Anemia

The most important fact about a VA anemia rating is that the old rule is gone. In 2018, VA repealed DC 7700 and its hemoglobin-based percentage ladder. Current 38 CFR § 4.117 separates anemia by type and often grades it by treatment, transfusions, painful episodes, infections, or other disease-specific features.

That means “What is my hemoglobin?” is no longer enough to estimate a rating. The first question is “What kind of anemia is this?” Iron deficiency, folate deficiency, pernicious or B12 deficiency, acquired hemolytic anemia, sickle cell anemia, and aplastic anemia all follow different codes.

This page focuses on the three common deficiency-anemia codes, explains the blood-loss exception that changes DC 7720 claims, and shows how to organize service-connection and C&P evidence without relying on obsolete criteria.

TL;DR

• DC 7700 and its hemoglobin ladder were removed in the 2018 hemic revision.
• DC 7720, iron deficiency: 0 percent for asymptomatic or diet-only treatment; 10 percent for continuous oral supplementation or 1 to 3 IV iron infusions in 12 months; 30 percent for 4 or more IV infusions in 12 months.
• Iron-deficiency anemia caused by blood loss is rated under the condition causing the blood loss, not DC 7720.
• DC 7721, folic acid deficiency: 0 percent for asymptomatic or diet-only treatment; 10 percent for continuous high-dose oral supplementation.
• DC 7722, pernicious or B12 deficiency: 10 percent for continuous qualifying B12 treatment; a temporary 100 percent applies at initial diagnosis when the code's transfusion or central-nervous-system criteria are met.
• Other anemia types use other codes. A broad “anemia” diagnosis does not identify the rating formula.
• Direct and secondary service connection require evidence identifying the anemia's cause, not just a low lab value.
• No verified aggregate Board-outcome cut covering current type-specific anemia codes was available, so this page publishes no grant-rate statistic.

The 2018 Change: Why DC 7700 Advice Is Stale

Before December 2018, DC 7700 used hemoglobin levels and symptoms. VA's hemic-system rewrite removed that code and created more specific categories. Current ratings track how the diagnosed disease behaves and what treatment it requires.

Older articles may still show 10, 30, 70, and 100 percent based mainly on hemoglobin. That is not the current schedule. Hemoglobin remains clinically important for diagnosing and monitoring anemia, but it is not the percentage ladder for DCs 7720 through 7722.

DC 7720: Iron-Deficiency Anemia

Current DC 7720 has three levels:

• 0%: asymptomatic, or treatment only by dietary modification.
• 10%: IV iron at least once but fewer than four times during a 12-month period, or continuous oral supplementation.
• 30%: IV iron four or more times during a 12-month period.

The code contains a decisive note: iron-deficiency anemia caused by blood loss is evaluated under the diagnostic code for the condition causing the blood loss. A veteran with documented bleeding from a gastrointestinal or other service-connected condition should not assume DC 7720 is the rating path. The source condition and its current criteria control.

This also means GERD or IBS cannot be treated as proof of chronic blood loss simply because they are gastrointestinal diagnoses. The medical record needs to identify actual bleeding and connect it to the iron deficiency.

DC 7721: Folic-Acid-Deficiency Anemia

DC 7721 is narrow:

• 0%: asymptomatic, or requiring dietary modification only.
• 10%: requiring continuous treatment with high-dose oral supplementation.

The file should show the diagnosed deficiency and the prescribed treatment. An over-the-counter vitamin on a medication list does not automatically prove that the code's continuous high-dose treatment criterion is met.

DC 7722: Pernicious and B12-Deficiency Anemia

DC 7722 provides:

• 10%: continuous treatment with B12 injections, sublingual or high-dose oral tablets, or nasal spray or gel.
• 100% at initial diagnosis: severe anemia requiring transfusion, or central-nervous-system impairment such as encephalopathy, myelopathy, or severe peripheral neuropathy requiring parenteral B12 therapy.

The 100 percent evaluation is temporary. The code requires a mandatory examination six months after hospital discharge or the end of parenteral B12 treatment. After that period, VA evaluates the ongoing anemia and separately evaluates qualifying residuals, such as neurological impairment, under the appropriate code.

Other Anemia Types Use Different Codes

The word anemia is a finding shared by many diseases. Current § 4.117 also includes acquired hemolytic anemia under DC 7723, sickle cell anemia under DC 7714, aplastic anemia under DC 7716, and other hemic disorders with their own rules.

Those codes do not use the simple 7720 treatment ladder. For example, sickle cell criteria focus on painful episodes and functional effects, while aplastic anemia criteria address transfusions, infections, medication, and transplant. The diagnosis and etiology need to be settled before anyone can identify a meaningful code or ceiling.

Service-Connection Paths

Direct service connection. The record should show anemia or its cause during service, a current diagnosis with type and etiology, and a link between them. Serial CBCs may show onset or continuity, but the clinician's etiologic analysis makes the lab pattern useful.

Secondary to a service-connected condition. Examples can include anemia from chronic kidney disease, treatment, malabsorption, or documented blood loss. Each mechanism requires medical evidence. For kidney disease, the provider should identify the renal mechanism rather than merely note that both diagnoses exist. For hemorrhoids or another possible bleeding source, the record should document bleeding sufficient to cause or aggravate the deficiency.

Secondary aggravation. Under 38 CFR § 3.310, the evidence should identify baseline anemia severity and the additional worsening caused by the service-connected condition.

What to Document for the C&P Exam

Useful evidence includes:

• the exact anemia diagnosis and cause;
• CBC and clinician-selected confirmatory studies, such as iron, ferritin, folate, B12, reticulocyte, or hemolysis testing;
• prescribed oral supplements, dose, and continuity;
• dated IV infusion records during the relevant 12 months;
• transfusion, hospitalization, and parenteral B12 records;
• neurological findings and residual diagnoses when DC 7722 is involved;
• records identifying any bleeding source; and
• a medical opinion linking the cause to service or to a service-connected disability.

Symptoms such as fatigue, shortness of breath, dizziness, or weakness help describe functional impact, but the current deficiency-anemia codes are driven by the diagnosis and treatment thresholds above.

Common Failure Modes

Using the repealed ladder. The claim argues from hemoglobin cutoffs under DC 7700 rather than current type-specific criteria.

No anemia subtype. The file says only “anemia,” leaving VA without the facts needed to choose a code.

Counting supplements without context. The record does not show whether treatment is continuous, high-dose when required, or prescribed for the diagnosed deficiency.

Ignoring the blood-loss note. The veteran seeks DC 7720 even though the medical record attributes iron deficiency to ongoing blood loss.

Assuming a GI diagnosis causes bleeding. Coexistence is not causation. The nexus must identify the actual mechanism.

Bottom Line

There is no single current “VA rating for anemia.” DC 7700 is obsolete. Iron, folate, B12, hemolytic, sickle cell, aplastic, and other anemias use different codes. Identify the type and cause first, then match the treatment and disease course to the correct current criteria. For iron-deficiency anemia due to blood loss, remember that the source condition, not DC 7720, is the rating path.

Methodology and Limitations

• Authorities checked: Current 38 CFR § 4.117, including DCs 7714, 7716, and 7720 through 7723, checked against the eCFR Title 38 snapshot dated 2026-08-01. The 2018 revision history is reflected in the current code set and Federal Register history maintained with the schedule.
• Medical source: General type distinctions were checked against MedlinePlus anemia and B12-deficiency materials. Individual testing and treatment decisions belong to a clinician.
• Board statistics: No verified aggregate Board-outcome cut aligned to the current anemia codes was available, so none is published.
• Limitations: The page concentrates on common deficiency anemias. It does not reproduce every § 4.117 code or determine the cause of an individual veteran's abnormal labs.