VA Disability Ratings and Benefits for GERD (Gastroesophageal Reflux Disease) 

GERD, a severe form of acid reflux where stomach acid frequently flows back into the esophagus, is rated by the VA at 0%, 10%, 30%, 50% or 80%, based on how much veterans are affected by symptoms like heartburn, regurgitation, and difficulty swallowing. Hill & Ponton helps veterans understand how to establish service connection, meet the VA rating criteria, and win maximum disability compensation.

Veterans and GERD

GERD is one of the most frequently diagnosed digestive conditions among veterans. Military service often exposes service members to factors that increase the risk of acid reflux, such as irregular eating schedules, high stress, limited access to fresh food, and long-term use of pain or anti-inflammatory medications. These conditions can lead to long-term digestive complications that persist long after discharge. 

A Veterans Health Administration (VHA) study found that 25.52% of veterans treated within the VA system have GERD. However, that number only includes veterans actively receiving VA healthcare. It does not account for those seeking care through private providers, those misdiagnosed, or those who have not sought treatment. 

A 2023 study on gastrointestinal disorders among Gulf War veterans revealed that those with both Gulf War Illness and PTSD were far more likely to report GI conditions. The most common were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps. Researchers believe chronic stress and chemical exposures, combined with long-term inflammation, may explain why these disorders are more prevalent among this group. 

Beyond physical factors, mental health disorders can increase acid production and disrupt digestion, leading to more frequent reflux symptoms. Many veterans also take medications for pain, sleep, or mood disorders that can weaken the lower esophageal sphincter, making reflux worse. Risk factors for GERD in veterans include: 

• Prolonged stress and disrupted sleep during deployment 
• Use of pain or anti-inflammatory medications (NSAIDs) 
• Exposure to environmental toxins like burn pits or chemicals 
• Dietary challenges during field operations 
• Coexisting mental health conditions such as PTSD, depression or anxiety 

How Does the VA Rate GERD?

As of May 2024, GERD is rated under Diagnostic Code 7206 based on esophageal stricture-related criteria, such as dysphagia, aspiration, and the need for repeated esophageal dilatations or surgical intervention. However, the VA may still rate GERD under the older Diagnostic Code 7346 for hiatal hernia if the claim was filed before May 2024,  if the older criteria are more favorable to the veteran than the new ones.  

GERD Ratings Under DC 7206

• 80% rating – 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 (defined as involuntary loss greater than 20% of an individual’s baseline weight sustained for three months with diminished quality of self-care or work tasks) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube) 
• 50% rating – Recurrent or refractory esophageal stricture(s) causing dysphagia, requiring 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 – Recurrent esophageal stricture(s) causing dysphagia, requiring dilatation no more than 2 times per year
• 10% rating – Esophageal stricture(s) requiring daily medications to control dysphagia otherwise asymptomatic 
• 0% rating – Documented history with no daily symptoms or requirement for daily medications

VA Notes:

1. Esophageal stricture must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. A diagnosis of GERD for VA purposes does not require documentation by medical imaging and a 10 percent evaluation for GERD can also be assigned without imaging documenting esophageal stricture when the veteran requires continuous medication
2. Non-gastrointestinal complications of procedures should be rated under the appropriate system.   
3. This diagnostic code applies, but is not limited to, esophagitis, mechanical or chemical; Mallory Weiss syndrome (bleeding at junction of esophagus and stomach due to tears) due to caustic ingestion of alkali or acid; drug-induced or infectious esophagitis due to Candida, virus, or other organism; idiopathic eosinophilic, or lymphocytic esophagitis; esophagitis due to radiation therapy; esophagitis due to peptic stricture; and any esophageal condition that requires treatment with sclerotherapy.  
4. Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved.  
5. Refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.  

Historical GERD Ratings Under DC 7346

Before May 2024, the VA rated GERD under Diagnostic Code 7346 (Hiatal Hernia). This code focused on symptoms like pain, vomiting, and epigastric distress rather than imaging or surgical intervention. Many veterans with older or ongoing claims may still be rated under this code if it is more favorable than the new criteria. 

Under DC 7346, GERD is evaluated based on the frequency and severity of reflux symptoms, and whether they cause measurable health impairment. The criteria are as follows: 

• 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. 

When Do Historical DC 7346 Rating Criteria Apply?  

For veteran whose claims predate the May 2024 regulatory changes, DC 7346 is used when the criteria would result in a more favorable evaluation, such as when GERD causes ongoing pain, nausea, regurgitation, or substernal discomfort without evidence of esophageal narrowing. For example, a veteran who experiences daily reflux and sleep disturbances but lacks a barium swallow or endoscopic report showing a stricture could still be rated under DC 7346. The VA must always apply the version of the law most favorable to the veteran, meaning both codes (7206 and 7346) should be reviewed, and the one that provides the higher rating must be used. 

Getting VA Disability for GERD 

To qualify for VA disability compensation for gastroesophageal reflux disease (GERD), a veteran must establish service connection. This means proving that the condition began during service, was caused by service or a service-connected condition, or was worsened by service or a service-connected condition. The VA requires three main elements to approve a GERD claim: 

• A current medical diagnosis of GERD from a qualified provider. 
• Evidence of an in-service event, illness, or exposure that may have caused or aggravated the condition, or primary service-connected condition. 
• A medical nexus, or link, between the current diagnosis and the in-service event, exposure, or primary service-connected condition.  

The nexus is usually the most critical element. It connects the veteran’s current GERD symptoms to their time in service. A strong nexus letter from a doctor who understands VA disability standards can make a significant difference in a claim’s success. Veterans may establish service connection for GERD in one of three main ways: 

• Direct service connection – when GERD began in service or was caused by something that happened during service. 
• Secondary service connection – when GERD develops because of another service-connected condition, such as asthma, PTSD, or medications prescribed for chronic pain or other conditions. 
• Aggravation – when a preexisting digestive issue was permanently worsened by military service or by a primary service-connected condition.  

Veterans should provide all relevant evidence, including medical records, prescriptions, imaging studies, and lay statements describing symptom frequency and severity. A detailed Compensation and Pension (C&P) exam will usually determine how GERD impacts health and daily life. Properly documenting symptoms and medical evidence can help ensure the VA rates GERD fairly and accurately. 

Is GERD a Presumptive Condition? 

GERD is not a presumptive condition under current VA regulations. This means it is not automatically assumed to be service connected, even if the veteran served in a qualifying location or period. Veterans must still provide medical evidence linking GERD to their service or to another service-connected condition. However, GERD may develop secondarily to a presumptive condition covered under the PACT Act, which expanded benefits for veterans exposed to toxins such as Agent Orange, burn pits, and other environmental hazards. 

For example, veterans who develop asthma or chronic bronchitis because of burn pit exposure, and later develop GERD as a complication of those conditions, may be eligible for compensation. In this case, GERD would be rated as a secondary disability rather than a presumptive one. To strengthen a secondary service connection claim, veterans should provide: 

• A clear medical diagnosis of GERD. 
• Documentation showing the primary service-connected condition (for example, asthma or PTSD). 
• A nexus letter from a healthcare provider explaining how the service-connected condition caused or worsened the veteran’s GERD. 
• Evidence of consistent treatment or symptom progression since service.

Even though GERD itself is not listed as a presumptive condition, veterans exposed to toxic substances may still win their claims if medical evidence links the condition to a presumptive illness caused by that exposure. Find out what to expect at a C&P exam for GERD. 

GERD as a Secondary Disability

GERD often develops as a secondary condition to another service-connected illness or as a side effect of treatment for such conditions. This is one of the most common ways veterans successfully obtain benefits for GERD. A secondary connection means that while GERD was not directly caused by military service itself, it resulted from or was worsened by another condition that is already service connected.  

Many chronic illnesses, mental health disorders, and medications can contribute to or aggravate GERD symptoms. Veterans frequently develop GERD secondary to conditions that affect the respiratory system, digestive tract, or mental health. Below are the most common medical scenarios where GERD can be claimed as a secondary disability. 

GERD and Hiatal Hernia 

A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity. This displacement weakens the lower esophageal sphincter (LES), the muscle responsible for keeping stomach acid from flowing upward into the esophagus. When the LES loses its strength or proper position, acid reflux becomes frequent and difficult to control. 

Because of this direct anatomical link, GERD and hiatal hernia often occur together in veterans’ medical records. The presence of a hiatal hernia can make GERD symptoms, such as heartburn, chest discomfort, and regurgitation, more persistent and harder to treat with medication alone. 

In many VA claims, GERD is rated as secondary to a service-connected hiatal hernia when the hernia is proven to be the underlying cause of reflux. Conversely, if GERD develops first and leads to increased intra-abdominal pressure or inflammation, the resulting hernia can be rated as secondary to GERD. The VA bases this determination on the sequence of medical diagnoses, imaging results, and physician opinions that clarify which condition came first or causes the greater level of impairment. 

For veterans, documenting the connection between these two conditions through endoscopy reports, imaging results, and gastroenterologist statements is essential. Doing so helps ensure both conditions are recognized under the correct diagnostic codes and rated fairly for their combined impact on health. See how to service connect hiatal hernia. 

GERD Secondary to Asthma 

Asthma and GERD are deeply connected because both conditions affect the airway and chest pressure system. When asthma flares up, it increases pressure in the chest and abdomen during breathing. This pressure can push stomach acid up into the esophagus, leading to frequent reflux and inflammation. Over time, the irritation caused by acid exposure can make asthma symptoms worse, creating a cyclical relationship between the two illnesses. 

A study involving over 100,000 veterans found that individuals with GERD were 1.15 times more likely to have asthma than those without reflux. Additional research published in the National Library of Medicine confirmed that the relationship works both ways: each disease can trigger or aggravate the other. Acid reflux can inflame the airways, while asthma attacks can increase reflux episodes through breathing strain and coughing. 

Because asthma is a presumptive condition for many veterans under the PACT Act, GERD can often be successfully claimed as a secondary disability when medical records show the two conditions are linked. Veterans should gather: 

• Documentation from a pulmonologist or gastroenterologist showing how asthma affects reflux frequency. 
• Treatment records demonstrating that asthma symptoms worsen GERD or vice versa. 
• Notes showing improvement in reflux symptoms with proper asthma control, such as inhaler or corticosteroid use.  

Veterans who experience coughing, wheezing, and heartburn together, especially at night, should mention these symptoms during their C&P exam or medical evaluations. Establishing this secondary link can result in additional disability compensation and ensure both conditions are properly treated through VA healthcare. 

GERD Secondary to Respiratory Diseases 

Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis are frequently linked to GERD. Both conditions affect how pressure builds in the chest and abdomen during breathing, which can cause stomach acid to move upward into the esophagus. Over time, the repeated exposure to acid can irritate lung tissue and worsen breathing problems, creating a cycle of inflammation that impacts both the lungs and digestive system. 

Recent research confirmed this connection. Studies published in the International Journal of Chronic Obstructive Pulmonary Disease and the The European Respiratory Journal found that GERD both drives and is driven by respiratory disease. When acid reaches the throat or airways, it can trigger coughing fits, bronchospasm, or even microaspiration, where tiny amounts of stomach contents enter the lungs. These events may worsen lung scarring and contribute to chronic inflammation. 

At the same time, medications used to treat respiratory conditions (such as corticosteroids and bronchodilators) can increase the likelihood of reflux by relaxing the esophageal sphincter or slowing digestion. Veterans with long-term COPD or pulmonary fibrosis who develop new or worsening reflux symptoms should document when these symptoms began and what medications they were taking. For a strong secondary claim, veterans should include:  

• Medical evidence showing the onset of reflux after starting respiratory treatment. 
• Notes or imaging indicating aspiration-related irritation in the throat or lungs. 
• A nexus opinion connecting respiratory conditions or medications to GERD.   

Demonstrating this interaction can support a secondary service connection and may increase overall disability compensation by reflecting the combined effects of both diseases. 

GERD Secondary to Sleep Apnea 

Veterans with obstructive sleep apnea (OSA) often experience worsening reflux symptoms at night. During sleep, repeated airway blockages cause sudden pressure changes in the chest and throat. These fluctuations can force stomach acid upward, especially when the body is lying flat. The result is nighttime heartburn, coughing, or choking sensations that interrupt sleep and worsen fatigue the next day. 

A study published in Neurogastroenterology and Motility found that OSA can lead to GERD because of increased intra-thoracic pressure. Researchers also observed that treating sleep apnea with continuous positive airway pressure (CPAP) therapy significantly reduced nighttime heartburn, regurgitation, and overall acid exposure in the esophagus. This improvement provides strong medical evidence of a cause-and-effect relationship between the two conditions. 

Medical literature supports the bidirectional link between sleep apnea and GERD and the VA may recognize this link if veterans submit relevant medical treatises with the claim. Obstructed breathing can worsen reflux, while acid irritation in the throat can inflame tissues that further block the airway. This interaction can also complicate CPAP use, as some veterans report increased reflux symptoms when using the device due to air pressure. To establish GERD as secondary to sleep apnea, veterans should provide: 

• A confirmed diagnosis of OSA through a sleep study. 
• Medical records or physician statements showing reflux symptoms are more severe during sleep. 
• Documentation that GERD symptoms improve with consistent CPAP use or worsen when sleep apnea is untreated.    

GERD Secondary to PTSD 

Veterans with PTSD often experience high levels of stress, which can lead to increased stomach acid production and affect the body’s ability to manage it, causing discomfort and ongoing digestive issues. Recent research shows that 20% of veterans returning from Iraq and Afghanistan develop gastrointestinal diseases – and those with a mental health diagnosis are twice as likely to be diagnosed with a gastrointestinal illness. 

By providing medical evidence that post-traumautic stress disorder triggered or exacerbated acid reflux, veterans may be able to claim GERD as a secondary condition for a higher VA disability rating and additional compensation. Veterans should provide: 

• A current PTSD diagnosis that is already service connected. 
• Medical evidence showing a link between stress-related symptoms or medications and acid reflux. 
• A nexus letter from a psychiatrist or gastroenterologist explaining how the mental health condition or its treatment aggravated GERD. 
• Lay statements describing how PTSD episodes or medication use affect digestion or trigger reflux flare-ups.    

Because PTSD is common among combat and trauma-exposed veterans, establishing this connection often results in a stronger overall disability claim. Proper documentation ensures the VA recognizes how both conditions combine to affect daily functioning and quality of life. See how to claim GERD secondary to PTSD.  

GERD Secondary to Anxiety and Depression 

Veterans suffering from anxiety may develop GERD as a secondary condition due to the physical effects of chronic anxiety on the body. Anxiety often triggers increased acid production, disrupts digestion, and can lead to behaviors like overeating or smoking, which worsen GERD symptoms. Additionally, the medications used to manage anxiety and depression often worsen reflux symptoms. Veterans seeking to establish GERD as secondary to anxiety or depression should collect: 

• Documentation of a service-connected anxiety or depressive disorder. 
• Treatment notes showing when reflux symptoms began in relation to medication use or mental health changes. 
• A nexus opinion from a medical provider confirming that anxiety or antidepressant use likely caused or aggravated GERD.     

This evidence demonstrates that even though GERD may not have started during service, it developed as a direct consequence of managing a service-connected mental health condition. Recognizing this link ensures veterans receive fair compensation for both the psychological and physical effects of their service. See how to get rated for GERD secondary to anxiety.  

GERD Secondary to Medications Used for Pain or Injuries 

Many veterans develop GERD as a result of long-term medication use for service-connected orthopedic injuries or chronic pain conditions. Drugs commonly prescribed to manage pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and opioids, can directly irritate the stomach lining or alter how the digestive system functions. Over time, these side effects can lead to chronic reflux and inflammation of the esophagus. 

NSAIDs, including ibuprofen and naproxen, are especially problematic because they reduce the stomach’s protective mucus layer, allowing acid to damage the lining. Muscle relaxants and certain painkillers may also weaken the lower esophageal sphincter (LES), the muscle that prevents acid from moving back into the esophagus. This combination creates the ideal conditions for GERD to develop or worsen. 

Common Conditions Treated with Medication That Can Cause GERD 

• Arthritis 
• Back and neck injuries 
• Joint or ligament damage 
• Migraines or tension headaches 
• Fibromyalgia

Veterans who take these medications regularly and begin to experience frequent heartburn, nausea, or difficulty swallowing should have their symptoms documented in their medical records. A medical nexus statement from the prescribing physician or gastroenterologist can help connect GERD to the necessary medication regimen used to treat a service-connected condition. When filing a secondary claim, it’s also helpful to include: 

• Pharmacy records showing long-term or high-dose use of NSAIDs or opioids. 
• Gastroenterology or other treatment notes confirming that reflux symptoms began during or after pain treatment. 
• Any recommendations for switching to alternative medications that reduce reflux risk.

This evidence helps demonstrate that GERD developed as a direct result of medical treatment for a service-connected injury or illness, not from unrelated causes. Veterans who can prove this relationship are eligible for additional disability compensation under VA secondary service connection rules. 

How to Increase Your GERD VA Rating

If you believe your GERD rating is too low or if your symptoms have worsened, you can file for an increased disability rating with the VA. To support your request, you’ll need to show that your condition has become more severe or that it now causes additional health complications. 

Start by gathering new medical evidence, such as updated treatment records, endoscopy or imaging results, and notes from your gastroenterologist that describe changes in your symptoms. Lay statements from family members or coworkers explaining how GERD affects your daily life, like difficulty sleeping, eating, or working, can also strengthen your claim. When filing for an increase, be as detailed as possible. Include any of the following: 

• Increased frequency or intensity of heartburn, regurgitation, or difficulty swallowing. 
• New complications such as weight loss, aspiration, or chest pain. 
• Medication changes, especially if you’ve moved from over-the-counter antacids to prescription treatments or multiple medications to manage symptoms. 
• Impact on your diet, work, or sleep patterns. 

You can submit your evidence through the VA’s online portal or by mail using VA Form 21-526EZ. Hill & Ponton may also be able to help you with your appeal at no upfront cost. Tell us about your case. 

If you already have the maximum GERD VA rating under Diagnostic Code 7206, you may still be eligible to increase your overall compensation by connecting GERD to other secondary conditions or by qualifying for Total Disability based on Individual Unemployability (TDIU). These options can raise your overall benefits even when GERD alone doesn’t meet the 100% rating. 

Conditions Secondary to GERD 

GERD can cause or worsen several other medical conditions over time. When acid reflux damages tissues in the throat, lungs, or digestive tract, it can lead to chronic complications that qualify as secondary disabilities. Veterans with service-connected GERD may be eligible for additional compensation if these related conditions develop as a result. 

Common Secondary Conditions 

• Esophagitis: Untreated GERD can inflame or damage the esophageal lining, causing esophagitis, which leads to pain, bleeding, and trouble swallowing. If confirmed by endoscopy, it may qualify for a separate or higher rating, especially if ulcers or infections are present. 
• Barrett’s Esophagus: This is a serious GERD complication where chronic acid exposure changes the esophageal lining to pre-cancerous tissue. Barrett’s often requires long-term monitoring and may be rated separately if it poses additional health risks. 
• Respiratory Conditions: GERD can worsen or trigger asthma-like symptoms or reactive airway disease (RAD) due to acid irritating the lungs. 
• Laryngitis and Other Throat Issues: When acid reaches the throat or vocal cords, it may cause laryngopharyngeal reflux (LPR), leading to hoarseness, coughing, or throat pain. Conditions like chronic laryngitis or pharyngitis may qualify as secondary if diagnosed and persistent.
• Anxiety Disorders: Veterans with GERD often develop anxiety due to chest pain, fear of regurgitation, or unpredictable flare-ups. GERD has been linked to conditions like GAD, panic disorder, and somatic symptom disorder. 
• Sleep Disorders: Nighttime acid reflux can disrupt sleep, leading to insomnia or other sleep-related issues. A sleep study or doctor’s note showing reflux-related sleep problems can support a secondary claim. 
• Dental Erosion: Stomach acid can damage tooth enamel, causing decay and sensitivity. Veterans with visible dental erosion due to GERD may qualify for VA dental claims if the condition affects nutrition or overall health. 

Get a 100% Disability Rate for GERD with TDIU

Even if GERD alone does not qualify for a standard 100% rating, veterans may still be eligible to receive maximum compensation through Total Disability based on Individual Unemployability (TDIU). This benefit recognizes that a combination of service-connected conditions can make it impossible for a veteran to maintain substantially gainful employment (defined as work that pays above poverty level). 

To qualify for TDIU, veterans must show that their service-connected disabilities, either individually or together, prevent them from holding consistent work that provides more than marginal income. GERD can contribute to unemployability when symptoms are severe enough to interfere with basic job functions such as eating, sleeping, or focusing due to constant pain or fatigue: 

• Frequent absences for medical appointments, testing, or flare-up management 
• Sleep loss from nighttime reflux or pain, leading to poor concentration or productivity 
• Dietary restrictions that limit stamina during physical or shift-based jobs 
• Medication side effects like drowsiness, nausea, or dizziness

While GERD alone rarely meets the criteria for TDIU, it often combines with other service-connected disabilities (such as PTSD, asthma, or orthopedic injuries) to create a cumulative impact that limits employment. Veterans with severe GERD symptoms should ensure all secondary conditions are documented, as this strengthens the case for unemployability. 

Hill & Ponton may be able to help veterans apply for or appeal TDIU benefits. Find out more about TDIU and how combined service-connected conditions can qualify you for compensation at the 100% rate, even if your individual GERD rating is lower.

Frequently Asked Questions