Marginal Ulcer — VA Disability Rating (DC 7304)
Diagnostic Code 7304 · 38 CFR §4.114
What Is It?
DC 7306 no longer exists. VA rewrote the digestive schedule effective May 19, 2024 (89 FR 19743). That rewrite removed DC 7305 and DC 7306 and folded both into DC 7304, retitled "Peptic ulcer disease." VA said so itself in the rulemaking, code by code: the removal "would not, in and of itself, alter existing evaluations or grants of service connection. Rather, VA would modify the individual’s record to reflect the grant of service connection under" the current code. 38 CFR § 3.951(a) says the same thing as a rule of general application — a readjustment to the rating schedule is not grounds for reducing an evaluation already in effect unless medical evidence establishes that the disability has actually improved. The old code still appears in this page’s web address because the address has not changed; the code the page teaches has. A marginal ulcer is a peptic ulcer at the surgical junction where the stomach has been joined to the small intestine — the gastrojejunostomy created in a Billroth II, a gastric bypass, or a partial gastrectomy. The jejunal mucosa was never built to handle gastric acid, so ulceration at the anastomosis is a recognised long-term complication, often appearing years after the surgery and often harder to heal than an ordinary ulcer.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Post-operative for perforation or hemorrhage, for three months. A mandatory VA examination follows the three months and the evaluation is then set on residuals, with any change subject to 38 CFR § 3.105(e). |
| 60% | Continuous abdominal pain with intermittent vomiting, recurrent hematemesis (vomiting blood) or melena (tarry stools); and manifestations of anemia which require hospitalization at least once in the past 12 months. |
| 40% | Episodes of abdominal pain, nausea, or vomiting that last at least three consecutive days, occur four or more times in the past 12 months, and are managed by daily prescribed medication. |
| 20% | Episodes of abdominal pain, nausea, or vomiting that last at least three consecutive days, occur three times or less in the past 12 months, and are managed by daily prescribed medication. |
| 0% | History of peptic ulcer disease documented by endoscopy or diagnostic imaging studies. |
Evidence Needed
An upper endoscopy (EGD) with biopsy from the gastrojejunostomy site is the strongest objective evidence — it confirms the marginal location, documents the size and depth of the ulceration, and rules out malignancy. The operative report from the original gastric or intestinal surgery establishes the anatomical setup that produced the marginal ulcer in the first place. Lab work showing iron-deficiency anemia and positive fecal occult blood supports the higher rating tiers. A symptom log over several months captures the recurrence pattern. Medication records — proton pump inhibitors, H2 blockers, sucralfate, octreotide for refractory cases — show the chronic management burden. Service records or surgical records documenting the in-service abdominal procedure that preceded the ulcer establish the nexus.
C&P Exam Tips
Bring the original operative report, the endoscopy findings, the medication list, and the symptom diary. The rating tiers turn on episode frequency, severity, and systemic impact — be specific about pain pattern, vomiting episodes, bleeding events, weight history, and any hospitalizations. If you have had multiple endoscopies showing recurrent ulceration despite treatment, list each one with dates. Describe how the condition affects your ability to eat normally, hold a job, and maintain weight. Note any transfusions or iron infusions received.
How to File
File VA Form 21-526EZ naming marginal or anastomotic ulcer; the rater assigns DC 7304. Attach the operative report for the original gastric surgery, the endoscopy confirming the ulcer at the anastomosis, and a counted symptom log. Where the original surgery was itself for a service-connected condition, file the marginal ulcer as secondary to it — that nexus is usually cleaner than direct service connection.
Common Mistakes
Filing without the operative report or endoscopy findings, leaving the rater unable to confirm the marginal anatomy Assuming marginal, duodenal and gastric ulcers still carry different rating ceilings — since 19 May 2024 all three are peptic ulcer disease under DC 7304 and share one table Not pursuing the postgastrectomy syndrome secondary claim under DC 7308 when symptoms include dumping or malabsorption Underreporting recurrence frequency, which is the variable that distinguishes the moderate, moderately severe, and severe tiers
Frequently Asked Questions
DC 7306 is on my rating decision and I cannot find it in the regulations.
It was removed effective May 19, 2024 when VA rewrote the digestive schedule. VA stated that the removal "would not, in and of itself, alter existing evaluations or grants of service connection" — your award stands and the record is updated to DC 7304. 38 CFR § 3.951(a) independently bars a reduction on the strength of a schedule change alone.
Old sources show a 100 percent level for marginal ulcer. Does DC 7304 have one?
Yes, but it is a different 100. Under DC 7304 the 100 percent is a three-month post-operative evaluation for perforation or hemorrhage, followed by a mandatory VA examination and then a rating on residuals under 38 CFR § 3.105(e). It is not an open-ended severity tier.
Can I claim dumping syndrome separately?
Postgastrectomy syndrome has its own code, DC 7308. Because § 4.114 bars combining most digestive evaluations with each other, VA generally assigns a single evaluation under the predominant code and elevates it a step where the overall severity warrants, rather than stacking the two.