How the VA rates GERD
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. Most of what you will read online about GERD ratings describes the old rules.
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. Under the old criteria that was commonly 10%. A veteran whose reflux has never been scoped has no way to reach any compensable tier, because every tier above zero requires a documented stricture. If you have GERD and have not had an endoscopy, that is the first thing to ask for.
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. The VA's general rule for schedule changes is that an existing rating is re-evaluated under the new criteria only when there is a reason to review it, a claim for increase or a routine future exam, 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 on symptoms can become 0% on the new scale if no stricture is found.
A claim that was pending on the effective date gets whichever version produces the higher rating for the period before the change. 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 permanently, 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: GERD is usually a secondary claim
Direct service connection works if your service treatment records show reflux complaints, an H2 blocker or PPI prescription, or an in-service diagnosis. Many do. Look for "GERD," "reflux," "heartburn," "dyspepsia," or a prescription for ranitidine, famotidine, or omeprazole.
But GERD is far more often filed as a secondary condition under § 3.310, and three theories account for most of those claims:
- Medication. Long-term NSAID use for a service-connected back, knee, or other musculoskeletal condition is a well-recognized cause of reflux and gastritis. Years of prescribed ibuprofen or naproxen in your records, followed by a GERD diagnosis, is the cleanest secondary theory in the system.
- Mental health. GERD is commonly claimed as secondary to PTSD, anxiety, or depression, on the basis that chronic stress response and some psychiatric medications worsen reflux. This requires an individualized medical opinion that engages with your history; a form letter citing a study is routinely rejected.
- Sleep apnea. There is a documented association between obstructive sleep apnea and nighttime reflux, and GERD is sometimes claimed on that basis, again with an 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.
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.