Hiatal Hernia VA Disability Rating: Criteria, Evidence & Pay

What is a hiatal hernia and how does it affect veterans?

A hiatal hernia occurs when part of the stomach pushes upward through the hiatus — the opening in the diaphragm where the esophagus passes through to connect to the stomach. Normally, the diaphragm helps keep stomach acid from flowing into the esophagus. When the stomach protrudes through this opening, the anti-reflux mechanism is compromised, allowing acid and partially digested food to flow back into the esophagus and causing the hallmark symptoms of heartburn, regurgitation, chest pain, and difficulty swallowing.

Veterans develop hiatal hernias at elevated rates because of the physical demands of military service. Repeatedly carrying heavy loads — rucksacks weighing 80 to 100+ pounds — increases intra-abdominal pressure, which can force the stomach through the diaphragmatic opening over time. Strenuous physical training, combat activities involving heavy lifting and straining, and chronic coughing from respiratory conditions all increase the risk. Additionally, the stress of military service and combat increases stomach acid production, worsening symptoms.

A hiatal hernia significantly affects daily quality of life. Eating becomes a source of discomfort rather than enjoyment — certain foods trigger severe heartburn and regurgitation, large meals are impossible, and eating too close to bedtime causes nighttime reflux that disrupts sleep. Veterans with hiatal hernia often experience persistent chest pain that can mimic cardiac symptoms, difficulty swallowing food and liquids, nausea and vomiting, and gradual weight loss from avoiding meals. In severe cases, chronic bleeding from esophageal erosion leads to anemia and fatigue.

VA diagnostic code for hiatal hernia

Hiatal hernia is rated under Diagnostic Code (DC) 7346 per 38 CFR § 4.114, Schedule of Ratings — Digestive System.

DC 7346 specifically covers hiatal hernia, and it is the same code used to rate GERD and other esophageal reflux conditions. Effective May 19, 2024, the VA updated the rating criteria for DC 7346 to align with esophageal stricture criteria (DC 7203), replacing the old four-level scale (0/10/30/60%) with a new five-level scale (0/10/30/50/80%).

Rating criteria for hiatal hernia

The VA assigns hiatal hernia ratings at five possible levels under the updated criteria effective May 19, 2024:

0% rating

Criteria: The condition is diagnosed and service-connected but symptoms are mild and do not meet the criteria for a 10% rating.

Monthly payment: $0 (but establishes service connection for future increases and secondary claims)

10% rating — $180.42/month

Criteria: Moderate esophageal stricture — difficulty swallowing with some impairment of general health.

What this looks like: You experience recurring difficulty swallowing certain foods, along with heartburn and regurgitation from the hiatal hernia. These symptoms are present and documented, causing some impact on your general health. You manage with medications such as proton pump inhibitors and dietary modifications, but the condition still affects your comfort and daily routine.

30% rating — $552.47/month

Criteria: Moderately severe esophageal stricture — significant difficulty swallowing with considerable impairment of general health.

What this looks like: You have significant difficulty swallowing that goes beyond occasional discomfort. Food frequently gets stuck or passes slowly, heartburn is persistent despite treatment, and regurgitation is regular. Together, these symptoms considerably impair your health — you have difficulty eating normally, your sleep is regularly disrupted by reflux, you may be losing weight, and your daily functioning is significantly affected.

50% rating — $1,132.90/month

Criteria: Severe esophageal stricture — permitting liquids only, with marked impairment of general health.

What this looks like: Your hiatal hernia and resulting esophageal damage are severe enough that you can only tolerate liquids or very soft foods. Swallowing solid food is extremely difficult or painful. You have marked impairment of your general health, including significant weight loss, nutritional deficiencies, and substantial limitations on daily functioning.

80% rating — $2,102.15/month

Criteria: Esophageal stricture permitting passage of liquids only, with marked impairment of general health.

What this looks like: Your condition is at its most severe level. You are limited to liquids only, with severe weight loss, malnutrition, and profound impact on your overall health. You may require supplemental nutrition or medical intervention to maintain adequate caloric intake. Daily functioning is substantially impaired by the inability to eat solid food.

What evidence do you need?

Service records

• Service treatment records showing GI complaints, heartburn, acid reflux, or abdominal pain during service
• Records documenting physical demands (heavy lifting, pack weights, physical training)
• Deployment and duty records showing strenuous physical requirements
• Records of any GI medications prescribed during service
• If claiming secondary: complete records for the primary service-connected condition

Medical evidence

• Current diagnosis of hiatal hernia from a gastroenterologist or primary care physician
• Upper GI series (barium swallow) — The primary imaging test that visualizes the hiatal hernia by showing the stomach protruding through the diaphragm
• Upper endoscopy (EGD) — Shows the hernia directly and documents any esophageal damage, erosion, Barrett’s esophagus, or bleeding
• Treatment records showing ongoing symptoms and medication management
• Prescription records for PPIs (proton pump inhibitors), H2 blockers, antacids, and other GI medications
• Weight records — Documentation of weight changes over time if you have lost weight due to the condition
• Lab results — Complete blood count showing anemia if applicable; stool tests if melena is suspected
• Records of any surgical interventions (Nissen fundoplication, hiatal hernia repair)

Nexus letter

A medical opinion connecting your hiatal hernia to service. The nexus letter should explain how the physical demands of military service — heavy lifting, carrying heavy loads, strenuous physical training — contributed to the development of the hiatal hernia by chronically increasing intra-abdominal pressure. If claiming as secondary to a condition that causes chronic coughing or vomiting, the nexus should explain that mechanism. Cite relevant medical literature supporting the connection.

Buddy statements

Statements from fellow service members who can describe the heavy physical demands during service (pack weights, lifting requirements). Statements from family members who have witnessed your symptoms — difficulty eating, regurgitation episodes, visible weight loss, disrupted sleep from reflux, dietary restrictions, frequent medication use, and how the condition affects your daily life and social activities.

Personal statement

Describe the physical demands of your military service, when GI symptoms began, how the condition has progressed, and how the hiatal hernia affects your daily life. Detail which foods you can no longer eat, how meals are limited, sleep disruption from nighttime reflux, pain episodes, any weight loss, and how the condition limits your ability to enjoy meals and social activities.

C&P exam tips for hiatal hernia

What the examiner evaluates

• Confirmation of hiatal hernia diagnosis
• Presence and severity of specific symptoms: dysphagia, pyrosis, regurgitation, pain, vomiting
• Evidence of weight loss and nutritional impact
• Evidence of GI bleeding (hematemesis, melena) and anemia
• Current treatment regimen and its effectiveness
• Overall impact on health
• If claiming secondary: the connection to the primary condition

How to prepare

1. Bring imaging and endoscopy results. Upper GI series and endoscopy results that show the hiatal hernia provide objective evidence of the structural problem. If you have had these tests, bring copies.
2. Document all qualifying symptoms. The updated rating criteria focus on the severity of esophageal stricture and swallowing difficulty. Before the exam, write down all symptoms you experience — dysphagia, pyrosis, regurgitation, pain, vomiting, weight loss — and how frequently they occur.
3. Track your weight. If you have lost weight because of difficulty eating, document the weight change with medical records or weigh-in logs. Weight loss and nutritional impact are important for higher ratings.
4. Bring lab results showing anemia. If you have anemia from chronic GI bleeding, bring complete blood count results. This evidence supports higher ratings by documenting overall health impairment.
5. Describe the impact on eating. Explain what you can and cannot eat, how much you eat compared to before the condition developed, how often you vomit or regurgitate, and how meals are limited by pain and discomfort. The examiner needs to understand the “considerable impairment of health” that the 30% rating requires.

Common mistakes

• Not having imaging evidence confirming the hiatal hernia
• Underreporting symptoms because you have adapted your diet and lifestyle to avoid triggers
• Not tracking weight changes over time
• Not documenting the severity of swallowing difficulties, which is central to the updated rating criteria
• Not distinguishing hiatal hernia symptoms from cardiac symptoms (chest pain from reflux vs. cardiac chest pain)
• Not bringing a list of all dietary restrictions and foods you can no longer eat
• Failing to explain how the condition has worsened over time, including any progression in symptom severity

Common secondary conditions linked to hiatal hernia

Hiatal hernia is often connected to other conditions that can increase your overall combined rating:

• Depression — Chronic pain, dietary restrictions, social limitations from GI symptoms, and reduced quality of life from a hiatal hernia contribute to depression. The impact of chronic digestive disorders on mental health is well-documented.
• Sleep apnea — Hiatal hernia and reflux disrupt sleep, and there is a bidirectional relationship between reflux and sleep-disordered breathing. The negative intrathoracic pressure from sleep apnea can worsen reflux, and the hernia’s disruption of the diaphragm may contribute to airway issues.
• Anxiety — The unpredictability of symptoms, the fear of eating, and the social limitations caused by a hiatal hernia contribute to anxiety. Chronic pain and discomfort are well-established anxiety triggers.
• Esophageal conditions — Chronic acid exposure from the hernia can lead to Barrett’s esophagus, esophageal stricture, and other complications that may be separately ratable.
• Dental erosion — Chronic regurgitation of stomach acid damages tooth enamel, which can be claimed as a dental condition.
• GERD — A hiatal hernia directly causes or worsens GERD by compromising the lower esophageal sphincter. While both are rated under DC 7346 and cannot be separately rated, the conditions are medically interrelated and documentation of both strengthens the overall claim.

Standalone rating amounts for hiatal hernia

For reference, here are the 2026 monthly payment amounts for hiatal hernia at each rating level (veteran with no dependents):

These amounts increase with dependents (spouse, children, dependent parents).

How to calculate your monthly payment

Your total VA disability payment depends on your combined rating across all service-connected conditions. Hiatal hernia at 30% combined with PTSD, sleep apnea, and other conditions can produce a significantly higher combined rating.

Use our VA disability calculator to:

• Calculate your combined rating with multiple conditions
• Understand how VA math combines ratings
• Estimate your monthly payment including dependents

For the full breakdown of payment amounts at every rating level, see our 2026 VA disability pay rates page.

Disclaimer: This content is for informational purposes only and does not constitute legal or medical advice. For personalized guidance on your VA disability claim, consult a VA-accredited Veterans Service Organization (VSO), attorney, or claims agent. You can find accredited representatives at VA.gov.