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VA Rating Assistant

DC 7709 · 38 CFR 4.117

Hodgkin's Disease C&P Exam Prep

To evaluate the current status of Hodgkin's lymphoma for VA disability rating purposes under DC 7709, including whether the disease is active, in a treatment phase, or in remission, and if in remission, to document residual conditions for rating under appropriate diagnostic codes.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Hematologic_and_Lymphatic_Conditions_Including_Leukemia (Hematologic_and_Lymphatic_Conditions_Including_Leukemia)
Examiner:
Hematologist or Oncologist

What the examiner evaluates

  • Current disease status: active, treatment phase, or remission
  • Type and stage of Hodgkin's lymphoma at diagnosis and currently
  • Treatment history including chemotherapy, radiation, immunotherapy, and stem cell/bone marrow transplant
  • Date of most recent treatment and anticipated completion date
  • Laboratory values including CBC with differential, hemoglobin, hematocrit, RBC count, WBC count, platelet count
  • Presence and frequency of infections requiring hospitalization or treatment
  • Need for ongoing biologic therapy, myelosuppressive therapy, or growth factors
  • Residual conditions resulting from the disease or its treatment (e.g., neuropathy, cardiac effects, pulmonary fibrosis, secondary malignancy)
  • Functional impact and occupational impairment
  • B symptoms: night sweats, unexplained weight loss, fevers
  • Lymphadenopathy, splenomegaly, or hepatomegaly
  • History of bone marrow or stem cell transplant

Exam will be conducted by a hematologist or oncologist, either in person or via telehealth. The examiner will review your claims file and medical records before or during the exam. Bring a complete list of all current medications and a timeline of your treatment history. In most states, you have the right to record the examination with advance notice.

Measurements and tests

Complete Blood Count (CBC) with Differential

What it measures: Measures hemoglobin, hematocrit, RBC count, WBC count with differential, and platelet count - all critical values on the DBQ that directly influence rating decisions

What to expect: The examiner will document your most recent lab values and their dates. Bring printed copies of all recent lab results from your treating oncologist or hematologist.

Critical thresholds

  • Hemoglobin < 10 g/100 mL Indicates significant anemia potentially warranting separate rating under anemia diagnostic codes
  • Platelet count - 30,000 Severe thrombocytopenia, may warrant 100% rating under immune thrombocytopenia criteria
  • Platelet count 30,001-50,000 Moderate thrombocytopenia, rated at higher levels under ITP criteria
  • WBC differential with ANC <500 Severe neutropenia, may indicate need for continuous growth factor support

Tips

  • Bring dated printouts of all recent CBC results - ideally from the past 6-12 months showing a trend
  • If your counts fluctuate, bring results that show your worst values, not just the most recent
  • Note which labs were drawn while on active treatment versus off treatment

Pain considerations: Not applicable for this specific test, but bone pain associated with bone marrow involvement or growth factor injections (e.g., G-CSF/Neupogen) should be separately documented and communicated to the examiner.

Infection History Documentation

What it measures: The frequency and severity of infections, which directly map to rating criteria for agranulocytosis and immune-compromised conditions

What to expect: The examiner will ask about infections requiring hospitalization, antibiotic treatment, or outpatient management. The DBQ specifically tracks whether infections occur once per 12-month period, once every 3 months, or once every 6 weeks.

Critical thresholds

  • Infections requiring hospitalization 3+ times per 12-month period Maps to highest severity infection criteria on DBQ
  • Infections requiring hospitalization 1-2 times per 12-month period Maps to moderate severity infection criteria
  • Infections recurring on average at least once per 12-month period Maps to lowest severity infection criteria requiring continuous medication

Tips

  • Keep a written log of every infection requiring medical care - include dates, type of infection, treatment received, and whether hospitalization was required
  • Count ER visits for infection-related symptoms even if you were not formally admitted
  • Document opportunistic infections specifically, as these indicate significant immune compromise

Pain considerations: Document any pain associated with infections, including bone pain from sinusitis, chest pain from pneumonia, or abdominal pain from gut infections, as these contribute to overall functional impairment.

Transfusion and Infusion Frequency Assessment

What it measures: How frequently the veteran requires blood or platelet transfusions, IV iron infusions, or erythropoiesis-stimulating agents (ESAs), which are tracked on the DBQ and affect rating levels

What to expect: The examiner will ask about the number and frequency of transfusions and infusions received over the past 12 months. This includes red blood cell transfusions, platelet transfusions, and IV iron infusions.

Critical thresholds

  • 4 or more blood or platelet transfusions per 12-month period Higher severity threshold on DBQ
  • 1-3 blood or platelet transfusions per 12-month period Moderate severity threshold on DBQ
  • IV iron infusions 4+ times per 12-month period Significant iron deficiency anemia severity marker
  • IV iron infusions 1-3 times per 12-month period Moderate iron deficiency anemia severity marker

Tips

  • Request infusion logs from your treatment facility showing exact dates and types of infusions
  • Count outpatient transfusions and infusions, not just inpatient ones
  • Note whether transfusions were given as part of chemotherapy protocol or for independent anemia/thrombocytopenia management

Pain considerations: Discomfort, fatigue, and recovery time associated with transfusions and infusions should be described to the examiner as part of functional impact.

Rating criteria by percentage

100%

Hodgkin's lymphoma with active disease OR during a treatment phase. Under 38 CFR 4.117, DC 7709, a 100% rating is assigned whenever the disease is active or the veteran is undergoing any therapeutic treatment including surgery, radiation therapy, antineoplastic chemotherapy, immunotherapy, or other therapeutic procedures. The 100% rating continues beyond cessation of treatment. Six months after discontinuance of treatment, a mandatory VA examination is required to determine the appropriate rating based on residuals.

Key symptoms

  • Active Hodgkin's lymphoma confirmed by biopsy, PET scan, or CT imaging
  • Currently receiving chemotherapy (e.g., ABVD, BEACOPP, brentuximab vedotin)
  • Currently receiving radiation therapy to lymph node regions
  • Currently receiving immunotherapy or biologic therapy for Hodgkin's lymphoma
  • Currently undergoing or recovering from bone marrow or stem cell transplant
  • Treatment phase not yet completed - including maintenance therapy
  • Disease recurrence after prior remission requiring reinitiation of treatment
  • B symptoms: unexplained fever >38-C, drenching night sweats, unexplained weight loss >10% body weight in 6 months
  • Lymphadenopathy, splenomegaly, mediastinal mass
  • Significant fatigue and functional impairment during treatment

From 38 CFR: 38 CFR 4.117, DC 7709: 'With active disease or during a treatment phase - 100.' Note states the 100% evaluation shall continue beyond cessation of any surgical, radiation, antineoplastic chemotherapy, or other therapeutic procedures. Six months after discontinuance, a mandatory VA examination determines the appropriate disability rating based on residuals.

0%

Hodgkin's lymphoma in complete remission with no active disease and no current treatment, evaluated more than six months after cessation of all therapeutic procedures. At this stage, the veteran is rated on residual conditions under appropriate diagnostic codes (e.g., peripheral neuropathy, cardiac dysfunction, pulmonary fibrosis, secondary malignancy, hypothyroidism). The 0% or higher rating depends entirely on documented residuals and their severity.

Key symptoms

  • Complete remission confirmed by PET-CT or CT imaging
  • No active chemotherapy, radiation, or biologic therapy
  • More than 6 months since last therapeutic treatment
  • No evidence of recurrence or metastasis
  • Rating transitions to residual conditions under appropriate diagnostic codes
  • Possible residuals include: peripheral neuropathy from vincristine/taxanes, cardiac dysfunction from anthracyclines (doxorubicin), pulmonary fibrosis from bleomycin, hypothyroidism from neck radiation, secondary malignancies, avascular necrosis from steroids, infertility, lymphedema, fatigue

From 38 CFR: 38 CFR 4.117, DC 7709 Note: 'If there has been no local recurrence or metastasis, rate on residuals under the appropriate diagnostic code(s).' Residuals must be separately identified and rated - for example, peripheral neuropathy under DC 8520-8530, cardiac conditions under DC 7000-7020, pulmonary conditions under DC 6600-6817.

Describing your symptoms accurately

Fatigue and Functional Capacity

How to describe it: Describe fatigue in concrete, functional terms. Specify how many hours per day you can be active before exhaustion sets in, whether you require daytime napping, your ability to perform basic activities of daily living (ADLs), and how fatigue has affected your employment or job performance. Quantify: 'I can walk one block before needing to rest' is more useful than 'I get tired easily.'

Example: On my worst days, I cannot get out of bed before noon. I require 2-3 hours of daytime sleep in addition to 10+ hours of nighttime sleep. I am unable to prepare meals, shower without sitting down, or drive. I have missed [X] days of work in the past [Y] months due to treatment-related fatigue.

Examiner listens for: Specific functional limitations, impact on employment, frequency of worst-day symptoms versus average days, whether fatigue is related to active treatment, anemia, or residual post-treatment effects.

Avoid: Do not say 'I'm managing' or 'I push through it.' Do not downplay fatigue as normal tiredness. Be specific about how fatigue has changed your daily routines and work capacity compared to before your diagnosis.

Night Sweats, Fever, and B Symptoms

How to describe it: Describe B symptoms with specificity: How many nights per week do you experience drenching night sweats requiring clothing or sheet changes? Quantify weight loss in pounds over a specific time period. Describe fever frequency, peak temperature, and duration. These symptoms are important both for indicating active disease and for documenting residual autonomic dysfunction after treatment.

Example: During active disease / treatment, I was changing my sleep clothes and sheets 3-4 times per night due to soaking night sweats. I lost 22 pounds over 3 months without dieting. I had fevers of 101-103-F occurring 3-4 times per week, each lasting 6-8 hours.

Examiner listens for: Whether B symptoms are currently present (indicating active disease) or were present during the rating period, frequency and severity, whether they have resolved with treatment or persist, and any post-treatment autonomic symptoms.

Avoid: Do not characterize drenching night sweats as 'sleeping hot.' Do not round down weight loss. Do not omit low-grade fevers - report actual temperature readings if you have them.

Treatment Side Effects and Toxicities

How to describe it: Systematically describe side effects from each component of your treatment regimen. For chemotherapy: nausea, vomiting, neuropathy, hair loss, cognitive changes ('chemo brain'), mouth sores, susceptibility to infection. For radiation: fatigue, skin changes, hypothyroidism (if neck irradiated), pulmonary symptoms (if chest irradiated), cardiac symptoms (if mediastinal irradiated). For steroids: weight gain, avascular necrosis, mood changes, blood sugar dysregulation.

Example: Following my [chemotherapy regimen] treatment, I experienced Grade 3 peripheral neuropathy in both hands and feet - I dropped items regularly, could not button shirts, and experienced burning/shooting pain rated 7/10 that woke me from sleep. My pulmonary function tests after radiation showed a 30% reduction in DLCO, and I experience shortness of breath with minimal exertion such as climbing one flight of stairs.

Examiner listens for: Specific treatment-related toxicities that may constitute ratable residual conditions, whether side effects are acute or chronic/permanent, functional impact of each toxicity, and whether the veteran has been evaluated by specialists for treatment-related complications.

Avoid: Do not omit treatment-related conditions because you believe they are 'part of treatment.' Each residual condition can be separately rated. Do not say side effects have 'gotten better' without specifying current baseline - even improved neuropathy may be ratable.

Infection Susceptibility and Immune Compromise

How to describe it: Provide a specific account of infections over the past 12 months: type of infection, date, treatment required (oral antibiotics, IV antibiotics, hospitalization), duration of illness, and any complications. Describe prophylactic medications you take to prevent infections (e.g., prophylactic antibiotics, antifungals, antivirals, G-CSF injections).

Example: Over the past 12 months, I have had 4 infections requiring medical treatment: two episodes of pneumonia (one requiring hospitalization for 5 days with IV antibiotics), one episode of shingles requiring antiviral treatment, and one episode of cellulitis treated with oral antibiotics. I take daily prophylactic trimethoprim-sulfamethoxazole and acyclovir due to my immunocompromised state.

Examiner listens for: Total number of infections per year, severity (outpatient vs. inpatient), types of organisms (typical vs. opportunistic), whether prophylactic medications are required, and whether infections are recurrent despite treatment.

Avoid: Do not forget to count urgent care visits for infections, ER visits that did not result in admission, or infections treated at home with prescription antibiotics called in by your doctor. All of these represent medically significant infections.

Pain - Disease and Treatment Related

How to describe it: Describe pain using the who/what/when/where/how framework. Distinguish between lymph node pain, bone pain (from marrow involvement or growth factor injections), neuropathic pain from chemotherapy, musculoskeletal pain from steroids or avascular necrosis, and any other pain sources. Rate pain on a 0-10 scale at rest and with activity. Describe your worst-day pain level and frequency.

Example: On my worst days, the neuropathic burning pain in my feet rates 8/10 and prevents me from standing for more than 5 minutes. I experience bone pain in my lower back rated 6/10 that worsens with any physical activity and is not fully controlled by [medication]. I take [specific medications] daily for pain management but still have breakthrough pain [X] days per week.

Examiner listens for: Specific pain locations, character (aching, burning, shooting, pressure), severity rating, what worsens and relieves pain, impact on sleep and daily function, and current pain management regimen and its effectiveness.

Avoid: Do not use vague terms like 'some discomfort' or 'a little sore.' Do not report only current pain if your worst-day pain is significantly higher. Report pain during your worst days as well as your average days.

Cognitive and Psychological Impact

How to describe it: Describe cognitive changes ('chemo brain') including memory difficulties, word-finding problems, difficulty concentrating, and processing speed changes. Describe psychological impact including anxiety about recurrence, depression, PTSD-like symptoms from cancer diagnosis, and social isolation. Connect these to specific functional limitations at work or home.

Example: I frequently forget words mid-sentence, lose track of conversations, and have to read the same paragraph multiple times before it registers. I was demoted at work because I could no longer manage my previous responsibilities. I experience anxiety attacks before every surveillance scan that leave me unable to function for 2-3 days. I have been diagnosed with [anxiety/depression] by my treating physician and am prescribed [medications].

Examiner listens for: Objective functional impairment from cognitive changes, whether psychological symptoms meet criteria for a separate psychiatric rating, impact on employment and relationships, and whether these symptoms are being treated.

Avoid: Do not dismiss cognitive symptoms as 'just stress.' Cognitive impairment from chemotherapy is a recognized medical condition. Do not fail to mention psychological symptoms - anxiety and depression related to cancer can be separately rated.

Common mistakes to avoid

Saying 'I'm doing well' or 'I'm in remission' without clarifying the rating context

Why: Veterans in remission who are less than 6 months post-treatment are still entitled to 100% under DC 7709. Remission does not eliminate entitlement - it changes how you are rated. Saying 'I'm doing well' without context can cause the examiner to record you as asymptomatic when you may still be entitled to 100%.

Do this instead: Know your treatment end date precisely. If you completed treatment less than 6 months ago, clearly state: 'I completed [treatment type] on [date], which was [X weeks/months] ago.' If it has been more than 6 months, focus the conversation on your current residual conditions and document each one thoroughly.

Impact: 100%

Failing to document residual conditions separately when in remission

Why: Under DC 7709, veterans in complete remission with no recurrence are rated on residuals under appropriate diagnostic codes. Many veterans leave the exam without discussing residuals - such as peripheral neuropathy, cardiac effects, pulmonary fibrosis, or hypothyroidism - which results in a 0% rating for Hodgkin's disease with no compensation for lasting treatment-related damage.

Do this instead: Before the exam, prepare a comprehensive list of every condition you attribute to your Hodgkin's disease or its treatment. Bring documentation from specialists (cardiologist, pulmonologist, endocrinologist, neurologist) evaluating treatment-related complications. Request that each residual condition be separately noted on the DBQ.

Impact: Post-remission rating on residuals

Not knowing or communicating your specific chemotherapy regimen and its known toxicities

Why: Different regimens have predictable, well-documented toxicity profiles. ABVD causes bleomycin-induced pulmonary toxicity and doxorubicin-induced cardiomyopathy. BEACOPP has higher rates of secondary malignancy. Stanford V involves radiation-related complications. The examiner needs to connect your residual symptoms to your specific treatment - if you cannot name your regimen, this connection may be missed.

Do this instead: Before the exam, obtain a complete treatment summary from your oncologist listing: all chemotherapy agents received, cumulative doses if available, radiation fields and doses, and dates of each treatment phase. Bring this document to the exam.

Impact: Post-remission rating on residuals

Underreporting fatigue by describing it on a 'good day' rather than a representative or worst-day basis

Why: Per M21-1 guidance, the VA rates conditions based on their overall impact including worst-day presentations. Fatigue from Hodgkin's disease and its treatment can be profoundly disabling, but veterans who are having a good day on exam day often underreport by describing their current state rather than their typical or worst-day experience.

Do this instead: Prepare a written fatigue diary covering the past 30 days noting worst-day, average-day, and best-day energy levels and functional capacity. Present this to the examiner and verbally describe your worst-day experience when asked about fatigue.

Impact: Functional ratings for residuals

Failing to disclose the 6-month mandatory re-examination requirement and its implications

Why: Under DC 7709, a reduction in rating after the mandatory 6-month post-treatment examination is subject to 38 CFR 3.105(e) protections. Veterans who do not understand this may accept a rating reduction without exercising their right to challenge it. Also, veterans may not realize a reexamination is mandatory - missing it could complicate their claim.

Do this instead: Mark your calendar for 6 months after your last treatment date and proactively contact your VA Regional Office to schedule the mandatory re-examination. At the re-exam, be prepared to thoroughly document all residual conditions. If a rating reduction is proposed based on the re-exam, request a review under 38 CFR 3.105(e) before any reduction takes effect.

Impact: 100% (post-treatment continuance)

Not mentioning prophylactic medications as evidence of ongoing immune compromise

Why: Veterans taking prophylactic antibiotics, antifungals, antivirals, or G-CSF injections after treatment are demonstrating that their immune system remains compromised - this is medically significant and relevant to rating residual immune dysfunction. Examiners may not ask directly about prophylactic medications.

Do this instead: Proactively disclose all prophylactic medications including the reason each was prescribed. State: 'My oncologist has me on [medication] specifically because my immune system is still compromised following treatment.' Bring your current medication list.

Impact: Post-remission immune-related residuals

Presenting only to the Hodgkin's DBQ without requesting evaluation of secondary conditions

Why: Secondary conditions caused by Hodgkin's disease or its treatment (e.g., chemotherapy-induced peripheral neuropathy, radiation-induced hypothyroidism, doxorubicin-induced cardiomyopathy, steroid-induced avascular necrosis) are each separately ratable and may significantly increase total combined disability rating.

Do this instead: File separate claims or request that the C&P examiner address each secondary condition. Ensure your claims include nexus statements connecting each residual condition to your service-connected Hodgkin's disease and its treatment. Obtain supporting letters from treating specialists.

Impact: Overall combined rating

Prep checklist

  • critical

    Gather complete oncology treatment records

    Obtain records from all treating oncologists, radiation oncologists, and hematologists documenting: initial diagnosis with pathology report, staging workup results (PET/CT scans), complete treatment summary with all agents used, response assessments, surveillance scan results, and all office visit notes. Request a formal Treatment Summary Letter from your oncologist summarizing your entire treatment course.

    before exam

  • critical

    Print all recent laboratory results

    Collect CBC with differential, comprehensive metabolic panel, and any disease-specific labs (LDH, beta-2 microglobulin, ESR) from the past 6-12 months. Arrange by date to show trends. Highlight your lowest counts and any abnormal values. Include lab results drawn during treatment phases and off-treatment.

    before exam

  • critical

    Document exact treatment dates

    Record the precise start date and end date of every treatment modality: first and last day of each chemotherapy cycle, radiation start and end dates, transplant admission and discharge dates, and start and end dates of any immunotherapy or targeted therapy. The 6-month post-treatment clock for the mandatory re-examination runs from the date of last treatment.

    before exam

  • critical

    Prepare a comprehensive residual conditions list

    Create a written list of every symptom or condition you attribute to your Hodgkin's disease or its treatment. For each: name the condition, when it began, current severity, how it was diagnosed, and current treatment. Include neuropathy, cardiac symptoms, pulmonary symptoms, hormonal changes, cognitive changes, fatigue, pain, lymphedema, sexual dysfunction, and psychological symptoms.

    before exam

  • critical

    Obtain specialist records for treatment-related complications

    Request records from all specialists evaluating treatment-related complications: cardiologist for anthracycline cardiotoxicity (echocardiograms, EKGs), pulmonologist for bleomycin lung toxicity (PFTs, DLCO), endocrinologist for radiation-induced hypothyroidism, neurologist for peripheral neuropathy, and any other relevant specialists. These records are essential for rating residual conditions.

    before exam

  • recommended

    Compile infection log

    Create a chronological log of every infection in the past 12 months including: date, type of infection, medical provider seen, treatment received (type and route of antibiotics), whether you required hospitalization, and duration of illness. Include any ER visits for infection-related symptoms even if not admitted.

    before exam

  • recommended

    Write out your symptom narrative

    Before the exam, write a 1-2 page description of your current condition focusing on: how your condition affects your daily life, your worst-day experience in the past month, any employment impact (missed days, reduced hours, job changes), activities you can no longer perform, and how your quality of life has changed since diagnosis and treatment.

    before exam

  • recommended

    Know your ICD-10 code for Hodgkin's lymphoma

    The primary ICD-10 code for Hodgkin's lymphoma is C81.x (where x specifies the subtype: C81.0 = Nodular lymphocyte predominant; C81.1 = Nodular sclerosis; C81.2 = Mixed cellularity; C81.3 = Lymphocyte depleted; C81.4 = Lymphocyte-rich; C81.7 = Other; C81.9 = Unspecified). Know your specific subtype - this will be entered on the DBQ ICD code field.

    before exam

  • critical

    Prepare current medication list

    List all current medications with dose, frequency, and reason for prescribing. Highlight any medications prescribed specifically for: infection prophylaxis, treatment-related neuropathy, cardiac protection, hormone replacement after radiation-induced hypothyroidism, pain management, and psychiatric/psychological symptoms. This list helps the examiner connect each medication to a ratable condition.

    before exam

  • recommended

    Bring Buddy Statements from family members or close contacts

    Buddy statements from people who observe your daily functioning can document what you may underreport. Ask someone who sees you regularly to write a statement describing: changes they have observed in your energy and activity level, incidents of you being too ill to function, changes in your personality or cognitive function, and how your condition has affected your family relationships.

    before exam

  • critical

    Do not present yourself at your best

    Veterans often dress up and act as well as possible for medical exams out of habit or politeness. For a C&P exam, present yourself accurately - if you are having a bad day, that is actually most representative. Wear clothing that is comfortable, not your 'best' appearance. Do not minimize fatigue you are feeling on the day of the exam.

    day of

  • recommended

    Bring all documentation in organized folders

    Organize your documents in labeled folders: (1) Treatment Records, (2) Laboratory Results, (3) Specialist Records, (4) Medication List, (5) Infection Log, (6) Buddy Statements, (7) Symptom Narrative. Having organized documentation shows the examiner exactly what evidence exists and ensures nothing is overlooked.

    day of

  • recommended

    Know your right to record the examination

    In most states, veterans have the right to record their C&P examination, though advance notice may be required. Check your state's recording consent laws. If you plan to record, notify the examination scheduling office when your exam is booked. Recording protects you if the examiner's report does not accurately reflect what was discussed.

    day of

  • critical

    Answer questions about your worst-day experience, not your best

    When asked 'How are you doing?' or 'How do you feel?', redirect to your representative experience: 'On my worst days, which happen [X] times per week/month, I experience...' Then also describe your average days. This ensures the examiner documents the full range of your condition rather than only your current presentation.

    during exam

  • critical

    Explicitly state all residual conditions and connect them to treatment

    Do not wait for the examiner to identify residual conditions. Proactively state: 'In addition to the Hodgkin's lymphoma itself, I have been diagnosed with [condition] which my oncologist attributes to [treatment component].' Provide the examiner with your specialist records to document each residual condition.

    during exam

  • critical

    Confirm the examiner documents active disease status or treatment phase status accurately

    If you are currently in active treatment or within 6 months of completing treatment, clearly communicate this and confirm the examiner is documenting 'active disease' or 'treatment phase' in the appropriate DBQ fields. A 100% rating under DC 7709 requires this documentation.

    during exam

  • critical

    Describe functional impact on employment

    Clearly state whether and how your condition has affected your ability to work: missed days, reduced hours, inability to perform job duties, job loss, inability to seek employment, or need for accommodations. This functional information is critical for the DBQ and for any TDIU (Total Disability based on Individual Unemployability) consideration.

    during exam

  • critical

    Request a copy of the completed DBQ

    After the exam is completed and submitted, request a copy of the DBQ through your VA MyHealtheVet account or by submitting a records request. Review it carefully to ensure the examiner accurately documented: your diagnosis, treatment history, current disease status, all residual conditions, and your reported symptoms and functional limitations.

    after exam

  • recommended

    Review DBQ for errors and request a supplemental opinion if needed

    If the DBQ contains factual errors, omissions, or conclusions that do not align with your documented medical history, you can request a supplemental examination or submit a written response identifying the errors. You can also submit a private medical opinion (nexus letter) from a treating physician to counter an unfavorable DBQ.

    after exam

  • critical

    Mark the 6-month mandatory re-examination date

    Under DC 7709, a mandatory VA examination is required 6 months after discontinuance of all treatment. Mark this date on your calendar and proactively contact your VA Regional Office approximately 4-5 months after your last treatment to ensure the re-examination is scheduled. At the re-exam, focus on thoroughly documenting all residual conditions.

    after exam

  • recommended

    Consider filing secondary service connection claims for treatment-related residuals

    If you are approaching or past the 6-month post-treatment mark, consider filing secondary service connection claims for all treatment-related conditions before or concurrent with the mandatory re-exam. Conditions to consider: peripheral neuropathy (DC 8520-8530), cardiomyopathy (DC 7020), pulmonary fibrosis (DC 6832), hypothyroidism (DC 7903), avascular necrosis (DC 5255), depression/anxiety (DC 9434/9400).

    after exam

Your rights during a C&P exam

  • Under 38 CFR 4.117, DC 7709, you are entitled to a 100% rating for Hodgkin's lymphoma with active disease OR during any treatment phase - this includes the entire period of chemotherapy, radiation, immunotherapy, or other therapeutic procedures.
  • The 100% rating continues beyond cessation of treatment - it does not automatically end when treatment stops. A mandatory VA examination must be scheduled 6 months after your last treatment before any rating reduction can be considered.
  • Any reduction in rating based on the mandatory 6-month re-examination is subject to the provisions of 38 CFR 3.105(e), which requires advance notice and an opportunity to respond before any reduction takes effect.
  • If your Hodgkin's lymphoma is in complete remission with no recurrence, you are still entitled to ratings for residual conditions under appropriate diagnostic codes - a remission determination does not mean zero compensation.
  • You have the right to have all evidence in your claims file reviewed by the C&P examiner before they complete the DBQ. If you have medical records not yet in your file, bring copies to the exam and ask the examiner to review them.
  • In most states, you have the right to record your C&P examination. Contact your VA Regional Office or the examination scheduling service to confirm the specific procedure for your location.
  • You have the right to request a second opinion or supplemental examination if you believe the initial DBQ was inadequate, contained errors, or did not consider all relevant evidence.
  • You have the right to submit a private medical nexus opinion from your treating oncologist or a private physician to support your claim or rebut an unfavorable VA examination.
  • If your Hodgkin's disease is determined to be service-connected, all secondary conditions caused by the disease or its treatment are potentially service-connectable under 38 CFR 3.310 - you do not need to prove each secondary condition was directly caused by your military service.
  • If your combined service-connected disability prevents you from securing or following substantially gainful employment, you may be entitled to Total Disability based on Individual Unemployability (TDIU) at the 100% rate under 38 CFR 4.16.
  • Veterans who served in the Republic of Vietnam and were exposed to herbicide agents (Agent Orange) may have a presumptive service connection for Hodgkin's lymphoma under 38 CFR 3.309(e) - no proof of direct exposure is required if you served in the geographic area during the qualifying period.
  • Veterans exposed to radiation during military service may have a presumptive or radiogenic disease claim for Hodgkin's lymphoma under 38 CFR 3.309(d) - consult with a VSO if this may apply to your service history.

Related conditions

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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.