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VA Rating Assistant

DC 7316 · 38 CFR 4.114

Cholelithiasis, Chronic C&P Exam Prep

To document the current severity of chronic cholelithiasis (gallstones) and any related complications including biliary tract disease, obstruction, infection, or surgical history in order to assign a disability rating under 38 CFR - 4.114. Cholelithiasis, chronic (DC 7315/7316) is rated as chronic biliary tract disease under DC 7314, with ratings of 0%, 10%, or 30% depending on symptom frequency, severity, and required interventions.

Format:
Interview + Physical
Typical duration:
20-30 minutes
DBQ form:
gallbladder (gallbladder)
Examiner:
Gastroenterologist or Physician

What the examiner evaluates

  • Confirmed diagnosis of cholelithiasis and related gallbladder or biliary tract conditions
  • History and onset of the condition, including any in-service connection
  • Whether the veteran has had a cholecystectomy (gallbladder removal) and any residuals
  • Frequency and severity of biliary colic attacks, including right upper quadrant pain
  • Presence of recurrent obstruction requiring hospitalization or therapeutic procedures
  • Need for biliary tract stricture dilation (at least twice in a 12-month period)
  • Associated symptoms: nausea, vomiting, diarrhea, constipation, abdominal pain
  • Whether the veteran is asymptomatic or symptomatic
  • Laboratory findings: bilirubin, alkaline phosphatase, WBC, amylase, lipase
  • Imaging results: ultrasound, CT, MRI/MRCP, HIDA scan, ERCP, EUS
  • Current medications prescribed for the gallbladder condition
  • Medically directed dietary modifications
  • Functional and occupational impact of the condition
  • Any complications such as bile duct injury, biliary stricture, pancreatitis
  • History of hospitalizations related to the condition

The exam will typically begin with an interview covering your symptom history, followed by a physical examination of the abdomen. The examiner will review your medical records, laboratory results, and imaging studies. Bring all relevant records including any civilian treatment records not in your VA file. You have the right to request that the exam be recorded in most states.

Measurements and tests

Abdominal Examination

What it measures: Physical tenderness, guarding, Murphy's sign, distension, or palpable masses in the right upper quadrant and epigastric region

What to expect: The examiner will palpate your abdomen, particularly the right upper quadrant where the gallbladder is located. They may press firmly and ask you to breathe in deeply to assess for Murphy's sign.

Critical thresholds

  • Right upper quadrant tenderness on palpation Supports symptomatic rating; documents ongoing inflammation or obstruction
  • Post-cholecystectomy scar assessment Documents surgical history relevant to rating level and any residual complications

Tips

  • Do not take pain medication immediately before the exam if it will mask your true level of tenderness
  • Inform the examiner if the exam itself causes pain during palpation
  • Mention any referred shoulder pain (common with biliary colic) during the physical exam

Pain considerations: If palpation causes pain, clearly state the severity on a 0-10 scale and describe where the pain radiates. Biliary colic often radiates to the right shoulder or back - make sure to communicate this accurately.

Laboratory Studies Review

What it measures: Liver function (bilirubin, alkaline phosphatase), infection markers (WBC), and pancreatic involvement (amylase, lipase)

What to expect: The examiner will review any laboratory results in your file. They may also order new labs if recent results are unavailable. Abnormal values can indicate active obstruction, infection, or pancreatitis.

Critical thresholds

  • Elevated bilirubin Suggests biliary obstruction, supports higher severity rating
  • Elevated alkaline phosphatase Indicates biliary tract disease activity
  • Elevated WBC Indicates acute infection or cholecystitis, supports symptomatic rating
  • Elevated amylase or lipase Suggests gallstone-related pancreatitis, a serious complication

Tips

  • Bring copies of all recent lab results, especially from civilian providers not in your VA record
  • Ask your treating provider for a summary letter that references abnormal labs and their clinical significance
  • If labs were taken during an acute attack, ensure those dates are clearly documented

Pain considerations: N/A - laboratory testing is a records review component during the C&P exam.

Imaging Studies Review

What it measures: Presence and size of gallstones, gallbladder wall thickness, biliary duct dilation, ductal obstruction, or post-surgical changes via ultrasound, CT, MRI/MRCP, HIDA scan, ERCP, EUS, or transhepatic cholangiogram

What to expect: The examiner will review existing imaging in your record. A new ultrasound or other imaging may be ordered if recent imaging is unavailable. This is a records-review component at the C&P exam itself.

Critical thresholds

  • Multiple stones with ductal dilation on ultrasound or CT Supports higher severity rating and risk of obstruction
  • Biliary stricture on MRCP or ERCP Directly relevant to 30% rating criterion if requiring repeat dilation
  • Positive HIDA scan with low ejection fraction Confirms biliary dyskinesia and chronic dysfunction

Tips

  • Bring printed copies of radiology reports if imaging was done outside the VA system
  • Note the dates of all imaging studies so the examiner can request them if not already in your file
  • If imaging showed stones that later passed or were removed, that history is still relevant to document chronicity

Pain considerations: N/A - imaging review is conducted from records during the C&P exam.

Rating criteria by percentage

30%

Chronic biliary tract disease (DC 7314) with recurrent obstruction requiring hospitalization or with biliary tract strictures requiring dilation at least twice in a 12-month period.

Key symptoms

  • Recurrent biliary obstruction episodes requiring emergency or inpatient hospitalization
  • Biliary tract strictures requiring therapeutic dilation at least twice per year
  • Severe right upper quadrant pain with frequent acute attacks
  • Jaundice with documented bilirubin elevation
  • Repeated emergency interventions (ERCP, stenting, or surgical decompression)
  • Significant impact on daily functioning and work capacity
  • History of cholangitis or recurrent infection associated with obstruction

From 38 CFR: Under DC 7314, a 30% rating is warranted when chronic biliary tract disease manifests with recurrent obstruction requiring hospitalization, or when biliary tract strictures require dilation at least two times within any 12-month period. Cholelithiasis, chronic (DC 7315/7316) is rated by analogy to DC 7314.

10%

Chronic biliary tract disease with recurrent episodes of right upper quadrant pain, nausea, and vomiting, or with symptomatic cholelithiasis not requiring hospitalization for obstruction and not meeting the 30% criteria.

Key symptoms

  • Recurrent right upper quadrant or epigastric pain (biliary colic)
  • Postprandial pain triggered by fatty foods
  • Nausea and/or vomiting associated with attacks
  • Intermittent or nocturnal abdominal pain
  • Diarrhea or fat malabsorption symptoms
  • Need for medically directed dietary modification
  • Symptoms managed with medication but not fully controlled
  • Multiple documented attacks per year without requiring hospitalization

From 38 CFR: Under DC 7314, a 10% rating applies to chronic biliary tract disease with symptomatic attacks - including recurrent abdominal pain (postprandial or nocturnal), nausea, vomiting, and colic - that do not meet the severity threshold for the 30% rating. Cholelithiasis, chronic is rated by reference to DC 7314.

0%

Asymptomatic cholelithiasis or chronic biliary tract disease without clinically documented attacks, without recurrent obstruction, and without ongoing functional impairment. Condition is diagnosed but produces no ratable current disability.

Key symptoms

  • No current symptoms attributable to gallstones or biliary tract disease
  • Condition confirmed on imaging but no symptomatic attacks
  • No dietary restrictions required
  • No medications required for the gallbladder condition
  • No hospitalizations or procedures required

From 38 CFR: Under DC 7314, a 0% (noncompensable) rating is assigned when chronic biliary tract disease is present but currently asymptomatic, with no clinically documented attacks, obstruction, or required interventions. A 0% service-connected rating still establishes service connection, which may have future benefit implications.

Describing your symptoms accurately

Biliary Colic Pain Episodes

How to describe it: Describe the location (right upper abdomen, radiating to right shoulder or back), intensity (use 0-10 scale), duration of each episode (typically 30 minutes to several hours), what triggers it (fatty meals, large meals, lying down), and how frequently attacks occur per week or month. Specify whether pain wakes you from sleep (nocturnal pain).

Example: On my worst days, the pain in my right upper abdomen reaches 9 out of 10 and radiates up through my right shoulder blade. The attack lasts about 3 to 4 hours, during which I cannot work, drive, or care for myself. I become nauseous and vomit repeatedly. These severe attacks happen approximately two to three times per month and have caused me to miss work and cancel plans regularly.

Examiner listens for: Clinically documented attack pattern, frequency, functional impact, association with meals, nocturnal occurrence, and whether attacks have required emergency care or hospitalization.

Avoid: Do not say 'I just get a little stomach ache sometimes.' Accurately describe the full intensity and duration of biliary colic attacks. Veterans often minimize pain - report your typical attack and your worst attack separately.

Nausea and Vomiting

How to describe it: Specify how often nausea occurs (daily, with each attack, multiple times per week), whether it is accompanied by vomiting, how long episodes last, and whether it affects your ability to eat, work, or function. Note if nausea is present even between acute attacks.

Example: During a bad attack, I vomit four to five times and am unable to keep any food or liquid down for 6 to 8 hours. Even between attacks, I experience daily low-grade nausea, especially after eating, which has caused me to significantly reduce my food intake and lose weight.

Examiner listens for: Whether nausea and vomiting are isolated to attacks or persistent, their impact on nutrition and weight, and whether they require medication management or IV fluids.

Avoid: Do not omit persistent low-level nausea between attacks. Accurately report both attack-associated and background symptoms. Do not say 'I get queasy sometimes' if you mean you experience vomiting that prevents normal eating.

Dietary Restrictions and Weight Loss

How to describe it: Describe any medically directed dietary modifications - such as low-fat diet, avoidance of specific trigger foods, or meal size restrictions - prescribed by a physician. Report any unintentional weight loss, nutritional deficiencies, or need for supplementation due to the condition.

Example: My gastroenterologist has placed me on a strict low-fat diet and told me to avoid fried foods, dairy, and red meat entirely. Despite following the diet, I still have attacks. I have lost 18 pounds over the past year because eating triggers pain, so I often skip meals or eat very small amounts.

Examiner listens for: Whether dietary modification is medically directed (not self-initiated), the scope of restrictions, evidence of weight loss, nutritional impact, and whether restrictions affect quality of life and social functioning.

Avoid: Do not say 'I just try to eat healthy.' Accurately state that your dietary changes were medically prescribed and describe the scope of restrictions. Document any weight loss with dates and amounts.

Diarrhea and Bowel Changes

How to describe it: Describe frequency of loose stools or diarrhea, urgency, nocturnal episodes, and any pattern related to eating or attacks. After cholecystectomy, bile acid diarrhea is common - accurately report this if present.

Example: After my cholecystectomy, I developed chronic diarrhea that occurs 4 to 6 times per day, often urgently. On bad days, I have nocturnal episodes that disrupt my sleep. This has prevented me from taking long trips, attending social events, or working in settings without easy bathroom access.

Examiner listens for: Frequency of diarrhea per day, urgency, nocturnal occurrence, relationship to meals, and functional limitations caused by unpredictable bowel symptoms.

Avoid: Do not omit post-cholecystectomy diarrhea as a residual symptom. Many veterans do not realize that diarrhea following gallbladder removal is a ratable residual. Report all bowel changes accurately.

Hospitalizations and Emergency Interventions

How to describe it: List each hospitalization with the approximate date, facility name, reason (acute cholecystitis, obstruction, cholangitis, pancreatitis), procedures performed (ERCP, stenting, drainage), and length of stay. Clearly distinguish between elective cholecystectomy and emergency admissions for obstruction or infection.

Example: I was hospitalized twice in the past 12 months - once for acute cholangitis requiring IV antibiotics for 5 days, and once for biliary obstruction that required an emergency ERCP with stent placement. Each hospitalization resulted in 5 or more days of missed work and required weeks of recovery.

Examiner listens for: Number of hospitalizations per year, whether they were for obstruction or infection, the procedures required, and the overall pattern of recurrent severe disease requiring inpatient care - directly relevant to the 30% rating threshold.

Avoid: Do not downplay emergency room visits as 'just checkups.' If you were admitted, treated with IV fluids, antibiotics, or underwent procedures, those qualify as hospitalizations. Bring discharge summaries to support your account.

Functional and Occupational Impact

How to describe it: Clearly describe how your condition affects your ability to work (missed days, modified duties, inability to maintain attendance), perform household tasks, care for dependents, engage in social activities, or exercise. Use specific examples with frequency and duration.

Example: My condition has caused me to miss approximately 2 to 3 days of work per month due to acute attacks. I can no longer do yard work, lift more than 10 pounds without triggering pain, or eat meals with coworkers or family due to unpredictable attacks. I have declined promotions that required travel because I cannot rely on my symptoms being controlled.

Examiner listens for: Concrete examples of how the condition limits occupational and daily functioning, not just a general statement that it 'bothers' you. The examiner must complete the functional impact section of the DBQ.

Avoid: Do not say 'I manage okay' or 'I just push through it.' Accurately describe the real impact on your life. Veterans who minimize functional limitations are often rated lower than their actual disability warrants.

Common mistakes to avoid

Reporting only current symptoms without describing attack history

Why: The rating criteria for DC 7314 are heavily dependent on the pattern of attacks, hospitalizations, and procedures over time. If you only describe how you feel today, the examiner may miss the full severity of your chronic condition.

Do this instead: Prepare a written timeline of significant attacks, emergency visits, hospitalizations, and procedures. Bring this to the exam and offer it to the examiner as a supplement to your verbal history.

Impact: 10% vs. 30%

Assuming the exam is over once the gallbladder has been removed

Why: Many veterans believe that after cholecystectomy (gallbladder removal), their condition is resolved and no longer ratable. In fact, post-cholecystectomy syndrome - including bile acid diarrhea, recurrent biliary strictures, and ongoing abdominal pain - is fully ratable as a residual.

Do this instead: Clearly describe all symptoms that persist after surgery, including diarrhea, pain, bloating, and any need for further procedures. Ensure the examiner documents post-surgical residuals.

Impact: 0% vs. 10% or 30%

Describing a 'typical' day rather than your worst days and most severe attacks

Why: VA rating is based on the overall disability picture, and M21-1 guidance instructs that examiners should capture the full range of severity including flare-ups and worst-day functioning. Reporting only average days underrepresents your disability.

Do this instead: When asked about symptoms, explicitly describe both your average day and your worst-day experience. Use phrases like 'On my worst days...' and 'During an acute attack...' to clearly communicate the full range.

Impact: All levels

Not bringing documentation of civilian hospitalizations or procedures

Why: C&P examiners review the evidence in your VA file. If your most significant hospitalizations or ERCP procedures were done at non-VA facilities and those records are not in your file, the examiner may not have access to the most important evidence for a 30% rating.

Do this instead: Request and bring copies of all non-VA hospital discharge summaries, operative reports, and procedure notes. Submit them to the VA before or on the day of the exam through your VSO or directly at the exam.

Impact: 10% vs. 30%

Failing to mention medically directed dietary restrictions

Why: Medically directed dietary modification is a specific DBQ checklist item and a ratable criterion. Veterans who self-impose dietary changes without mentioning physician direction may not have this documented, weakening the evidence for a symptomatic rating.

Do this instead: Explicitly state that your dietary restrictions were recommended or prescribed by your treating physician. Bring a letter from your doctor confirming the medical necessity of your dietary changes if possible.

Impact: 0% vs. 10%

Minimizing the frequency and impact of nausea and vomiting

Why: Nausea and vomiting are listed explicitly on the DBQ as symptoms the examiner must document. Understating these symptoms can result in the examiner not checking the relevant boxes, which directly impacts the rating.

Do this instead: Accurately report the frequency, severity, and functional impact of nausea and vomiting. Note if these symptoms have caused weight loss, dehydration requiring IV fluids, or inability to maintain employment.

Impact: 0% vs. 10%

Not connecting symptoms to the service-connected condition during the exam

Why: If you have multiple GI conditions, the examiner may attribute symptoms to a non-service-connected condition unless you clearly connect each symptom to your service-connected cholelithiasis.

Do this instead: When describing symptoms, explicitly state 'This symptom is related to my gallstones/biliary tract disease' or 'My doctor told me these symptoms are caused by my gallbladder condition.' This helps ensure the examiner attributes findings to the correct condition.

Impact: All levels

Prep checklist

  • critical

    Gather all medical records related to your gallbladder condition

    Collect VA and non-VA records including diagnosis records, imaging reports (ultrasound, CT, MRI/MRCP, HIDA scan), laboratory results (bilirubin, alkaline phosphatase, WBC, amylase, lipase), operative reports for cholecystectomy or ERCP, and hospitalization discharge summaries.

    before exam

  • critical

    Create a written attack log or symptom timeline

    Write down the dates, triggers, duration, and severity of significant biliary colic attacks, emergency room visits, hospitalizations, and procedures over the past 1-3 years. Include facility names and approximate dates. Bring this document to the exam.

    before exam

  • recommended

    Request a buddy statement or support letter from your treating physician

    Ask your gastroenterologist or primary care physician to write a letter summarizing your diagnosis, symptom severity, frequency of attacks, dietary restrictions, medications, and functional limitations. A physician's corroborating letter carries significant evidentiary weight.

    before exam

  • critical

    Review the 38 CFR - 4.114 DC 7314 rating criteria

    Understand that your rating is based on DC 7314 (Chronic Biliary Tract Disease). The 30% threshold requires recurrent hospitalization for obstruction or biliary stricture dilation at least twice in 12 months. The 10% threshold requires symptomatic attacks. Know which tier your symptoms fall into so you can communicate accurately.

    before exam

  • recommended

    List all current medications prescribed for the gallbladder condition

    Prepare a complete list of medications, including dosage and prescribing provider, for ursodeoxycholic acid (if used), antispasmodics, bile acid sequestrants, proton pump inhibitors, or other GI medications. The DBQ requires the examiner to document medications for this condition.

    before exam

  • recommended

    Document functional and occupational limitations in writing

    Write a brief statement describing how your condition affects your ability to work, travel, socialize, eat, and perform daily activities. Include specific examples (missed work days per month, inability to eat in certain settings, weight loss amount and timeframe). Bring this statement to the exam.

    before exam

  • recommended

    Verify what records are already in your VA claims file

    Request a copy of your VA Claims File (C-File) or review your records through MyHealtheVet to identify any gaps in documentation, particularly for non-VA hospitalizations or procedures. Submit any missing records to VA before the exam.

    before exam

  • critical

    Do not take pain medication that would mask your true symptom level immediately before the exam

    While you should not suffer unnecessarily, be aware that taking strong analgesics shortly before a C&P exam may make you appear more comfortable than you typically are, which can result in an underrating. If you must take medication, inform the examiner and document what you took and when.

    day of

  • critical

    Bring all gathered records and documents to the exam

    Bring your attack log, physician letter, medication list, imaging reports, and hospitalization records in a folder. Offer them to the examiner at the start of the exam and ask that they be included in the DBQ or referred to the VA rater.

    day of

  • critical

    Arrive well-rested if possible and note how you feel on exam day versus typical and worst days

    If exam day happens to be a relatively good day, explicitly tell the examiner: 'Today is a relatively good day for me. My typical experience is... and on my worst days...' This ensures the examiner captures the full range of your disability.

    day of

  • optional

    Bring a trusted person with you if allowed

    A family member, caregiver, or VSO representative can accompany you to provide moral support, take notes, and offer a corroborating perspective on your symptoms and functional limitations if asked by the examiner.

    day of

  • critical

    Describe both your typical symptoms AND your worst-day symptoms

    Per M21-1 guidance, examiners should capture the full range of disability including flare-ups. When asked about your symptoms, provide both your average experience and explicitly describe your worst attacks. Use the phrase 'On my worst days...' to frame worst-case descriptions.

    during exam

  • critical

    Confirm that all relevant symptoms are being documented

    As the examiner asks questions, mentally cross-reference with the key symptom categories: pain (location, radiation, severity, frequency), nausea, vomiting, diarrhea, dietary restrictions, hospitalizations, procedures, and functional impact. If a category is not asked about, politely raise it yourself.

    during exam

  • critical

    Be specific about hospitalization history and ERCP/dilation procedures

    If you have had biliary obstruction requiring hospitalization or biliary stricture dilations, clearly state the number of occurrences within a 12-month period. This directly determines whether you qualify for the 30% rating threshold under DC 7314.

    during exam

  • critical

    Clearly describe the functional and occupational impact of your condition

    The DBQ has a dedicated section for functional impact. Provide concrete examples: 'I miss 2-3 days of work per month,' 'I cannot eat with my family due to unpredictable attacks,' 'I had to resign from a position because I couldn't maintain attendance.' Specific examples are more persuasive than general statements.

    during exam

  • recommended

    Request a copy of the completed DBQ

    You have the right to request a copy of the completed DBQ. Ask the examiner or the exam facility how to obtain a copy after the exam is submitted. Review it for accuracy and report any significant errors or omissions to your VSO promptly.

    during exam

  • recommended

    Document what happened at the exam while memory is fresh

    Immediately after the exam, write down what questions were asked, what symptoms you reported, what physical examination was performed, and your overall impression of whether the examiner captured the full severity of your condition. Share this with your VSO.

    after exam

  • recommended

    Monitor your VA.gov claims status and obtain a copy of the DBQ

    Check VA.gov regularly for updates to your claim status. Once the DBQ is available in your records, review it for accuracy. If significant symptoms were omitted or mischaracterized, contact your VSO about submitting a statement to supplement the record.

    after exam

  • optional

    Consider submitting a personal statement (VA Form 21-4138) if the exam was inadequate

    If you believe the examiner did not ask about key symptoms, did not review relevant records, or the exam was very brief and superficial, submit a personal statement detailing what was missed. You can also request a new exam through your VSO if the DBQ is incomplete or inadequate.

    after exam

Your rights during a C&P exam

  • You have the right to request that your C&P examination be recorded (audio or video) in most U.S. states. Check your state's recording consent laws and notify the examiner at the start of the exam if you intend to record.
  • You have the right to receive a copy of the completed DBQ examination report. Request this through your VSO or directly from the VA after the exam is submitted to the rating activity.
  • You have the right to bring a representative, family member, or VSO to your C&P examination. They may provide support and take notes, though they typically cannot answer questions on your behalf unless asked.
  • You have the right to submit additional evidence (buddy statements, private medical opinions, treatment records) at any time before a rating decision is issued. Submit supporting evidence as early as possible.
  • You have the right to challenge an inadequate or incomplete examination. If the DBQ does not address all your claimed symptoms or the exam was perfunctory, you or your VSO can request a new examination before a rating decision.
  • You have the right to a VA examination that is 'adequate for rating purposes,' meaning it must address all symptoms relevant to the diagnostic criteria under which you are being rated. An examiner cannot refuse to document a claimed symptom without explanation.
  • You have the right to request an increase in your rating at any time if your condition has worsened since the last evaluation. You may file a Supplemental Claim with new and relevant evidence or request a new C&P examination.
  • Under the benefit of the doubt rule (38 U.S.C. - 5107(b)), when there is approximate balance of positive and negative evidence regarding any issue material to a claim, the benefit of the doubt shall be given to the claimant.
  • You have the right to retain a private medical examiner (IME - Independent Medical Examination) to provide a competing medical opinion if you believe the VA C&P examiner's findings are inaccurate or unfavorable.
  • You have the right to be evaluated under the most favorable diagnostic code available. Because DC 7315/7316 (Cholelithiasis, Chronic) is rated as DC 7314 (Chronic Biliary Tract Disease), ensure the examiner and rater apply the full range of DC 7314 criteria to your condition.

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.