In the realm of veteran medical ailments, certain health conditions often intertwine with service-related disabilities, sometimes manifesting as an intermediate step in the process of claiming VA disability compensation. Leah explains the relationship between obesity and non-alcoholic fatty liver disease, shedding light on how they can serve as critical factors in the determination of VA disability ratings.
Understanding Non-Alcoholic Fatty Liver Disease (NAFLD)
According to the Mayo Clinic, NAFLD, often abbreviated as NALD, refers to a liver condition prevalent among individuals who consume minimal to no alcohol. It involves the accumulation of excessive fat in the liver, predominantly affecting those who are overweight, obese or have conditions such as type 2 diabetes or high cholesterol.
NAFLD ranges from simple fatty liver (steatosis), which typically causes no harm, to nonalcoholic steatohepatitis (NASH), a more serious form involving liver inflammation and damage.
Often symptomless, NAFLD can be diagnosed with blood tests, imaging such as ultrasounds, or liver biopsy. Though there’s no medication for NAFLD, lifestyle changes like weight loss, healthy eating, regular exercise, and avoiding alcohol can help manage the condition.
Approximately 25% of the global population grapples with NAFLD. Alarmingly, it stands as the most common form of chronic liver disease, affecting millions globally.
Non-Alcoholic Fatty Liver Disease (NAFLD) in Veterans
Veterans can be at higher risk of developing Non-Alcoholic Fatty Liver Disease (NAFLD) due to various factors. Military-related exposures to toxins, combined with high-calorie diets and limited access to nutritious foods during deployments, contribute to weight gain.
Obesity, along with comorbidities like diabetes, metabolic syndrome, mental health issues like PTSD and depression, and substance use disorders, greatly increases the risk of NAFLD in veterans.
According to the Defense Health Agency’s Medical Surveillance Monthly Report, 19,069 active-duty service members were diagnosed with NAFLD between 2000 and 2017, with an overall incidence rate of 77.7 cases per 100,000 person-years. The report highlights a sharp rise in NAFLD cases, increasing from 12.6 to 152.8 cases per 100,000 person-years.
Exploring the Impact of NAFLD
While NAFLD may initially present as a seemingly asymptomatic condition, it can progress to more severe forms, such as non-alcoholic steatohepatitis (NASH), characterized by liver inflammation and potential complications like fibrosis and cirrhosis of the liver.
Cirrhosis, the most severe complication of NAFLD and NASH, can lead to serious health issues such as liver failure, increased risk of liver cancer, and life-threatening complications like internal bleeding and fluid buildup. Advanced stages of NASH can require a liver transplant.
This escalation mirrors the damage inflicted by prolonged alcohol abuse, underscoring the gravity of NAFLD as a silent yet insidious health concern.
Obesity As a Secondary Condition to NAFLD
Obesity is a prevalent condition among veterans, often linked to service-related factors like stress and sedentary lifestyles, contributing to the development of Non-Alcoholic Fatty Liver Disease (NAFLD). The Centers for Disease Control and Prevention (CDC) reports that among the 21 million military veterans in the U.S., 64.0% of women and 76.1% of men are overweight or obese, higher than the civilian population.
While the VA typically does not grant direct service connection for obesity, it can be rated as a secondary condition if it worsens a primary service-connected issue like NAFLD. Veterans seeking VA disability benefits for NAFLD often provide solid medical evidence, including doctor reports and liver function tests, to link the condition to their service or as a secondary condition to another service-connected disability.
Connecting Non-Alcoholic Fatty Liver Disease And Obesity: The Intermediate Step
Obesity emerges as a pivotal intermediate step in the trajectory toward NAFLD and, consequently, in the assessment of veterans’ disability. Numerous studies have elucidated the profound association between obesity and NAFLD, highlighting how excessive weight contributes to the development and exacerbation of this liver disorder. Sedentary lifestyles compounded by poor dietary habits exacerbate the risk, underscoring the importance of holistic lifestyle interventions in mitigating NAFLD progression.
Insights from Medical Literature
A plethora of research publications underscores the intricate interplay between obesity and NAFLD, offering valuable insights into their pathophysiological mechanisms and management strategies. Studies such as “The Diagnosis and Management of Non-Alcoholic Fatty Liver Disease” from the American Association for the Study of Liver Diseases provide comprehensive guidance on navigating this complex condition.
The study, “Obesity and Non-Alcoholic Fatty Liver Disease: Biochemical, Metabolic, and Clinical Implications,” explores the intricate link between obesity and NAFLD. It reveals that as obesity rates rise, so does the prevalence of NAFLD, affecting up to 85% of individuals with extreme obesity.
A recent meta-analysis involving 2,667,052 participants from the general population estimated the global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) to be 50.7% (46.9–54.4%) among overweight and obese individuals, with higher rates in males than females.
Implications for VA Disability Ratings
In the realm of VA disability ratings, the nexus between NAFLD, obesity, and military service warrants careful consideration. Veterans grappling with NAFLD can pursue disability claims, with the severity of symptoms and their impact on daily functioning determining the assigned rating.
The VA rates fatty liver disease, also referred to as hepatic steatosis, according to the 38 CFR § 4.114, Diagnostic Code 7345. These disability ratings for liver, ranging from 0% to 100%, apply to chronic liver disease without cirrhosis, with evaluations based on the severity of symptoms and the need for treatment.
- A 100% rating is assigned for progressive chronic liver disease requiring both parenteral antiviral and immunomodulatory therapies for six months post-treatment.
- A 60% rating is for cases requiring continuous medication, causing significant weight loss, and at least two symptoms such as daily fatigue, malaise, anorexia, hepatomegaly (enlarged liver), pruritus (itchiness), or arthralgia (joint pain).
- A 40% rating is given for cases with minor weight loss and at least two of the same symptoms.
- A 20% rating is assigned for intermittent symptoms like fatigue, malaise, or hepatomegaly.
- A 0% rating is given when the disease is asymptomatic but there is a history of liver disease. The severity and frequency of symptoms determine the appropriate disability rating for liver disease.
Navigating VA Disability Claims for NAFLD
Navigating the intricacies of VA disability claims necessitates a nuanced understanding of medical evidence, service records, and the regulatory framework governing disability evaluations. While a diagnosis of NAFLD alone may not suffice to secure disability benefits, establishing a clear link between the condition, military service, and its impact on functional impairment is crucial.
To establish service connection for fatty liver disease, veterans must meet three criteria:
- A current diagnosis of fatty liver disease
- Evidence of an in-service event, injury, or illness related to the condition
- A medical nexus linking the diagnosis to the in-service event
For instance, if a veteran gained significant weight from a service-related knee injury or limited access to healthy food, leading to fatty liver disease, they could qualify for a service connection. In such cases, the veteran would likely need to undergo a Compensation & Pension (C&P) examination, where a VA examiner would provide an opinion linking the condition to their service.
Collaborating with accredited professionals versed in veteran advocacy can streamline the claims process and optimize the likelihood of a favorable outcome.
Conclusion
In conclusion, the convergence of NAFLD and obesity underscores the multifactorial nature of health conditions impacting veterans’ well-being. By elucidating the complex interplay between these entities, we empower veterans to navigate the disability claims process with clarity and confidence. Through a holistic approach encompassing medical evidence, advocacy, and comprehensive healthcare interventions, we strive to uphold the welfare of those who have served our nation with valor and sacrifice.
Also read: OSA Secondary to Sinusitis in VA Disability
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Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
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