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Liver Cirrhosis

Severe scarring of the liver that prevents it from working properly. As of May 19, 2024, DC 7312 rates cirrhosis primarily on your Model for End-Stage Liver Disease (MELD) score, with an alternate symptom pathway at every level for cases where no MELD score is on file. For claims pending before May 19, 2024, the VA must apply whichever is more favorable: the new criteria or the old version.

Code: 7312
Criteria: 38 CFR 4.114, DC 7312
Exam length: ~30-45 minutes
Form: Liver Conditions DBQ

Rating steps

0%
10%
30%
60%
100%

The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.

What happens at the appointment

The examiner will review your cirrhosis diagnosis including the underlying cause (hepatitis, alcohol, NASH, autoimmune, toxic exposure), confirmatory testing, and current disease stage.
Lab work will be assessed including liver function tests, albumin, bilirubin, INR/PT, platelet count, and the Model for End-Stage Liver Disease (MELD) score to gauge disease severity.
The examiner will perform a physical examination looking for signs of advanced liver disease including jaundice, ascites, spider angiomas, palmar erythema, and hepatic encephalopathy.
Imaging studies (ultrasound, CT, MRI) and any liver biopsy results will be reviewed to document the extent of cirrhosis, portal hypertension, and any hepatocellular carcinoma screening.
Complications of cirrhosis will be evaluated, including esophageal varices, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, and coagulopathy.

What the examiner is actually filling in

01The examiner rates cirrhosis under DC 7312, which since May 19, 2024 steps primarily on the Model for End-Stage Liver Disease (MELD) score: above 6 = 10%, 10 or 11 = 30%, above 11 = 60%, and 15 or more = 100%. Each level also has a symptom pathway for cases with no MELD score on file, running from anorexia, weakness, abdominal pain or malaise at 10% up to continuous daily debilitating symptoms with ascites, spontaneous bacterial peritonitis, encephalopathy, variceal hemorrhage, coagulopathy, portal gastropathy, or hepatorenal syndrome at 100%.
02The examiner documents whether cirrhosis is compensated or decompensated and records any evidence of portal hypertension, ascites, encephalopathy, or variceal bleeding.
03Lab-based severity scoring (Child-Pugh, MELD) is used to objectively classify disease stage and is documented alongside clinical findings.
04Hospitalizations for cirrhosis complications over the past twelve months are recorded. "Incapacitating episodes" are no longer a DC 7312 criterion, but a variceal hemorrhage or an episode of hepatic encephalopathy in the last year is named at the 60% level, so the dates of those admissions matter.
05The functional impact statement addresses how cirrhosis affects cognitive function (encephalopathy), physical stamina (fatigue, muscle wasting), and the ability to maintain employment.

Rated under 38 CFR 4.114, DC 7312. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

Request updated labs within two weeks of your exam including a comprehensive metabolic panel, CBC, INR, and albumin — these directly determine your rating level.
If you experience even mild hepatic encephalopathy (forgetfulness, confusion, sleep-wake reversal), report it explicitly — this is a significant finding that supports higher ratings.
Document every paracentesis (ascites drainage) procedure with dates and volumes removed, as recurrent ascites requiring drainage indicates decompensated cirrhosis.
Report episodes of GI bleeding (hematemesis, melena) with dates and treatments, as variceal hemorrhage is a serious complication that supports the highest rating levels.
Describe the daily impact of fatigue and muscle wasting in functional terms: how far you can walk, how long you can stand, and what activities you can no longer perform.

What costs veterans points

Not describing the full spectrum of cirrhosis complications — encephalopathy, ascites, variceal bleeding, and coagulopathy each contribute to overall disability severity.
Underreporting hepatic encephalopathy symptoms because they can be subtle — confusion, difficulty concentrating, personality changes, sleep disturbances, and "brain fog" all count.
Failing to bring current lab work, which is essential for the examiner to calculate disease severity through MELD scoring and Child-Pugh classification.
Not connecting cirrhosis to its underlying cause when that cause is service-related, particularly for veterans with service-connected hepatitis or toxic exposure history.
Assuming compensated cirrhosis (no current complications) will not be rated — even compensated cirrhosis with abnormal labs and symptoms warrants a compensable rating.

The rating criteria, in plain language

Rating levels for Liver Cirrhosis under 38 CFR 4.114, DC 7312
Rating	Rating criteria	What that means for you
0%	Asymptomatic, but with a history of liver disease	You have a documented history of liver disease but no current symptoms.
0%	What supports this level Imaging, biopsy, or lab results confirming cirrhosis Current treatment notes showing no symptoms
10%	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	Your MELD score is above 6 and below 10, or you have anorexia, weakness, abdominal pain, or malaise.
10%	What supports this level Lab panel supporting a MELD score (bilirubin, INR, creatinine, sodium) Provider note recording the MELD score Symptom documentation
30%	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	Your MELD score is 10 or 11, or you have signs of portal hypertension such as an enlarged spleen or ascites, plus weakness, anorexia, abdominal pain, or malaise.
30%	What supports this level Imaging showing splenomegaly or ascites Lab panel supporting a MELD score Symptom documentation
60%	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	Your MELD score is above 11 and below 15, or you have daily fatigue plus at least one episode in the last year of variceal bleeding, portal gastropathy, or hepatic encephalopathy.
60%	What supports this level Lab panel supporting a MELD score Hospital or endoscopy records for a variceal bleed Documentation of encephalopathy episodes with dates
100%	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	Your MELD score is 15 or higher, or you have continuous daily debilitating symptoms and generalized weakness together with at least one of the listed complications.
100%	What supports this level Lab panel supporting a MELD score of 15 or more Records of ascites, spontaneous bacterial peritonitis, encephalopathy, variceal hemorrhage, coagulopathy, portal gastropathy, or hepatorenal/hepatopulmonary syndrome Transplant evaluation records if applicable

The middle column is our transcription of the criteria at 38 CFR 4.114, DC 7312, condensed for reading. Read the section itself on eCFR before relying on the exact wording. The items under each level are the kinds of evidence that document it — not a VA checklist, and not a prediction of which level applies to you.

Mistakes we see most often

Not documenting all symptoms including fatigue, abdominal pain, weight loss, and jaundice — each contributes to the rating.

Not connecting cirrhosis to service-connected hepatitis C, alcohol use disorder, or fatty liver disease.

Not making sure a MELD score is calculated and recorded — DC 7312 steps on MELD (above 6, 10 or 11, above 11, 15 or more). If no MELD score is in your records, VA rates on symptoms instead, so make sure the underlying labs (bilirubin, INR, creatinine, sodium) are drawn and documented.

Not documenting hospitalizations for complications like variceal bleeding, ascites, or hepatic encephalopathy.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

View condition guide →View evidence checklist →

Folder readiness

Tick these off as you gather them. Nothing here is required — the exam happens either way — but each one is something the examiner cannot record if it is not in front of them.

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Take it with you

Print the whole guide — what the examiner records, the folder list with your ticks, the criteria table and the mistakes to avoid — and bring it to the appointment.

Frequently paired

Hepatitis CDC 7354

Documented secondary or co-occurring conditions. Each is examined separately and has its own guide.

Free tool · 282 guides · DBQ-aligned

C&P Exam Preparation Guides

The VA orders this exam to verify your diagnosis and measure how severe it is right now. It can shape your rating and your monthly compensation — but it does not decide your claim. A rating specialist weighs it against your full record, and if the exam does not reflect your condition, you can say so and ask the VA to correct it.

Source forms
Coverage

Liver Cirrhosis

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam

Liver Cirrhosis

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam