As of May 19, 2024 gastroesophageal reflux disease (GERD) has been assigned a unique diagnostic code, 7206. Along with the new diagnostic code for 2024 came substantial changes. You can read more about the changes affecting the VA Rating for GERD here.

This article will discuss GERD, the Compensation and Pension exam for GERD, and the 38 CFR GERD VA Rating.

Disease Overview

GERD is a chronic condition where stomach contents flow back into the esophagus, causing uncomfortable symptoms or complications. It is often referred to as acid reflux. Common symptoms include heartburn and regurgitation, but GERD can also lead to other esophageal and non-esophageal issues. Diagnosing the disease can be challenging since there isn’t a single definitive test. Doctors often rely on a combination of patient history, reported symptoms, and specific tests to confirm the condition.

Doctors use several methods to diagnose GERD, including symptom questionnaires, esophageal pH monitoring, and endoscopy. Esophageal pH monitoring tracks acid exposure in the esophagus over 24 hours to confirm reflux episodes. Questionnaires like the Frequency Scale for Symptoms of GERD (FSSG) help assess how often and how severe the symptoms are. Endoscopy can detect damage to the esophagus lining, which may indicate erosive reflux disease (ERD). Often, doctors begin treatment with a drug class called Proton Pump Inhibitors, known as PPIs, to see if symptoms improve, which can also help confirm GERD. 1,2,3

Long-term symptoms of GERD that don’t go away can cause serious problems, like narrowing of the esophagus, called strictures. People with severe or hard-to-control GERD are more likely to develop these strictures and might need treatments like surgery or a procedure to widen the esophagus to help with swallowing, called dilatation. It’s important to check on GERD symptoms regularly and catch problems early to prevent these complications. 4

GERD can be caused by problems with the body, how it works, or the way we live. A weak lower esophageal sphincter (LES), too much stomach acid, and problems with esophageal movement can all contribute to GERD. Risk factors include obesity, aging, certain eating habits (like consuming fatty or spicy foods), and smoking. These factors can increase pressure on the stomach or weaken the LES, making acid reflux more likely. 5 Medical literature reports that GERD can develop secondary to mental health problems like anxiety and depression. Additionally, mental health problems can make GERD symptoms worse. 6

In addition, GERD is linked to other health conditions. It can make respiratory issues like asthma and chronic cough worse, possibly due to acid irritating the airways. GERD can also lead to Barrett’s esophagus, a condition that increases the risk of esophageal cancer, especially in people with long-term GERD symptoms. 7,8

Veterans experiencing 7206 Gastroesophageal reflux disease symptoms should document them in a Statement in Support of Claim.

History of GERD

During a Compensation and Pension (C&P) exam, the veteran’s GERD history is recorded using the Esophageal Conditions DBQ.

Section II is dedicated for the examiner to document the history of the condition and medications the veteran is taking to treat GERD.

Section III focuses on specific questions about the rating schedule. It asks about daily symptoms, medications needed to treat symptoms, and problems like difficulty swallowing. It also covers questions about esophageal strictures, whether they have come back, and if procedures like dilatation (used to treat strictures) were needed. The section also asks about steroid use, stent placement for strictures, and other issues like aspiration, undernutrition, major weight loss, surgeries, or treatments with a feeding tube (PEG tube) related to esophageal strictures.

Physical Examination for GERD

C&P examiners usually won’t do a physical exam for GERD unless you’ve had surgery to treat it. If you have had surgery, they will check and measure any scars.

Testing for GERD

Section VI focuses on diagnostic tests. This is where the examiner writes down what tests have been done, like an EGD, X-rays, Barium swallow, MRI, CT, biopsies, or lab tests.

C&P examiners won’t order tests to diagnose or confirm GERD. Instead, they use the information already in the VA claims file. That’s why it’s important for the veteran or their advocate to send medical records to the VA Intake Center before the C&P exam that establish the diagnosis.

Ratings for GERD

Before May 19, 2024, GERD was evaluated in a manner similar to Hiatal Hernia. You can view the 38 CFR regarding 7346 Hiatal Hernia prior to May 19, 2024 here. 

Now, veterans seeking disability ratings for GERD can refer to diagnostic code 7206 in the 38 CFR. 

The VA GERD Rating Schedule:

• 0% Rating
  • GERD diagnosis
  • without daily symptoms, and
  • without requirement for daily medications

• 10% Rating
  • GERD diagnosis, and
  • requires daily medications to control symptoms of difficulty swallowing (dysphagia) but no symptoms otherwise (asymptomatic)

• 30% Rating
  • GERD and esophageal stricture diagnosis
  • with history of a recurrent esophageal stricture causing difficulties swallowing and has required dilatation less than 2 times per year.

• 50% Rating
  • GERD and esophageal stricture diagnosis
  • with history of a recurrent or resistant (refractory) esophageal stricture causing difficulties swallowing and has required at least one of the following:
    • dilatation 3 or more times per year
    • dilatation using steroids at least one time per year, or
    • esophageal stent placement

• 80% Rating
  • GERD and esophageal stricture diagnosis
  • with history of a recurrent or resistant (refractory) esophageal stricture causing difficulties swallowing and has required at least one of the following:
    • aspiration
    • undernutrition
    • substantial weight loss as defined by section 4.112(a)
  • and received either a Percutaneous Esophago-Gastrointestinal tube (PEG tube) or had surgery to address their esophageal strictures

Of note, the veteran can be granted for the service connected condition based on your personal medical doctor’s diagnosis. 

The M21-1 explains that you don’t need medical imaging to be diagnosed with GERD for service connection. 

It also says that a 10% rating for GERD can be given, as long as the veteran needs daily medication.

Further Learning

For further information, tune into the Valor 4 Vet and Exposed Vet Radio Show discussing 7206 Gastroesophageal reflux disease from August 1, 2024 here.

You can read the M21-1 Adjudication Procedures Manual regarding 7206 Gastroesophageal reflux disease here. 

References

1. Roman, Sabine, C. Prakash Gyawali, Edoardo Savarino, Rena Yadlapati, Frank Zerbib, Justin C. Y. Wu, Marcelo F. Vela et al., 2017. “Ambulatory reflux monitoring for diagnosis of gastro‐esophageal reflux disease: update of the porto consensus and recommendations from an international consensus group”, Neurogastroenterology & Motility(10), 29:1-15. https://doi.org/10.1111/nmo.13067
2. Kusano, Motoyasu, Michio Hongo, and Hiroto Miwa, 2012. “Response to gastroesophageal reflux disease therapy: assessment at 4 weeks predicts response/non-response at 8 weeks”, Digestion(4), 85:282-287. https://doi.org/10.1159/000336715
3. Kandulski, Arne, Dörthe Jechorek, Carlos Caro, Jochen Weigt, Thomas Wex, K. Mönkemüller, and Peter Malfertheiner, 2013. “Histomorphological differentiation of non-erosive reflux disease and functional heartburn in patients with ppi-refractory heartburn”, Alimentary Pharmacology & Therapeutics(6), 38:643-651. https://doi.org/10.1111/apt.12428
4. Al-Refaie, Maimona Abdulmageed, Mohammed Mohammed Alsurmi, Yasser Abdurabo Obadiel, Haitham Mohammed Jowah, and Khaled Mohammed Alsharafy, 2024. “Fundoplication for pediatric gastroesophageal reflux disease: indications, techniques, and outcomes”, Cureus. https://doi.org/10.7759/cureus.72930
5. Rybka, Aleksandra, Kamila Malesa, Olga Radlińska, Karolina Krakowiak, Elżbieta M. Grabczak, Marta Dąbrowska, and Ryszarda Chazan, 2014. “The utility of oesophageal ph monitoring in diagnosing gastroesophageal reflux disease-related chronic cough”, Advances in Respiratory Medicine(6), 82:489-494. https://doi.org/10.5603/piap.2014.0065
6. Tack, Jan, Anja Becher, Catherine Mulligan, and David A. Johnson, 2012. “Systematic review: the burden of disruptive gastro‐oesophageal reflux disease on health‐related quality of life”, Alimentary Pharmacology & Therapeutics(11), 35:1257-1266. https://doi.org/10.1111/j.1365-2036.2012.05086.x
7. Amelink, Marijke, Selma B. de Nijs, Jan Cees de Groot, Peter M.B. van Tilburg, P.I. van Spiegel, Frans H. Krouwels, René Lutter et al., 2013. “Three phenotypes of adult‐onset asthma”, Allergy(5), 68:674-680. https://doi.org/10.1111/all.12136
8. Chandar, Apoorva K., Komal S. Keerthy, Rajesh Gupta, William M. Grady, Marcia I. Canto, Nicholas J. Shaheen, Prashanthi N. Thota et al., 2023. “Patients with esophageal adenocarcinoma with prior gastroesophageal reflux disease symptoms are similar to those without gastroesophageal reflux disease: a cross-sectional study”, American Journal of Gastroenterology(5), 119:823-829. https://doi.org/10.14309/ajg.0000000000002593