Veterans who suffer from GERD, a severe form of acid reflux where stomach acid frequently flows back into the esophagus, may be eligible for VA disability benefits. VA rates GERD from 0% to 10%, 30%, 50% or 80%, under Diagnostic Code 7206. The rating is based on symptoms such as dysphagia, weight loss, and esophageal strictures.
What Is the GERD VA Rating?
- 80% – 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
- 50% – 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% – Recurrent esophageal stricture(s) causing dysphagia, requiring dilatation no more than 2 times per year
- 10% – Esophageal stricture(s) requiring daily medications to control dysphagia otherwise asymptomatic
- 0% – Documented history with no daily symptoms or requirement for daily medications
VA Notes:
(1) Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy.
(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.
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Is GERD a Gulf War Presumptive Condition?
GERD is not considered a presumptive condition under VA regulations, meaning it is not automatically assumed to be service connected. However, under the PACT Act, Gulf War veterans exposed to certain environmental hazards, such as Agent Orange or burn pits, may still develop GERD as a secondary condition. The PACT Act expands coverage for veterans with exposure to these toxic substances, making it easier for them to establish a link between their acid reflux and their service.
In these cases, veterans will need to provide medical evidence that connects their acid reflux to either their exposure or a service-connected condition resulting from exposure. While GERD itself isn’t presumptively covered under the PACT Act, service connection may still be achievable with proper documentation and proof of exposure. Find out what to expect at the C&P exam for GERD.
How Is GERD Service Connected?
- A current diagnosis of GERD
- Evidence of an in-service event or exposure that caused or aggravated the acid reflux
- A nexus linking your GERD to your military service
Veterans who did not develop GERD until after their service may still establish a secondary service connection if their GERD is linked to a service-connected condition.
What Is GERD Secondary To?
- PTSD: Veterans with PTSD may develop GERD as a secondary condition due to the medications used to manage their mental health, or from stress-related symptoms that exacerbate acid reflux. See GERD secondary to PTSD.
- Anxiety: Anxiety can lead to gastrointestinal issues, including GERD, as it increases acid production and delays stomach emptying. Read about GERD secondary to anxiety.
- Migraines: Certain migraine medications can aggravate GERD symptoms. Learn more about GERD secondary to medications.
- Hiatal Hernia: The upper stomach moves into the chest through the diaphragm, weakening the lower esophageal sphincter and causing acid reflux. See how to service connect hiatal hernia.
My GERD Claim Was Denied, What Can I Do?
GERD can severely impact a veteran’s health, leading to symptoms like heartburn, regurgitation, and difficulty swallowing. If you developed this condition during or after your military service, your heartburn may still qualify for a VA rating for gastroesophageal reflux disease. You have several options to pursue VA benefits after a denial:
- Request a Higher-Level Review: If you believe the decision was made in error but don’t have new evidence, you can request a higher-level review. A senior reviewer will take a fresh look at your claim and may overturn the denial if mistakes are found.
- File a Supplemental Claim: If you have new and relevant evidence that wasn’t included in the original claim, you can file a supplemental claim. This new information can strengthen your case and lead to a different outcome.
- File an Appeal at the Board of Veterans’ Appeals: You can appeal the decision within one year of receiving the denial.
Choosing the best option depends on the specifics of your case and why VA denied your claim. For guidance on your next steps, contact us for a free review of your case. We’ll help you understand your options and how to move forward.
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. To do this, gather new medical evidence, such as updated treatment records or documentation of increased symptom severity, and submit it to VA.
However, if you are already receiving the maximum GERD VA rating under Diagnostic Code 7206, you may still be eligible to increase your overall rating by connecting GERD to secondary conditions.
Get a 100% Disability Rate for GERD with TDIU
Total Disability Individual Unemployability (TDIU) allows veterans to receive compensation at the 100% disability rate, even if their GERD rating is less than 100%. Veterans should note that it is typically the combination of multiple service-connected conditions, in addition to GERD, that would qualify them for this benefit, and that GERD itself would not be severe enough on its own.
Below is a great example of a veteran who was secondary connected for GERD, but it was not the primary factor in the Board’s decision to grant TDIU. However, it was evident in the veteran’s medical history and was important in demonstrating the need for this benefit.
Case Example: Winning TDIU for GERD
In this case, a veteran who served in the United States Army from January 1966 to December 1967 filed a claim for disability benefits due to a combination of service-connected conditions, including mild atheromatous changes of the bilateral lower extremities, bilateral shoulder sternum costochondritis, glaucoma, and gastroesophageal reflux disease. The veteran initially sought an increased disability rating and Total Disability Individual Unemployability due to the inability to maintain gainful employment.
The Board of Veterans’ Appeals reviewed the evidence and ultimately granted TDIU, finding that the veteran’s service-connected conditions collectively prevented him from securing substantially gainful employment. However, it is important to note that TDIU was not awarded solely based on GERD. Instead, the Board recognized that the combined impact of bilateral lower extremity disabilities, shoulder conditions, and glaucoma were the primary contributors to the veteran’s inability to work, with GERD being an additional factor.
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Cassandra, an Accredited Agent and claims advocate for Matthew Hill & Shelly Mark’s teams, reviewed the information provided in this post.
