Do I need a nexus letter for a GERD claim?

Not always. The strongest claims rely on service treatment records, presumptive rules, or a clear C&P opinion. A nexus letter is most useful when the condition was diagnosed after service, when STRs are silent, or when the VA issued a negative C&P opinion. See our nexus letter anatomy at /nexus-letters for the seven sections a strong opinion includes.

What is the C&P exam for GERD actually scoring?

The Disability Benefits Questionnaire (DBQ) for GERD is the structured form the examiner completes. This page explains the sections of the form and the cited rating criteria in plain English. Describe only facts that are true, including how symptoms vary and affect daily activities or work.

Can I file GERD as a secondary condition?

Yes, if you can show the condition was caused or aggravated by an already service-connected disability. Common secondary patterns are documented at /nexus-letters. The opinion needs to address the specific theory (direct, secondary, or aggravation) and the medical mechanism.

What if my GERD claim is denied?

Three appeal lanes open: Higher-Level Review (no new evidence, senior reviewer takes another look), Supplemental Claim (file new evidence, 1-year clock), or Board Appeal (binding decision by a Veterans Law Judge). Pick based on what you have. See /resources/appeals for the full decision tree.

GERD DBQ Field Guide

GERD is rated on a cluster of symptoms, not a single number. There is no goniometer and no audiogram — the rating turns on which combination of symptoms you have and how much they impair your overall health. The VA has long evaluated symptomatic reflux and hiatal hernia under 38 CFR § 4.114, Diagnostic Code 7346, and the rating-criteria terms here are clinical terms most veterans never think to say out loud.

A note on the 2024 digestive update. VA revised the digestive-system rating schedule (effective May 2024), and some esophageal conditions — including certain GERD presentations — are now evaluated under the esophageal stricture code (DC 7206). Many claims still map to DC 7346, and the symptom vocabulary below is what drives the evaluation either way. See the GERD condition guide for how the current schedule applies to your specific diagnosis.

What the examiner is filling out

Diagnosis — GERD, hiatal hernia, esophagitis, Barrett’s esophagus, or stricture.
Symptoms — the checklist: epigastric distress, pyrosis (heartburn), regurgitation, dysphagia (difficulty swallowing), substernal/arm/shoulder pain, nausea, vomiting, sleep disturbance from reflux.
Weight loss / nutrition — material or substantial weight loss, and any anemia.
Impairment of health — whether the symptom combination is productive of considerable or severe impairment of health.
Objective findings — endoscopy (EGD), pH study, imaging, and treatment history.

The DC 7346 schedule

10%Two or more of the 30% symptoms, of less severity

Two or more of the symptoms required for the 30% rating, but at a lower severity. The common entry tier for documented, treated reflux.

30%Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health

The core combination: epigastric distress + dysphagia + pyrosis + regurgitation + radiating pain, 'productive of considerable impairment of health.' This is the tier most well-documented GERD claims target.

60%Pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health

The highest schedular tier for DC 7346. The escalators are objective: material weight loss, vomiting blood (hematemesis) or black stool (melena), and moderate anemia — or any combination productive of 'severe impairment of health.'

How to read the criteria

The schedule is written in medical vocabulary. The examiner ticks boxes that use these exact terms, so use them — in your own words, but hit the concepts:

Use the criteria to understand the form

The rating schedule describes findings VA may consider. It is not a script. Describe only what is true in your own words, including frequency, duration, treatment, good and bad days, and effects on daily activities or work. Do not select or rehearse a rating tier.

The evidence that confirms severity

GERD is one of the conditions where objective records carry real weight:

EGD (upper endoscopy) — documents esophagitis, Barrett’s, stricture, or hiatal hernia size.
Medication list — ongoing PPI/H2-blocker use shows persistent, treatment-requiring disease.
Weight and lab records — documented weight loss and anemia are the 60% escalators.
A symptom log — frequency of reflux, regurgitation, and sleep disruption over recent months.

Persistently recurrent symptoms despite medication is more persuasive than symptoms with no treatment history — it shows the condition is real and resistant.

Describe the full picture accurately

Accuracy reminder

Describe what is true in your own words, including frequency, duration, treatment, good and bad days, and effects on daily activities or work. Do not exaggerate, omit improvement, rehearse a rating tier, or guess. If something varies or you do not know, say that clearly.

GERD is frequently a secondary claim

GERD often arises secondary to a service-connected condition — commonly as a side effect of long-term NSAID use for service-connected musculoskeletal pain, or secondary to a mental-health condition. If that fits you, it is a secondary claim under 38 CFR § 3.310; the DBQ rates severity the same way, and a nexus opinion connects it to the primary condition.

Use this with the rest of the site

▸ GERD condition guide — the full rating schedule, evidence checklist, and tactical plays.
▸ C&P Exam Prep generator — builds a personalized checklist for your specific conditions.
▸ Coach preview — free five-question preview; the dashboard organizes C&P prep and a VSO packet.
▸ Full C&P exam guide — the universal say/don’t-say rules that apply to every exam.

Educational content only. DBQ structures are public knowledge from M21-1 and archived sources; VA discontinued public DBQ distribution in 2020 but the rating criteria these forms map to remain in 38 CFR Part 4. Not legal or medical advice. Always consult a VA-accredited VSO or attorney for claim-specific guidance. CFR citations: 38 CFR § 4.114 Diagnostic Code 7346 (hiatal hernia / symptomatic GERD), DC 7206 (esophageal stricture, used for certain GERD presentations after the 2024 digestive-schedule revision), § 3.310 (secondary service connection). Confirm the current diagnostic code for your specific diagnosis against 38 CFR § 4.114 as revised..