GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The Veteran, an Army Veteran who served from July 1989 to February 1990 and in the Army National Guard for 13 years, appeals the denial of an increased disability rating for Gastroesophageal Reflux Disease (GERD). The Veteran initially sought service connection for GERD in January 2023, which was initially denied, then granted at 10% secondary to major depressive disorder following a duty to assist error. After a supplemental claim and subsequent denials, the Veteran sought an increased rating. The Board reviewed the pre- and post-amendment rating criteria for GERD, applying the more favorable pre-amendment criteria (DC 7346) as the claim predated May 19, 2024. The Veteran's reported symptoms, including recurrent epigastric distress, dysphagia, pyrosis, regurgitation, substernal pain, nausea, and vomiting, were found to meet the criteria for a 30 percent rating, causing considerable impairment of health. While the Veteran also claimed fatigue due to GERD-induced insomnia, this symptom was not considered as it overlapped with a service-connected chronic fatigue syndrome. The Board found the symptoms did not meet the criteria for a 60 percent rating, which would require more severe indicators like material weight loss or hematemesis. Therefore, the Board granted a 30 percent rating for GERD, finding it the most favorable applicable rating.

Rationale

Symptoms met criteria for 30% rating under pre-amendment DC 7346; Persistently recurrent epigastric distress, dysphagia, pyrosis, regurgitation, substernal pain; Caused considerable impairment of health

Full Decision Text

Citation Nr: A26040177
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251001-594762
DATE: April 29, 2026

ORDER

Entitlement to an initial disability rating of 30 percent, but no higher, for gastroesophageal reflux disease (GERD) is granted. 

FINDING OF FACT

The Veteran's GERD was characterized by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health.

CONCLUSION OF LAW

The criteria for a disability of 30 percent for GERD for the entire period on review have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.21, 4.114, DC 7346 (2023).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from July 1989 to February 1990 and was a member of the United States Army National Guard for 13 years. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), also known as the Agency of Original Jurisdiction (AOJ). The April 2025 rating decision was a higher-level review of a December 2024 rating decision.

In the October 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 December 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or her 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, which was subsequently subject to higher-level review 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. 

Entitlement to an initial disability rating greater than 10 percent for GERD.

The Veteran contends that she is entitled to an increased initial disability rating for GERD. 

As a preliminary matter, the Veteran applied for service connection for GERD on January 29, 2023. See January 2023 Application for Disability Compensation and Related Compensation Benefits. The Veteran was denied service connection for GERD secondary to major depressive disorder in a July 2023 rating decision. In a December 2023 higher level review, a duty to assist error was identified. Subsequently, in the June 2024 rating decision, the Veteran was granted service connection for GERD secondary to major depressive disorder at a 10 percent disability rating effective January 29, 2023, the date of the Veteran's claim. After filing a supplemental claim, she was denied an initial disability rating of more than 10 percent for GERD. See December 2024 rating decision. Subsequently, the Veteran requested a higher-level review, and her claim was denied again in the April 2025 rating decision on appeal. Therefore, the Veteran continuously pursued her claim since the January 29, 2023 claim. Consequently, the Board will consider the Veteran's evaluation for GERD beginning January 29, 2023. See 38 C.F.R. § 3.2500(c), (h).

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. See 38 U.S.C.
, the Veteran requested a higher-level review, and her claim was denied again in the April 2025 rating decision on appeal. Therefore, the Veteran continuously pursued her claim since the January 29, 2023 claim. Consequently, the Board will consider the Veteran's evaluation for GERD beginning January 29, 2023. See 38 C.F.R. § 3.2500(c), (h).

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. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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. 38 C.F.R. § 4.3.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

Legal Criteria

As a preliminary matter, the Board notes that effective May 19, 2024, VA amended the schedule of ratings for the digestive system and created DC 7206 for GERD. Prior to May 19, 2024, GERD did not have its own DC, and VA often rated it by analogy to hiatal hernia under Diagnostic Code (DC) 7346.

The pre-amendment rating criteria apply only to claims filed before May 19, 2024, which is the case in this instance. For claims filed before May 19, 2024, both the pre- and post-amendment rating criteria may be applied, whichever is more favorable to the Veteran. However, if the post-amendment criteria are more favorable to the Veteran, the award based on the post-amendment criteria may not be made effective before May 19, 2024.

Prior to May 19, 2024, a 10 percent rating is warranted for disability manifested by two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent rating is contemplated for persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, causing considerable impairment of health. The maximum 60 percent rating 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. 38 C.F.R. § 4.114, DC 7346 (2023).

The terms "severe impairment of health" and "considerable impairment of health" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. However, the Board shall apply the ordinary meanings of the words. "Considerable" is defined as "large in extent or degree." Merriam-Webster's Collegiate Dictionary 267 (11th ed. 2012). "Severe" is defined as "very painful or harmful." Id. at 1140.

From May 19, 2024, DC 7206 provides that a noncompensable evaluation is assigned for documented history without daily symptoms or requirement for daily medications. A 10 percent rating is warranted for esophageal stricture(s) that require daily medications to control dysphagia otherwise asymptomatic. A 30 percent rating is assigned for 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 assigned for 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 assigned for documented history of recurrent or refractory esophageal stricture(s)
 medications to control dysphagia otherwise asymptomatic. A 30 percent rating is assigned for 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 assigned for 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 assigned for 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 or percutaneous esophago-gastrointestinal tube (PEG tube). 38 C.F.R. § 4.114, DC 7206. 

Factual Background

The Veteran's April 2022 VAMC medical records show that the Veteran was experiencing nausea. See VAMC records added October 2022. In January 2024,  the Veteran reported that she was experiencing GERD symptoms at night and tried elevating her bed to alleviate the symptoms, to no avail. See VAMC records added September 2024. 

The Veteran was afforded a VA examination for esophageal conditions in January 2024. The Veteran reported symptoms of reflux, regurgitation, substernal pain, four or more episodes a year of sleep disturbance caused by reflux lasting less than one day, four or more episodes a year of nausea lasting less than one day, and four or more episodes a year of vomiting lasting less than 1 day. No esophageal stricture was noted in the exam. The Veteran reported taking over the counter Tums and Rolaids 4-5 times a week to help control the heartburn. 

The Veteran was afforded another VA examination for esophageal conditions in September 2024.  The Veteran reported that her sleep was frequently disrupted by reflux, "with the sensation of food and acid coming back up." The Veteran explained that she frequently experienced heartburn, chest pain, abdominal pain, difficulty swallowing food, reflux, nausea, and vomiting. She also reported that her throat often caused her pain. No esophageal stricture was noted in the exam.

In an August 2024 statement in support of claim, the Veteran stated that her severe and persistent GERD symptoms significantly impacted her daily life, as she regularly experienced heartburn, chest pain, abdominal pain, difficulty swallowing food, reflux, nausea, and vomiting. The Veteran stated that she avoided spicy and acidic foods, as they exacerbated her symptoms. The Veteran claimed that her throat often hurt and that her sleep was frequently disrupted by reflux, with the sensation of food and acid coming back up and out of her nose. 

The Veteran also submitted an October 2025 statement in support of her claim, reiterating the symptoms mentioned above and contending that the January 2024 VA examination failed to capture how severe and persistent her GERD symptoms were and how much they interfere with daily functioning. The Veteran stated that the frequency, intensity, and overall impact on her health and well-being warranted a higher rating than 10 percent. 

Analysis

As the date of the Veteran's claim to entitlement to service connection for GERD was filed January 29, 2023, before the May 19, 2024, amendment, the Board must consider both the pre- and post-amendment rating criteria and apply whichever is more favorable to the Veteran. 

After reviewing the evidence, the Board concludes that the Veteran is entitled to an initial disability rating of 30 percent. Under the pre-amendment rating criteria of DC 7346, a 30 percent rating is contemplated for persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, causing considerable impairment of health. DC 7346 (2023). The Veteran's symptoms reported to her physicians in her medical records, in both VA examinations, and in her statements meet the criteria above. The Veteran's reports of trouble swallowing, substernal pain, vomiting, nausea, and heartburn are consistent. The Veteran's records and lay statements show that her GERD symptoms were frequent and disruptive to her daily life. The Veteran also contends that her extreme tiredness and fatigue was due to her GERD causing insomnia; however, the Board will not consider that symptom as it overlaps with the symptoms of the Veteran's service-connected chronic fatigue syndrome. See DC 6354. Notwithstanding
itation, accompanied by substernal or arm or shoulder pain, causing considerable impairment of health. DC 7346 (2023). The Veteran's symptoms reported to her physicians in her medical records, in both VA examinations, and in her statements meet the criteria above. The Veteran's reports of trouble swallowing, substernal pain, vomiting, nausea, and heartburn are consistent. The Veteran's records and lay statements show that her GERD symptoms were frequent and disruptive to her daily life. The Veteran also contends that her extreme tiredness and fatigue was due to her GERD causing insomnia; however, the Board will not consider that symptom as it overlaps with the symptoms of the Veteran's service-connected chronic fatigue syndrome. See DC 6354. Notwithstanding the fatigue, the Board finds that the Veteran's reported persistent and severe GERD symptoms cause the Veteran considerable impairment of health warranting a disability rating of 30 percent under DC 7346. 

However, a disability rating in excess of 30 percent is not warranted. The Veteran's symptoms reported to her physicians in her medical records, in both VA examinations, and in her statements do not meet the criteria of the next higher disability rating, a 60 percent disability rating. In fact, neither January 2024 nor September 2024 VA examiner stated that the Veteran had symptoms of material weight loss and hematemesis or melena with moderate anemia. See January 2024 VA examination, September 2024 VA examination. The evidence also does not show symptom combinations productive of severe impairment of health, as the reported symptoms do not rise to a level to be considered very painful or harmful. As such, the Veteran is not entitled to a disability rating in excess of 30 percent for GERD from January 29, 2023. See 38 C.F.R. § 4.114, DC 7346.

Under the post-amendment rating criteria of DC 7206, ratings of 10 percent and greater require esophageal stricture(s). The January 2024 VA examination and the September 2024 VA examination noted that the Veteran had no diagnosed esophageal stricture. Although the Veteran is not entitled to a rating greater than 10 percent under the post-amendment rating criteria of DC 7206, the most favorable of the two diagnostic codes will be applied as the Veteran's January 29, 2023, claim was filed before the May 19, 2024, amendment. 

Beginning January 29, 2023, the Veteran's GERD was characterized by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. See 38 C.F.R. § 3.2500(c), (h); 38 C.F.R. § 4.114, DC 7346 (2023). As such, the Veteran is entitled to an initial rating of 30 percent, but no higher, for GERD. 

 

 

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Clark, C.

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.