Peptic Ulcer and Ulcerative Colitis VA Disability Benefits

Many veterans experience chronic or recurring stomach pain. However, as strange as it may seem, VA disability for chronic stomach pain may depend on where the pain originates. Even though many of the conditions experienced during military service can cause or aggravate digestive problems, peptic ulcer and ulcerative colitis military disability benefits can be difficult to obtain. Nevertheless, armed with some knowledge of the confusing and contradictory way the VA approaches digestive system disorders, you and your VA disability benefits attorney can put together a claim that has a fighting chance for approval.

The Differences Among Peptic Ulcer Disease, Peptic Ulcer, and Ulcerative Colitis

The terms peptic ulcer disease, peptic ulcers, ulcerative colitis, gastric ulcers, duodenal ulcers, and marginal (or gastrojejunal) ulcers appear in the VA’s regulations. However, these terms describe different conditions and are tied to different VA disability benefits.

Do Peptic Ulcers Qualify for Disability?

The short answer is yes, but it requires some twisted logic. Although the VA provides extensive ratings for digestive system disabilities, you will not find the term “peptic ulcer” anywhere in the ratings schedules. Rather, “peptic ulcer” appears in 38 CFR 4.110. This regulation sets out the VA’s position that the term “peptic ulcer” is too vague of a diagnosis and requires the location of the ulcer to be identified to obtain a VA disability rating.

Ulcers of the digestive system can occur in the esophagus, stomach, or small intestine. Ulcers are sores and breaks in the lining of these digestive organs. Without the protective lining, digestive acid can eat away at the esophagus, stomach, or small intestine leading to chronic stomach pain, vomiting, and even malnutrition if the veteran is unable to eat or keep food in his or her stomach.

Peptic ulcers qualify for disability, but not if they are diagnosed as “peptic ulcers.” One ratings table exists for ulcers in the stomach (listed as gastric ulcers) and upper small intestine (listed as duodenal ulcers). A different ratings table exists for ulcers in the middle small intestine (listed as marginal or gastrojejunal ulcers). Thus, to obtain VA disability benefits for peptic ulcers, your private doctor or VA doctor will need to narrow down the diagnosis to a gastric ulcer, duodenal ulcer, or marginal ulcer.

VA disability ratings for gastric ulcers and duodenal ulcers range from 10% to 60% based on the frequency and severity of symptoms including pain, vomiting, blood in your vomit or stool, malnutrition, and anemia. VA disability ratings for marginal ulcers range from 10% to 100% based on similar symptomology. A disability rating of 100% is awarded for marginal ulcers that are totally incapacitating.

An esophageal ulcer is rated slightly differently. There is no ratings table for esophageal ulcers. However, esophageal ulcer, gastroesophageal reflux disease (GERD), and hiatal hernia produce the same symptoms and their causes can be intertwined.

When a disability does not have a specific ratings table associated with it, the VA uses the closest analogous ratings table that produces the same overall symptoms. The VA consistently uses the hiatal hernia ratings table for GERD and esophageal ulcers in its reported cases. The VA disability ratings for hiatal hernia range from 10% to 60% depending on the severity of the pain, vomiting, regurgitation, heartburn, difficulty swallowing, and blood in the vomit or stool that you experience.

To summarize, peptic ulcers qualify for disability when the specific location of the ulcer is identified. If the ulcer is a gastric ulcer or duodenal ulcer, it qualifies under 38 CFR 4.110, Diagnostic code 7304 or 7305, respectively. Marginal ulcers qualify for disability under 38 CFR 4.110, Diagnostic code 7306. Esophageal ulcers qualify for disability by analogy to hiatal hernia under 38 CFR 4.110, Diagnostic code 7346.

Remember, keep a notepad of all of your symptoms and the dates that they affect your ability to work. Presenting the days you had to take off work, spend the day in bed, or visit the emergency room will help build your case with the VA.

One of our VA Disability Lawyers gives tips on what to do at your C&P Exam for VA benefits.

How Veterans with Ulcers Can Get Benefits

In a seemingly contradictory manner, the VA’s regulations specifically list peptic ulcer disease in 38 CFR 3.309 as a disability that is entitled to a presumptive service connection for prisoners of war (POWs) held 30 days or longer. How can the VA regulations simultaneously take the position that “peptic ulcer disease” is an acknowledged disability suffered by POWs but that “peptic ulcers” are too vague to receive a disability rating?

Reconciling this contradiction requires an understanding of the VA’s process for granting a disability benefits claim. Every claim must include both a ratable disability and a service connection that ties the disability to the veteran’s military service.

“Peptic ulcer disease” can be thought of as a family of disorders that clearly includes gastric ulcers and duodenal ulcers and may possibly include esophageal ulcers and marginal ulcers as well. The VA’s past cases support the proposition that peptic ulcer disease is a disability that is entitled to benefits. However, to obtain a rating, a veteran must have a more specific diagnosis than peptic ulcer disease.

By analogy, a back injury is a disability that is entitled to VA disability benefits. However, to obtain a rating, a veteran must obtain a diagnosis of whether the back injury affects the cervical spine or lumbar spine because each is associated with different ratings.

Can You Get Ulcerative Colitis Military Disability Benefits?

Yes, the VA has a ratings table specifically for ulcerative colitis. However, bear in mind that ulcerative colitis is not the same as peptic ulcer disease. Therefore, it is not possible to substitute a diagnosis of ulcerative colitis for a diagnosis of peptic ulcer disease to smooth the VA disability benefits claim process.

Ulcerative colitis is an inflammation of the large intestine or colon. Peptic ulcers, as discussed previously, affect the esophagus, stomach, and small intestine. Therefore, they do not occur in the same organs.

More importantly, ulcerative colitis produces different symptoms than peptic ulcers. Peptic ulcers cause ongoing stomach pain, vomiting, bloody vomit (hematemesis) or stool (melena), weight loss, and anemia. Ulcerative colitis causes fatigue, weight loss, anemia, malnutrition, urgent bowel movements, nausea, and fever.

Peptic Ulcer Symptoms	Ulcerative Colitis Symptoms
Weight Loss	Weight Loss
Vomiting	Vomiting
Anemia	Anemia
Bloody Stool or Vomit	Urgent Bowel Movements
Stomach Pain	Fatigue

Finally, ulcerative colitis and peptic ulcers have different causes. Ulcerative colitis is an autoimmune disorder while peptic ulcers are caused primarily by Helicobacter pylori bacteria and exacerbated by stress.

The ratings for ulcerative colitis military disability benefits range from 10% to 100% depending on the frequency of flare-ups, the severity of symptoms during and between flare-ups, and the existence of complications such as malnutrition, anemia, or liver abscess.

Establishing a Service Connection for Peptic Ulcer and Ulcerative Colitis

Every VA disability claim must claim some connection between the disability and your military service. In ordinary cases, there are three ways to prove a service connection. However, peptic ulcer disease is a bit unusual in that former POWs are entitled to a presumption of service connection. This provides some veterans with an additional path for establishing a service connection.

Presumptive Service Connection for POWs with Peptic Ulcer Disease

If your service records show that you were held captive for 30 days or longer as a POW, you are entitled to a presumptive service connection for peptic ulcer disease. Note that this does not apply to ulcerative colitis military disability claims.

The benefits of a presumptive service connection are that no facts need to be alleged in the claim to establish a service connection and the service connection exists regardless of when the peptic ulcer disease manifested. This presumptive service connection can significantly reduce the paperwork needed for a VA disability claim and eliminate one common ground – lack of service connection – used to reject claims.

Peptic Ulcers and Ulcerative Colitis Caused by Service

A service connection to support peptic ulcer or ulcerative colitis military disability can be established by providing evidence that the digestive system disability manifested during your time in the service. This can be established by providing military medical records that include a diagnosis of ulcers or ulcerative colitis. If several of you in your division caught something that brought it on, you can use buddy statements to back up your claim.

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Peptic Ulcers and Ulcerative Colitis Diagnosed After Service

If your diagnosis for peptic ulcers or ulcerative colitis occurred after service, you may still be able to connect the disability to your service. One way to establish a service connection is to show that your military medical records include symptoms of ulcers or ulcerative colitis that went undiagnosed or misdiagnosed.

For example, suppose you experienced chronic abdominal pain and vomiting during your time in the military, but were never diagnosed with gastric ulcers or were misdiagnosed with, for example, an infectious disease. You may be able to establish a service connection by submitting a medical opinion letter connecting the symptoms you experienced in the service to your later diagnosis of gastric ulcers.

This claim might be furthered if you can point to a specific cause of your disability that occurred during your service. For example, peptic ulcers are known to be brought on by exposure to radiation, certain pharmaceuticals like aspirin and ibuprofen, and contaminated water. Similarly, ulcerative colitis can be brought on by exposure to certain bacterial and viral infections, anti-inflammatory drugs, and antibiotics.

Peptic Ulcers and Ulcerative Colitis Worsened by Service

If you had pre-existing peptic ulcers or ulcerative colitis when you joined the military and your military service worsened your condition, you may be able to establish a service condition. The primary obstacle that you will need to overcome when asserting that your peptic ulcer or ulcerative colitis military disability was worsened by your service is that the worsening must be more severe than a natural progression of your condition.

If your condition was under control prior to your service and worsened significantly during your service, for example, you may be able to show that your service was the cause of the worsening. Again, it may be helpful to tie the worsening of your peptic ulcers or ulcerative colitis to a specific occurrence during your service, such as a physical injury that was treated with large or longstanding doses of aspirin.

Claiming Peptic Ulcer and Ulcerative Colitis Military Disability as a Secondary Service-Connected Disability

One way to overcome the service connection requirement is to claim peptic ulcers or ulcerative colitis as a secondary service-connected disability. To submit a secondary service-connected disability, you must have a primary service-connected disability. Often, this disability has a clear service connection, such as an injury, disease, or condition that was diagnosed during your military service.

Disabilities proved by medical evidence to be related to the primary disability, or treatment for the primary disability can be claimed as secondary service-connected disabilities. This relationship, called a nexus, is usually established by a medical opinion letter from your VA doctor or private doctor.

Suppose you suffered a knee injury in combat, a training accident, or a vehicle collision during your time in the military and you were able to obtain VA disability benefits for this knee injury. If your knee injury is treated with non-steroidal anti-inflammatory drugs (NSAIDs), you may be able to claim gastric ulcers as a secondary service-connected disability because NSAIDs are a well-established cause of gastric ulcers.

When a claim for a secondary service-connected disability is approved, the disability ratings for the primary and secondary disabilities are aggregated using VA math. When calculating an overall disability rating using VA math, the result is not simply the sum of the individual ratings. Rather, the overall rating is calculated using a formula. Without getting too technical, just keep in mind that under VA math, a 20% rating plus a 30% rating does not give a 50% rating.

How to Do VA Math with the VA Combined Ratings Table

Increasing Your Peptic Ulcer or Ulcerative Colitis VA Disability Benefits

The VA disability ratings for peptic ulcers and ulcerative colitis are skewed toward the low end of the scale. If the VA assigns a rating that is too low, you can submit additional evidence that moves you into a higher rating category by showing the severity of your symptoms. According to the VA’s policies, you are not required to manifest all the symptoms associated with a higher rating if the overall symptomology is better matched by the higher rating category than a lower rating category.

For example, the difference between a 40% rating and a 60% rating for a gastric ulcer or duodenal ulcer is based primarily on whether the pain is “moderately severe” or “severe” and is accompanied by vomiting blood or blood in your stool. If you experience severe pain and vomiting, but without blood in the vomit or stool, you may be entitled to the higher rating since the overall symptomology is more like the higher category than the lower category.

As mentioned previously, you can also increase your overall disability rating by combining multiple secondary service-connected disabilities. If the disabilities are either connected to your service or related to one another, you can file a claim for VA disability benefits for them in the aggregate.

For example, an injury incurred in combat or active training may have led to post-traumatic stress disorder (PTSD). The NSAIDs prescribed to treat the injury and the excess stomach acid produced as a result of the PTSD may cause or aggravate ulcers. Thus, you may be able to obtain a nexus letter tying the service-connected injury and PTSD to a gastric, duodenal, or esophageal ulcer. While each may be minor when considered separately, VA math is intended to fully compensate you for the aggregate effect of the related disabilities.

Is Ulcerative Colitis Considered a Disability Under the ADA?

Yes. However, the interplay between VA disability benefits, the Americans with Disabilities Act (ADA), and Social Security Disability Insurance (SSDI) is complicated. It may be possible to qualify for both VA disability benefits and SSDI simultaneously. If the peptic ulcer and ulcerative colitis military disability benefits are too low to compensate you for your inability to work, you may try seeking Social Security disability benefits. However, the ADA is intended to protect people with disabilities from discrimination in the workplace and, thus, is often incompatible with drawing SSDI since SSDI presumes you are unable to work.

Contact a VA benefits attorney, regardless of your current location or whether you were deployed during your service, to discuss VA disability for chronic stomach pain from peptic ulcers or ulcerative colitis.