This post will outline the basics of GERD and how service-connection VA disability benefits may be possible under the VA schedule of ratings, despite the lack of an exact disability rating schedule for this condition from the Department of Veterans Affairs.
Among gastrointestinal disorders, gastroesophageal reflux disease (GERD) is a very common condition that can lead to other secondary conditions, like heartburn or dysphagia.
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.
If you experienced GERD following military service, you may be able to seek VA benefits for your condition and get a VA disability rating for GERD.
Typically speaking, a higher rating is reserved for more severe symptoms and side effects from the primary condition as they try to compensate the veteran.
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:
- Nausea and regurgitation
- Pain in chest or abdominal pain
- Difficulty swallowing or painful swallowing
- Respiratory problems
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, 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 stomach 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 lower esophageal sphincter 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 erosive acid, and this causes the burning sensation in the chest and throat.
This sensation is more commonly called 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)
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)
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.
- 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.”
VA Diagnostic Codes for GERD
GERD specifically is typically rated under Diagnostic Code 7346, which is the rating used for hiatal hernia.
While the VA ratings for GERD may not mimic that of other conditions, that doesn’t mean you can’t obtain veterans benefits for your medical condition. 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.
Since there is not a specific GERD VA Disability rating system, individuals may choose to obtain veterans disability compensation by proving direct or secondary service connection in their VA disability claim.
Direct 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
Service connection can be granted to a secondary disability on the 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 VA claim for GERD secondary to COPD. However, you will need a doctor or health care practitioner’s opinion that your COPD condition caused or aggravated GERD.
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