GERD VA Rating

By Shirley Chia. Published 2026-05-28. Source: 38 CFR 4.114 DC 7346.

One thing to settle first: the 2024 rewrite

Older guides rate GERD under DC 7346. In May 2024 the VA overhauled the digestive-system schedule, and GERD now has its own code: DC 7206, for esophageal conditions. Claims decided before that date still cite 7346, so you will see both numbers around. The practical brackets are similar, and this guide gives you both so your decision letter makes sense whichever schedule the rater used.

The rating brackets

10 percent

Under the old 7346 language: "With two or more of the symptoms for the 30 percent evaluation of less severity." In plain terms, you have some of the 30% symptoms but milder — epigastric distress and heartburn without dysphagia, say, or symptoms that a daily proton-pump inhibitor mostly controls. This is the floor for a diagnosed, treated GERD that has not progressed.

What wins it: a current diagnosis, treatment records showing ongoing symptoms even on medication, and the service-connection element. That is it. Do not over-document for 10% and accidentally undersell a 30% picture.

30 percent

The 7346 language reads: "With persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health." Break it into elements:

1. Persistently recurrent epigastric distress — chronic upper-abdominal discomfort, not the occasional bad meal
2. Dysphagia — difficulty swallowing
3. Pyrosis — heartburn
4. Regurgitation — acid or food coming back up
5. Substernal, arm, or shoulder pain — pain radiating from the chest

And the umbrella finding the rater has to make: considerable impairment of health.

Here is the part most veterans get wrong. You do not need every symptom on that list. The Court of Appeals for Veterans Claims has been clear for years that a symptom list in a rating criterion describes a disability picture, not a checklist where one missing box drops you a bracket (this is the Mauerhan line of reasoning, and raters apply it across diagnostic codes). Persistent distress, heartburn, and regurgitation, with no substernal pain, can still land at 30% if the overall picture is one of considerable impairment. The mistake is letting an examiner write "no dysphagia noted" and treating that as fatal. It is not.

This is the bracket most diagnosed GERD lands on, and for a simple reason: it captures symptomatic reflux that someone is actively treating, without requiring the weight loss or bleeding that defines the next tier up.

50 and 60 percent

The top of the old 7346 was a single 60% bracket: the 30% picture plus "pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health." The 2024 DC 7206 schedule splits the high end, adding intermediate brackets keyed to documented findings like recurrent esophageal stricture requiring dilation, so a 50% step now exists between 30 and 80 on the esophageal code. Whichever schedule applies, the severe end turns on objective findings, not just worse symptoms:

1. Material weight loss — generally read as a sustained loss of roughly 10% or more of baseline body weight, documented in the record
2. Hematemesis — vomiting blood, usually from esophageal erosion or an ulcer
3. Melena — black, tarry stools, the marker of upper-GI bleeding
4. Moderate anemia — typically hemoglobin in the low double digits with documented chronicity, traced to GI blood loss rather than another cause

The high brackets are uncommon for reflux alone, because most GERD that gets diagnosed and treated never reaches the bleeding-and-anemia stage. When it does, the rater should also look at whether a separate, complicating condition has developed — esophageal stricture, Barrett's esophagus with dysplasia, or esophageal cancer — each of which has its own code and may be rated separately and combined under 38 CFR 4.25 rather than folded into the GERD evaluation.

What evidence wins each bracket

Each rung needs one more documented fact than the one below. For 10%, a diagnosis plus symptoms that persist on medication — the note reading "still symptomatic on omeprazole 20 mg" is doing the work. For 30%, a symptom pattern across months: recurrent distress, heartburn, and regurgitation, a documented diet change, a step-up in medication after the first drug failed. The "considerable impairment of health" finding is the rater's call, so give them the raw material to make it. For the 50-60% range, objective findings — a weight chart showing the loss, a CBC showing anemia, an EGD describing erosion or ulceration, an ER or GI note documenting a hematemesis or melena episode.

The PTSD-to-GERD secondary chain

Most GERD claims that succeed are not direct claims. They are secondary claims under 38 CFR 3.310, and the primary condition is usually PTSD. The regulation lets you service-connect a condition that is either caused by or aggravated by an already service-connected disability. Both prongs matter for GERD, and the aggravation prong is the one veterans forget — even if your reflux predated your PTSD, PTSD that makes it measurably worse is compensable for the degree of worsening. There are three mechanisms a good nexus letter can lean on.

Sympathetic activation

PTSD keeps the sympathetic nervous system running hot. That chronic activation raises gastric acid secretion and slackens the lower esophageal sphincter, the valve that is supposed to keep stomach contents down. When the valve loosens and acid output climbs, reflux goes up. The stress-and-gut literature, including Mayer's 2011 review in Nature Reviews Neuroscience, lays out the brain-gut signaling that drives this.

Sleep disruption

Reflux at night does more damage than reflux during the day, because when you are upright gravity helps clear acid out of the esophagus and when you are flat it does not. PTSD wrecks sleep — fragmented sleep, more awakenings, more time lying awake. That means more hours of acid sitting against the esophageal lining. A nexus letter that ties your sleep study or your documented insomnia to nocturnal reflux is making a clinically sound argument.

Medication side effects

This is often the cleanest link to draw. The drugs used to treat PTSD have well-documented GI effects. SSRIs (sertraline, paroxetine, fluoxetine) and SNRIs (venlafaxine, duloxetine) can irritate the GI mucosa and alter motility. Mirtazapine and quetiapine, frequently added for PTSD-related sleep, relax the lower esophageal sphincter and slow gastric emptying. If your reflux worsened after a medication change, that timeline is gold — say so explicitly and point the examiner to the pharmacy record.

How to file it

1. Lock in the service-connected PTSD rating first. See our PTSD rating guide. The secondary claim has nowhere to attach without it.
2. Get a real diagnosis — an EGD, a pH study, or a documented symptomatic response to a PPI trial. "Heartburn" in a note is weaker than "GERD, confirmed on EGD with grade B esophagitis."
3. Get a nexus letter that names at least one of the three mechanisms and uses the "at least as likely as not" standard. See our nexus letter guide.
4. File under 38 CFR 3.310 and make sure the application says GERD secondary to PTSD, not just GERD. The wording routes the claim.

Gulf War MUCMI pathway

If you have qualifying Southwest Asia service, there is a third route that skips the nexus letter entirely. Under 38 CFR 3.317, functional gastrointestinal disorders are among the medically unexplained chronic multisymptom illnesses (MUCMI) that can be presumptively service-connected. You need qualifying deployment to the Persian Gulf theater (Saudi Arabia, Kuwait, Iraq, Bahrain, Qatar, UAE, Oman, Yemen, or the Gulf waters, 1990 to present), chronic symptoms lasting six months or more, and a pattern of recurrent GI distress that is not otherwise medically explained. When the presumption applies, it does the linking work — no nexus opinion required — and the disability is rated by analogy to the closest digestive code.

Common mistakes that sink GERD claims

Most GERD denials and lowball ratings trace back to a short list of avoidable errors.

• Filing GERD direct when it should be secondary. If your reflux started years after service and there is nothing in your service treatment records, a direct claim is an uphill fight. If you already have service-connected PTSD, the secondary route is usually far stronger. File it that way from the start instead of getting denied direct and appealing.
• "Well-controlled on medication" used against you. Raters sometimes reason that if a PPI controls your symptoms, your impairment is minimal. The criteria do not rate you on your medicated good days — they rate the underlying disability. Make sure your records show what happens when you miss doses, and that symptoms persist even on treatment. The need for continuous medication is itself evidence of an active, recurrent condition.
• No nexus on the aggravation prong. A nexus letter that only argues causation, when your reflux clearly predated the PTSD, hands the rater an easy denial. The letter should address aggravation in the alternative.
• Letting a thin C&P exam stand. A 15-minute exam where the examiner checks "no weight loss, no anemia" and moves on does not capture a 30% picture. If the exam contradicts your treatment records, that is grounds for a supplemental claim with the records attached.
• Calling it "acid reflux" or "heartburn" on the form. Claim GERD by name, and name the secondary basis. Vague claim language gets routed badly.

The C&P exam: what to expect and how to prepare

The GERD compensation-and-pension exam usually runs off a DBQ (disability benefits questionnaire) for esophageal conditions. The examiner is filling boxes on symptom frequency, dysphagia, regurgitation, substernal pain, weight loss, anemia, and any complications. A few things help:

Bring a one-page symptom summary — how often you get heartburn and regurgitation, whether it wakes you at night, what foods you have cut out, and how your medications have escalated over time. Examiners work fast, and a written summary keeps your worst-day reality on the record instead of your best-day answers. Describe a typical bad week, not a good day. If you have lost weight, bring numbers. If your reflux is tied to PTSD medications, name them and say roughly when each started. And if the DBQ ends up contradicting your gastroenterologist's notes, that contradiction is exactly what a supplemental claim or higher-level review is built to fix.

How GERD interacts with TDIU and SMC

A 30% GERD rating rarely drives a claim by itself, but it pulls real weight when it combines. Total disability based on individual unemployability (TDIU) under 38 CFR 4.16 has a schedular gate: one disability at 60% or more, or a combined 70% or more with at least one disability at 40% or more. GERD stacked onto a PTSD rating can be the difference that clears that gate. And because GERD secondary to PTSD shares the PTSD as its common source, it does not knock you out of the "single 60%" path some veterans use — the schedular math under 4.25 is what controls.

Special monthly compensation (SMC) is a different animal. GERD does not itself trigger SMC, but if your combined rating reaches 100% (or TDIU) and you have a separate, distinct disability rated at 60% or more, SMC at the housebound rate under 38 USC 1114(s) can apply. The point: do not treat a 30% GERD as a rounding error. In a combined rating it can move you across a threshold that changes the monthly check substantially.

Worked example

Sources cited in this article

• 38 CFR 4.114 — Schedule of ratings: digestive system (DC 7206 esophageal conditions; DC 7346 hiatal hernia, pre-2024)
• 38 CFR 3.317 — Compensation for certain disabilities due to undiagnosed illnesses (MUCMI)
• 38 CFR 3.310 — Secondary service connection (causation and aggravation)
• 38 CFR 4.16 — Total disability ratings for compensation based on unemployability (TDIU)
• Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nature Reviews Neuroscience. 2011.
• VA M21-1 Adjudication Procedures Manual (secondary GI conditions); VA final rule revising 38 CFR 4.114, effective May 19, 2024.

VetDisabilityCalc is an independent reference site. We are not VA-accredited and we do not prepare or present VA claims. This guide is reference material and is not legal advice.