Evidence Checklist: Fatty Liver Disease

Hepatic ultrasound or CT/MRI showing hepatic steatosisCritical

Imaging documenting increased echogenicity on ultrasound, or decreased attenuation on CT, or signal loss on MRI consistent with hepatic steatosis. MRI-PDFF provides quantitative fat fraction.

FibroScan (CAP + stiffness) for fibrosis and steatosis stagingCritical

FibroScan results providing controlled attenuation parameter (CAP) for steatosis grading and liver stiffness measurement for fibrosis staging — critical for determining NAFLD vs. NASH with fibrosis.

Nexus opinion linking fatty liver disease to service ("at least as likely as not")Critical

A medical opinion connecting NAFLD/NASH to service-connected diabetes, obesity, hypertriglyceridemia, or metabolic syndrome conditions that arose or worsened during service.

Liver biopsy (if performed) staging NASH and fibrosis

Pathology report from liver biopsy documenting NAS (NAFLD activity score), hepatocyte ballooning, lobular inflammation, and fibrosis stage (F0–F4) — the gold standard for NASH diagnosis.

Liver function tests and metabolic labs (ALT, AST, lipid panel, A1C, glucose)

Serial liver panels showing ALT/AST elevation patterns, and metabolic labs documenting associated conditions (dyslipidemia, insulin resistance) that support the NAFLD diagnosis.

Treatment and specialist follow-up records

Hepatology or gastroenterology records documenting weight management efforts, dietary counseling, management of metabolic risk factors, and any clinical trial participation.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Completed DBQ Liver ConditionsCritical

Standardized form capturing steatosis and fibrosis staging, liver function results, complications, and functional impact.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.