VA GERD Claims: DC 7206 Ratings and Service Connection

Overview

GERD is rated under DC 7206 within 38 CFR 4.114. GERD claims work a bit differently from many conditions: the easiest path to a grant is often not proving the reflux started in service, but showing it was caused or worsened by a condition VA already covers. In a review of the Board's published decisions on GERD, service-connection grants, direct and secondary combined, were common, but so were denials for a missing in-service link, no current diagnosis, or a missed exam; a separate share of cases were not about winning coverage at all, but disputes over the rating percentage or the effective date once GERD was already service connected. This guide walks the whole path: how service connection works, the direct and secondary pathways, what evidence wins, why claims get denied, a checklist before you file, the claims process step by step, how to read your decision letter, and what to do whether you win or you're denied.

What the VA Counts as Gastroesophageal reflux disease (GERD)

GERD is a chronic condition in which stomach acid repeatedly flows back up into the esophagus, the tube that connects the throat to the stomach. The common symptoms are heartburn, regurgitation, chest discomfort, and difficulty or pain when swallowing (called dysphagia). Over time, repeated acid exposure can inflame or narrow the esophagus. That narrowing is called an esophageal stricture, and as you will see below, the current VA rating turns heavily on whether a stricture is documented.

For VA purposes, GERD is now rated under 38 CFR 4.114, diagnostic code 7206, which is specifically titled "Gastroesophageal reflux disease." That code does not stop at GERD. Note 3 to DC 7206 states that it applies to a broad family of esophageal conditions, including esophagitis (mechanical or chemical), Mallory Weiss syndrome from caustic ingestion, drug-induced or infectious esophagitis, idiopathic eosinophilic or lymphocytic esophagitis, esophagitis from radiation therapy, esophagitis due to peptic stricture, and any esophageal condition that requires treatment with sclerotherapy.

The 2024 Code Transition: From DC 7346 to DC 7206

This is the single most important thing to understand about a GERD claim today, because most older guides on the internet are now out of date.

What changed, in plain language

• Before the 2024 reorganization: GERD was not its own code. Raters evaluated it by analogy, most often under DC 7346 (hiatal hernia), which topped out at 60 percent for symptoms such as persistent pyrosis (heartburn), regurgitation, substernal or arm or shoulder pain, and dysphagia productive of considerable impairment of health.
• After the 2024 reorganization: GERD is DC 7206. The ladder is 0/10/30/50/80, and the criteria are built around documented esophageal stricture, dysphagia, the number of dilatation procedures per year, stent or PEG tube placement, aspiration, and substantial weight loss. The highest available schedular rating is 80 percent.

When a regulation changes, the VA generally applies the version of the rule that is more favorable to the veteran for the period each version was in effect. The VA's own manual guidance and longstanding case law direct raters to consider both the old and new criteria for a claim that was pending across the change, and to use whichever yields the higher evaluation for the relevant time period. In practice this means a claim filed before the May 2024 effective date may still be evaluated under the old DC 7346 criteria for the earlier period, while a claim filed after that date is evaluated under DC 7206. This guide reports what the regulation says. It does not predict which version applies to any individual file.

How Service Connection Works, At a High Level

Before the specific pathways below, it helps to understand the three things every GERD claim ultimately has to show. This is the same basic test that applies to any VA disability claim, just applied to this condition.

1. A current diagnosis. You need GERD, or acid reflux, diagnosed now or at some point during your claim. Without a current diagnosis there is nothing to connect to service.
2. An in-service event, or a service-connected condition behind it. Either your reflux began during service (shown by records or credible symptoms), or it was caused or worsened by a disability VA already covers, such as a mental-health condition, IBS, or medication taken for a service-connected joint.
3. A medical nexus. A medical opinion connecting your GERD to that in-service cause or service-connected condition, and the opinion carries far more weight when it explains its reasoning rather than stating a bare conclusion.

What VA Looks For: Tests, Records, and Diagnostic Codes

Whether you're filing directly or secondary to another condition, the record VA actually reviews centers on a small set of documents and data points.

• The diagnosis itself: a current GERD diagnosis from a VA or private exam, ideally supported by one of the imaging methods discussed under Diagnostic Tests below.
• Service treatment records: any documentation of heartburn, reflux, vomiting, or stomach medication during service, or a steady history of symptoms since discharge.
• The diagnostic codes involved: DC 7206 for GERD itself, plus whatever code applies to the condition you're connecting it to, for example a service-connected psychiatric disorder, DC 7319 (IBS), or the code for a service-connected knee or back condition behind a long-term pain medication.
• The actual form the examiner fills out: the esophageal-conditions Disability Benefits Questionnaire (DBQ), discussed later in this guide.

How Gastroesophageal reflux disease (GERD) Gets Service Connected

Direct service connection

Direct service connection requires the three standard elements: a current GERD diagnosis, an in-service event or onset (for example, documented reflux, dyspepsia, or treatment during service), and a medical nexus linking the two. The framework a direct claim is decided under is described in M21-1, Part V, Subpart i, Chapter 1, Section A. In the Board's published decisions, the missing nexus is by far the most common reason a direct GERD service-connection claim is denied. Continuity of symptoms, in-service records of reflux or stomach trouble plus a steady history of symptoms since, is one of the stronger forms of direct evidence, alongside lay and buddy statements describing what a family member or fellow servicemember personally observed. See 38 CFR 3.303.

Presumptive service connection

There is no toxic-exposure presumptive for GERD itself. GERD is a structural and functional reflux condition with a known cause, so it is not on any Agent Orange, burn pit, or PACT Act presumptive list, and it is not one of the eight Camp Lejeune presumptive conditions. One narrow, adjacent pathway exists for Persian Gulf War veterans: the VA presumes service connection for qualifying chronic, medically unexplained "functional gastrointestinal disorders," a group the VA defines to include irritable bowel syndrome, functional dyspepsia, and functional abdominal pain syndrome, that are at least 10 percent disabling. The current presumptive window runs through December 31, 2026. That pathway covers functional GI disorders without structural change, not a diagnosed structural GERD or esophageal stricture, so it is adjacent rather than a GERD presumptive. See the VA's Gulf War medically unexplained illness page and the presumptive-period extension notice.

Established secondary pathways for GERD include:

DC 7206 Rating Levels

The full current title in the schedule is "Gastroesophageal reflux disease." Both GERD and the closely related esophageal stricture code (DC 7203) use the same five-step ladder. The rating is driven by documented structural findings and treatment, not by symptom severity alone. Here are the criteria, taken verbatim from 38 CFR 4.114.

80 percent is the maximum schedular rating for GERD. There is no 60 percent and no 100 percent level under DC 7206. The plain-language version of each row is below.

The other notes from the regulation:

• Note 1: Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy.
• Note 2: Non-gastrointestinal complications of procedures should be rated under the appropriate system.
• Note 3: This code applies to a broad list of esophageal conditions, including esophagitis (mechanical or chemical), Mallory Weiss syndrome from caustic ingestion, drug-induced or infectious esophagitis, idiopathic eosinophilic or lymphocytic esophagitis, esophagitis from radiation therapy, esophagitis due to peptic stricture, and any esophageal condition that requires treatment with sclerotherapy.
• Note 4: "Recurrent" esophageal stricture means the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved.
• Note 5: "Refractory" esophageal stricture means the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.

The "substantial weight loss" used in the 80 percent row is defined at 38 CFR 4.112(a) as an involuntary loss greater than 20 percent of baseline weight, sustained for three months, with diminished quality of self-care or work tasks.

Evidence That Wins These Claims

The Board's published decisions show a private medical opinion is the highest-yield evidence for these claims:

For the rating level (as opposed to service connection), the deciding evidence is the imaging and procedure record: a barium swallow, CT, or EGD documenting the stricture (per Note 1), plus dilatation procedure notes showing how many dilatations occurred per year and whether any used steroids or involved a stent. See the DBQ guide.

Evidence Checklist

• Current diagnosis: a GERD (or acid reflux) diagnosis in your VA or private medical records, ideally supported by a barium swallow, CT, or EGD.
• In-service records or continuity of symptoms: for a direct claim, records showing reflux, stomach trouble, vomiting, or related medication during service, plus a steady history of symptoms since. This continuity-of-symptoms evidence, under 38 CFR 3.303, has supported direct grants where in-service records documented reflux symptoms and treatment well before the current claim.
• Lay and buddy statements: you don't need a doctor to describe what you felt. First-person and family statements describing frequent heartburn, regurgitation, or vomiting, especially during and shortly after service, have supported grants alongside the medical evidence. See the Buddy & Lay Statements Guide.
• A reasoned medical nexus opinion: the clearest path to a grant is an opinion that explains how the connection works, cites supporting medical literature applied to your own facts, and directly addresses each service-connected condition you're claiming as the source, rather than a bare conclusion.
• The diagnostic codes involved: DC 7206 for the GERD itself, plus the code for whatever condition you're connecting it to (a mental-health code, DC 7319 for IBS, or the code covering the joint condition behind a long-term medication).

Why These Claims Get Denied

Beyond the general "no nexus" and "no current diagnosis" reasons covered above, a few specific denial patterns show up often enough in the Board's published decisions to call out on their own.

Common Mistakes

Pitfalls and Procedural Mistakes

Distinct from the substantive reasons claims get denied above, these are process mistakes that can sink an otherwise winnable file.

Do's and Don'ts

A condensed version of everything above, in the order it actually matters when you sit down to build your file.

Common Secondary Conditions

Secondary conditions run in two directions: conditions that can cause GERD, and conditions that GERD can in turn cause. The Board's published decisions catalogue both directions, and the grant rates differ sharply by pathway.

Conditions that can cause GERD (GERD as the secondary)

When GERD is claimed as secondary to a service-connected primary condition, each bar is the published BVA grant rate, with the number of decisions below it. This is the "ways to connect via another condition" list:

(All figures are grant rates from published BVA decisions, secondary-claim dataset. The mental-health pathways generally reflect medication side effects rather than the mental condition itself.)

Conditions GERD can cause (GERD as the primary)

GERD is itself a recognized cause of downstream secondary claims. Each bar is the published BVA grant rate for a condition claimed secondary to GERD, in other words, conditions secondary to GERD once GERD itself is already service connected:

Asthma is also claimed secondary to GERD, but on a very small sample (n = 10), so it is not charted here. All figures are from published BVA decisions, secondary-claim dataset.

Pyramiding and Rating Separately

The VA's pyramiding rules prevent paying twice for the same symptoms. The digestive schedule has a specific anti-combining instruction at 38 CFR 4.114. It directs that ratings under a listed group of digestive codes (diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive) are not combined with each other. Instead, when more than one of those ratings would be warranted, the VA assigns a single evaluation under the code that reflects the predominant disability picture, and elevates it one step if the overall severity warrants it. The same rule is why GERD and IBS generally receive one rating for the predominant condition rather than two separate ones, under 38 CFR 4.113 and 4.114.

Where GERD produces a complication outside the digestive system, Note 2 to DC 7206 directs that the non-gastrointestinal complication be rated under the appropriate body system rather than folded into the GERD rating.

Quick Checklist Before You File

Bring these together before you submit anything.

For the mechanics of actually submitting the claim, see the Standard Claim Guide and the Fully Developed Claim Guide (filing with all your evidence up front can speed up the decision).

The Claims Process, Step by Step

Once you file, your claim moves through a series of hand-offs. Understanding who does what helps you know who to contact, and what to expect, at each stage.

1. You file the claim. Directly with VA, through VA.gov, or with the help of an accredited representative.
2. VA acknowledges the claim and assigns it for development. A Veteran Service Representative (VSR) is assigned to gather your service treatment records, VA and private medical records, and any other evidence needed.
3. The VSR orders a Compensation & Pension (C&P) exam if one is needed. Most GERD claims involve one, especially secondary claims where a nexus opinion is required.
4. The C&P exam is conducted. By a VA clinician or a contracted examiner, who completes the esophageal-conditions Disability Benefits Questionnaire (DBQ) documenting the diagnosis, severity, and, where relevant, a nexus opinion.
5. The file goes to a Rating Veteran Service Representative (RVSR), the "rater." The rater reviews the complete file, including the exam results, and decides whether service connection is warranted and at what percentage.
6. A senior reviewer may review the decision before it's finalized, depending on the complexity of the claim.
7. VA issues the decision letter. This states whether the claim is granted or denied, the rating percentage if granted, and the reasons behind the decision.
8. If you disagree, you choose an appeal lane. Higher-Level Review, Supplemental Claim, or a Board appeal, covered later in this guide.

Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner

For the full walkthrough of every stage with more detail, see Inside Your Claim and Claim Stages.

Diagnostic Tests and the DBQ

The primary Disability Benefits Questionnaire for this condition is VA Form 21-0960G-1, "Esophageal Conditions (Including Gastroesophageal Reflux Disease (GERD), Hiatal Hernia and Other Esophageal Disorders)." The questions on that form track the rating criteria, so the underlying tests below are what give the form, and the rater, something to work with. The evaluation framework is described in M21-1, Part V, Subpart iii, Chapter 6, Digestive Disabilities.

• Esophagogastroduodenoscopy (EGD, or upper endoscopy): direct visualization of esophagitis, erosions, strictures, and Barrett's esophagus. One of the three imaging methods DC 7206 Note 1 accepts.
• Barium swallow (esophagram, or upper GI series): accepted under DC 7206 Note 1 to document stricture and dysphagia.
• Computed tomography (CT) of the chest or abdomen: the third imaging method accepted under DC 7206 Note 1.
• Esophageal dilatation records and procedure notes: the count and method of dilatations per year (and any steroid dilatation or stent placement) drive the difference between the 30 and 50 percent levels.
• Documentation of daily medication use: proton pump inhibitors (such as omeprazole, pantoprazole, or lansoprazole) or H2 blockers. Per M21-1, daily medication used to control symptoms supports the 10 percent level even without a separately documented stricture.
• Weight and nutrition records and aspiration findings: needed to assess the 80 percent criteria (aspiration, undernutrition, substantial weight loss under 38 CFR 4.112(a)) and any PEG-tube placement.
• 24-hour esophageal pH monitoring and esophageal manometry: sometimes used clinically to confirm reflux and esophageal motility, supporting the diagnosis.

Your C&P Exam

See the DBQ Guide for how the esophageal-conditions DBQ works in general, including whether a private DBQ completed by your own doctor can be submitted instead of relying solely on a VA exam.

Before your C&P exam, bring a clear, specific account of your symptoms, focus on how the condition affects your daily function on your worst days, not just an average day. Be consistent with what's already in your medical records and prior statements, since an inconsistent onset story is one of the pitfalls covered above. For a full walkthrough of what to expect and how to prepare, see the C&P Exam Prep Guide.

Reading Your Decision Letter, and What to Do If Denied

Your decision letter has two parts: a narrative section explaining the reasoning (often called "reasons and bases"), and a codesheet showing the actual rating percentage, the effective date, and the diagnostic code used. See the Reading Your Decision Letter Guide for how to find and interpret each part, or use the Letter Interpreter tool to upload your own letter and get a plain-English breakdown.

If your claim is denied, or the rating is lower than you expected, you have three main lanes:

• Supplemental Claim: refile with new and relevant evidence, such as a new nexus opinion or updated imaging. See Supplemental Claim Guide.
• Higher-Level Review (HLR): a senior reviewer looks at the same evidence again for a difference of opinion, no new evidence is added. See HLR Guide.
• Board Appeal: your case goes to a Veterans Law Judge at the Board of Veterans' Appeals, with options for a direct review, an evidence docket, or a hearing. See Board Appeal Guide.

Not sure which lane fits your situation? See the Appeals decision guide for a side-by-side comparison of all three.

After You Win: Maintaining Your Rating and Getting the Right Start Date

A grant is not always the end of the story. Keep your treatment consistent, continued follow-up and records showing ongoing symptoms and management, protects you if VA schedules a future reexamination. Not every rating gets reexamined; understand when a rating becomes protected from future review and what to do if VA proposes to reduce it. See Protect Your Rating and Future Reexaminations for the specifics.

Two details specific to GERD are worth knowing once you're already service connected. First, VA generally must evaluate your symptoms as they would be without the relief your medication provides, when the rating criteria don't reference medication, so describe your symptoms as they are day to day, not just how you feel while treated. Second, when GERD and another digestive condition like IBS are both in the file, VA generally assigns one rating for the predominant condition rather than separate ratings for each, see Pyramiding above. If your GERD worsens after the initial grant, for example progressing to require dilatation more often or a newly documented stricture, you can file for an increased rating. See the Rating Increase Guide.

For the effective date of your award: it's generally the date VA received your claim or the date the condition arose, whichever is later, and it can't be earlier than the day after you left service. Filing an intent to file can preserve an earlier date only if you complete the claim within one year. See the Reading Your Decision Letter Guide for more on effective dates.

Quick Reference Tables

Secondary Connection Pathways

From Filing to Decision: Who Does What

Frequently Asked Questions

Sources

1. 38 CFR 4.114, DC 7206, gastroesophageal reflux disease (digestive schedule)
2. 38 CFR 3.303, service connection, including continuity of symptoms; 38 CFR 3.303(d), service connection for a disease diagnosed after service
3. 38 CFR 3.310, secondary service connection, caused or aggravated
4. 38 CFR 3.102, benefit of the doubt; 38 USC 5107(b), benefit of the doubt
5. 38 CFR 3.317, Persian Gulf War presumptive service connection; 38 USC 1117, Persian Gulf War qualifying chronic disability
6. 38 CFR 3.301, line of duty and willful misconduct
7. 38 CFR 4.113, digestive diseases rated together (no pyramiding)
8. 38 CFR 3.400, effective dates; 38 CFR 3.155, intent to file
9. 38 CFR 3.655, failure to report for a VA examination
10. 38 USC 1110 and 1131, basic service connection
11. 38 USC 1154(b), the combat rule for combat veterans' lay evidence
12. M21-1, Part V, Subpart iii, Chapter 6, Digestive Disabilities
13. VA.gov, Gulf War medically unexplained illnesses (functional GI presumptive)
14. VA News, presumptive period extended through Dec. 31, 2026

Related Tools and Guides