GERD Secondary to PTSD: Service Connection and Winning a VA Rating 

Post-traumatic stress disorder (PTSD) affects far more than mental health: it has a profound impact on the body’s digestive system. Veterans with PTSD are 1.5 times /more likely to develop GERD than those without the disorder, according to new research from 2023 and 2024. This Hill & Ponton guide helps veterans understand how to get service connection for GERD as secondary to PTSD, prepare for the examination and win their claim. 

How Does PTSD Lead to GERD?

The body’s “fight-or-flight” response, which is often overactive in PTSD, increases stomach acid production and slows digestion. This combination makes acid reflux more frequent and more severe. Over time, chronic stress can also weaken the lower esophageal sphincter (LES, the muscle that keeps stomach acid in the stomach), allowing acid to move upward into the esophagus more easily. 

Medications prescribed for PTSD can further aggravate reflux. Drugs such as antidepressants, sedatives, and mood stabilizers may relax the LES or delay gastric emptying, which worsens symptoms like burning, chest pain, and regurgitation. Veterans who notice reflux after starting PTSD medication should discuss these effects with their doctor and document the timing in their medical records. 

Additionally, GERD severity can be increased by smoking, alcohol use, disrupted sleep patterns, and anxiety-induced eating behaviors, all commonly associated with PTSD. These lifestyle and behavioral links provide further evidence for establishing a secondary connection. 

VA Ratings for GERD Secondary to PTSD

As of May 2024, the VA rates GERD at 0%, 10%, 30%, 50% or 80% under Diagnostic Code 7206 for esophageal stricture-related symptoms. However, the VA may still use the older Diagnostic Code 7346 (with ratings of 0%, 10%, 30%, and 60%), if the claim was filed prior to May 2024 and it is more favorable to the veteran. 

GERD Ratings Under DC 7206

• 80% rating – Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube)  
• 50% rating – Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement  
• 30% rating – Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year  
• 10% rating – Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic  
• 0% rating – Documented history without daily symptoms or requirement for daily medications  

Historical GERD Ratings Under DC 7346

• 60% rating – Symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health
• 30% rating – Persistently recurrent epigastric distress with dysphagia, pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health
• 10% rating – Two or more of the symptoms for the 30 percent evaluation of less severity
• 0% rating – Asymptomatic or minimal symptoms controlled by diet or medication, not productive of health impairment

DC 7346 is used for claims filed prior to the May 2024 revision of the rating criteria, in situations when chronic GERD does not include strictures or require surgical intervention, or where the available medical evidence does not meet the standards required for evaluation under DC 7206. Find out more about GERD ratings. 

Service Connecting GERD as a Secondary Condition

Veterans seeking a VA rating for GERD secondary to PTSD must prove that their GERD was caused or worsened by PTSD. This will require:

• Diagnosis for GERD
• Diagnosis and service connection for PTSD
• Nexus letter – a professional opinion from a physician explaining how the GERD symptoms are linked to the service-connected PTSD
• Personal statements from the veteran, family members and/or fellow service members explaining how PTSD impacted the veteran’s digestive system

Preparing for the VA C&P Exam 

Veterans must generally attend a Compensation & Pension (C&P) exam, where a VA examiner will assess the severity of GERD and its relationship to PTSD. See what to expect at the C&P exam.

VA now places significant emphasis on daily symptoms like difficulty swallowing, medication use, and whether or not the veteran’s GERD requires treatments. Prepare for the VA Compensation & Pension exam by documenting GERD symptoms: nausea, heartburn, vomiting, dietary restrictions, regurgitation, medication use.

Veterans should ensure the examiner considers both direct relationship to service and aggravation (worsening) by PTSD. If the examiner fails to consider the case of aggravation of GERD, the report can be challenged by submitting a rebuttal medical opinion or appealing the VA decision. 

Winning a Claim for GERD Secondary to PTSD: Case Example

A veteran who served on active duty from December 1971 to October 1973, with additional service in the Reserves, filed a claim for gastroesophageal reflux disease as secondary to his service-connected posttraumatic stress disorder. The veteran argued that his GERD symptoms were worsened due to his PTSD, leading to the appeal for secondary service connection.  

In decision no. A21016248 from October 1, 2021, the Board of Veterans’ Appeals granted service connection for GERD as secondary to the veteran’s PTSD. The decision was based on the evidence presented, including a letter from the veteran’s physician confirming that GERD was aggravated by PTSD, even though a VA examiner did not fully address the aggravation aspect of the claim.

How This Veteran Won His Appeal 

• Private Medical Opinion on Aggravation: The veteran’s private physician provided a letter stating that the veteran’s GERD symptoms were aggravated by his PTSD. This was pivotal in establishing the secondary connection and proved to be a critical piece of evidence in the appeal. 
• Inadequate VA Examination: The VA examiner concluded that GERD was not caused by PTSD but failed to consider whether PTSD aggravated the GERD symptoms. This omission allowed the Board to weigh the private medical opinion more heavily. 
•  Favorable Ruling with Benefit of the Doubt: By resolving reasonable doubt in favor of the veteran, the Board determined that the medical evidence was at least in equipoise, meaning the evidence for and against the claim was evenly balanced. This principle ultimately led to the grant of secondary service connection. 

This case illustrates how veterans can receive service connection for conditions like GERD when they are aggravated by service-connected mental health issues such as PTSD or anxiety. With proper medical evidence, even conditions not directly caused by military service can qualify for VA benefits through secondary connection.