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The VA rating rules for hiatal hernia changed with the digestive-schedule revision effective May 19, 2024. Current 38 CFR § 4.114 says Diagnostic Code 7346, for hiatal and paraesophageal hernias, is rated as esophagus, stricture of, under DC 7203.
That means current ratings focus on documented dysphagia, daily medication needed to control it, dilation procedures, stents, aspiration, nutrition, substantial weight loss, surgery, and PEG-tube use. The former 10-, 30-, and 60-percent symptom ladder based on epigastric distress and reflux is not the current DC 7346 formula.
TL;DR
- Current DC 7346 routes hiatal and paraesophageal hernias to DC 7203.
- The available DC 7203 levels are 0, 10, 30, 50, and 80 percent.
- Imaging or endoscopy must document the relevant findings.
- Daily acid-suppression medication by itself does not recreate the old hiatal-hernia formula.
- Dysphagia treatment history is central: medication, dilation frequency, steroids used with dilation, stents, surgery, and PEG-tube use.
- GERD now has its own code, DC 7206, but overlapping esophageal manifestations cannot be paid twice.
- No verified condition-specific Board outcome dataset was available, so this page does not publish a grant-rate statistic.
Current DC 7346 and DC 7203 Ratings
0 percent
A documented history without daily symptoms or a requirement for daily medication is noncompensable under the DC 7203 framework.
10 percent
A documented esophageal-stricture history that requires daily medication to control dysphagia, while otherwise asymptomatic.
30 percent
Recurrent esophageal stricture causing dysphagia that requires dilation no more than twice per year.
50 percent
Recurrent or refractory stricture causing dysphagia that requires at least one of the following:
- dilation three or more times per year;
- dilation using steroids at least once per year; or
- esophageal-stent placement.
80 percent
Recurrent or refractory stricture causing dysphagia with aspiration, undernutrition, or substantial weight loss, plus treatment with surgical correction or a PEG tube.
The regulation defines recurrent and refractory strictures and requires findings documented by barium swallow, CT, or esophagogastroduodenoscopy (EGD).
Why Older Hiatal-Hernia Advice Is Wrong
Many search results still quote the former DC 7346 criteria: two or more symptoms for 10 percent, persistently recurrent epigastric distress for 30 percent, or severe impairment of health for 60 percent. Those were the pre-May 2024 rules.
Current claims must be evaluated under the current schedule, subject to the effective-date and claim-history rules that may preserve an older evaluation in an individual case. A veteran with an existing protected rating should not assume that the historical percentage disappears merely because the schedule changed.
Hiatal Hernia, GERD, and Pyramiding
Hiatal hernia and GERD are related but distinct diagnoses. GERD is now DC 7206, while hiatal and paraesophageal hernias remain DC 7346 and cross-reference DC 7203.
Separate diagnoses do not automatically produce separate ratings. 38 CFR § 4.14 prevents duplicate compensation for the same dysphagia, regurgitation, or esophageal impairment. Distinct, nonoverlapping manifestations may require separate analysis, but the decision must explain which symptom supports which evaluation.
Service Connection
Direct service connection
Direct service connection under § 3.303 requires a current diagnosis, an in-service event or disease, and a medical link. Useful records may include in-service imaging, endoscopy, documented swallowing problems, surgery, trauma, or persistent upper-digestive complaints followed by a medical opinion explaining the later diagnosis.
Heavy lifting or physical strain should not be presented as a proven cause merely because it occurred during service. A clinician must address the veteran's hernia type, medical history, and other risk factors.
Secondary service connection
A secondary claim under § 3.310 needs medical evidence that a service-connected disability or its treatment caused or aggravated the hiatal hernia. The opinion should distinguish causation from symptom overlap. GERD symptoms alone do not automatically prove that GERD caused the anatomic hernia.
What the C&P Record Should Establish
The record should answer:
- Was a hiatal or paraesophageal hernia confirmed by imaging, EGD, or surgery?
- Is dysphagia present, and is it tied to a documented esophageal stricture?
- Is daily medication required specifically to control dysphagia?
- How many dilations occurred in each 12-month period?
- Were steroids used during dilation, or was a stent placed?
- Is there aspiration, undernutrition, or substantial weight loss?
- Was surgical correction performed, or is a PEG tube required?
- Which symptoms overlap with GERD or another digestive rating?
Common Failure Modes
- Using the former 10/30/60 symptom ladder as current law.
- Describing heartburn without documenting the DC 7203 findings.
- Omitting procedure dates, especially dilation frequency.
- Treating all swallowing complaints as a confirmed stricture.
- Claiming separate GERD and hiatal-hernia ratings for the same manifestations.
- Assuming physical demands alone establish medical causation.
Bottom Line
Current DC 7346 sends hiatal and paraesophageal hernias to the DC 7203 esophageal-stricture framework. The decisive evidence is objective testing plus the dysphagia-treatment history, not the old reflux-symptom checklist.
Legal sources: 38 CFR § 4.114, § 4.14, § 3.303, and § 3.310, checked August 14, 2026.