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Nexus Letters for Anemia
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA blood-disorder evaluations and independent medical opinions • Last updated: June 2026
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Anemia wears you down quietly. You are tired in a way sleep does not fix. You get short of breath on stairs you used to take two at a time. Maybe you feel lightheaded or look pale. Anemia means your blood is not carrying enough oxygen. The cause can be low iron, a vitamin shortfall, or a problem with how your bone marrow makes blood cells.
For a VA claim, the type of anemia matters a lot. The VA rates each type under its own rule. And here is the part that trips people up. Anemia is very often a symptom of something else: bleeding somewhere, kidney disease, a drug side effect, or marrow disease. The VA usually wants you to chase the cause, not just the low count. That is also where the strongest claims live.
Our doctors connect your anemia, or the cause behind it, to your service in the language the VA expects. One flat fee of $1,500. The first consultation is free.
How VA Rates Anemia
Anemia is rated under 38 C.F.R. § 4.117 (the hemic and lymphatic systems). There is no longer a single 'anemia' code. The VA looks at what kind of anemia you have. Then it rates that type under the matching diagnostic code. Two rules shape almost every anemia claim. First, blood-loss anemia is rated as the bleeding cause, not as anemia. Under DC 7720, iron deficiency anemia due to blood loss is not evaluated under that code; it is evaluated under the criteria for the condition causing the blood loss. Second, the rating turns on the treatment you need (infusions, injections, transfusions, immunosuppressants). It does not turn on a single hemoglobin number. Here are the most common codes for veterans, quoted word for word, then what each one means.
"7720 Iron deficiency anemia: Requiring intravenous iron infusions 4 or more times per 12-month period ... 30. Requiring intravenous iron infusions at least 1 time but less than 4 times per 12-month period, or requiring continuous treatment with oral supplementation ... 10. Asymptomatic or requiring treatment only by dietary modification ... 0. Note: Do not evaluate iron deficiency anemia due to blood loss under this diagnostic code. Evaluate iron deficiency anemia due to blood loss under the criteria for the condition causing the blood loss." (DC 7720) ... "7722 Pernicious anemia and Vitamin B12 deficiency anemia: For initial diagnosis requiring transfusion due to severe anemia, or if there are signs or symptoms related to central nervous system impairment, such as encephalopathy, myelopathy, or severe peripheral neuropathy, requiring parenteral B12 therapy ... 100. Requiring continuous treatment with Vitamin B12 injections, Vitamin B12 sublingual or high-dose oral tablets, or Vitamin B12 nasal spray or gel ... 10." (DC 7722) ... "7723 Acquired hemolytic anemia: Requiring a bone marrow transplant or continuous intravenous or immunosuppressive therapy (e.g., prednisone, Cytoxan, azathioprine, or rituximab) ... 100. Requiring immunosuppressive medication 4 or more times per 12-month period ... 60. Requiring at least 2 but less than 4 courses of immunosuppressive therapy per 12-month period ... 30. Requiring one course of immunosuppressive therapy per 12-month period ... 10. Asymptomatic ... 0." (DC 7723)
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| DC 7720 | Iron deficiency anemia (not from blood loss). Ratings available: 0% / 10% / 30%, based on whether you need IV iron infusions four or more times a year (30%), at least one but fewer than four IV infusions or continuous oral supplementation (10%), or diet-only / asymptomatic (0%). | 0% to ~$552/mo |
| DC 7721 | Folic acid deficiency. Ratings available: 0% / 10%. | 0% to ~$180/mo |
| DC 7722 | Pernicious anemia / Vitamin B12 deficiency. Ratings available: 10% / 100%. Usually 10% once on B12 therapy; 100% only at an initial diagnosis severe enough to need a transfusion, or with central-nervous-system impairment needing parenteral B12. | ~$180 to ~$3,939/mo |
| DC 7723 | Acquired hemolytic anemia. Ratings available: 0% / 10% / 30% / 60% / 100%, driven by how much immunosuppressive treatment you need (one course a year is 10%, four or more is 60%, continuous IV/immunosuppressive therapy or a bone-marrow transplant is 100%). | 0% to ~$3,939/mo |
| DC 7716 | Aplastic anemia. Ratings available: 30% / 60% / 100%. | ~$552 to ~$3,939/mo |
| DC 7714 | Sickle cell anemia. Ratings available: 10% / 30% / 60% / 100%. | ~$180 to ~$3,939/mo |
Here is the most important thing to know about anemia ratings. The VA rates the type and the treatment, and it usually pushes you toward the cause. Iron deficiency (DC 7720) tops out at 30%. You get that only if you need IV iron infusions four or more times a year. Daily oral iron rates 10%. Diet-only or asymptomatic is 0%. And if your iron-deficiency anemia comes from blood loss (a bleeding ulcer, GI bleeding, heavy menstrual loss), the VA does not rate it here at all. It rates the condition causing the bleeding. B12 / pernicious anemia (DC 7722) is usually 10% once you are on B12 injections or high-dose B12. It jumps to 100% in only two cases. One is an initial diagnosis severe enough to need a transfusion. The other is central-nervous-system damage needing parenteral B12. After that acute period the VA drops it to 10% and rates any nerve or other residuals separately. Acquired hemolytic anemia (DC 7723) has the full ladder, 0% to 100%. How much immunosuppressive treatment you need drives it. The rating leans on treatment. So your infusion logs, injection records, transfusion history, and immunosuppressant courses set the number. A single low hemoglobin reading, on its own, rarely sets a rating under these codes. Full verbatim criteria for DC 7714 (sickle cell) and DC 7716 (aplastic) live in the same eCFR section. They are summed up above to keep the page focused on the most common types.
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
Anemia is usually a symptom: find the cause
This is the heart of an anemia claim, so it gets its own section. Anemia is often the downstream result of another problem. The VA's own rules push you to find and claim that root cause. The strongest service-connection arguments usually live there. Common causes worth checking:
- 1
GI bleeding
A bleeding ulcer, gastritis, hemorrhoids, or another GI source can slowly drain iron and cause anemia. The VA rates blood-loss anemia as the GI condition. So service-connecting the ulcer or GI disease is the play.
- 2
Chronic kidney disease (CKD)
Damaged kidneys make less erythropoietin. That is the hormone that tells the marrow to make red cells. So CKD commonly causes anemia. If your kidney disease is (or can be) service-connected, the anemia rides with it. Kidney conditions are rated under the genitourinary system.
- 3
Medication side effects
Some drugs can suppress the marrow or cause bleeding and lead to anemia. That includes drugs taken for service-connected conditions. Anemia secondary to a drug you take for a service-connected condition is a recognized secondary theory (38 C.F.R. § 3.310).
- 4
Bone-marrow and blood disorders
Aplastic anemia, myelodysplastic syndromes, and related marrow problems are their own diagnoses with their own codes. For some veterans, they carry their own exposure presumptions.
If GI bleeding, kidney disease, or a drug you take for a service-connected condition drives your anemia, the cause is usually the stronger claim. We can write the nexus opinion that connects the cause to your service, and the anemia to the cause.
Making a VA Disability Claim for Anemia
A VA disability claim for anemia needs three things to line up:
A current diagnosis, with the type identified
Lab work and provider notes naming the specific anemia (iron deficiency, B12/pernicious, hemolytic, aplastic, etc.). The type drives the code.
A service connection, usually through the cause
This can be anemia that began in service. It can be a link to a qualifying exposure (for marrow diseases). Most often, it is a link to another service-connected condition that causes the anemia (GI bleeding, kidney disease, or a drug side effect).
A medical nexus
A qualified opinion that your anemia (or its root cause) is 'at least as likely as not' connected to your service or to a service-connected cause.
You may have read that 'anemia is linked to benzene' or to the contaminated water at Camp Lejeune. There is truth there. But the VA rules are narrower than the headlines. Benzene is a known bone-marrow toxin. It is linked to marrow diseases: aplastic anemia, myelodysplastic syndromes, and certain leukemias. It is not linked to everyday iron-deficiency or B12 anemia. It was also one of the contaminants in the Camp Lejeune water supply. There is a set of presumptive conditions for Camp Lejeune. It covers veterans (and family members) who served or lived there for at least 30 cumulative days between August 1, 1953 and December 31, 1987. That list includes aplastic anemia and other myelodysplastic syndromes. It does not make ordinary iron-deficiency or B12 anemia presumptive. The honest takeaway: the toxic-exposure angle for anemia is real. But it is specific to marrow diseases like aplastic anemia and MDS. It does not cover garden-variety anemia. Do not assume a presumption covers your anemia. Check the exact diagnosis and the exact exposure rule first. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b). The VA carries it out in 38 C.F.R. § 3.102.
How to Connect Anemia to Service
There are a few ways to tie anemia to your service. The secondary path is the most common one, because anemia is so often a symptom of another condition. The exposure path is narrow and reaches only marrow diseases.
Secondary connection (the most common path for anemia)
Another service-connected condition caused or worsened your anemia (38 C.F.R. § 3.310).
- GI bleeding. A service-connected ulcer or digestive condition draining iron over time. The VA rates the bleeding source, so service-connecting that condition is the play.
- Chronic kidney disease. Damaged kidneys make less erythropoietin, the hormone that drives red-cell production. So CKD commonly causes anemia.
- A medication. A drug taken for a service-connected condition that suppresses the marrow or causes bleeding can lead to anemia.
Exposure-based connection (narrow - marrow diseases)
The exposure path for anemia is narrow and reaches only marrow diseases, not ordinary iron-deficiency or B12 anemia.
- Camp Lejeune. For aplastic anemia and myelodysplastic syndromes, qualifying Camp Lejeune service (30+ cumulative days, Aug 1, 1953 to Dec 31, 1987) is a presumptive path.
- Benzene and radiation. These exposures can support marrow-disease claims under their own rules. This path does not reach ordinary iron-deficiency or B12 anemia.
Direct connection
Anemia that began in service, or was first documented there. The right medical opinion ties it to your service.
- Documented in service. Lab work or treatment for anemia on active duty, with a medical opinion connecting it to your service.
Aggravation
You had anemia before service, and service made it permanently worse (beyond its natural course).
- Worse during service. Your anemia progressed, or your treatment had to be stepped up, on active duty, beyond normal change over time.
Secondary Conditions
Anemia rarely stands alone. It is usually downstream of another condition. And the chronic fatigue it causes can take a toll of its own. Each link the VA can rate is rated on its own and added to your combined rating. So they are worth writing down.
Anemia may be secondary to
- Chronic kidney disease. Reduced erythropoietin from damaged kidneys is a leading cause of anemia. Rated under the genitourinary system.
- GI bleeding (ulcers, gastritis, GERD-related bleeding). Chronic blood loss drains iron; the VA rates the bleeding source.
- Medication side effects. Some drugs for service-connected conditions can cause anemia.
Conditions that may be secondary to or co-occur with anemia
- Fatigue and reduced exercise tolerance. Chronic anemia can strain the heart over time.
- Mental-health effects. Living with a chronic blood condition and constant fatigue can contribute to a depression or anxiety condition. That condition is rated separately and can be claimable.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. For anemia, the lab work that names the type and the treatment records do the heavy lifting.
Frequently Asked Questions
How does the VA rate anemia?
Under 38 C.F.R. 4.117, by type. There is no single anemia code anymore. Iron deficiency anemia (not from blood loss) is DC 7720. It is rated 0% to 30% based on whether you need IV iron infusions. B12 / pernicious anemia is DC 7722, usually 10% once you are on B12 therapy. Acquired hemolytic anemia is DC 7723, rated 0% to 100% based on immunosuppressive treatment. The rating turns on the treatment you need, not on a single lab number.
Is there still a 'DC 7700' for anemia?
No. Diagnostic Code 7700 was removed from 38 C.F.R. 4.117 in the 2022 update to the hemic and lymphatic rating schedule. Anemia is now rated under codes for each type, such as 7720 (iron deficiency), 7722 (B12 / pernicious), and 7723 (hemolytic). If you see older guides citing DC 7700, they are out of date.
My anemia is from a bleeding ulcer. How is that rated?
Not as anemia. Under DC 7720, the VA does not rate iron-deficiency anemia caused by blood loss. It rates the condition causing the bleeding. So a bleeding ulcer or GI condition would be rated under the digestive system. Service-connecting that condition is usually the stronger claim.
Can anemia be connected to my service-connected kidney disease?
Yes, on a secondary basis under 38 C.F.R. 3.310. Chronic kidney disease reduces erythropoietin, the hormone that tells your bone marrow to make red blood cells. So anemia is a common result of CKD. If your kidney disease is service-connected, anemia secondary to it is worth a close look. It is the kind of link a nexus letter establishes.
Is anemia a Camp Lejeune or burn-pit presumptive condition?
Only in a narrow way. For Camp Lejeune (30+ cumulative days between Aug 1, 1953 and Dec 31, 1987), the presumptive list includes aplastic anemia and myelodysplastic syndromes. Those are marrow diseases, not ordinary iron-deficiency or B12 anemia. Burn-pit and particulate-matter presumptions (asthma, sinusitis, rhinitis, certain cancers) do not cover anemia. Check your exact diagnosis against the exact exposure rule.
Do I need a nexus letter for anemia?
Usually, yes, unless a presumption clearly applies. Anemia is so often a symptom of another condition. So the claim usually turns on tying the root cause to your service, then the anemia to the cause. A nexus letter gives the 'at least as likely as not' medical opinion the VA needs. That opinion is what we write.
Anemia is rarely the whole story. We help you tell the rest of it.
Let our doctors write an anemia nexus letter that meets the VA's evidence standards and supports the benefits you earned.
Sources & Regulatory References
- 38 CFR 4.117, Schedule of ratings, hemic and lymphatic systems, including DC 7714, 7716, 7720, 7721, 7722, 7723 (eCFR) https://www.ecfr.gov/current/title-38/section-4.117
- 38 CFR 3.310, Secondary service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.310
- 38 CFR 3.102, Reasonable doubt (eCFR) https://www.ecfr.gov/current/title-38/section-3.102
- Camp Lejeune water contamination health issues (VA.gov) https://www.va.gov/disability/eligibility/hazardous-materials-exposure/camp-lejeune-water-contamination/
- Camp Lejeune: Past Water Contamination (VA Public Health) https://www.publichealth.va.gov/exposures/camp-lejeune/index.asp
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 2026 VA disability compensation rates (VA.gov) https://www.va.gov/disability/compensation-rates/veteran-rates/