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C&P Exam Prep: Hodgkin's Disease

DC 7709 hemic-and-lymphatic 38 CFR 4.117

DBQ Overview

Interview + Physical
Form Name
Hematologic_and_Lymphatic_Conditions_Including_Leukemia
Form Code
Hematologic_and_Lymphatic_Conditions_Including_Leukemia
Page Count
10
Examiner Type
Hematologist or Oncologist
Estimated Duration
30-45 minutes
Exam Format
Interview + Physical

What to Expect During Your Exam

Exam Overview

To evaluate the current status of Hodgkin's lymphoma for VA disability rating purposes under DC 7709, including whether the disease is active, in a treatment phase, or in remission, and if in remission, to document residual conditions for rating under appropriate diagnostic codes.

What the examiner evaluates:

  • Current disease status: active, treatment phase, or remission
  • Type and stage of Hodgkin's lymphoma at diagnosis and currently
  • Treatment history including chemotherapy, radiation, immunotherapy, and stem cell/bone marrow transplant
  • Date of most recent treatment and anticipated completion date
  • Laboratory values including CBC with differential, hemoglobin, hematocrit, RBC count, WBC count, platelet count
  • Presence and frequency of infections requiring hospitalization or treatment
  • Need for ongoing biologic therapy, myelosuppressive therapy, or growth factors
  • Residual conditions resulting from the disease or its treatment (e.g., neuropathy, cardiac effects, pulmonary fibrosis, secondary malignancy)
  • Functional impact and occupational impairment
  • B symptoms: night sweats, unexplained weight loss, fevers
  • Lymphadenopathy, splenomegaly, or hepatomegaly
  • History of bone marrow or stem cell transplant

Exam will be conducted by a hematologist or oncologist, either in person or via telehealth. The examiner will review your claims file and medical records before or during the exam. Bring a complete list of all current medications and a timeline of your treatment history. In most states, you have the right to record the examination with advance notice.

Typical duration: 30-45 minutes

Complete Blood Count (CBC) with Differential

Measures hemoglobin, hematocrit, RBC count, WBC count with differential, and platelet count - all critical values on the DBQ that directly influence rating decisions

What to expect:

The examiner will document your most recent lab values and their dates. Bring printed copies of all recent lab results from your treating oncologist or hematologist.

Key thresholds:

  • Hemoglobin < 10 g/100 mL — Indicates significant anemia potentially warranting separate rating under anemia diagnostic codes
  • Platelet count - 30,000 — Severe thrombocytopenia, may warrant 100% rating under immune thrombocytopenia criteria
  • Platelet count 30,001-50,000 — Moderate thrombocytopenia, rated at higher levels under ITP criteria
  • WBC differential with ANC <500 — Severe neutropenia, may indicate need for continuous growth factor support

Tips:

  • Bring dated printouts of all recent CBC results - ideally from the past 6-12 months showing a trend
  • If your counts fluctuate, bring results that show your worst values, not just the most recent
  • Note which labs were drawn while on active treatment versus off treatment

Pain considerations: Not applicable for this specific test, but bone pain associated with bone marrow involvement or growth factor injections (e.g., G-CSF/Neupogen) should be separately documented and communicated to the examiner.

Infection History Documentation

The frequency and severity of infections, which directly map to rating criteria for agranulocytosis and immune-compromised conditions

What to expect:

The examiner will ask about infections requiring hospitalization, antibiotic treatment, or outpatient management. The DBQ specifically tracks whether infections occur once per 12-month period, once every 3 months, or once every 6 weeks.

Key thresholds:

  • Infections requiring hospitalization 3+ times per 12-month period — Maps to highest severity infection criteria on DBQ
  • Infections requiring hospitalization 1-2 times per 12-month period — Maps to moderate severity infection criteria
  • Infections recurring on average at least once per 12-month period — Maps to lowest severity infection criteria requiring continuous medication

Tips:

  • Keep a written log of every infection requiring medical care - include dates, type of infection, treatment received, and whether hospitalization was required
  • Count ER visits for infection-related symptoms even if you were not formally admitted
  • Document opportunistic infections specifically, as these indicate significant immune compromise

Pain considerations: Document any pain associated with infections, including bone pain from sinusitis, chest pain from pneumonia, or abdominal pain from gut infections, as these contribute to overall functional impairment.

Transfusion and Infusion Frequency Assessment

How frequently the veteran requires blood or platelet transfusions, IV iron infusions, or erythropoiesis-stimulating agents (ESAs), which are tracked on the DBQ and affect rating levels

What to expect:

The examiner will ask about the number and frequency of transfusions and infusions received over the past 12 months. This includes red blood cell transfusions, platelet transfusions, and IV iron infusions.

Key thresholds:

  • 4 or more blood or platelet transfusions per 12-month period — Higher severity threshold on DBQ
  • 1-3 blood or platelet transfusions per 12-month period — Moderate severity threshold on DBQ
  • IV iron infusions 4+ times per 12-month period — Significant iron deficiency anemia severity marker
  • IV iron infusions 1-3 times per 12-month period — Moderate iron deficiency anemia severity marker

Tips:

  • Request infusion logs from your treatment facility showing exact dates and types of infusions
  • Count outpatient transfusions and infusions, not just inpatient ones
  • Note whether transfusions were given as part of chemotherapy protocol or for independent anemia/thrombocytopenia management

Pain considerations: Discomfort, fatigue, and recovery time associated with transfusions and infusions should be described to the examiner as part of functional impact.

Estimate

Rating Criteria Breakdown

100% Hodgkin's lymphoma with active disease OR during a treatment ...

Hodgkin's lymphoma with active disease OR during a treatment phase. Under 38 CFR 4.117, DC 7709, a 100% rating is assigned whenever the disease is active or the veteran is undergoing any therapeutic treatment including surgery, radiation therapy, antineoplastic chemotherapy, immunotherapy, or other therapeutic procedures. The 100% rating continues beyond cessation of treatment. Six months after discontinuance of treatment, a mandatory VA examination is required to determine the appropriate rating based on residuals.

Key Symptoms

  • Active Hodgkin's lymphoma confirmed by biopsy, PET scan, or CT imaging
  • Currently receiving chemotherapy (e.g., ABVD, BEACOPP, brentuximab vedotin)
  • Currently receiving radiation therapy to lymph node regions
  • Currently receiving immunotherapy or biologic therapy for Hodgkin's lymphoma
  • Currently undergoing or recovering from bone marrow or stem cell transplant
  • Treatment phase not yet completed - including maintenance therapy
  • Disease recurrence after prior remission requiring reinitiation of treatment
  • B symptoms: unexplained fever >38-C, drenching night sweats, unexplained weight loss >10% body weight in 6 months
  • Lymphadenopathy, splenomegaly, mediastinal mass
  • Significant fatigue and functional impairment during treatment

CFR: 38 CFR 4.117, DC 7709: 'With active disease or during a treatment phase - 100.' Note states the 100% evaluation shall continue beyond cessation of any surgical, radiation, antineoplastic chemotherapy, or other therapeutic procedures. Six months after discontinuance, a mandatory VA examination determines the appropriate disability rating based on residuals.

0% Hodgkin's lymphoma in complete remission with no active dise ...

Hodgkin's lymphoma in complete remission with no active disease and no current treatment, evaluated more than six months after cessation of all therapeutic procedures. At this stage, the veteran is rated on residual conditions under appropriate diagnostic codes (e.g., peripheral neuropathy, cardiac dysfunction, pulmonary fibrosis, secondary malignancy, hypothyroidism). The 0% or higher rating depends entirely on documented residuals and their severity.

Key Symptoms

  • Complete remission confirmed by PET-CT or CT imaging
  • No active chemotherapy, radiation, or biologic therapy
  • More than 6 months since last therapeutic treatment
  • No evidence of recurrence or metastasis
  • Rating transitions to residual conditions under appropriate diagnostic codes
  • Possible residuals include: peripheral neuropathy from vincristine/taxanes, cardiac dysfunction from anthracyclines (doxorubicin), pulmonary fibrosis from bleomycin, hypothyroidism from neck radiation, secondary malignancies, avascular necrosis from steroids, infertility, lymphedema, fatigue

CFR: 38 CFR 4.117, DC 7709 Note: 'If there has been no local recurrence or metastasis, rate on residuals under the appropriate diagnostic code(s).' Residuals must be separately identified and rated - for example, peripheral neuropathy under DC 8520-8530, cardiac conditions under DC 7000-7020, pulmonary conditions under DC 6600-6817.

How to Describe Your Symptoms

Fatigue and Functional Capacity

How to describe:

Describe fatigue in concrete, functional terms. Specify how many hours per day you can be active before exhaustion sets in, whether you require daytime napping, your ability to perform basic activities of daily living (ADLs), and how fatigue has affected your employment or job performance. Quantify: 'I can walk one block before needing to rest' is more useful than 'I get tired easily.'

Worst-day example:

“On my worst days, I cannot get out of bed before noon. I require 2-3 hours of daytime sleep in addition to 10+ hours of nighttime sleep. I am unable to prepare meals, shower without sitting down, or drive. I have missed [X] days of work in the past [Y] months due to treatment-related fatigue.”

What the examiner listens for:

Specific functional limitations, impact on employment, frequency of worst-day symptoms versus average days, whether fatigue is related to active treatment, anemia, or residual post-treatment effects.

Understatements to avoid:

Do not say 'I'm managing' or 'I push through it.' Do not downplay fatigue as normal tiredness. Be specific about how fatigue has changed your daily routines and work capacity compared to before your diagnosis.

Night Sweats, Fever, and B Symptoms

How to describe:

Describe B symptoms with specificity: How many nights per week do you experience drenching night sweats requiring clothing or sheet changes? Quantify weight loss in pounds over a specific time period. Describe fever frequency, peak temperature, and duration. These symptoms are important both for indicating active disease and for documenting residual autonomic dysfunction after treatment.

Worst-day example:

“During active disease / treatment, I was changing my sleep clothes and sheets 3-4 times per night due to soaking night sweats. I lost 22 pounds over 3 months without dieting. I had fevers of 101-103-F occurring 3-4 times per week, each lasting 6-8 hours.”

What the examiner listens for:

Whether B symptoms are currently present (indicating active disease) or were present during the rating period, frequency and severity, whether they have resolved with treatment or persist, and any post-treatment autonomic symptoms.

Understatements to avoid:

Do not characterize drenching night sweats as 'sleeping hot.' Do not round down weight loss. Do not omit low-grade fevers - report actual temperature readings if you have them.

Treatment Side Effects and Toxicities

How to describe:

Systematically describe side effects from each component of your treatment regimen. For chemotherapy: nausea, vomiting, neuropathy, hair loss, cognitive changes ('chemo brain'), mouth sores, susceptibility to infection. For radiation: fatigue, skin changes, hypothyroidism (if neck irradiated), pulmonary symptoms (if chest irradiated), cardiac symptoms (if mediastinal irradiated). For steroids: weight gain, avascular necrosis, mood changes, blood sugar dysregulation.

Worst-day example:

“Following my [chemotherapy regimen] treatment, I experienced Grade 3 peripheral neuropathy in both hands and feet - I dropped items regularly, could not button shirts, and experienced burning/shooting pain rated 7/10 that woke me from sleep. My pulmonary function tests after radiation showed a 30% reduction in DLCO, and I experience shortness of breath with minimal exertion such as climbing one flight of stairs.”

What the examiner listens for:

Specific treatment-related toxicities that may constitute ratable residual conditions, whether side effects are acute or chronic/permanent, functional impact of each toxicity, and whether the veteran has been evaluated by specialists for treatment-related complications.

Understatements to avoid:

Do not omit treatment-related conditions because you believe they are 'part of treatment.' Each residual condition can be separately rated. Do not say side effects have 'gotten better' without specifying current baseline - even improved neuropathy may be ratable.

Infection Susceptibility and Immune Compromise

How to describe:

Provide a specific account of infections over the past 12 months: type of infection, date, treatment required (oral antibiotics, IV antibiotics, hospitalization), duration of illness, and any complications. Describe prophylactic medications you take to prevent infections (e.g., prophylactic antibiotics, antifungals, antivirals, G-CSF injections).

Worst-day example:

“Over the past 12 months, I have had 4 infections requiring medical treatment: two episodes of pneumonia (one requiring hospitalization for 5 days with IV antibiotics), one episode of shingles requiring antiviral treatment, and one episode of cellulitis treated with oral antibiotics. I take daily prophylactic trimethoprim-sulfamethoxazole and acyclovir due to my immunocompromised state.”

What the examiner listens for:

Total number of infections per year, severity (outpatient vs. inpatient), types of organisms (typical vs. opportunistic), whether prophylactic medications are required, and whether infections are recurrent despite treatment.

Understatements to avoid:

Do not forget to count urgent care visits for infections, ER visits that did not result in admission, or infections treated at home with prescription antibiotics called in by your doctor. All of these represent medically significant infections.

Pain - Disease and Treatment Related

How to describe:

Describe pain using the who/what/when/where/how framework. Distinguish between lymph node pain, bone pain (from marrow involvement or growth factor injections), neuropathic pain from chemotherapy, musculoskeletal pain from steroids or avascular necrosis, and any other pain sources. Rate pain on a 0-10 scale at rest and with activity. Describe your worst-day pain level and frequency.

Worst-day example:

“On my worst days, the neuropathic burning pain in my feet rates 8/10 and prevents me from standing for more than 5 minutes. I experience bone pain in my lower back rated 6/10 that worsens with any physical activity and is not fully controlled by [medication]. I take [specific medications] daily for pain management but still have breakthrough pain [X] days per week.”

What the examiner listens for:

Specific pain locations, character (aching, burning, shooting, pressure), severity rating, what worsens and relieves pain, impact on sleep and daily function, and current pain management regimen and its effectiveness.

Understatements to avoid:

Do not use vague terms like 'some discomfort' or 'a little sore.' Do not report only current pain if your worst-day pain is significantly higher. Report pain during your worst days as well as your average days.

Cognitive and Psychological Impact

How to describe:

Describe cognitive changes ('chemo brain') including memory difficulties, word-finding problems, difficulty concentrating, and processing speed changes. Describe psychological impact including anxiety about recurrence, depression, PTSD-like symptoms from cancer diagnosis, and social isolation. Connect these to specific functional limitations at work or home.

Worst-day example:

“I frequently forget words mid-sentence, lose track of conversations, and have to read the same paragraph multiple times before it registers. I was demoted at work because I could no longer manage my previous responsibilities. I experience anxiety attacks before every surveillance scan that leave me unable to function for 2-3 days. I have been diagnosed with [anxiety/depression] by my treating physician and am prescribed [medications].”

What the examiner listens for:

Objective functional impairment from cognitive changes, whether psychological symptoms meet criteria for a separate psychiatric rating, impact on employment and relationships, and whether these symptoms are being treated.

Understatements to avoid:

Do not dismiss cognitive symptoms as 'just stress.' Cognitive impairment from chemotherapy is a recognized medical condition. Do not fail to mention psychological symptoms - anxiety and depression related to cancer can be separately rated.

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

Day Of

During the Exam

After the Exam

Your Rights During a C&P Exam

  • Under 38 CFR 4.117, DC 7709, you are entitled to a 100% rating for Hodgkin's lymphoma with active disease OR during any treatment phase - this includes the entire period of chemotherapy, radiation, immunotherapy, or other therapeutic procedures.
  • The 100% rating continues beyond cessation of treatment - it does not automatically end when treatment stops. A mandatory VA examination must be scheduled 6 months after your last treatment before any rating reduction can be considered.
  • Any reduction in rating based on the mandatory 6-month re-examination is subject to the provisions of 38 CFR 3.105(e), which requires advance notice and an opportunity to respond before any reduction takes effect.
  • If your Hodgkin's lymphoma is in complete remission with no recurrence, you are still entitled to ratings for residual conditions under appropriate diagnostic codes - a remission determination does not mean zero compensation.
  • You have the right to have all evidence in your claims file reviewed by the C&P examiner before they complete the DBQ. If you have medical records not yet in your file, bring copies to the exam and ask the examiner to review them.
  • In most states, you have the right to record your C&P examination. Contact your VA Regional Office or the examination scheduling service to confirm the specific procedure for your location.
  • You have the right to request a second opinion or supplemental examination if you believe the initial DBQ was inadequate, contained errors, or did not consider all relevant evidence.
  • You have the right to submit a private medical nexus opinion from your treating oncologist or a private physician to support your claim or rebut an unfavorable VA examination.
  • If your Hodgkin's disease is determined to be service-connected, all secondary conditions caused by the disease or its treatment are potentially service-connectable under 38 CFR 3.310 - you do not need to prove each secondary condition was directly caused by your military service.
  • If your combined service-connected disability prevents you from securing or following substantially gainful employment, you may be entitled to Total Disability based on Individual Unemployability (TDIU) at the 100% rate under 38 CFR 4.16.
  • Veterans who served in the Republic of Vietnam and were exposed to herbicide agents (Agent Orange) may have a presumptive service connection for Hodgkin's lymphoma under 38 CFR 3.309(e) - no proof of direct exposure is required if you served in the geographic area during the qualifying period.
  • Veterans exposed to radiation during military service may have a presumptive or radiogenic disease claim for Hodgkin's lymphoma under 38 CFR 3.309(d) - consult with a VSO if this may apply to your service history.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.