VA Rating for GERD Secondary to PTSD: How to Prove Service Connection

Gastroesophageal reflux disease (GERD) is one of the most common digestive-related conditions veterans experience after their service. The chronic stress, anxiety, and physiological changes associated with post-traumatic stress disorder (PTSD) can have a direct impact on the digestive system, causing or exacerbating acid reflux and other GERD-related symptoms. This condition can be debilitating and significantly affect a veteran’s quality of life. PTSD not only alters mental health but also has physical consequences, such as increasing stomach acid production, which in turn triggers GERD.

For veterans who developed GERD as a result of PTSD or its treatment, filing for VA disability benefits may be an essential step toward securing financial compensation and receiving the care needed. This guide will break down the VA’s process for rating GERD secondary to PTSD, how to prove service connection, and the importance of obtaining strong medical evidence, particularly a well-supported nexus letter, to strengthen your claim.

GERD in Veterans

GERD is a chronic digestive condition that occurs when stomach acid frequently flows back into the esophagus, causing symptoms like heartburn, regurgitation, chest pain, and difficulty swallowing. Veterans are particularly susceptible to GERD due to several service-related factors, including:

• Exposure to Toxic Substances: Gulf War veterans, for example, may have been exposed to chemical warfare agents, pesticides, and other toxins that can cause chronic gastrointestinal (GI) issues.
• Increased Intestinal Permeability (Leaky Gut): Research indicates that veterans suffering from chronic abdominal pain or diarrhea may develop leaky gut, which exacerbates GI problems.
• Changes in Gut Microbiome: Deployment-related infections and stress can alter gut bacteria, increasing the risk of GI diseases like GERD.
• Acute Enteric Infections: Food or waterborne pathogens encountered during deployment may lead to long-term GI complications.
• Chronic Stress and PTSD: Ongoing stress, anxiety, and PTSD symptoms can disrupt digestive functions, leading to acid reflux and GERD.
• Medication Side Effects: Common medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and PTSD treatments can irritate the digestive system, making GERD symptoms worse.

“For veterans, the combination of PTSD and potential service-related exposures makes them more vulnerable to GERD,” says Dr. David Green, a gastroenterologist specializing in veterans’ health. “This is why it’s critical to consider GERD as a secondary condition when evaluating PTSD-related claims.”

The Link Between GERD and PTSD

PTSD is known to have a profound impact on the body’s physiological functions, including the digestive system. Stress and anxiety associated with PTSD trigger the release of stress hormones, which can increase stomach acid production, ultimately leading to GERD symptoms like heartburn, regurgitation, and chest pain. Additionally, medications commonly prescribed to treat PTSD, such as SSRIs (selective serotonin reuptake inhibitors) and other antidepressants, can exacerbate GERD by relaxing the lower esophageal sphincter, which normally prevents stomach acid from rising into the esophagus.

A 2013 study of over 1,100 Iraq and Afghanistan veterans revealed that those who screened positive for PTSD or depression were significantly more likely to report GI symptoms, including GERD. Specifically, 73% of veterans who experienced GI issues also screened positive for PTSD, highlighting the strong connection between mental health conditions and digestive disorders.

“It’s not surprising that PTSD can manifest physically, including in the digestive system,” says Dr. Sarah Reynolds, a clinical psychologist who specializes in trauma and stress-related disorders. “The body’s response to chronic stress can create lasting disruptions, contributing to conditions like GERD.”

VA Rating for GERD Secondary to PTSD

The VA rates GERD under Diagnostic Code (DC) 7206, with ratings ranging from 0% to 80%, depending on the severity of the symptoms and the type of treatment required. The rating is determined by factors such as the need for medication, esophageal dilatations, and the presence of complications like weight loss or aspiration.

GERD VA Rating Chart:

Condition	VA Rating
Recurrent or refractory esophageal stricture causing dysphagia with aspiration, undernutrition, or substantial weight loss, treated with surgery or PEG tube	80%
Recurrent esophageal stricture causing dysphagia requiring three or more dilatations per year, or esophageal stent placement	50%
Recurrent esophageal stricture causing dysphagia requiring dilatation two or fewer times per year	30%
Esophageal stricture requiring daily medication to control dysphagia	10%
No symptoms or requirement for daily medication	0%

The VA uses diagnostic imaging, such as a barium swallow, esophagogastroduodenoscopy (EGD), or CT scan, to assess the severity of GERD and determine the appropriate rating.

Proving Service Connection for Secondary Conditions

To establish service connection for GERD secondary to PTSD, you must provide medical evidence showing that your GERD is related to your service-connected PTSD. There are two key elements for proving secondary service connection:

1. Current Diagnosis: You need documentation from a healthcare provider confirming your diagnosis of GERD.
2. Medical Nexus: You must show that your GERD is “at least as likely as not” caused or aggravated by your service-connected PTSD. This is where a nexus letter becomes crucial.

How to File a VA Claim for GERD Secondary to PTSD?

To file a claim for GERD secondary to PTSD, you must submit your VA claim through one of the following methods:

• Online via the VA website.
• By mail by completing and sending the VA Form 21-526EZ.
• Via fax by submitting the completed claim form.
• In person at your local VA regional office.

Be sure to include all relevant medical records, including a current diagnosis of GERD and any evidence linking it to your PTSD.

The Importance of a Nexus Letter

A nexus letter is a formal opinion from a qualified healthcare provider that links your GERD directly to your PTSD or its treatments. This letter provides the critical “medical nexus” that the VA requires to approve your claim for secondary service connection.

A strong nexus letter should:

• Be written by a qualified healthcare provider, such as a gastroenterologist or a mental health professional familiar with PTSD.
• Explain the medical rationale connecting your GERD to your service-connected PTSD, citing relevant studies and medical literature.
• Include a detailed discussion of your symptoms and medical history, especially how PTSD and its treatments have contributed to or worsened your GERD.
• Address the “at least as likely as not” standard, meaning there is a 50% or greater probability that PTSD caused or aggravated your GERD.

“A strong nexus letter is one of the most crucial pieces of evidence for veterans seeking secondary service connection,” says attorney Michael Turner, who specializes in VA disability claims. “Without it, even a well-documented diagnosis of GERD may not be enough to secure approval for a disability rating.”

Final Thought

GERD secondary to PTSD is a prevalent issue among veterans, with the combination of chronic stress, medications, and service-related exposures contributing to acid reflux and digestive problems. By obtaining a current GERD diagnosis, gathering supporting medical evidence, and submitting a strong nexus letter, you can build a solid claim and potentially receive the compensation you deserve.

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