GERD VA Disability Rating Changes
By Telemedica
5/14/2024
On March 19th, 2024, the VA announced several changes to the rating criteria for Gastroesophageal Reflux Disease (GERD) and fifty-four other medical conditions.
In this post, we examine what the VA is changing and how it impacts your GERD VA disability rating.
What is Changing?
The most notable change is the complete restructuring of the GERD VA disability rating criteria.
Currently, the VA rates GERD analogous to Hiatal Hernia (Diagnostic Code 7346). This means they use the same criteria to evaluate and assign a rating percentage to GERD symptoms as they do for Hiatal Hernia symptoms.
Under this diagnostic code, GERD can be rated at 10%, 30%, or 60%, depending on the frequency, severity, and duration of your symptoms.
(Old) GERD VA Disability Rating Chart
| 7346 Hernia Hiatal | 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 | 60 |
| Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health | 30 |
| With two or more of the symptoms for the 30 percent evaluation of less severity | 10 |
(New) GERD VA Disability Rating Chart
Beginning May 19th, 2024, the VA will rate GERD under its own Diagnostic Code, DC 7206. This is a new diagnostic code created specifically for rating GERD symptoms.
Under DC 7206, a GERD VA disability claim can be rated at 0%, 10%, 30%, 50%, or 80%, depending on your symptoms.
| 7206 Gastroesophageal reflux disease (GERD): | 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) | 80 |
| 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 | 50 |
| Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year | 30 |
| Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic | 10 |
| Documented history without daily symptoms or requirement for daily medications | 0 |
| Note (1): Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. | |
| Note (2): Non-gastrointestinal complications of procedures should be rated under the appropriate system. | |
| Note (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. | |
| Note (4): Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved. | |
| Note (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. | |
Are These Changes Good or Bad for Veterans?
Even though these changes increase the highest GERD VA disability rating from 60% to 80%, most veterans will not qualify for a GERD rating above 0% for claims filed after May 19th. This is because the new rating criteria requires the presence of esophageal stricture.
Esophageal stricture is an abnormal narrowing of the esophageal lumen, which causes difficulty swallowing. While esophageal stricture is the most significant and chronic symptom of GERD, not all veterans suffering from GERD have esophageal stricture. Many suffer primarily from other serious symptoms such as chronic cough or Laryngitis.
But unless they also suffer from esophageal structure, they won’t qualify for a VA rating under DC 7206.
Why is the VA Making These Changes?
According to the 57-page final ruling released by the VA, “the [intended] effect of this action is to ensure that the rating schedule uses current medical terminology and provides detailed and updated criteria for evaluation of digestive conditions for disability rating purposes.”
The ruling also cites the VA’s larger strategy of aligning evaluation criteria with a condition’s most chronic and debilitating symptoms
Will The New Rating Criteria Affect my GERD VA Disability Rating?
No, if you already have a GERD VA disability rating, these changes won’t affect your rating or any other VA benefits.
Anyone who is rated for GERD before May 19th, 2024, will be “grandfathered in” under the old rating criteria. You’ll keep your rating at the same compensation level.
Also, anyone who files for GERD before May 19th will be evaluated by whichever rating criteria is more favorable to them.
When is the GERD VA Disability Rating Change Effective Date?
The new GERD VA disability rating criteria is effective May 19, 2024.
Can You be Re-evaluated for GERD to Get a Higher Rating Under the New Criteria?
Yes, but it’s not recommended unless your symptoms qualify you for a higher rating on the scale.
In this case, if you aren’t certain you have esophageal stricture to the extent you could qualify for a rating higher than you already have, contacting the VA to be reevaluated could result in the VA lowering your GERD VA disability rating.
But if you’re confident you qualify for a higher GERD rating, you can file an increase claim.
Secondary Conditions to GERD
It’s also possible to increase your combined VA rating for GERD if you believe your GERD is responsible for a secondary condition.
A secondary condition is a medical condition that is caused or made worse by a disability that’s already rated by the VA. For example:
- Your service-connected knee pain is causing your back pain
- Your migraines are due to your service-connected tinnitus
Conditions that GERD can cause or aggravate include, but are not limited to:
- Asthma
- Migraines
- Sleep Apnea
If you’re able to prove through medical evidence that your GERD caused or aggravated any of the above conditions (known as secondary service connection), you should consider filing a claim for a secondary condition.
Can GERD be a Secondary Condition?
Yes, many conditions and medications could be responsible for causing or aggravating GERD.
NOTE: Don’t stop taking any medications prescribed to you without first talking with your doctor.
GERD Secondary to Medications
In some cases, asthma medications such as Elixophyllin, Theo-24, NSAIDs, and Theochron can exacerbate acid reflux.
Drugs taken to treat anxiety and depression can also contribute to GERD by causing mucosal damage, reducing lower esophageal sphincter pressure (LESP), or affecting esophagogastric motility.
GERD Secondary to Asthma
According to a study published in The Gastroenterology and Hepatology Journal, there is a connection between acid reflux and Asthma. It’s difficult to say why, but it’s known that acid reflux can make asthma worse, and vice versa.
GERD Secondary to Anxiety
GERD can develop when mental health conditions, such as anxiety and panic disorder, lead to an overproduction of stomach acid.
GERD Secondary to PTSD
Similar to anxiety, GERD can develop when symptoms of Post-traumatic Stress Disorder (PTSD), such as stress and depression, lead to an overproduction of stomach acid.
Medications taken to treat PTSD can also lead to GERD as a side effect.
GERD Secondary to Migraines
If migraines are causing your GERD, it’s likely because of the medication you’re taking to treat them.
In fact, a study published in The Journal of Headache and Pain recommends that physicians “minimize prescribing NSAIDs or NSAID-containing acute migraine medications in this population” (referring to patients who also have GERD).
GERD VA Disability Frequently Asked Questions (FAQs)
Below we address several frequently asked questions about GERD and VA disability benefits:
What is GERD?
GERD is an acronym that stands for gastroesophageal reflux disease. It is a severe case of acid reflux and occurs when stomach acid “backwashes” into your esophagus enough times to irritate the lining tissue.
What are Common Symptoms of GERD?
Veterans with GERD experience symptoms such as:
- A burning sensation in your chest (heartburn), usually after eating, which may worsen at night
- Chest pain
- Difficulty eating and swallowing
- Regurgitation of food particles or sour liquid
- The sensation of a lump in your throat
If you have nighttime GERD and acid reflux, you might also experience:
- Chronic cough
- Laryngitis
- New or worsening asthma
- Disrupted sleep and insomnia
How is GERD Diagnosed?
A qualified medical provider can diagnose GERD using:
- Upper endoscopy. This is when a thin, flexible tube fitted with a light and camera is inserted into your throat to check your esophagus for signs of reflux and inflammation.
- Ambulatory acid (pH) probe test. This is when a monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates into your esophagus.
- X-ray of the upper digestive system. GERD can be diagnosed using X-rays to track any reflux of a chalky liquid that coats and fills the inside lining of your digestive tract.
- Esophageal manometry. This is a test designed to assess rhythmic muscle contractions in the esophagus during swallowing. It evaluates the coordination and strength of esophageal muscles and is commonly performed for individuals with difficulty swallowing.
- Transnasal esophagoscopy. This test is done by putting a thin, flexible tube with a video camera through your nose and moving it down your throat into the esophagus.
NOTE: If you’ve received a GERD diagnosis but treatment isn’t helping, it’s a good idea to double check with a specialist that you’ve been correctly diagnosed. Gastrointestinal illnesses that don’t fit the mold of any diagnosable condition are sometimes mistakenly diagnosed as GERD.
If your condition doesn’t fit a known diagnosable condition, and you meet the minimum service requirements, you could be eligible for a VA rating for a presumptive condition.
How Many Veterans Have GERD?
According to publicly available data, as of 2023, the VA has rated more than 488,655 veterans for Hiatal hernia (DC 7346).
Because the VA has historically rated GERD using the rating criteria for Hiatal Hernia (DC 7346), it’s hard to say exactly how many of these ratings are for GERD.
This figure also only accounts for veterans who have successfully won their claim. It does not include veterans who haven’t filed or who have been denied.
How do You Service Connect GERD?
Service connection is when you can prove your military service caused your disability or made it worse. The VA will not award disability compensation if your service is not responsible for your condition.
All VA claims must have the same three things in order for your condition to be considered service-connected:
- A current medical diagnosis of your condition. The VA can’t rate a condition that hasn’t been formally diagnosed.
- Evidence of an in-service event, injury, disease, or aggravation. You need evidence showing that what you claim caused your disability occurred. This evidence can be military medical records or lay statements from people who were there.
- A “nexus” (or link) between #1 and #2 via competent medical evidence. If you get a nexus letter, this link will usually be expressed using one of these statements of probability:
- “Is due to” = 100% certain
- “More likely than not” = greater than 50% certain
- “At least as likely as not” = equal to 50% certain
- “Not likely due to” = less than 50% certain
- “Is not due to” = 0% chance
Is GERD a VA Presumptive Condition?
No, GERD is not included in the VA’s list of presumptive conditions.
This is because GERD is a structural condition and not a functional condition. Most presumptive conditions are functional conditions, meaning that there are symptoms present but no physical evidence of a condition. Structural conditions have symptoms and physical evidence of the condition.
Medical Evidence Wins VA Claims
Whether you need a Nexus Letter for GERD or another digestive condition, we make it EASY for veterans to connect with a licensed provider through our HIPAA-compliant telemedicine platform—anytime, anywhere!
From DBQs and nexus letters, to mental health and telemedicine evaluations, the team at Telemedica is standing by to serve you.
Get the evidence you need to WIN your VA claim today.
Content Reviewed by: Tara Thompson, PA-C
Tara Thompson PA-C is a board-certified Physician Assistant. She completed her training through Chatham University, graduating with a Master’s of Physician Assistant Studies Degree in 2007. Her work experience has been diverse and includes first assist in all surgical specialties, Plastic Surgery and ENT clinical work, and Emergency Medicine. She served as a Physician Assistant in the US Army from 2009-2021 and has been an expert in medical evidence for VA disability claims since 2019.