Chronic myelogenous leukemia is a slow growing cancer of the bone marrow in which there are too many myeloblasts in the blood and bone marrow. This condition can also be called chronic myeloid leukemia, chronic granulocytic leukemia, or CML.

The cause of CML is unknown, but it is thought to be caused by a genetic mutation of the myeloid cells. Increased risk factors associated with the disease include:

• a combination of viruses; genetic and immunologic factors

• exposure to radiation and certain chemicals such as benzene and some antineoplastic drugs

There are usually no signs or symptoms of CML, but when they occur symptoms include:

• bone and joint pain

• easy bleeding

• fatigue

• fever

• loss of appetite

• night sweats

• pain or fullness below the ribs on the left side

• splenomegaly

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

The treatment goal for CML is to eliminate the blood cells affected, or to stop the mutation that causes the white blood cells to grow out of control. Treatment options include:

• targeted drug therapy, including tyrosine kinase inhibitors (TKI) and myelosuppresants

• bone marrow transplant or stem cell transplant

• chemotherapy

• combinations of the above

Persons with CML may also participate in clinical trials that study the newest treatments for the condition. Managing side effects from treatment option is also part of the treatment.

Total remission is possible in individual cases. However, relapse almost always occurs, as does minimal residual disease (MRD). Subsequent periods of remission will likely be of shorter duration.

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

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

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

• 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)).

• If the condition undergoes leukemic transformation, evaluate as leukemia under diagnostic code 7703.

• A 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant; or during the period of treatment with chemotherapy (including myelosuppressants). Six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105.