How to Receive VA Disability Benefits for GERD and Acid Reflux

Gastroesophageal reflux disease, also called GERD, acid reflux, or heartburn, is a relatively common disorder that affects many veterans. GERD has many different causes, including medications, physical trauma, and psychological stress. That means many veterans are entitled to VA disability benefits for GERD and acid reflux either as a primary or secondary service-connected disability.

Is Acid Reflux Considered a Disability Qualified for VA Benefits?

Yes. Since acid reflux and its effects can interfere with your ability to work, you can obtain GERD and acid reflux VA disability benefits. The two steps to applying for VA disability for GERD and acid reflux are to prove you suffer from symptoms that meet the criteria under the VA disability rating schedule and establish a primary or secondary service connection to your GERD.

What Is the VA Disability Rating for Acid Reflux?

There is no VA rating schedule for GERD or acid reflux. When the VA receives a disability claim for GERD, it uses the rating schedule that produces “a common disability picture characterized in the main.” The most analogous rating schedule is 38 C.F.R. § 4.114, Diagnostic Code 7346. This schedule provides the ratings for hiatal hernia VA benefits and lists all the symptoms that occur in cases of GERD.

Under this rating schedule, the VA disability rating for GERD ranges from 10% to 60% depending on the frequency and severity of symptoms. The highest disability rating of 60% is available when GERD causes pain, vomiting, material weight loss, and blood in the vomit (known as hematemesis) or blood in the stool (known as melena) with moderate anemia. A 60% disability rating can also be awarded for other symptom combinations that produce a “severe impairment” of health.

The next highest disability rating for GERD and acid reflux VA disability benefits is 30%. This rating is awarded for GERD symptoms that produce a “considerable impairment” of health including persistently recurrent epigastric distress with difficulty swallowing (known as dysphagia), heartburn (known as pyrosis), and regurgitation, accompanied by chest, arm, or shoulder pain.

The VA has a great deal of discretion in distinguishing between a “severe impairment” and a “considerable impairment” of health. These terms are not defined in the rating schedules or the VA regulations. Rather, the VA has the authority to interpret these terms to reach “fair and equitable” outcomes. However, to obtain a higher rating, you will likely need to meet most, if not all, of the symptoms listed in the rating schedule.

The lowest disability rating is awarded when GERD produces two or more of the symptoms at the 30% level, but with less severity. These symptoms result in a 10% disability rating for GERD and acid reflux VA disability benefits.

How to Establish a Service Connection to Obtain GERD and Acid Reflux VA Disability Benefits

Every VA disability benefits claim must include a connection between the disability and your military service. In the most straightforward cases, your military medical records include a diagnosis for GERD or acid reflux while you served. Alternatively, your military records might include an event, such as an accident, that occurred during your service which your doctor can assert to be a cause of your GERD or acid reflux. Either of these would be enough to establish a service connection unless there is evidence that the GERD or acid reflux predated your enlistment or commissioning into the service.

If your GERD predated your military service, you may also establish a service connection if your service caused your GERD to worsen at a greater rate than a natural progression of the disease. Again, a service connection could be supported by an event during your service that is pinpointed as the cause of the worsening.

However, in many cases, this in-service diagnosis is missing. Fortunately, GERD can be caused by many other conditions. Thus, your GERD can be characterized as either exacerbated by your service or as a secondary service-connected disability.

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Can a Veteran’s Service Cause GERD?

When GERD is a primary disability, you may need to be prepared to show that the condition was not a pre-existing condition or that your service exacerbated a pre-existing condition to support a claim for GERD and acid reflux VA disability benefits. To explain how your service could have directly caused or exacerbated your GERD, it is important to understand what GERD is.

GERD occurs when stomach acid leaks into the esophagus. This acid can even reach the mouth or nose. This acid can erode the lining of the esophagus, eat away at tooth enamel, cause bad breath, and lead to discomfort and pain. If untreated, the acid can lead to inflammation, scarring, bleeding, and ulcers in the esophagus. Over time, GERD can even increase the risk of esophageal cancer.

The cause of the leak is usually a weak, malfunctioning, or damaged esophageal sphincter. This valve sits between the esophagus and stomach and, when functioning, allows food and drink into the stomach while preventing stomach acid and digested food from backing up into the esophagus. In veterans with GERD, the valve is unable to prevent backward flows or “reflux” of acid.

This valve can become weakened or damaged as a result of physical trauma experienced during service. For example, an injury sustained in combat, training, or a vehicle collision can damage the valve or nerves controlling the valve. Moreover, medical treatment and medications for such an injury can weaken or damage the valve leading to GERD.

Another cause of acid leaking from the stomach is the overproduction of acid. Even if it does not rise to the level of a disabling condition, anxiety, stress, and depression during your time in the service can cause or exacerbate GERD.

Can a Veteran’s Primary Disability Cause GERD?

GERD is often included in a VA disability benefits claim as a secondary service-connected disability. This can often be an easier path for obtaining GERD and acid reflux VA disability benefits than trying to establish a service connection for GERD itself.

Secondary service-connected disabilities piggyback off a primary service-connected disability that is related to, or caused by the secondary disability. The process begins with establishing a service connection for a primary disability. Then, you provide a nexus letter from a VA doctor or private doctor that establishes a relationship between the primary disability and GERD. If the VA approves benefits for the primary disability, it will also approve benefits for any secondary disabilities with a nexus to it.

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GERD is sufficiently related to many primary disabilities to obtain GERD and acid reflux VA disability benefits under the secondary service-connected disability doctrine. These include:

• Anxiety states, including post-traumatic stress disorder (PTSD): GERD may occur in veterans with a normally functioning valve when the stomach produces too much acid. Medical evidence establishes that anxiety states can lead to overproduction of stomach acid, leading to GERD.
• Medications: Many medications can lead to GERD. Prescription and over-the-counter pain medication, for example, can upset your stomach, leading to overproduction of stomach acid and GERD. Muscle relaxants can cause the muscles holding the valve closed to relax, leading to leakage of acid from the stomach. Similarly, high blood pressure medication can also relax the muscles around the esophageal sphincter, causing GERD.
• Obesity: Medications and disabilities (such as hormone imbalances resulting from chemical exposure) that cause weight gain can also lead to GERD. The additional weight pressing on your stomach can cause stomach acid to leak from the valve.
• Sleep disorders: Irregular sleep and the medications used to treat irregular sleep can lead to GERD. GERD is more likely to occur during sleep because the muscles are relaxed, your esophagus is horizontal with respect to your stomach, and you swallow less frequently. This allows gravity to pull acid from your stomach past the valve.
• Disabilities that involve coughing: Although they would seem unrelated, respiratory disorders that cause coughing can lead to acid reflux, particularly at night. Violent coughing can trigger abdominal muscle spasms that squeeze the stomach and its contents. During these coughing fits, acid can push past the valve and into the esophagus.
• Hernia: Hiatal hernia is a condition in which the stomach and esophageal sphincter protrude through the diaphragm that normally separates the stomach from the chest. This puts a great deal of pressure on the stomach and its contents that can force acid from the stomach into the esophagus.
• Peritoneal adhesions: Peritoneal adhesion is scar tissue that forms between the lining of the abdominal cavity and the internal organs. Peritoneal adhesions can be caused by physical trauma, surgery, or internal bleeding – all conditions that can be experienced by service members. Peritoneal adhesions can cause GERD when scar tissue forms between the peritoneum and stomach, causing the stomach to twist or contort from its natural position.

How to Aggregate VA Disability Ratings

If GERD is established as a secondary service-connected disability, the rating for GERD is aggregated with the rating for the primary disability using VA math to provide an overall rating for the primary disability plus the GERD and acid reflux VA disability benefits. However, VA math is not simple addition. Rather, it is a formula that is used for combined disabilities to arrive at an overall disability rating.

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Without getting too technical, VA math deducts each individual disability rating from a running body total. For example, if a veteran has two disabilities rated at 30%, the overall disability rating is not 60%. Rather, 30% is deducted from the body total of 100%, which results in a body total of 70%. 30% of the remaining body total is 21%, which is deducted from the remaining body total of 70%. This leaves a body total of 49% and an overall disability rating of 51%, which is rounded to the nearest 10%. This means that two 30% disabilities produce an overall disability rating of 50%.

Applying this to a practical example, a veteran may choose to submit a claim for VA disability benefits for service-connected PTSD and secondary service-connected GERD and acid reflux. If both are rated at 30%, the veteran is awarded an overall PTSD, GERD and acid reflux VA disability benefits rating of 50%.

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How to Use GERD and Acid Reflux VA Disability Benefits to Claim Other Secondary Service-Connected Disabilities

The relationship between GERD and other health problems runs both ways. GERD and acid reflux are not only caused by other health conditions but can cause other health conditions.

The most direct examples are esophageal ulcers and cancer caused by erosion of the lining of the esophagus. As the acid erodes the lining of the esophagus, the ulcers can perforate and bleed requiring surgery or other treatment. Additionally, the body attempts to protect itself by replacing esophageal cells with intestinal cells. This condition, known as Barret’s esophagus, can increase your risk of esophageal cancer.

Coughing fits caused by GERD and acid reflux can cause you to aspirate stomach acid into your lungs leading to scarring or inflammation of the trachea and lung tissue. This causal link means that a diagnosis of asthma, chronic obstructive pulmonary disorder (COPD), or sleep apnea could be a secondary disability resulting from GERD.

It may also be possible for a doctor to establish a nexus between GERD and malnutrition or other nutritional disorders as you change your eating habits or are unable to keep certain foods in your stomach due to GERD.

Finally, lack of sleep, poor nutrition, and stress and anxiety resulting from GERD may support a nexus between GERD and depression, anxiety states, hypertension, heart disease, obesity, and diabetes.

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Strategies for Obtaining GERD and Acid Reflux VA Disability Benefits

If you have a primary disability that clearly arose during your service as recorded in your military medical history or was clearly caused by an event that occurred during your service, even if it was undiagnosed or misdiagnosed at the time, you may want to discuss with your doctor and a VA disability attorney whether that disability would support a secondary service-connected disability claim for GERD.

In many cases, it will be easier for you to establish a service connection for disabilities that cause GERD than for you to establish a service connection for GERD. For example, PTSD is widely accepted as arising from the stresses that you can experience while serving on active duty or active training. Moreover, GERD is widely accepted as being a consequence of the increased acid production caused by PTSD. In this example, you might follow the strategy of claiming PTSD as the primary disability and GERD as the secondary disability.

Conversely, your GERD may clearly arise from your service. For example, if you suffered a stomach injury or required abdominal surgery that left you with peritoneal adhesions or hiatal hernia, your GERD might be directly connected to your service, even if it was undiagnosed or misdiagnosed at the time. In this case, you might file a primary disability claim for GERD and acid reflux VA disability benefits.

If you use this strategy, you should remember to include claims for any other conditions caused by GERD as secondary service-related disabilities. If you do not have any secondary disabilities or the secondary disabilities have not yet manifested, you will be able to file a subsequent claim after you experience any secondary disabilities to increase your overall disability rating.

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