The gallbladder is sac-shaped like a pear, and it is located on the underside of the right lobe of the liver. Cholelithiasis is the condition related to the formation or presence of calculi, (bilestones), in the gallbladder or common duct.

The exact cause is unknown; however, the likely cause is thought to be associated with abnormal metabolism of cholesterol and bile salts. The stones may be present for many years before symptoms appear. Although it is not completely understood, there are three specific factors leading to gallstone formation: metabolic factors, stasis, and inflammation. Additional risk factors include: a positive family history; a high-calorie, high-cholesterol diet, associated with obesity; elevated estrogen levels from oral contraceptives; postmenopausal therapy; pregnancy or multiparity; use of agents that prevent accumulation of fatty substances in the blood; diabetes mellitus; ileitis; hemolytic disorders; liver disease; or pancreatitis.

The condition may be symptomatic or asymptomatic. Severe epigastric or right upper quadrant pain radiating to the back or referred to the right scapula is a characteristic symptom. Other symptoms may include: persistent intolerance to fat intake; belching (sour taste in mouth); flatulence; indigestion; diaphoresis; nausea; chills and low-grade fever; possible jaundice; and clay-colored stools.

Diagnostic measures may include: ultrasonography; percutaneous transhepatic cholangiography (PTC); endoscopic retrograde cholangiopancreatography (ERCP); abdominal x-ray; oral cholecystography; laboratory blood tests; serial enzyme tests; and electrocardiography (EKG).

Surgical procedures may include: cholecystectomy; cholecystectomy with operative cholangiography; and exploratory surgery of the common bile duct. Laparoscopic cholecystectomy is the preferred treatment if stones are present. Nonsurgical treatment includes controlling the diet (low-fat) to prevent future attacks, and using vitamin K if bleeding tendencies are present.

Residuals may depend on the response to treatment measures. There may be continued pain after surgery or recurrence of the stones.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].

• Rate as for chronic cholecystitis.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.[38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.14.  [38 CFR 4.113]