GASTROESOPHAGEAL REFLUX DISEASE (GERD)

GAYLE STROMMEN · 2026 · Case ID: A26025302

MIXED

Summary

The veteran, who served in the United States Marine Corps from June 1969 to January 1971, appeals the denial of an initial compensable evaluation for retroorbital headache with diplopia and an increased rating for hypertension to include chronic kidney disease stage 3. The veteran also sought service connection for GERD. The Board granted service connection for GERD, finding it etiologically linked to the veteran's service-connected disabilities, including PTSD and sleep apnea, based on a favorable VA examiner's opinion. The VA examiner concluded that the GERD was at least as likely as not proximately due to the veteran's service-connected conditions, citing NSAID use, stress from PTSD, and associations with sleep apnea and hypertension. The Board found this opinion probative and unopposed by contrary evidence. Regarding retroorbital headache with diplopia, the Board denied a compensable evaluation, noting the absence of characteristic prostrating attacks as required by Diagnostic Code 8100, despite the veteran's daily headaches. For hypertension with chronic kidney disease, the Board denied an increased rating beyond 30 percent, finding the veteran's GFR levels consistently met the criteria for that rating, with no evidence of lower GFRs, need for dialysis, or transplant eligibility. The Board reviewed evidence up to specific dates for each claim as per procedural rules.

Rationale

AOJ favorably found GERD diagnosis.; Veteran service connected for PTSD, sleep apnea, hypertensive heart disease, stroke residuals, and nerve disabilities.; VA examiner found GERD etiologically linked to service-connected disabilities.; Examiner concluded GERD was at least as likely as not proximately due to service-connected disabilities.; Board found VA opinion probative and unopposed by contrary evidence.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251202-620950

Full Decision Text

Citation Nr: A26025302
Decision Date: 03/20/26 Archive Date: 03/20/26

DOCKET NO. 251202-620950
DATE: March 20, 2026

ORDER

Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted.

Entitlement to an initial compensable evaluation for retroorbital headache with diplopia is denied.

Entitlement to an evaluation in excess of 30 percent for hypertension to include chronic kidney disease stage 3 is denied.

FINDINGS OF FACT

1. The Veteran's GERD is etiologically linked to his service-connected disabilities, to include posttraumatic stress disorder (PTSD), sleep apnea, hypertensive heart disease, stroke residuals, and various nerve disabilities of the bilateral lower extremities.

2. For the entire period on appeal, the Veteran's retroorbital headache with diplopia has not been manifested by characteristic prostrating attacks.

3. The Veteran's chronic kidney disease is manifested by a glomerular filtration rate (GFR) from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months, but not by a GFR of 45 mL/min/1.73 m2 or less, regular dialysis, or eligibility for a kidney transplant.

CONCLUSIONS OF LAW

1. The criteria for service connection for GERD have been met. 38 U.S.C. § 1110, 5107 (b); 38 C.F.R. § 3.310.

2. The criteria for entitlement to an initial compensable evaluation for retroorbital headache with diplopia have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1, 4.124a, Diagnostic Code (DC) 8100.

3. The criteria for entitlement to an evaluation in excess of 30 percent for hypertension to include chronic kidney disease stage 3 have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7101-7530.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from June 1969 to January 1971.

In the present case, the agency of original jurisdiction (AOJ) issued the rating decisions on appeal in December 2024, July 2025, and August 2025. The Veteran filed a timely appeal of that decision using VA Form 10182 in December 2025 and requested the Direct Review Lane with the Board. Accordingly, with respect to the claim for an increased rating for chronic kidney disease, the Board will consider evidence of record up to the December 6, 2024 AOJ decision. As to the claim for service connection for GERD, the Board will consider evidence up to the July 29, 2025 AOJ decision. As to the claim for an increased rating for headaches, the Board will consider evidence up to the August 20, 2025 AOJ decision. Evidence submitted outside these time frames cannot be considered.

The Board interprets the Veteran's request for advancement on the docket as a request to proceed with the adjudication of his appeal without delay, and without waiting for the time period to switch dockets outlined in Williams v. McDonough, 37 Vet. App. 305 (2024), to expire. Thus, the Board is proceeding with adjudication.

1. Entitlement to service connection for GERD

Service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 48 (1995) (en banc).

When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

In its December 2025 rating decision the AOJ favorably found that the Veteran has been diagnosed
or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 48 (1995) (en banc).

In its December 2025 rating decision the AOJ favorably found that the Veteran has been diagnosed with GERD. The Board is bound by this favorable finding. Thus, the first element of service connection has been met.

There is no dispute that the Veteran is service connected for PTSD, sleep apnea, bilateral upper extremity peripheral neuropathy of all radicular groups, hypertensive heart disease to include coronary artery disease, bilateral peripheral neuropathy of the femoral nerve, bilateral peripheral neuropathy of the cutaneous nerve, bilateral peripheral neuropathy of the ilio-inguinal nerve, bilateral peripheral neuropathy of the obturator nerve, and stroke affecting left eye small vessel disease.

In a May 2025 opinion, a VA examiner found that the Veteran's GERD was etiologically linked to his service-connected disabilities. Specifically, the examiner explained that chronic use of Nsaids to manage pain caused by his physical disabilities could lead to overproduction of acids in the stomach lining causing irritation and thinning of the gastrum mucosa contributing to reflux of those acids. The examiner also explained that chronic stress from a traumatic event or PTSD can harm your digestive system and your body's flight or fight responses cause excessive gastric acid production and reflux. GERD can develop when the symptoms of PTSD, such as anxiety, stress, and depression, lead to an overproduction of stomach acid. In some people, medications taken to treat PTSD can also lead to GERD as a side effect. Moreover, the examiner noted that studies have shown that individuals who have experienced a stroke have a higher likelihood of developing GERD compared to those who haven't had a stroke. Finally, the examiner stated that sleep apnea is often associated with GERD and hypertension can increase the risk of or exacerbate GERD. Ultimately, the examiner found that the cause of Veteran's GERD was multifactorial but, it was at least as likely as not that the Veteran's GERD was proximately due to his service-connected disabilities.

The Boards finds the opinion probative as it is supported by sufficient rationale and reveals review of the relevant medical literature. Finally, there is no competent medical evidence to contradict the examiner's findings.

The probative evidence supports service connection for GERD as secondary to the Veteran's service-connected disabilities. Accordingly, the Veteran's claim is granted.

Increased Ratings

The Veteran's entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Additionally, at the time of an initial rating, consideration of the appropriateness of a staged rating is also required. Fenderson v. West, 12 Vet. App. 119 (1999).

Disability evaluations are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4.

The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. 38 C.F.R. § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

When a question arises as to which of two ratings applies under a particular diagnostic code, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

1. Entitlement to an initial compensable evaluation for retroorbital headache with diplopia

The Board notes that the Veteran is challenging his initial rating. The Veteran was awarded service connection effective January 13, 2025. The Veteran is seeking a compensable evaluation for his headaches. The appeal period begins on January 13, 2025. The Veteran's headaches are rated under Diagnostic Code 8100 for the entire
1994).

1. Entitlement to an initial compensable evaluation for retroorbital headache with diplopia

Diagnostic Code 8100 provides ratings for migraine headaches. Migraine headaches with characteristic prostrating attacks averaging one in 2 months are rated 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. 38 C.F.R. § 4.124a. A 50 percent rating is the maximum rating provided under DC 8100. 38 C.F.R. § 4.124a. Governing case law and regulations have not defined "prostrating." For reference, the Board notes that "prostration" is defined as "extreme exhaustion or powerlessness." See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d. ed. 2012). Also, the Board notes that "migraine" is commonly associated with nausea, vomiting, constipation or diarrhea, and often with photophobia. Also, attacks are preceded by constriction of the cranial arteries, often with resultant prodromal sensory (especially ocular) symptoms. Id. at 1166.

The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 253 (2018). In Pierce v. Principi, 19 Vet. App. 400, 445 (2004), the Court noted that VA conceded that the phrase "productive of severe economic inadaptability" in Diagnostic Code 8100 should be construed as either "producing" or being "capable of producing" severe economic inadaptability.

The rating criteria do not define "prostrating." Dorland's Illustrated Medical Dictionary defines "prostration" as "extreme exhaustion or powerlessness." Dorland's Illustrated Medical Dictionary 1554 (31st ed. 2007). VA's Adjudication Procedures Manual (M21-1) defines prostrating under Diagnostic Code 8100 as "causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities." M21-1, pt. III, subpt. iv, ch. 4, sec. G(7)(b). While the Adjudication Manual is not binding on the Board, DAV v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017) ("The M21-1 Manual is binding on neither the agency nor tribunals"), the Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases." Overton v. Wilkie, 30 Vet. App. 257, 264 (2018).

VA regulations also do not define "economic inadaptability." In Pierce v. Principi, 18 Vet. App. 440, 445 (2004), the Court examined the term "productive of severe economic inadaptability" in the criteria for a 50 percent rating under Diagnostic Code 8100, and it noted that "[n]owhere in the DC is 'inadaptability' defined, nor can a definition be found elsewhere in title 38 of the [C.F.R.]." Id. at 446. The Court explained that "nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50% rating" because "[i]f 'economic inadaptability' were read to import unemployability," a claimant who "met the economic-inadaptability criterion, would then be eligible for a rating of total disability based on individual unemployability [(TDIU)]... rather than just a 50% rating." Id. The Court therefore rejected the notion that "severe economic inadaptability" was equivalent to
the DC is 'inadaptability' defined, nor can a definition be found elsewhere in title 38 of the [C.F.R.]." Id. at 446. The Court explained that "nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50% rating" because "[i]f 'economic inadaptability' were read to import unemployability," a claimant who "met the economic-inadaptability criterion, would then be eligible for a rating of total disability based on individual unemployability [(TDIU)]... rather than just a 50% rating." Id. The Court therefore rejected the notion that "severe economic inadaptability" was equivalent to an inability to secure or follow a substantially gainful occupation, the unemployability standard for TDIU. Id. In addition, the Court acknowledged VA's concession that the phrase "productive of severe economic inadaptability" in Diagnostic Code 8100 should be construed as either "producing" or "capable of producing" severe economic inadaptability. Id. at 445.

Turning to the medical evidence, VA treatment records from May 2024 reveal the Veteran complained of headaches occurring behind his eyes mostly when his blook pressure was quite high. In September 2024, the Veteran continued to complain of pressure like a retroorbital headache that got better with blood pressure control.

The Veteran was afforded a Headaches examination in March 2025. The Veteran was diagnosed with retroorbital headache with diplopia. The Veteran reported ongoing headaches with pressure and pain behind the eye, on both sides of his head. His treatment plan did not include medication. The Veteran did not endorse any non-headaches symptoms. The duration of the typical head pain was less than one day but occurred every day. The examiner found the Veteran did not suffer characteristic prostrating attacks of migraine or non-migraine pain.

The Board acknowledges the Veteran's complaints of chronic, daily headaches. However, there is no evidence of prostrating attacks at any frequency. The Veteran has not reported any symptoms that can be interpreted as prostrating. As noted, the rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 253 (2018). Thus, without evidence of prostrating attacks, there is no basis for a compensable rating and the claim is denied.

2. Entitlement to an evaluation in excess of 30 percent for hypertension to include chronic kidney disease stage 3

The Veteran is currently in receipt of 30 percent disability evaluation for his chronic kidney disease under Diagnostic Code 7101-7530, effective January 28, 2023. The Veteran contends that his kidney disease warrants a higher disability evaluation.

As applied here, hyphenated diagnostic codes are used when a rating for a particular disability under one diagnostic code is based upon rating of the residuals of that disability under another diagnostic code. 38 C.F.R. § 4.27 (2018). In this particular case, the Veteran's hypertensive vascular disease (hypertension) manifests in myriad disabilities including renal disease. The first set of four digits, 7101, is the diagnostic code for hypertension; whereas the second set of four digits after the hyphen, 7530, is the diagnostic code used to rate chronic renal disease. 38 C.F.R. § 4.115b.

Diagnostic Code 7530, which evaluates chronic renal disease, is rated under renal dysfunction. Under Diagnostic Code 7530, a 30 percent rating is warranted for chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months, a 60 percent rating is warranted for chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. An 80 percent rating requires chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. A maximum 100 percent evaluation is assigned for chronic kidney disease with glomerular filtration rate (GFR) less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient. 38 C.F.R. § 4.115a.

The Veteran submitted private treatment records from January 2023 to March 2024 which revealed glomerular filtration rates ranging from 49 to 71. VA treatment records showed an estimated GFR of 64 in February
disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. A maximum 100 percent evaluation is assigned for chronic kidney disease with glomerular filtration rate (GFR) less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient. 38 C.F.R. § 4.115a.

The Veteran underwent a VA examination for his chronic kidney disease in November 2023. The Veteran was diagnosed with chronic kidney disease that did not require regular dialysis. The examiner relied on January 2023 diagnostic testing which showed an estimated GFR of 64.

The Veteran was afforded VA examinations in June 2024 and November 2024. The Veteran was diagnosed with chronic kidney disease that did not require regular dialysis, and the Veteran had a GFR of 49 and 51 respectively.

Based on the foregoing, the Board finds that a disability evaluation in excess of 30 percent for the Veteran's chronic kidney disease is not warranted. For the entire period on appeal the Veteran's renal disease most nearly approximated that manifested by a GFR from 45 to 59 as contemplated by the 30 percent criteria under Diagnostic Code 7530. There is no evidence of a lower GFR. In fact, the record shows that the Veteran's GFR was at times higher than 59 with no structural abnormalities, red blood cell casts, or white blood cell casts. There is no evidence that the Veteran's kidney disease required regular dialysis, nor is the Veteran an eligible kidney transplant recipient.

Accordingly, the Board finds the Veteran's chronic kidney disease more closely approximates the 30 percent rating criteria, and the Veteran's claim is denied.

GAYLE STROMMEN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Sherman, C

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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