severity and impact on hygiene and sleep, whether it requires additional medications to manage, and how frequently it occurs.
Avoid: Minimizing pruritus by saying 'it's just itching.' Aquagenic pruritus is a recognized disabling manifestation of PV that affects quality of life. Describe its full impact on daily routines.
Thrombotic Risk and Prior Thrombotic Events
How to describe it: Report any prior blood clots (DVT, pulmonary embolism, stroke, TIA, heart attack, portal vein thrombosis) accurately, including dates, treatment required, and any residual effects. Mention if you are on anticoagulation therapy. Note that thrombotic complications may be rated separately - report them fully.
Example: In [year], I was hospitalized for a deep vein thrombosis in my left leg directly attributed to my polycythemia vera. I was placed on anticoagulation therapy for 6 months and still have chronic swelling in that leg. My hematologist confirmed the DVT was directly caused by my PV.
Examiner listens for: History of thrombotic events, current anticoagulation status, residual functional impairment from prior clots, and whether complications should be separately evaluated (hypertension, stroke, etc.).
Avoid: Failing to report prior thrombotic events because they were 'treated and resolved.' Residual effects and the anticoagulation burden itself are compensable and may warrant separate ratings.
Constitutional Symptoms and Functional Capacity
How to describe it: Describe night sweats, unintentional weight loss, fever, and early satiety (from splenomegaly). Be specific about frequency, severity, and functional impact. Quantify weight loss if applicable. Describe how these symptoms limit your ability to maintain full-time employment.
Example: I wake up drenched in night sweats 3-4 nights per week, requiring me to change my bedclothes and disrupting my sleep. Combined with my fatigue, this prevents me from performing more than light sedentary work. I have lost 12 pounds over the past 6 months without intentional dieting.
Examiner listens for: Frequency and severity of B-symptoms (night sweats, weight loss, fevers), functional capacity for work and daily activities, and whether symptoms suggest disease progression toward myelofibrosis.
Avoid: Saying 'I feel okay most days' when describing your average, rather than your typical symptomatic days. Always describe the full range of your symptom experience, not just your best days.
Treatment Burden and Side Effects
How to describe it: Describe the side effects of your PV treatments - phlebotomy-induced iron deficiency (fatigue, hair loss, brittle nails), hydroxyurea side effects (mouth sores, skin changes, immune suppression, risk of secondary malignancy), interferon side effects (flu-like symptoms, depression, fatigue), or ruxolitinib side effects (increased infection risk, anemia, bruising).
Example: My hydroxyurea causes significant mouth sores that make eating painful for about one week each month, and I have had three infections this year requiring antibiotic treatment, which my hematologist attributes to immune suppression from the medication. These side effects have reduced my ability to work full-time.
Examiner listens for: Side effects that cause independent functional impairment, infections requiring medical treatment, and whether treatment side effects are as disabling as the underlying disease.
Avoid: Not mentioning treatment side effects because they are 'just from the medication.' Treatment side effects are part of the total disability picture and should be fully described.
Common mistakes to avoid
Reporting only the most recent 12 months of phlebotomy when frequency has been higher in prior years
Why: Rating is based on the current level of treatment intensity. If your frequency has recently decreased due to adding medication, you may actually qualify for a higher rating based on the combined treatment approach rather than phlebotomy frequency alone.
Do this instead: Bring documentation for multiple years and understand that switching FROM phlebotomy TO continuous medication does not necessarily lower your rating - continuous medication use may independently support a 30% or 60% rating.
Impact: 30%-60%
Describing symptoms as 'manageable' or 'under control' during the exam
Why: A condition being 'controlled' by treatment does not mean it is not disabling - the level of treatment required IS the rating criterion for PV. Saying it is 'controlled' can lead the examiner to understate severity.
Do this instead: Reframe: 'My disease is being managed, but only by requiring [6 phlebotomies per year / daily ruxolitinib / continuous hydroxyurea]. Without this treatment intensity, my blood counts would become dangerous.' Describe the worst days and the treatment burden accurately.
Impact: All levels
Failing to report complications such as hypertension, gout, or prior thrombotic events
Why: Under Note (1) of DC 7704, these complications are rated separately and can significantly increase your combined rating. Many veterans do not know these are separately compensable.
Do this instead: Explicitly inform the examiner of ALL conditions your hematologist has linked to your PV: hypertension, gout, DVT, PE, stroke, TIA, portal vein thrombosis, splenomegaly. Request separate evaluation for each.
Impact: All levels - affects combined rating
Not knowing the exact classification of your medications (continuous vs. intermittent; biologic vs. myelosuppressive vs. molecularly targeted)
Why: The rating differentiators hinge on these precise classifications. Calling ruxolitinib 'just a pill' or hydroxyurea 'just a blood thinner' allows the examiner to potentially miscategorize your treatment intensity.
Do this instead: Before your exam, confirm with your hematologist: Is this medication continuous (daily scheduled) or intermittent (as-needed)? Is it classified as a biologic, myelosuppressive, or molecularly targeted agent? Bring this in writing.
Impact: 10%-60%
Underreporting fatigue and its functional impact on employment
Why: Fatigue is the most functionally disabling symptom of PV but is subjective and easily understated. Examiners use functional impact on employment as a key indicator in the remarks section of the DBQ.
Do this instead: Quantify fatigue: number of days per month with severe fatigue, hours per day you can be productive, whether you have missed work, reduced hours, or changed job duties due to PV-related fatigue.
Impact: All levels
Not requesting that the examiner address leukemic transformation if bone marrow biopsy shows progression
Why: If PV has transformed to myelofibrosis or AML, it must be evaluated under the appropriate leukemia diagnostic code per Note (2) of DC 7704, which carries a 100% rating. Veterans may not know to raise this.
Do this instead: If your hematologist has mentioned myelofibrosis progression or blast-phase transformation, bring bone marrow biopsy results and ask the examiner to address whether re-evaluation under a leukemia diagnostic code is warranted.
Impact: 100%
Prep checklist
- critical
Compile all CBC laboratory results from the past 24 months
Print or organize hemoglobin, hematocrit, RBC, WBC with differential, and platelet results by date. Highlight values that were abnormal. Include both VA and private lab results. This directly populates DBQ fields 566, 568, 570, 572, 574, 576 and supports your phlebotomy frequency claim.
before exam
- critical
Create a written phlebotomy log for the past 12-24 months
List every therapeutic phlebotomy date, the facility where it was performed, and the clinical indication (hematocrit level). Count the total number per 12-month period. This is the primary metric distinguishing 10%, 30%, and 60% ratings.
before exam
- critical
Obtain a supporting letter from your treating hematologist
Ask your hematologist to write a letter confirming your diagnosis, current treatment regimen (specifying continuous vs. intermittent use and drug classifications), phlebotomy frequency, and any complications attributable to PV. This letter, submitted before the exam, can guide the examiner's DBQ responses.
before exam
- critical
Document all current medications with classification
List each medication with name, dose, frequency, start date, and classification (biologic, myelosuppressive, molecularly targeted, interferon). Know whether each is continuous or intermittent. Include: hydroxyurea, ruxolitinib (Jakafi), pegylated interferon-alpha, busulfan, anagrelide, aspirin, anticoagulants.
before exam
- critical
List all PV-related complications for separate rating
Document any hypertension, gout, DVT, PE, stroke, TIA, portal vein thrombosis, or other thrombotic events with dates, treatments, and residual effects. Per DC 7704 Note (1), these are rated separately and can significantly increase your combined disability rating.
before exam
- recommended
Write a personal symptom statement describing your typical and worst-day experience
Create a written statement describing: fatigue severity and frequency, headaches/dizziness pattern, aquagenic pruritus, night sweats, splenomegaly symptoms, and functional limitations on work and daily activities. Use specific examples, frequencies, and severity scales.
before exam
- recommended
Review your C-file for existing records and identify gaps
Request your C-file through the VA to verify which medical records they already have. Identify any private hematology records not in your file and submit them before the exam using VA Form 21-4142.
before exam
- recommended
Bring bone marrow biopsy results if performed
If a bone marrow biopsy has been performed to confirm JAK2 mutation status, assess disease stage, or evaluate for myelofibrosis progression, bring the pathology report. This documents diagnosis and any disease evolution.
before exam
- critical
Arrive prepared to describe your worst-day symptoms, not your average or best days
Per M21-1 guidance, the examiner should evaluate your condition at its typical and worst level. Do not minimize symptoms because you are feeling relatively well on the exam day. Explicitly state: 'Today is a relatively good day, but on my worst days...' and describe those days in detail.
day of
- critical
Bring physical copies of all supporting documents
Bring: phlebotomy log, CBC results (chronological order), medication list, hematologist's supporting letter, bone marrow biopsy reports, records of any hospitalizations or emergency visits related to PV, and records of any thrombotic events.
day of
- recommended
Confirm your right to record the examination
In most states, veterans have the right to record their C&P examination with advance notice. Inform the examiner at the start of the appointment that you intend to record for your personal records. Check your state's recording consent laws before the exam.
day of
- optional
Bring a trusted person as a witness if possible
A family member or VSO representative who observes your daily struggles can provide lay evidence. Having a witness present also ensures the examiner's questions and your responses are accurately noted.
day of
- critical
Explicitly state the exact number of phlebotomies in the past 12 months
Do not let this go unaddressed. State clearly: 'In the past 12 months, I have required [X] therapeutic phlebotomies on [dates].' This is the single most important quantitative data point for your rating.
during exam
- critical
Clarify whether each medication is continuous or intermittent
When medications are discussed, confirm for the examiner whether you take each one every day (continuous) or only when blood values are out of range (intermittent). This distinction determines whether you qualify for the 10% vs. 30%+ rating criteria.
during exam
- critical
Describe the functional impact of PV on your ability to maintain employment
Explicitly address: missed workdays, reduced work hours, inability to perform physically demanding tasks, difficulty concentrating, and any job accommodations made due to PV. This information populates the functional impact section of the DBQ (field 585).
during exam
- recommended
Request the examiner address all separately ratable complications
Ask: 'I also have [hypertension/gout/prior DVT] that my hematologist has attributed to my polycythemia vera. Will those be addressed for separate rating?' Per DC 7704 Note (1), these must be rated separately.
during exam
- recommended
Do not perform better than your typical level of functioning
If you experience fatigue, shortness of breath, or discomfort during the exam, do not push through without noting it. Say: 'I want you to know I am experiencing [symptom] right now, which is typical for me.'
during exam
- critical
Request a copy of the completed DBQ
You have the right to a copy of the completed DBQ. Request it from the examiner before leaving or from the VA after the exam. Review it for accuracy, especially phlebotomy frequency, medication classifications, and lab values recorded.
after exam
- critical
File a supplemental claim if the DBQ is inaccurate
If the DBQ contains factual errors - wrong phlebotomy count, incorrect medication classification, missing complications - submit a written rebuttal with supporting evidence. Contact your VSO or accredited claims agent promptly as rating decisions follow quickly after C&P exams.
after exam
- recommended
Document your recollection of the exam immediately afterward
Write down everything discussed, every question asked, and every answer given as soon as possible after the exam. Note the examiner's name, credentials, and whether they reviewed your records or only relied on interview. This is your record if the DBQ is contested.
after exam
Your rights during a C&P exam
- You have the right to a thorough and contemporaneous examination - the examiner must actually examine you, not merely review records, unless a records-review examination is specifically authorized.
- You have the right to a copy of the completed DBQ after the examination is finalized.
- You have the right to record your C&P examination in most states - notify the examiner at the beginning of the appointment and check your state's recording consent laws.
- You have the right to submit a rebuttal or supplemental evidence if the DBQ contains factual errors, including requesting a new examination if the original is inadequate.
- You have the right under the PACT Act and existing regulations to have all relevant service treatment records, private medical records (submitted via VA Form 21-4142), and lay statements considered before a rating decision is issued.
- You have the right to have complications of your Polycythemia Vera - including hypertension, gout, stroke, and thrombotic disease - evaluated for separate ratings under DC 7704 Note (1).
- You have the right to a rating based on the worst-day presentation of your condition, not solely on how you appear during a single exam - explicitly describe your worst days to the examiner.
- You have the right to representation by an accredited Veterans Service Organization (VSO), claims agent, or attorney at no cost during the examination process.
- You have the right to request an Independent Medical Opinion (IMO) from a private specialist to rebut an inadequate or unfavorable C&P examination.
- If your PV transforms to myelofibrosis or leukemia, you have the right to re-evaluation under the appropriate leukemia diagnostic code per DC 7704 Note (2), which may entitle you to a 100% rating.
Related conditions
- Hypertension Directly listed as a separately ratable complication of Polycythemia Vera under DC 7704 Note (1). Hyperviscosity and elevated RBC mass contribute to secondary hypertension.
- Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) Major thrombotic complications of PV due to hyperviscosity and platelet dysfunction. Listed as separately ratable under DC 7704 Note (1). Prior DVT/PE with residual effects warrants independent evaluation.
- Stroke / Cerebrovascular Accident (CVA) Thromboembolic stroke is a known complication of PV hyperviscosity. Separately ratable under DC 7704 Note (1) with residual neurological deficits evaluated under the neurological diagnostic codes.
- Gout Hyperuricemia and gout are recognized complications of PV due to increased cell turnover elevating uric acid levels. Directly listed as separately ratable under DC 7704 Note (1).
- Essential Thrombocythemia / Primary Myelofibrosis PV can transform into myelofibrosis (post-PV MF) as part of disease progression. If transformation occurs, evaluation under the essential thrombocythemia/primary myelofibrosis criteria or leukemia codes (per DC 7704 Note 2) may be warranted.
- Acute Myeloid Leukemia (AML) / Leukemic Transformation PV can undergo blast-phase transformation to AML. Per DC 7704 Note (2), if leukemic transformation occurs, the condition must be evaluated as leukemia under the appropriate diagnostic code, which carries a 100% rating.
- Iron Deficiency Anemia Repeated therapeutic phlebotomy for PV depletes iron stores, causing secondary iron deficiency anemia with symptoms of fatigue, weakness, and hair loss. May warrant separate evaluation.
- Splenomegaly / Spleen Conditions Splenomegaly occurs commonly in PV due to extramedullary hematopoiesis and increased splenic sequestration. Can cause early satiety, left upper quadrant pain, and anemia - may warrant evaluation under DC 7706 combined with DC 7723.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.