Ulcerative Colitis — VA Disability Rating Criteria (DC 7323)

Diagnostic Code 7323 · 38 CFR §4.114

What Is It?

Ulcerative colitis is chronic inflammation and ulceration of the lining of the colon and rectum, producing bloody diarrhoea, urgency, cramping abdominal pain and, in a bad flare, fever and anaemia. Unlike Crohn's disease it stays in the large bowel and it involves the lining rather than the full thickness of the wall. In 38 CFR 4.114 it has its own number — DC 7323, "Colitis, ulcerative" — and that is the code that appears on a rating decision. What it does not have is criteria. The entire entry reads: rate as Crohn's disease or undifferentiated form of inflammatory bowel disease (DC 7326). So the percentage comes from the DC 7326 table, which the 2024 revision of the digestive schedule rewrote effective 19 May 2024, and that table has four rows. 100 percent for severe inflammatory bowel disease unresponsive to treatment, requiring hospitalisation at least once a year, and resulting in either an inability to work or recurrent abdominal pain with at least two of six-or-more daily episodes of diarrhoea, six or more daily episodes of rectal bleeding, recurrent rectal incontinence, or recurrent abdominal distension. 60 percent for moderate disease managed on an outpatient basis with immunosuppressants or biologic agents, with recurrent abdominal pain, four to five daily episodes of diarrhoea and intermittent signs of toxicity such as fever, tachycardia or anaemia. 30 percent for mild to moderate disease managed with oral and topical agents other than immunosuppressants or biologics, with three or fewer daily episodes and minimal signs of toxicity. And 10 percent for minimal to mild disease on the same agents with three or fewer daily episodes and no systemic toxicity. There is no 0 percent row; 38 CFR 4.31 supplies one where no listed criterion is met. If you are looking for Crohn's disease itself, it is DC 7326 and the page for it is linked below.

Rating Criteria

Evidence Needed

Note (2) to DC 7326 requires the diagnosis be confirmed by endoscopy or radiologic studies, so the colonoscopy report and its biopsy pathology are the foundation — for ulcerative colitis they also establish the extent of disease, whether proctitis, left-sided colitis or pancolitis. After that, the evidence is what the DC 7326 rows read on. The medication record showing the drug class: mesalamine and topical agents on one side, immunosuppressants and biologics such as azathioprine, infliximab, adalimumab, vedolizumab or ustekinumab on the other. A symptom record that counts daily episodes of diarrhoea and rectal bleeding rather than describing them. Laboratory work showing anaemia and inflammatory markers, and vital signs showing fever or tachycardia during flares. Admission records for any hospitalisation in the past year. And where a colectomy has been performed, the operative record, because the residuals may rate higher under DC 7329.

C&P Exam Tips

Bring numbers. The difference between the 30, 60 and 100 percent rows is how many episodes of diarrhoea a day and what class of drug is holding the disease, so give the examiner a count and a medication list rather than an impression. Say whether rectal bleeding is happening and how often, and whether there is incontinence — both appear in the 100 percent row and both are commonly left unmentioned. Report fever, racing heart and anaemia if they occur; those are the named signs of toxicity. Note the extent of disease from your last colonoscopy. And if surgery has been performed, ask that the residuals be evaluated under DC 7329 as well, since Note (1) to DC 7326 requires whichever code gives the higher rating.

How to File

File under DC 7323 on VA Form 21-526EZ — that is the code of record for ulcerative colitis — and build the evidence for the DC 7326 criteria, because that is where the percentage comes from. The opening paragraph of 38 CFR 4.114 bars combining ratings under DC 7301 through 7329, 7331, 7342, 7345 through 7350, 7352 and 7355 through 7357 with each other, and DC 7323, DC 7326 and DC 7329 all sit inside it: VA assigns one evaluation under the code reflecting the predominant disability picture and elevates it to the next higher evaluation where the severity of the overall disability warrants. 38 CFR 4.113 sets out why — coexisting abdominal conditions produce a common disability picture. Extraintestinal manifestations are outside the digestive schedule and combine normally under 38 CFR 4.25.

Common Mistakes

Looking for rating criteria under DC 7323 and concluding the code has none that apply — it has none of its own, but the DC 7326 table applies in full. Quoting the pre-2024 criteria, which read on malnutrition, anaemia and general health; the current rows read on drug class and daily episode counts. Describing symptoms instead of counting them. Leaving the medication class out of the record, which is the line between 30 and 60 percent. Expecting a 0 percent row, when 38 CFR 4.31 is what supplies the zero. And filing ulcerative colitis and Crohn's disease as two claims expecting two ratings, when the non-combination paragraph directs a single evaluation under the predominant code with a possible one-step elevation.

Frequently Asked Questions

Why does DC 7323 have no rating criteria?

Because the schedule puts them under another code. The whole DC 7323 entry reads "Rate as Crohn’s disease or undifferentiated form of inflammatory bowel disease (DC 7326)." Ulcerative colitis keeps its own number on the decision, but the percentage comes from the DC 7326 ladder: 100, 60, 30 and 10 percent.

What are the DC 7326 rows?

100 percent for severe disease unresponsive to treatment requiring hospitalisation at least once a year with either inability to work or recurrent abdominal pain plus two of four severe findings; 60 percent for moderate disease on immunosuppressants or biologics with four to five daily episodes of diarrhoea and intermittent toxicity; 30 percent for mild to moderate disease on oral and topical agents with three or fewer daily episodes and minimal toxicity; and 10 percent for minimal to mild disease on those agents with three or fewer episodes and no systemic toxicity.

Can I be rated separately for ulcerative colitis and Crohn’s disease?

No. Both codes are inside the non-combination group at the head of 38 CFR 4.114, so VA assigns a single evaluation under the code that reflects the predominant disability picture, and elevates it one step if the overall severity warrants. The elevation clause is the argument to make.

I had my colon removed. Does that change the code?

It can. Note (1) to DC 7326 provides that following colectomy or colostomy with persistent or recurrent symptoms, the rating is taken under either DC 7326 or DC 7329 (large intestine resection), whichever provides the higher rating. Ask for both to be considered.

Is there a 0 percent rating for ulcerative colitis?

Not in the criteria — the DC 7326 ladder stops at 10 percent. Where the requirements for a compensable evaluation are not met, 38 CFR 4.31 supplies a 0 percent evaluation, which still establishes service connection and leaves the claim open for a later increase.