GERD is an acronym for gastroesophageal reflux disease and it is a common condition affecting veterans. GERD is caused by acid reflux which occurs when stomach acid leaks into the esophagus. This dangerous situation can lead to a painful erosion of the lining of the esophagus. It can cause ulcers and it can increase the risk of cancer. Heartburn, difficulty swallowing, regurgitation, and chest pain are all common symptoms of GERD.
How does the VA rate GERD?
The VA uses diagnostic codes—numerical codes—to identify and rate a veteran’s disability. To assign a diagnostic code and rating the VA uses the VA Schedule for Rating Disabilities (VASRD). However, not all disabilities have their own diagnostic code.
When a specific impairment does not have its own diagnostic code, analogous ratings are assigned based on what condition most closely matches the symptoms the veteran is exhibiting.
The VA says that to ensure they “are closely analogous” VA examiners can look at “not only the functions affected” when assigning an analogous rating, but also “the anatomical localization and symptomatology”. By regulation the VA must apply a rating criterion that is most favorable (typically higher) to the veteran applying for disability benefits.
GERD does not have its own diagnostic code, so the VA rates as analogous to other digestive disorders, typically it is rated analogous to a hiatal hernia under 38 C.F.R. 4.114 diagnostic code 7346.
What are the eligibility requirements for GERD/hiatal hernia?
To be eligible for a VA Rating for GERD/hiatal hernia you must meet these requirements:
- You must have detailed medical records created when you received medical treatment in the service, were treated at a VA medical facility, or treated by a private physician that demonstrate you have been diagnosed with GERD/hiatal hernia.
- Proof that your GERD/hiatal hernia was caused or made worse by your active-duty military service by an in-service event, injury, or illness. This is known as the “nexus” for service connection.
- Persistent and recurring symptoms of GERD/hiatal hernia (Your records should include details about the frequency, severity, and duration of your GERD/hiatal hernia symptoms and a description of any functional loss due to your condition.)
What else will the VA require?
If you file a disability claim for GERD the VA will likely require that you submit to a Compensation and Pension (C&P) exam. A C&P exam is like a doctor appointment that allows the VA doctor to evaluate your physical condition and determine your level of impairment caused by your disability. The doctor’s report is used by the VA to help approve or deny a disability claim. You don’t receive treatment or medication at this appointment; rather, the doctor will likely examine you, ask you questions, order lab work, and do standard tests to assess your situation. (Click here for tips to help you be better prepared for your C&P exam.)
After the exam, the doctor will prepare a report that may include the following information:
- Your medical history
- A discussion of your current symptoms
- An assessment of the severity of your symptoms
- A professional opinion as to whether your disability is service-related
What criteria does the VA use to assign disability rating percentages for GERD?
If you’ve been approved for disability benefits from the VA, the agency will assign a disability rating percentage that specifies the seriousness of your condition. This percentage is associated with a certain monetary amount you’ll receive for your disability. To receive VA benefits, you don’t have to be completely disabled. However, your condition must have a 10% rating or higher to receive financial compensation.
Ratings for a hiatal hernia, and thus for GERD, range from 10% to 30% to 60% disabling which depend on the presence of certain symptoms. The requirements for each are as follows:
- For a 10% rating, a veteran must present with “two or more symptoms of the 30 percent evaluation of less severity.”
- A 30% rating requires “persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm and shoulder pain, productive of considerable impairment of heath.”
- A 60% rating requires “symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health.”
How Can You Increase Your VA Rating for GERD?
TDIU--If the symptoms of your service-connected GERD prevent you from being able to get and keep a job, you may be eligible for Total Disability Individual Unemployability. TDIU allows you to have your disability rating raised to 100 percent even though the rating on your disability does not equal 100 percent. Unemployability is the VA’s way of acknowledging that some veterans with disability ratings below 100 are unable to work due to their impairments.
Here are some general guidelines to be eligible for a TDIU rating:
- You must be honorably discharged from the military.
- You must have performed active duty.
- The military service must have caused or worsened a physical or mental condition.
- Your service must have been in the Army, Marines, Navy, Air Force, National Guard, Coast Guard, or Reservists.
(To better understand TDIU and how to avoid mistakes that may sabotage your chances to obtain the benefits you have rightfully earned, download our free book The Road Map to a 100 percent VA Rating—What Veterans Need to Know About TDIU from our website, cuddiganlaw.com.)
Secondary Service Condition--You may be able to receive an increased rating and greater disability benefits, for GERD through a secondary service connection. You’re eligible for secondary disability benefits if your illness or injury has caused or aggravated another different or separate condition. It is common for GERD to be secondary to PTSD, chronic obstructive pulmonary disease (COPD), migraines, and other conditions.
How do you increase your chances of winning disability benefits?
Because filing for disability can be complicated and sometimes frustrating, it’s important to hire an experienced VA disability attorney to help with your claim. There’s no easy formula for addressing veterans’ claims. At Cuddigan Law, we examine each case individually, develop the best strategy, and work with you to submit your claim or file an appeal if it’s been denied. Call or email us for a free evaluation of your situation.