IRRITABLE COLON SYNDROME

Summary

The veteran, who served from February 1979 to July 1990, appeals the denial of increased initial ratings for his service-connected Irritable Bowel Syndrome (IBS) and Gastroesophageal Reflux Disease (GERD). The veteran is currently rated at 30% for IBS and 10% for GERD, and sought ratings of 50% for IBS and 20% for GERD. Regarding IBS, the Board found the veteran was already receiving the maximum schedular rating of 30% under Diagnostic Code 7319, both under the prior and amended rating criteria, and therefore denied a higher rating. For GERD, the Board reviewed the updated rating schedule effective May 19, 2024, which now specifically lists GERD under Diagnostic Code 7206. The veteran reported ongoing symptoms including acid reflux, bloating, nausea, and bowel changes, managed with medication and dietary restrictions. A VA examination confirmed GERD and noted the need for daily medication to control dysphagia, but found no documented history of esophageal stricture. The Board found the objective medical evidence, including the VA examinations, did not support a rating higher than the current 10%, as the criteria for higher ratings involving recurrent or refractory esophageal strictures requiring specific treatments were not met. The Board concluded that the updated rating schedule, allowing separate ratings for IBS and GERD, was more favorable than the prior combined rating restriction, but ultimately denied the requested increases for both conditions.

Rationale

Veteran already receiving maximum rating under DC 7319; Amended rating criteria did not warrant higher rating

Full Decision Text

Citation Nr: A26038941
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250417-536940
DATE: April 27, 2026

ORDER

An initial rating in excess of 30 percent for irritable bowel syndrome (IBS) is denied.

An initial rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is denied.

FINDINGS OF FACT

1. The Veteran has been assigned the maximum schedular rating for IBS.

2. The Veteran's service-connected GERD has not resulted in esophageal stricture causing dysphagia which requires dilation no more than 2 times per year.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 30 percent for IBS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code (DC) 7319.

2. The criteria for entitlement to an initial rating in excess of 10 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.10, 4.114, DC 7399.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1979 to July 1990.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the March 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 Ratings

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule).  See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability.  See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).  If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7.  Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran.  See 38 C.F.R. § 4.3.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.41. However, where an increase in the disability rating, rather than the propriety of the initial rating, is at issue, the present level of disability is of primary importance, and past medical reports should not take precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Regardless
 38 C.F.R. § 4.7.  Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran.  See 38 C.F.R. § 4.3.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.41. However, where an increase in the disability rating, rather than the propriety of the initial rating, is at issue, the present level of disability is of primary importance, and past medical reports should not take precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Regardless of whether an appeal stems from disagreement with the initial rating assigned following an award of service connection or from disagreement with the rating assigned following a claim for increase, separate ratings can be assigned for separate periods of time based on the facts found. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)).

An initial rating in excess of 30 percent for IBS is denied.

The Veteran seeks a higher initial rating for his service-connected IBS, currently rated as 30 percent disabling under DC 7319 effective September 28, 2023, the date of receipt of his intent to file. 38 C.F.R. § 4.114. Specifically, he asserts that his rating "should be 50%." See April 2025 VA Form 10182. 

Prior to May 19, 2024, under DC 7319, mild irritable bowel syndrome, with disturbances of bowel function with occasional episodes of abdominal distress, is rated noncompensable. Moderate irritable colon syndrome, with frequent episodes of bowel disturbance with abdominal distress, is rated 10 percent disabling. Severe irritable colon syndrome, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress, is rated 30 percent disabling. 38 C.F.R. § 4.114 (2023).

Effective May 19, 2024, the rating schedule applicable to the digestive system, set forth in 38 C.F.R. § 4.114, was amended, to include DC 7319. See 89 Fed. Reg. 19735 (March 20, 2024). Under the amended diagnostic code, a 10 percent rating is warranted for abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.  A 20 percent rating is warranted for abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.  A 30 percent rating is warranted for abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.  38 C.F.R. § 4.114.

During a February 2025 VA examination, the Veteran reported abdominal pain with alternating constipation and diarrhea. The examiner described IBS with abdominal pain at least 1 day per week, and signs or symptoms that included changes in stool frequency and form, altered stool passage (described as urgency), and abdominal bloating. The Veteran's alternating constipation and diarrhea was described as more or less constant.

Here, the Veteran is in receipt of the highest rating under Diagnostic Code 7319, the specific code for irritable bowel or irritable colon syndrome, under both the old and new criteria. The Board notes that irritable colon is synonymous with irritable bowel. See Merriam-Webster's Medical Dictionary 395 (2016). As the Veteran is already in receipt of the highest available rating for this disability, a higher rating is not warranted. Copeland v. McDonald, 27 Vet. App. 333, 336 (2015) (where a condition is listed in the rating schedule, rating by
 as urgency), and abdominal bloating. The Veteran's alternating constipation and diarrhea was described as more or less constant.

Here, the Veteran is in receipt of the highest rating under Diagnostic Code 7319, the specific code for irritable bowel or irritable colon syndrome, under both the old and new criteria. The Board notes that irritable colon is synonymous with irritable bowel. See Merriam-Webster's Medical Dictionary 395 (2016). As the Veteran is already in receipt of the highest available rating for this disability, a higher rating is not warranted. Copeland v. McDonald, 27 Vet. App. 333, 336 (2015) (where a condition is listed in the rating schedule, rating by analogy is not appropriate). As the evidence is persuasively against the claim, an initial rating in excess of 30 percent for IBS must be denied.

An initial rating in excess of 10 percent for GERD is denied.

The Veteran is also seeking a higher initial rating for his service-connected GERD, currently rated as 10 percent disabling under DC 7206. 38 C.F.R. § 4.114. Specifically, he asserts that his rating "should be 20%." See April 2025 VA Form 10182.

The Board again acknowledges that VA amended the rating schedule for evaluating digestive system disabilities effective May 19, 2024. See 89 Fed. Reg. 19375. 

Prior to May 19, 2024, the Veteran's disability would generally be rated by analogy to DC 7346, for hiatal hernia, as, prior to the regulatory amendments that took effect in 2024, there were no diagnostic criteria specific to GERD.

Under pre-amendment DC 7346, a 60 percent rating was warranted for hiatal hernia 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 rating was warranted for "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 rating was warranted for two or more of the symptoms for the 30 percent evaluation of less severity. 38 C.F.R. § 4.114 (2023).

"Considerable" is defined as "large in extent or degree."  See www.merriam-webster.com/dictionary/considerable. "Severe" is defined as "very painful or harmful." See www.merriam-webster.com/dictionary/severe. The term "persistent" may be defined as "continuing to exist despite interference or treatment." See https://www.merriam-webster.com/dictionary/persistent.

The Board notes that prior to the regulatory amendment, ratings under DCs 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7346 inclusive could not be combined with each other. A single evaluation was to be assigned under the diagnostic code that reflected the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability picture warranted such elevation. 38 C.F.R. § 4.114 (2023). The Board notes that this restriction included the diagnostic codes for irritable colon syndrome (DC 7319) and hiatal hernia (DC 7346). 

As of May 19, 2024, the rating schedule now specifically lists GERD under Diagnostic Code 7206.

Diagnostic Code 7206 dictates that a documented history of GERD without daily symptoms or requirement for daily medication warrants a noncompensable rating. A documented history of esophageal stricture(s) that requires daily medications to control dysphagia, otherwise asymptomatic, warrants a 10 percent rating. A documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year warrants a 30 percent rating. A documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement warrants a 50 percent rating. Lastly, a documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s) or
. A documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement warrants a 50 percent rating. Lastly, a documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube) warrants a maximum 80 percent rating. The Board notes that medication use is contemplated by the amended rating criteria. See McCarroll v. McDonald, 28 Vet. App. 267 (2016).  

Diagnostic Code 7206 contains several relevant notes to assist in its application. Note (1) provides that findings associated with the disability in question must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. 38 C.F.R. § 4.114, Diagnostic Code 7206, Note (1).

Note (2) directs VA to evaluate non-gastrointestinal complications of procedures of the disability at issue under the appropriate system at issue. 38 C.F.R. § 4.114, Diagnostic Code 7206, Note (2).

Notes (4) and (5) define recurrent and refractory esophageal strictures as contemplated by Diagnostic Code 7206. Note (4) defines recurrent esophageal stricture as the inability to maintain target esophageal diameter beyond four weeks after the target diameter has been achieved. 38 C.F.R. § 4.114, Diagnostic Code 7206, Note (4). Comparatively, Note (5) defines refractory esophageal stricture as the inability to achieve target esophageal diameter despite receiving no fewer than five dilatation sessions performed at two-week intervals. 38 C.F.R. § 4.114, Diagnostic Code 7206, Note (5).

Finally, the Board notes that under 38 C.F.R. § 4.114 as amended, the ratings for IBS and GERD may be combined.

Turning to the evidence, the Veteran submitted a private medical opinion indicating that he has a current diagnosis of GERD that had its onset during active military service and has persisted to the present. The Veteran reported ongoing symptoms, including regurgitation two or more times a week. The clinician noted that the condition is managed with dietary restrictions and medication as needed. See July 2024 Medical Treatment Record - Non-Government Facility. 

The Veteran was afforded a VA examination in January 2025, at which time a diagnosis of GERD was confirmed. The Veteran reported his stomach condition started during service in 1983 and has continued to the present. He endorsed current symptoms, including acid reflux, abdominal bloating, occasional nausea, loose bowels, and occasional constipation. He stated that he has treated the condition with omeprazole and dietary modifications and reported that the condition has worsened since onset. The examiner found that the Veteran's esophageal condition requires daily medication to control dysphagia. A documented history of esophageal stricture(s) was not noted. The Veteran was not found to have Barrett's esophagus, and he was not found to have had surgery or other procedures for an esophageal condition or hiatal hernia. Regarding functional impact, the Veteran reported that he requires sporadic bathroom breaks when feeling nausea or when his bowels are symptomatic. See January 2025 Esophageal Conditions DBQ. 

The AOJ obtained an additional examination in February 2025. The examiner acknowledged the Veteran's report of pyrosis, reflux, nausea and abdominal pain with alternating constipation. The report indicated that the Veteran's symptoms have progressively worsened over the years, requiring daily medication to control.  The examiner found that the Veteran has dysphagia, requiring daily medication. A documented history of esophageal stricture(s) was not noted. The Veteran was not found to have Barrett's esophagus, nor was he found to have had surgery or other procedures performed for an esophageal condition or hiatal hernia. No functional impact was identified on this examination based on review of the record. The examiner further noted that symptoms attributable to GERD--including persistent recurrent epigastric distress, dysphagia, pyrosis, reflux, and nausea-occur at least once per month, (or greater than 12 times per year), with each episode lasting approximately one day.
, requiring daily medication to control.  The examiner found that the Veteran has dysphagia, requiring daily medication. A documented history of esophageal stricture(s) was not noted. The Veteran was not found to have Barrett's esophagus, nor was he found to have had surgery or other procedures performed for an esophageal condition or hiatal hernia. No functional impact was identified on this examination based on review of the record. The examiner further noted that symptoms attributable to GERD--including persistent recurrent epigastric distress, dysphagia, pyrosis, reflux, and nausea-occur at least once per month, (or greater than 12 times per year), with each episode lasting approximately one day. Notably, the examiner did not document evidence of substernal, arm, or shoulder pain. See February 2025 Esophageal Conditions DBQ. 

The medical records do not establish entitlement to an evaluation in excess of the current 10 percent rating assigned for GERD. The Board acknowledges the Veteran's belief that his symptoms warrant a higher rating, however his lay assertions are outweighed by the objective medical evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995).

Overall, the Board finds that the Veteran's GERD symptoms do not meet the criteria for a higher rating under the relevant diagnostic code and there is no basis for a rating in excess of 10 percent. The Board finds application of the new rating criteria, rather than the old, more favorable, as the Veteran's GERD and IBS may be rated separately, and the Veteran's GERD symptoms do not warrant a high enough rating under the old criteria to surpass his currently assigned separate ratings.

As the evidence of record persuasively weighs against the claim, an initial rating in excess of 10 percent for GERD must also be denied.

 

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Hampl, Samantha

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.