Leukemia is a progressive, malignant disease of the blood-forming cells in the bone marrow characterized by unrestrained growth of leukocytes.

The cause of leukemia is unknown. Increased risk factors associated with the disease include: a combination of viruses; genetic and immunologic factors; and exposure to radiation and certain chemicals such as benzene and some antineoplastic drugs.

Signs and symptoms usually reflect the suppression of normal blood-cell formation and organ infiltration as occurs with splenomegaly, anemia, thrombocytopenia, and granulocytopenia. The presenting symptoms may be non-specific such as:

• fatigue

• fever

• malaise

•  weight loss

 Bleeding is usually manifested by: petechiae caused by intradermal or submucosa hemorrhage easy bruising with epistaxis; or menstrual irregularity.

There may be hematuria, and gastrointestinal (GI) bleeding.

Other signs and symptoms may include:

• headache

• vomiting

• irritability and night sweats

• bone and joint pain may also be present

Tests may include complete blood count (CBC), blood serum chemistry, and bone marrow aspiration and biopsy.

Treatment may include: blood transfusions, bone marrow transplant and systemic chemotherapy drug regimens. Antibiotics, antifungal, antiviral drugs, and granulocyte injections are used to control infection. Platelet transfusion and red cell transfusion may also be used.

Total remission is possible in individual cases. However, relapse almost always occurs. Subsequent periods of remission will likely be of shorter duration. The prognosis, which is often unfavorable, depends on the type of leukemia and the individual's response to treatment. Treatment usually takes place in specialized, medical centers.

• Prior to December 9, 2018, chronic lymphocytic leukemia (CLL) was assigned a permanent and total (P&T) evaluation based on diagnosis alone. Following this date (the date the rating schedule was updated), this is no longer the case and the evaluation of CLL is based on the Rai stage. Refer to the M21 for more information.

• Consider service connection on a presumptive basis as a chronic condition (38 CFR 3.307; §3.309(a)).

• Consider service connection for leukemia (other than chronic lymphocytic leukemia) on a presumptive basis as a condition associated with radiation exposure (38 CFR 3.307; §3.309(d)).

• Consider service connection for leukemia (other than chronic lymphocytic leukemia) on a presumptive basis as a condition associated with ionizing radiation exposure (38 CFR 3.307; §3.309(d); §3.311).

• Consider service connection for chronic lymphocytic leukemia and all chronic B-cell leukemias (including hairy cell leukemia) on a presumptive basis as a condition associated with herbicide exposure (38 CFR 3.307(a)(6); §3.307(d); §3.309(e)).

• Consider service connection on a presumptive basis as a condition associated with exposure to contaminated water at Camp Lejeune (38 CFR 3.307(a)(7); §3.307(d); §3.309(f)).

• Consider service connection for acute nonlymphocytic leukemia on a presumptive basis as a condition associated with mustard gas exposure (38 CFR 3.316).

• Do not assign separate evaluations for chronic lymphocytic leukemia (CLL) (38 CFR 4.117, DC 7703) and non-Hodgkin's lymphoma (NHL) (38 CFR 4.117, DC 7715). They are cancers of the same body system and assignment of multiple evaluations would be pyramiding. In cases where both cancers are diagnosed, assign a 100-percent evaluation using a hyphenated DC.

• 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 38 CFR 3.105(e). If there has been no recurrence, rate on residuals.

• 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.

• Evaluate residuals of leukemia or leukemia therapy under the appropriate diagnostic code(s). Myeloproliferative Disorders: (Diagnostic Codes 7704, 7718, 7719).