38 CFR Part 4 — 38 CFR § 4.117
Polycythemia Vera
dc-7704-polycythemia-vera
Hematologic / lymphatic
Diagnostic code
7704
Why your DC matters: DC 7704 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 7704 — Polycythemia Vera — is listed under 38 CFR § 4.117 in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Educational index row from the rating schedule naming convention; confirm exact diagnostic code, effective date, and criteria in the current eCFR Part 4.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (7704) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “7704”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 7704 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 7704 in the subpart for your body system (use Find in Page if needed).
DC 7704 polycythemia vera is rated by treatment intensity — specifically phlebotomy frequency. The 30%/60% gates are objective (3 vs. 4-5 vs. 6+ phlebotomies per 12 months), making this one of the cleanest ratings in § 4.117. Veterans with myeloproliferative disorders following chemotherapy exposure (Vietnam-era herbicide-exposed, Camp Lejeune, or radiation-exposed cohorts) may have presumptive SC pathways. The play is documenting phlebotomy frequency carefully — many veterans on chronic phlebotomy programs don't realize each procedure counts toward the tier gate.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 100% | Requiring peripheral blood or bone marrow stem-cell transplant or chemotherapy. | Oncology records documenting stem-cell transplant or chemotherapy regimen (hydroxyurea, ruxolitinib, busulfan, IFN-α at chemotherapy-equivalent dosing). |
| 60% | Requiring phlebotomy 6 or more times per 12-month period, OR molecularly targeted therapy. | Phlebotomy log showing ≥ 6 procedures/year, OR oncology Rx for ruxolitinib or similar JAK inhibitors. |
| 30% | Requiring phlebotomy 4-5 times per 12-month period. | Phlebotomy log showing 4-5 procedures/year. |
| 10% | Requiring phlebotomy 3 or fewer times per 12-month period. | Phlebotomy log showing 1-3 procedures/year. |
What Qualifies Under DC 7704?
Confirmed polycythemia vera diagnosis
JAK2 V617F mutation (95%+ of PV cases) + elevated hematocrit + bone marrow proliferation evidence. Distinguishes PV from secondary erythrocytosis.
Treatment-driven tiers
DC 7704 schedule:
- • 10% — Phlebotomy 1-3 times/year
- • 30% — Phlebotomy 4-5 times/year
- • 60% — Phlebotomy 6+ times/year OR molecularly targeted therapy (e.g., ruxolitinib)
- • 100% — Stem-cell transplant or chemotherapy
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“Peripheral blood or bone marrow stem-cell transplant or chemotherapy”
100% gate. Includes transformation to acute leukemia or myelofibrosis requiring transplant; or active chemotherapy (hydroxyurea is borderline — verify with provider whether it counts as 'chemotherapy' for rating purposes).
“Phlebotomy 6 or more times per 12-month period OR molecularly targeted therapy”
Bridge to 60% via either path — high-frequency phlebotomy OR targeted Rx (ruxolitinib, JAK inhibitors). File under whichever applies.
“Phlebotomy 4-5 vs. 3 or fewer times per 12 months”
Frequency boundary — count carefully from phlebotomy records. Pull annual logs from the hematology infusion center.
Evidence Checklist — Specific to This Condition
Hematology diagnosis of polycythemia vera
CRITICALJAK2 V617F mutation testing (95%+ positive in PV), bone marrow biopsy, elevated EPO levels. Confirms PV vs. secondary erythrocytosis.
Phlebotomy frequency log (12 months)
CRITICALDate + units removed for each procedure. Drives the tier gate (3 vs. 4-5 vs. 6+).
Treatment regimen (hydroxyurea, ruxolitinib, IFN-α, anagrelide)
CRITICALDrives the medication tier path to 60% (targeted therapy) or 100% (chemotherapy-equivalent).
Hematocrit trend
IMPORTANTDocuments disease control adequacy + supports phlebotomy frequency justification.
Thrombotic complication history
IMPORTANTDVT, PE, MI, stroke. PV's primary morbidity. May rate separately under cardiovascular/neurological codes.
Service-era exposure documentation (Agent Orange, Camp Lejeune, radiation)
SUPPORTINGPresumptive SC pathways for myeloproliferative disorders.
C&P Exam Tips
Bring 12-month phlebotomy log printed
Each procedure counts toward the tier gate. Without a log, examiners default to the lowest credible count.
Bring oncology / hematology treatment notes
Documents PV diagnosis, current treatment regimen, response.
Document any thrombotic events
DVT, PE, MI, stroke from PV are separately ratable secondaries.
Don't accept 10% if you're on chronic phlebotomy
Count carefully. 4+ procedures/year = 30%; 6+ = 60%. Don't let the rater under-count.
Common Mistakes That Cost Veterans Points
Not tracking phlebotomy frequency
The 12-month log is the single most important piece of evidence. Build it from infusion center records.
Missing the molecularly targeted therapy path to 60%
Ruxolitinib (Jakafi) or other JAK inhibitors = 60% regardless of phlebotomy frequency. File under this alternate path if applicable.
Missing thrombotic complication secondaries
PV's primary morbidity is thrombosis (DVT, PE, stroke, MI). Each complication is separately ratable under cardiovascular/neurological codes.
Filing as secondary erythrocytosis
Secondary polycythemia (from sleep apnea, COPD, high altitude) is NOT polycythemia vera. PV requires JAK2 mutation + bone marrow proliferation evidence. File under appropriate primary code if secondary erythrocytosis.
Tactical Plays
⚡ Build a 12-month phlebotomy log BEFORE filing
Pull infusion center records and create a clean log: date + units removed per procedure. The 4+ procedures gate (30%) and 6+ procedures gate (60%) are objective. Without a log, examiners under-count.
⚡ Push for 60% via molecularly targeted therapy path
Ruxolitinib (Jakafi) or other JAK inhibitors qualify for 60% under DC 7704 — independent of phlebotomy frequency. If you're on a JAK inhibitor, file under this alternate path.
⚡ Audit thrombotic complications as separate ratings
PV's primary morbidity is thrombosis. Each DVT, PE, MI, stroke is separately ratable under cardiovascular/neurological codes. Many veterans miss these stacks.
Secondary Conditions to File With This One
Deep vein thrombosis / pulmonary embolism
STRONGDC 7121
PV's primary morbidity. Thrombotic events rate separately under cardiovascular codes.
Stroke / cerebrovascular accident
MODERATEDC 8009
Arterial thrombosis from PV; rate residuals separately.
Myocardial infarction
MODERATEDC 7006
PV-associated coronary thrombosis; rate cardiac residuals separately.
Transformation to acute leukemia or myelofibrosis
SITUATIONALDC 7703 / 7718
10-15% of PV transforms over decades. File separately if it occurs.
Splenectomy (if performed)
SITUATIONALDC 7706
Some PV patients undergo splenectomy for refractory splenomegaly; rate separately under DC 7706.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Phlebotomy 1-3 times/year — well-controlled PV.
30% — single, no dependents
Base rating
$552.47
TOTAL
$552.47/mo
Phlebotomy 4-5 times/year.
60% — single, no dependents
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Phlebotomy 6+ times/year OR JAK inhibitor therapy.
100% — single, no dependents
Base rating
$3,938.58
TOTAL
$3,938.58/mo
Active chemotherapy or stem-cell transplant.
60% PV + 60% post-DVT residuals
Base rating
$2,102.15
TOTAL
$2,102.15/mo
PV + thrombotic complications stack under different codes (7704 + 7121).
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
🩸What is polycythemia vera?
A myeloproliferative neoplasm characterized by overproduction of red blood cells (and often platelets/white cells). 95%+ have JAK2 V617F mutation. Primary morbidity is thrombosis from hyperviscosity.
↔️What's the difference between PV and secondary erythrocytosis?
PV = primary bone marrow disorder with JAK2 mutation. Secondary erythrocytosis = elevated RBCs from chronic hypoxia (sleep apnea, COPD, high altitude) — NOT PV. DC 7704 applies only to true PV.
💊What are 'molecularly targeted therapies' for PV?
JAK inhibitors — primarily ruxolitinib (Jakafi). Used in refractory PV or those intolerant to hydroxyurea. Qualifies for 60% under DC 7704 regardless of phlebotomy frequency.
💉Why does phlebotomy frequency matter?
Phlebotomy is the primary treatment to control hematocrit in PV. More frequent phlebotomies = more uncontrolled disease + greater functional impact. The tier gates (4-5 vs. 6+) are objective and chart-documented.
How to File Your Claim
Get hematology to confirm PV diagnosis
JAK2 V617F testing + bone marrow biopsy + EPO level.
Build 12-month phlebotomy frequency log
Pull infusion center records. Date + units removed per procedure.
Document treatment regimen
Hydroxyurea, ruxolitinib (JAK inhibitor), anagrelide, IFN-α. JAK inhibitor = 60% alternate path.
File 21-526EZ specifying 'polycythemia vera (DC 7704)'
Reference phlebotomy log + treatment regimen. File under highest-rating path.
Stack thrombotic complications as secondaries
DVT, PE, MI, stroke under cardiovascular/neurological codes.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
Phlebotomy frequency log is the single most important evidence
Tier gates are objective (4-5 vs. 6+ per year). Build the log from infusion center records.
JAK inhibitor therapy = 60% alternate path
Ruxolitinib (Jakafi) qualifies for 60% regardless of phlebotomy frequency.
Stack thrombotic complications
PV's primary morbidity is thrombosis. Each DVT, PE, MI, stroke is separately ratable.
Distinguish PV from secondary erythrocytosis
DC 7704 applies only to true PV with JAK2 mutation. Secondary erythrocytosis from sleep apnea/COPD doesn't qualify.
Related Tools & Resources
Frequently Asked Questions
How is polycythemia vera rated?
Treatment intensity-driven. Phlebotomy frequency drives the primary tier gates: 1-3/year = 10%, 4-5/year = 30%, 6+/year OR molecularly targeted therapy = 60%, stem-cell transplant or chemotherapy = 100%.
Does hydroxyurea count as 'chemotherapy' for the 100% tier?
Borderline — verify with your oncologist. Hydroxyurea is technically a cytotoxic agent but is often classified as 'cytoreductive therapy' rather than chemotherapy. If transformation to acute leukemia or myelofibrosis requires more aggressive chemotherapy, the 100% tier clearly applies.
Can DVT/PE rate separately from polycythemia vera?
Yes — thrombotic complications are PV's primary morbidity and rate separately under cardiovascular codes (DC 7121 for post-phlebitic syndrome) or neurological codes (for stroke residuals). Stack these on top of the DC 7704 rating.
Is polycythemia vera associated with any presumptive service-connection pathways?
Myeloproliferative disorders may have presumptive pathways under Agent Orange (for Vietnam-era veterans) or Camp Lejeune (Aug 1953 – Dec 1987 service). Verify your specific service period and check current presumptive lists.
Official Regulatory Source
Polycythemia vera is rated under 38 CFR § 4.117, DC 7704 — treatment-intensity driven schedule.
38 CFR § 4.117 — Hemic and Lymphatic Systems (eCFR) →Scroll to DC 7704. § 4.117 was restructured in 2018.
Next Steps
If your rating decision lists DC 7704, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 7704 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.