GERD After the May 2024 Rewrite: Live DC 7206 Criteria

Live DC 7346 still exists. It no longer carries a 0-10-30-60 hiatal-hernia symptom table. It now says: hiatal hernia and paraesophageal hernia, rate as esophagus, stricture of (DC 7203). The live regulation does not tell raters to keep using the old 7346 rows as current law. I am not printing those old rows as if they were.

What changed, and what did not

Before the 2024 digestive overhaul, a lot of GERD claims were analogized to the old hiatal-hernia language: pyrosis, regurgitation, substernal pain, "considerable impairment of health." That vocabulary is still floating around in stale blogs and in some older rating decisions.

Live DC 7206 does not use that vocabulary. It uses:

• Documented esophageal stricture
• Dysphagia
• Dilatation frequency
• Steroid dilatation or stent
• Surgical correction or PEG tube
• Daily medication to control dysphagia
• Aspiration, undernutrition, or substantial weight loss at the top row

If your current decision still quotes the old symptom list, that is your decision, not the current schedule. A future increase will be read against the live code. Read the actual notice.

Live DC 7206 percentages

Fetched from 38 CFR 4.114, DC 7206, eCFR issue date 2026-08-10.

7206 Gastroesophageal reflux disease

Live notes that travel with DC 7206:

• Note (1): Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy.
• Note (2): Non-gastrointestinal complications of procedures should be rated under the appropriate system.
• Note (3): This diagnostic code applies, but is not limited to, esophagitis (mechanical or chemical); Mallory Weiss syndrome due to caustic ingestion; drug-induced or infectious esophagitis; idiopathic eosinophilic or lymphocytic esophagitis; radiation esophagitis; peptic stricture; and any esophageal condition that requires treatment with sclerotherapy.
• Note (4): Recurrent esophageal stricture is the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved.
• Note (5): Refractory esophageal stricture is the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.

DC 7203 (esophagus, stricture of) uses the same percentage rows. Live 7346 simply points hiatal hernia there. If the file is hernia-plus-GERD, the rater still has to follow the 4.114 combination rule.

The 4.114 combination rule

The opening sentence of live 4.114 says not to combine ratings under diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive, with each other. When more than one of those codes is warranted, assign a single evaluation under the code that reflects the predominant disability picture, and elevate it to the next higher evaluation if the overall severity warrants it.

7206 is not in that "do not combine" list. 7346 is (it sits inside 7345 through 7350). The practical point: do not assume GERD, hiatal hernia, gastritis, and IBS all stack as separate percentages. Some of those codes are in the no-combine group. 4.14 still bars rating the same manifestation twice. If the same dysphagia is being used for two esophageal codes, that is pyramiding with extra paperwork.

What "documented" means here

Note (1) is the gate. Barium swallow, CT, or EGD. A primary-care assessment of "GERD, refill omeprazole" does not document a stricture. The 10, 30, 50, and 80 rows all start with a documented history of stricture.

That is the part older veterans find rude. Plenty of people have reflux that wrecks sleep and does not produce a stricture. Under the live table, that presentation is not a 30. It may be a 0 if there are no daily symptoms and no daily medications. It may be a 10 only if there is a documented stricture that requires daily medications to control dysphagia, and the veteran is otherwise asymptomatic.

Read that 10 percent row again. Daily medications to control dysphagia, otherwise asymptomatic. Daily PPI for heartburn, with no stricture and no dysphagia, is not the sentence the schedule wrote.

Weight loss has a definition

The 80 percent row borrows "substantial weight loss" from live 4.112(a): involuntary loss greater than 20 percent of baseline weight, sustained for three months, with diminished quality of self-care or work tasks. Undernutrition is also defined in 4.112(c). These are not "I dropped a few pounds after the spicy wing night" facts.

Aspiration is a clinical finding, not a metaphor for "food comes back up." If the 80 percent row is even in the conversation, the file should have the study, the stricture language, the treatment (surgery or PEG), and one of those three listed problems.

Secondary GERD is possible. It is not a recipe.

GERD can be claimed as secondary to a service-connected condition when the medical evidence shows causation or aggravation (38 CFR 3.310). NSAID use for a service-connected joint, some psychiatric medications, and post-surgical anatomy are the kinds of facts clinicians actually write about. A blog list of "file GERD secondary to X" is not a medical opinion.

I am not going to hand you a secondary flowchart. If a treating clinician connects the reflux to a service-connected disease or its treatment, that opinion is evidence. If the only connection is a forum post, that is not evidence.

Evidence that belongs in the file

• EGD, barium swallow, or CT that actually uses the word stricture, or the equivalent finding.
• Dilatation dates and counts, if you have had them. Three or more in a year is the 50 percent fork. Two or fewer is the 30.
• Medication list tied to dysphagia, not just to "reflux."
• Weight records if undernutrition or substantial weight loss is claimed. 4.112(a) is picky.
• Operative notes or PEG records for the 80 percent treatment clause.
• Your current rating decision, so you can see whether you are still being described under old 7346 language.

A heartburn log is not a stricture study. Know which row you think you are in.

What the C&P actually measures

The esophageal-conditions exam is looking for the live 7206 facts:

• Does a qualifying study document stricture?
• Is there dysphagia, and what does it do to solids, liquids, and daily eating?
• How often has dilatation been required in the past year?
• Steroids during dilatation? Stent? Surgery? PEG?
• Daily medications, and what they are controlling?
• Aspiration, undernutrition, weight change, and the 4.112 definitions?

The examiner is not scoring how dramatic your reflux story is. "It wakes me up at night" is a real symptom. It is not, by itself, a 50. The 50 is recurrent or refractory stricture causing dysphagia that requires dilatation three or more times a year, steroid dilatation at least once a year, or a stent.

If the examiner never had the EGD, the exam cannot invent one. Bring the study.

Quick answers

Is the old 0-10-30-60 hiatal-hernia table still current law?

Not in the live 4.114 text. Live 7346 now points to DC 7203. Live 7206 is the GERD code. I am not printing the old rows as current percentages.

Can I get 30 percent for GERD with only heartburn and regurgitation?

Not under the live 7206 30 percent row. That row requires a documented history of recurrent esophageal stricture causing dysphagia that requires dilatation no more than twice a year.

What study counts?

Note (1): barium swallow, CT, or EGD. That is the live list.

Does a daily PPI automatically mean 10 percent?

Only if the rest of the 10 percent row is true: documented stricture that requires daily medications to control dysphagia, otherwise asymptomatic. Daily PPI for pyrosis without a documented stricture is not that row.

Can GERD be secondary to another rating?

It can be claimed that way if the medical evidence shows causation or aggravation. There is no automatic secondary pairing in DC 7206.

Why does an old website still show 60 percent GERD?

Because it is still quoting the pre-May 19, 2024 hiatal-hernia analog. Live 7206 tops out at 80 and does not have a 60 row.

Sources

• 38 CFR 4.114, DC 7206, 7203, 7346: https://www.ecfr.gov/current/title-38/part-4/section-4.114
• 38 CFR 4.112 (weight loss, undernutrition): https://www.ecfr.gov/current/title-38/part-4/section-4.112
• 38 CFR 4.14 (pyramiding): https://www.ecfr.gov/current/title-38/part-4/section-4.14
• 38 CFR 3.310 (secondary service connection)
• Federal Register, digestive system rewrite, effective May 19, 2024 (89 FR 19743 is the 4.112 companion amendment date in the live text)

Educational content only. Not legal or medical advice. Confirm against the veteran's actual notice and current eCFR / VA.gov. For claim-specific help, use a VA-accredited VSO, claims agent, or attorney.