As of May 19, 2024, significant updates have been made to the GERD VA disability ratings. Previously, GERD was rated analogously under the criteria for hiatal hernia, but it now has its own specific rating criteria and diagnostic code. Leah Bucholz provides a breakdown of the new criteria for GERD VA disability ratings and what it means for veterans seeking disability compensation for GERD. She also explores the connection between GERD and service-related conditions and outlines how veterans can effectively document their claims.
Overview of GERD
What is GERD?
GERD or gastroesophageal reflux disease is a chronic condition common among veterans, often linked to their service. According to the Mayo Clinic, GERD involves the backward flow of stomach acid into the esophagus, causing symptoms like heartburn, chest pain, and regurgitation of food. Some may also experience dysphagia (difficulty swallowing), a sensation of a lump in the throat, or even chronic cough and laryngitis.
Causes and Risk Factors
Gastroesophageal reflux disease can be primary or secondary. Primary GERD occurs due to factors like diet, lifestyle, or anatomical abnormalities. Secondary GERD might develop from conditions like obesity, pregnancy, or as a side effect of medications. For veterans, GERD can be service-connected if it was diagnosed during service, aggravated by service, or secondary to another service-connected condition.
Treatment
Treatment for GERD typically includes lifestyle modifications, over-the-counter medications like antacids, and prescription medications such as proton pump inhibitors. In severe cases, surgical interventions may be necessary.
Updated VA Disability Ratings for GERD
Introduction to New Criteria
The VA has introduced significant updates to its disability rating schedule, including a new Diagnostic Code (DC 7206) specifically for Gastroesophageal Reflux Disease (GERD). Previously rated under Hiatal Hernia (DC 7346), GERD will now be evaluated as it relates to Esophageal Stricture under DC 7203, with new ratings of 0%,10%, 30%, 50%, or 80%.
The VA’s new rating criteria for GERD came into effect on May 19, 2024, introducing specific ratings based on the severity and impact of the condition. These updates provide a clearer framework for assessing and compensating veterans for their symptoms and complications related to GERD.
Detailed Rating Breakdown
The new rating system for GERD is primarily focused on the presence and severity of esophageal strictures, which are complications of the condition. Here’s a breakdown of the ratings:
80% Rating
An 80% GERD VA rating is assigned if the veteran has a documented history of recurrent or refractory esophageal stricture causing dysphagia with at least one of the following symptoms:
- Aspiration
- Undernutrition
- Substantial weight loss
50% Rating
A 50% disability rating is assigned if the veteran has a documented history of recurrent or refractory esophageal stricture causing dysphagia with at least one of the following:
- Dilation three or more times a year
- Dilation using steroids at least once a year
- Esophageal stent placement
30% Rating
A 30% GERD VA rating is assigned if the veteran has a documented history of recurrent esophageal strictures causing dysphagia that requires dilation no more than two times a year.
10% Rating
A 10% disability rating for GERD is assigned if the veteran has a documented history of esophageal stricture that requires daily medication to control dysphagia but is otherwise asymptomatic.
0% Rating
A 0% disability rating for GERD is assigned if there is a documented history of esophageal stricture without daily symptoms or the requirement for daily medication.
Service-Connection for GERD and Related Conditions
Veterans may qualify for VA disability compensation if their GERD is caused or worsened by military service. GERD can also develop as a secondary condition linked to service-connected disabilities like mental health issues, medications, sleep disorders, or chronic coughing.
For instance, medications prescribed for service-related conditions, such as chronic pain or high blood pressure, may trigger or worsen GERD. Nearly 10 to 15% of individuals with GERD also develop Barrett’s esophagus, for which veterans receive a 30% or 10% VA disability rating. Additionally, GERD can exacerbate sleep apnea or mental health disorders.
Veterans should consult their doctors to explore these service connections, as they may qualify for additional compensation if GERD is service-related.
How do these New VA Disability Ratings for GERD Affect Veterans?
The newly updated VA disability ratings for GERD zeroes in on symptoms of esophageal obstruction and dysphagia (difficulty swallowing). Without evidence of esophageal stricture, veterans may only qualify for a 0% rating, resulting in lower VA disability compensation. A 10% rating may be granted for GERD symptoms requiring daily medication, which is evaluated on a case-by-case basis.
Detailed Breakdown of the Disability Benefits Questionnaire (DBQ)
Introduction to the DBQ
The Disability Benefits Questionnaire (DBQ) for esophageal conditions, including GERD, has also been updated. This form is critical in the evaluation process as it helps document the severity of the veteran’s condition and the impact on their daily life.
Key Sections of the DBQ
Records Reviewed and Diagnosis
The DBQ starts with a section where the examiner reviews the veteran’s medical records and lists the diagnosed conditions. If GERD is one of the conditions, it will be marked along with the relevant diagnostic codes and the date of diagnosis.
Medical History
The examiner will then detail the veteran’s medical history, including medications taken, treatments undergone, and symptoms experienced. This section helps establish a comprehensive view of the service-connected condition and its management.
Signs and Symptoms
The DBQ includes a section where the examiner will note whether the veteran experiences any of the following symptoms related to esophageal conditions, including GERD:
- Difficulty swallowing (dysphagia)
- Painful swallowing (odynophagia)
- Regurgitation of food
- A sensation of a lump in the throat
These symptoms are critical in determining the severity of the condition and the appropriate VA disability rating.
Documentation of Esophageal Strictures
A significant update in the DBQ is the detailed documentation required for esophageal strictures. This includes whether the strictures are recurrent or refractory and whether they require treatments like dilation or stent placement. The examiner must also verify the strictures using diagnostic tests such as a barium swallow, CT scan, or EGD.
Functional Impact
The DBQ also assesses the functional impact of GERD on the veteran’s ability to work. This includes any limitations on physical activity, dietary restrictions, and other daily activities. This section helps establish the real-world impact of the condition, which is crucial for determining the appropriate compensation level.
Navigating VA Disability Benefits for GERD
To qualify for VA benefits for GERD, you must establish three key elements to form a service connection:
- A confirmed GERD diagnosis
- An in-service event or injury
- A medical nexus linking your condition to that event
Supporting evidence can include service treatment records, post-service medical treatment records, and the results of a Compensation & Pension (C&P) exam. If your GERD developed after military service, statements from family members and friends, along with a detailed medical nexus letter, can strengthen your case.
For secondary service connection, GERD must be proven to result from another service-connected condition, such as post-traumatic stress disorder (PTSD) or chronic coughing.
If your VA disability claim is denied, you can file a Supplemental Claim, request a Higher-Level Review, or appeal to the Board of Veterans’ Appeals. The VA will review all evidence, including the C&P exam, to assign a disability rating, which directly impacts your compensation. It is always best to seek expert legal advisement on these matters with accredited legal professionals.
Having thorough and accurate documentation, like Disability Benefits Questionnaires (DBQs) and relevant medical records, is essential to proving that your GERD symptoms are either caused by or made worse by your military service.
Conclusion
The new 2024 updates to the VA disability ratings for GERD provide a more precise and comprehensive framework for evaluating and compensating veterans for this condition. With specific criteria for GERD VA disability rating now in place, veterans can expect a more accurate assessment of their symptoms and related complications. It’s essential for veterans to work closely with their healthcare providers and legal professionals to ensure all necessary documentation is provided to support their claims. If you have GERD and believe it is related to your service, consider seeking assistance from a Veteran Service Officer (VSO) or other qualified professionals to navigate these updated criteria effectively. Officer (VSO) or other qualified professionals to navigate these updated criteria effectively.
Also read: The Impact of Smoking on Veterans Disability Benefits
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