LEUKEMIA

SHEREEN M. MARCUS · 2026 · Case ID: A26040693

MIXED

Summary

The veteran, who served in the U.S. Navy from October 1978 to October 1984, appeals the denial of an initial compensable rating for chronic lymphocytic leukemia (CLL). Service connection for CLL was previously granted at a noncompensable rate, effective June 14, 2023. The veteran sought higher-level review, which continued the noncompensable rating. The Board reviewed the evidence of record at the time of the higher-level review decision. The veteran submitted a private treatment record from October 2022, noting a CLL diagnosis in January 2016, worsening fatigue and weight loss in November 2020, and completion of treatment in June 2022 with no evidence of recurrent lymphoma. A VA examination in May 2024, with associated February 2024 laboratory testing, found the CLL in remission since June 14, 2023, with treatment completed in June 2022. The examiner noted severe fatigue and other resolved symptoms. The Board denied a compensable rating, finding no active disease and that treatment was completed. However, the Board remanded the issue of residuals, including chronic fatigue, due to insufficient evidence to adjudicate reported residuals like skin issues, dental problems, night sweats, and severe fatigue, and a pre-decisional duty to assist error in failing to obtain a comprehensive examination for these residuals.

Rationale

CLL in remission since June 14, 2023; Treatment completed June 2022; No evidence of active disease or recurrent lymphoma

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7703

Docket No.

250415-534225

Full Decision Text

Citation Nr: A26040693
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250415-534225
DATE: April 30, 2026

ORDER

Entitlement to an initial compensable rating for chronic lymphocytic leukemia (CLL) is denied.

REMANDED

Entitlement to an initial compensable evaluation for residuals, chronic lymphocytic leukemia (CLL), including chronic fatigue, is remanded.

FINDING OF FACT

The Veteran's chronic lymphocytic leukemia (CLL) has been in remission since 2022.

CONCLUSION OF LAW

The criteria for a compensable disability rating for the Veteran's CLL have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1 4.14, 4.117, Diagnostic Code 7703.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from October 1978 to October 1984.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025 higher-level review (HLR) rating decision issued by a VA Regional Office, the agency of original jurisdiction (AOJ). Upon review of a June 2024 rating decision, the AOJ continued the Veteran's noncompensable rating for CLL.

In the April 2025 VA Form 10182, Notice of Disagreement (NOD), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the June 2024 rating decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the issue of entitlement to an initial compensable evaluation for residuals, chronic lymphoblastic leukemia (CLL), including chronic fatigue, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an initial compensable rating for chronic lymphocytic leukemia (CLL) is denied.

Service connection for the Veteran's CLL was granted at a noncompensable rate, effective June 14, 2023, in a June 2024 rating decision. The Veteran timely sought higher-level review, and his noncompensable rating was continued in the April 2025 HLR decision on appeal. Accordingly, the Board will consider entitlement to a compensable rating from the June 14, 2023, date of service connection.

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

In making all determinations, the Board must fully consider
3.321(a), 4.1.

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge).

Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The Veteran's CLL is rated under 38 C.F.R. § 4.117, DC 7703, pertaining to leukemia. Under 7703, a 0 percent evaluation is warranted for chronic lymphocytic leukemia (CLL) or monoclonal B-cell lymphocytosis (MBL), asymptomatic, Rai Stage 0. A 100 percent evaluation is warranted when there is active disease or during a treatment phase. Otherwise, residuals are rated under the appropriate diagnostic code(s).

Note (1) to DC 7703 states that a 100 percent evaluation shall continue beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no recurrence, rate on residuals.

Note (2) states: Evaluate symptomatic chronic lymphocytic leukemia that is at Rai Stage I, II, III, or IV the same as any other leukemia evaluated under this diagnostic code.

Note (3) states: Evaluate residuals of leukemia or leukemia therapy under the appropriate diagnostic code(s). Myeloproliferative Disorders: (Diagnostic Codes 7704, 7718, 7719). 38 C.F.R. § 4.117, DC 7703.

Turning to the evidence of record, an October 2022 private treatment record outlines that the Veteran was initially diagnosed with CLL in January 2016. In November 2020, the Veteran presented with worsening fatigue and 15-pound weight loss. See October 2022 Private Treatment Record. Based on the Veteran's thrombocytopenia, B symptoms, and rapid doubling time, CLL-directed therapy was recommended. Id. The Veteran concluded treatment in June 2022, and the provider noted that there was no evidence of recurrent lymphoma. Id. The Veteran's thrombocytopenia was also noted as resolved, and his weight loss and anemia were noted to have improved. Id.

The Veteran was afforded a VA examination in May 2024 with February 2024 laboratory testing also associated with the claims file. The Veteran reported current symptoms of night sweats, tooth sensitivity and breaking, and severe fatigue. May 2024 VA Examination. The May 2024 VA examiner noted that the Veteran's CLL was in remission, that his treatment was completed in June 2022, and that the Veteran was currently in watchful waiting status. Id. The examiner further found that the Veteran did not have anemia, thrombocytopenia, or polycythemia vera. Id. The May 2024 examiner finally noted that the Veteran's CLL causes him to be severely fatigued at times and that he could not leave his home during his treatment.

Based upon the forgoing, the Board finds that a compensable rating for CLL under the criteria of DC 7703 is not warranted. The Veteran's CLL was successfully treated with chemotherapy completed in June 2022. The evidence of record indicates that the Veteran is currently under a watchful waiting status and that his CLL has been
that the Veteran was currently in watchful waiting status. Id. The examiner further found that the Veteran did not have anemia, thrombocytopenia, or polycythemia vera. Id. The May 2024 examiner finally noted that the Veteran's CLL causes him to be severely fatigued at times and that he could not leave his home during his treatment.

Based upon the forgoing, the Board finds that a compensable rating for CLL under the criteria of DC 7703 is not warranted. The Veteran's CLL was successfully treated with chemotherapy completed in June 2022. The evidence of record indicates that the Veteran is currently under a watchful waiting status and that his CLL has been in full remission since June 14, 2023, date of service connection. Indeed, the May 2024 VA examiner found the Veteran's CLL was in full remission, and an October 2022 private treatment record indicates there was no evidence of recurrent lymphoma. Therefore, under the criteria of DC 7703, a compensable rating cannot be granted as there is no evidence of active disease, and the Veteran's treatment was completed in June 2022.

As outlined below, however, the Board must remand the issue of whether the Veteran is entitled to an initial compensable evaluation of residuals due to chronic lymphoblastic leukemia (CLL), including chronic fatigue.

With regard to the underlying CLL, however, as there is no evidence of active disease, the appeal as to a compensable rating must be denied.

REASONS FOR REMAND

1. Entitlement to an initial compensable evaluation of residuals, chronic lymphocytic leukemia (CLL), including chronic fatigue, is remanded.

The Board finds that a remand is warranted to correct a pre-decisional duty to assist error as the pre-decisional evidence of record is insufficient to adjudicate the reported residuals associated with the Veteran's CLL.

In particular, the Veteran reported multiple residuals associated with his CLL, to include skin issues, dental problems, night sweats, and severe fatigue. See February 2024 Statement in Support of Claim; May 2024 VA Examination. Furthermore, the May 2024 VA examiner expressly noted that the Veteran's CLL causes him to be severely fatigued within the functional impact portion of the examination report. The evidence of record is otherwise silent regarding whether the reported residuals are associated with the Veteran's CLL and as to the severity of any such residuals. Accordingly, there is insufficient evidence of record to make a fully informed decision on the issue of the reported residuals of the Veteran's CLL.

The Board thus finds that an examination addressing the reported residuals of the Veteran's CLL, to include chronic fatigue, should have been obtained, a pre-decisional duty to assist error that must be corrected on remand.

While the Board is remanding this matter at this time, the Board is mindful of the holding in Smith v. Wilkie, 32 Vet. App. 332 (2020) and the impact of implicit credibility determinations within remand orders. The Board does not at this time make any determinations regarding the credibility of any evidence currently of record, to include those described in this remand.

The matter is REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of any residuals associated with the Veteran's CLL. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the disability under the rating criteria.

The examiner is directed to complete any disability benefit questionnaires needed to fully understand the Veteran's disability picture, to include the Veteran's severe fatigue associated with his CLL, as outlined in the May 2024 VA Examination of record.

The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate.

If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

2. After the above development, and any other development deemed necessary, readjudicate the claim.

SHEREEN M. MARCUS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Knopp, Derek A.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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