Hard and Very Hard are fairly similar, as guard and camera patterns are the same

Hard gives more resources than Very Hard, but fewer than Easy or Normal

Hard and Very Hard both have boss behavior modifiers

Snake can take more damage than on Very Hard

On reaction for first guard on second screen, hold right when he spots you to avoid getting hit on Any%. Example here

Rest of the stage move like on Very Hard, 35 still possible.

Guard/camera routing is the same as Very Hard.

Five-Seven does spawn in truck, which is better than picking it up in Stage 01.

First screen of Tower, make sure to flick downleft when on alert at the green crates. Alternatively, you can go downright for a moment. Example here

In gas room, perform a checkmark down to the wall to make the guard shoot the wall. Example here

In card room, perform the beginning of rank 1 movement, then hug the top of the crates to force the guard to open the door for you. Example here

Undetermined if chaff is worthwhile or not on Any%

Do a small delay at the door in the gas mask room. Example here

There is a way to run on alert and avoid getting damaged in the guard mud room, but it's inconsistent. Example here

R5 does not spawn by the rock in the bird room.

Ration by Slasher Hawk's door spawns, unlike Very Hard.

Bird flies fast, just like Very Hard

Refer to Very Hard routing, grenades and spare stuns are not here, same guard/camera routes, only left C4, etc.

When running Alert in the Box room, you could cause an alert early by throwing a grenade in the ladder room, or do a single punch to make the guard consistently avoid hitting Snake. Example here

Marionette Owl will heal if you shoot a doll, just like in Very Hard

If you are routing in the ration by electrified water, make sure to make the guard hear you late. Example here

C4 by electric box blown up after card pickup is there, unlike Very Hard

Grenades in bottom right corner of first screen of 1F are there, unlike Very Hard. Pick up on Stage 09?

Floor 50 Grenades exist, unlike Very Hard

All others rooms should be the same

Ration along bottom exists, unlike Very Hard.

Nikita ammo along right wall exists, unlike Very Hard