GERD (Hiatal Hernia) — VA Disability Rating Criteria (DC 7206)

Diagnostic Code 7206 · 38 CFR §4.114

What Is It?

Gastroesophageal reflux disease has its own diagnostic code. Since 19 May 2024 that code is DC 7206, "Gastroesophageal reflux disease," created when VA rewrote the whole digestive schedule (89 FR 19743, published 20 March 2024, effective 19 May 2024). Before that rewrite GERD had no code of its own and was rated by analogy under DC 7346, hiatal hernia, on a 10/30/60 ladder built around epigastric distress, pyrosis and regurgitation. That ladder is gone. DC 7346 still exists but now reads "Hiatal hernia and paraesophageal hernia: Rate as esophagus, stricture of (DC 7203)," and DC 7206 carries the same five-step criteria that DC 7203 does. The practical consequence is large and it surprises people: the current criteria are keyed almost entirely to documented esophageal stricture, dysphagia, and what treatment the stricture requires — not to how badly the reflux itself burns. A veteran with daily heartburn controlled by a proton pump inhibitor and no documented stricture sits at 10 percent. The tiers above that are earned by dilatation frequency, stent placement, surgical correction, or a feeding tube.

Rating Criteria

Evidence Needed

The criteria are findings-based, so the findings are the claim. DC 7206 Note (1) requires that findings be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy — an EGD report is the single most useful document you can put in the file. Beyond that: every dilatation with its date (the 30, 50 and 80 rows are counted per year), any steroid-assisted dilatation, any stent placement, any surgical correction, and any PEG tube. Your medication list showing a daily acid-suppressing prescription supports the 10 percent row. If you are claiming the 80 percent row, add the aspiration or undernutrition documentation and weight measurements — 38 CFR 4.112(a) defines substantial weight loss as a loss of more than 20 percent of baseline weight sustained for three months or longer, and baseline is the average weight over the two-year period preceding onset.

C&P Exam Tips

Bring the endoscopy and dilatation history with dates and let the examiner copy the count. The examiner is being asked how many dilatations per year, not how uncomfortable the reflux is, so a vivid description of heartburn will not move the rating while a missing procedure date will. Say plainly whether you have ever had a stricture identified, and if so whether it recurred after dilatation — DC 7206 Note (4) defines a recurrent stricture as the inability to maintain the target esophageal diameter beyond four weeks after that diameter has been achieved, and Note (5) defines refractory as the inability to achieve the target diameter despite no fewer than five dilatation sessions at two-week intervals. Those two definitions decide three of the five rows.

How to File

File for GERD under DC 7206. Naming the old code is not fatal — VA rates the disability, not the number you write — but naming 7206 keeps the decision aimed at the criteria that exist. Attach the endoscopy report, the dilatation and procedure history with dates, and your medication list. If a hiatal hernia or paraesophageal hernia was diagnosed, claim it as well: it is DC 7346 and it rates as esophagus, stricture of (DC 7203), which is the same ladder, so it will not be double-counted but it belongs in the record. GERD is frequently secondary to a service-connected condition — to the medication burden of a musculoskeletal or mental-health condition, or to sleep apnea — and a secondary claim needs a nexus opinion tying it to that condition.

Common Mistakes

The commonest mistake now is arguing severity of symptoms rather than documenting stricture and treatment, which is what the current criteria count. The second is relying on an old rating-criteria article: any source that shows GERD at 10/30/60 with "persistently recurrent epigastric distress" is quoting a table that was replaced in May 2024. The third is assuming a 2024 rewrite lowers an existing award — the final rule states it would not disturb evaluations currently in effect, so a rating already assigned under the pre-2024 criteria stays until an actual change in the disability warrants a review. The fourth is dropping the procedure dates: three of the five rows are counted per year, and an undated dilatation history is uncountable.

Frequently Asked Questions

Does GERD have its own VA diagnostic code?

Yes, since 19 May 2024. DC 7206 is "Gastroesophageal reflux disease." Before that date GERD had no code of its own and was rated by analogy under DC 7346, hiatal hernia. If you see GERD described as "rated under the hiatal hernia code," that description is pre-2024.

What happened to the old 10/30/60 hiatal hernia criteria?

They were removed. The pre-2024 DC 7346 table rated epigastric distress, dysphagia, pyrosis and regurgitation at 10, 30 and 60 percent. Current DC 7346 has no percentages at all — it reads "Hiatal hernia and paraesophageal hernia: Rate as esophagus, stricture of (DC 7203)."

Can I get more than 10 percent if my reflux is controlled by medication?

Not on the medication alone. The 10 percent row is exactly "documented history of esophageal stricture(s) that requires daily medications to control dysphagia, otherwise asymptomatic." Everything above 10 requires dilatation, steroid-assisted dilatation, a stent, surgical correction, or a PEG tube.

Is 80 percent really the maximum for GERD?

Eighty percent is the highest row in DC 7206. A higher combined evaluation can still come from separately ratable conditions — aspiration pneumonia, undernutrition sequelae, or a mental-health condition — rated under their own codes and combined under 38 CFR 4.25.

Will my existing GERD rating be reduced because the criteria changed?

The 2024 final rule states it would not disturb evaluations currently in effect. A rating assigned under the old criteria is not re-scored because the schedule changed; a reduction still requires an actual change in the disability, a VA examination, and the due-process steps in 38 CFR 3.105(e).

My GERD started after I was put on medication for a service-connected condition. Can I claim it?

Yes, as a secondary condition. You need a diagnosis, the service-connected primary already established, and a medical opinion linking the reflux to that condition or its treatment. The rating criteria are the same either way.