Diagnostic Code 7354 · 38 CFR §4.114
Hepatitis C is a blood-borne viral infection that attacks the liver, causing inflammation that can progress over years to fibrosis, cirrhosis, and liver cancer. It is one of the most common chronic infections among Vietnam-era veterans. The VA rates hepatitis C under DC 7354 based on your symptoms and incapacitating episodes — not on the virus itself — so two veterans with the same diagnosis can be rated very differently depending on how the infection affects them. An important wrinkle: modern direct-acting antiviral drugs now cure more than 95 percent of cases, and the VA provides this treatment. A cure can clear the active infection and lower the DC 7354 rating, but any liver damage already done — fibrosis or cirrhosis — is permanent and is rated separately. So a cured veteran is often still entitled to compensation for the residual damage.
| Rating | Criteria |
|---|---|
| 0% | Nonsymptomatic — no current signs or symptoms of active hepatitis C infection. If the virus has been cured but left liver damage behind, that damage is rated separately (for example, cirrhosis under DC 7312) rather than at 0%. |
| 10% | Intermittent fatigue, malaise, and anorexia (loss of appetite); or incapacitating episodes — periods of acute symptoms severe enough to require bed rest prescribed by a physician — having a total duration of at least one week but less than two weeks in the past 12 months. |
| 20% | Daily fatigue, malaise, and anorexia, without weight loss or an enlarged liver (hepatomegaly), requiring dietary restriction or continuous medication; or incapacitating episodes totaling at least two weeks but less than four weeks in the past 12 months. |
| 40% | Daily fatigue, malaise, and anorexia with minor weight loss (a 10 to 20 percent loss of baseline weight sustained three months or more) and an enlarged liver (hepatomegaly); or incapacitating episodes totaling at least four weeks but less than six weeks in the past 12 months. |
| 60% | Daily fatigue, malaise, and anorexia with substantial weight loss (more than 20 percent of baseline weight, sustained three months or more) or other signs of malnutrition, and an enlarged liver; or incapacitating episodes totaling at least six weeks in the past 12 months, though not occurring constantly. |
| 100% | Near-constant debilitating symptoms — fatigue, malaise, nausea, vomiting, anorexia, joint pain (arthralgia), and right-upper-quadrant pain — due to the hepatitis C infection. |
A diagnosis confirmed by serologic testing — a positive hepatitis C antibody test plus a viral load (HCV RNA) test. Lab work over time and, if there is liver damage, imaging (FibroScan or ultrasound) or a biopsy. For the rating itself, the most useful evidence documents your symptoms and any incapacitating episodes — periods of acute symptoms severe enough that a physician ordered bed rest — because those are scored by their total duration over the year. For service connection, you need evidence of an in-service risk factor (jet-injector immunizations, a blood transfusion before 1992, combat blood exposure, or similar) plus a nexus opinion. If you have been cured, gather evidence of any residual liver damage so it can be rated on its own.
Yes. The military used multi-use jet (air gun) injectors for mass immunizations, and the VA recognizes them as a plausible way blood-borne infections like hepatitis C could have spread. For many veterans with no other risk factor, the jet-injector theory — supported by a nexus opinion — is the basis for service connection.
Yes, if the virus caused liver damage before it was cleared. The active-infection symptoms may resolve after a cure, which can lower the DC 7354 rating, but fibrosis and cirrhosis are permanent and are rated separately under their own diagnostic codes.
For hepatitis C, an incapacitating episode is a period of acute symptoms severe enough that a physician prescribed bed rest. The VA adds up the total duration of these episodes over the past 12 months: at least one week supports 10%, two weeks 20%, four weeks 40%, and six weeks 60%.
No. Hepatitis C is not on any presumptive list, so the VA will not assume your service caused it. You must identify an in-service risk factor and provide a nexus opinion linking it to your infection.
Separately, under DC 7312, based on complications such as ascites, hepatic encephalopathy, variceal bleeding, and weight loss. Because of anti-pyramiding rules, the same symptom cannot be counted under both the hepatitis C code and the cirrhosis code, so the two are rated on their distinct features.
The VA defines minor weight loss as a 10 to 20 percent loss of your baseline weight sustained for three months or more, and substantial weight loss as more than 20 percent. Baseline is your average weight over the two years before the disease began.
Yes. Hepatitis C is linked to extrahepatic conditions such as type-2 diabetes, cryoglobulinemia, porphyria cutanea tarda, certain B-cell lymphomas, and kidney disease (glomerulonephritis). If you are service-connected for hepatitis C, these may be claimed as secondary conditions with a nexus opinion.