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C&P Exam Prep: Non-Hodgkin's Lymphoma
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 determine the current status of Non-Hodgkin's Lymphoma (NHL) - whether it is active, in treatment phase, indolent/low-grade non-contiguous, or in remission - and to document residuals if in remission, in order to assign an accurate disability rating under DC 7715.
What the examiner evaluates:
- Current disease status: active disease, treatment phase, indolent/low-grade non-contiguous NHL, or remission
- Type, subtype, and stage of NHL at diagnosis and currently
- All current and past treatments including chemotherapy, radiation, biologic therapy, immunotherapy, stem cell or bone marrow transplant
- Dates of treatment initiation and completion or anticipated completion
- Current laboratory values: CBC with differential, hemoglobin, hematocrit, RBC count, WBC count, platelet count
- Presence and frequency of infections, hospitalizations, and related complications
- Need for ongoing therapies: biologic therapy, myelosuppressive therapy, interferon, growth factors, transfusions
- Functional impact on occupational and daily activities
- Residual conditions if in remission (e.g., peripheral neuropathy, fatigue, secondary malignancy, cardiovascular effects from treatment)
- Nexus between service and diagnosis, including Agent Orange/herbicide exposure history if applicable
Exam will likely be conducted by a VA-contracted or VA-employed hematologist or oncologist, either in person or via telehealth. Bring all oncology records, treatment summaries, and recent lab work. The examiner will review your claims file (C-file) prior to the exam. If the exam is telehealth, ensure you are in a private, quiet location and have your medication list and treatment records accessible.
Typical duration: 30-45 minutes
Complete Blood Count (CBC) with Differential
Evaluates red blood cells, white blood cells, platelets, hemoglobin, and hematocrit to assess bone marrow function and detect cytopenias related to NHL or its treatment
What to expect:
Blood draw or review of recent lab results. Examiner will document hemoglobin (gm/100mL), hematocrit, RBC count, WBC count with differential, and platelet count with dates.
Key thresholds:
- Platelet count - 30,000 despite treatment — Supports higher severity rating for thrombocytopenic conditions; may support 100% if active disease present
- Platelet count 30,001-50,000 — Documents significant thrombocytopenia; relevant if NHL is causing marrow suppression
- Hemoglobin significantly below normal — Supports documentation of anemia as residual or active manifestation; may warrant separate rating for anemia
- WBC differential showing lymphocytosis or abnormal cells — Supports active or residual disease documentation
Tips:
- Bring printed copies of your most recent CBC results, ideally within the past 3-6 months
- If labs were done during an active treatment phase, bring those records too to show disease burden
- Note the date of each lab result - the examiner records this on the DBQ
- If you have had multiple labs showing fluctuating values, bring all of them
Pain considerations: Not applicable for lab draws. However, if you experience significant fatigue, bruising, or bleeding symptoms related to abnormal counts, describe these clearly to the examiner as they reflect functional severity.
Disease Status Determination (Active vs. Remission)
Determines whether NHL is currently active, in the treatment phase, in an indolent/non-contiguous low-grade phase, or in complete/partial remission - the single most important factor for the 100% rating under DC 7715
What to expect:
The examiner will review pathology reports, PET/CT scans, bone marrow biopsy results, and oncologist notes to determine disease status. They will check the DBQ box for 'Active Disease,' 'Treatment Phase,' 'Indolent and non-contiguous phase of low grade NHL,' or 'In Remission.'
Key thresholds:
- Active disease OR currently in treatment phase — 100% rating under DC 7715 - mandatory
- Indolent and non-contiguous phase of low-grade NHL — 100% rating under DC 7715 - mandatory
- In remission with no treatment within past 2 years — Rated on residuals under appropriate diagnostic codes; mandatory VA exam required 2 years after treatment ends
- Treatment completed within past 2 years — 100% rating continues until 2-year post-treatment mandatory exam under 38 CFR - 4.117 note
Tips:
- Provide complete treatment records showing start and end dates of all chemotherapy, radiation, biologic, and immunotherapy regimens
- If in remission, confirm with your oncologist exactly when treatment was discontinued - this starts the 2-year clock for the mandatory re-examination
- If you have had a bone marrow or peripheral blood stem cell transplant, bring all transplant records including admission and discharge dates
- Know your NHL subtype (e.g., diffuse large B-cell, follicular, mantle cell, marginal zone, T-cell) as this affects low-grade vs. aggressive classification
Pain considerations: Disease status itself is determined by records and imaging, not pain. However, if active disease causes pain (e.g., from enlarged lymph nodes, bone marrow involvement, or organomegaly), clearly describe location, frequency, severity on a 0-10 scale, and functional impact.
PET/CT Scan and Imaging Review
Identifies active disease sites, extent of lymphoma involvement, and response to treatment
What to expect:
Examiner will review existing imaging reports - they will not typically order new imaging at the C&P exam. Bring radiology reports from your most recent PET scan, CT scan, or MRI.
Key thresholds:
- Active FDG-avid lesions on PET scan — Supports active disease classification, ensuring 100% rating
- Complete metabolic response on PET — May support remission status - important context if past treatment was within 2 years
Tips:
- Bring printed copies of radiology reports, not just the images themselves
- Include the interpreting radiologist's impression section
- If imaging showed bulky disease, extranodal involvement, or marrow involvement, make sure these records are in your claims file
Pain considerations: If enlarged lymph nodes or organ involvement caused physical symptoms (pain, pressure, difficulty breathing, abdominal discomfort), describe these specifically with frequency and severity.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Non-Hodgkin's Lymphoma with active disease, during a treatment phase, or with indolent and non-contiguous phase of low-grade NHL. Per 38 CFR - 4.117 DC 7715, a 100% evaluation continues beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Two years after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. |
CFR: 38 CFR - 4.117 DC 7715: 'Non-Hodgkin's lymphoma: When there is active disease, during treatment phase, or with indolent and non-contiguous phase of low grade NHL - 100.' Note: The 100% evaluation continues beyond cessation of treatment. Two years after discontinuance of treatment, a mandatory VA examination determines the appropriate rating. Any reduction is subject to 38 CFR - 3.105(e) protections. |
| 0% | Non-Hodgkin's Lymphoma in complete remission with no active disease and no ongoing treatment for 2 or more years following the mandatory post-treatment VA examination. At this stage, the veteran is rated on residuals under the appropriate diagnostic codes for any lasting effects of the disease or its treatment. |
CFR: 38 CFR - 4.117 DC 7715 Note: 'If there has been no recurrence, rate on residuals under the appropriate diagnostic code(s).' Residuals are rated separately and may include conditions such as chemotherapy-induced peripheral neuropathy (DC 8520/8521), cardiac conditions (DC 7000-7020), pulmonary conditions (DC 6600-6846), or cognitive impairment. |
100% Non-Hodgkin's Lymphoma with active disease, during a treatme ...
Non-Hodgkin's Lymphoma with active disease, during a treatment phase, or with indolent and non-contiguous phase of low-grade NHL. Per 38 CFR - 4.117 DC 7715, a 100% evaluation continues beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Two years after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination.
Key Symptoms
- Active lymphoma confirmed by biopsy, imaging, or lab findings
- Currently undergoing chemotherapy (e.g., R-CHOP, R-CVP, EPOCH, bendamustine-rituximab)
- Currently undergoing radiation therapy
- Currently receiving biologic therapy (e.g., rituximab, obinutuzumab, brentuximab)
- Currently receiving immunotherapy or CAR-T cell therapy
- Bone marrow or peripheral blood stem cell transplant within evaluation period
- Indolent low-grade NHL in non-contiguous phase (e.g., follicular lymphoma grade 1-2, marginal zone, small lymphocytic)
- Treatment completed within the past 2 years (rating continues until mandatory 2-year exam)
- Systemic B symptoms: fever, night sweats, unexplained weight loss
- Significant fatigue, cytopenias, organomegaly, or lymphadenopathy from active disease
CFR: 38 CFR - 4.117 DC 7715: 'Non-Hodgkin's lymphoma: When there is active disease, during treatment phase, or with indolent and non-contiguous phase of low grade NHL - 100.' Note: The 100% evaluation continues beyond cessation of treatment. Two years after discontinuance of treatment, a mandatory VA examination determines the appropriate rating. Any reduction is subject to 38 CFR - 3.105(e) protections.
0% Non-Hodgkin's Lymphoma in complete remission with no active ...
Non-Hodgkin's Lymphoma in complete remission with no active disease and no ongoing treatment for 2 or more years following the mandatory post-treatment VA examination. At this stage, the veteran is rated on residuals under the appropriate diagnostic codes for any lasting effects of the disease or its treatment.
Key Symptoms
- Complete remission confirmed by imaging and labs
- No ongoing chemotherapy, radiation, biologic, or immunotherapy
- 2 or more years since last treatment
- Residual peripheral neuropathy from chemotherapy (rated separately under neurological codes)
- Residual cardiac toxicity from anthracyclines (rated separately under cardiac codes)
- Residual pulmonary fibrosis from radiation or bleomycin (rated separately under pulmonary codes)
- Secondary malignancy from prior treatment (rated separately)
- Chronic fatigue or immunosuppression (rated separately if applicable)
- Endocrine dysfunction from treatment (rated separately)
CFR: 38 CFR - 4.117 DC 7715 Note: 'If there has been no recurrence, rate on residuals under the appropriate diagnostic code(s).' Residuals are rated separately and may include conditions such as chemotherapy-induced peripheral neuropathy (DC 8520/8521), cardiac conditions (DC 7000-7020), pulmonary conditions (DC 6600-6846), or cognitive impairment.
How to Describe Your Symptoms
Fatigue and Energy Limitation
How to describe:
Describe fatigue as it manifests on your worst days, not just average days. Quantify how many hours per day you can be active before needing to rest, how fatigue affects your ability to work, perform household tasks, or care for yourself. Use specific examples: 'On my worst days, I cannot get out of bed for more than 2 hours. Even simple activities like cooking a meal exhaust me for the rest of the day.'
Worst-day example:
“On my worst days during treatment, I could not stand long enough to shower without sitting down. I slept 14-16 hours and still felt exhausted. I could not drive, prepare food, or engage in any meaningful activity. This occurred at least 3-4 days per week during my chemotherapy cycles.”
What the examiner listens for:
Specific functional limitations tied to fatigue - inability to sustain employment, inability to perform activities of daily living, need for rest periods, impact on social functioning. The examiner wants to understand how fatigue translates into actual disability, not just that you feel tired.
Understatements to avoid:
Do not say 'I get a little tired sometimes.' Instead, accurately describe the full extent: 'My fatigue is severe and persistent, requiring me to rest multiple times throughout the day and preventing me from maintaining any regular work schedule or physical activity.'
Treatment Side Effects (Chemotherapy, Radiation, Biologic Therapy)
How to describe:
List every medication and treatment regimen you have received, including dates. Describe all side effects accurately: nausea, vomiting, hair loss, mucositis, infections, hospitalizations for neutropenic fever, neuropathy, cognitive changes ('chemo brain'), cardiac symptoms, and any treatment-related hospitalizations.
Worst-day example:
“During my third cycle of R-CHOP, I was hospitalized for 5 days with febrile neutropenia. My white blood cell count dropped to critically low levels. I experienced severe nausea, was unable to eat for 4 days, and lost 15 pounds during that treatment course. I required IV antibiotics and growth factor injections to recover enough to continue treatment.”
What the examiner listens for:
Specific treatments received, frequency, duration, hospitalizations, and the functional impact of treatment side effects. The examiner needs to check specific treatment boxes on the DBQ (chemotherapy, radiation, biologic therapy, stem cell transplant) and document their impact.
Understatements to avoid:
Do not minimize your treatment experience by saying 'the treatment went okay.' Accurately report every hospitalization, every dose reduction, every growth factor injection (G-CSF/Neulasta/Neupogen), and every treatment complication.
Infections and Immune Compromise
How to describe:
Describe frequency, severity, and type of infections you have experienced due to NHL or its treatment. Note whether infections required hospitalization, IV antibiotics, emergency room visits, or outpatient antibiotic treatment. The DBQ has specific checkboxes for infection frequency that directly impact ratings.
Worst-day example:
“Over the past 12 months, I have had 4 separate infections requiring treatment - two required hospitalization, one for pneumonia and one for a blood infection. I was on prophylactic antibiotics for 6 months following my stem cell transplant. Even now, I catch infections easily and take much longer to recover than before my diagnosis.”
What the examiner listens for:
Number of infections per year, whether infections required hospitalization, and whether you are on continuous prophylactic antibiotics. The DBQ distinguishes between infections requiring hospitalization 1-2 times per year vs. 3 or more times per year - be precise.
Understatements to avoid:
Do not fail to mention minor infections that still required medical treatment. Even outpatient antibiotic courses count. Document every infection in your personal statement before the exam.
Blood Transfusions and Growth Factor Injections
How to describe:
Accurately report the number and frequency of blood transfusions (red cells, platelets) and myeloid growth factor injections (filgrastim/G-CSF, pegfilgrastim/Neulasta) you have required. The DBQ has specific threshold checkboxes (1-3 transfusions per year vs. 4+ per year; intermittent vs. continuous growth factor use).
Worst-day example:
“During my chemotherapy, I required platelet transfusions twice and red blood cell transfusions three times over a 6-month period due to severe myelosuppression. I received Neulasta injections after every chemotherapy cycle to prevent life-threatening infections.”
What the examiner listens for:
Specific counts of transfusions and growth factor administrations per year, documented in medical records. These directly correspond to DBQ checkboxes that determine treatment intensity and support ratings.
Understatements to avoid:
Do not guess at numbers. Review your treatment records before the exam and bring documentation of every transfusion and growth factor injection with dates.
Residual Symptoms After Remission
How to describe:
If you are in remission, clearly and accurately describe all persistent symptoms that remain from the disease or its treatment. These include peripheral neuropathy (numbness, tingling, burning in hands/feet from vincristine or other neurotoxic agents), cognitive dysfunction ('chemo brain'), cardiac problems, pulmonary changes, hormonal/endocrine effects, and psychological impact. Each residual must be described separately for separate ratings.
Worst-day example:
“Even though my lymphoma is in remission, I have permanent numbness and burning pain in both feet from the chemotherapy. I cannot stand for more than 20 minutes without significant discomfort. I also experience memory problems and difficulty concentrating that have affected my ability to return to work. On my worst days, the neuropathic pain wakes me at night and I cannot walk without discomfort.”
What the examiner listens for:
Specific, documented residual conditions that can be rated under separate diagnostic codes. The examiner needs to identify what secondary ratings apply once the 100% NHL rating is removed at the 2-year post-treatment exam.
Understatements to avoid:
Do not say 'I feel mostly fine now.' Accurately report every symptom that persists. Failure to report residuals at the 2-year post-treatment exam can result in a reduction to 0% with no separate ratings.
Functional and Occupational Impact
How to describe:
Describe specifically how NHL and its treatment has affected your ability to work, maintain employment, and perform daily activities. If you had to stop working, reduce hours, change jobs, or take medical leave, state this clearly. Include the impact on your ability to drive, care for family, perform household chores, exercise, and maintain social relationships.
Worst-day example:
“I had to stop working entirely for 8 months during chemotherapy because I was too weak and immunocompromised to leave the house safely. Even after treatment ended, I returned to work part-time and have not been able to resume full-time employment due to persistent fatigue and neuropathy. I can no longer perform physical labor or stand for extended periods.”
What the examiner listens for:
Concrete examples of how the condition has limited occupational functioning and daily activities. This supports the DBQ's functional impact section and the examiner's narrative, which can influence extra-schedular consideration and TDIU claims.
Understatements to avoid:
Do not say 'it has been hard but I manage.' Be specific about what you cannot do and what you have given up. The DBQ has checkboxes for whether symptoms 'preclude even light manual labor' or 'preclude other than light manual labor' - your description must support the accurate box.
Common Mistakes to Avoid
Not knowing exact treatment dates or saying treatment 'ended a while ago'
The 2-year post-treatment mandatory examination clock starts from the date treatment was discontinued. Imprecise dates can result in incorrect rating decisions, including premature reduction of the 100% rating.
Instead: Before your exam, confirm the exact end date of your last treatment (chemotherapy, radiation, biologic therapy) with your oncologist. Bring a treatment summary letter from your oncologist documenting all treatment dates.
Impact: 100% - may cause premature reduction or confusion about whether the 2-year continuation period is still active
Describing yourself as 'in remission' without clarifying treatment was completed within the past 2 years
Under DC 7715, the 100% rating continues for 2 full years after treatment ends, even in remission. Veterans who say 'I'm in remission and doing well' may inadvertently suggest they no longer warrant the 100% rating before the 2-year period expires.
Instead: Clearly state: 'I completed treatment on [date]. I understand my 100% rating is protected until 2 years after that date, when a mandatory VA examination is required.' Bring your treatment end documentation.
Impact: 100% - risk of improper early reduction
Failing to disclose all treatment modalities received
Each treatment type (chemotherapy, radiation, biologic therapy, immunotherapy, stem cell transplant) has its own DBQ checkbox. Missing treatments means incomplete documentation that fails to reflect true disease severity and treatment burden.
Instead: Create a comprehensive treatment chronology before your exam listing every drug, every regimen, every radiation field, every infusion, and every procedure with dates. Bring this as a written document.
Impact: 100% treatment phase documentation
Not mentioning Agent Orange / herbicide exposure nexus at the exam
Non-Hodgkin's Lymphoma is a presumptive condition for veterans exposed to Agent Orange/herbicides during service (38 CFR - 3.309(e)). If service connection has not yet been established, the examiner's nexus opinion is critical. Veterans sometimes forget to mention their exposure history.
Instead: Clearly state your herbicide/Agent Orange exposure history: where you served (Vietnam, Korea DMZ, certain bases), what duties you performed, and any documented exposure. The examiner must be aware this is a presumptive condition for qualifying veterans.
Impact: Service connection - foundational to any rating
Failing to report all residual conditions during the 2-year post-treatment mandatory exam
When the 100% rating ends at the 2-year mandatory exam, each residual condition must be individually identified, described, and rated. Veterans who present as 'doing well' without cataloging residuals may receive a 0% rating with no secondary conditions rated.
Instead: Before the 2-year mandatory exam, prepare a comprehensive list of all persistent symptoms: neuropathy, cardiac changes, pulmonary function changes, cognitive issues, secondary cancers, hormonal changes, psychological impact, and any other lasting effects. Request that the examiner rate each residual separately.
Impact: 0% with residuals - directly impacts overall combined rating after remission
Understating the frequency and severity of infections
The DBQ has specific frequency thresholds for infections that correspond to rating levels (e.g., once every 6 weeks, once every 3 months, once per year; hospitalization 1-2 times vs. 3+ times per year). Understating infection frequency leads to inaccurate documentation.
Instead: Count and record every infection episode, ER visit, hospitalization, and antibiotic course in the past 12 months. Bring documentation. Use exact numbers, not vague descriptions like 'I get sick a lot.'
Impact: 100% treatment phase and residual ratings
Not mentioning a bone marrow or stem cell transplant
Transplant procedures are separately documented on the DBQ and represent the highest level of treatment intensity. Failure to mention a transplant omits critical information that reflects disease severity.
Instead: Bring your transplant admission and discharge records, including dates, transplant type (autologous vs. allogeneic), conditioning regimen, and any graft-versus-host disease history.
Impact: 100% - documents highest treatment intensity
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to record your C&P examination in most states. Notify the examiner at the start of the exam that you intend to record for your personal records.
- You have the right to request and receive a copy of your completed DBQ form through your VBMS eFolder, VA.gov, or through your VSO representative.
- You have the right to request a new or supplemental C&P examination if the original exam was inadequate - for example, if the examiner did not review your records, the exam was rushed, or the opinion contains factual errors.
- Under 38 CFR - 4.117 DC 7715, your 100% rating is protected and continues for 2 full years after the end of treatment. The VA cannot reduce your rating before the mandatory 2-year post-treatment examination.
- Any reduction in your evaluation following the mandatory 2-year post-treatment examination is subject to the due process protections of 38 CFR - 3.105(e), which requires advance notice and the opportunity to submit evidence before any reduction takes effect.
- Non-Hodgkin's Lymphoma is a presumptive service-connected condition for veterans exposed to Agent Orange/herbicides under 38 CFR - 3.309(e). You do not need to prove a direct nexus if you qualify under this presumption.
- You have the right to bring a family member, caregiver, or VSO representative with you to the C&P examination to provide support and corroborate your symptoms.
- You have the right to submit a personal statement (buddy statement) describing your symptoms and functional limitations, which the examiner must consider.
- You have the right to request that all residual conditions from NHL treatment be evaluated and rated separately under appropriate diagnostic codes at the 2-year post-treatment mandatory exam.
- If the VA examiner's opinion is negative or inadequate, you have the right to obtain and submit a private medical opinion (Independent Medical Expert/IMO) to rebut the VA opinion.
- You have the right to file a Notice of Disagreement (NOD) within one year of any rating decision you believe is incorrect, initiating the appeals process.
- Under the PACT Act, additional service-connected presumptions may apply for veterans exposed to burn pits, radiation, or other toxic substances during service. Consult your VSO to evaluate whether additional presumptives apply to your NHL diagnosis.
Related Conditions
- Hodgkin's Lymphoma Related lymphoma type rated under DC 7709; different post treatment review timeline (6 months vs. 2 years for NHL). Rated on same DBQ form.
- Chemotherapy-Induced Peripheral Neuropathy Common residual from vincristine, taxanes, and platinum based agents used in NHL treatment; rated separately under neurological diagnostic codes (DC 8520/8521/8599) once NHL enters remission.
- Anemia May be a direct manifestation of NHL or a treatment side effect; rated separately under DC 7700 7703 if present as a distinct condition with its own functional impact beyond the NHL rating.
- Immune Thrombocytopenia (ITP) Can occur as a complication of NHL or its treatment; rated separately on the same DBQ form under specific platelet count and treatment threshold criteria.
- Cardiac Conditions (Cardiomyopathy, Heart Failure) Anthracycline based chemotherapy (doxorubicin in R CHOP) can cause cardiomyopathy and congestive heart failure; rated separately under DC 7000 7020 as a secondary condition to NHL treatment.
- Secondary Malignancy (Treatment-Related AML/MDS) Prior NHL chemotherapy and radiation increases risk for secondary acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS); may be ratable as secondary service connected conditions.
- Myelodysplastic Syndrome (MDS) Can arise as a secondary condition from NHL treatment; rated on the same DBQ form under specific treatment and laboratory threshold criteria.
- PTSD / Mental Health Conditions Cancer diagnosis and treatment can cause or exacerbate PTSD, anxiety, and depression; may be ratable as secondary to NHL under a direct medical nexus theory if documented by a mental health professional.
- Pulmonary Fibrosis / Radiation Pneumonitis Radiation therapy to the mediastinum or chest for NHL can cause radiation pneumonitis and pulmonary fibrosis; rated separately under pulmonary diagnostic codes (DC 6825 6833) as a secondary condition.
- Acquired Agranulocytosis Severe reduction in neutrophils from NHL or myelosuppressive treatment; rated on the same DBQ form with specific treatment intensity thresholds.
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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.