GERD Secondary to PTSD

Overview

Gastroesophageal reflux disease (GERD) is a chronic condition in which stomach contents flow back into the esophagus, causing heartburn, regurgitation, and sometimes inflammation or narrowing (stricture) of the esophagus. Veterans with service-connected PTSD can claim GERD as secondary under 38 CFR § 3.310. There are two routes: PTSD itself, and the medications used to treat it.

Before filing, understand the rating. Since May 19, 2024, GERD has its own code, DC 7206, and compensable ratings require a documented esophageal stricture. Heartburn controlled by medication, without a stricture, is generally service-connected at 0%. That still has value (VA treatment for the condition, and a higher rating later if a stricture develops).

How GERD Is Connected to PTSD

Veteran data. In a study of 1,058 Gulf War era veterans from a VA cohort, GERD was among the most frequently reported GI disorders. Veterans with both Gulf War Illness and PTSD had about twice the odds of self-reported GERD compared with veterans who had Gulf War Illness without PTSD (adjusted odds ratio 2.04) (Malhotra et al., 2023). In Australian Defence Force veterans, those with PTSD were 77% to 81% more likely to undergo upper GI endoscopy or abdominal ultrasound, which reflects more upper-GI complaints (Crawford et al., 2023). These are associations. They support a link but do not prove it in an individual case.

Medication effects. SSRIs and SNRIs are first-line PTSD medications. In a 2025 U.S. health-records study of patients with depression, those who started SSRIs or SNRIs had higher odds of a new GERD diagnosis than propensity-matched patients not taking antidepressants. The association grew with longer use (Saleh & Fass, 2025). This is often the most concrete link for a claim: the drug was prescribed for service-connected PTSD, and reflux began or worsened afterward.

Stress and behavior. Many people with GERD report that stress worsens their symptoms. PTSD can also go along with alcohol use, tobacco, irregular meals, and poor sleep, all of which can worsen reflux. An examiner may treat some of these as independent causes, so the opinion should address them directly.

Evidence Requirements

• Current GERD diagnosis. VA’s Esophageal Conditions DBQ notes that GERD can be diagnosed clinically, by relief of typical symptoms with PPIs, H2 blockers, or antacids. Endoscopy is not required for the diagnosis itself.
• Imaging or endoscopy for any stricture. Under DC 7206 Note (1), findings must be documented by barium swallow, CT, or EGD. Without this, the rating will be 0%.
• Service-connected PTSD. Your rating decision.
• Medication history with the names, doses, and start dates of PTSD medications, and when reflux began or worsened.
• GI treatment records: PPIs, H2 blockers, and any dilatation procedures with dates.
• Medical nexus opinion.
• Symptom log and lay statements describing heartburn, regurgitation, and any trouble swallowing, with frequency.

Nexus Letter Tips

Who should write it. Any qualified clinician: your primary care provider, a gastroenterologist, or the prescriber of your PTSD medication. VA does not require a specialist; what matters is reasoning that fits your records.

Key language. The opinion should state that your GERD is “at least as likely as not” (50% or greater probability) caused or aggravated by your service-connected PTSD or its treatment. That is the standard VA applies under the benefit-of-the-doubt rule (38 U.S.C. 5107(b); 38 CFR 3.102).

What the letter should address:

• Your PTSD diagnosis and treatment history, including medications and dates
• Your GERD diagnosis, onset, and treatment
• The medication timeline, if applicable
• The published association data, described accurately
• Other risk factors (weight, alcohol, tobacco, NSAIDs, hiatal hernia) and why PTSD or its treatment is still at least as likely as not a cause or aggravating factor
• For aggravation: the baseline severity before PTSD or its medications worsened it

Avoid speculative wording (“could possibly be related”) and generic template letters that don’t mention your records.

Rating Criteria for GERD

GERD is rated under Diagnostic Code 7206 (Gastroesophageal reflux disease) in 38 CFR § 4.114, created in the digestive system update effective May 19, 2024. Before then, GERD was rated by analogy to DC 7346 (hiatal hernia), and older decisions and guides still show those criteria. DC 7206 rates GERD on documented esophageal stricture and its treatment, not on heartburn or overall health impact.

• 0%: Documented history without daily symptoms or requirement for daily medications
• 10%: Documented history of esophageal stricture(s) that requires daily medications to control dysphagia, otherwise asymptomatic
• 30%: Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year
• 50%: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of: dilatation 3 or more times per year, dilatation using steroids at least one time per year, or esophageal stent placement
• 80%: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with aspiration, undernutrition, and/or substantial weight loss (as defined by § 4.112(a)), and treatment with either surgical correction of esophageal stricture(s) or a PEG tube

Monthly compensation at 10% (single veteran, no dependents, 2026): $180.42

What this means for your claim: Heartburn and regurgitation support the diagnosis, but a compensable rating depends on a documented stricture. If you have difficulty swallowing, tell your provider. Ask whether an EGD or barium swallow is appropriate, and keep records of every dilatation and of any medication you take daily to control swallowing symptoms. See our GERD rating guide for the full criteria and notes.

Overlap with other ratings: GERD is a digestive disability, separate from the PTSD rating, so rating both does not pyramid. If you also have a hiatal hernia (DC 7346, also rated as esophageal stricture), VA will not compensate the same swallowing problem twice (§ 4.14).

How to File This Secondary Claim

1. Confirm your GERD diagnosis with your primary care provider or a gastroenterologist. Report trouble swallowing specifically.
2. Get the right testing if you have dysphagia. Ask whether an EGD or barium swallow is indicated.
3. Get a nexus opinion connecting your GERD to PTSD or its medications.
4. Gather evidence: GI records, PTSD medication history, procedure reports, and a symptom log.
5. File VA Form 21-526EZ on VA.gov, listing GERD as secondary to service-connected PTSD.
6. Upload your evidence with the claim.
7. Attend the C&P exam.

C&P Exam Tips

Examiners use the Esophageal Conditions DBQ. It asks about dysphagia, whether daily medication is needed to control it, any documented stricture and whether it is recurrent or refractory, dilatations, and related findings.

• Describe your symptoms accurately, including frequency and duration. Cover typical days and flare-ups, and separate heartburn from trouble swallowing (food sticking, needing to drink to get food down).
• Bring your medication list for both GERD and PTSD, with start dates.
• Bring procedure reports, and the dates of any dilatations.
• Explain the timeline: when reflux began relative to your PTSD and any medication changes.
• Mention weight loss or nutrition problems if you have them.

Impact on Combined Rating

Example: A veteran rated 70% for PTSD receives 10% for GERD secondary to PTSD.

Using 38 CFR § 4.25:

1. Start with 70%: 30% of efficiency remains.
2. 10% of the remaining 30 = 3, for a combined value of 73.
3. 73 rounds to 70%.

In this example, the 10% GERD rating alone does not change the combined rating.

Example with an additional condition: A veteran rated 70% for PTSD and 10% for tinnitus adds a 10% GERD rating:

1. 70 and 10 combine to 73; 27 remains.
2. 10% of 27 = 2.7, giving 75.7, which is 76 in the § 4.25 table.
3. 76 rounds to 80%.

Use our VA disability calculator to see how adding GERD would affect your specific combined rating.

For personalized guidance on your VA disability claim, consult a VA-accredited VSO, attorney, or claims agent.