Anemia VA Rating: Criteria, Tiers by Type, and 2026 Pay

The VA rates anemia anywhere from 0% to 100%, paying between $180.42 and $3,938.58 per month in 2026 depending on the severity of the condition and how much treatment it requires. Your anemia VA rating is driven mainly by how often you need transfusions, infusions, injections, or immunosuppressive therapy, and how frequently you have painful episodes or infections. Lab values matter less than the record of treatment. Before any percentage is assigned, you have to show the anemia is connected to your military service.

What Drives the Rating Percentage

The VA evaluates anemia under the Schedule of Ratings for Hemic and Lymphatic Systems in 38 CFR 4.117. There is no single anemia code. Each type of anemia has its own diagnostic code with its own severity tiers.¹

Across every code, the same idea runs through the criteria: how often does the veteran need medical intervention? A veteran who gets transfusions every six weeks will rate higher than one transfused once a year, even if their blood counts look similar. That is why treatment records, not lab reports, decide most claims. Every documented infusion, injection, hospitalization, and painful crisis pushes the rating up a tier.

Rating Tiers by Type of Anemia

Aplastic Anemia (DC 7716)

Aplastic anemia occurs when the bone marrow fails to produce enough blood cells. It rates at three levels:¹

100%: peripheral blood or bone marrow stem cell transplant; or platelet or red cell transfusions at least once every six weeks over 12 months; or recurring infections at least once every six weeks over 12 months.
60%: transfusions or recurring infections at least once every three months; or continuous immunosuppressive therapy or platelet-stimulating agents.
30%: at least one transfusion or one infection per 12-month period.

The gap between 30% and 60% often comes down to documentation. Quarterly transfusions that only appear as two clear entries in the file can land at 30% instead of 60%.

Sickle Cell Anemia (DC 7714)

Sickle cell anemia rates on painful crises per year and how those episodes limit work:¹

100%: four or more painful episodes per year in skin, joints, bones, or major organs, with residuals preventing even light manual labor.
60%: three painful episodes per year, or symptoms preventing anything beyond light manual labor.
30%: one or two painful episodes per year.
10%: asymptomatic but in established remission with identifiable organ impairment.

Sickle cell trait alone, with no documented pathological findings, is not ratable. Symptomatic trait that does not fit the standard criteria may be forwarded to the Director of Compensation Service for extra-schedular consideration.¹

Iron Deficiency Anemia (DC 7720)

Iron deficiency anemia carries a maximum schedular rating of 30%:¹

30%: intravenous iron infusions four or more times per 12-month period.
10%: IV iron infusions at least once but fewer than four times per year, or continuous oral iron supplementation.
0%: asymptomatic or managed by diet alone.

Important boundary: iron deficiency anemia caused by blood loss is not rated under DC 7720. If a service-connected gastrointestinal condition causes chronic bleeding that leads to the iron deficiency, the anemia is rated under the diagnostic code for whatever is causing the blood loss.¹ The other code may allow a higher rating than the 30% cap.

Pernicious and Vitamin B12 Deficiency Anemia (DC 7722)

Two levels, with a built-in re-evaluation:¹

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

The 100% rating runs from the date of initial diagnosis until a mandatory VA exam six months after hospital discharge or the end of parenteral B12 therapy. It then drops to 10%. Lasting effects like peripheral neuropathy or cognitive impairment get rated separately under their own codes and combined with the 10% anemia rating.¹

Acquired Hemolytic Anemia (DC 7723)

Rated on how much immunosuppressive treatment the condition requires:¹

100%: bone marrow transplant, or continuous intravenous or immunosuppressive therapy.
60%: immunosuppressive medication four or more times per 12-month period.
30%: two to three courses of immunosuppressive therapy per year.
10%: one course of immunosuppressive therapy per year.
0%: asymptomatic.

If a bone marrow transplant was required, 100% runs from the date of hospital admission and continues for six months after discharge, followed by a mandatory re-examination. A splenectomy gets a separate rating under DC 7706 that combines with the hemolytic anemia rating.¹

2026 Monthly Compensation

VA disability compensation is tax-free. The 2026 rates, effective December 1, 2025, reflect a 2.8% cost-of-living increase. For a veteran with no dependents:²

10%: $180.42
20%: $356.66
30%: $552.47
40%: $795.84
50%: $1,132.90
60%: $1,435.02
70%: $1,808.45
80%: $2,102.15
90%: $2,362.30
100%: $3,938.58

Veterans rated 30% or higher receive additional compensation for dependents. A veteran rated 100% with a spouse and one child receives $4,318.99 per month. Each additional child under 18 adds $109.11, and a spouse who qualifies for Aid and Attendance adds $201.41.²

Proving the Anemia Is Service-Connected

No rating attaches until the VA agrees the anemia is linked to service. Three pathways exist.

Direct Service Connection

Direct service connection needs three pieces: a current medical diagnosis, documentation of an event, injury, or exposure during active service, and a medical nexus opinion connecting the two. The nexus opinion typically states the anemia is “at least as likely as not” related to the in-service event. Missing any of the three sinks the claim.

Secondary Service Connection

If your anemia developed because of another service-connected condition, you can claim it as secondary. The regulation covers any disability “proximately due to or the result of” a service-connected disease or injury. A service-connected gastrointestinal disorder causing chronic blood loss that produces iron deficiency anemia is a common example. Aggravation also counts: if a service-connected condition made pre-existing anemia measurably worse, the worsened portion can be service-connected even if the anemia itself started before service.³

Presumptive Service Connection

“Primary anemia” is on the VA’s list of chronic diseases that qualify for presumptive service connection when they appear within one year of discharge.⁴ If anemia manifests to a compensable degree within a year of leaving active duty, the VA presumes it is service-connected without requiring proof of a specific in-service event or a nexus opinion.⁵

Anemia itself is not on the PACT Act’s presumptive list, which focuses on cancers. Several of those cancers, including lymphoma, can cause secondary anemia, so a veteran granted lymphoma as a presumptive condition could then claim the resulting anemia as secondary.⁶

What the C&P Exam Actually Looks At

You file for compensation using VA Form 21-526EZ.⁷ Before filing the full claim, consider submitting VA Form 21-0966, Intent to File. That locks in an earlier potential effective date, and you then have one year to complete the formal application.⁸

After the VA receives the claim, it will usually schedule a Compensation and Pension exam. The examiner works from a Disability Benefits Questionnaire specific to hematologic conditions, recording your diagnosis, frequency of transfusions, whether you need continuous medication, and how often infections or painful crises occur.⁹

Because the rating turns on treatment frequency, the single most useful thing you can do before this exam is compile a clean 12-month log of every transfusion, infusion, injection, and hospitalization, with dates. Veterans lose rating levels not because their condition is mild but because their records have gaps.

When Payments Start

For a direct service connection claim, the effective date is either the date the VA receives your claim or the date the condition began, whichever is later.¹⁰ Filing within one year of separation lets the effective date reach back to the day after discharge.

For presumptive claims filed within a year of separation, the effective date is the date the condition first appeared. File later than a year, and the effective date defaults to whichever is later: the filing date or the onset date.¹⁰ For an increase on an existing rating, the VA can backdate to the earliest date you can show the condition worsened, but only if you file within one year of that date.

If Your Anemia Keeps You From Working

A veteran whose anemia prevents substantially gainful employment may qualify for Total Disability Based on Individual Unemployability (TDIU), which pays at the 100% rate even when the schedular rating is lower.¹¹

Schedular TDIU: a single service-connected disability rated 60% or higher, or a combined rating of 70% or higher with at least one disability at 40%.
Extra-schedular TDIU: if you fall short of those thresholds but are still unemployable because of service-connected conditions, the VA can refer your case to the Director of Compensation Service.

This pathway matters most for veterans with aplastic anemia rated at 60% who are too debilitated to work, or those whose anemia combines with other service-connected conditions to cross 70%. The VA treats earnings below the federal poverty threshold for one person as “marginal employment,” so occasional or sheltered work does not disqualify you.¹¹

Temporary 100% After Surgery or Hospitalization

A bone marrow transplant, extended hospitalization, or related surgery may qualify for a temporary 100% convalescent rating under 38 CFR 4.30. It runs from the date of hospital admission and continues for one to three months after discharge depending on recovery.¹² Once that period ends, the standard schedular rating resumes. Several anemia codes, including aplastic and acquired hemolytic, have their own built-in 100% periods after transplants that may overlap with or extend beyond the convalescent rating.

Appealing a Denial or Low Rating

If the VA denies the claim or assigns a rating your treatment records should have supported, there are three review options under the Appeals Modernization Act:¹³

Supplemental Claim (VA Form 20-0995): submit new and relevant evidence the VA hasn’t previously seen. This is usually the strongest option when the original decision was based on incomplete treatment records.¹⁴
Higher-Level Review: a senior reviewer re-examines the existing file for errors. No new evidence is allowed, so this fits cases where you believe the rating criteria were misapplied to evidence already in the record.
Board Appeal: VA Form 10182, filed within one year of the mailing date of the decision, sends the case to the Board of Veterans’ Appeals.¹⁵

For anemia, the most common cause of a low rating is a treatment record that doesn’t clearly show how often transfusions, infusions, or painful episodes occurred. A Supplemental Claim with updated treatment logs and a detailed medical opinion is generally more productive than a Higher-Level Review confined to what the VA already has. Free help with any of these steps is available through accredited Veterans Service Organizations listed in the VA’s representative search tool.¹⁶

1
eCFR. 38 CFR 4.117 – Schedule of Ratings—Hemic and Lymphatic Systems
2
Veterans Affairs. Current Veterans Disability Compensation Rates
3
eCFR. 38 CFR 3.310 – Disabilities That Are Proximately Due to, or Aggravated by, Service-Connected Disease or Injury
4
eCFR. 38 CFR 3.309 – Disease Subject to Presumptive Service Connection
5
Veterans Affairs. Disabilities That Appear Within 1 Year After Discharge
6
Veterans Affairs. The PACT Act and Your VA Benefits
7
Veterans Affairs. How to File a VA Disability Claim
8
Veterans Affairs. Your Intent to File a VA Claim
9
Veterans Affairs. Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits Questionnaire
10
Veterans Affairs. Disability Compensation Effective Dates
11
eCFR. 38 CFR 4.16 – Total Disability Ratings for Compensation Based on Unemployability of the Individual
12
eCFR. 38 CFR 4.30 – Convalescent Ratings
13
Veterans Affairs. Higher-Level Reviews
14
Veterans Affairs. Supplemental Claims
15
Veterans Affairs. Decision Review Request: Board Appeal (Notice of Disagreement)
16
Veterans Affairs. Get Help From a VA Accredited Representative or VSO