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View Full Enhanced Guide →38 CFR Part 4 — 38 CFR § 4.114
Hiatal Hernia And Paraesophageal Hernia
dc-7346-hiatal-hernia-and-paraesophageal-hernia
Digestive
Diagnostic code
7346
Why your DC matters: DC 7346 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 7346 — Hiatal Hernia and Paraesophageal Hernia — also covers GERD (gastroesophageal reflux disease) and related esophageal conditions, listed under 38 CFR § 4.114.
GERD and hiatal hernias can be rated at 10%, 30%, or 60% based on symptom severity and persistence despite treatment. Most veterans with GERD receive 10% or 30%.
For a comprehensive guide with visual compensation breakdowns, secondary conditions, evidence strategies, and claim timelines, visit the detailed guide page for this condition.
Exact rating criteria: 10% for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, 30% for persistently recurrent symptoms with two or more of (substrate epigastric distress, dysphagia, pyrosis, regurgitation, nausea, vomiting) with esophagitis confirmed by endoscopy, 60% for symptoms not controlled by medication with two or more of the listed symptoms.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 7346 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 7346 in the subpart for your body system (use Find in Page if needed).
GERD is one of the most successful PTSD secondaries because the medical link (stress, anxiety, PTSD meds) is well-accepted. The trick is getting beyond 10%: the examiner needs to write down a specific cluster of symptoms — pyrosis, regurgitation, dysphagia, and substernal pain — not just 'heartburn.'
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 60% | Symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; OR other symptom combinations productive of severe impairment of health. | EGD/endoscopy findings, weight log showing loss, CBC showing anemia. |
| 30% | Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm/shoulder pain — productive of considerable impairment of health. | GI consult notes documenting the full symptom cluster; PPI Rx history; possibly Barrett's esophagus on biopsy. |
| 10% | Two or more of the 30% symptoms, but of less severity. | Primary care notes mentioning daily reflux + at least one related symptom, continuous PPI use. |
What Qualifies as 'Gastroesophageal Reflux Disease' Under DC 7346?
Documented reflux disorder
Clinical diagnosis (PCP, GI, or VA documentation) of GERD, hiatal hernia, or paraesophageal hernia, typically supported by EGD findings (esophagitis, Barrett's, hiatal hernia) and chronic PPI use.
Symptom cluster severity drives the tier
DC 7346 ladders by symptom combinations. The CFR vocabulary is specific:
- • 10% — two of the 30% symptoms but less severe
- • 30% — persistently recurrent epigastric distress + dysphagia + pyrosis + regurgitation + substernal/arm/shoulder pain (productive of considerable impairment)
- • 60% — pain + vomiting + material weight loss + hematemesis/melena + moderate anemia (productive of severe impairment)
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“Dysphagia, pyrosis, and regurgitation with substernal pain”
Examiners default to 10% if they only document 'heartburn.' This is the full symptom string CFR requires for 30%. If you experience all of these, make sure your DBQ lists each one — not 'GERD symptoms' as a lump.
“Considerable impairment of health”
This is the qualifier CFR uses to gate 30%. Examiner needs to attest the symptoms 'considerably' impair health — sleep disruption, weight loss, dietary restriction all support this.
“Material weight loss with hematemesis or melena”
60% requires actual GI bleeding (vomiting blood or black stools) plus weight loss plus anemia. Not common — but if it applies, ensure CBC and stool studies are in the file.
Evidence Checklist — Specific to This Condition
GI specialist DBQ (Esophageal Conditions)
CRITICALBetter than a PCP DBQ. A gastroenterologist documents the symptom cluster more thoroughly.
EGD / endoscopy report
IMPORTANTObjective finding (esophagitis, Barrett's, hiatal hernia) anchors the diagnosis and supports severity.
Continuous PPI prescription history
CRITICALDaily omeprazole/pantoprazole for years = chronic condition requiring continuous medication.
Nexus letter linking GERD to PTSD or service
CRITICALIf filing as secondary to PTSD, anxiety, or service-connected musculoskeletal NSAID use, get an explicit medical opinion.
Symptom diary
SUPPORTING30 days of meals, symptoms, sleep impact. Helps the examiner check the 'persistently recurrent' box.
C&P Exam Tips
List every symptom by name
Don't say 'heartburn.' Say 'pyrosis, regurgitation into my throat, difficulty swallowing pills and steak, and chest pain that wakes me up.' These are the CFR words.
Bring the symptom diary
Hand the examiner a printed 30-day log. 'Persistently recurrent' is what they need to document for 30% — your diary proves it.
Don't downplay sleep disruption
Nighttime reflux that wakes you up is critical evidence of 'considerable impairment.' If you sleep on a wedge or in a recliner, say so.
Common Mistakes That Cost Veterans Points
Filing as primary when secondary is easier
If you're already rated for PTSD, anxiety, or MDD, GERD as secondary skips the in-service-onset requirement. Much higher grant rate.
Stopping PPIs before the exam
Some veterans think showing severe symptoms means going off meds. Bad strategy — gaps in treatment = 'improved condition.' Stay on meds; describe symptoms despite treatment.
Not claiming NSAID-related GERD as secondary to MSK
Chronic ibuprofen/naproxen for service-connected back/joint pain causes GERD. This is a well-accepted secondary pathway.
Tactical Plays
⚡ PTSD → GERD is the easy lane
If you're service-connected for any mental health condition, file GERD as secondary. The medical literature on stress-induced reflux is overwhelming; a one-paragraph nexus letter from any PCP typically wins.
⚡ NSAID secondary for MSK veterans
If you're rated for chronic back/knee/shoulder pain and have a long Motrin/Naproxen history, that's textbook NSAID gastropathy → GERD. File secondary to the MSK condition. Pharmacy printout is the proof.
⚡ Push for 30% with the four-symptom cluster
The jump from 10% to 30% triples your monthly comp. Make sure the C&P report mentions pyrosis, regurgitation, dysphagia, and substernal pain — not just 'heartburn.'
Secondary Conditions to File With This One
IBS
MODERATEDC 7319
Both share gut-brain axis dysfunction. Often co-occurs with PTSD-secondary GERD.
Sleep impairment / insomnia (rated under mental health)
MODERATENighttime GERD disrupts sleep; sleep disruption worsens mental health ratings.
Dental erosion
SITUATIONALDC 9913
Chronic acid reflux erodes enamel. Requires dental records documenting the erosion.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Two of the 30% symptoms, but less severe.
30% — single, no dependents
Base rating
$552.47
TOTAL
$552.47/mo
Full symptom cluster with considerable impairment of health.
60% — single, no dependents
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Severe impairment — vomiting + weight loss + GI bleeding + anemia.
30% with spouse + 1 child
Base rating
$552.47
Dependents (spouse + 1 child)
+$114.00
TOTAL
$666.47/mo
Most common GERD tier with family.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
🔥What is 'Pyrosis'?
Medical term for heartburn — burning retrosternal sensation. CFR uses the clinical term, so make sure your DBQ uses 'pyrosis' rather than colloquial 'heartburn.'
🥄What is 'Dysphagia'?
Difficulty swallowing. For DC 7346 30%+ ratings, dysphagia must be documented — often shown by difficulty swallowing pills, large food boluses, or by formal swallow study findings.
🌊What is 'Regurgitation'?
Effortless return of gastric contents into the mouth or throat without nausea or retching. Distinct from vomiting. Document nighttime regurgitation specifically — it's a strong 30% indicator.
⚖️What does 'Considerable Impairment of Health' mean?
The CFR qualifier gating the 30% tier. Sleep disruption, dietary restriction, weight changes, and work absences all support 'considerable impairment.' Without that qualifier documented, you cap at 10%.
How to File Your Claim
File VA Form 21-526EZ listing GERD/hiatal hernia by name
Use the CFR terminology 'gastroesophageal reflux disease (DC 7346)' or 'hiatal hernia (DC 7346)' — not 'acid reflux.' If MDD/PTSD/anxiety is service-connected, claim GERD as secondary to that condition.
Submit GI specialist DBQ (preferred over PCP)
Make sure the DBQ lists pyrosis, regurgitation, dysphagia, AND substernal/arm/shoulder pain by name — not 'GERD symptoms' as a lump. The four-symptom cluster unlocks 30%.
Attach EGD report + continuous PPI prescription history
Endoscopy findings (esophagitis, Barrett's, hiatal hernia) anchor the diagnosis. Pharmacy printout showing years of daily omeprazole/pantoprazole establishes chronicity.
Add a 30-day symptom diary
Daily log of meals, symptoms, sleep disruption. Establishes 'persistently recurrent' for the 30% gate. Helps the examiner check that box rather than reading 'occasional heartburn.'
Nexus letter if filing as secondary to PTSD/MDD/MSK
Short medical opinion from any PCP or GI doc linking GERD to (a) stress-induced acid hypersecretion, (b) chronic NSAID use for service-connected musculoskeletal pain. One paragraph typically suffices.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
DC 7346 vs DC 7206 — verify which schedule applies
VA updated the digestive rating schedule effective May 19, 2024. Claims with effective dates after that may be rated under DC 7206 (esophageal stricture criteria). The displayed rating ladder above is DC 7346. Verify with a VSO.
Don't stop PPIs before the exam
Gaps in treatment read as 'improved condition.' Stay on prescribed meds and describe what symptoms remain DESPITE treatment.
Use the secondary lane if you're already rated for mental health
PTSD → GERD is one of the highest-success secondary pathways in the schedule. A single nexus paragraph usually wins. Don't fight in-service onset if you have an easier path.
Document all four symptoms for 30%
Pyrosis + regurgitation + dysphagia + substernal pain. If your DBQ only mentions 'heartburn,' the rater defaults to 10%. The four-symptom cluster triples your monthly comp.
Related Tools & Resources
Frequently Asked Questions
Is GERD the same as hiatal hernia for VA rating?
Both are rated under DC 7346 with the same tier structure (10/30/60). The diagnosis can be either; the rating depends on symptom severity, not which underlying anatomy is present.
How is GERD rated after the 2024 schedule update?
Effective May 19, 2024, VA may rate GERD claims under DC 7206 (esophageal stricture criteria) which uses different symptom thresholds. Your effective date determines which schedule applies. Both ladders cap at 80% (DC 7206) vs 60% (DC 7346).
Can I file GERD secondary to NSAID use for back pain?
Yes. Chronic ibuprofen, naproxen, and other NSAIDs for service-connected musculoskeletal conditions cause well-documented NSAID gastropathy progressing to GERD. Pharmacy printout + nexus letter from PCP typically wins.
What if my GERD is fully controlled on medication?
Per § 4.126 (which applies broadly), ratings reflect impairment DESPITE treatment. If your symptoms break through, describe those breakthrough symptoms — not how well meds usually work.
Does Barrett's esophagus get a separate rating?
Barrett's itself is rated under DC 7203 (esophagus stricture/dysphagia) or as a complication noted on the GERD rating. Esophageal cancer arising from Barrett's would be rated separately under DC 7343.
Official Regulatory Source
GERD/hiatal hernia is rated under 38 CFR § 4.114, Diagnostic Code 7346 (or DC 7206 for claims with effective dates on/after May 19, 2024).
38 CFR § 4.114 — Digestive System (eCFR) →Both DCs are within § 4.114 — the digestive system schedule.
⚠️ Verify with a VSO
VA updated the digestive rating schedule effective May 19, 2024. Claims with effective dates after that may be rated under DC 7206 (esophageal stricture criteria) instead of DC 7346 — verify which schedule applies to your effective date with a VSO.
Next Steps
If your rating decision lists DC 7346, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
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 only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.