IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

Summary

The veteran, who served in the United States Army from October 1982 to October 1986, appeals the rating decision concerning his gastroesophageal reflux disease (GERD) with irritable bowel syndrome (IBS). The veteran sought an increased rating, contending his symptoms approximated a 30 percent disability level. The Board reviewed the evidence under both pre-May 19, 2024, and post-May 19, 2024, rating criteria for digestive system disabilities. The veteran submitted lay evidence detailing frequent and severe alternating constipation and diarrhea, along with constant abdominal pain and discomfort. While the VA examiner in April 2019 found no significant diagnosis, subsequent July 2021 examinations confirmed GERD and IBS, noting frequent abdominal distress and alternating bowel symptoms. The Board found the evidence in approximate balance regarding whether the veteran experienced more or less constant abdominal distress under the pre-May 19, 2024, criteria for IBS (Diagnostic Code 7319). Applying the benefit of the doubt, the Board found the veteran's reported symptoms, including continuous abdominal pain and discomfort, met the criteria for a 30 percent rating under the former Diagnostic Code 7319. The Board determined this former criteria was more favorable than the current criteria. Therefore, the Board granted an initial rating of 30 percent for GERD with IBS.

Rationale

Evidence in approximate balance for constant abdominal distress under former DC 7319; Benefit of the doubt resolved in veteran's favor; Former criteria more favorable than current criteria

Full Decision Text

Citation Nr: A26039675
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 211029-195033
DATE: April 28, 2026

ORDER

Entitlement to an initial rating of 30 percent, but no higher, for gastroesophageal reflux disease (GERD) with irritable bowel syndrome (IBS) is granted.

FINDING OF FACT

The Veteran's GERD with IBS has been more nearly approximate to symptoms that are severe with diarrhea, or alternating diarrhea and constipation with more or less constant abdominal distress.

CONCLUSION OF LAW

The criteria for entitlement to an initial rating of 30 percent, but no higher, for GERD with IBS, have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.113, 4.114, Diagnostic Codes 7319-7346.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in active service in the United States Army from October 1982 to October 1986.

The rating decision on appeal was issued in August 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the October 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On June 2, 2025, the Veteran, through his representative, withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the August 2021AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. 

1. Entitlement to an initial increased rating of 30 percent, but no higher, for gastroesophageal reflux disease (GERD) with irritable bowel syndrome (IBS) is granted.

The Veteran contends that his GERD with IBS has been more nearly approximate to a 30 percent rating throughout the entirety of the appeal. See July 2019 Sworn Declaration of Veteran. 

Disability evaluations are determined by evaluating the extent to which a veteran's service connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Schedule). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7 and 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002).

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3.

Evidence to be considered in the appeal of an initial assignment of a disability rating is not limited to that reflecting the then-current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran
).

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3.

Evidence to be considered in the appeal of an initial assignment of a disability rating is not limited to that reflecting the then-current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to receive a staged rating. That is, it is possible to be awarded separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007) (in determining the present level of a disability for any increased evaluation claim, the Board must consider staged ratings).

Disabilities of the digestive system are evaluated under the regulatory criteria found at 38 C.F.R. §§ 4.110- 4.114.  VA amended the Rating Schedule for evaluating disabilities involving the digestive system, including GERD, effective May 19, 2024.  See 89 Fed. Reg. 19375 (Mar. 20, 2024).  

Where a law or regulation changes during the pendency of a claim for increased rating, the amendments cannot be construed to have retroactive effect unless the language requires such a result.  See Kuzma v. Principi, 341 F.3d 1327, 1328 (2003) (citing Landgraf v. USI Film Prods., 511 U.S. 244 (1994)).  There is no such language in the amendments to the regulations at issue in this case.  Consequently, the Board has considered whether an increased rating may be warranted under either the old or new version of the schedule for rating disabilities of the digestive system; but application of the newer regulations can be no earlier than the effective date of the change.  As the appeal period in the present matter begins on September 3, 2081, the date of service connection for the disability, the Board will evaluate the Veteran's service-connected GERD with IBS under both the pre-amended and amended criteria and apply the rating criteria that is more favorable to the Veteran.

The Veteran's GERD with IBS is rated under 38 C.F.R. § 4.114, Diagnostic Codes 7319-7346 (in effect prior to May 19, 2024).  The Board notes that hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27.  The hyphenated disability will be rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology.  38 C.F.R. §§ 4.20, 4.27.  Furthermore, in accordance with 38 C.F.R. § 4.114, ratings under Diagnostic Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

Under Diagnostic Code 7346, a 10 percent rating is assigned with two or more of the symptoms for the 30 percent evaluation of less severity; a 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health; and, a 60 percent rating is assigned for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, DC 7346 (2021).

Under Diagnostic Code 7319, a noncompensable rating is warranted for mild symptoms noted as disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent rating is warranted for moderate symptoms noted as frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is warranted for severe symptoms noted as diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114, DC 
 is assigned for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, DC 7346 (2021).

Under Diagnostic Code 7319, a noncompensable rating is warranted for mild symptoms noted as disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent rating is warranted for moderate symptoms noted as frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is warranted for severe symptoms noted as diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114, DC 7319 (2021).  

The words "mild," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities.  Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions."  38 C.F.R. § 4.6. According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "mild" means slight or gentle; "moderate" means limited in scope or effect; and "severe" means very painful or harmful or of a great degree.

However, effective May 19, 2024, VA amended the criteria for rating digestive system disabilities. Diagnostic Code 7346 for hiatal hernia and paraesophageal hernia is directed to be rated as stricture of the esophagus under Diagnostic Code 7203. Also, effective May 19, 2024, the rating schedule now specifically lists GERD under Diagnostic Code 7206. Whereas Diagnostic Code 7319 was amended to refer specifically to irritable bowel syndrome. 

Under both Diagnostic Code 7203 and 7206, a noncompensable rating is warranted for a documented history without daily symptoms or requirement for daily medications.

A 10 percent rating is warranted for a documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptotic.

A 30 percent rating is warranted for a documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than two times per year.

A 50 percent rating is warranted for 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.

Finally, an 80 percent rating is warranted for 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).

From May 19, 2024, under Diagnostic Code 7319, 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 the 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 for at least one day per week during the previous three months; and two or more of the following: (1) change in the stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

Turning to the evidence, the Veteran was afforded a VA examination in April 2019 for stomach conditions. There, the examiner noted current symptoms of constipation once or twice a month without treatment, medications, or surgery. No signs or symptoms of any stomach or duodenum conditions were reported nor any other
. A 30 percent rating is warranted for abdominal pain related to defecation for at least one day per week during the previous three months; and two or more of the following: (1) change in the stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

Turning to the evidence, the Veteran was afforded a VA examination in April 2019 for stomach conditions. There, the examiner noted current symptoms of constipation once or twice a month without treatment, medications, or surgery. No signs or symptoms of any stomach or duodenum conditions were reported nor any other conditions. The VA examiner remarked that the medical history of the Veteran did not support a diagnosis of IBS or peptic ulcer disease at the time. The VA examiner also opined that the constipation the Veteran experienced was diet related and that, although he experienced occasional abdominal pain, there was a lack of evidence to diagnose the disorder. 

In July 2021, the Veteran was afforded VA examinations for GERD, intestinal conditions, and stomach conditions. Beginning with the GERD examination, the VA examiner confirmed a diagnosis of GERD that had worsened since its onset around 1982. The Veteran reported symptoms of persistent recurrent epigastric distress, substernal pain, and sleep disturbances lasting one to nine days at a time. The VA examiner noted the Veteran did not have epigastric stricture, or other pertinent findings or symptoms. The Veteran provided that the epigastric pain caused significant anxiety and distress. 

During the July 2021 VA examination for intestinal conditions, the VA examiner confirmed a diagnosis of IBS with symptoms of alternating diarrhea and constipation every other week, epigastric pain, and abdominal discomfort every day treated with probiotics. The Veteran reported episodes of bowel disturbance with abdominal distress as occurring frequently. These episodes cause him much anxiety and distress. 

Finally, the Veteran was afforded a VA examination for the stomach in July 2021. While the VA examiner remarked the Veteran did not have a stomach condition, the findings on the exam were attributed to GERD and IBS. The Veteran reported continuous abdominal pain. 

The Veteran has also submitted lay evidence of his symptoms, their frequency, and medications to treat them. For his IBS, the Veteran submitted symptoms of abdominal cramping, excessive gas, bloating, constipation, diarrhea, backaches, anxiety, acid reflux, mucus in stool, and fatigue. See March 2019 Correspondence. He takes several medications for treatment, to include digestive enzymes, probiotics, immodium, dulcolax, and dicyclomine. The Veteran also submitted IBS logs illustrating the frequency of constipation and diarrhea and their severity. Between April 2020 and October 2020, the Veteran reported 24 instances of constipation and 46 instances of diarrhea in alternating occurrences. See. Generally, November 2020 Medical Treatment Record (IBS Logs). Between May 2020 and October 2020, the Veteran also noted that he had constant stomach pain and cramps. See Id. 

Under the pre-May 19, 2024 regulations, Diagnostic Code 7346, notes that a 30 percent rating is 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. While the Veteran reported symptoms of substernal pain and epigastric distress, there was no occurrence of dysphagia, pyrosis, or regurgitation. See July 2021 GERD Disability Benefits Questionnaire (DBQ). Therefore, the Veteran does not meet the criteria for an increased rating under the former diagnostic code for GERD. 

Under the current diagnostic code for GERD, rated under Diagnostic Code 7206, a 30 percent rating is warranted for a documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than two times per year. However, no stricture was reported. Therefore, the Veteran does not meet the criteria for an increased rating under the current diagnostic code for GERD. See July 2021 GERD Disability Benefits Questionnaire (DBQ).

In reviewing the former diagnostic code for IBS, in effect prior to May 19, 2024, Diagnostic Code 7319, permits a 30 percent rating for severe symptoms noted as diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. While the Veteran reported alternating episodes of diarrhea and constipation, the VA examiner only noted frequent episodes of abdominal distress. However, the Veteran reported "abdominal discomfort every day" when discussing symptoms. Therefore, there is an approximate balance
 year. However, no stricture was reported. Therefore, the Veteran does not meet the criteria for an increased rating under the current diagnostic code for GERD. See July 2021 GERD Disability Benefits Questionnaire (DBQ).

In reviewing the former diagnostic code for IBS, in effect prior to May 19, 2024, Diagnostic Code 7319, permits a 30 percent rating for severe symptoms noted as diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. While the Veteran reported alternating episodes of diarrhea and constipation, the VA examiner only noted frequent episodes of abdominal distress. However, the Veteran reported "abdominal discomfort every day" when discussing symptoms. Therefore, there is an approximate balance of evidence as to whether the Veteran's IBS caused more or less constant abdominal distress. See July 2021 VA examination for intestinal conditions.

Under the version in effect from May 19, 2024, 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 the 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 for at least one day per week during the previous three months; and two or more of the following: (1) change in the stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. 

Here, the Veteran noted frequent abdominal distress with alternating diarrhea and constipation occurring every other week. Therefore, the Veteran meets the criteria for the 30 percent rating as of the effective date of the current regulation, May 19, 2024. However, as discussed above, the more advantageous regulation to the Veteran is the former criteria for Diagnostic Code 7319. See July 2021 VA examination for intestinal conditions.

After careful consideration of the evidence of record, the Board finds that the evidence is in approximate balance in finding that the Veteran's symptoms of GERD with IBS are more nearly approximate to a 30 percent rating under Diagnostic Code 7319 (2021). The Veteran has clearly demonstrated alternating diarrhea and constipation; however, whether the Veteran has more or less continuous abdominal distress is the remaining question. Given the totality of the evidence of record, the Board finds that there is sufficient evidence to find that the 30 percent rating under Diagnostic Code 7319 (2021) more nearly represents the Veteran's symptoms. Specifically, the Veteran has reported continuous abdominal pain, daily abdominal discomfort, and constant stomach pain and cramps. See July 2021 VA Stomach Examination. 

Accordingly, after resolving all reasonable doubt in the Veteran's favor, the Board finds that a 30 percent rating is warranted for the Veteran's combined gastrointestinal disability under the former criteria set forth in Diagnostic Code 7319 during the entire appeal period. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

T. Berry

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Faul, Frank J.

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.