GERD VA Rating

For years, a GERD rating turned on whether your medical record listed the right cluster of reflux symptoms. That is no longer how it works. As of May 19, 2024, VA rates GERD under its own Diagnostic Code 7206, and the rating runs on a different question entirely: do you have a documented esophageal stricture, and how often does it need treatment? A veteran with daily heartburn but no stricture can land at 0%. A veteran with a stricture that needs dilatation three times a year can reach 50%. The whole analysis moved from your symptom list to your endoscopy and procedure history.

This was the single biggest change to the digestive rating schedule in decades, and most of the GERD guidance still floating around describes the old rules. Here is how DC 7206 actually works, what the transitional rule means if your claim was pending when the change hit, why VA denies GERD claims, and where claims gain or lose tiers under the new framework.

TL;DR

• As of May 19, 2024, GERD has its own code, DC 7206, with five tiers: 0%, 10%, 30%, 50%, and 80%. The old DC 7346 hiatal-hernia-by-analogy framework, with its 0/10/30/60 symptom criteria, is gone for GERD.
• The new criteria are objective and procedural. They turn on a documented esophageal stricture, how many times a year it needs dilatation, and whether you have needed a stent, steroid dilatation, surgery, or a feeding tube.
• The findings have to be documented by barium swallow, CT, or EGD. Reported symptoms alone do not carry the rating the way they used to.
• The ceiling went up. The old top tier was 60%. The new top tier is 80%, for a recurrent or refractory stricture with aspiration, undernutrition, or substantial weight loss plus surgery or a PEG tube.
• The transitional rule matters. For a claim pending when the rule changed, VA applies the old criteria to the period before May 19, 2024, and from that date it weighs both sets and uses the one more favorable to you.
• DC 7346 still exists, but it now means hiatal hernia and paraesophageal hernia, and it rates as esophageal stricture under DC 7203. It is no longer the GERD code.
• Direct service connection turns on in-service onset. Secondary service connection most often runs through PTSD or through medications prescribed for service-connected conditions.

GERD VA rating criteria under DC 7206

Here is the rating schedule for GERD under 38 CFR § 4.114, Diagnostic Code 7206, as it reads in the current regulation.

80 percent: 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)

50 percent: 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

30 percent: Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year

10 percent: Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic

0 percent: Documented history without daily symptoms or requirement for daily medications

Note 1 to DC 7206 says the findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy (EGD). Notes 4 and 5 define the two key words. A stricture is "recurrent" when the target esophageal diameter cannot be kept beyond 4 weeks after it was reached, and "refractory" when the target diameter cannot be reached despite at least 5 dilatation sessions at 2-week intervals.

Read the tiers from the bottom up and the logic is clear. At 0%, you have a documented history but no daily burden. At 10%, you need daily medication to keep dysphagia under control. At 30% and above, you have a stricture that keeps coming back and needs a procedure, and the rating climbs with how often the procedure is needed and how severe the consequences get.

The word that runs through every compensable tier is "stricture." That is the gatekeeper of the new framework, and it is the part that surprises veterans most.

GERD at 0 and 10 percent

The bottom two tiers are where most uncomplicated GERD lands under DC 7206.

0% (noncompensable). A documented history without daily symptoms and without a need for daily medication. This is the rating for GERD that is real but quiet: a past diagnosis, no current daily burden. It establishes service connection without paying compensation, which still matters, because a noncompensable rating can be increased later if the condition worsens and it can anchor secondary claims.

10%. A documented history of esophageal stricture that requires daily medication to control dysphagia, otherwise asymptomatic. The key elements are a documented stricture and daily medication aimed at swallowing difficulty. A veteran on a daily proton pump inhibitor whose records also document a stricture and dysphagia fits here. A veteran on a daily PPI for heartburn, with no documented stricture, is harder to place at 10% under the literal language, which is one of the sharpest differences from the old framework.

GERD at 30 and 50 percent: counting dilatations

The middle of the scale runs on a simple, countable measure: how often your stricture needs dilatation, the procedure that stretches a narrowed esophagus open.

30%. A recurrent esophageal stricture causing dysphagia that requires dilatation no more than two times per year. The evidence that proves it is procedural: GI procedure notes with dates, an endoscopy or barium swallow documenting the stricture, and dysphagia complaints tied to it.

50%. A recurrent or refractory stricture causing dysphagia that requires any of three things: dilatation three or more times per year, dilatation using steroids at least once a year, or placement of an esophageal stent. The line between 30% and 50% is mostly a counting exercise. Three dilatations in a year rather than two moves you up. A stent or a steroid dilatation moves you up regardless of count.

Because these tiers are countable, the evidence that wins them is countable too. The single most useful thing in a DC 7206 claim is a clean procedure history: every dilatation, with its date, pulled from your GI records.

GERD at 80 percent

The top tier describes a stricture that has stopped responding and started causing systemic harm. It requires a recurrent or refractory stricture causing dysphagia, plus at least one of three complications (aspiration, undernutrition, or substantial weight loss as defined in § 4.112(a)), and treatment by either surgical correction or a PEG feeding tube.

That is a severe clinical picture, and it is higher than the old 60% ceiling. Aspiration means food or liquid going into the airway because the esophagus cannot move it down safely. Undernutrition and substantial weight loss reflect an esophagus that can no longer reliably feed the body. For most GERD, 80% is rare, the same way the old 60% was rare.

New VA rating for GERD: what changed in May 2024

On May 19, 2024, VA put into effect a final rule overhauling the digestive rating schedule at 38 CFR § 4.114 ("Schedule for Rating Disabilities: The Digestive System," 89 FR 19735, March 20, 2024). GERD had never had its own diagnostic code. For decades it was rated by analogy to hiatal hernia under DC 7346, using symptom language: epigastric distress, dysphagia, heartburn, regurgitation, substernal pain, weight loss, and bleeding. The tiers ran 0%, 10%, 30%, and 60%.

The 2024 rule moved GERD onto DC 7206 and rebuilt the criteria around esophageal stricture. The same rule reassigned DC 7346 to hiatal hernia and paraesophageal hernia, and told raters to evaluate those hernias as esophageal stricture under DC 7203. So three codes now share one framework.

• DC 7206 is GERD, rated on the stricture criteria directly.
• DC 7203 is esophageal stricture, the framework the others borrow.
• DC 7346 is hiatal or paraesophageal hernia, rated as DC 7203.

If you read older guidance that says GERD is "rated as hiatal hernia under 7346" with a 60% ceiling, that guidance is describing a system that no longer applies to claims decided today.

Why a documented stricture now decides the rating

Under the old DC 7346, you could reach 10% or 30% on reflux symptoms alone. You did not need a structural finding. Under DC 7206, the compensable tiers are written around a documented esophageal stricture, which is a narrowing of the esophagus that shows up on imaging or endoscopy.

That is a real shift. Plenty of veterans have genuine, daily GERD that has never produced a stricture. Read literally, a veteran with daily symptomatic reflux and no documented stricture can land at 0%.

In my read of how the criteria are written, this is the central tension of the new framework. It rewards veterans whose GERD has progressed to a documented, treated stricture and gives them a higher ceiling than the old rules ever did. It is harder on veterans whose GERD is symptomatic but structurally mild. If your reflux has never been worked up past a symptom note, the new criteria give a rater very little to grant on.

How much VA pays for GERD

The compensation steps are steep, and the new ceiling adds a tier the old code never had. For a single veteran with no dependents at the 2026 rates (effective December 1, 2025), the GERD tiers pay as follows.

• 10% pays $180.42 a month.
• 30% pays $552.47 a month.
• 50% pays $1,132.90 a month.
• 80% pays $2,102.15 a month.

The jump from 30% to 50% is worth $580.43 a month, about $6,965 a year tax-free, and it can ride on the difference between two documented dilatations in a year and three. VA pays by your combined rating, so the GERD tier adds money only when it changes the combined percentage.

Which GERD criteria apply to a pending claim

This is the part that decides which version of the rules you live under, and it is worth getting exactly right.

• If VA decided your claim before May 19, 2024, the old DC 7346 criteria applied to that decision.
• If your claim or appeal was pending when the rule changed, VA applies the old criteria to the period before May 19, 2024. From May 19, 2024 on, it considers both the old and the new criteria and uses whichever is more favorable to you. The new criteria cannot be applied to any period before their effective date. Board decisions on GERD cite 38 U.S.C. § 5110(g) and Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003), for this rule.

That more-favorable rule is not a formality. The two frameworks reward different fact patterns. A veteran with a documented stricture, regular dilatations, and weight loss may do better under DC 7206, where those facts map onto 50% or 80%. A veteran with heavy reflux symptoms but no stricture may do better under the old DC 7346, where symptoms alone could reach 30%. For a pending claim, the right move is to make the record support the better of the two, not to assume the new code helps.

If you have a claim or appeal that was open across the change, confirm that the rating decision actually addressed both sets of criteria. A decision that applied only the new criteria to a claim pending before the change, and came out worse than the old criteria would have, is the kind of error that supports a higher-level review or appeal.

Esophagitis, Barrett's esophagus and hiatal hernia

Esophagitis does not have a single guaranteed VA percentage. The current notes to DCs 7203 and 7206 expressly include several forms of esophagitis, among them eosinophilic, drug-induced, infectious and radiation esophagitis and esophagitis due to peptic stricture. The criteria focus on documented history, swallowing difficulty, strictures, and required treatment. A diagnosis of inflammation alone does not establish the findings for a higher level. Keep the endoscopy, imaging or barium-swallow reports, medication history, and records of any dilations or other procedures.

Barrett's esophagus is a change in the lower esophageal lining that develops after years of reflux, diagnosed on biopsy during endoscopy. Since May 19, 2024, it has its own code, DC 7207. With an esophageal stricture, Barrett's is rated as esophageal stricture under DC 7203. Without a stricture, it rates 30% with high-grade dysplasia and 10% with low-grade dysplasia, each documented by pathologic diagnosis. If malignancy develops, DC 7207 sends the rating to DC 7343. Barrett's also requires surveillance endoscopy, and those endoscopies are often where a stricture gets found and documented.

Hiatal hernia is rated under DC 7346, which now rates as esophageal stricture under DC 7203. Because GERD and a hiatal hernia are both rated on the same stricture criteria, and 38 CFR § 4.14 bars rating the same symptoms twice, a separate rating for each needs findings that belong to each.

Source: 38 CFR § 4.114, DCs 7203, 7206, 7207 and 7346 (opens in a new tab).

How to prove GERD for a VA claim: documenting the stricture

GERD diagnosis at VA still rests on familiar footing, but the new rating criteria change what the workup needs to capture.

Upper endoscopy (EGD) remains the most common procedure. Under DC 7206 it does double duty: it diagnoses GERD and it is where an esophageal stricture gets documented. An EGD that describes a stricture, its location, and any dilatation performed during the procedure is the single most valuable document in a DC 7206 claim.

Barium swallow and CT are named in the regulation as acceptable ways to document the stricture and its consequences.

24-hour pH monitoring measures acid exposure and confirms pathologic reflux. It establishes the GERD diagnosis well, particularly when endoscopy looks normal, but on its own it does not document the stricture the rating wants.

Esophageal manometry measures sphincter and motility function and helps distinguish GERD from disorders like achalasia.

PPI response trial still supports the diagnosis when symptoms improve on medication and return off it.

Any of these establishes that you have GERD. The new question is whether the record also establishes a stricture and what was done about it. A strong record now has the EGD or barium swallow that documents the stricture, the procedure notes for every dilatation or stent with dates, and, for the top tier, the records of aspiration, weight loss, surgery, or PEG-tube placement.

Is GERD service connected? Direct and secondary claims

How GERD connects to service did not change with the rating rules. There is no presumption for GERD.

Direct service connection

Direct service connection requires evidence that your GERD began in service or was caused by an in-service event. The strongest direct claims have in-service documentation: sick call visits for reflux, an in-service EGD, or treatment records describing chronic heartburn on active duty. Many veterans first develop or get diagnosed with GERD after separation, so if you can document a continuous complaint from service forward, the direct theory holds up. If your reflux first appeared years after separation, you generally need a secondary theory.

GERD secondary to PTSD

Secondary service connection under 38 CFR § 3.310 covers a condition caused by a service-connected condition, or aggravated by it, meaning it would be less severe but for that condition. In the Board's 2021 to 2026 service connection rulings, secondary GERD claims were granted more often than direct ones; the Board section below shows both rates. The most common chain runs through PTSD. In a 2023 survey study of Gulf War veterans, those with Gulf War illness and PTSD reported GERD more often than those with Gulf War illness alone (Malhotra and colleagues, Neurogastroenterology and Motility, PMID 36942766). That is an association, so the opinion in a claim still has to name the path in your records, such as medication effects, weight gain or disrupted sleep. The Board section below also lists the secondary pairs for GERD with their counts and grant rates. The GERD secondary to PTSD page covers that claim and its Board results, and secondary conditions to PTSD lists the others.

Other secondary chains

Other chains veterans argue include GERD secondary to medications prescribed for service-connected conditions, such as NSAIDs for joint pain or opioids for chronic pain (delayed gastric emptying is a known opioid side effect, PMID 18443635), and GERD secondary to anxiety or depression. For Gulf War veterans, 38 CFR § 3.317 covers functional gastrointestinal disorders, but only chronic symptoms that no structural, endoscopic, laboratory, or other objective finding explains. A GERD diagnosis confirmed by endoscopy or pH testing generally falls outside that framework.

For any of these chains, the nexus opinion has to do real work. A bare "more likely than not" with no explanation does not get a case granted. The opinion has to name a mechanism, connect it to your history, and, for aggravation, say how much worse the GERD is than it would be without the service-connected condition.

The GERD C&P exam and private GI opinions

The standard C&P esophageal exam runs through a DBQ. The examiner asks about symptoms, reviews records, and fills out the form.

Where the C&P exam falls short under DC 7206 is in the structural and procedural detail the new tiers require. Whether a stricture was documented, how many times it was dilated this year, whether a stent or steroid dilatation was used, and whether there is aspiration or weight loss are exactly the facts that decide 0% versus 30% versus 50%. Bring the dated list of procedures to the exam and make sure the examiner sees the endoscopy reports.

A private GI evaluation, particularly from the gastroenterologist who performs your endoscopies and dilatations, generates that record. The treating GI knows the stricture, the procedure dates, and the trajectory. The Board's standard for competing medical opinions has not changed.

"A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning."

A treating specialist's procedure record tends to be more factually accurate, because it captures dated events rather than recalled symptoms, and that is precisely what DC 7206 rewards. The Board section below shows how GERD claims went when the Board relied on a favorable opinion, an opinion against the claim, or none.

Why VA denies GERD claims

Across 13,787 decided Board rulings on GERD from 2021 to 2026, 26.2% were granted, 24.4% denied and 49.4% remanded. A ruling is one issue the Board decided in one decision; one decision often rules on several issues. That grant rate is 1.5 percentage points above the 24.7 percent across all decided Board rulings, and remand is the most common outcome. When the Board denied GERD service connection, it most often found no link between the GERD and service; the Board section below shows how often each part of the claim failed and why claims were sent back.

Much of that window predates the May 2024 change, so many of those decisions applied the old DC 7346 criteria. They show how the Board reasons about GERD, but they are a weaker guide to the exact tier you would receive today. Across the GERD decisions I review, the same gaps repeat, and under the new framework they cluster around the structural and procedural proof the tiers demand.

No link to service. The reflux started years after separation, there is no in-service treatment, and no opinion explains a secondary chain. This is the most common reason a GERD service connection claim fails.

No documented stricture. A record full of reflux symptoms with no EGD or barium swallow documenting a stricture gives a rater nothing to grant a compensable tier on.

Procedure history not pulled together. Dilatations are often scattered across separate GI visit notes. Three dated dilatations in a year is a 50% fact only if the record shows all three.

Stent or steroid dilatation buried in the notes. Either one supports 50% on its own, but only if the rater sees it.

No weight, nutrition, or aspiration documentation at the top end. The 80% tier needs aspiration, undernutrition, or substantial weight loss alongside surgery or a PEG tube.

Daily medication not clearly tied to dysphagia. At 10%, the medication has to be aimed at controlling dysphagia from a documented stricture, not just at heartburn.

Relying on old-framework evidence. Symptom journals and heartburn frequency were the right evidence under DC 7346. They still help show impairment, but they do not satisfy the stricture and procedure language of DC 7206.

Questions veterans ask about GERD

What is the VA rating for GERD?

Under DC 7206, GERD rates 0, 10, 30, 50 or 80 percent. The compensable levels require a documented esophageal stricture: 10 percent for daily medication to control dysphagia, 30 percent for dilatation up to twice a year, 50 percent for three or more dilatations a year, a steroid dilatation or a stent, and 80 percent for complications that need surgery or a feeding tube.

Is GERD a presumptive condition for veterans?

No. GERD is not on the PACT Act lists or the Gulf War list. The Gulf War rule at 38 CFR § 3.317 covers functional gastrointestinal disorders, which by definition have no structural or endoscopic explanation, so GERD confirmed by endoscopy generally does not qualify. You prove GERD on a direct or a secondary theory.

Can GERD be secondary to PTSD?

Yes. GERD claimed as secondary to PTSD is one of the publishable pairs in the Board data, and GERD secondary to PTSD covers that claim in full. The opinion has to explain the path in your records, such as medication effects, weight gain or disrupted sleep, and show that PTSD caused the GERD or made it worse than it would otherwise be.

Did the 2024 GERD changes reduce my rating?

A schedule change alone cannot reduce a rating already in effect. Under 38 CFR § 3.951(a), VA can reduce it only if medical evidence shows the condition actually improved.

Can I be rated for GERD and a hiatal hernia separately?

Only if each has its own findings. Both are now rated on the esophageal stricture criteria, and 38 CFR § 4.14 bars rating the same symptoms twice, so most veterans with both receive one rating for the shared stricture.

What happens at a GERD C&P exam?

The examiner completes the esophageal conditions DBQ, asks about swallowing trouble, medication and procedures, and reviews your records. Bring a dated list of every dilatation and the endoscopy or barium swallow reports, since those decide the tier.

Bottom Line

GERD now has its own diagnostic code, and the rating runs on different machinery than it used to. DC 7206 asks whether you have a documented esophageal stricture and how often it needs treatment, not how many reflux symptoms your record lists. The tiers climb from 0% through 10%, 30%, and 50% to a new 80% ceiling, and the middle of the scale is mostly a count of dilatations per year. The stricture requirement is the gatekeeper: veterans whose GERD has progressed to a documented, treated stricture can reach higher than the old rules allowed, while veterans with symptomatic but structurally mild reflux can find the compensable tiers harder to reach. If your claim was pending across May 19, 2024, the more-favorable rule lets you take the better of the old and new criteria from that date, which is worth using deliberately rather than by default. The evidence that moves a DC 7206 claim is structural and procedural: the EGD or barium swallow that documents the stricture, and the dated procedure history that shows how often it is treated.

Methodology and Limitations

• Data source: 38 CFR § 4.114, Diagnostic Code 7206 (effective May 19, 2024, 89 FR 19735), with DC 7203 (esophageal stricture), DC 7207 (Barrett's esophagus) and DC 7346 (hiatal and paraesophageal hernia, rated as DC 7203) for the related framework, checked against the eCFR text in October 2026. The pre-2024 DC 7346 GERD criteria are described for the transitional-rule analysis. 38 CFR §§ 3.310, 3.317, 3.951 and 4.14 for service connection, the Gulf War rule, preserved ratings and pyramiding. Pattern language is drawn from a review of BVA decisions on GERD claims.
• Sample size: Board figures come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds, 511,036 decisions containing 1,378,030 rulings. That includes 13,787 decided Board rulings on GERD (15,047 rulings in all, counting dismissed and withdrawn issues): 26.2% were granted, 24.4% denied and 49.4% remanded. The Board section on this page breaks these down by appeal type, claim theory, medical opinion and secondary pair; those figures are computed from the data, not typed here.
• Important caveat on the corpus: Much of the 2021 to 2026 window predates the May 2024 change, so many of the Board's GERD rulings in this data applied the old DC 7346 criteria. They describe how the Board reasons, not the schedular tier a rater applies today under DC 7206.
• Limitations: Board language patterns are paraphrased composites in some places, not direct quotes from a single decision. "Refractory," "substantial weight loss," and "undernutrition" are applied case by case under the notes to DC 7206 and § 4.112. The transitional more-favorable rule is fact-specific and depends on when your claim was pending and decided. Compensation amounts reflect the 2026 VA rate tables (effective December 1, 2025) for a single veteran with no dependents and change annually with COLA. BVA-level patterns reflect cases that appealed; most GERD claims resolve at the regional office level. These observations are not predictions of individual outcomes, and Claim Raven is data analysis, not legal, medical, or VA-accredited advice.