VA can grant gastroesophageal reflux disease (GERD) as secondary to a service-connected condition when the nonsteroidal anti-inflammatory drugs (NSAIDs) or other medicines you take for that condition caused or worsened the reflux. The Board of Veterans' Appeals did exactly that in February 2025 for a veteran who took ibuprofen, naproxen and meloxicam for service-connected knee and foot conditions. The medical link is plausible, because the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists NSAIDs among medicines that can raise the chance of GERD or worsen it. The claim turns on records that show why you took the medicine, when, and how the reflux followed, and on an opinion that weighs the other causes in your record.

What the Board did with GERD secondary to NSAIDs

In A25014545 (February 18, 2025), the veteran said he took Motrin, meloxicam, Advil and naproxen for his service-connected knee conditions and that his reflux began after regular use. VA treatment records backed him up: a 2010 note recorded Motrin for left knee pain, a 2017 note recorded Motrin for the knee and Mobic (meloxicam) for foot pain, and later notes recorded NSAIDs for the foot and increased pain when he ran out of meloxicam. GERD was first diagnosed in October 2019.

The VA opinions were mixed. A December 2021 examiner listed NSAIDs among risk factors for GERD but said the literature "does not confirm" that NSAIDs cause it, and did not resolve that inconsistency when asked. An April 2022 VA examiner said the medical literature supports NSAIDs as a risk or causal factor and found it at least as likely as not that the veteran's GERD was due to his NSAID use. The Board described a private physician assistant's opinion as vague. The Board found the April 2022 opinion probative because it rested on an accurate history and literature consistent with the other opinions, and granted GERD as secondary to the knee and foot conditions through NSAID use. It did not need to reach the veteran's alternative theory that service-connected conditions caused weight gain that led to GERD.

The lesson is that the grant rested on ordinary treatment records connecting the medicine to the service-connected condition, and on one examiner who applied the literature to that history.

For context, Claim Raven's analysis of Board decisions counts 2,248 decided records under the single label GERD: 36.7% favorable, 37.4% denied and 25.9% remanded, with service-connection and rating appeals mixed together. Among 433 GERD denials with a classified reason, the most common was no nexus (35.1%). Across secondary claims, opinions the Board described as strong went with favorable outcomes in 94.1% of 2,973 condition records, compared with 1.7% where the opinion was weak. They come from Board appeals of already-disputed claims decided mostly in 2024 and 2025, and they show patterns rather than your chances.

What the medical sources support

NIDDK's page on GERD symptoms and causes lists NSAIDs, along with benzodiazepines, calcium channel blockers, certain asthma medicines and tricyclic antidepressants, among medicines that can increase the chance of GERD or make its symptoms worse. It also lists other contributors, including a hiatal hernia, smoking, pregnancy and excess weight. A defensible opinion weighs the factors that actually appear in your record.

Keep the diagnosis straight. NIDDK names NSAIDs as one of the two most common causes of peptic ulcers, a different condition from GERD. A record of an ulcer or gastritis should not be relabeled as GERD, and a clinician should say which diagnosis the record supports. NIDDK explains that clinicians often diagnose GERD from symptoms and history and use tests to look for complications or other problems.

Under 38 C.F.R. § 3.310, GERD can be service connected because treatment for a service-connected condition caused it or made existing reflux worse. A medication theory has four links, and each needs its own evidence:

  1. A service-connected condition, shown by the rating decision.
  2. The medicine taken for that condition, shown by prescriptions, refill history or clinic notes that name the reason for use. A pharmacy list proves you took a drug. It does not prove why.
  3. A current GERD diagnosis.
  4. A medical explanation tying the medicine to the GERD in your history, including dose and timing.

If you had reflux before the NSAIDs, the claim is about aggravation. The regulation's text asks for a baseline from medical evidence before the worsening and pays only the increase above it. Spicer v. McDonough (Fed. Cir. 2023) also bars VA from using that regulation to reject a claim where reflux would be less severe but for the service-connected condition or its treatment.

If the medicine was prescribed for PTSD rather than a physical condition, the theory runs through PTSD instead, covered in GERD secondary to PTSD. If VA grants either theory, GERD is rated under Diagnostic Code 7206, which since May 19, 2024 ties compensable ratings to a documented esophageal stricture. The GERD condition guide explains that scale.

A medication and reflux chronology

Date or periodService-connected condition being treatedNSAID name, dose and sourceReflux symptom or GERD findingTreatment changeRecord and page, or uncertainty

Enter every prescription and over-the-counter NSAID you actually used, including gaps and changes. Use the bottle, pharmacy record or clinic note for doses rather than memory. If you also used an NSAID for an unrelated problem, say so. Do not stop, start or change a medicine to build a claim; talk with your clinician about reflux, possible side effects and treatment choices. NIDDK lists warning signs, such as trouble swallowing, chest pain or signs of bleeding, that need prompt medical attention.

Questions for the clinician about NSAIDs and GERD

  1. Which digestive diagnosis does my record support: GERD, another condition, or more than one?
  2. Were these NSAIDs taken for the service-connected condition, and how much exposure is documented?
  3. Does the timing and dose history support causation, worsening of earlier reflux, or neither? If worsening, what earlier records show the baseline?
  4. How do weight, a hiatal hernia, tobacco and other medicines in my record affect the conclusion?

The answer may be that the evidence is insufficient. The guide to nexus letters for secondary conditions explains how to frame causation and aggravation for any secondary opinion.

Sources and scope

Checked September 23, 2026: the current eCFR text of 38 C.F.R. § 3.310; the Spicer opinion; NIDDK's GERD causes and diagnosis pages; and the full text of Board decision A25014545, which binds only that appeal. Claim Raven earns revenue from the nexus readiness check on this page and its other claim tools.