Evidence Checklist: Hepatitis C

Nexus opinion linking hepatitis C to service ("at least as likely as not")Critical

A medical opinion connecting HCV to service-related exposure — jet gun inoculations (pre-1997), blood transfusions, IV drug use during service, or combat wounds. Jet gun exposure is a strong basis for many veterans.

Liver biopsy or FibroScan (transient elastography) for fibrosis stagingCritical

Liver biopsy pathology report or FibroScan result staging fibrosis (F0–F4 / Metavir) and activity grade. Cirrhosis (F4) or advanced fibrosis drives higher ratings.

Hepatitis C viral load (HCV RNA PCR) and genotypeCritical

Lab results documenting HCV RNA quantification (active infection or prior treatment) and genotype, establishing active disease and treatment requirements.

Liver function tests (ALT, AST, bilirubin, albumin, INR)Critical

Serial liver panel results showing hepatic inflammation, synthetic function impairment (low albumin, elevated INR), and bilirubin elevation — key markers of severity.

Antiviral treatment records (DAA therapy or prior interferon)

Records documenting direct-acting antiviral (DAA) regimens (sofosbuvir/ledipasvir, etc.) or prior interferon/ribavirin therapy, including SVR (sustained virologic response) status.

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.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Liver ConditionsCritical

Standardized form capturing HCV status, fibrosis stage, liver function, complications, and overall health impact.

Service treatment records (STRs)Critical

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