What Is Chronic Liver Disease?

Chronic liver disease is an umbrella term that encompasses multiple conditions that affect the liver. The most common causes of liver disease include viruses, genetics, excessive alcohol use, poor diet, and reactions to medications or toxic chemicals. Most liver diseases damage the liver in similar ways, so that the progression of the illness looks similar regardless of the underlying condition causing the disease. Given the importance of the liver’s functions in the body, early detection is key for successful treatment and preventing the development of additional comorbidities that can result from extensive liver damage.

Many people do not look or feel sick when they have liver disease until the disease has advanced significantly, which can complicate efforts for early detection. At a certain point in the progression of liver disease, the damage can become irreversible and lead to liver failure, at which point many people join a waitlist for a liver transplant. In the United States, there are currently over eleven thousand individuals awaiting liver transplants. 

For veterans, chronic liver disease often results from other conditions, such as mental health disorders or toxic chemical exposure. One of the most common risk behaviors for chronic liver disease, which is alcohol abuse, is present in a growing number of veteran populations. Between 60 and 80 percent of Vietnam veterans with PTSD also have alcohol abuse disorder, and around 22 percent of Operation Enduring Freedom and Operation Iraqi Freedom veterans with PTSD also have a substance use disorder. Studies have shown that exposure to trauma is a major contributor to the development of alcohol abuse disorder, so it is not a surprise to see that a growing number of veterans are developing issues with alcohol abuse, and subsequently receiving diagnoses of liver disease.

How The VA Rates Chronic Liver Disease

Chronic liver disease has several levels of progression, typically beginning with inflammation (hepatitis), progressing to fibrosis (scarring) and then cirrhosis (severe scarring), and then sometimes becoming liver cancer. Under 38 CFR § 4.114, the VA uses one of two different rating schedules to evaluate chronic liver disease, depending on whether the veteran under evaluation has cirrhosis or not.

Diagnostic Code 7312: Cirrhosis of the liver, primary biliary cirrhosis, or cirrhotic phase of sclerosing cholangitis:

  • 100 – Generalized weakness, substantial weight loss, and persistent jaundice, or; with one of the following refractory to treatment: ascites, hepatic encephalopathy, hemorrhage from varices or portal gastropathy (erosive gastritis)
  • 70 – History of two or more episodes of ascites, hepatic encephalopathy, or hemorrhage from varices or portal gastropathy (erosive gastritis), but with periods of remission between attacks
  • 50 – History of one episode of ascites, hepatic encephalopathy, or hemorrhage from varices or portal gastropathy (erosive gastritis)
  • 30 – Portal hypertension and splenomegaly, with weakness, anorexia, abdominal pain, malaise, and at least minor weight loss
  • 10 – Symptoms such as weakness, anorexia, abdominal pain, and malaise

For evaluation under diagnostic code 7312, documentation of cirrhosis (by biopsy or imaging) and abnormal liver function tests must be present.

Diagnostic Code 7345: Chronic liver disease without cirrhosis (including hepatitis B, chronic active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis, etc., but excluding bile duct disorders and hepatitis C)

  • 100 – Near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)
  • 60 – Daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly
  • 40 – Daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period
  • 20 – Daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period
  • 10 – Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period
  • 0 – Nonsymptomatic

For VA purposes of evaluating conditions under diagnostic code 7345, an “incapacitating episode” means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Hepatitis B infection must be confirmed by serologic testing in order for the VA to evaluate it under diagnostic code 7345.

Get Help With Your Chronic Liver Disease Claim

If you or someone you know is a veteran with chronic liver disease who is looking for assistance with his or her VA claim, please contact our office today. Our experienced veterans disability attorneys are ready to help.