GERD VA Rating in 2026: What the May 2024 Rewrite Actually Requires
Since May 19, 2024, VA rates GERD on one thing: a documented narrowing of the esophagus, called a stricture. Heartburn, regurgitation, and chest pain no longer set the rating, no matter how often they happen.
That means a veteran with daily reflux and no stricture on a barium swallow, CT, or endoscopy will generally be rated 0 percent. Many articles still describe the old symptom-based scale, and some describe the new one wrong. Below is what the regulation says, what it means if you already hold a rating, and how to build a claim under the current rules.
What changed on May 19, 2024
VA rewrote the digestive section of the rating schedule, 38 CFR 4.114, in a final rule published March 20, 2024 (89 FR 19743). The new criteria took effect May 19, 2024.
| Before May 19, 2024 | Since May 19, 2024 | |
|---|---|---|
| Diagnostic code | No GERD code; rated by analogy to hiatal hernia (DC 7346) | Its own code, DC 7206 |
| What set the rating | Symptoms: heartburn (pyrosis), regurgitation, difficulty swallowing, chest or shoulder pain, and their effect on health | A documented esophageal stricture and how it is treated |
| Available ratings | 10%, 30%, 60% | 0%, 10%, 30%, 50%, 80% |
| Proof required | Symptom reports and treatment records | Barium swallow, CT, or upper endoscopy (EGD) showing the stricture |
Hiatal hernia changed the same way. It now points to the esophageal stricture criteria too, so rating GERD “like a hiatal hernia” no longer leads back to the old symptom scale.
The current rating ladder for DC 7206
Every level from 10 to 80 percent starts with the same requirement: a documented esophageal stricture. Imaging or endoscopy must show it.
| Rating | What the regulation requires, in plain language |
|---|---|
| 80% | Recurrent or refractory stricture causing trouble swallowing, with aspiration, undernutrition, or substantial weight loss, treated by surgery on the stricture or a feeding tube (PEG) |
| 50% | Recurrent or refractory stricture causing trouble swallowing that needs dilation 3 or more times a year, steroid dilation at least once a year, or a stent |
| 30% | Recurrent stricture causing trouble swallowing that needs dilation no more than 2 times a year |
| 10% | Documented stricture that needs daily medication to control trouble swallowing, and is otherwise without symptoms |
| 0% | Documented history, without daily symptoms or a need for daily medication |
Two definitions from the regulation matter. A stricture is recurrent when the target diameter can’t be held for more than 4 weeks after it is reached. It is refractory when the target can’t be reached after at least 5 dilations spaced 2 weeks apart.
The mistake most online advice makes
You will read that a daily proton pump inhibitor, such as omeprazole or pantoprazole, is enough for 10 percent under the new code. That is not what the regulation says.
The 10 percent level requires a documented stricture and daily medication to control trouble swallowing. The medication is what separates 10 from 0 percent for someone who already has a stricture. It is not a separate route to 10 percent without one.
The gap is easy to miss. Most GERD is controlled with medication and never produces a stricture. Under the current code, that veteran’s reflux can be service-connected and still be rated 0 percent.
If you already have a GERD rating
A change to the rating schedule does not by itself reduce a rating you already hold. Under 38 U.S.C. 1155, a readjustment of the schedule can’t reduce an existing rating unless your condition has actually improved. A 30 percent rating granted under the old hiatal hernia criteria stays at 30 percent on that basis alone.
Think carefully before filing for an increase. An increase claim is decided under the current code, so a higher rating now requires a documented stricture. The claim also brings a new exam, and any proposed reduction would still need evidence of real improvement. If your reflux has genuinely worsened, the question to ask your doctor is whether testing shows narrowing of the esophagus.
If your claim was pending on May 19, 2024
For a claim that was already open when the rules changed, VA looks at both versions:
- For the period before May 19, 2024, only the old symptom-based criteria can apply.
- From May 19, 2024 on, VA applies whichever version is more favorable to you.
If you were rated under the new code for a claim filed before that date, check the decision. It should show that the old criteria were considered for the earlier period. If they weren’t, that is a legal error you can raise in a Higher-Level Review.
How to build a GERD claim under the current rules
A 0 percent rating is still worth having. It establishes service connection permanently, so a later stricture becomes an increase claim instead of a fight over where the condition came from.
- Pick the route to service connection. GERD is often claimed secondary to something already rated: NSAID use for a service-connected pain condition, or a service-connected mental health condition and its medications. Name it on the claim form that way, for example “GERD, secondary to NSAID use for service-connected lumbar spine condition.”
- Get a nexus opinion that fits the route. For a secondary claim, the doctor’s opinion should state that GERD is “at least as likely as not caused or aggravated by” the rated condition, and explain why.
- Ask about testing if you have trouble swallowing. Food sticking, choking, or needing to wash food down are the symptoms that can point to a stricture. Only a barium swallow, CT, or upper endoscopy can document one, and without that record no level above 0 percent is available.
- Get every dilation into the record. From 30 percent up, the rating counts dilations per year. Each procedure should appear in your treatment records with its date.
- Make sure the medication’s purpose is written down. At 10 percent, the daily medication has to be for controlling trouble swallowing caused by the stricture.
Denied, or not sure which part of your claim is missing? Chapter 2 of Mastering VA Disability Claims explains the three things every claim must prove, and how to read a denial letter to see which one failed.
Get Chapter 2 freeRelated esophageal conditions
- Hiatal hernia (DC 7346) is now rated using the esophageal stricture criteria, the same ladder as GERD.
- Barrett’s esophagus (DC 7207) has its own code. Without a stricture, it is rated 10 percent with low-grade dysplasia and 30 percent with high-grade dysplasia, both confirmed by pathology. With a stricture, it is rated on the stricture ladder. Barrett’s often develops from long-standing reflux, so it can be claimed secondary to service-connected GERD.
Sources
- 38 CFR 4.114, Schedule of ratings: digestive system (eCFR), current as of September 24, 2026
- Final rule, Schedule for Rating Disabilities: The Digestive System, 89 FR 19743 (March 20, 2024), effective May 19, 2024
- 38 U.S.C. 1155, readjustment of the rating schedule
This article is general information, not legal or medical advice. Rating criteria change; check the current regulation at eCFR.gov before you file. Not affiliated with the U.S. Department of Veterans Affairs.