What is the Fatty Liver VA Rating?

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The VA rates fatty liver disease, also known as hepatic steatosis, under 38 CFR § 4.114, Diagnostic Code 7345, with ratings ranging from 10% to 100%, with breaks at 20%, 40%, and 60%.

The rating factors include the severity of symptoms such as fatigue, malaise, and anorexia, as well as the need for dietary restrictions, medication, or hospitalization.

Your final VA disability rating for fatty liver 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 about more VA digestive system ratings and review the VA Disability Ratings Guide.  

Pro Tip: The VA considers both Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease (AFLD) under this diagnostic code, evaluating them based on similar criteria for liver damage and functional impairment.

Summary of Key Points

• VA Rating for Fatty Liver Disease: As of May 19, 2024, the VA rates fatty liver disease under 38 CFR § 4.114, Diagnostic Code 7345. The ratings range from 10% to 100%, with specific breaks at 20%, 40%, and 60%, based on the frequency, severity, and duration of symptoms.

• Other Rating Factors: The VA considers the severity of symptoms such as fatigue, malaise, anorexia, and the need for dietary restrictions, medication, or hospitalization when determining the appropriate rating for fatty liver disease.

• Functional Impairment: The final VA disability rating for fatty liver disease depends on how the symptoms affect the veteran’s daily life, work, and social functioning, taking into account the frequency, severity, and duration of these symptoms.

What is Fatty Liver Disease?

Fatty Liver Disease, also known as hepatic steatosis, is a condition where excess fat builds up in the liver.

This buildup can lead to liver inflammation and damage, affecting liver function.

Types of Fatty Liver Disease

Here’s the two types of fatty liver disease explained:

#1. Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD occurs in individuals who drink little to no alcohol.

It’s one of the most common liver diseases globally, particularly in Western countries.

• Simple Fatty Liver (Steatosis): This is the initial stage where there is fat accumulation in the liver cells without significant inflammation or liver damage.

• Non-Alcoholic Steatohepatitis (NASH): A more severe form of NAFLD, NASH involves liver inflammation and damage, which can lead to fibrosis (scarring) and cirrhosis (severe scarring and liver failure).

Risk Factors for NAFLD:

• Obesity

• Type 2 diabetes

• Insulin resistance

• High cholesterol and triglycerides

• Metabolic syndrome

• Poor diet and lack of physical activity

#2. Alcoholic Fatty Liver Disease (AFLD)

AFLD is caused by heavy alcohol consumption.

It ranges from simple fatty liver to more severe liver damage.

• Alcoholic Steatosis: The early stage of liver damage from alcohol, characterized by fat accumulation in liver cells.

• Alcoholic Hepatitis: Inflammation of the liver due to excessive alcohol intake, which can range from mild to severe.

• Alcoholic Cirrhosis: Severe scarring of the liver due to long-term alcohol abuse, leading to liver failure and other complications.

Risk Factors for AFLD:

• Heavy alcohol consumption

• Genetic predisposition

• Poor diet

• Obesity

Pro Tip: The VA disability system has specific criteria for when alcohol abuse can be service connected so long as it’s not due to a veteran’s own willful misconduct.

Fatty Liver Disease Risk Factors in Military Veterans

Military veterans face unique risk factors for developing fatty liver disease due to their service-related experiences and lifestyle.

Here are some of the primary risk factors to be aware of:

1. High Alcohol Consumption

• Prevalence: Veterans may have higher rates of alcohol consumption due to the stress and trauma associated with military service, leading to an increased risk of Alcoholic Fatty Liver Disease (AFLD)​.

2. Obesity

• Weight Management: The transition from active duty to civilian life can lead to lifestyle changes, including reduced physical activity, contributing to obesity, which is a major risk factor for Non-Alcoholic Fatty Liver Disease (NAFLD)​​. Although weight gain and obesity can’t get their own VA rating, they can be used as an interim link to service connection.

3. Diabetes and Metabolic Syndrome

• Prevalence of Diabetes: Veterans are more likely to develop type 2 diabetes and metabolic syndrome due to various factors, including physical inactivity, poor diet, and the stress associated with military service, all of which are risk factors for NAFLD​​.

4. Medications

• Medication Use: Many veterans are prescribed medications for service-related conditions, some of which can have hepatotoxic effects, contributing to liver damage and fatty liver disease​.

5. Stress and Mental Health Conditions

• PTSD and Depression: Chronic stress, PTSD, and depression are prevalent among veterans, and these conditions can lead to lifestyle choices that increase the risk of fatty liver disease, such as poor diet, lack of exercise, and alcohol use​.

6. Poor Nutrition

• Diet: Access to nutritious food may be limited during deployment, leading to poor dietary habits that can persist post-service, contributing to the risk of fatty liver disease​.

7. Inactivity

• Reduced Physical Activity: The transition to civilian life often results in reduced physical activity levels, which can contribute to obesity and fatty liver disease​​.

What is the VA Rating for Fatty Liver?

As of May 19, 2024, the VA rates fatty liver disease, also called hepatic steatosis, under 38 CFR § 4.114, Diagnostic Code (DC) 7345, with ratings from 10% to 100% based on the severity and frequency of symptoms.

The ratings include breaks at 20%, 40%, and 60%, considering factors such as fatigue, malaise, anorexia, and the impact on daily functioning and overall health.

Read about the 2024 updates for digestive system VA rating changes.

DC 7345, Chronic liver disease without cirrhosis:

• 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 rate at 100%

• 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 rate at 60%

• 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 rate at 40%

• Chronic liver disease with at least one of the following: (1) intermittent fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, or (5) pruritus rate at 20%

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

Note (1): The 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 individuals 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)

Explanation of Terms:

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 rate at 100%:

• This category involves severe chronic liver disease that necessitates the use of both antiviral and immunomodulatory therapies administered intravenously. The individual receives a 100% rating during the treatment period and for six months after treatment cessation.

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 rate at 60%:

• This classification denotes chronic liver disease that leads to significant weight loss and at least two accompanying symptoms such as fatigue, malaise, loss of appetite, enlarged liver, itching, or joint pain. It warrants a 60% disability rating.

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 rate at 40%:

• In this category, chronic liver disease results in minor weight loss and two or more associated symptoms, leading to a 40% disability rating.

Chronic liver disease with at least one of the following: (1) intermittent fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, or (5) pruritus rate at 20%:

• Individuals experiencing intermittent fatigue, malaise, loss of appetite, enlarged liver, or itching due to chronic liver disease receive a 20% disability rating.

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

• Individuals with a past history of liver disease but currently without symptoms are rated at 0% disability.

Conclusion

Fatty liver disease can significantly impact a veteran’s health, energy levels, and overall quality of life, especially as symptoms progress and liver damage worsens over time. Under Diagnostic Code 7345, the VA evaluates fatty liver disease based on symptom severity, weight loss, medication requirements, and how the condition affects daily functioning and overall health.

Veterans dealing with chronic fatigue, malaise, abdominal symptoms, liver enlargement, nutritional issues, or related complications should make sure their medical evidence clearly documents the progression and functional impact of the condition. Strong medical records, lab testing, imaging studies, and physician statements can help support a higher VA disability rating for fatty liver disease, including both NAFLD and AFLD.

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