Back to BVA DecisionsMIXEDService Branch ARMY Special Benefit NO SPECIAL BENEFIT Diagnostic Code 7312 Docket No. 251105-592200
CIRRHOSIS OF LIVER
M. HYLAND · 2026 · Case ID: A26020856
Summary
The veteran, who served in the United States Army from October 1969 to September 1971 and again from December 1990 to June 1991, appeals a May 2025 rating decision. The veteran sought an initial 100 percent disability rating for cirrhosis of the liver and a compensable rating for hepatitis C. The Board reviewed evidence including VA examinations, private treatment records, and a private DBQ. For cirrhosis of the liver, the Board found the evidence supported a 100 percent rating based on a Model for End-Stage Liver Disease score of 22, continuous daily debilitating symptoms, generalized weakness, ascites, hepatic encephalopathy, and hepatorenal syndrome, resolving reasonable doubt in the veteran's favor. For hepatitis C, the Board denied a compensable rating, finding that the symptoms documented in the private records and DBQ overlapped with those already compensated under the 100 percent rating for cirrhosis of the liver, and thus, a separate rating was not warranted. The Board noted that the evidence was not in approximate balance, making the benefit of the doubt doctrine inapplicable to the hepatitis C claim.
Rationale
100 percent rating warranted per DC 7312; MELD score of 22; Continuous daily debilitating symptoms, generalized weakness, ascites, hepatic encephalopathy, hepatorenal syndrome; Benefit of the doubt resolved in veteran's favor
Full Decision Text
Citation Nr: A26020856 Decision Date: 03/09/26 Archive Date: 03/09/26 DOCKET NO. 251105-592200 DATE: March 9, 2026 ORDER Entitlement to an initial 100 percent disability rating for cirrhosis of the liver is granted. Entitlement to a compensable disability rating for hepatitis C is denied. FINDINGS OF FACT 1. The Veteran's cirrhosis of the liver has been manifested by continuous daily debilitating symptoms and generalized weakness with ascites, hepatic encephalopathy, and hepatorenal syndrome; and Model for End-Stage Liver score of 22. 2. The Veteran's hepatitis C symptoms are duplicative of the symptoms contemplated by the rating assigned for his service-connected cirrhosis of the liver. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial 100 percent disability rating for cirrhosis of the liver have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, Diagnostic Code 7312. 2. The criteria for entitlement to a compensable disability rating for hepatitis C have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.14, 4.114, Diagnostic Code 7345. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1969 to September 1971 and from December 1990 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) from a May 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the November 5, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the May 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 1. Entitlement to an initial 100 percent disability rating for cirrhosis of the liver is granted. Service connection for cirrhosis of the liver was granted in a May 2025 rating decision, with a 10 percent rating assigned, effective April 17, 2025. 38 C.F.R. § 4.114, Diagnostic Code 7312. Under Diagnostic Code 7312, a noncompensable rating is warranted for asymptomatic cirrhosis of the liver, but with a history of liver disease. Id. A 10 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score greater than 6 but less than 10; or with evidence of either anorexia, weakness, abdominal pain, or malaise. Id. A 30 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score in a May 2025 rating decision, with a 10 percent rating assigned, effective April 17, 2025. 38 C.F.R. § 4.114, Diagnostic Code 7312. Under Diagnostic Code 7312, a noncompensable rating is warranted for asymptomatic cirrhosis of the liver, but with a history of liver disease. Id. A 10 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score greater than 6 but less than 10; or with evidence of either anorexia, weakness, abdominal pain, or malaise. Id. A 30 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score of 10 or 11; or with signs of portal hypertension such as splenomegaly or ascites (fluid in the abdomen) and either weakness, anorexia, abdominal pain, or malaise. Id. A 60 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score greater than 11 but less than 15; or with daily fatigue and at least one episode in the last year of either (1) variceal hemorrhage, or (2) portal gastropathy or hepatic encephalopathy. Id. A maximum 100 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score greater than or equal to 15; or with continuous daily debilitating symptoms, generalized weakness and at least one of the following: (1) ascites (fluid in the abdomen), or (2) a history of spontaneous bacterial peritonitis, or (3) hepatic encephalopathy, or (4) variceal hemorrhage, or (5) coagulopathy, or (6) portal gastropathy, or (7) hepatopulmonary or hepatorenal syndrome. Id. Note (3) associated with 38 C.F.R. § 4.114, Diagnostic Code 7312, directs to rate the condition based on symptomatology where the evidence does not contain a Model for End-Stage Liver Disease score. Upon review of the record, the Board finds that a 100 percent rating is warranted for the Veteran's service-connected cirrhosis of the liver. In April 2025, a VA examiner indicated that the Veteran had a diagnosis of cirrhosis of the liver with ascites. In support of his claim and within the appropriate evidentiary window, the Veteran submitted private treatment records and a disability benefits questionnaire (DBQ) in November 2025. The July 2025 private treatment records reveal the Veteran experienced complications of cirrhosis of the liver including, portal hypertension, acquired pancytopenia, encephalopathy, ascites, malnutrition of a moderate degree, and hepatorenal syndrome. In the August 2025 private DBQ, the clinician found that the Veteran's cirrhosis of the liver resulted in symptoms of weakness, generalized weakness, malaise, daily fatigue, abdominal pain, continuous daily debilitating symptoms, ascites, portal hypertension, hepatic encephalopathy, and hepatorenal syndrome. The Veteran's Model for End-Stage Liver Disease score was 22. The clinician noted that his findings were based on review of the Veteran's medical records and speaking with the Veteran's gastroenterologist. Based on the above and after resolving reasonable doubt in the Veteran's favor, the Board finds that a 100 percent rating is warranted for the Veteran's cirrhosis of the liver. As noted above, a 100 percent rating is warranted for liver disease with Model for End-Stage Liver Disease score greater than or equal to 15; or continuous daily debilitating symptoms, generalized weakness and either ascites (fluid in the abdomen), a history of spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, coagulopathy, portal gastropathy, hepatopulmonary or hepatorenal syndrome. Here, the evidence shows that the Veteran's Model for End-Stage Liver Disease score was 22. Additionally, the Veteran has continuous daily debilitating symptoms and generalized weakness along with ascites, hepatic encephalopathy, and hepatorenal syndrome. Accordingly, after resolving reasonable doubt in the Veteran's favor, the Board finds a 100 percent rating is warranted for the Veteran's service-connected cirrhosis of the liver. 2. Entitlement to a compensable disability rating for hepatitis C is denied. The Veteran seeks a compensable disability rating for his service-connected hepatitis C. The Veteran's hepatitis C is rated under Diagnostic Code 7354 which instructs VA to rate hepatitis C under Diagnostic Code 7345. See 38 C.F.R. § 4.114. Under Diagnostic Code 7345 (chronic liver disease Additionally, the Veteran has continuous daily debilitating symptoms and generalized weakness along with ascites, hepatic encephalopathy, and hepatorenal syndrome. Accordingly, after resolving reasonable doubt in the Veteran's favor, the Board finds a 100 percent rating is warranted for the Veteran's service-connected cirrhosis of the liver. 2. Entitlement to a compensable disability rating for hepatitis C is denied. The Veteran seeks a compensable disability rating for his service-connected hepatitis C. The Veteran's hepatitis C is rated under Diagnostic Code 7354 which instructs VA to rate hepatitis C under Diagnostic Code 7345. See 38 C.F.R. § 4.114. Under Diagnostic Code 7345 (chronic liver disease without cirrhosis), a noncompensable rating is warranted for a previous history of liver disease, currently asymptomatic. Id. A 20 percent rating is warranted for chronic liver disease with at least one of the following: (1) intermittent fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, or (5) pruritus. Id. A 40 percent rating is warranted for 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. Id. A 60 percent rating is warranted for 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. Id. The maximum 100 percent rating is warranted for 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. Id. 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.). Id. at Note (4). In April 2025, a VA examiner indicated that the Veteran has hepatitis C with a previous history of liver disease. The examiner noted no other signs or symptoms attributable to the Veteran's hepatitis C. In support of his claim and within the appropriate evidentiary window, the Veteran submitted private treatment records and a disability benefits questionnaire (DBQ) in November 2025. The July 2025 private treatment records reveal the Veteran chronic viral hepatitis C with malnutrition of a moderate degree and debility due to disease. In the August 2025 private DBQ, the clinician found that the Veteran experiences daily fatigue, malaise, hepatomegaly, arthralgia, and requires continuous medication due to his hepatitis C. The clinician further indicated that the Veteran is not a candidate for antiviral therapy and or parenteral immunomodulatory drugs due to the extent of his liver condition. The Board notes that the clinician's findings were based on review of the Veteran's medical records and speaking with the Veteran's gastroenterologist. Upon review of the record, the Board finds that a compensable disability rating is not warranted for the Veteran's hepatitis C. As noted above, the Veteran may not be compensated for the same symptoms twice, even if they are due to both his hepatitis C and cirrhosis of the liver. Here, the Veteran's hepatitis C symptoms shown on VA examination, private treatment records, and the private DBQ overlap with the symptoms contemplated in the 100 percent rating assigned for his service-connected cirrhosis of the liver. Therefore, a compensable rating is not warranted for the Veteran's hepatitis C, and the claim for an increased rating is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the competing evidence is not in approximate balance, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential an increased rating is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the competing evidence is not in approximate balance, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.