HIATAL HERNIA

Summary

The Veteran, a veteran who served from October 1988 to January 1992 and January 2003 to March 2004, and is a recipient of the Combat Infantry Badge, appeals the denial of service connection for GERD and the adequacy of the rating assigned. The Board notes that service connection for GERD was already granted in a prior decision, making the appeal solely about the rating. The Veteran sought an increased rating for GERD, contending it was more severe than the noncompensable evaluation assigned. The Board reviewed the pre-amended and post-amended rating criteria for GERD. Under the pre-amended criteria (DC 7346), the Veteran had symptoms consistent with a 10 percent rating but lacked the substernal pain or recurrent esophageal stricture required for higher ratings. Under the post-amended criteria (DC 7206), the evidence also did not support a higher rating due to a lack of documented recurrent esophageal stricture. The Board found the evidence in approximate balance for a 10 percent rating under the pre-amended criteria, but the evidence weighed against a higher rating. The Board also addressed the issue of pyramiding, noting that sleep impairment due to GERD was already accounted for under the Veteran's service-connected PTSD rating. Ultimately, the Board granted a 10 percent rating for GERD effective March 28, 2024.

Rationale

Evidence in approximate balance for 10% rating under pre-amended DC 7346; Evidence weighs against higher rating due to lack of substernal pain or recurrent esophageal stricture; Benefit of the doubt applied for 10% rating

Full Decision Text

Citation Nr: A26039842
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250616-554779
DATE: April 28, 2026

ORDER

Entitlement to an initial 10 percent rating, but no higher, for gastroesophageal reflux disease (GERD) since March 28, 2024 is granted, subject to the laws and regulations governing the award of monetary benefits.

FINDING OF FACT

The evidence is in approximate balance as to whether, since March 28, 2024, GERD is manifested by two or more symptoms for the 30 percent evaluation under 38 C.F.R. § 4.114, Diagnostic Code (DC) 7346, but not by substernal, arm or shoulder pain or by recurrent esophageal stricture.

CONCLUSION OF LAW

The criteria for entitlement to an initial 10 percent rating, but no higher, for GERD since March 28, 2024 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.655, 4.1, 4.7, 4.114, DCs 7206 and 7346.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1988 to January 1992 and from January 2003 to March 2004 and is the recipient of the Combat Infantry Badge. 

These matters are before the?Board of Veterans' Appeals?(Board) on appeal of a March 2025 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 

In the July 2025 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 March 2025 agency of original jurisdiction (AOJ) 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.

In addition to the issue listed above, in his July 2025 VA Form 10182, the Veteran indicated disagreement with an August 2024 rating decision which denied entitlement to service connection for GERD and a November 2024 rating decision which identified a duty to assist error during higher-level review for GERD. As service connection for GERD was subsequently granted in the March 2025 rating decision, any appeal of the August 2024 rating decision's denial of service connection for GERD is moot, as that benefit has been granted in full. The November 2024 finding of a duty to assist error was not an appealable determination, as it did not constitute a decision on entitlement to any benefit. Accordingly, the issue of entitlement to a compensable initial rating for GERD, stemming from the March 2025 rating decision is the only issue before the Board in this appeal. 

The Veteran contends that his GERD is more severe than contemplated by the currently assigned noncompensable evaluation. Entitlement to service connection for GERD was granted in a March 2025 rating decision, effective March 28, 2024. The Veteran appealed from that initial rating.

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1999). Nevertheless, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119
 in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1999). Nevertheless, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods within the period on appeal.

Where there is a question as to which of the two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

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 diagnostic code 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.

Pursuant to DC 7346 as in effect prior to May 19, 2024, a 10 percent rating is warranted for two or more symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The maximum 60 percent evaluation is warranted 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.

VA amended the criteria for rating digestive system disabilities, effective May 19, 2024. See Schedule for Rating Disabilities: The Digestive System, 89 Fed. Reg. 19375 (March 20, 2024).  

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new version of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

Under the amended criteria, GERD is rated under 38 C.F.R. § 4.114, DC 7206. Under that DC, 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 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
ia 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. § 4.114. 38 C.F.R. § 4.112(a) defines substantial weight loss as "involuntary loss greater than 20 [percent] 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 (EGD). 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.

Notes (4) and (5) define recurrent and refractory esophageal strictures as contemplated by DC 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." 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." Id.

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 (last visited May 1, 2025).

On VA examination in April 2024, the Veteran reported he was started on Prilosec for GERD in August 2023. Initially, his symptoms improved with medication, but they were now worsening. The Veteran had symptoms of pyrosis, reflux and regurgitation. There was no substernal, arm or shoulder pain. There was no esophageal stricture, spasm of esophagus or acquired diverticulum. 

In December 2024, the Veteran was noted to have GERD and was waking up with acid reflux. He was using a proton pump inhibitor (PPI) medication with improvement and had no problems swallowing food.  

On VA examination in January 2025, the Veteran reported current GERD symptoms of heartburn, reflux and nausea. GERD was treated with medication, but the Veteran stated that after initial improvement his symptoms had recurred. There was no substernal, arm or shoulder pain, and no history of esophageal stricture.  

The evidence of record is in approximate balance as to whether a 10 percent rating is warranted under the pre-amended DC 7346. The evidence shows symptoms of pyrosis (heartburn) and regurgitation which constitute "two or more symptoms for the 30 percent evaluation." However, the evidence weighs persuasively against finding that a higher rating is warranted under the pre-amended DC 7346. In this regard, the evidence does not show substernal, arm or shoulder pain as required to support a higher rating. 

With regard to the amended DC 7206, a higher rating cannot be assigned under that DC, as the evidence weighs persuasively against finding any documented history of recurrent esophageal stricture.

The Board acknowledges that the pre-amended DC 7346 does not explicitly consider the effects of medication and that therefore, the Board must discount
6. The evidence shows symptoms of pyrosis (heartburn) and regurgitation which constitute "two or more symptoms for the 30 percent evaluation." However, the evidence weighs persuasively against finding that a higher rating is warranted under the pre-amended DC 7346. In this regard, the evidence does not show substernal, arm or shoulder pain as required to support a higher rating. 

With regard to the amended DC 7206, a higher rating cannot be assigned under that DC, as the evidence weighs persuasively against finding any documented history of recurrent esophageal stricture.

The Board acknowledges that the pre-amended DC 7346 does not explicitly consider the effects of medication and that therefore, the Board must discount the effects of medication when evaluating the Veteran's GERD under DC 7346. See Jones v. Shinseki, 26 Vet. App. 56 (2012); Ingram v. Collins, 38 Vet. App. 130 (2025). In this case, the Veteran stated that medication initially improved his GERD symptoms, but that symptoms subsequently recurred. The Veteran's report that medication has not durably improved his GERD symptoms supports that his description of current symptoms is representative of his symptoms in an unmedicated state. By contrast, there is no evidence of record showing that in the absence of medication GERD would be manifested by substernal, arm or shoulder pain or by recurrent esophageal stricture. Accordingly, the April 2024 and January 2025 VA examinations are adequate to inform the Board's judgment, and remand to obtain a medical opinion discounting the effects of medication would only serve to delay adjudication without any further benefit flowing to the Veteran. 

Finally, to the extent that the record documents sleep impairment associated with GERD, the Veteran has been awarded service connection for PTSD, rated 10 percent disabling from November 23, 2009, under 38 C.F.R. § 4.130, DC 9411. That DC contemplates chronic sleep impairment, and the record shows that chronic sleep impairment is considered a symptom of the Veteran's PTSD. See March 2010 rating decision. Therefore, any additional award of benefits based on that symptom would violate the rule against pyramiding (rating the same disability or its manifestations under different DCs). See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 

Based on the foregoing, the Board finds that the competent and credible evidence is in approximate balance as to whether a 10 percent rating for GERD is warranted. However, the evidence is neither evenly nor approximately balanced as to whether a rating in excess of 10 percent is warranted. Rather, the evidence persuasively weighs against finding that GERD was manifested by substernal, arm or shoulder pain or by recurrent esophageal stricture. To this extent, the benefit of the doubt doctrine does not apply. 38?U.S.C. §?5107(b), Lynch, 21 F.4th 776. The claim is granted in part.

 

 

S. Kim

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bametzreider, Paul

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.