This article dives into everything you need to know about the GERD VA rating, including eligibility criteria, rating percentages, and the steps to increase your VA rating.
Gastroesophageal reflux disease (GERD) is a prevalent condition among veterans and civilians alike. However, veterans with GERD may be eligible for disability benefits through the Department of Veterans Affairs (VA), especially when their condition impacts their quality of life or daily functioning.
What Is GERD, and How Does It Affect Veterans?
Gastroesophageal reflux disease, or GERD, is a chronic digestive disorder where stomach acid flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing. In severe cases, GERD can damage the esophagus lining, leading to complications such as Barrett’s esophagus and esophageal cancer.
For many veterans, GERD is often linked to the physical and mental stresses of military service. Conditions like PTSD, stress, anxiety, and depression, common among veterans, can exacerbate GERD symptoms. Likewise, lifestyle factors during and after service, such as diet, smoking, and alcohol use, can increase the likelihood of developing GERD.
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What Is the GERD VA Rating?
The GERD VA rating is the percentage assigned by the VA to a veteran’s disability based on the severity of the condition and its impact on daily life and work ability. The VA does not have a specific diagnostic code for GERD; instead, it rates GERD by analogy to other gastrointestinal conditions such as hiatal hernia or esophagitis.
The VA rating scale for GERD ranges from 0% to 60%, and the percentage assigned depends on the severity of the symptoms. The rating can significantly impact the compensation and benefits veterans receive, making it crucial for veterans to understand how GERD is rated.
Understanding the VA Disability Rating System
The VA rates disabilities in percentages (0%, 10%, 30%, 60%, etc.) to assess the impact of a condition on a veteran’s life. Each percentage reflects the degree to which the disability limits one’s ability to function, specifically concerning employment. For example, a 0% rating means that the condition is service-connected but does not entitle the veteran to compensation. Meanwhile, a 60% rating indicates a severe condition with significant symptoms that greatly impact daily life.
GERD VA Rating Criteria
The GERD rating criteria is taken from CFR 38-4 for digestive issues.
60% Rating
This rating is assigned to veterans experiencing symptoms like pain, vomiting, weight loss, hematemesis (vomiting blood), or melena (black, tarry stools). These symptoms must be associated with severe impairment of health and greatly affect the veteran’s quality of life.
30% Rating
Veterans who experience persistently recurring epigastric distress, dysphagia (difficulty swallowing), pyrosis (heartburn), or regurgitation may receive this rating. Additionally, these symptoms must lead to considerable impairment of health, impacting daily tasks and activities.
10% Rating
For veterans with only two or more symptoms of epigastric distress, such as heartburn and regurgitation, with mild or infrequent episodes, the VA may assign a 10% rating.
0% Rating
This rating means that GERD symptoms are present but mild and do not impact the veteran’s health or ability to perform daily functions.
Establishing Service Connection for GERD
To qualify for a GERD VA rating, veterans must establish a service connection for their condition. This means demonstrating that GERD is either caused or worsened by military service. There are three main ways to establish a service connection:
Direct Service Connection
The veteran must provide medical evidence showing that GERD began during their time in service. This could involve documenting symptoms in service medical records or obtaining a diagnosis shortly after discharge.
Secondary Service Connection
Veterans who develop GERD due to an already service-connected condition, such as PTSD or medications prescribed for another condition, may apply for a secondary service connection. For example, PTSD can exacerbate GERD symptoms, allowing a veteran to seek a GERD VA rating as a secondary condition.
Aggravation
If a veteran had GERD prior to enlistment but found their symptoms worsened due to service-related factors, they could file a claim showing that military service aggravated their pre-existing condition.
Evidence Needed to Support Your Claim
Securing a VA rating for GERD requires substantial medical evidence. Here are some essential documents veterans should consider gathering:
Medical Records
Documentation of GERD symptoms, diagnoses, and treatments from both VA and civilian healthcare providers can help build a strong case. Records showing recurring symptoms, hospitalizations, or treatments like antacids, proton pump inhibitors, or dietary changes can be invaluable. The VA will look for ongoing treatment documentation supporting that.
Service Medical Records
These records should ideally include any mention of GERD symptoms during service, such as complaints of heartburn, chest pain, or stomach issues.
Statements from Friends and Family
Personal statements from those close to you, including family members or coworkers, can support your claim. Their observations of how GERD affects your daily life and functioning may strengthen your case.
Applying for an Increased GERD VA Rating
If your GERD symptoms worsen over time, you may qualify for an increase in your VA rating. To apply for an increased rating:
Gather Updated Medical Evidence
Submit recent records showing the escalation of GERD symptoms, additional treatments, and any newly developed complications. This evidence helps demonstrate that your condition has worsened.
File a VA Form 21-526EZ
Use this form to request an increased rating. It’s the standard form for veterans filing disability claims. You can find this form online when you file for VA disability claims.
Request a VA Reexamination
In some cases, the VA may request a new medical examination to assess the current severity of GERD. During this examination, be honest about your symptoms and describe any effects on your daily life and ability to work.
Consider Assistance from a Veterans Service Officer (VSO)
Navigating the VA rating process can be challenging. VSOs are trained to assist veterans in completing and filing disability claims and can provide valuable advice on maximizing your GERD VA rating.
Common Mistakes to Avoid When Filing a GERD Claim
Veterans often face obstacles when filing for GERD VA ratings. Here are some mistakes to avoid to increase your chances of receiving the highest possible rating:
Inadequate Evidence
Many claims are denied due to insufficient medical documentation or missing service records. Ensure your file includes current and relevant records, ideally with supporting statements.
Ignoring Secondary Conditions
GERD may lead to secondary conditions like esophagitis, Barrett’s esophagus, or chronic cough. Don’t forget to mention these secondary conditions, as they may increase your overall VA rating.
Not Seeking Help
Many veterans struggle with the process on their own. Consider working with a VSO or seeking assistance from veteran-friendly organizations to guide you through the VA claims system.
Underrating Symptoms
Downplaying symptoms or being vague about how GERD affects you can lead to a lower rating. Describe your symptoms in detail, especially if they impact your ability to work or carry out daily tasks.
The Appeal Process: What to Do if Your Claim is Denied
If the VA denies your GERD claim or assigns a rating you believe is too low, you have the right to appeal. There are three main levels of appeal:
Higher-Level Review (HLR)
A higher level review involves requesting that a more senior claims adjudicator review your application for errors.
Supplemental Claim
If you have new evidence to submit, such as additional medical records or a doctor’s statement, you can file a supplemental claim.
Board of Veterans’ Appeals
This option involves a formal appeal process where a judge reviews your case.
Each stage has specific requirements, so working with a legal advisor or a VSO during the appeal process may improve your chances of success.
