What Is GERD in VA Claims?

GERD — chronic acid reflux — is rated under 38 CFR § 4.114, typically DC 7346 (hiatal hernia) by analogy. The VA has no specific GERD diagnostic code, so it's rated by the condition that best matches the symptoms.

GERD is one of the most underrated and underclaimed conditions among veterans. Military service contributes through chronic stress (increases acid production), long-term NSAID use for service-connected pain (damages the stomach lining), irregular meal schedules, field rations, and burn pit/environmental exposures.

The strongest pathway for most veterans is secondary service connection. GERD secondary to PTSD (stress increases acid production), GERD secondary to chronic pain conditions (years of "Ranger candy" — 800mg ibuprofen — damages the GI tract), and GERD secondary to medications for service-connected conditions are all well-supported by research. Veterans who served at burn pit locations may also qualify under the PACT Act's presumptive conditions.

How the VA Rates GERD

Rated under DC 7346 (hiatal hernia) by analogy:

10%: Two or more of the 30% symptoms with less severity. Most common rating — frequent heartburn, some regurgitation, managed with daily medication but with breakthrough symptoms.

30%: Persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm/shoulder pain, productive of considerable impairment of health.

60%: Pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptoms productive of severe impairment of health.

Daily medication matters: If you take a daily PPI (omeprazole, pantoprazole) and still have breakthrough symptoms, that supports at least 10%. If maximum-dose PPI therapy doesn't control symptoms, 30% criteria become applicable.

Barrett's esophagus or esophageal stricture from chronic acid can be rated separately. Gastric ulcers from the same NSAID use can also be rated under DC 7304-7306 independently.

What Happens at Your GERD C&P Exam

The exam is a records review and clinical interview — no physical measurements.

Symptoms to describe with frequency: Heartburn (daily despite medication), regurgitation (3-4 times per week), difficulty swallowing, chest pain, nausea, bloating, sleep disruption from reflux. "I wake up choking on acid 2-3 nights per week. I've propped my bed on blocks."

Treatment history: Name every medication, dose, duration, whether it fully controls symptoms, and what hasn't worked. Escalating treatment history (OTC antacids → H2 blockers → PPI → double-dose PPI) demonstrates severity.

Diagnostic studies: Upper endoscopy showing esophagitis, Barrett's changes, or hiatal hernia is the strongest evidence. pH monitoring showing abnormal acid exposure. Barium swallow showing reflux. Get an endoscopy before filing if you haven't had one.

Health impact: Weight changes, foods you can't eat, sleep disruption, work impact. "I can't eat after 6pm. Can't lie flat. Lost 15 pounds because eating triggers pain."

Common mistakes: Saying "the medication handles it" when you have breakthrough symptoms. Not reporting nighttime reflux. Not connecting GERD to NSAID use or PTSD stress. Not getting an endoscopy before filing.

Medical Studies Supporting GERD Service Connection

NSAID-induced GI damage research is extensive. Studies in the American Journal of Gastroenterology document that chronic NSAID use causes dose-dependent damage to gastric and esophageal mucosa, directly causing or worsening GERD, gastritis, and ulcers. Military "Ranger candy" culture makes this pathway particularly strong.

PTSD and GI studies show PTSD is associated with 2-3x higher GERD rates. The mechanism involves chronic autonomic dysregulation, increased acid secretion during stress responses, and altered GI motility. Published in Psychosomatic Medicine.

Burn pit exposure research increasingly links environmental exposure to GI conditions. The PACT Act recognizes certain GI conditions as presumptive for qualifying burn pit exposure.

Stress and gastric acid studies document that chronic psychological stress increases acid secretion through cortisol and catecholamine pathways — directly contributing to GERD development.

Documents You Need for a GERD Claim

Upper Endoscopy Results: Esophagitis, Barrett's, hiatal hernia, or gastritis findings carry the most weight. Request a GI referral if you haven't had one.

Medication Records: VA pharmacy records showing PPI history — duration, doses, escalation. Longer and higher doses = stronger evidence.

Personal Statement: Symptoms in detail — frequency, severity, dietary restrictions, sleep disruption. If secondary to NSAIDs, describe the pain condition requiring them, duration and dosage, and when GI symptoms developed.

Nexus Letter: Gastroenterologist citing NSAID-GI damage literature (for NSAID pathway) or stress-acid secretion research (for PTSD pathway).

NSAID Use History: Prescription records, OTC use documentation, dosage and duration. Service treatment records showing ibuprofen prescriptions are particularly valuable.

Service Records: Deployment records for burn pit locations if applicable. Service treatment records showing any GI complaints during service.

GERD Secondary Conditions

Claim GERD secondary to: PTSD/anxiety — chronic stress increases acid production. One of the strongest secondary pathways. Chronic pain conditions requiring NSAIDs — back, knee, shoulder pain treated with long-term ibuprofen. The most overlooked pathway. Medications — opioids, muscle relaxants, antidepressants prescribed for service-connected conditions can relax the esophageal sphincter. Sleep apnea — CPAP use and negative intrathoracic pressure promote reflux.

Claim secondary to GERD: Barrett's esophagus — pre-cancerous change from chronic acid. Rated separately. Esophageal stricture — scarring that narrows the esophagus. Asthma/reactive airway — acid aspiration into lungs causes bronchospasm. Dental erosion — chronic acid damages enamel. Sleep disturbance — nighttime reflux disrupts sleep.

The NSAID pathway is the most commonly overlooked. Most veterans with chronic pain have taken ibuprofen for years. If you're service-connected for a pain condition, GERD secondary to NSAID use is straightforward and many veterans don't know to file it.