Diagnostic Code 7722 · 38 CFR §4.117
DC 7722 covers pernicious anemia and vitamin B12 deficiency anemia. Pernicious anemia is an autoimmune condition where the body attacks the stomach cells that produce intrinsic factor, a protein required to absorb vitamin B12 from food. Without adequate B12, the body cannot produce healthy red blood cells, leading to megaloblastic anemia. Beyond the typical anemia symptoms of fatigue, weakness, and shortness of breath, B12 deficiency can cause serious neurological problems including numbness and tingling in the hands and feet, difficulty walking, memory problems, confusion, and mood changes. For veterans, B12 deficiency can develop secondary to gastrointestinal conditions or surgeries that impair absorption (such as gastric bypass or bowel resection related to service injuries), prolonged use of acid-reducing medications prescribed for service-connected GERD or ulcers, or autoimmune conditions triggered by service-related stressors. The neurological damage from B12 deficiency can become permanent if not caught early, making timely diagnosis and treatment critical.
| Rating | Criteria |
|---|---|
| 0% | B12 deficiency or pernicious anemia diagnosed but hemoglobin and neurological function are maintained at normal levels with regular B12 injections or supplementation. No residual symptoms. |
| 10% | Anemia controlled with treatment but with mild residual symptoms such as persistent fatigue, mild tingling in extremities, or reduced stamina that affects daily endurance. |
| 30% | Despite treatment, ongoing moderate anemia symptoms and neurological effects such as noticeable numbness in hands or feet, balance difficulties, or cognitive slowing that limit some daily activities and reduce work capacity. |
| 70% | Significant anemia and neurological damage despite treatment — severe peripheral neuropathy affecting hand function or gait, substantial cognitive impairment, or persistent severe fatigue that makes maintaining employment very difficult. |
| 100% | Severe refractory anemia requiring transfusions and/or irreversible neurological damage including inability to walk without assistance, severe cognitive decline, or combined symptoms that prevent any sustained physical or mental activity. |
Blood work showing low serum B12 levels, elevated methylmalonic acid, and a CBC with macrocytic anemia (high MCV, low hemoglobin) form the diagnostic foundation. For pernicious anemia specifically, antibodies against intrinsic factor or parietal cells help confirm the autoimmune cause. Serial lab results demonstrating the ongoing need for B12 replacement are important. Neurological examination findings and nerve conduction studies document any neuropathy. Treatment records showing B12 injection frequency and response are needed. If secondary to a GI condition or medication, a nexus opinion linking the B12 malabsorption to the service-connected primary condition is essential.
Yes. If B12 deficiency has caused peripheral neuropathy, the nerve damage can be rated under the neurological diagnostic codes in addition to the anemia rating under DC 7722. This is particularly important if you have permanent nerve damage that affects hand function or walking.
Pernicious anemia is a specific autoimmune cause of B12 deficiency where the body attacks its own intrinsic factor. Other causes of B12 deficiency include malabsorption from GI conditions, gastric surgery, and certain medications. Both are rated under DC 7722, but the underlying cause affects the nexus approach.