Reviewed by Jonathan Teplitsky · Updated September 2026 · Informational only — not legal or medical advice; Rank and Pay is not affiliated with the VA.
The Department of Veterans Affairs (VA) evaluates chronic liver conditions under Diagnostic Code (DC) 7345, assigning a fatty liver disease VA rating from 0 percent to 100 percent based on symptoms, weight loss, and required therapies. Evaluating a claim requires examining specific diagnostic criteria, clinical classifications, and the symptoms documented in service treatment records.
Clinical Classification of MASLD and Fatty Liver Disease
In June 2023, a multi-society clinical consensus endorsed by the American Association for the Study of Liver Diseases (AASLD) and international liver organizations updated the medical terminology for liver steatosis. The consensus renamed nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). It also renamed nonalcoholic steatohepatitis (NASH) to metabolic dysfunction-associated steatohepatitis (MASH).
This updated naming convention directly links the hepatic condition to underlying metabolic risk factors. These factors include type 2 diabetes mellitus, obesity, hypertension, and abnormal lipid levels. Older service treatment records, VA medical files, and Compensation and Pension (C&P) examination reports often use the terms NAFLD or NASH.
Both terms describe the same pathology. When excess fat accumulates in liver cells, the condition can remain stable or advance toward chronic inflammation and fibrosis. Because early stages produce few symptoms, veterans often discover the condition during routine blood panels or abdominal imaging for unrelated health concerns.
Rating Criteria for Fatty Liver Disease Under DC 7345
Under the digestive system rating schedule established in 38 CFR § 4.114, the VA evaluates chronic liver disease without cirrhosis under Diagnostic Code 7345. Disability percentages under DC 7345 depend on whether the liver condition is stable or progressive, the presence of specific constitutional symptoms, and the intensity of required treatment.
The VA rating schedule outlines five distinct disability tiers under DC 7345:
- 0 percent rating: Assigned when a veteran has a documented history of liver disease but is currently asymptomatic.
- 20 percent rating: Assigned for chronic liver disease presenting with at least one symptom such as intermittent fatigue, malaise, anorexia, hepatomegaly (liver enlargement), or pruritus (severe itching).
- 40 percent rating: Assigned for progressive chronic liver disease that requires continuous medication and causes minor weight loss, accompanied by at least two symptoms including daily fatigue, malaise, anorexia, hepatomegaly, pruritus, or arthralgia (joint pain).
- 60 percent rating: Assigned when progressive chronic liver disease meets the 40 percent symptom and continuous medication criteria, but causes substantial weight loss.
- 100 percent rating: Assigned for progressive chronic liver disease that requires both parenteral antiviral therapy and parenteral immunomodulatory therapy. This maximum evaluation continues during active treatment and persists for six months after therapy ceases.
To secure a compensable rating of 20 percent or higher, medical records must corroborate specific constitutional symptoms in addition to laboratory findings. A veteran managing mild steatosis without symptoms receives a non-compensable 0 percent evaluation. A 0 percent rating provides no monthly cash benefit, but it establishes formal service connection and grants access to VA healthcare for the condition.
Evaluating Cirrhosis Under DC 7312 and Pyramiding Restrictions
When chronic inflammation causes irreversible scarring, fatty liver disease can advance to cirrhosis of the liver, which the VA rates under Diagnostic Code 7312. DC 7312 evaluates liver impairment using the Model for End-Stage Liver Disease (MELD) score or objective clinical manifestations of hepatic failure.
The disability schedule under DC 7312 includes five evaluation levels based on laboratory scoring or objective symptoms:
- 0 percent rating: Asymptomatic with a history of liver disease.
- 10 percent rating: A MELD score greater than 6 but less than 10, or clinical evidence of anorexia, weakness, abdominal pain, or malaise.
- 30 percent rating: A MELD score of 10 or 11, or clinical signs of portal hypertension such as splenomegaly or ascites combined with weakness, anorexia, abdominal pain, or malaise.
- 60 percent rating: A MELD score greater than 11 but less than 15, or daily fatigue accompanied by at least one episode in the past year of variceal hemorrhage, portal gastropathy, or hepatic encephalopathy.
- 100 percent rating: A MELD score of 15 or greater, or continuous daily debilitating symptoms and generalized weakness accompanied by at least one complication such as ascites, a history of spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, coagulopathy, portal gastropathy, or hepatopulmonary or hepatorenal syndrome.
Pyramiding is prohibited. Under 38 CFR § 4.114, the VA forbids combining ratings under DC 7301 through 7329, 7331, 7342, 7345 through 7350, 7352, and 7355 through 7357 with each other. The adjudicator must assign a single evaluation under whichever code reflects the predominant disability picture, elevated to the next higher evaluation if the overall severity warrants it.
Veterans tracking combined ratings across different body systems can calculate their combined disability using the VA disability rating calculator. Other digestive system evaluations are outlined in the guide to gastrointestinal conditions.
Presumptive Status and Toxic Exposure Rules for Liver Conditions
Fatty liver disease is not on the VA list of presumptive conditions associated with herbicide agents such as Agent Orange. The official registry published on the VA Public Health Agent Orange conditions list identifies only one liver condition: Porphyria Cutanea Tarda. Porphyria Cutanea Tarda is a disorder of porphyrin metabolism and skin fragility. That condition is distinct from hepatic steatosis.
Veterans who served in qualifying locations covered by Agent Orange exposure or the PACT Act presumptive conditions list cannot claim fatty liver disease under an automatic statutory presumption. A claim based solely on environmental exposure will be denied without a direct medical nexus. Service connection requires either direct evidence linking the condition to military service or secondary connection to an already service-connected disability.
Direct connection requires three elements. These elements include an in-service injury or illness, a current medical diagnosis of MASLD, and a medical nexus linking the two. Because in-service documentation of liver disease is rare, most successful claims proceed through secondary service connection.
Establishing a Fatty Liver Disease VA Rating Through Secondary Service Connection
The most frequent path to establishing a fatty liver disease VA rating is filing a secondary claim linked to service-connected type 2 diabetes mellitus. Type 2 diabetes is recognized as a presumptive condition for veterans with documented Agent Orange exposure. Metabolic dysfunction associated with diabetes is an established clinical driver in the development and acceleration of hepatic steatosis.
Under VA disability rules, a secondary condition is an illness caused or aggravated by a primary service-connected disability. When insulin resistance, hyperglycemia, and altered lipid metabolism from type 2 diabetes lead directly to hepatic fat storage, the resulting liver disease qualifies under secondary conditions guidelines. The veteran must substantiate this relationship with an objective medical nexus opinion.
A private physician or specialist must prepare the medical nexus opinion. The medical professional reviews the service records and medical history to state whether it is at least as likely as not that diabetes caused or aggravated the liver steatosis. Veterans can review the nexus letter guide for detailed instructions on obtaining medical opinions that satisfy VA evidentiary thresholds.
Gathering Objective Medical Evidence for a Claim
Filing a claim for fatty liver disease requires objective diagnostic imaging and laboratory testing that confirm chronic hepatic involvement. Abdominal ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI), or transient elastography (FibroScan) establish the physical presence of steatosis. Blood panels with elevated alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels help substantiate chronic hepatic inflammation.
Records must also document ongoing clinical treatment and specific constitutional symptoms. Veterans seeking a rating of 40 percent or higher must submit pharmacy records showing continuous prescribed medication and clinical charts documenting weight loss. A personal symptom log that tracks daily fatigue, malaise, itching, or joint pain provides vital corroborating evidence during the C&P examination.
Veterans preparing a claim can review their medical records for continuous medication use and symptom logs before filing for a fatty liver disease va rating.
This page is informational only and is not legal or medical advice. Rank and Pay is not affiliated with the Department of Veterans Affairs. Rating criteria are summarized from 38 CFR Part 4; for your specific claim, consult the VA, an accredited Veterans Service Officer (VSO), or an accredited attorney.