38 CFR Part 4 — 38 CFR § 4.114
Hiatal hernia and paraesophageal hernia — VA Diagnostic Code 7346
Digestive
Diagnostic code
7346
38 CFR § 4.114 lists Diagnostic Code 7346 as “Hiatal hernia and paraesophageal hernia” and says: “Rate as esophagus, stricture of (DC 7203).” DC 7346 does not print its own percentages. Gastroesophageal reflux disease is a different code, DC 7206. VA’s Fiscal Year 2024 Annual Benefits Report lists “Hiatal hernia” among digestive disabilities of all compensation recipients (530,859). The report is on [benefits.va.gov](https://www.benefits.va.gov/REPORTS/abr/docs/2024-abr.pdf).
Reviewed 2026-10-03. Text checked against eCFR on 2026-10-05; Title 38 last amended 2026-08-27. On that date the titles list showed Title 38 up to date as of 2026-10-01 (latest issue date 2026-08-27).
The rating criteria at each level
7346 Hiatal hernia and paraesophageal hernia
Rating %: —
Criteria (verbatim). Rate as esophagus, stricture of (DC 7203).
| Rating % | Criteria (verbatim) |
|---|---|
| — | Rate as esophagus, stricture of (DC 7203). |
7203 Esophagus, stricture of — the criteria DC 7346 uses
Rating %: 80
Criteria (verbatim). Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction or percutaneous esophago-gastrointestinal tube (PEG tube)
Rating %: 50
Criteria (verbatim). Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement
Rating %: 30
Criteria (verbatim). Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year
Rating %: 10
Criteria (verbatim). Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic
Rating %: 0
Criteria (verbatim). Documented history without daily symptoms or requirement for daily medications
| Rating % | Criteria (verbatim) |
|---|---|
| 80 | Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction or percutaneous esophago-gastrointestinal tube (PEG tube) |
| 50 | Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement |
| 30 | Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year |
| 10 | Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic |
| 0 | Documented history without daily symptoms or requirement for daily medications |
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 (bleeding at junction of esophagus and stomach due to tears) due to caustic ingestion of alkali or acid; drug-induced or infectious esophagitis due to Candida, virus, or other organism; idiopathic eosinophilic, or lymphocytic esophagitis; esophagitis due to radiation therapy; esophagitis due to peptic stricture; and any esophageal condition that requires treatment with sclerotherapy.
Note (4): Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved.
Note (5): Refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.
Notes (1) through (5) are printed under DC 7203. DC 7346 says to rate as that code.
38 CFR § 4.112(a) says substantial weight loss means involuntary loss greater than 20% of an individual’s baseline weight sustained for three months with diminished quality of self-care or work tasks. The 80 percent line of DC 7203 uses that definition.
The opening paragraph of 38 CFR § 4.114 says: “Do not combine ratings under diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive, with each other. Instead, when more than one rating is warranted under those diagnostic codes, assign a single evaluation under the diagnostic code that reflects the predominant disability picture, and elevate it to the next higher evaluation if warranted by the severity of the overall disability.” DC 7346 is inside 7345 through 7350. DC 7203 is not in that list.
Source: 38 CFR § 4.114, Diagnostic Codes 7346 and 7203, eCFR full-text XML for 2026-08-27. Prevalence count: VBA Annual Benefits Report, Fiscal Year 2024.
What the words mean in your records
Rate as DC 7203
That is the entire DC 7346 instruction. The percentages a reader is looking up are the DC 7203 lines.
Dysphagia
The 80, 50, 30, and 10 percent lines of DC 7203 use the word dysphagia. The schedule does not define it in a sentence under this code. Note (1) says findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy.
Recurrent and refractory
Note (4) defines recurrent esophageal stricture as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved. Note (5) defines refractory esophageal stricture as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.
Substantial weight loss
Section 4.112(a) defines it as involuntary loss greater than 20% of baseline weight sustained for three months with diminished quality of self-care or work tasks. Baseline weight is defined in § 4.112(b). Undernutrition is defined in § 4.112(c).
Evidence that speaks to each level
80
What the rater needs to see. Documented history of recurrent or refractory stricture causing dysphagia with aspiration, undernutrition, and/or substantial weight loss as § 4.112(a) defines it, and treatment with either surgical correction or a PEG tube.
Where that usually lives. Barium swallow, CT, or esophagogastroduodenoscopy, plus the treatment record. Note (1) names those three studies.
50
What the rater needs to see. Recurrent or refractory stricture causing dysphagia which requires dilatation 3 or more times per year, dilatation using steroids at least one time per year, or esophageal stent placement.
Where that usually lives. Procedure notes that count dilatations, steroid dilatation, or stent placement.
30
What the rater needs to see. Recurrent stricture causing dysphagia which requires dilatation no more than 2 times per year.
Where that usually lives. The same procedure notes.
10 and 0
What the rater needs to see. The 10 percent line is a documented history of stricture that requires daily medications to control dysphagia otherwise asymptomatic. The 0 percent line is a documented history without daily symptoms or requirement for daily medications.
Where that usually lives. The medication list and the symptom history, with the imaging or endoscopy Note (1) requires.
VA’s public DBQ list, checked October 3, 2026, names “Esophageal Disorders” and, separately, “Hernias (Including Abdominal, Inguinal and Femoral Hernias).” This page does not choose which form a clinician uses. DC 7346’s rating instruction points at esophageal stricture.
The exam form
The studies named in DC 7203 Note (1) are barium swallow, computerized tomography, or esophagogastroduodenoscopy.
The GERD guide on this site is Diagnostic Code 7206, not DC 7346. The DBQ index is DBQ guides.
Related codes and how they interact
Codes that also say “rate as DC 7203,” and GERD
DC 7203 is the stricture code quoted above.
DC 7204, esophageal motility disorder, says rate as DC 7203. Its note names achalasia, diffuse esophageal spasm, and other motor disorders.
DC 7205, acquired diverticulum of the esophagus, says rate as DC 7203.
DC 7206 is “Gastroesophageal reflux disease.” It prints its own 80, 50, 30, 10, and 0 percent lines. The 80 percent line requires surgical correction of esophageal stricture(s) or a PEG tube. The DC 7203 80 percent line says “surgical correction” without those extra words. The public page is the GERD guide.
Secondary conditions and presumptions
DC 7346 does not name a secondary condition. 38 CFR § 3.309 does not name hiatal hernia or paraesophageal hernia. A secondary question is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers aggravation and requires a medical baseline.
Short answers
What is the VA rating for hiatal hernia under DC 7346?
DC 7346 says to rate it as esophageal stricture under DC 7203. The DC 7203 lines are 80, 50, 30, 10, and 0 percent. Findings must be documented by barium swallow, CT, or esophagogastroduodenoscopy. Education only. VA decides on the evidence.
What is substantial weight loss in the 80 percent line?
Section 4.112(a) says substantial weight loss means involuntary loss greater than 20% of baseline weight sustained for three months with diminished quality of self-care or work tasks. The 80 percent line also requires aspiration, undernutrition, and/or that weight loss, plus surgical correction or a PEG tube.
FAQ
How does VA rate a hiatal hernia under DC 7346?
38 CFR § 4.114 says to rate hiatal hernia and paraesophageal hernia as esophageal stricture, DC 7203. That code prints 80, 50, 30, 10, and 0 percent, based on documented stricture, dysphagia, and the treatment in each line. Education only.
Is GERD the same code?
No. The current schedule lists gastroesophageal reflux disease as DC 7206, with its own percentage lines. DC 7346 is hiatal hernia and paraesophageal hernia, rated as DC 7203.
What records does the 7203 note require?
Note (1) says findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. Notes (4) and (5) define recurrent and refractory stricture.
Where does the 530,859 figure come from?
The Fiscal Year 2024 Annual Benefits Report lists “Hiatal hernia” with 530,859 among digestive disabilities of all compensation recipients. That count is not a rating.
Next steps
- Read the decision for DC 7346 or DC 7203, the study named in Note (1), and the dilatation or surgery dates.
- The free worksheet is a place to write the code, the measurements, and the records you already have. It does not file a claim or protect a filing date. C&P prep (Founding Pass) is a separate worksheet. An accredited representative is at find a VSO.
- Other digestive codes are on the digestive diagnostic-code index. GERD is the GERD guide.
Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.
Other codes in this body system
Nearby catalog entries in Digestive, ordered by diagnostic code number. All Digestive codes
- DC 7335Ano, fistula in, including anorectal fistula, anorectal abscess
- DC 7336Hemorrhoids, external or internal
- DC 7337Pruritus ani (anal itching)
- DC 7338Hernia, including femoral, inguinal, umbilical, ventral, incisional, and other (but not including hiatal)
- DC 7342Visceroptosis
- DC 7343Neoplasms, malignant
- DC 7344Benign neoplasms, exclusive of skin growths
- DC 7345Chronic liver disease without cirrhosis
- DC 7347Pancreatitis, chronic
- DC 7348Vagotomy with pyloroplasty or gastroenterostomy
- DC 7350Liver abscess
- DC 7351Liver transplant
- DC 7352Pancreas transplant
- DC 7354Hepatitis C (or non-A, non-B hepatitis)
- DC 7355Celiac disease
- DC 7356Gastrointestinal dysmotility syndrome
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 7346 • va.gov
⚠️ Important Disclaimer
This page provides general educational information based on public VA regulations and VA.gov resources. It is not legal or medical advice, and My Claim Packet is not a VA-accredited representative. Any worksheets or draft documents produced by the tools must be reviewed for accuracy and are not filed with VA for you. Ratings and service connection are decided case-by-case from the individual record. Consult a VA-accredited VSO, claims agent, attorney, or qualified clinician for help with your situation, and verify current rules using the linked official source.