Diagnostic Code 7718 · 38 CFR §4.117
DC 7718 covers two related myeloproliferative neoplasms: essential thrombocythemia (ET) and primary myelofibrosis (PMF). Essential thrombocythemia is a chronic blood disorder where the bone marrow overproduces platelets, increasing the risk of blood clots and, paradoxically, abnormal bleeding. Symptoms include headaches, dizziness, vision changes, burning or tingling in the hands and feet, and fatigue. Primary myelofibrosis is a more serious condition where scar tissue gradually replaces bone marrow, leading to severe anemia, an enlarged spleen, bone pain, fatigue, and vulnerability to infections. Both conditions involve abnormal bone marrow function and share similar driver mutations (JAK2, CALR, or MPL). For veterans, these conditions may be linked to radiation exposure, benzene or chemical exposure during service, or other toxic environmental exposures. ET can sometimes progress to myelofibrosis over time. The VA rates both under a single code based on treatment burden and symptom severity.
| Rating | Criteria |
|---|---|
| 10% | Essential thrombocythemia or primary myelofibrosis that is stable and managed with low-dose aspirin or observation alone, with mild symptoms such as occasional headaches or minor fatigue. |
| 30% | Condition requiring cytoreductive medication (such as hydroxyurea or anagrelide for ET, or ruxolitinib for PMF) to control blood counts or spleen size, with moderate symptoms affecting daily stamina. |
| 60% | Condition requiring multiple medications, regular transfusions for anemia, or causing significant complications such as blood clots, substantial splenomegaly, or marked constitutional symptoms (drenching night sweats, weight loss, severe fatigue) that substantially limit daily functioning. |
| 100% | Advanced disease with transformation to acute leukemia, massive splenomegaly requiring splenectomy consideration, transfusion dependence, or requiring stem cell transplant evaluation. Daily living and employment are severely impaired. |
A confirmed diagnosis through blood work showing elevated platelet counts (for ET) or bone marrow biopsy showing fibrosis (for PMF) is essential. Molecular testing for JAK2, CALR, or MPL mutations helps confirm the diagnosis. Hematology records documenting the treatment regimen — aspirin, cytoreductive drugs, JAK inhibitors, transfusions — demonstrate severity. Imaging showing spleen size is important for myelofibrosis. Records of complications such as blood clots, bleeding events, or disease progression support a higher rating. Service records documenting toxic exposure (radiation, chemicals) and a hematology nexus opinion connecting the condition to that exposure are needed.
Essential thrombocythemia primarily involves overproduction of platelets with clotting risk, while primary myelofibrosis involves scarring of the bone marrow leading to anemia and enlarged spleen. They are related conditions that share genetic mutations, and ET can sometimes progress to myelofibrosis. Both are rated under DC 7718.
Yes. Both conditions can result from toxic exposures during military service, including radiation, benzene, and other chemicals. A hematology nexus opinion linking the condition to documented in-service exposure is the key evidence needed.