Gastroesophageal reflux disease (GERD) is common, often leading to secondary issues like heartburn or dysphagia.
With around sixty million Americans experiencing heartburn monthly, and twenty-five million daily, according to the National Institute of Diabetes and Kidney Digestive Disease, veterans suffering from GERD post-service may qualify for VA benefits.
The severity of symptoms generally influences the rating.
What Is Gastroesophageal Reflux Disease?
Gastroesophageal reflux disease, or GERD, is a condition in which gastric acid and partially digested food flow up from the stomach into the esophagus.
This results in the painful sensations that are associated with heartburn. Continuous irritation of the esophageal lining poses a risk for developing more severe complications such as esophageal cancer.
Common Symptoms of GERD
- Heartburn
- Nausea and regurgitation
- Pain in chest or abdominal pain
- Anemia
- Difficulty swallowing or painful swallowing
- Respiratory problems
- Vomiting
- Ulcers
VA Ratings for GERD
GERD is usually rated comparable to a hiatal hernia under 38 CFR 4.114, Digestive System, Diagnostic Code 7346 (Schedule of Ratings – Digestive System).
The severity of symptoms determines the range of ratings assigned by this code.
VA Rating Criteria for GERD
- 10 percent – a veteran is rated at 10% if they have two or more of the common signs of GERD from the 30% schedule but not severe enough to justify the full 30% rating.
- 30 percent – VA recognizes 30% for GERD when it leads to “persistently recurrent epigastric discomfort with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm and shoulder pain that is very severe.”
- 60 percent – “Severe impairment of health” shall be defined as the veteran experiences “pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations resulting in substantial debilitation of health.”
How Does GERD Occur?
The esophagus, or food pipe, is a 9.5-inch muscular tube connecting the mouth to the stomach.
It transports food using muscular movements. The lower esophageal sphincter (LES) at the esophagus’s base opens for food to enter the stomach and typically remains closed otherwise.
In GERD, the LES malfunctions, allowing stomach acids and food to flow back into the esophagus, leading to heartburn due to the esophagus’s inability to withstand acid like the stomach can.
This backflow causes the discomfort known as heartburn, pyrosis, or acid reflux.
What Causes GERD?
It is a well-established fact that certain medications, lifestyle choices, and non-related physical disorders can contribute to GERD.
Not only do some medications weaken the LES, but some medications and outside factors can aggravate the already-irritated esophageal lining.
Medications for GERD
There are some medications that are known to weaken or relax the LES.
Many of these act as muscle relaxants, and can cause the wrong muscles to relax, such as the LES.
These medications include:
- Calcium channel blockers
- Anticholinergics (used to treat urinary tract disorders, allergies, and glaucoma)
- Beta adrenergic agonists (used to treat asthma and obstructive lung diseases)
- Dopamine agonists (used to treat Parkinson’s)
- Antidepressants
- Sedatives
- Narcotics
There are also medications that irritate the esophageal lining, such as:
- NSAIDs, such as ibuprofen and naproxen (Aleve)
- Potassium
- Iron pills
- Bisphosphonates (used to treat osteoporosis)
- Antibiotics
Risk Factors for GERD
There are many risk factors for heartburn and GERD.
Many of them necessitate the regular consumption of medications listed above.
- Eating pattern: People who eat heavy meals and then lie on their back or go to bed are at risk for heartburn and acid reflux.
- Pregnancy: Symptoms of GERD are often unavoidable during the third trimester, then the growing uterus puts pressure on the stomach and forces acids and partially digested food back up through the LES.
- Obesity
- Respiratory Disorders: People with asthma and COPD have a high risk of GERD. This is due not only to the medications which they must take to control their symptoms, but also due to the chronic irritation that these disorders inflict on the esophagus..
- Smoking: Studies have shown that smoking reduces LES muscle function, increases acid secretion, impairs muscle reflexes in the throat, and damages protective mucus membranes. Smoking also reduces salivation, which helps neutralize acid.
- Alcohol Use: There are mixed opinions on this particular risk factor. Alcohol is known to relax the LES muscles and, in high amounts, may irritate the lining of the esophagus. Other studies, however, have shown some types of alcohol, such as wine, to actually protect the lining of the esophagus.
Certain health conditions like a hiatal hernia can also cause GERD.
It’s important to always consult a doctor if you are experienced recurrent epigastric distress, discomfort in the digestive system, IBS, or other symptom combinations.
Doing so is an important part in seeking VA disability GERD benefits.
These regulations only apply to functional gastrointestinal disorders, which involve abnormal functions of an organ in the gastrointestinal tract, without a structural alteration in the tissues (such as irritable bowel syndrome).
GERD is not considered a functional gastrointestinal disorder; rather, it is considered a structural gastrointestinal disorder.
On top of it all, there is not even a rating schedule for GERD in the VA rulebook.
So, the typical percent evaluation VA rating system and diagnostic code may not apply in your disability compensation case. You would also have to watch out for potential “pyramiding.”
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Get a Free Case EvaluationDirect Service Connection for GERD
In order to show a direct service connection for GERD, you will need to gather medical evidence and show severe impairment of health in your medical records.
If you were diagnosed with GERD while on Active Duty, and if a medical expert provides a favorable opinion that your GERD condition began during and has continued since service, you can obtain service connection on a direct basis.
Secondary Service Connection for GERD
GERD, or gastroesophageal reflux disease, can significantly impact a person’s health beyond the immediate symptoms of heartburn and acid reflux.
It has the potential to lead to or exacerbate several secondary conditions, making its management crucial.
Here’s a concise list of some common secondary conditions associated with GERD:
- Esophagitis: Inflammation of the esophagus caused by acid repeatedly flowing back into the esophagus from the stomach.
- Barrett’s Esophagus: A condition where the esophageal lining changes, potentially leading to esophageal cancer, due to chronic acid exposure.
- Asthma: GERD can worsen asthma symptoms due to aspirated acid irritating the airways.
- Dental Erosion: Acid from the stomach can damage tooth enamel, leading to tooth decay and sensitivity.
- Laryngitis: Inflammation of the voice box from stomach acid reflux into the throat, causing hoarseness and other voice issues.
- Sleep Disturbances: Nighttime reflux can lead to sleep disruption and conditions like insomnia.
- COPD (Chronic Obstructive Pulmonary Disease): Though primarily caused by smoking and environmental factors, GERD can exacerbate COPD symptoms. The reflux of stomach acid into the airways can lead to increased irritation, inflammation, and infections, aggravating respiratory conditions.
Managing GERD effectively is key to preventing or mitigating these secondary conditions, highlighting the importance of appropriate treatment and lifestyle adjustments.
