What is the VA Disability Rating for Hepatitis B?

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Effective May 19, 2024, under the new DC 7345 for chronic liver disease without cirrhosis, veterans can get a Hepatitis B VA disability rating between 0% and 100% with breaks at 20%, 40%, and 60%.

Your final VA rating for Hepatitis B depends on the frequency (how often), severity (how bad), and duration (how long) of symptoms and how those symptoms negatively impact your work, life, and social functioning.

>> Learn more about the VA digestive system rating changes here.  

Summary of Key Points

• Hepatitis B, confirmed by serologic testing, is rated under DC 7345 for chronic liver disease without cirrhosis. The VA disability ratings for Hepatitis B are 0%, 20%, 40%, 60%, or 100%.

• DC 7354 includes Hepatitis B (confirmed by serologic testing), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune liver disease, Wilson’s disease, Alpha-1-antitrypsin deficiency, hemochromatosis, drug-induced hepatitis, and non-alcoholic steatohepatitis (NASH).

• Hepatitis C or non-A or non-B hepatitis are rated under DC 7354 but evaluated under DC 7345.

• If you already have a VA rating for Hepatitis B, there will be no change to your current VA rating—you are “grandfathered” in under the old rating criteria.

What is Hepatitis B?

Hepatitis B is a viral infection that targets the liver and can lead to both acute and chronic disease.

It is caused by the hepatitis B virus (HBV).

The virus is transmitted through contact with the blood or other body fluids of an infected person.

This can happen through direct blood-to-blood contact, unprotected sex, use of contaminated needles, and from an infected mother to her baby during childbirth.

About Hepatitis B

• Transmission: HBV is more infectious than HIV and can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.

• Symptoms: Many people do not experience any symptoms when newly infected. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain. A small number of people can develop a chronic infection, which can later lead to cirrhosis (scarring) of the liver, liver cancer, or liver failure.

• Prevention: A safe and effective vaccine is available and recommended as part of routine vaccinations for infants, children, and adults. Other preventive measures include using condoms during sex, avoiding sharing needles or items such as razors or toothbrushes with an infected person, and ensuring safe blood transfusions and medical procedures.

• Diagnosis: It is diagnosed with blood tests, which can detect the virus itself, or antibodies produced in response to the virus, indicating whether the infection is recent, ongoing, or if a person has been vaccinated and has immunity.

• Treatment: There is no specific treatment for acute hepatitis B; care aims to maintain comfort and adequate nutritional balance, including rehydration and treatment of symptoms as necessary. For chronic hepatitis B, antiviral medications can be used to fight the virus and slow its ability to damage the liver.

Hepatitis B Risk Factors and Considerations for Veterans

For veterans, as with the general population, certain risk factors and considerations can elevate the likelihood of Hepatitis B infection.

The lifestyle and occupational hazards associated with military service, along with historical medical practices, may contribute to an increased risk among veterans.

Risk Factors for Hepatitis B Among Veterans:

• Exposure to Blood: Veterans who have been exposed to blood through combat injuries or medical procedures may be at increased risk, especially if the exposure occurred before the widespread adoption of rigorous blood screening for HBV.

• Deployment Overseas: Service members deployed to regions with higher HBV prevalence (such as parts of Africa, Eastern Europe, and Asia) may face increased risks due to potential exposure through medical care, sexual contacts, or even personal grooming practices like shaving and tattooing with non-sterile equipment.

• Medical Procedures and Vaccinations: Historically, the reuse of needles and syringes for vaccinations and medical treatments was more common. Although practices have improved significantly, veterans who received medical care during times or in settings where sterilization practices were not optimal may be at increased risk.

• Tattoos and Piercings: Veterans with tattoos or piercings obtained from unregulated facilities or with equipment that was not properly sterilized are at risk.

• Sexual Activity: Unprotected sex, having multiple sex partners, or having a sexually transmitted disease increases the risk of contracting HBV, similar to the general population.

• Drug Use: The use of injected drugs and sharing needles or syringes represent significant risk factors for HBV infection, not only among veterans but in the general population as well.

VA Disability Rating for Hepatitis B

The VA rates Hepatitis B under the new DC 7345 for chronic liver disease without cirrhosis, and has ratings that range from 0% to 100% with breaks at 20%, 40%, and 60%.

100% VA Rating for Hepatitis B

Progressive chronic liver disease requiring use of both parenteral antiviral therapy (direct antiviral agents), and parenteral immunomodulatory therapy (interferon and other); and for six months following discontinuance of treatment.

Detailed Explanation of the 100 Percent VA Rating Criteria

The 100% rating criteria for Hepatitis B is reserved for the most severe cases and applies as follows:

• Progressive Chronic Liver Disease: This indicates that the Hepatitis B infection has progressed to a chronic stage, meaning it is long-lasting and ongoing. Chronic Hepatitis B can lead to liver damage over time.

• Parenteral Antiviral Therapy (Direct Antiviral Agents): “Parenteral” means administered in a way other than through the digestive system, often through injections or intravenous (IV) infusions. “Antiviral therapy” refers to medication used to treat viral infections, in this case, Hepatitis B. “Direct antiviral agents” are medications that directly target the virus, inhibiting its replication and reducing its presence in the body.

• Parenteral Immunomodulatory Therapy (Interferon and Other): Similar to antiviral therapy, this refers to medications administered through injections or IV that modulate or modify the immune response. “Interferon” is a type of protein naturally produced by the body’s immune system to fight viruses. In the context of Hepatitis B treatment, it’s used to enhance the immune response against the virus.

• For Six Months Following Discontinuance of Treatment: This indicates that the veteran must continue to meet the criteria for the 100% VA rating for six months after stopping treatment. This suggests that even after treatment, the condition may persist or continue to affect the veteran’s health significantly.

60% VA Rating for Hepatitis B

Progressive chronic liver disease requiring continuous medication and causing substantial weight loss and at least two of the following: (1) daily fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, (5) pruritus, and (6) arthralgia.

Detailed Explanation of the 60 Percent VA Rating Criteria

Here’s a breakdown of the rating criteria for the 60% disability rating for Hepatitis B:

• Progressive Chronic Liver Disease: Like the 100% rating criteria, this indicates that the Hepatitis B infection has progressed to a chronic stage, suggesting ongoing liver damage.

• Continuous Medication: This means the veteran requires ongoing medication to manage the condition, indicating that the Hepatitis B infection is not fully controlled and may require long-term treatment to manage symptoms and prevent complications.

• Substantial Weight Loss: This indicates significant weight loss, which may be due to various factors related to Hepatitis B, such as liver dysfunction, decreased appetite, or malabsorption of nutrients.

At Least Two of the Following: To qualify for the 60% VA rating criteria, the veteran must experience at least two of the following symptoms:

• Daily Fatigue: Persistent and debilitating fatigue experienced on a daily basis.

• Malaise: A general feeling of discomfort, illness, or unease.

• Anorexia: Loss of appetite or a decreased desire to eat, leading to reduced food intake.

• Hepatomegaly: Enlargement of the liver, which can be a sign of liver inflammation or damage.

• Pruritus: Itching, often related to liver dysfunction and bile accumulation.

• Arthralgia: Joint pain, which may be associated with systemic symptoms of the disease or as a side effect of medication.

40% VA Rating for Hepatitis B

Progressive chronic liver disease requiring continuous medication and causing minor weight loss and at least two of the following: (1) daily fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, (5) pruritus, and (6) arthralgia.

Detailed Explanation of the 40 Percent VA Rating Criteria

The 40% rating criteria includes the following:

• Progressive Chronic Liver Disease: Similar to the 100% and 60% rating criteria, this term indicates that the Hepatitis B infection has advanced to a chronic stage, suggesting ongoing liver damage and disease progression.

• Continuous Medication: This implies that the veteran requires ongoing medication to manage the condition, suggesting that the Hepatitis B infection is not fully controlled and may necessitate long-term treatment to alleviate symptoms and prevent complications.

• Minor Weight Loss: This indicates that the veteran experiences some degree of weight loss due to the Hepatitis B infection, but the weight loss is not as significant as in cases with higher VA ratings.

At Least Two of the Following: To qualify for the 40% VA rating, the veteran must experience at least two of the following symptoms:

• Daily Fatigue: Persistent tiredness or exhaustion experienced on a daily basis.

• Malaise: A general feeling of discomfort, unease, or mild illness.

• Anorexia: Reduced appetite or diminished desire to eat, which may result in decreased food intake.

• Hepatomegaly: Enlargement of the liver, which can indicate liver inflammation or damage.

• Pruritus: Itching, often associated with liver dysfunction and bile accumulation.

• Arthralgia: Joint pain, which may be linked to systemic symptoms of the disease or medication side effects.

20% VA Rating for Hepatitis B

Chronic liver disease with at least one of the following: (1) intermittent fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, or (5) pruritus.

Detailed Explanation of the 20 Percent VA Rating Criteria

The 20% rating criteria should be applied as follows:

• Chronic Liver Disease: This indicates that the veteran has developed long-term liver disease as a result of Hepatitis B infection. Chronic liver disease refers to ongoing liver damage and dysfunction.

At Least One of the Following Symptoms: To qualify for the 20% VA rating, the veteran must experience at least one of the specified symptoms:

• Intermittent Fatigue: Periodic episodes of tiredness or exhaustion, which may not be persistent but occur from time to time.

• Malaise: A general feeling of discomfort, unease, or mild illness.

• Anorexia: Reduced appetite or diminished desire to eat, potentially leading to decreased food intake.

• Hepatomegaly: Enlargement of the liver, which can indicate inflammation or damage to the liver.

• Pruritus: Itching, often associated with liver dysfunction and bile accumulation.

0% VA Rating for Hepatitis B

Previous history of liver disease, currently asymptomatic rate at 0%

Detailed Explanation of the 0 Percent Non-Compensable VA Rating Criteria

The 0% rating for Hepatitis B indicates that there is a previous history of liver disease, but the veteran doesn’t have symptoms.

Here’s a summary:

• Previous History of Liver Disease: This suggests that the veteran has had Hepatitis B in the past, which has caused liver disease. This could mean that they have had inflammation or damage to the liver due to the Hepatitis B infection.

• Currently Asymptomatic: “Asymptomatic” means the veteran is not experiencing any symptoms related to their Hepatitis B infection at the time of evaluation. This could mean that they have undergone treatment or that the infection is in a dormant state, not actively causing any liver-related symptoms or complications.

Note (#1): 100% evaluation shall continue for six months following discontinuance of parenteral antiviral therapy and administration of parenteral immunomodulatory drugs. Six months after discontinuance of parenteral antiviral therapy and parenteral immunomodulatory drugs, determine the appropriate disability rating by mandatory VA exam. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination.

Note (#2): For veterans for whom physicians recommend both parenteral antiviral therapy and parenteral immunomodulatory drugs, but for whom treatment is medically contraindicated, rate according to DC 7312 (Cirrhosis of the liver).

Note (#3): This diagnostic code includes Hepatitis B (confirmed by serologic testing), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune liver disease, Wilson’s disease, Alpha-1-antitrypsin deficiency, hemochromatosis, drug-induced hepatitis, and non-alcoholic steatohepatitis (NASH). Track Hepatitis C (or non-A, non-B hepatitis) under DC 7354 but evaluate it using the criteria in this entry.

Note (#4): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (See § 4.14)

What If I Already Have VA Disability for Hepatitis B?

If you already have VA disability for Hepatitis B, there will be no change to your current VA disability rating; you are “grandfathered” in under the old rating criteria.

A reduction in your rating will only occur if there is improvement in a disability sufficient to warrant a reduction under the old criteria.

All VA claims related to these digestive systems that were submitted and in “pending” status as of May 19, 2024, will be considered under both the old and new rating criteria, and whichever criteria is more favorable to the veteran will be applied.

In summary, get your VA claim submitted ASAP!

Why?

Because the VA rater must consider both the old and new criteria and select the rating that’s most favorable to you.

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