GERD Secondary to PTSD

If your PTSD is service connected and you have gastroesophageal reflux disease (GERD), you can claim the GERD as secondary to the PTSD. The claim can rest on PTSD itself, on a medicine prescribed for it, or on PTSD making reflux you already had worse. GERD has common causes of its own, such as weight, smoking, a hiatal hernia and certain medicines, so the medical opinion has to explain why PTSD matters in your history. This page covers the research, the 2024 rating rules, the medication path and what a nexus letter must explain.

Can PTSD cause GERD?

The research shows a link in groups of veterans and others exposed to trauma. It does not settle whether PTSD causes GERD, and a careful opinion says so.

• A survey of 1,058 Gulf War-era veterans (Malhotra and colleagues, Neurogastroenterology and Motility, 2023) found that among veterans with Gulf War illness, those who also had PTSD had higher odds of self-reported GERD than those without PTSD (adjusted odds ratio 2.04).
• A 2024 analysis of VA patient records (Kent, SAGE Open Medicine) found PTSD and GERD correlated in both directions among veterans who served in wartime periods.
• Among 10,953 World Trade Center responders with no upper digestive symptoms at their first visit (Litcher-Kelly and colleagues, Psychosomatic Medicine, 2014), psychological distress symptoms, including probable PTSD, predicted new upper digestive symptoms three years later, with odds ratios from 1.9 to 5.4.
• A 2023 genetic study (Zhou and colleagues, Psychological Medicine) found that PTSD and GERD share genetic architecture. It found evidence that GERD affects PTSD risk, and of the digestive disorders studied, only GERD also showed an effect running from PTSD.
• Not every study agrees. A 2025 Mendelian randomization study of 24 digestive diseases (Ma and colleagues, Medicine) linked genetic risk for PTSD to only one of them, pancreatic cancer, and not to GERD.
• In a laboratory study of 46 patients with heartburn (Fass and colleagues, Gastroenterology, 2008), stressful noise made them feel acid in the esophagus sooner and more intensely. A smaller study of 10 GERD patients (Hemmink and colleagues, 2009) found no such effect from a mental stress task.

These are associations in groups. None shows that PTSD caused one veteran's GERD. The explanations these studies discuss are the two-way link between the brain and the gut, shared genes tied to immune pathways, and stress making reflux feel worse. Medicines and weight are two more paths.

How VA decides GERD secondary to PTSD

Secondary service connection is in 38 CFR § 3.310. VA grants it in two ways:

• Caused by. Your service-connected PTSD caused the GERD, at least as likely as not.
• Aggravated by. Your GERD is aggravated by your service-connected PTSD, meaning it would be less severe but for the PTSD (M21-1 V.ii.2.D). VA rates only the part above the baseline level of the GERD before the aggravation, so the opinion should describe that baseline.

Under § 3.310(b), VA sets that baseline from medical records made before the worsening, or from the earliest records after it. Your oldest reflux records are evidence, not something to hide.

The claim needs three things in the file: a current GERD diagnosis, service-connected PTSD, and a medical opinion linking the two with reasoning.

When your GERD started before your PTSD

Reflux that came first does not end the claim. In Board decision A25028989 (March 2025), the veteran's GERD was diagnosed in 2006 and the PTSD in 2019. VA examiners reasoned that a condition diagnosed first could not be caused by PTSD, and skipped aggravation or dismissed it without a rationale. A private physician wrote that the link was not clearly causal but that PTSD had aggravated the GERD, and the Board granted on that basis. Board decisions are not precedential, but they show what the Board accepts.

When weight gain is the link

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists being overweight or having obesity among the factors that can affect the valve at the bottom of the esophagus and lead to GERD. In the Nurses' Health Study II (Kubzansky and colleagues, JAMA Psychiatry, 2014), women who developed four or more PTSD symptoms saw their body mass index rise faster afterward, and those who started at a normal weight had 1.36 times the odds of becoming overweight or obese. VA does not treat obesity as a disability on its own, but VA's General Counsel (VAOPGCPREC 1-2017) allows it to be a middle step: the PTSD or its medication caused weight gain, the weight gain was a substantial factor in causing the GERD, and the GERD would not have happened without the weight gain. The Court of Appeals for Veterans Claims built on that framework in Walsh v. Wilkie (2020). An opinion on this theory has to answer all three parts.

VA rating for GERD secondary to PTSD

GERD secondary to PTSD is rated the same way as any GERD, under Diagnostic Code 7206 in 38 CFR § 4.114:

• 80%: recurrent or refractory esophageal stricture causing trouble swallowing, with aspiration, undernutrition or substantial weight loss, treated with surgery to correct the stricture or a feeding (PEG) tube
• 50%: recurrent or refractory stricture causing trouble swallowing that requires dilatation three or more times a year, dilatation using steroids at least once a year, or an esophageal stent
• 30%: recurrent stricture causing trouble swallowing that requires dilatation no more than two times a year
• 10%: documented history of esophageal stricture that requires daily medicine to control trouble swallowing, otherwise without symptoms
• 0%: documented history without daily symptoms or a need for daily medicine

The findings must be documented by barium swallow, CT scan or upper endoscopy (EGD). Every compensable level describes a stricture, a narrowing of the esophagus, so reflux controlled by a daily acid reducer with no documented stricture does not match the literal 10 percent wording. A grant at 0 percent still service connects the GERD, and the rating can rise if a stricture develops.

These rules took effect May 19, 2024. The GERD VA rating page explains the stricture tiers and which criteria apply if your claim was pending on that date.

VA rates GERD separately from PTSD, because GERD is a digestive condition with its own code. The two ratings combine under 38 CFR § 4.25, larger rating first. A 70 percent PTSD rating and a 30 percent GERD rating combine to 79, because the 30 percent takes its share of the remaining 30. VA rounds 79 to 80 percent.

GERD from PTSD medication

Some medicines can cause GERD or make it worse. NIDDK lists benzodiazepines, the sedatives that make you calmer or sleepy, and tricyclic antidepressants among them, along with NSAIDs and calcium channel blockers. If a PTSD prescription is part of your theory, the opinion should name the drug, the start date and the reflux history around it. In Board decision A25088795 (October 2025), the Board granted GERD secondary to PTSD on a private opinion that discussed both the veteran's PTSD symptoms and the PTSD medication.

If the medicine is an NSAID taken for a different service-connected condition, that is a separate theory, secondary to that condition. Do not stop or change a prescription to test a claim theory. Talk to your prescriber first.

The C&P exam for GERD secondary to PTSD

VA usually orders an exam or a medical opinion for this claim. The examiner is asked whether your GERD is at least as likely as not caused by your PTSD and, separately, whether the PTSD aggravated it. Both questions matter. An opinion that answers only the first one is inadequate under El-Amin v. Shinseki (2013).

What the examiner looks at:

• Your GERD diagnosis and the records it rests on
• The timeline of your reflux complaints, your PTSD symptoms and your PTSD treatment
• Your weight history, smoking, NSAID use and any hiatal hernia finding
• Any endoscopy, barium swallow or CT report, which also decides the rating

In A25088795, the Board gave the VA opinions no weight because none addressed aggravation and their reasoning was inadequate. A weak opinion reads like this fictional line: "GERD is commonly caused by diet and obesity; less likely than not related to PTSD." It names a general cause without saying whether that cause is present in your record, and it never addresses aggravation. C&P exam prep can help you get ready. The Board section below shows how the Board ruled on these appeals.

Why GERD secondary to PTSD claims get denied

The gaps that lead to a denial are the same ones § 3.310 points to:

• The only medical opinion is a negative VA opinion, and nothing in the file answers it.
• A private opinion states a conclusion with no reasoning, or ignores the weight, hiatal hernia or NSAID use in your records.
• The medication theory is asserted, but no doctor names the drug, the dates and the reflux history around them.
• Your reflux predates your PTSD and no opinion addresses aggravation.

Nexus letter for GERD secondary to PTSD

A GERD nexus letter is a clinician's written medical opinion on the link. A strong one does six things:

1. States the GERD diagnosis and the records reviewed, including your PTSD treatment history.
2. Lays out the timeline of reflux complaints, PTSD symptoms and PTSD treatment, with dates, naming any PTSD medicine that is part of the theory.
3. Gives an opinion on causation: your GERD is at least as likely as not caused by your service-connected PTSD, including its treatment if that is part of the theory.
4. Gives a separate opinion on aggravation: your GERD is aggravated by your service-connected PTSD, meaning it would be less severe but for the PTSD, and describes the baseline before the aggravation.
5. Weighs the competing causes in your record, such as weight, smoking, a hiatal hernia or NSAIDs, instead of ignoring them.
6. Applies any cited study to your facts, including what the research does not settle.

Example of reasoning that covers both questions

This is a fictional excerpt. It is not a template, and it does not describe a real veteran:

"I reviewed the claims file, including primary care notes from 2019 to 2025. The first reflux complaint appears in March 2021, four months after clonazepam was started for PTSD-related sleep disturbance; no earlier record mentions reflux. NIDDK lists benzodiazepines among medicines that can cause GERD or make it worse. The veteran's weight has been stable, and the 2023 endoscopy showed no hiatal hernia. On causation, it is at least as likely as not that the veteran's GERD is caused by the veteran's service-connected PTSD, including its treatment. On aggravation, if reflux existed earlier, the notes show a change from occasional antacids to daily prescription treatment, and the GERD is at least as likely as not aggravated by the veteran's service-connected PTSD, meaning it would be less severe but for the PTSD and its treatment."

Where these opinions break down is predictable: a conclusion with no reasoning behind it, an incomplete review of the records, a study attached but never applied, or no answer on aggravation. Raven Nexus can organize your records and the research into a draft for your doctor to review.

Records to gather for GERD secondary to PTSD

• Your PTSD rating decision and the GERD diagnosis, with the records the diagnosis rests on.
• Every record of reflux, heartburn or trouble swallowing, starting with the earliest, including any from before PTSD treatment.
• Your full medication history, with start dates, dose changes and the reason each drug was prescribed.
• Endoscopy, barium swallow or CT reports, which matter for both the diagnosis and the DC 7206 rating.
• Records that bear on other causes: weight over time, hiatal hernia findings, NSAID use and smoking history.
• Any existing VA or private opinions, read in full so a new opinion can respond to them.

Other conditions claimed secondary to PTSD have their own pages: sleep apnea secondary to PTSD and migraines secondary to PTSD.

Questions veterans ask about GERD secondary to PTSD

Can GERD be secondary to PTSD?

Yes. VA can grant GERD secondary to service-connected PTSD under 38 CFR § 3.310 when PTSD or its treatment caused the GERD or made it worse. The Board has granted it, in A25088795 on a private opinion that tied the GERD to PTSD and its medication, and in A25028989 on aggravation.

Is GERD secondary to PTSD?

Not automatically. Studies of veterans find more GERD among those with PTSD, but they show association, not that PTSD caused your reflux. A medical opinion has to apply the research to your own records and other risk factors.

What is the VA rating for GERD secondary to PTSD?

The same as any GERD under Diagnostic Code 7206: 0, 10, 30, 50 or 80 percent. Every compensable level requires a documented esophageal stricture, and the GERD rating combines with your PTSD rating.

Can GERD be secondary to anxiety for VA disability?

Yes, if your anxiety is service connected. Section 3.310 covers a disability caused or aggravated by any service-connected condition, and a 2023 meta-analysis of 36 studies (Zamani and colleagues) concluded there is likely a two-way causal relationship between anxiety or depression and GERD.

Can my PTSD medication cause GERD?

It can be part of the claim. NIDDK lists benzodiazepines and tricyclic antidepressants among medicines that can cause GERD or make it worse.

Do I need an endoscopy for this claim?

Not always for the diagnosis, but the rating needs one of the listed tests. DC 7206 requires stricture findings to be documented by barium swallow, CT scan or upper endoscopy.

Sources

• 38 CFR § 3.310, secondary service connection, including the baseline rule in § 3.310(b); M21-1 V.ii.2.D, aggravation of a nonservice-connected disability by a service-connected one.
• 38 CFR § 4.114, Diagnostic Code 7206, gastroesophageal reflux disease, and its notes; 38 CFR § 4.25, combined ratings table.
• VA General Counsel Precedent Opinion 1-2017 (VAOPGCPREC 1-2017), obesity as an intermediate step; Walsh v. Wilkie, 32 Vet. App. 300 (2020).
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013), an opinion must address aggravation.
• National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of GER and GERD (last reviewed July 2020). https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes
• Malhotra D, Boyle SH, Gifford EJ, et al. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterology and Motility. 2023;35(5):e14548. PMID 36942766.
• Kent KG. The relationship between post-traumatic stress disorder and gastrointestinal disease in United States Military Veterans. SAGE Open Medicine. 2024;12:20503121241260000. PMID 38911441.
• Litcher-Kelly L, Lam Y, Broihier JA, et al. Longitudinal study of the impact of psychological distress symptoms on new-onset upper gastrointestinal symptoms in World Trade Center responders. Psychosomatic Medicine. 2014;76(9):686-693. PMID 25373890.
• Zhou S, Luo H, Tian Y, et al. Investigating the shared genetic architecture of post-traumatic stress disorder and gastrointestinal tract disorders: a genome-wide cross-trait analysis. Psychological Medicine. 2023;53(16):7627-7635. PMID 37218628.
• Ma L, Li X, Zhang Y. Post-traumatic stress disorder, attention deficit and hyperactivity disorder, and 24 gastrointestinal diseases: Evidence from Mendelian randomization analysis. Medicine (Baltimore). 2025;104(20):e42423. PMID 40388735.
• Fass R, Naliboff BD, Fass SS, et al. The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. Gastroenterology. 2008;134(3):696-705. PMID 18206149.
• Hemmink GJ, Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Does acute psychological stress increase perception of oesophageal acid? Neurogastroenterology and Motility. 2009;21(10):1055-e86. PMID 19453516.
• Kubzansky LD, Bordelois P, Jun HJ, et al. The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry. 2014;71(1):44-51. PMID 24258147.
• Zamani M, Alizadeh-Tabari S, Chan WW, Talley NJ. Association Between Anxiety/Depression and Gastroesophageal Reflux: A Systematic Review and Meta-Analysis. American Journal of Gastroenterology. 2023;118(12):2133-2143. PMID 37463429.
• Board of Veterans' Appeals citations A25088795 (October 15, 2025, granted) and A25028989 (March 28, 2025, granted). Board decisions are not precedential.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.