Fatty Liver Disease and VA Disability Ratings

CCK Law: Our Vital Role in Veterans Law

What Is Fatty Liver Disease?

Fatty liver disease is a condition in which fat builds up in the liver, potentially leading to liver damage or the development of more severe diseases.

The liver is the largest organ inside the body and aids in digestion, energy storage, and removal of toxins. When it is damaged, it can have serious effects on a veteran’s health. There are two main types of this disease:

Nonalcoholic Fatty Liver Disease

Also called metabolic dysfunction-associated steatotic liver disease (MASLD), this is a type of fatty liver disease that is not related to heavy alcohol use.

It includes two further subtypes:

• Simple fatty liver–You have fat in your liver but little or no inflammation or liver cell damage. This subtype does not usually get severe enough to cause liver damage or complications.
• Nonalcoholic steatohepatitis–You have inflammation and liver cell damage, as well as fat in your liver. Here, inflammation and liver cell damage can cause scarring of the liver. This subtype may lead to cirrhosis or liver cancer.

Alcoholic Fatty Liver Disease

This type is due to heavy alcohol use and consumption. Specifically, the body’s process of breaking down alcohol can generate harmful substances, which then damage liver cells, promote inflammation, and weaken your body’s natural defenses.

If alcoholic fatty liver disease progresses, it typically results in alcoholic hepatitis and cirrhosis.

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Is Nonalcoholic Fatty Liver Disease Common Among Veterans?

Yes, nonalcoholic fatty liver disease is fairly common among veterans. One 2023 study determined that, of a sample population of veterans receiving primary care through VA, about 40 percent could be diagnosed with the disease, with 10 percent suffering from some sort of liver scarring or damage.

The study hypothesizes that these high rates of liver disease are due to the prevalence of conditions like diabetes and obesity among veterans.

Rates of nonalcoholic fatty liver disease also seem to be rising among service members. One 2019 study concluded that, between 2000 and 2017, the incidence of this disease among active duty military service members increased from 12.6 cases per 100,000 person per year to 152.8 cases.

The overall rate of incidence among male service members was more than 1.5 times the rate among female service members. Overall incidence rates increased with advancing age and were highest among military personnel 50 years or older.

This is significant because service members with severe nonalcoholic fatty liver disease resulting in impaired liver function are unable to perform their military duties and are disqualified from service. The repercussions of this increase could be serious and have a profound effect on both VA and the Veterans Health Administration.

How Do I Prove Service Connection?

To prove service connection, veterans must provide evidence of the following to VA:

• A current diagnosis of fatty liver disease;
• An in-service event, injury, or illness related to the disease; and
• A medical nexus linking the current diagnosis to the in-service event, injury, or illness.

An example of this in action might resemble the following:

• Say a veteran underwent a medical examination during service and was noted to have high cholesterol. The medical personnel then prescribed the veteran an oral medication to help lower bad cholesterol and fats and raise good cholesterol.
• However, the medication had an adverse effect, eventually causing the veteran to develop fatty liver disease, for which they receive an official diagnosis from their doctor.
• Here, the veteran may be qualified for service connection because their condition resulted from the medication prescribed during service, which would count as an in-service event.
• Finally, the veteran would likely need to attend a Compensation & Pension examination for a VA examiner to provide a nexus opinion.

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How Does VA Rate Fatty Liver Disease?

Once service connection is established, VA will provide a disability rating depending on the severity of the condition. VA rates fatty liver disease under 38 CFR § 4.114, Schedule of Ratings – Digestive System, Diagnostic Code (DC) 7345. This DC applies to any chronic liver disease that does not include cirrhosis. The evaluations are as follows:

• 100 percent – “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”
• 60 percent – “Progressive chronic liver disease requiring continuous medication and causing substantial weight loss and at least two of the following:
  • Daily fatigue
  • Malaise
  • Anorexia
  • Hepatomegaly
  • Pruritus
  • Arthralgia”
• 40 percent – “Progressive chronic liver disease requiring continuous medication and causing minor weight loss and at least two of the following:
  • Daily fatigue
  • Malaise
  • Anorexia
  • Hepatomegaly
  • Pruritus
  • Arthralgia
• 20 percent – “Chronic liver disease with at least one of the following:
  • Intermittent fatigue
  • Malaise
  • Anorexia
  • Hepatomegaly
  • Pruritus”
• 0 percent – “Previous history of liver disease, currently asymptomatic”

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