Among gastrointestinal disorders, gastroesophageal reflux disease (GERD) is a very common condition that is associated with heartburn. In fact, according to the National Institute of Diabetes and Kidney Digestive Disease, approximately sixty million people experience heartburn at least once a month, and twenty-five million experience the symptoms daily. The purpose of this post is to explain what GERD is and how you can obtain service-connection from the VA for this condition.
What exactly is GERD?
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.
Symptoms of GERD include:
- Pain in chest or upper abdomen
- Difficulty swallowing or painful swallowing
- Respiratory problems
How does GERD occur?
The esophagus, commonly called the food pipe, is a narrow muscular tube that is about 9.5 inches long. It connects the back of the mouth with the stomach. When you swallow food, muscles in the esophagus move the food toward the stomach. At the base of the esophagus is a band of muscle, called the lower esophageal sphincter (LES), which opens and closes to allow food and liquids to pass into the stomach. Except for belching, this is the only time that the LES is supposed to open. Once food and liquids have passed safely into the stomach, the acids and enzymes in the stomach begin to break down the starch, protein and fat in the food. While the stomach has a lining tough enough to withstand the acid, the esophagus does not.
What happens in cases of GERD is the LES opens when it is not supposed to—namely after the enzymes and acids have started working on the contents of the stomach. When this occurs, gastric acid and partially digested food flow back up into the esophagus. The lining in the esophagus, as mentioned before, is not thick enough to withstand acid, and this causes the burning sensation in the chest and throat. In its normal, healthy state, the LES opens and closes when it is supposed to. However, if the muscle weakens, it may not be able to close completely after swallowing, and therefore may allow gastric acid and partially digested food to escape the stomach.
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 also some medications and outside factors can aggravate the already-irritated esophageal lining.
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)
There are also medications that irritate the esophageal lining, such as:
- NSAIDs, such as ibuprofen and naproxen (Aleve)
- Iron pills
- Bisphosphonates (used to treat osteoporosis)
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
- 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.
- 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.
What does this mean for your VA case?
GERD is one of those interesting and rather inexplicable exceptions to the VA rules. For example, the VA’s regulations on presumptive Persian Gulf War conditions (conditions which are automatically considered service-connected if you meet the qualifying criteria) include gastrointestinal disorders. However, there is a caveat to this. 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.
One can argue that this does not make any sense. But while this particular regulation does make it harder to obtain service-connection for GERD, there are ways to get around this.
Direct Service Connection
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
Service connection can be granted on a secondary basis if a medical expert can provide a favorable opinion that one condition was developed secondarily to a condition that has already been service-connected. In this particular case, we mentioned respiratory conditions as being a risk factor for GERD. Say, for example, the VA has service-connected you for COPD. Over time, you developed GERD due to chronic irritation of the esophagus and due to the effects of the medications that help control your COPD. You can file a claim for GERD secondary to COPD. However, you will need a doctor or medical practitioner’s opinion that your COPD condition caused or aggravated GERD.