GERD (Gastroesophageal Reflux) VA Rating

Overview

GERD is one of the most successful secondary mental health claims — many psychiatric medications cause or worsen reflux.

Severity is judged by symptom triad: persistent epigastric distress, dysphagia, pyrosis (heartburn), and regurgitation.

In Depth

GERD (gastroesophageal reflux disease) has no dedicated diagnostic code in the VA rating schedule, so it is rated by analogy under 38 CFR § 4.20 to DC 7346 (hiatal hernia), the closest listed condition with comparable symptoms. This means the same three-tier scale used for hiatal hernia — 10%, 30%, and 60% — applies to GERD, based on a symptom cluster rather than a lab value or imaging finding.

The 30% tier requires 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. The 60% tier requires pain, vomiting, material weight loss, or hematemesis/melena with moderate anemia, or other symptom combinations productive of severe impairment of health. The 10% tier applies to two or more of the 30%-level symptoms present at a lesser degree of severity.

GERD is one of the more successful secondary mental-health-adjacent claims because a wide range of psychiatric medications (SSRIs, SNRIs, and others), along with chronic stress and anxiety themselves, are documented in medical literature to cause or worsen reflux. It is also frequently secondary to chronic NSAID use taken to manage a service-connected musculoskeletal condition, since long-term NSAID use is a recognized cause of GI irritation and reflux symptoms.

Because GERD is rated by analogy rather than under its own code, and because the DC 7346 symptom list is somewhat dated in its wording (referencing 'substernal or arm or shoulder pain' rather than more modern GERD terminology), a treatment record or nexus opinion that maps a veteran's actual symptoms onto that specific regulatory language — rather than describing symptoms only in general clinical terms — can make the connection between the evidence and the rating criteria clearer to a rater.

How to Establish Service Connection

• Direct: in-service GI symptoms documented in STRs.
• Secondary to PTSD/depression medications, anxiety, or chronic NSAID use for service-connected musculoskeletal conditions.

Rating Criteria

Paraphrased from 38 CFR § 4.114, Diagnostic Code 7346 (analogous)

See what each percentage pays in 2026 and how it combines with your current rating →

Evidence Checklist

• Endoscopy or barium swallow documenting reflux/hernia.
• Prescription history (PPIs, H2 blockers).
• Symptom log documenting regurgitation, dysphagia, sleep disruption.
• Nexus letter linking GERD to psychiatric medication or service-connected musculoskeletal NSAID use.

Evidence VA Commonly Cites in These Claims

Descriptive summary of evidence types frequently referenced in rating decisions for this condition. Not a checklist of actions to take — every claim is decided on its own facts.

• ★An endoscopy, barium swallow, or pH study documenting reflux or a hiatal hernia provides objective diagnostic support, even though the rating criteria are primarily symptom-based.
• ★A prescription history for PPIs (proton pump inhibitors) or H2 blockers, along with any escalation in dosage or medication changes over time, supports both the diagnosis and severity.
• ★A symptom log noting regurgitation, dysphagia, chest or substernal pain, and sleep disruption from nighttime reflux helps map the record onto the specific DC 7346 language used in the 30% and 60% tiers.
• ★For secondary claims, a nexus opinion should specifically identify the psychiatric medication (or chronic NSAID use for a service-connected musculoskeletal condition) and describe the medical mechanism connecting it to GERD.
• ★If weight loss or anemia has occurred, make sure lab values and weight trends over time are documented, since these are specific findings referenced in the 60% tier.

Illustrative Scenarios

These are hypothetical educational examples — not actual case results, predictions, or guarantees of outcomes.

Common pitfalls VA sees

• Assuming GERD has its own diagnostic code — it does not; it is rated by analogy to hiatal hernia under DC 7346, and understanding that analogy helps explain the specific symptom language used in the tiers.
• Documenting GERD symptoms only in general clinical terms without addressing the specific factors listed in DC 7346 (dysphagia, pyrosis, regurgitation, substernal or arm/shoulder pain, weight loss, anemia).
• Leaving the medication or NSAID history out of a secondary claim, when it is often the strongest evidentiary link available.
• Not tracking weight changes or anemia over time when symptoms are more severe, since these specific findings relate to the 60% tier.
• Treating occasional heartburn as equivalent to the persistently recurrent symptom pattern the higher tiers require.

What the C&P Exam Documents

General information about how this condition is typically evaluated. This is not coaching on what to say and is not a substitute for medical or legal advice.

• →Describe your symptoms using the specific terms relevant to the rating criteria where accurate — heartburn (pyrosis), difficulty swallowing (dysphagia), regurgitation, and any chest, substernal, arm, or shoulder pain.
• →Bring a list of current and past medications, including any psychiatric medications or long-term NSAID use, if you believe your GERD may be secondary to another condition.
• →Mention any weight loss, vomiting, or noted anemia on recent labs, since these map to the more severe rating tier.
• →Describe how symptoms affect sleep and daily function, particularly nighttime reflux.

Frequently Asked Questions