GASTROESOPHAGEAL REFLUX DISEASE (GERD)

ANN K. MINAMI · 2026 · Case ID: A26038928

DENIED

Summary

The veteran, who served in the U.S. Army from December 1983 to March 2005, appeals the denial of an increased rating for his gastroesophageal reflux disease (GERD) for the period prior to November 2, 2023. The veteran was initially granted service connection for GERD in August 2005. He has pursued an increased rating since October 2018, with multiple denials from the agency of original jurisdiction (AOJ). The AOJ identified a duty to assist error in a June 2023 Higher-Level Review, leading to further development. A February 2024 rating decision granted a 30 percent rating effective November 2, 2023, based on a VA examination. The veteran appealed for an earlier effective date. The Board previously denied a rating higher than 10 percent for the period prior to November 2, 2023. A Joint Motion for Remand (JMR) in December 2025 led to this current review, requiring the Board to readdress the rating by analogy under DC 7346 and define subjective terms. The Board reviewed VA examinations from November 2019 and December 2020, along with the veteran's lay statements and a private opinion. The VA examinations indicated symptoms of pyrosis, reflux, regurgitation, substernal pain, and sleep disturbance, but did not meet the criteria for persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia, nor did they indicate considerable or severe impairment of health. The Board found the private opinion inadequate as it lacked examination details and thorough record review. Ultimately, the Board concluded that the veteran's GERD symptoms, even with medication, did not demonstrate a degree of impairment less than considerable or severe, thus not warranting a rating higher than 10 percent for the period prior to November 2, 2023. The appeal for an earlier effective date is also implicitly denied by this finding.

Rationale

VA examinations did not find symptoms meeting criteria for persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia.; VA examinations did not find symptoms productive of considerable or severe impairment of health.; Private medical opinion was inadequate as it lacked examination details and thorough record review.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7346

Docket No.

240223-419669

Full Decision Text

Citation Nr: A26038928
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 240223-419669
DATE: April 27, 2026

ORDER

A rating in excess of 10 percent for gastroesophageal reflux disease (GERD), for the period on appeal prior to November 2, 2023, is denied.

FINDING OF FACT

During the period on appeal prior to November 2, 2023, the Veteran's GERD symptomatology has included pyrosis, reflux, regurgitation, substernal pain, sleep disturbance, and nausea. The Veteran's GERD has not manifested symptoms of persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia. His GERD symptomatology has not been shown to be productive of either considerable or severe impairment of health.

CONCLUSION OF LAW

The criteria for a rating in excess of 10 percent for GERD, for the period on appeal prior to November 2, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.114, Diagnostic Code (DC) 7399-7346.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from December 1983 to March 2005.

The rating decision on appeal was issued in February 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

Although the Veteran initially requested Higher-Level Review (HLR) when submitting the June 2023 VA Form 20-0996, Decision Review Request: HLR, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development.

In the February 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the February 2024 agency of original jurisdiction (AOJ) supplemental claim decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Rating GERD

By way of history, the Veteran was granted service connection for GERD in an August 2005 rating decision. On October 29, 2018, the Veteran filed an intent to file, which he followed up with a formal claim on October 25, 2019, requesting an increased rating for his GERD. In a November 2019 rating decision, the Veteran was denied a rating in excess of 10 percent for GERD. A rating decision was issued in July 2020 due to a mandated special review in which a rating in excess of 10 percent for GERD was denied. On September 23, 2020, the Veteran submitted an intent to file, which he followed up with a formal claim on September 24, 2020, requesting an increased rating for his GERD. In a December 2020 rating decision, the Veteran was denied a rating in excess of 10 percent for GERD. In December 2021, the Veteran filed a supplemental claim requesting an increased rating for GERD. In a December 2021 rating decision, the Veteran was denied a rating in excess of 10 percent for GERD.

In June 2023, the Veteran submitted VA Form 20-0996 Request for HLR, in which he identified the December 2021 rating decision and requested an increased rating for GERD. An extension request due to COVID-19 for timely filing was submitted in conjunction with the Veteran's June 2023 HLR request. The AOJ accepted the Veteran's June 2023 extension request and issued a
the Veteran was denied a rating in excess of 10 percent for GERD. In December 2021, the Veteran filed a supplemental claim requesting an increased rating for GERD. In a December 2021 rating decision, the Veteran was denied a rating in excess of 10 percent for GERD.

In June 2023, the Veteran submitted VA Form 20-0996 Request for HLR, in which he identified the December 2021 rating decision and requested an increased rating for GERD. An extension request due to COVID-19 for timely filing was submitted in conjunction with the Veteran's June 2023 HLR request. The AOJ accepted the Veteran's June 2023 extension request and issued a HLR rating decision in September 2023, in which a duty to assist error was identified warranting additional development regarding the issue of an increased rating for GERD. In a February 2024 rating decision, the Veteran was granted an increased rating for GERD of 30 percent effective November 2, 2023, the date he underwent a VA examination showing that a 30 percent rating was warranted.

In February 2024, the Veteran submitted a VA Form 10182 Board appeal, in which he indicated that he was seeking an earlier effective date prior to November 2, 2023, for the award of the 30 percent rating for GERD. Specifically, it was argued that an effective date of September 23, 2020, if not earlier, was warranted for the award of the 30 percent rating for GERD. In a March 2025 Board decision, a rating in excess of 10 percent for GERD, for the period on appeal prior to November 2, 2023, was denied. The Veteran appealed the March 2025 Board decision to the United States Court of Appeals for Veterans Claims (Court or CAVC). In a December 2025 Joint Motion for Remand (JMR), the parties agreed that the March 2025 Board decision should be vacated and the appeal remanded. In particular, the Court found that remand was required for the Board to: (1) readdress whether the Veteran warranted a higher rating when rating by analogy under DC 7346 in accordance with Webb v. McDonough 71 F.4th 1377, 1380 (Fed. Cir. 2023), and (2) define applicable subjective terms in accordance with Johnson v. Wilkie, 30 Vet. App. 245, 254 (2018).

Thus, the issue of a rating in excess of 10 percent for GERD for the period on appeal prior to November 2, 2023, is returned to the Board for further adjudication in accordance with the findings from the December 2025 JMR. As the Veteran has continuously pursued an increased rating for GERD since he filed an intent to file on October 29, 2018, the period on appeal begins with the October 29, 2018, intent to file.

Prior to May 19, 2024, GERD was not specifically listed in the Schedule for Rating Disabilities. When an unlisted disorder is encountered, it is permissible to rate it under a closely related disease or injury in which not only the functions affected, but also the anatomical localization and symptomatology, are closely analogous. 38 C.F.R. § 4.20. According to the policy in the Schedule for Rating Disabilities, when a disability is not specifically listed, the DC will be "built up," meaning that the first two digits will be selected from that part of the schedule most closely identifying the part of the body involved, and the last two digits will be "99." 38 C.F.R. § 4.27. The Veteran's GERD was rated by analogy to hiatal hernia under 38 C.F.R. § 4.114, DC 7399-7346.

Strict adherence is not required when rating an unlisted disorder by analogy. For unlisted disorders, 38 C.F.R. § 4.20 provides that it is "permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous." In Lendenmann v. Principi, 3 Vet. App. 345 (1992), the Court explained that in deciding whether a listed disease is "closely related" to the unlisted one, VA may take into consideration the functions affected, the anatomical location, and the symptomatology of the disorders. See Webb v. McDonough, 71 F.4th 1377, 1379 (Fed. Cir. 2023). The Board errs when it requires a showing
.F.R. § 4.20 provides that it is "permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous." In Lendenmann v. Principi, 3 Vet. App. 345 (1992), the Court explained that in deciding whether a listed disease is "closely related" to the unlisted one, VA may take into consideration the functions affected, the anatomical location, and the symptomatology of the disorders. See Webb v. McDonough, 71 F.4th 1377, 1379 (Fed. Cir. 2023). The Board errs when it requires a showing that the unlisted disorder strictly meets the requirements of the DC as if directly rating under that code. Id. at 1380-81.

DC 7346 provides the following: A 60 percent evaluation with symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. A 30 percent evaluation with persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 10 percent evaluation with two or more of the symptoms for the 30 percent evaluation of less severity. 38 C.F.R. § 4.114, DC 7346.

The Board notes that 38 C.F.R. § 4.114, DC 7346 does not define the terms "less," "persistently recurrent," "considerable," or "severe." The Court has held that the Board's statement of reasons or bases may be inadequate where it does not define key terms, Johnson v. Wilkie, 30 Vet. App. 245, 247 (2018), and the Board must ensure that any ambiguous terms used in VA regulations are properly defined when applying the diagnostic criteria for a particular disability. Rivera-Colon v. McDonough, 35 Vet. App. 221, 229 (2022). The Court has discussed, and approved of, the use of dictionaries such as Dorland's Medical Dictionary by the Board. While the Court notes that dictionaries or treatises cannot properly be used to make medical determinations, the Court presumes that terms carry their ordinary dictionary meanings where they are not defined in the regulation. Holmes v. Wilkie, 33 Vet. App. 67, 71-72 (2020). The Court similarly held that, in discussing the meaning of terms, the Board is permitted to consult a dictionary. See Nielson v. Shinseki, 23 Vet. App. 56, 59 (2009) ("It is commonplace to consult dictionaries to ascertain a term's ordinary meaning.").

Merriam-Webster's Dictionary defines "less" as of reduced size, extent, or degree. See Merriam-Webster's Collegiate Dictionary (Merriam-Webster's) 713 (11th ed. 2020). "Persistent" is defined as existing for a long or longer than usual time or continuously. Id. at 924. "Recurrent" is defined as returning or happening time after time. Id. at 1041. "Considerable" is defined as large in extent or degree. Id. at 266. "Severe" is defined as very painful or harmful. Id. at 1140. See also Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary.

The rating criteria under Diagnostic Code 7346 are not successive or cumulative with that of the lower rating. See Tatum v. Shinseki, 23 Vet. App. 152, 155 (2009); see also Stankevich v. Nicholson, 19 Vet. App. 470, 472 (2006) (stating that disabilities rated by analogy will not show all objective criteria of the analogous rating).

During the pendency of the appeal, VA published amendments to 38 C.F.R. § 4.114, the Schedule of Ratings for the Digestive System, effective May 19, 2024. However, given that the period on appeal pre-dates the revisions to the regulations, they are inapplicable to this appeal.

During the period on appeal prior to November 2, 2023, the Veteran underwent two VA examinations, one in November 2019 and one in December 2020. At the November 2019 VA examination, the Veteran reported occasional heart burn, bloating, and acid reflux. The VA examiner indicated that the Veteran's GERD manifests with symptoms of pyrosis and reflux. The examiner did not find the Veteran's symptoms to result in persistently recurrent epigastric distress, dysphagia, regurgitation, substernal or arm or shoulder pain, nausea or vomiting, material weight loss, hematemesis, or melena with moderate anemia. Nor were his symptoms found to be productive of either considerable or severe impairment of health. The Veteran did not have an esophageal stricture, spasm of the esophagus, or an acquired diverticulum of the esophagus. No other pertinent physical findings, complications, conditions, signs, or symptoms were recorded concerning the Veteran's GERD. No functional impacts were noted.

In September 2020, the Veteran submitted a statement, in which he reported that he had multiple symptoms of GERD that included heartburn, regurgitation, acid reflux, difficulty swallowing, and a feeling of food coming back up into his throat multiple times per day. He noted that he has to avoid certain foods, such as spicy foods and acidic types of foods. He relayed that he cannot eat late in the day or at night, or large meals, otherwise his regurgitation will worsen. He also noted that he has chest pain when his GERD is flaring up. His sleep habits have also been impacted due to his GERD symptoms. Due to a lack of sleep, he has noticed difficulty concentrating, daytime fatigue, trouble thinking, irritability, and frequent yawning. Thus, he stated that his GERD was having a profound effect on the rest of his life and his overall health and well-being.

At the December 2020 VA examination, the Veteran reported chronic substernal heartburn and coughing when he regurgitates stomach contents. The VA examiner indicated that the Veteran's GERD manifests with symptoms of pyrosis, reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux that occurs four or more times per year and lasts an average of less than one day, and nausea that occurs four or more times per year and lasts an average of less than one day. The examiner did not find the Veteran's symptoms to result in persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia. Nor were his symptoms found to be productive of either considerable or severe impairment of health. The Veteran did not have an esophageal stricture, spasm of the esophagus, or an acquired diverticulum of the esophagus. No other pertinent physical findings, complications, conditions, signs, or symptoms were recorded concerning the Veteran's GERD. No functional impacts were noted.

The Veteran submitted a private medical opinion in December 2021 concerning his GERD, however, the opinion is inadequate for rating purposes. The private nurse that provided the opinion simply copied the schedular criteria in the opinion, noted some definitions, quoted a lay statement from the Veteran, and noted conceded symptoms found on the December 2020 rating decision. The nurse then concluded that a 60 percent rating was warranted for the Veteran's GERD. However, there are no indications anywhere in the opinion that the nurse actually examined the Veteran or at a minimum spoke with him concerning his symptoms and the impact of his GERD, or that she had thoroughly reviewed his file and medical treatment records to obtain an accurate picture of his GERD. Thus, as the opinion does not appear to be based upon a thorough and accurate analysis of the Veteran's GERD symptoms through examination and review of all pertinent records, the opinion is inadequate for ratings purposes, and therefore, the findings are inapplicable.

A review of the Veteran's VA treatment records during the period on appeal does not reflect any findings of any greater significance than those relayed in the above VA examinations. That is, while they show the Veteran to have GERD, they do not show the Veteran's GERD to manifest with symptoms of persistently recurrent epigastric
the impact of his GERD, or that she had thoroughly reviewed his file and medical treatment records to obtain an accurate picture of his GERD. Thus, as the opinion does not appear to be based upon a thorough and accurate analysis of the Veteran's GERD symptoms through examination and review of all pertinent records, the opinion is inadequate for ratings purposes, and therefore, the findings are inapplicable.

A review of the Veteran's VA treatment records during the period on appeal does not reflect any findings of any greater significance than those relayed in the above VA examinations. That is, while they show the Veteran to have GERD, they do not show the Veteran's GERD to manifest with symptoms of persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia. Nor do they indicate that the Veteran's symptoms are productive of either considerable or severe impairment of health.

Based upon the foregoing, a rating in excess of 10 percent for the Veteran's GERD for the period on appeal prior to November 2, 2023, is not warranted. Although strict adherence to the criteria of DC 7346 is not required, the Veteran's GERD was manifested at its worst at the December 2020 VA examination by two or more of the symptoms for a 30 percent rating (pyrosis, reflux, regurgitation, and substernal pain). While those symptoms have disturbed the Veteran's sleep throughout the year, and the Veteran has reported that due to a lack of sleep he has noticed difficulty concentrating, daytime fatigue, trouble thinking, irritability, and frequent yawning, the Veteran's functional ability was not found to be impacted, which indicates that impairment of function and health was of an extent and degree less than large, i.e., of less severity than considerable. The described and documented persistent and recurrent GERD symptoms do not alone establish a large impact on his daily activities, or as both the November 2019 and December 2020 VA examiners found, does not establish that his GERD symptoms impacted work or produced at least considerable impairment of health. See Merriam-Webster's at 266 (defining considerable).

Thus, the Board concludes that the Veteran's GERD caused symptoms resulting in a degree of impairment less than both considerable and severe, a degree of impairment inconsistent with the level of disability contemplated by any rating other than the 10 percent rating already assigned. The criteria for a rating in excess of 10 percent for GERD under the only applicable criteria are therefore not met during the period on appeal prior to November 2, 2023. 38 C.F.R. § 4.114, DC 7346.

The criteria of 38 C.F.R. § 4.114, DC 7346 do not specifically contemplate the effects of medication. "The Court in Jones concluded that when relevant rating criteria do not explicitly contemplate a Veteran using medication to allay symptoms of a service-connected disability, the Board, in assessing the severity of that disability for rating purposes, must discount the beneficial effects of medication used." Ingram v. Collins, 38 Vet. App. 130, 135 (2025) (citing Jones v. Shinseki, 26 Vet. App. 56, 61 (2012)). The Board finds that both the November 2019 and December 2020 VA examiners discounted ameliorative effects in acknowledging the Veteran's utilization of medication (Nexium on the November 2019 VA examination and Omeprazole on the December 2020 VA examination), with consideration of his symptoms (pyrosis and reflux on the November 2019 VA examination, and pyrosis, reflux, regurgitation, and substernal pain on the December 2020 VA examination), while certifying that the current level of severity of the Veteran's GERD was captured on the examinations.

The Veteran is competent to report observable symptoms, Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), and consideration has been given to those reports. However, the Veteran's statements concerning the functional impact upon his daily life due to his GERD, such as found in his September 2020 statement, do not indicate that his symptomatology is productive of either considerable or severe impairment of health. Both the November 2019 and December 2020 VA examiners considered the Veteran's reports and history, but neither examiner found the Veteran to have symptoms of persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia. Moreover, neither examiner found considerable or severe impairment of health. Overall, with or without medication, the Veteran's GER
), and consideration has been given to those reports. However, the Veteran's statements concerning the functional impact upon his daily life due to his GERD, such as found in his September 2020 statement, do not indicate that his symptomatology is productive of either considerable or severe impairment of health. Both the November 2019 and December 2020 VA examiners considered the Veteran's reports and history, but neither examiner found the Veteran to have symptoms of persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia. Moreover, neither examiner found considerable or severe impairment of health. Overall, with or without medication, the Veteran's GERD is not shown to be of such a severity under any applicable (or potentially applicable) criteria warranting elevation to the next higher evaluation.

While the criteria are not successive and these characterizations not dispositive, they are consistent with the weight of the competent and probative evidence of record which does not suggest GERD resulted in persistently recurrent epigastric distress, dysphagia, vomiting, material weight loss, hematemesis, or melena with moderate anemia, or any symptoms or combinations productive of considerable impairment of health during the period on appeal prior to November 2, 2023. Such also weighs against finding that GERD symptoms were productive of any greater degree, to include severe impairment of health. 38 C.F.R. § 4.10; 38 C.F.R. § 4.114, DC 7346.

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Thus, the Board finds that the Veteran's GERD symptomatology, either individually or in combination, was not productive of considerable impairment of health, or worse, at any time over the period on appeal prior to November 2, 2023. As such, a rating in excess of 10 percent for GERD is not warranted at any time over the period on appeal prior to November 2, 2023.

Accordingly, a rating in excess of 10 percent for GERD, for the period on appeal prior to November 2, 2023, is denied.

Ann K. Minami

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Lutgens-Staley, Associate Counsel

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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