Chronic Liver Disease (Non-Cirrhotic) — VA Disability Rating Criteria (DC 7345)

Diagnostic Code 7345 · 38 CFR §4.114

What Is It?

DC 7345 is the schedule's general entry for chronic liver disease that has not progressed to cirrhosis, and Note (3) to the entry lists exactly what it takes in: hepatitis B confirmed by serologic testing, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune liver disease, Wilson's disease, alpha-1-antitrypsin deficiency, hemochromatosis, drug-induced hepatitis, and non-alcoholic steatohepatitis. The same Note adds that hepatitis C is tracked under DC 7354 but evaluated using the criteria in this entry, which is why this one table decides most liver claims at VA. Once cirrhosis is established the code changes to DC 7312. The criteria are built on treatment and symptoms, not on laboratory numbers: no row mentions a viral load, an enzyme level or a fibrosis score. The 100 percent row requires progressive disease needing both parenteral antiviral therapy and parenteral immunomodulatory therapy, and it continues for six months after that treatment stops. The 60 and 40 percent rows both require continuous medication plus weight loss plus at least two of six named findings — daily fatigue, malaise, anorexia, hepatomegaly, pruritus and arthralgia — and they are separated only by how much weight was lost. The 20 percent row needs one of five findings and no medication requirement at all. And the 0 percent row exists for a previous history of liver disease that is currently asymptomatic, which is worth claiming because it establishes service connection.

Rating Criteria

Evidence Needed

The diagnosis first: serology, autoantibody panels, ceruloplasmin, ferritin and transferrin saturation, alpha-1-antitrypsin phenotype, imaging, and any liver biopsy or elastography report — whichever establishes which of the Note (3) diseases you have. Then the two things the criteria actually read on. Treatment: what medication, whether it is continuous, and whether any of it was parenteral rather than oral, with start and stop dates. And symptoms: the six named findings recorded by name and frequency in the treatment notes, because a rater cannot count a symptom that is not written down. Weight needs a documented history — 38 CFR 4.112 defines substantial weight loss as involuntary loss of more than 20 percent of baseline sustained three months, minor weight loss as 10 to 20 percent, and baseline as the clinically documented two-year average before onset or the weight recorded at your most recent discharge physical. Where cirrhosis, portal hypertension or malignancy has developed, bring those records too, because they move the claim to a different code.

C&P Exam Tips

Ask that the examination report name your specific diagnosis rather than "chronic liver disease," since Note (3) is a list of named diseases. Go through the six findings one at a time and say whether each is present and how often — daily fatigue and intermittent fatigue sit on different rows. Bring the medication list and point out anything given by injection or infusion. Give the weight history in dates and numbers. If you have hepatitis C, mention it explicitly: the criteria used are these, but the code of record is DC 7354. And if a physician recommended both parenteral antiviral therapy and parenteral immunomodulatory drugs but treatment was medically contraindicated, make sure that is documented — Note (2) directs that those veterans be rated under DC 7312 for cirrhosis instead, which is usually the more favourable route.

How to File

File under DC 7345 on VA Form 21-526EZ with the diagnostic workup, the treatment record and the symptom and weight history — unless you have hepatitis C, in which case the code of record is DC 7354 and the criteria on this page still apply. Both codes sit inside the non-combination group in the opening paragraph of 38 CFR 4.114 (DC 7301 through 7329, 7331, 7342, 7345 through 7350, 7352 and 7355 through 7357), so a veteran with liver disease and another listed digestive condition receives one evaluation under the predominant code, elevated a step where the overall severity warrants. Conditions outside the digestive schedule combine normally under 38 CFR 4.25.

Common Mistakes

Arguing the rating from liver enzymes, viral load or a fibrosis score — none of them appear in the criteria. Reporting a single symptom when the 60 and 40 percent rows require at least two of the six named findings. Estimating weight loss instead of documenting it against the 38 CFR 4.112 baseline. Missing the 0 percent row, which is written for exactly the veteran whose liver disease is currently quiet and which preserves service connection. Staying on DC 7345 after cirrhosis is diagnosed, when DC 7312 is the correct code. And overlooking Note (2), which routes a veteran for whom both parenteral therapies are contraindicated to DC 7312 instead of leaving them stranded below the 100 percent row.

Frequently Asked Questions

What conditions does DC 7345 cover?

Note (3) to the entry names them: hepatitis B confirmed by serologic testing, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune liver disease, Wilson’s disease, alpha-1-antitrypsin deficiency, hemochromatosis, drug-induced hepatitis, and non-alcoholic steatohepatitis. Hepatitis C is tracked under DC 7354 but evaluated on these same criteria.

What happens when cirrhosis develops?

The evaluation moves to DC 7312, cirrhosis of the liver. DC 7345 is written for chronic liver disease without cirrhosis, and Note (4) directs that sequelae such as cirrhosis or liver malignancy be evaluated under the appropriate code — without counting the same signs and symptoms twice.

Is a 0 percent rating worth claiming?

Yes. The 0 percent row covers a previous history of liver disease that is currently asymptomatic. It pays nothing now, but it establishes service connection, which is what lets you file for an increase later without having to prove the in-service origin all over again.

Why does the 100 percent row mention interferon?

Because the criteria predate modern oral therapy. The row requires both parenteral antiviral therapy — direct antiviral agents given by injection or infusion — and parenteral immunomodulatory therapy such as interferon, and it continues for six months after that treatment is discontinued. Note (2) provides the alternative for veterans who need both but for whom treatment is medically contraindicated: rate under DC 7312.

How is weight loss measured?

38 CFR 4.112 defines it. Substantial weight loss is involuntary loss of more than 20 percent of baseline weight sustained for three months with diminished quality of self-care or work tasks; minor weight loss is between 10 and 20 percent on the same terms. Baseline is the clinically documented average for the two years before onset, or the weight at your most recent discharge physical.