Crohn's Disease and Ulcerative Colitis VA Rating: DC 7326 and DC 7323 Rating Schedule

Under the modern 38 CFR 4.114 digestive schedule, Diagnostic Code 7323 for ulcerative colitis explicitly instructs raters to evaluate the condition under Diagnostic Code 7326 (Crohn's disease or undifferentiated inflammatory bowel disease). The legacy ulcerative colitis rating structure, which used subjective terms like pronounced, severe, or moderately severe, has been eliminated. Both Crohn's disease and ulcerative colitis are evaluated using identical objective criteria across treatment intensity, daily bowel movement frequency, systemic toxicity markers, and hospitalization history.

Under Note (2) to DC 7326, the VA strictly requires that a diagnosis of Crohn's disease, ulcerative colitis, or undifferentiated IBD be confirmed by endoscopy (such as colonoscopy, sigmoidoscopy, or upper endoscopy) or radiologic studies (such as CT enterography or barium radiography). A clinical diagnosis based solely on patient history or physical examination cannot support an evaluation under DC 7326. In addition, Note (3) clarifies that qualifying inflammation may involve the small bowel (ileitis), large bowel (colitis), or any component of the gastrointestinal tract from the mouth to the anus, provided objective study confirmation is present.

DC 7326 assigns evaluations across four schedular tiers. A 10% rating requires minimal to mild symptomatic IBD managed with oral or topical agents (other than immunosuppressants or biologics), with recurrent abdominal pain, three or fewer daily diarrhea episodes, and no signs of systemic toxicity. A 30% rating requires mild to moderate IBD managed with oral or topical non-biologic agents, recurrent abdominal pain, three or fewer daily diarrhea episodes, and minimal signs of toxicity such as fever, tachycardia, or anemia. A 60% rating requires moderate IBD managed on an outpatient basis with immunosuppressants or other biologic agents, recurrent abdominal pain, four to five daily episodes of diarrhea, and intermittent signs of toxicity. The 100% rating requires severe IBD unresponsive to treatment, requiring hospitalization at least once per year, and resulting in either an inability to work or recurrent abdominal pain associated with at least two of: six or more daily diarrhea episodes, six or more daily rectal bleeding episodes, recurrent rectal incontinence, or recurrent abdominal distension.

Two critical evidentiary factors dictate percentage jumps under DC 7326. The first is medication category: veterans treated with oral or topical anti-inflammatory medications (such as mesalamine, sulfasalazine, or oral budesonide) are restricted to a maximum 30% rating. Reaching the 60% tier requires treatment with immunosuppressants (such as azathioprine or methotrexate) or biologic agents (such as infliximab, adalimumab, or vedolizumab). The second factor is systemic toxicity: moving from 10% to 30% requires objective laboratory or vital sign documentation of minimal toxicity (low-grade fever, pulse elevation, or anemia), whereas 10% specifically requires no signs of systemic toxicity.

Under Note (1) to DC 7326, following a colectomy or colostomy with persistent or recurrent symptoms, the disability is evaluated under either DC 7326 or DC 7329 (resection of large intestine), whichever provides the higher rating. Furthermore, like all intestinal conditions listed in 38 CFR 4.114, DC 7326 is governed by the digestive non-combination rule. Ratings under DC 7326 cannot be combined under 38 CFR 4.25 with ratings for other listed digestive disorders such as IBS (DC 7319) or GERD (DC 7206). Instead, the rater assigns a single evaluation reflecting the predominant disability picture, with elevation to the next higher tier if overall severity warrants.