How to Get VA Disability for GERD Secondary to Anxiety 

Anxiety and depression are strongly tied to digestive health, and veterans experiencing these mental health challenges often develop GERD as a result. This Hill & Ponton guide walks veterans through the process of connecting GERD to their service‑connected anxiety, combining ratings, and winning their claim.

How Does Anxiety Lead to GERD? 

A study of Iraq and Afghanistan veterans found that those with a mental health diagnosis were twice as likely to develop a gastrointestinal condition, including GERD. The findings show that mental health and physical health are deeply interconnected, especially for veterans coping with long-term anxiety, depression, or post-deployment stress. 

The body’s stress response activates the sympathetic nervous system, which increases stomach acid production, delays emptying of the stomach, and makes the digestive tract more sensitive to acid exposure. Over time, this heightened state can lead to chronic reflux and inflammation of the esophagus. 

In addition to physiological effects, medications used to manage anxiety often worsen reflux symptoms. Common drugs such as SSRIs, tricyclic antidepressants (TCAs), and benzodiazepines can relax the lower esophageal sphincter (LES), allowing acid to escape from the stomach into the esophagus. This can cause new reflux symptoms or intensify existing ones. 

How the VA Rates GERD Secondary to Anxiety

As of May 2024, the VA rates GERD at 0%, 10%, 30%, 50%, or 80% under Diagnostic Code 7206, based on esophageal stricture-related  symptoms (learn what to expect at the C&P exam), medication use, and whether or not the condition requires treatments. However, the VA may still apply the older Diagnostic Code 7346  if the claim was filed prior to May 2024 and that criteria are more favorable to the veteran. 

GERD Ratings Under DC 7206

• 80% – Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube)  
• 50% – Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement  
• 30% – Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year  
• 10% – Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic  
• 0% – Documented history without daily symptoms or requirement for daily medications 

Historical GERD Ratings Under DC 7346

• 60% – Symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 
• 30% – Persistently recurrent epigastric distress with dysphagia, pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. 
• 10% – Two or more of the symptoms for the 30 percent evaluation of less severity. 
• 0% – Asymptomatic or minimal symptoms controlled by diet or medication, not productive of health impairment. 

Service Connecting GERD as a Secondary Condition

If you have medical evidence of GERD being aggravated or caused by an anxiety disorder, VA may grant a secondary service connection for the condition. To prove the claim and obtain a VA rating for GERD, veterans should provide:

• Diagnosis for both conditions
• Service connection for the primary anxiety condition
• Nexus letter explaining how anxiety caused or worsened GERD
• Personal statements from the veteran and family or service members detailing the effect of anxiety on the veteran’s digestive system

Combining GERD and Anxiety Ratings 

When GERD is service connected as secondary to anxiety, the VA assigns a separate disability rating for GERD in addition to the rating already in place for the anxiety condition. However, VA does not simply add these ratings together. Instead, it assumes that a veteran is 100% functional when healthy. As impairments are added, each new condition reduces the remaining “unimpaired” portion. 

Example: When anxiety is rated at 70% and GERD is rated at 30%, the VA does not add them to a total of 100%. This is how it works instead:

1. Start with the highest rating (70% anxiety) 
2. Calculate 30% of the remaining 30% function = 0.30 × 30 = 9% 
3. Add that to 70%, so 70 + 9 = 79% 
4. Rounded to the nearest 10%, resulting in a 80% combined rating  

This means the veteran receives compensation at the 80% level, not 100%. (To simplify things for veterans, the Hill & Ponton VA Disability Calculator automatically calculates the combined percentage and estimates the corresponding monthly disability compensation amount).

Case Example: Winning a Claim for GERD Secondary to Anxiety

Citation A25007304 (Jan. 28, 2025) 

A veteran who served from April 1996 to May 2000 sought service connection for GERD as secondary to his service connected unspecified anxiety disorder. The case was reviewed under the Direct Review docket, meaning only evidence available at the time of the July 2021 original decision could be considered. 

Evidence Supporting the Veteran

• Anxiety disorder officially diagnosed in October 2017, with chronic sleep impairment 
• GERD symptoms documented beginning December 2018, after the development of the anxiety disorder 
• A January 2019 VA examination confirming GERD (with heartburn, reflux, regurgitation, and sleep disturbance) 
• VA treatment records that showed ongoing GERD symptoms requiring medication 
• A detailed April 2021 private nexus opinion from a nurse practitioner stating that the Veteran’s GERD was at least as likely as not caused or aggravated by his service‑connected anxiety disorder. The nurse detailed how prolonged stress responses and disrupted REM sleep can weaken the lower esophageal sphincter, increase stomach acid, and impair digestion, all of which increase the likelihood of GERD. She also noted that anxiety‑related metabolic dysfunction and weight gain can raise abdominal pressure, further contributing to GERD. 

In May 2021, a VA examiner stated that there was no established “consensus” in the medical literature linking anxiety and GERD. However, the examiner failed to provide any supporting medical studies or contradictory evidence to substantiate this claim. Additionally, the examiner did not address the possibility that the Veteran’s anxiety may have worsened his GERD, misinterpreted portions of the Veteran’s prior medical history, and did not offer any meaningful rebuttal to the detailed, medically supported rationale provided by the private nurse practitioner. Due to these deficiencies, the Board assigned little weight to the VA examiner’s opinion. 

The Board of Veterans’ Appeals ultimately concluded that the Veteran’s GERD developed after his diagnosis of anxiety disorder and that the medical explanation connecting the two was thorough and well‑supported. Applying the benefit of the doubt standard, the Board granted service connection for GERD secondary to anxiety disorder.