What is Chronic B-Cell Leukemia?
Chronic B-cell leukemia develops from a specific type of white blood cells, B-cells, which affect the body’s immune system. There are various types of chronic B-cell leukemia including, but not limited to, prolymphocytic leukemia (PLL) and hairy cell leukemia (HCL). However, the most common form of B-cell leukemia, accounting for 37 percent of all cases, is chronic lymphocytic leukemia (CLL). This specific form of the disease is characterized by the production of an excessive number of white blood cells. The cancer cells start in the bone marrow, but then travel into the blood. Once in the blood they can spread to other organs, where they can prevent other cells in the body from functioning normally. Importantly, chronic means the leukemia cells can survive longer than normal cells thereby building up and crowding out the normal cells. As a result, types of chronic B-cell leukemia are harder to cure than types of acute leukemia.
The symptoms associated with chronic B-cell leukemia tend to build up very slowly. Therefore, many people do not have any symptoms for at least a few years. Nonetheless, when symptoms do present, they include the following:
- Persistent fatigue
- Frequent infections
- Weight loss without trying
- Swollen lymph nodes
- Enlarged liver or spleen
- Easy bleeding or bruising
- Tiny red spots in the skin (i.e. petechiae)
- Bone pain or tenderness
Chronic B-cell leukemia usually affects older adults, especially men over the age of 60. People under the age of 45 rarely develop this disease. In order to diagnose chronic B-cell leukemia, doctors typically conduct blood tests to obtain a complete blood count and determine the type of lymphocytes involved. However, bone marrow biopsies and imaging tests are sometimes needed as well. Those who are diagnosed with early stage CLL are generally monitored closely, but not given any treatment whereas those with later stages of CLL commonly receive chemotherapy, targeted drug therapy, or immunotherapy.
Chronic B-Cell Leukemia and Agent Orange Exposure
The Institute of Medicine focused on CLL in its report “Veterans and Agent Orange: Update 2002” and concluded that there is “sufficient evidence of an association between exposure to Agent Orange and chronic lymphocytic leukemia, including hairy cell leukemia and other B-cell leukemias”. Based on these findings, VA expanded CLL to include all chronic B-cell leukemias as related to Agent Orange exposure and other herbicides during military service. VA’s final regulation recognizing this association and establishing service connection took effect on October 30, 2010.
Now, veterans who develop chronic B-cell leukemia and were exposed to Agent Orange or other herbicides during military service do not have to prove a connection between their disease and service to be eligible to receive treatment at VA facilities and disability benefits.
VA Disability Benefits for Chronic B-Cell Leukemia as Related to Agent Orange Exposure
Upon granting service connection for a veteran’s chronic B-cell leukemia, VA will assign a disability rating based on the presence and severity of symptoms and treatment. Leukemia is rated under 38 CFR § 4.117, Schedule of ratings – Hemic and Lymphatic Systems, using diagnostic code (DC) 7703. When a veteran’s leukemia, including types of chronic B-cell leukemia, is active or during a treatment phase, VA will assign the 100 percent rating. This total rating continues for six months following the last treatment, and is then rated as either anemia or aplastic anemia, whichever would result in the greater benefit. The rating criteria for anemia under DC 7700 is as follows:
- “100% – hemoglobin 5gm/100ml or less, with findings such as high output congestive heart failure or dyspnea at rest.
- 70% – hemoglobin 7gm/100ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months)
- 30% – hemoglobin 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath
- 10% – hemoglobin 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches
- 0% – 10gm/100ml or less, asymptomatic.”
Whereas the rating criteria for aplastic anemia under DC 7716 is based on different factors:
- “100% – requiring bone marrow transplant, or; requiring transfusion of platelets or red cells at least once every six weeks, or; infections recurring at least once every six weeks
- 60% – requiring transfusion of platelets or red cells at least once every three months, or; infections recurring at least once every three months
- 30% – requiring transfusion of platelets or red cells at least once per year but less than once every three months, or; infections recurring at least once per year but less than once every three months
- 10% – requiring continuous medication for control.”