GERD VA rating: the 2024 criteria for acid reflux
For decades, acid reflux was rated on symptoms: heartburn, regurgitation, pain. In May 2024 the VA rewrote the digestive schedule, and GERD is now rated on one thing, whether the reflux has physically narrowed your esophagus. Older articles about GERD ratings may still describe the old rules.
VA rates GERD and acid reflux under diagnostic code 7206. Since May 19, 2024, the rating turns on esophageal stricture, a narrowing of the esophagus shown by barium swallow, CT, or endoscopy, not on heartburn. The levels are 0%, 10%, 30%, 50%, and 80%, and every level above 0% needs a documented stricture, so reflux without one is rated 0% (38 CFR § 4.114).
Gastroesophageal reflux disease has its own diagnostic code now, DC 7206, in 38 CFR § 4.114. Before the rewrite it had no code of its own and was rated by analogy to hiatal hernia (DC 7346), whose criteria talked about "persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation." Those words are gone. The criteria that replaced them are built around esophageal stricture, the scarring and narrowing that long-term reflux can cause.
The current tiers
| Rating | What the schedule requires |
|---|---|
| 0% | Documented history, without daily symptoms or a requirement for daily medication. |
| 10% | Documented history of esophageal stricture that requires daily medication to control dysphagia (difficulty swallowing), otherwise asymptomatic. |
| 30% | Documented history of recurrent esophageal stricture causing dysphagia, requiring dilatation no more than two times a year. |
| 50% | Recurrent or refractory stricture causing dysphagia that requires dilatation three or more times a year, dilatation with steroids at least once a year, or an esophageal stent. |
| 80% | Recurrent or refractory stricture causing dysphagia with aspiration, undernutrition, or substantial weight loss, treated with surgical correction or a feeding (PEG) tube. |
The note under the code requires that the findings be documented by barium swallow, CT, or endoscopy. A diagnosis written from symptoms alone, with no imaging or scope, does not establish the stricture the tiers are built on.
Daily heartburn controlled by omeprazole, with no stricture, is now a 0% rating. The 0% wording describes a history without daily symptoms or daily medication, but daily medication without a stricture meets none of the tiers above it, so the rating still lands at 0%. Under the old criteria, heartburn together with at least one other listed symptom, such as regurgitation, trouble swallowing, or chest pain, could be rated 10%. A veteran whose reflux has never been imaged or scoped has no way to reach any compensable tier, because every tier above zero requires a stricture documented by barium swallow, CT, or endoscopy. If you have GERD and have never had one of those studies, that is the first thing to ask for.
Suppose a veteran with service-connected GERD starts having trouble swallowing. An endoscopy (EGD) in January documents a peptic stricture, which satisfies Note (1), and the stricture is dilated to its target diameter. Three weeks later the dysphagia returns, a repeat EGD shows the narrowing is back, and it is dilated again in February. No further dilatation is needed for the rest of the year.
- Recurrent? Note (4) defines a recurrent stricture as one where target diameter cannot be maintained beyond 4 weeks after it is reached. Here the widened diameter held for three weeks, so the stricture is recurrent.
- How many dilatations? Two in the year. The 30% tier covers recurrent stricture causing dysphagia that requires dilatation no more than 2 times per year.
- Any 50% trigger? None: no third dilatation, no dilatation using steroids, no stent.
On those facts the criteria line up with the 30% tier. Change a single fact, a third dilatation that year or one dilatation using steroids, and they line up with the 50% language instead. A stricture that never reached target diameter despite at least 5 sessions at 2-week intervals would be refractory under Note (5), a category the schedule names only at 50% and 80%.
If you were rated before May 19, 2024
Ratings in place before the rewrite were assigned under the old criteria and are not reduced just because the criteria changed: 38 U.S.C. § 1155 bars a schedule change from reducing a rating in effect on its effective date unless an improvement in the disability is shown. A schedule change does not by itself put an existing rating up for review: the rating is re-evaluated under the new criteria only when there is a reason to review it, such as a claim for increase or a reexamination VA schedules under 38 CFR § 3.327, and even then the old criteria apply to the period before the effective date and the new criteria after. If you file for an increase, be aware that the new tiers are the ones you will be measured against going forward, and a 10% rating assigned on symptoms goes higher only if a recurrent stricture requiring dilatation, or worse, is documented. The 10% itself is not lost merely because no stricture is found; a reduction needs evidence that the condition has actually improved.
A claim that was pending on the effective date is rated under the old criteria for the period before May 19, 2024, and under whichever version produces the higher rating from that date on. The new criteria cannot be applied to any period before their effective date. Read increases and reductions before filing anything on an existing GERD rating.
Why GERD is still worth claiming
Even at 0%, a service-connected GERD rating does three things. It establishes the service link, so if a stricture develops later the path to 30% or higher is an increase claim rather than a new service-connection fight. It supports secondary claims for conditions that grow out of GERD or its treatment. And it entitles you to VA care for the condition at no cost, including the endoscopy.
Service connection: direct or secondary
Direct service connection under § 3.303 needs evidence that the GERD you have now was incurred in service, or, if it began before service, was aggravated by it. The place to start is service treatment records that show reflux complaints, an H2 blocker or PPI prescription, or an in-service diagnosis. Look for "GERD," "reflux," "heartburn," "dyspepsia," or a prescription for ranitidine, famotidine, or omeprazole.
GERD can also be service connected as a secondary condition under § 3.310, when it is proximately due to, or aggravated by, a condition that is already service connected. Three theories can support that link:
- Medication. The theory is that long-term NSAID use for a service-connected back, knee, or other musculoskeletal condition caused or aggravated the reflux. Years of prescribed ibuprofen or naproxen in your records, followed by a GERD diagnosis, gives the medical opinion a documented timeline to work from.
- Mental health. GERD can be claimed as secondary to PTSD, anxiety, or depression, on the theory that the condition, or the medication that treats it, causes or worsens reflux. This requires an individualized medical opinion that engages with your history, not a form letter citing a study.
- Sleep apnea. A claim secondary to obstructive sleep apnea rests on the theory that the apnea worsens nighttime reflux, and it too needs a medical opinion.
Whatever the theory, the opinion needs to say the GERD is at least as likely as not caused or aggravated by the named service-connected condition, and explain why. The secondary conditions guide covers what that letter has to contain and the aggravation baseline rule that catches people.
The exam
The esophageal conditions DBQ asks about stricture, dilatation history, dysphagia, medication, weight, and imaging. Bring the endoscopy or barium swallow report, your medication list with start dates, and any records of dilatation procedures. If you have lost weight, bring the numbers; the 80% tier references the weight-loss definitions in § 4.112. For the general approach to exams, read Preparing for a C&P exam.
The checklist
- A diagnosis of GERD, with imaging or endoscopy if a stricture is suspected.
- Records of the medications you take and how long you have taken them.
- Any dilatation procedures, with dates.
- In-service reflux complaints or prescriptions, or a nexus opinion on a secondary theory naming the primary condition.
- For the medication theory: the prescription history for the NSAID or other drug, tied to the service-connected condition it treats.
GERD rating questions
What is the VA rating for GERD?
GERD is rated under diagnostic code 7206 at 0%, 10%, 30%, 50%, or 80%. 10% needs a documented stricture that requires daily medication to control trouble swallowing. 30% needs a recurrent stricture causing trouble swallowing that is dilated (stretched) no more than twice a year. 50% needs dilatation three or more times a year, dilatation with steroids at least once a year, or a stent. 80% adds aspiration, undernutrition, or substantial weight loss, treated with surgery or a feeding tube. 0% covers a documented history without daily symptoms or daily medication (38 CFR § 4.114, DC 7206).
What changed in the new GERD rating?
VA's rewrite of the digestive schedule took effect May 19, 2024. Before it, GERD had no code of its own and was rated by analogy to hiatal hernia (DC 7346), where heartburn together with at least one other listed symptom, such as regurgitation or trouble swallowing, could be rated 10%. The new code, DC 7206, rates on esophageal stricture instead. A rating already in place is not reduced just because the criteria changed; a reduction needs evidence that the condition actually improved (89 FR 19735; 38 U.S.C. § 1155).
How does VA rate acid reflux?
Acid reflux is rated as GERD under DC 7206, and the same code covers several kinds of esophagitis, the irritation reflux can cause. Daily heartburn controlled by medication, with no stricture, meets none of the levels above 0%, so it is rated 0%. That 0% still makes the condition service connected, which matters if a stricture develops later or a secondary condition follows. If you have never had a barium swallow, CT, or endoscopy, ask about one, because Note (1) requires one of those studies to document the findings (38 CFR § 4.114, DC 7206).
What do the GERD criteria mean by a recurrent or refractory stricture?
The notes under DC 7206 define both. A stricture is recurrent when the esophagus cannot stay at its target width for more than 4 weeks after a dilatation reaches it. It is refractory when it cannot reach that width despite at least 5 dilatation sessions at 2-week intervals. The 30% level needs a recurrent stricture, and the 50% and 80% levels accept either kind. The findings must be documented by barium swallow, CT, or esophagogastroduodenoscopy (EGD, an upper endoscopy) (38 CFR § 4.114, DC 7206, Notes (1), (4) and (5)).
How much VA compensation is there for GERD?
The monthly payment follows your combined rating, not GERD on its own. A 0% GERD rating does not by itself raise the payment, and a rating of 10% or more is combined with your other ratings under VA's combined ratings table to set one payment amount, listed on VA's rate tables. Even at 0%, service connection means no copayment for VA care of the condition, and it is the base for any later increase or secondary claim (38 CFR § 4.25; § 17.108(e)(1); VA disability compensation rates).
Sources
- 38 CFR § 4.114, Schedule of ratings, digestive system, Diagnostic Code 7206 (gastroesophageal reflux disease). The current 0 to 80% GERD tiers, the barium swallow, CT, or EGD documentation rule, and the Note (4) and (5) definitions of recurrent and refractory stricture.
- 89 FR 19735 (Mar. 20, 2024), Schedule for Rating Disabilities: The Digestive System. The final rule that created DC 7206, effective May 19, 2024, and VA's reasons for rating GERD on stricture instead of heartburn and regurgitation.
- 38 CFR § 4.112(a), Weight loss and nutrition. Defines substantial weight loss, one of the 80% findings.
- 38 U.S.C. § 1155, Authority for schedule for rating disabilities. A schedule change cannot reduce a rating in effect on its effective date unless improvement is shown.
- Board of Veterans' Appeals, Citation Nr. A25039916 (Apr. 30, 2025). A GERD appeal pending across the change, rated under the old hiatal hernia analogy (DC 7346) and checked against new DC 7206.
- 38 CFR § 3.310, Disabilities that are proximately due to, or aggravated by, service-connected disease or injury. Secondary service connection, including the aggravation baseline rule.
- 38 CFR § 4.25, Combined ratings table. How a GERD rating combines with your other ratings into one percentage.
- VA.gov, Current Veterans disability compensation rates. The monthly payment for each combined rating.
- 38 CFR § 17.108(e)(1), Copayments for inpatient hospital care and outpatient medical care. No copayment for VA care of a noncompensable 0% service-connected disability.
- VA Esophageal Conditions Disability Benefits Questionnaire. The exam form, with its questions on stricture, dilatation, dysphagia, daily medication, weight loss, and imaging.
READY214 shows the secondary relationships that commonly follow the conditions you already have, including the medication pathways, and tracks the evidence each one still needs. Free, no account needed to look.