Evidence Checklist: Liver Cirrhosis

Liver biopsy or FibroScan confirming cirrhosis (F4 fibrosis)Critical

Liver biopsy pathology report showing bridging fibrosis and nodular regeneration, or FibroScan (transient elastography) with stiffness values consistent with cirrhosis (>=12.5 kPa).

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

A medical opinion connecting cirrhosis to service-connected hepatitis C/B, alcohol use disorder during service, or other service-related hepatotoxic exposure.

Gastroenterology or hepatology follow-up records

Ongoing specialist follow-up records documenting cirrhosis management, medication adjustments, and monitoring for disease progression.

Liver function and synthetic function labs (albumin, INR/PT, bilirubin, platelet count)Critical

Serial labs documenting impaired synthetic function (low albumin <3.5, prolonged PT/INR) and thrombocytopenia from portal hypertension — key MELD and Child-Pugh scoring components.

Abdominal ultrasound or CT showing cirrhotic morphology and portal hypertension

Imaging documenting nodular liver surface, splenomegaly, ascites, or portosystemic collaterals indicating portal hypertension.

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 cirrhosis stage, liver function test results, complications, and overall functional impact.

Service treatment records (STRs)Critical

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