Hepatitis C — VA Disability Rating Criteria (DC 7354)

Diagnostic Code 7354 · 38 CFR §4.114

What Is It?

Hepatitis C is a blood-borne virus that attacks the liver and can damage it silently for decades. Veterans were exposed through jet-injector inoculation, transfusions given before donor screening existed, combat medical care, shared equipment and occupational needlesticks, and it remains one of the most-claimed liver conditions at VA. In 38 CFR 4.114 it has its own number — DC 7354, "Hepatitis C (or non-A, non-B hepatitis)" — but the entry is one line long and it assigns no percentages. It reads: rate under DC 7345, chronic liver disease without cirrhosis. Note (3) to DC 7345 says the same thing from the other side — track hepatitis C under DC 7354, but evaluate it using the criteria in that entry. So DC 7354 is the code that appears on your rating decision, and the DC 7345 table is what decides the number. That table has five rows. 100 percent requires progressive chronic liver disease needing both parenteral antiviral therapy and parenteral immunomodulatory therapy, and it continues for six months after treatment stops. 60 percent requires continuous medication, substantial weight loss, and at least two of six named findings — daily fatigue, malaise, anorexia, hepatomegaly, pruritus and arthralgia. 40 percent is the same with minor weight loss instead. 20 percent requires only one of intermittent fatigue, malaise, anorexia, hepatomegaly or pruritus, with no medication requirement. And 0 percent covers a previous history of liver disease that is currently asymptomatic — the row that matters most to the many veterans cured by modern antivirals, because it keeps service connection alive. Direct-acting antiviral drugs now clear the virus in the large majority of cases and VA provides the treatment, so a cure is the ordinary outcome rather than the exception; what the evaluation then turns on is the findings that remain. Where the disease has progressed to cirrhosis the evaluation moves to DC 7312 instead, and 38 CFR 4.114 does not combine the two — it directs one evaluation under whichever code is predominant.

Rating Criteria

Evidence Needed

The hepatitis C antibody test plus a confirmatory RNA or PCR result establishes the diagnosis and the code. Everything else is evidence for the DC 7345 criteria: the treatment record with dates and route of administration, since the top row turns on parenteral rather than oral therapy and continues six months past its end; the six named findings recorded by name and frequency in the clinical notes; and a documented weight history measured against the baseline defined in 38 CFR 4.112. Add the exposure history from service — the inoculation record, transfusion records, medic or corpsman duties, documented needlesticks — because the nexus argument is usually about how you were exposed rather than about whether you are infected. If treatment cleared the virus, document what is left: the findings that persist, and any elastography, imaging or biopsy showing fibrosis or cirrhosis, because that is what the evaluation now rests on. If liver damage has progressed, the biopsy, elastography or imaging showing cirrhosis moves the claim to DC 7312.

C&P Exam Tips

Bring the confirmatory RNA result so the diagnosis is not in question, and then spend the examination on the criteria that actually decide the rating. Go through the six named findings one by one and say whether each is present and how often. Give the weight history in dates and numbers. Say whether any treatment was given by injection or infusion and when it stopped. If you achieved a sustained virologic response, say so and describe what symptoms remain — a cured virus with continuing fatigue, malaise or arthralgia is still rated on those findings, and a cured virus with no symptoms is the 0 percent row rather than a denial. If both parenteral antiviral therapy and parenteral immunomodulatory drugs were recommended but treatment was medically contraindicated, make sure that is in the record: Note (2) to DC 7345 sends those veterans to DC 7312 for cirrhosis instead.

How to File

File under DC 7354 on VA Form 21-526EZ — that is the code of record — and build the evidence for the DC 7345 criteria, because that is where the percentage comes from. Hepatitis C is not a presumptive condition, so the claim also has to identify an in-service risk factor — jet-injector immunizations, a transfusion given before donor screening, combat blood exposure, medic or corpsman duties, a documented needlestick — and connect it to the infection, usually with a nexus opinion. The non-combination paragraph at the head of 38 CFR 4.114 covers DC 7301 through 7329, 7331, 7342, 7345 through 7350, 7352 and 7355 through 7357, and both DC 7345 and DC 7354 are inside it, so hepatitis is not stacked with another listed digestive rating; VA assigns one evaluation under the predominant code and elevates it a step where the overall severity warrants. Extrahepatic conditions — neuropathy, diabetes, a mental-health condition — are outside the digestive schedule and combine normally under 38 CFR 4.25.

Common Mistakes

Looking for rating criteria under DC 7354 itself and concluding there are none. Arguing the rating from viral load, liver enzymes or a fibrosis score, none of which appear in the DC 7345 criteria. Reporting one symptom when the 60 and 40 percent rows require two of the six named findings. Estimating weight loss rather than documenting it against the 38 CFR 4.112 baseline. Assuming a cure ends the claim, when the 0 percent row is written for exactly that situation and the 100 percent evaluation runs six months past the end of parenteral therapy. Treating hepatitis C as though it were an exposure presumptive like the Agent Orange conditions, and filing without the in-service risk factor and the nexus opinion the claim actually needs. And staying on this code after cirrhosis is diagnosed, when DC 7312 applies.

Frequently Asked Questions

Can hepatitis C be connected to jet injector guns during service?

Yes. The military used multi-use jet (air gun) injectors for mass immunizations, and the VA recognizes them as a plausible way blood-borne infections like hepatitis C could have spread. For many veterans with no other risk factor, the jet-injector theory — supported by a nexus opinion — is the basis for service connection.

Why does DC 7354 have no rating criteria?

Because the schedule puts them somewhere else. The DC 7354 entry reads "Rate under DC 7345 (Chronic liver disease without cirrhosis)," and Note (3) to DC 7345 confirms that hepatitis C is tracked under DC 7354 but evaluated using the DC 7345 criteria. The number on your decision is 7354; the ladder that produced it is DC 7345's.

What are the DC 7345 rows?

100 percent for progressive chronic liver disease requiring both parenteral antiviral and parenteral immunomodulatory therapy, continuing six months after treatment stops; 60 percent for continuous medication with substantial weight loss and at least two of daily fatigue, malaise, anorexia, hepatomegaly, pruritus and arthralgia; 40 percent for the same with minor weight loss; 20 percent for at least one of intermittent fatigue, malaise, anorexia, hepatomegaly or pruritus; and 0 percent for a previous history of liver disease, currently asymptomatic.

Do incapacitating episodes matter for hepatitis C?

Not under this code. The phrase appears in several parts of the rating schedule with a different meaning each time, and the DC 7345 criteria that decide a hepatitis C rating do not use it at all — there is no bed-rest count and no duration-in-weeks table here. What the rows turn on is continuous medication, weight loss measured against the 38 CFR 4.112 baseline, and the named findings: fatigue, malaise, anorexia, hepatomegaly, pruritus and arthralgia. If you have read otherwise, the source is describing criteria that are no longer in force.

Is hepatitis C a presumptive condition like Agent Orange?

No. Hepatitis C is not on any presumptive list, so the VA will not assume your service caused it. You must identify an in-service risk factor and provide a nexus opinion linking it to your infection.

I was cured. Is my rating taken away?

Not automatically, and not without process. Where a 100 percent evaluation was assigned for parenteral therapy, it continues for six months after treatment is discontinued, and a mandatory VA examination then sets the rating, with 38 CFR 3.105(e) governing any reduction. Remaining symptoms are still rated on the same criteria, and where none remain the 0 percent row keeps service connection in place. Liver damage the virus already caused does not clear with the virus — where it amounts to cirrhosis the evaluation moves to DC 7312, which carries its own criteria.

How does the VA rate cirrhosis caused by hepatitis C?

Under DC 7312, on complications such as ascites, hepatic encephalopathy and variceal bleeding. It is not an addition to the hepatitis C rating: DC 7312 and DC 7345 both sit inside the non-combination list at the head of 38 CFR 4.114, so VA assigns one evaluation under whichever code is predominant and elevates it a step where the overall severity warrants, rather than combining the two.

What counts as weight loss for the rating?

Under 38 CFR 4.112, minor weight loss is an involuntary loss of 10 to 20 percent of your baseline weight sustained for three months, and substantial weight loss is an involuntary loss of more than 20 percent sustained for three months. Baseline is the clinically documented average weight for the two years before the illness began, or the weight recorded at your most recent discharge physical.

Can hepatitis C cause conditions outside the liver?

Yes. Hepatitis C is linked to extrahepatic conditions such as type-2 diabetes, cryoglobulinemia, porphyria cutanea tarda, certain B-cell lymphomas, and kidney disease (glomerulonephritis). If you are service-connected for hepatitis C, these may be claimed as secondary conditions with a nexus opinion.

Does hepatitis B use this code?

No. Hepatitis B is rated under DC 7345 itself — Note (3) to that entry states the code includes hepatitis B confirmed by serologic testing. Only hepatitis C and non-A, non-B hepatitis are tracked under DC 7354.