How VA rates GERD
The current DC 7206 focuses on documented esophageal strictures, dysphagia, required treatment, and specified complications. Heartburn or use of an acid-reducing medicine alone does not establish a compensable level under this code. Earlier claim periods may require review of the criteria applicable at that time.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 0% | Documented history without daily symptoms or a requirement for daily medications. |
| 10% | Documented esophageal stricture requiring daily medication to control dysphagia, otherwise asymptomatic. |
| 30% | Documented recurrent esophageal stricture causing dysphagia that requires dilation no more than twice per year. |
| 50% | Documented recurrent or refractory esophageal stricture causing dysphagia, requiring dilation at least three times per year, dilation using steroids at least once per year, OR esophageal stent placement. |
| 80% | Documented recurrent or refractory esophageal stricture causing dysphagia, with aspiration, undernutrition, OR substantial weight loss under section 4.112(a), AND treatment by surgical correction of the stricture or a PEG tube. |
DBQ and symptom topics to review
Review these topics against your own records and symptoms. Do not exaggerate or minimize; describe functional impact accurately.
- Documented history without daily symptoms or a requirement for daily medications.0%Compare the complete criterion with documented findings; not a personal rating.
- Documented esophageal stricture requiring daily medication to control dysphagia, otherwise asymptomatic.10%Compare the complete criterion with documented findings; not a personal rating.
- Documented recurrent esophageal stricture causing dysphagia that requires dilation no more than twice per year.30%Compare the complete criterion with documented findings; not a personal rating.
- Documented recurrent or refractory esophageal stricture causing dysphagia, requiring dilation at least three times per year, dilation using steroids at least once per year, OR esophageal stent placement.50%Compare the complete criterion with documented findings; not a personal rating.
- Documented recurrent or refractory esophageal stricture causing dysphagia, with aspiration, undernutrition, OR substantial weight loss under section 4.112(a), AND treatment by surgical correction of the stricture or a PEG tube.80%Compare the complete criterion with documented findings; not a personal rating.
What may happen in the exam room
- Review of barium swallow, CT, or endoscopy findings.
- Review of swallowing difficulties, treatment, dilation procedures, and complications.
Measurements and findings to understand
- Documented stricture and dysphagia.
- Number of dilations in a year, steroid use during dilation, stent placement, or surgery.
- Documented aspiration, undernutrition, substantial weight loss, or PEG-tube treatment.
Questions the examiner may cover
- What testing confirmed the esophageal findings?
- How often have procedures been required?
- What swallowing difficulties and treatment effects do you experience?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- Describe actual swallowing difficulty and its frequency.
- Use procedure records rather than estimating how often dilation occurred.
Common mistakes to avoid
- Applying the old hiatal-hernia criteria without checking the applicable claim period.
- Treating reflux medication alone as proof of the stricture criterion.
Evidence to organize before the exam
- Endoscopy, imaging, and procedure reports.
- Gastroenterology records and medication list.
- Nutrition and weight records when relevant.
Preparation notes
- Describe symptoms and documented findings without assuming a cause.
- Do not change prescribed medication or diet for the examination without clinician guidance.
Important context
Definitions matter. DC 7206 defines recurrent stricture by inability to maintain target diameter beyond four weeks, and refractory stricture by inability to achieve it despite at least five dilation sessions at two-week intervals. These are clinical findings, not self-assessments.
Official rating source
38 CFR 4.114, DC 7206. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Endoscopy and treatment records can document esophageal complications relevant to current DC 7206 and related esophageal criteria.
Review only with a diagnosed respiratory disability and medical support.
Dental records and individualized clinician reasoning are needed.
Document nighttime reflux as functional impact; it is not a separate disability by default.