GERD

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, 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 refractory stricture with aspiration, undernutrition, or substantial weight loss plus surgery or a PEG tube.
• The transitional rule matters. Claims decided before May 19, 2024 use the old criteria. Claims pending on or after that date get whichever set of criteria, old or new, is 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.
• GERD diagnosis still rests on endoscopy, pH monitoring, manometry, or a documented PPI response. The new wrinkle is that the rating wants proof of a stricture, not just proof of reflux.
• Direct service connection turns on in-service onset. Secondary service connection most often runs through PTSD or through medications prescribed for service-connected conditions.

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. 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 underlying 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.

What DC 7206 Actually Says

Here is the rating schedule for GERD under 38 CFR § 4.114, Diagnostic Code 7206, in the five tiers VA now uses. Every tier requires the stricture and its consequences to be documented by barium swallow, CT, or EGD.

80 percent: Recurrent or refractory esophageal stricture causing dysphagia with aspiration, undernutrition, or substantial weight loss, requiring either surgical correction or a percutaneous esophago-gastrointestinal (PEG) tube.

50 percent: Recurrent or refractory esophageal stricture causing dysphagia requiring dilatation three or more times per year, treatment by steroid dilatation, or esophageal stent placement.

30 percent: Recurrent esophageal stricture causing dysphagia requiring dilatation no more than two times per year.

10 percent: Documented history of esophageal stricture requiring daily medications to control dysphagia, otherwise asymptomatic.

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

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.

Why the Stricture Requirement Is the New Gatekeeper

Under the old DC 7346, you could reach 10% or 30% on reflux symptoms alone: heartburn, regurgitation, and the rest. 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. Reflux that is controlled, or reflux that damages the esophagus diffusely without narrowing it, may not generate the structural finding the new tiers ask for. 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.

The practical takeaway is that the diagnostic workup now carries the rating. Whether an EGD or barium swallow documented a stricture, and whether your records capture the dilatations and procedures that followed, is what separates a 0% from a 50%. The symptom journal that used to win a 30% under the old code does not, by itself, satisfy the stricture language of the new one.

This is also why the transitional rule, covered below, is so important for veterans whose claims straddle the change.

The 0% and 10% Tiers

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

0% (noncompensable). A documented history of an esophageal condition 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.

The 10% tier is the one most affected by the requirement for a structural finding. Under DC 7346, daily symptoms got you into the compensable range. Under DC 7206, daily medication plus a documented stricture does. If the stricture is in your record, 10% is straightforward. If it is not, the rater has a gap to fill.

The 30% and 50% Tiers: 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 two elements are recurrence and a dilatation frequency at or below twice a 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, treatment by steroid dilatation, 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 both signal a stricture that ordinary dilatation is not holding.

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. A rater can grant 50% off a record that shows three dated dilatations in twelve months in a way they never could off a narrative about how bad the swallowing feels.

The 80% Tier: Refractory Disease With Complications

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, and treatment by either surgical correction or a percutaneous esophago-gastrointestinal (PEG) feeding tube.

That is a severe clinical picture, and it is meaningfully 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. The surgery or PEG-tube element means the stricture has driven care past dilatation and stenting into operative correction or assisted feeding.

For most GERD, 80% is rare, the same way the old 60% was rare. It describes disease that has progressed well beyond reflux into structural failure of the esophagus. When records support it, the higher ceiling is a real gain over the old framework: 80% rather than 60% for the worst presentations.

What the New Tiers Are Worth

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 2026 rates:

• 10% pays roughly $175 a month.
• 30% pays roughly $537 a month.
• 50% pays roughly $1,102 a month.
• 80% pays roughly $2,045 a month.

The jump from 30% to 50%, the new tier in the middle, is worth about $565 a month, close to $6,780 a year tax-free, and it can ride on the difference between two documented dilatations in a year and three. The jump from the old 60% ceiling to the new 80% ceiling is larger still. Whatever else the 2024 rule did, it raised the stakes on getting the procedure history into the file accurately.

The Transitional Rule: Which Criteria Apply to Your 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 apply. The 0/10/30/60 symptom framework governs that decision.
• If your claim was pending on or after May 19, 2024, VA must consider both the old and the new criteria and apply whichever is more favorable to you.

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 the new 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, it is worth confirming 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 that came out worse than the old criteria would have, is the kind of error that supports a higher-level review or appeal.

Diagnostic Requirements: Documenting the Stricture, Not Just the Reflux

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, critically, 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. A barium esophagram that shows narrowing, or imaging that documents aspiration or structural change, supports the higher tiers directly.

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. Where DC 7206 claims get stuck is a record with a solid reflux diagnosis and no structural workup: no EGD that looked for a stricture, no barium swallow, no procedure history. The diagnosis is clean and the rating still stalls at 0% because nothing in the file speaks to the criteria.

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.

Service Connection Pathways: Direct, Secondary, and the PTSD Chain

How GERD connects to service did not change with the rating rules. There is no presumption for GERD, though certain Gulf War undiagnosed-illness claims can include functional GI symptoms.

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. Direct claims are harder than they sound, because many veterans first develop or get diagnosed with GERD after separation, during the years when reflux becomes more common. 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.

Secondary service connection through PTSD

Secondary service connection under 38 CFR § 3.310 is where most GERD claims actually win. The most common chain runs through PTSD, with mechanisms including PTSD-driven autonomic effects on gastric motility and the lower esophageal sphincter, PTSD medications such as SSRIs and SNRIs that affect the sphincter and contribute to weight gain, and PTSD-related sleep disruption that increases nighttime reflux.

Other secondary chains

Other common chains include GERD secondary to NSAIDs prescribed for service-connected musculoskeletal conditions, secondary to opioids prescribed for service-connected pain (opioids slow gastric emptying), secondary to anxiety disorders through a PTSD-like mechanism, and GERD as part of a Gulf War illness presentation under the functional GI disorders 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, cite supporting literature when possible, and connect that mechanism to your specific history.

Why Private GI Specialist Evaluations Tend to Outperform C&P Exams

The standard C&P esophageal exam runs through a DBQ in 20 to 30 minutes. The examiner asks about symptoms, reviews records, and fills out the form.

Where the C&P falls short, under DC 7206, is in the structural and procedural detail the new tiers require. The DBQ asks whether dysphagia is present. It does not reliably capture whether a stricture was documented, how many times it was dilated this year, whether a stent or steroid dilatation was used, or whether there is aspiration or weight loss. Those are exactly the facts that decide 0% versus 30% versus 50%.

A private GI specialist evaluation, particularly from the gastroenterologist who actually performs your endoscopies and dilatations, generates that record. The treating GI knows the stricture, the procedure dates, and the trajectory. The notes describe the dilatation history, stent placement, response to treatment, and any nutritional consequences. That is the documentation the new criteria are written around.

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.

Common Evidence Gaps That Keep GERD Claims Low

Across the GERD decisions I review, the same gaps repeat. Under the new framework, they cluster around the structural and procedural proof the tiers demand.

No documented stricture. This is the big one. 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. If a stricture exists, it has to be in the imaging or endoscopy record.

Procedure history not pulled together. Dilatations are often scattered across separate GI visit notes. A claim that does not assemble them into a clean dated list leaves the rater to count, and uncounted dilatations do not raise a tier. 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. These get lost inside long procedure reports.

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. Weight trends and nutrition notes have to be in the file and tied to the esophageal disease.

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. The record should connect the two.

Relying on old-framework evidence. Symptom journals, diet-modification logs, and heartburn frequency were the right evidence under DC 7346. They still help paint impairment, but they do not satisfy the stricture and procedure language of DC 7206. If your evidence package was built for the old code, it needs the structural layer added.

Barrett's Esophagus and Its Rating Implications

Barrett's esophagus is a precancerous change in the lower esophageal lining that develops after years of untreated or undertreated GERD, diagnosed on biopsy during endoscopy. It does not have its own diagnostic code and is evaluated in connection with the underlying esophageal disease.

Barrett's matters to the analysis in three ways. It establishes a chronic, ongoing condition, which undercuts any "controlled GERD" reading that would otherwise support a 0% rating. It requires ongoing surveillance endoscopy, every three to five years for non-dysplastic Barrett's and more often with dysplasia, and that surveillance keeps the esophageal disease active in the record. And Barrett's with high-grade dysplasia or progression to adenocarcinoma shifts the analysis to malignancy ratings under DC 7343, which carries 100% during active treatment.

Under DC 7206, the most useful thing Barrett's does for a rating is bring you back into the esophagus on a recurring basis. The surveillance endoscopies are where a stricture gets found and documented, and a documented stricture is what the compensable tiers require. Barrett's by itself, without a stricture or the complications the tiers name, does not set the rating, but it often produces the records that do.

What the Board's Language Looks Like, and Why the Corpus Is Historical

A word of caution about pattern-reading on GERD specifically. Claim Raven's index holds 2,248 BVA GERD cases inside a broader corpus of 101,518 condition records drawn from 49,876 Board decisions, and within that GERD subset, outcomes ran 37.4% denied, 36.7% granted, and 25.9% remanded.

Almost all of those decisions were issued under the old DC 7346 criteria, because they predate the May 2024 change. They are useful for understanding how the Board reasons about GERD, how it weighs treating-specialist opinions against C&P exams, and how often these claims get remanded rather than decided. They are less useful as a guide to the exact rating tier you will receive today, because the schedular criteria they applied are not the ones a rater uses now.

What carries forward is the Board's basic posture. When it grants, it ties the evidence to the criteria element by element. When it denies a higher tier, it names what the record did not show. Under the old code, the missing element was usually a symptom like dysphagia or substernal pain. Under DC 7206, the missing element is usually structural: no documented stricture, or a stricture with no procedure history behind it. The reasoning style is the same. The element that decides the case has moved from the symptom list to the endoscopy report.

As the post-2024 decisions accumulate, the patterns under DC 7206 will come into focus. For now, the honest read is that the historical grant and denial rates describe a framework that no longer governs new ratings.

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 transitional rule lets you take the better of the old and new criteria, 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. Same reflux, different rulebook, and the file that wins now is the one built around the esophagus, not just the symptoms.

Methodology and Limitations

• Data source: 38 CFR § 4.114, Diagnostic Code 7206 (effective May 19, 2024), with DC 7203 (esophageal stricture) and DC 7346 (hiatal and paraesophageal hernia, rated as DC 7203) for the related framework. The pre-2024 DC 7346 GERD criteria are described for the transitional-rule analysis. Pattern language is drawn from a review of BVA decisions on GERD claims.
• Sample size: Patterns are drawn from Claim Raven's index of 101,518 condition records drawn from 49,876 Board decisions, including 2,248 GERD cases. Within that GERD subset, outcomes ran 37.4% denied, 36.7% granted, and 25.9% remanded.
• Important caveat on the corpus: The BVA GERD cases in this dataset were almost entirely decided under the old DC 7346 criteria, before the May 2024 change. 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 interpretive terms applied case by case, and § 4.112 governs how weight loss is measured. The transitional more-favorable rule is fact-specific and depends on when your claim was pending and decided. Compensation amounts reflect 2026 VA rate tables 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.