Stomach & Digestion — VA Disability Ratings

How Stomach & Digestion conditions are rated

The digestive schedule at 38 CFR §4.114 runs from the mouth and esophagus through the stomach, intestines, liver, gallbladder, pancreas, peritoneum, rectum and anus, and it includes hernias and the residuals of digestive surgery. Diagnostic codes run 7200 through 7357.

The rule with the widest reach in this section is the one that limits separate ratings. §4.113 explains why: diseases of the digestive system, particularly within the abdomen, "while differing in the site of pathology, produce a common disability picture" of abdominal distress or pain, anemia, and disturbances in nutrition, so certain coexisting conditions cannot be rated separately without violating the pyramiding rule in §4.14. §4.114 puts that into practice. Ratings under diagnostic codes 7301 through 7329, 7331, 7342, 7345 through 7350, 7352, and 7355 through 7357 are not combined with each other. Instead, the rater assigns "a single evaluation under the diagnostic code that reflects the predominant disability picture," and elevates it to the next higher evaluation "if warranted by the severity of the overall disability." Two conditions in that range do not produce two combined ratings; they produce one rating that may or may not be raised a step. Codes outside the list, such as the mouth and esophagus codes (7200 through 7207), hernias other than hiatal hernia (DC 7338), and malignant neoplasms (DC 7343), are not named in that rule.

Weight and nutrition are defined terms. Under §4.112, "substantial weight loss" means "involuntary loss greater than 20% of an individual's baseline weight sustained for three months with diminished quality of self-care or work tasks," and "minor weight loss" means involuntary loss between 10% and 20%, also sustained for three months. Baseline weight is "the clinically documented average weight for the two-year period preceding the onset of illness" or, if relevant, the weight at your most recent discharge physical. The section also defines undernutrition and the nutritional support methods, total parenteral nutrition and assisted enteral nutrition, that appear in the higher levels of several codes.

Gastroesophageal reflux disease has its own code, DC 7206, and it is rated on documented esophageal stricture. The levels run from 0% for a "documented history without daily symptoms or requirement for daily medications," through 10% when daily medication is needed to control difficulty swallowing and 30% or 50% depending on how often dilatation is required, whether steroids are used, or whether a stent is placed, to 80% with aspiration, undernutrition, or substantial weight loss and surgical correction or a PEG tube. The findings "must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy." Hiatal hernia (DC 7346) is also rated as esophageal stricture under DC 7203. A decision written under earlier criteria may cite different codes, so reading the current text can help before deciding whether to file for an increase.

Irritable bowel syndrome (DC 7319) is rated on how often abdominal pain related to defecation occurred during the previous three months, together with two or more listed symptoms such as a change in stool frequency or form: at least once for 10%, at least three days per month for 20%, and at least one day per week for 30%.

Evidence that tends to matter here: dated weight records, endoscopy and imaging reports, a record of how often symptoms occur rather than only that they occur, and prescription history showing what treatment has been required and for how long.