Digestive system: ulcers, Crohn’s, liver, hernia and the exam

How VA rates digestive conditions

38 CFR 4.112, 4.113, 4.114

The digestive schedule was rewritten and published at 89 FR 19743 (March 20, 2024). Two rules shape almost every claim:

• No stacking among most digestive codes. Ratings under codes 7301 to 7329, 7331, 7342, 7345 to 7350, 7352 and 7355 to 7357 are not combined with each other. When more than one applies, VA assigns a single evaluation under the code that reflects the predominant disability picture and may raise it to the next higher level if the overall disability warrants.
• Weight loss has set definitions. Substantial weight loss is involuntary loss of more than 20% of baseline weight sustained for three months with diminished self-care or work. Minor weight loss is 10% to 20%, sustained for three months, with stomach or bowel symptoms and diminished self-care, work or food intake. Baseline weight is the documented average for the two years before the illness began, or the weight at the most recent discharge physical, or ideal weight or BMI tables, whichever is most favorable to the Veteran.

For reflux and irritable bowel, see IBS and GERD ratings. This page covers the rest of the schedule.

Esophagus, reflux and hiatal hernia

38 CFR 4.114, DC 7203 to 7207, 7346

• Esophageal stricture (7203): 80% for recurrent or refractory stricture causing dysphagia with aspiration, undernutrition or substantial weight loss, treated by surgery or a PEG tube. 50% when it requires dilatation three or more times a year, steroid dilatation at least once a year, or a stent. 30% for dilatation no more than twice a year. 10% when daily medication controls dysphagia. 0% for history without daily symptoms or medication.
• Reflux disease (7206), hiatal and paraesophageal hernia (7346), motility disorders such as achalasia (7204) and esophageal diverticulum (7205) are rated on the same stricture levels.
• Barrett’s esophagus (7207): without stricture, 30% with high-grade dysplasia and 10% with low-grade dysplasia on pathology. With stricture, use 7203. If cancer develops, rate it under 7343.
• Findings must be documented by barium swallow, CT or upper endoscopy (EGD).

Ulcers, gastritis and surgery complications

38 CFR 4.114, DC 7303 to 7310, 7348

• Peptic ulcer disease (7304): 100% for three months after surgery for perforation or hemorrhage. 60% for continuous abdominal pain with intermittent vomiting, recurrent vomiting of blood or tarry stools, and anemia requiring hospitalization at least once in 12 months. 40% for episodes of pain, nausea or vomiting lasting at least three consecutive days, four or more times in 12 months, managed by daily prescribed medication. 20% for the same episodes three times or fewer. 0% for a history documented by endoscopy or imaging.
• Chronic gastritis (7307) is rated as peptic ulcer disease. The code includes H. pylori infection, drug-induced gastritis, Zollinger-Ellison syndrome and portal-hypertensive gastropathy with varix-related complications.
• Chronic complications of upper GI surgery (7303): 80% when TPN or tube feeding is needed for more than 30 consecutive days in the last six months. 50% for daily vomiting despite treatment, six or more watery bowel movements daily, or meal-induced light-headedness with sweating needing medication. 30% with two or more of: vomiting twice a week or more, pain within an hour of eating needing dietary changes, or three to five watery stools daily. 10% for nausea or vomiting managed by ongoing treatment. 0% asymptomatic. The code covers surgery on the esophagus, stomach, pancreas and small intestine, including bariatric surgery.
• Vagotomy (7348): 40% with confirmed stricture or continuing gastric retention; 30% with confirmed alkaline gastritis or persisting diarrhea; 20% with incomplete vagotomy.

Crohn’s, colitis, diverticulitis and surgery

38 CFR 4.114, DC 7319 to 7330, 7355, 7356

• Crohn’s disease and ulcerative colitis (7326; ulcerative colitis 7323 is rated under it): 100% for severe disease unresponsive to treatment with hospitalization at least once a year and either inability to work or recurrent pain with at least two of: six or more daily episodes of diarrhea, six or more daily episodes of rectal bleeding, recurrent incontinence, or recurrent distension. 60% for moderate disease managed as an outpatient with immunosuppressants or biologics, with recurrent pain, four to five daily episodes of diarrhea and intermittent signs of toxicity. 30% for mild to moderate disease on oral and topical agents with three or fewer daily episodes. 10% for minimal to mild disease with no systemic toxicity. Diagnosis must be confirmed by endoscopy or radiologic studies.
• Diverticulitis (7327): 30% when hospitalization for distress, fever and leukocytosis occurred in the past 12 months with a complication such as hemorrhage, obstruction, abscess, peritonitis or perforation. 20% for hospitalization without complication. 0% if asymptomatic or managed by diet and medication.
• Small intestine resection (7328): 80% with undernutrition, anemia and TPN; 60% with oral supplements, continuous medication and intermittent TPN; 40% with four or more daily episodes of diarrhea causing undernutrition and anemia; 20% with four or more daily episodes of diarrhea; 0% asymptomatic.
• Large intestine resection (7329): 100% for total colectomy with ileostomy, high-output syndrome and more than two dehydration episodes needing IV fluids in 12 months. 60% for total colectomy, with or without permanent ostomy. 40% for partial colectomy with permanent ostomy. 20% for partial colectomy with reanastomosis, loss of the ileocecal valve and diarrhea more than three times daily. 10% for partial colectomy with reanastomosis.
• External fistula (7330): 100%, 60% or 30% by nutrition support, discharge and drainage.
• Celiac disease (7355): 80%, 50% or 30% by malabsorption, nutritional deficiencies and systemic effects. A serum antibody test or endoscopy with biopsy must confirm it.
• Gastrointestinal dysmotility (7356): 80% for complete dependence on TPN or continuous tube feeding; 50% for intermittent tube feeding with recurrent emergency treatment; 30% for symptoms managed by ambulatory care with prescribed dietary management. Lower levels exist.

Sphincter control, hemorrhoids and related conditions

38 CFR 4.114, DC 7332 to 7337

• Loss of sphincter control (7332): 100% for complete loss not responsive to a prescribed bowel program, or incontinence two or more times a day needing pad changes two or more times a day. 60% for incontinence two or more times a week. 30% for two or more times a month. 10% for at least once every six months. 0% for history without current symptoms.
• Stricture of the rectum or anus (7333): 100% if the anus cannot open and solid feces cannot be expelled; 60% for lumen reduced by 50% or more with pain and straining; 30% for reduction under 50% with straining; 10% for narrowing managed by diet.
• Rectal prolapse (7334): 100% for persistent irreducible prolapse; 50%, 30% or 10% by how it reduces and when it occurs.
• Anal fistula (7335): 60%, 40%, 20% or 10% by number of fistulas, abscesses, drainage and pain.
• Hemorrhoids (7336): 20% for persistent bleeding and anemia, or continuously prolapsed internal hemorrhoids with three or more thrombosis episodes a year. 10% for prolapsed internal hemorrhoids with two or fewer thrombosis episodes a year, or external hemorrhoids with three or more.
• Pruritus ani (7337): 10% with bleeding or excoriation, 0% without.

Hernias

38 CFR 4.114, DC 7338

Hiatal hernia is rated under the esophagus code above. For other hernias (femoral, inguinal, umbilical, ventral, incisional), the rating depends on size and pain with four activities: bending over, activities of daily living, walking and climbing stairs.

• 100%: irreparable for 12 months or more, 15 cm or larger, and pain with at least three of the four activities.
• 60%: irreparable for 12 months or more, 15 cm or larger, and pain with two of the activities.
• 30%: irreparable for 12 months or more, 3 cm to under 15 cm, and pain with at least two of the activities.
• 20%: same size, pain with one of the activities.
• 10%: irreparable for 12 months or more and smaller than 3 cm.
• 0%: asymptomatic, repairable, or repaired.

With two compensable inguinal hernias, the worse one is rated first and 10% is added for the second, except that nothing is added when the worse one is 100%. The regulation says any one of bathing, dressing, hygiene or transfers is enough to count for activities of daily living.

Cirrhosis, hepatitis, bile duct, pancreas and transplants

38 CFR 4.114, DC 7312 to 7354

• Cirrhosis (7312): 100% with a MELD score of 15 or more, or continuous daily debilitating symptoms with generalized weakness and a listed complication (ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, coagulopathy, portal gastropathy, or hepatopulmonary or hepatorenal syndrome). 60% for a MELD score over 11 but under 15, or daily fatigue with an episode in the last year of variceal hemorrhage, portal gastropathy or encephalopathy. 30% for a MELD score of 10 or 11, or signs of portal hypertension with weakness, anorexia, pain or malaise. 10% for a MELD score over 6 but under 10, or anorexia, weakness, pain or malaise. 0% asymptomatic. Without a MELD score, rate on symptoms.
• Chronic liver disease without cirrhosis (7345), including hepatitis C (7354) and hepatitis B: 100% while on both parenteral antiviral and parenteral immunomodulatory therapy and for six months after, then a mandatory exam. 60% requiring continuous medication with substantial weight loss and at least two of: daily fatigue, malaise, anorexia, hepatomegaly, pruritus, arthralgia. 40% for the same with minor weight loss. 20% with at least one of intermittent fatigue, malaise, anorexia, hepatomegaly or pruritus. 0% for history, currently asymptomatic.
• Chronic biliary tract disease (7314), including cholangitis and Sphincter of Oddi dysfunction: 30% for three or more documented attacks of right upper quadrant pain with nausea and vomiting in 12 months, or dilatation of strictures; 10% for one or two attacks; 0% for none. Gallstones (7315) are rated the same way.
• Complications of gallbladder removal (7318): 30% for recurrent pain with chronic diarrhea of three or more watery stools a day; 10% for intermittent pain with one to two watery stools a day; 0% asymptomatic.
• Chronic pancreatitis (7347): 100% for daily pain episodes with three or more hospitalizations a year, physician pain management, and malabsorption needing diet and enzyme supplements. 60% for three or more episodes a year with at least one hospitalization a year. 30% for at least one episode a year needing inpatient treatment. Endocrine effects such as diabetes are rated separately under 7913.
• Transplants: liver (7351) 100% from admission for surgery, a minimum of 60% while eligible and awaiting transplant, and a minimum of 30% afterwards. Pancreas (7352) 100% from admission with a minimum of 30%. Liver abscess (7350): 100% for six months from diagnosis, then a mandatory exam and residuals.
• Digestive cancers (7343): 100%, continuing past treatment, with a mandatory exam six months after treatment stops.

What VA’s digestive exam forms cover

VA Liver, Stomach and Duodenum, Intestines and Hernia DBQs (all updated July 2024)

• Liver form (2024-07-05): fatigue, malaise, anorexia, weight loss with baseline and current weights, continuous medication, antiviral and immunomodulatory therapy dates, cirrhosis complications with dates in the past 24 months, MELD score, liver abscess, transplant, labs, imaging and biopsy.
• Stomach form (2024-07-05): ulcer history, episodes of pain, nausea or vomiting lasting three consecutive days and daily medication, vomiting blood, tarry stools, anemia hospitalizations, surgery complications, and testing. The form has no weight question, so keep your own weight record.
• Intestines form (2024-07-05): sections for IBS, inflammatory bowel disease, diverticular disease, resections, fistula, celiac disease, dysmotility, neoplasms and testing. The form does not mention hemorrhoids.
• Hernia form (2024-07-03): surgery, repairable or irreparable, size in three bands, pain with each activity and whether pain has lasted 12 months or more.

See Preparing for Your C&P Exam.

What I could not verify

• Rating levels come from the eCFR text of 38 CFR 4.112 and 4.114, current as of October 16, 2026. eCFR is unofficial, and the official text wins over me.
• I did not restate every note, such as the full definitions of nutritional support in 4.112(d), the text of 38 CFR 4.113, the lowest dysmotility level, or the detailed notes on liver disease types. Read the regulation for those.
• I did not read VA’s esophageal disorders exam form or cover dental and oral conditions (7200 to 7202) beyond the code list, or reflux and irritable bowel levels, which are on the IBS and GERD page.
• I checked the exam forms through a text reader, not line by line. The forms themselves are the authority.
• I did not research presumptive conditions for digestive disease. See presumptive conditions by era.