GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The veteran, who served with multiple periods of service from October 1972 to October 2001, appeals the denial of a compensable rating for gastroesophageal reflux disease (GERD) with hiatal hernia and dysphagia. The veteran asserts that his GERD has worsened, causing significant pain and reflux one to two times a week, requiring elevated sleeping positions and often leading to coughing fits. He claims medication does not control the symptoms well. The Board reviewed evidence of record up to a September 2025 VA examination, which found the veteran's GERD to be without daily symptoms or need for daily medication, and noted no documented history of esophageal stricture(s). The Board found the evidence did not meet the criteria for a compensable rating under Diagnostic Code 7206, as the veteran's condition did not approximate the requirements for even a 10 percent rating. The Board concluded that the evidence was not in equipoise and therefore the benefit of the doubt doctrine did not apply. Service connection for GERD with hiatal hernia was previously granted at a non-compensable level, and the claim for an increased rating was denied.

Rationale

No documented history of esophageal stricture(s); VA examination found no daily symptoms or need for daily medication; Condition does not approximate criteria for compensable rating

Full Decision Text

Citation Nr: A26039803
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260309-635391
DATE: April 28, 2026

ORDER

A compensable rating for gastroesophageal reflux disease (GERD) with hiatal hernia and dysphagia is denied.

FINDING OF FACT

The Veteran's GERD with hiatal hernia and dysphagia does not include a documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic.

CONCLUSION OF LAW

The criteria for a compensable rating for GERD with hiatal hernia and dysphagia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.114, Diagnostic Code 7206.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty service from October 1972 to October 1974; July 1984 to August 1985; and from August 1985 to October 2001.

In October 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a September 2025 rating decision. In January 2026, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior September 2025 rating decision. In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Given this procedural history, the Board may only consider the evidence of record at the time of the September 2025 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 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. 

The Board acknowledges the United States Court of Appeals for Veterans Claims decision in Williams v. McDonough, 37?Vet. App.?305 (2024), which found that under 38 C.F.R. § 20.202(c)(2), the Board generally may not decide an appeal before the deadline for requesting an AMA docket switch has elapsed.?38 C.F.R. § 20.202(c) allows appellants to switch AMA dockets by completing and submitting a new VA Form 10182 within 60 days from when the Board receives the original VA Form 10182, or one year from the date the AOJ mails notice of the decision on appeal, whichever is later, unless (1) an appellant has already submitted evidence or testimony as described in 38 C.F.R. §§ 20.302 and 20.303, or (2) the appellant or representative has requested a waiver of the ability to request to switch dockets during this timeframe.?See also Williams, 37?Vet. App.?at 305.?Neither has occurred in this case; however, the Veteran's case has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c).?The Board finds that this constitutes an implicit waiver of his ability to request a docket switch, which would otherwise require the Board to hold the appeal open until one year following the January 2026 decision in this case. Therefore, the Board finds that adjudication of the claim is proper and without prejudice to the Veteran.? 

1. Entitlement to a compensable rating for GERD with hiatal hernia and dysphagia.

Service connection for GERD with hiatal hernia was originally granted in an August 2012 rating decision with a noncompensable (zero percent) rating assigned effective August 19, 2010. The disability was recharacterized as GERD with hiatal hernia and dysphagia in an October 2012 rating decision that continued the rating
 ability to request a docket switch, which would otherwise require the Board to hold the appeal open until one year following the January 2026 decision in this case. Therefore, the Board finds that adjudication of the claim is proper and without prejudice to the Veteran.? 

1. Entitlement to a compensable rating for GERD with hiatal hernia and dysphagia.

Service connection for GERD with hiatal hernia was originally granted in an August 2012 rating decision with a noncompensable (zero percent) rating assigned effective August 19, 2010. The disability was recharacterized as GERD with hiatal hernia and dysphagia in an October 2012 rating decision that continued the rating.

The Veteran is seeking a higher rating, asserting that his GERD has gotten worse over time and that at least one to two times a week, he has significant pain and reflux. The Veteran reports that he has to sleep with several pillows to keep himself propped up, but even that does not always help. He asserts that medication does not control it well, and when he has flare-ups, the burning and pain are terrible. The Veteran reports that he also has frequent coughing fits and often has to clear his throat because of how bad the reflux gets. See August 2025 VA Form 21-10210.

During a September 2025 VA esophageal conditions Disability Benefits Questionnaire (DBQ), the Veteran reported that he had significant pain and reflux one to two times a week and that he sleeps with his head elevated on pillows. Current symptoms were pain, reflux, and cough. No other assertions have been provided by either the Veteran or his attorney. See Barela v. Peake, 22 Vet. App. 155, 159 (2008) (noting that an attorney has the ethical duty to educate himself about the relevant law, analyze the factual and legal elements of a case, adequately prepare, and zealously represent his client's interest).

The Veteran's GERD with hiatal hernia and dysphagia is rated pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7206 for GERD. Diagnostic Code 7206 provides a noncompensable rating 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 asymptomatic. A 30 percent rating is warranted for a documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 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. A maximum 80 percent rating is warranted for a documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of these symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by 38 C.F.R. § 4.112(a), and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube). 38 C.F.R. § 4.112(a) defines substantial weight loss as "involuntary loss greater than 20% of an individual's baseline weight sustained for three months with diminished quality of self-care or work tasks." 

Diagnostic Code 7206 contains several 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. Note (2), directs VA to evaluate non-gastrointestinal complications of procedures of the disability at issue under the appropriate system at issue. Notes (4) and (5) define recurrent and refractory esophageal strictures as contemplated by Diagnostic Code 7206. Specifically, Note (4) defines recurrent esophageal stricture as "the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved." Comparatively, Note (5) defines refractory esophageal stricture as "the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals."

For the following reasons, the Veteran's GERD with hiatal hernia and dysphagia does not include a documented history of esophageal stricture(s) that requires daily medications to control
 at issue. Notes (4) and (5) define recurrent and refractory esophageal strictures as contemplated by Diagnostic Code 7206. Specifically, Note (4) defines recurrent esophageal stricture as "the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved." Comparatively, Note (5) defines refractory esophageal stricture as "the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals."

For the following reasons, the Veteran's GERD with hiatal hernia and dysphagia does not include a documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic.

The Board initially notes that the medical evidence of record dated within the relevant evidentiary window does not include any treatment related to this disability, and that the September 2025 VA examiner specifically noted that the Veteran's June 2025 primary care record was silent for complaint, history, or diagnosis of GERD, reflux symptoms, or related medications. In addition, the VA examiner also indicated that the Veteran's GERD with hiatal hernia and dysphagia was without daily symptoms and without daily medication and that there was no documented history of esophageal stricture(s). There is no lay or medical evidence to suggest otherwise. Therefore, the Board must rely solely on the VA examination.

In sum, the Veteran's GERD with hiatal hernia and dysphagia does not more nearly approximate the criteria required for a compensable rating. There is no reasonable doubt to be resolved. Since the criteria for a 10 percent rating under Diagnostic Code 7206 are not met, an increased rating is not warranted and the claim is denied. See 38 C.F.R. § 4.31.

 

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Van Wambeke, 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.