GERD as a Secondary VA Condition: How to Claim It Under 38 CFR 3.310

If you are service-connected for PTSD and taking medication for it, there is a good chance your gut is paying the price. Gastroesophageal reflux disease — GERD — is one of the most commonly overlooked secondary conditions in the VA system. Veterans on SSRIs, SNRIs, or other psychiatric medications frequently develop GERD as a direct side effect, and that connection is exactly what 38 CFR § 3.310 was written to cover. Here is how to claim it.

Why GERD Qualifies as a Secondary Condition Under 38 CFR § 3.310

Secondary service connection under 38 CFR § 3.310(a) applies when a disability is proximately due to or the result of a service-connected condition. That means if your PTSD medication is causing or aggravating your GERD, the GERD can be service-connected as secondary to PTSD. You do not need to prove that GERD started in the military — you need to prove that your service-connected PTSD (or its treatment) is causing or worsening your GERD.

The medical connection is well-established. SSRIs like sertraline and fluoxetine, SNRIs like venlafaxine, and other psychiatric medications commonly prescribed for PTSD are known to cause gastrointestinal side effects including acid reflux, esophageal irritation, and GERD. Additionally, PTSD itself — through chronic stress, hyperarousal, and disrupted sleep — directly affects gut motility and acid production. Either pathway supports a secondary claim.

The VA Diagnostic Code for GERD: DC 7346

The VA rates GERD under Diagnostic Code 7346 in 38 CFR § 4.114, which covers the digestive system. DC 7346 covers hiatal hernia with symptoms, and the VA applies it to GERD when the condition produces reflux symptoms. The rating criteria are:

• 10% — Two or more of the following: heartburn, regurgitation, substernal or arm or shoulder pain, feeling of fullness after meals, nausea, vomiting, anorexia, or other symptoms
• 30% — Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health
• 60% — Symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health

Most veterans with medication-induced GERD will rate at 10% or 30%. That may not sound like much, but it adds to your combined rating and can push you over a threshold that increases your overall compensation. Do not leave it unclaimed.

What Your Nexus Letter Needs to Say

The most important piece of evidence for a secondary GERD claim is a nexus letter from a qualified medical provider. The letter needs to do three things: confirm your current GERD diagnosis, identify your service-connected PTSD and the medications prescribed for it, and state that the GERD is at least as likely as not caused or aggravated by the PTSD medication or the PTSD itself.

The "at least as likely as not" standard — a 50% or greater probability — is the legal threshold under 38 CFR § 3.102. Your provider does not need to say PTSD definitely caused your GERD. They need to say it is at least as likely as not. That is a lower bar than most veterans realize, and a good nexus letter clears it without difficulty when the medication connection is documented in your treatment records.

For a detailed breakdown of what makes a nexus letter hold up under VA scrutiny, the Nexus Letters for VA Claims guide covers the exact language and structure that works.

Evidence You Need to Build the Claim

Before you file, pull together the following:

• Your VA or private treatment records showing a GERD diagnosis
• Your PTSD treatment records showing which medications you have been prescribed and for how long
• A nexus letter from your treating gastroenterologist, primary care provider, or a private medical examiner
• A personal statement describing your symptoms, when they started, and how they affect your daily life

Your VA treatment records are particularly valuable here because they document both the PTSD diagnosis and the medication history in the same system. Under 38 CFR § 3.159(c), the VA is required to obtain relevant VA records when you identify them. Make sure you list your VA treatment facility on your claim form so the VA pulls those records.

The VA Secondary Claims Manual walks through the full evidence-building process for secondary conditions, including GERD, and shows you how to structure the claim so the rater can follow the connection without guesswork.

Filing the Claim

File your secondary GERD claim on VA Form 21-526EZ. In the condition description, write "GERD secondary to PTSD" or "GERD secondary to PTSD medication." Be specific. If you write just "GERD," the VA may try to evaluate it as a standalone condition and deny it for lack of in-service incurrence. The secondary language tells the rater exactly what theory of entitlement you are using.

If you already have a GERD diagnosis in your VA records and you are currently service-connected for PTSD, this is a straightforward claim. Use the free VA claim tools to check your eligibility and map out the evidence you need before you submit.

Bottom Line

GERD secondary to PTSD medication is a legitimate, well-supported claim that thousands of veterans are leaving on the table. The regulatory framework under 38 CFR § 3.310 is clear, the medical connection is documented in the literature, and the evidence is usually sitting in your VA treatment records. Get a nexus letter, file the claim, and stop letting the VA ignore a condition your service-connected disability is causing.