1. What This Condition Is
GERD happens when stomach acid flows back up into the esophagus repeatedly. The lower esophageal sphincter, the valve between the stomach and the esophagus, does not close properly, allowing acid to irritate and eventually scar the esophageal lining. Over time that scarring can cause strictures: narrowing that makes swallowing difficult or painful. In severe cases, chronic acid damage leads to Barrett's esophagus, a precancerous change in the esophageal tissue. Veterans develop GERD at high rates, driven by the stress of service, irregular eating patterns, NSAIDs and ibuprofen use for pain, and the downstream effects of PTSD, anxiety, and sleep disruption.
2. VA Rating Criteria
The VA updated its digestive system rating schedule effective May 19, 2024. GERD now has its own dedicated Diagnostic Code 7206 under 38 CFR Part 4, Section 4.114. Previously, GERD was evaluated analogously to hiatal hernia (DC 7346). The new DC 7206 criteria focus on esophageal stricture, which is the primary objective finding driving impairment.
| Rating | Criteria |
|---|---|
| 0% (NC) | Documented history of GERD without daily symptoms or daily medication requirement |
| 10% | Documented esophageal stricture requiring daily medications to control dysphagia; otherwise asymptomatic |
| 30% | Recurrent or refractory esophageal stricture with dysphagia requiring: dilatation 3 or more times per year, OR steroid-assisted dilatation at least once per year, OR esophageal stent placement |
| 80% (Max) | Recurrent or refractory esophageal stricture with dysphagia accompanied by aspiration, undernutrition, or other severe complications |
Barrett's esophagus note: If Barrett's esophagus is documented with high-grade dysplasia but without esophageal stricture, the VA rates it at 30%. Low-grade dysplasia without stricture is rated at 10%. If stricture is present alongside Barrett's, rate under DC 7203 (esophageal stricture).
Important: A veteran who is managing GERD with daily proton pump inhibitors or H2 blockers but has not yet developed confirmed esophageal stricture will often receive a 0% rating under the new criteria. If your GERD causes functional impairment beyond what daily medication controls, document that clearly with your provider and push for objective endoscopic findings.
3. What to Expect at Your C&P Exam
The examiner will review your current symptoms and treatment. Expect questions about how often you experience heartburn or regurgitation, whether you have difficulty swallowing, whether you have had an endoscopy or barium swallow study, whether you take daily medication and how well it controls symptoms, and whether you have ever been hospitalized for GERD-related complications.
The examiner will want to know if you have had any esophageal dilatation procedures, stent placement, or surgeries such as a Nissen fundoplication. Bring a complete medication list with dose and frequency. If you have endoscopy reports documenting esophagitis, Barrett's changes, or stricture, bring those records. The examiner is looking for objective evidence of structural or functional impairment.
4. Evidence You Need to Win
Diagnosis: A formal diagnosis from a treating physician, ideally with endoscopy findings. Imaging studies such as barium swallow studies or upper GI series add objective support.
In-service event: Stress, mission-related eating irregularities, heavy NSAID use, or a documented history of GI complaints in service records. If your PTSD or anxiety is already service-connected, a secondary GERD claim may be the strongest pathway.
Nexus letter: A gastroenterologist or primary care physician must opine that the in-service exposure or connected condition is "at least as likely as not" a contributing cause. Under Barr v. Nicholson, 21 Vet. App. 303 (2007), the opinion must review records, describe the current condition, and explain the medical rationale.
DBQ form: The Esophageal Conditions, Gall Bladder, and Pancreatitis DBQ is the relevant form for a VA exam. If obtaining a private examination, provide the DC 7206 criteria to the examiner before the appointment.
Records of treatment: Every prescription, every endoscopy, every urgent care or ER visit for GI complaints. The new rating criteria under DC 7206 are procedure-frequency driven, so documented intervention history is critical.
Personal statement: Describe what daily life with GERD looks like. Include how often symptoms occur, how well medication controls them, and whether dysphagia affects your ability to eat, maintain weight, or function at work.
5. Secondary Conditions to Consider
GERD drives a number of downstream conditions that may qualify as secondary service-connected disabilities under 38 CFR 3.310.
Barrett's esophagus: Chronic acid exposure is the primary driver of Barrett's metaplasia. If your GERD is service-connected and you develop Barrett's, it is directly ratable under the DC 7206 framework.
Dental erosion and periodontal disease: Chronic acid reflux damages tooth enamel and irritates gum tissue. Secondary dental claims are underutilized by veterans with established GERD ratings.
Asthma and chronic cough: Acid microaspiration is a recognized cause of airway inflammation and reactive airway disease. If you have service-connected GERD and later develop asthma or a chronic cough, secondary connection is medically supportable.
PTSD and anxiety (as a primary, not secondary): The relationship between GERD and mental health runs in both directions. If your PTSD preceded or caused your GERD, file GERD as secondary to your mental health condition. Gastric motility is directly disrupted by autonomic nervous system dysregulation in anxiety and PTSD.
Sleep disturbance: Nighttime reflux disrupts sleep architecture and is a documented contributor to fatigue, mood disturbance, and daytime impairment. Documenting this connection supports a secondary sleep disorder claim.
6. Common Mistakes That Kill Claims
Relying only on symptom description without objective testing. Under DC 7206, ratings above 0% generally require evidence of esophageal stricture. Veterans who have never had an endoscopy may have significant symptoms but weak objective evidence. Work with your provider to get the imaging done.
Not claiming GERD as secondary to PTSD or another mental health condition. This is one of the most commonly missed secondary claims in VA practice. The physiological link between stress, autonomic dysregulation, and acid hypersecretion is well-established in the medical literature.
Missing the transition from the old to the new rating criteria. Veterans rated under the old hiatal hernia analog prior to May 2024 may want to review whether a Supplemental Claim under VA Form 20-0995 could produce a better outcome under DC 7206, depending on their documented impairment profile.
Failing to document every endoscopy and procedure. The new rating criteria are anchored to dilatation frequency and stent placement. If those procedures happened at civilian facilities outside the VA, you need to request and submit those records through VA Form 21-4142 (Authorization to Release Records).
Accepting a 0% noncompensable rating as a dead end. A noncompensable rating still establishes service connection. If your condition worsens and you develop stricture, Barrett's changes, or dysphagia, you can file a Supplemental Claim for an increased rating without re-proving service connection.
7. FWD Assist Resources
The following books from the FWD Assist HQ catalog are relevant to a GERD claim:
The Nexus Letter Playbook explains what a treating gastroenterologist or internist needs to include in a nexus opinion that will survive VA scrutiny, particularly for secondary claims.
Secondary Conditions That Add Ratings covers the PTSD-to-GERD and GERD-to-asthma secondary chains in detail, with guidance on how to structure each claim.
Crush Your C&P Exam covers how to prepare for a digestive system examination and how to present your functional impairment history clearly.
The VA Appeals Playbook covers the Supplemental Claim, Higher-Level Review, and BVA appeal lanes under the AMA if your initial claim is denied or rated at 0%.
Visit fwdassisthq.com for the full catalog.
8. Get Help Without a Claim Shark
Free accredited help is available through VSOs including the DAV, VFW, American Legion, and AMVETS, as well as through county and state veterans service officers.
If you hire a VA-accredited attorney or claims agent, federal law under 38 U.S.C. 5905 prohibits charging fees before an initial VA decision. After a decision, fees are capped at 20% of past-due benefits. No accredited representative should ever charge upfront fees, monthly retainers, or a percentage of your ongoing monthly compensation. Those practices are illegal.
Verify accreditation before hiring anyone: va.gov/ogc/accreditation.asp.