What is the VA Rating for Hiatal Hernia?

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Effective May 19, 2024, under the new Diagnostic Code (DC) 7346, veterans can get a VA rating for hiatal hernia between 0% and 80% with breaks at 10%, 30%, and 50%.

Your final hiatal hernia VA rating depends on the frequency (how often), severity (how bad), and duration (how long) of symptoms and how those symptoms negatively impact your work, life, and social functioning.

>> Learn more about the VA digestive system rating changes here.  

Summary of Main Points

• Hiatal hernia and paraesophageal hernia are now rated with DC 7346 under CFR Title 38, Part 4, the Schedule for Rating Disabilities. DC 7346 instructs the VA to rate hiatal hernia with the new DC 7203 Esophagus, stricture of with ratings of 0%, 10%, 30%, 50%, and 80%.

• All other types of hernias including femoral, inguinal, umbilical, ventral, incisional, and others are rated under DC 7338 with ratings of 0%, 10%, 20%, 30%, 60%, and 100%.

• If you already have a VA disability rating for hiatal hernia, there will be no change to your current VA rating—you are “grandfathered” in under the old rating criteria.

What is Hiatal Hernia and Paraoesophageal Hernia?

Hiatal Hernia

A hiatal hernia occurs when part of your stomach bulges up through the diaphragm and into the chest cavity.

The diaphragm is a large muscle that separates your abdomen from your chest and helps with breathing by contracting and drawing air into the lungs.

It has a small opening (hiatus) through which the esophagus passes before connecting to the stomach.

In a hiatal hernia, the stomach pushes up through this opening.

There are two main types of hiatal hernias:

• Sliding Hiatal Hernia: This is the most common type. It happens when the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This type of hernia is often associated with gastroesophageal reflux disease (GERD).

• Fixed Hiatal Hernia: Also known as a paraesophageal hernia, this is less common but potentially more serious. In this condition, part of the stomach pushes through the hiatus and stays there, but the esophagus remains in place. It can lead to complications such as the stomach becoming “strangled,” or losing its blood supply.

Paraoesophageal Hernia

The paraesophageal hernia is a specific type of hiatal hernia where the stomach herniates through the diaphragm next to the esophagus but the gastroesophageal junction (where the stomach and esophagus meet) does not.

This type of hernia is less common but can be more problematic because part of the stomach can become trapped or pinched in the diaphragm, leading to a risk of blood supply being cut off to the herniated stomach portion (strangulation).

Unlike sliding hiatal hernias, paraesophageal hernias may not cause symptoms related to acid reflux but can lead to more severe symptoms such as chest pain, difficulty swallowing, and sometimes stomach pain.

What are the Symptoms of Hiatal Hernia and Paraesophageal Hernia?

Both hiatal hernias and paraoesophageal hernias can share some symptoms, but there are also distinct differences in the symptoms they commonly cause due to their different anatomical presentations.

Hiatal Hernia Symptoms

Most commonly associated with sliding hiatal hernias, symptoms can include:

• Heartburn: Often worse when bending over or lying down.

• Regurgitation of food or liquids into the mouth: Particularly common after meals.

• Difficulty swallowing: Foods and liquids may feel like they are stuck in the esophagus.

• Chest or abdominal pain: Can vary in intensity and duration.

• Feeling full quickly after eating: Leading to unintentional weight loss in some cases.

• Belching: More frequent or intense belching than normal.

• Nausea: A feeling of sickness with an inclination to vomit.

Paraoesophageal Hernia Symptoms

Symptoms are often related to the mechanical displacement of the stomach and may include:

• Feeling of fullness or pressure in the chest: Especially after eating.

• Chest pain: Can be mistaken for heart pain (angina).

• Breathlessness: Due to the stomach pressing against the diaphragm, affecting lung capacity.

• Difficulty swallowing: Although this may be less related to acid reflux than in sliding hiatal hernias, it can occur if the hernia affects the esophagus’s position.

• Severe abdominal pain and vomiting: Indicative of a possible emergency if the hernia becomes strangulated or obstructed.

Paraoesophageal hernias may not always produce symptoms until they are quite large or until complications develop.

Thus, they can sometimes be discovered incidentally during investigations for other issues.

In both types of hernias, severe or sudden symptoms, such as sudden chest pain that can feel like a heart attack, require immediate medical evaluation to rule out life-threatening conditions and to address any potential complications of the hernia itself.

Risk Factors and Considerations for Veterans

Veterans might face unique risk factors and considerations for developing conditions like hiatal hernia and paraoesophageal hernia due to various aspects of their service and lifestyle.

Here’s a closer look at some of these factors:

Physical Strain and Injury

• Heavy Lifting and Physical Training: Rigorous physical activity, including heavy lifting and intense training often required during military service, can increase intra-abdominal pressure. This heightened pressure can contribute to the formation of hernias, including hiatal and paraoesophageal hernias.

• Combat-Related Injuries: Injuries sustained in combat or during training can also predispose veterans to hernias. Trauma to the torso might weaken the diaphragm or abdominal muscles, making herniation more likely.

Lifestyle Factors

• Diet: Dietary habits can influence the risk of developing gastroesophageal reflux disease (GERD), which is closely associated with hiatal hernias. Diets high in processed foods, fats, and low in fiber may increase this risk.

• Smoking: Smoking can weaken the connective tissue and may increase the risk of hernias. It also exacerbates GERD symptoms.

Stress and Mental Health

• Psychological Stress: The high levels of stress experienced during military service can lead to increased acid production and changes in gastrointestinal motility, potentially worsening symptoms of any existing hiatal hernia and possibly contributing to its development.

• Mental Health Conditions: Conditions such as PTSD (Post-Traumatic Stress Disorder) can have physical manifestations, including increased risk for various gastrointestinal disorders.

Age and Service Duration

• Aging: The risk of developing hernias increases with age due to the natural weakening of the body’s tissues. Veterans who served for longer periods might be at increased risk as they age.

• Chronic Conditions: Veterans with long-term health conditions like obesity, COPD (chronic obstructive pulmonary disease), or other conditions that increase intra-abdominal pressure are at a higher risk of developing hernias.

Healthcare Access and Utilization

• Medical Care: Access to and utilization of healthcare services can influence the management and outcomes of hernias. Veterans with consistent access to VA healthcare services might have better management of their symptoms and conditions than those who do not seek or have access to such care.

Chemical Exposure

• Environmental and Chemical Exposures: Certain veterans may have been exposed to chemicals or environments during service that could indirectly influence their risk of developing various health conditions, possibly affecting their digestive system’s integrity.

VA Rating for Hiatal Hernia

The VA rates both hiatal hernia and paraesophageal hernia under the new DC 7346, which instructs the VA to assign ratings under DC 7203, Esophagus, stricture of as follows:

80% VA Disability Rating for Hiatal Hernia

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).

Detailed Explanation of the 80 Percent Rating Criteria

• Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia: This means that the veteran must have medical records confirming repeated instances or persistent cases of esophageal strictures, which are narrowings of the esophagus that impede swallowing.

With at least one of the symptoms present:

• Aspiration: Inhaling food or liquid into the lungs, which can lead to respiratory issues or pneumonia.

• Undernutrition: Poor nutrition resulting from difficulty in swallowing, which can lead to deficiencies in essential nutrients.

• Substantial weight loss: Losing a significant amount of weight, as defined by the VA’s regulations.

• Treatment with either surgical correction or percutaneous esophago-gastrointestinal tube (PEG tube): The veteran must have undergone either surgical intervention to repair the hernia or the placement of a percutaneous esophago-gastrointestinal (PEG) tube. A PEG tube is a feeding tube inserted directly into the stomach through the abdominal wall to provide nutrition when swallowing is impaired.

50% VA Disability Rating for Hiatal Hernia

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.

Detailed Explanation of the 50 Percent Rating Criteria

• Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia: Similar to the previous rating criteria, the veteran must have medical records confirming repeated instances or persistent cases of esophageal strictures leading to difficulty in swallowing.

With at least one of the following:

• Dilatation 3 or more times per year: This refers to the need for mechanical widening (dilatation) of the esophagus using instruments to relieve narrowing caused by strictures. Requiring this procedure frequently suggests significant impairment in swallowing function.

• Dilatation using steroids at least one time per year: Steroids may be used in conjunction with dilatation to reduce inflammation and scarring in the esophagus, indicating more severe strictures.

• Esophageal stent placement: In some cases, a stent—a mesh-like tube—is placed in the esophagus to keep it open, facilitating swallowing when strictures are severe.

30% VA Disability Rating for Hiatal Hernia

Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year.

Detailed Explanation of the 30 Percent Rating Criteria

• Documented history of recurrent esophageal stricture(s) causing dysphagia: As with the previous scenarios, the veteran must have medical documentation confirming repeated instances of esophageal strictures leading to difficulty in swallowing.

• Which requires dilatation no more than 2 times per year: This indicates that the veteran needs mechanical widening (dilatation) of the esophagus using instruments to relieve narrowing caused by strictures, but it occurs with less frequency compared to the criteria for higher disability ratings.

10% VA Disability Rating for Hiatal Hernia

Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic.

Detailed Explanation of the 10 Percent Rating Criteria

• Documented history of esophageal stricture(s) that requires daily medications to control dysphagia: The veteran must have medical documentation confirming the presence of esophageal strictures that cause difficulty in swallowing (dysphagia) and necessitate the use of daily medications to manage this symptom.

• Otherwise asymptomatic: Apart from the dysphagia requiring medication, the veteran does not exhibit other significant symptoms related to the hiatal hernia.

0% VA Disability Rating for Hiatal Hernia

Documented history without daily symptoms or requirement for daily medications.

Detailed Explanation of the 0 Percent Non-Compensable Rating Criteria

• Documented history without daily symptoms or requirement for daily medications: The veteran has a medical history of hiatal hernia, but does not experience daily symptoms related to the condition, nor do they require daily medications for its management.

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.

Detailed Explanation of the Notes for Hiatal Hernia VA Ratings

• Documentation Requirement: Findings related to the condition must be supported by medical evidence obtained through specific diagnostic procedures, such as barium swallow, computerized tomography (CT), or esophagogastroduodenoscopy (EGD). This ensures that the diagnosis and severity of the condition are accurately assessed based on objective medical evidence.

• Rating of Non-Gastrointestinal Complications: If the veteran experiences complications from procedures used to diagnose or treat the condition that are unrelated to the gastrointestinal system, such as complications from anesthesia or surgery, these should be evaluated and rated separately under the appropriate disability system.

• Scope of Diagnostic Code: The provided diagnostic code for hiatal hernia and associated esophageal conditions applies to a range of specific conditions and scenarios beyond just esophagitis. This includes various causes of esophagitis (such as chemical, drug-induced, or infectious), Mallory Weiss syndrome, radiation-induced esophagitis, peptic stricture, and others listed. It is not limited to only these conditions but encompasses any esophageal condition that requires treatment with sclerotherapy.

• Definition of Recurrent Esophageal Stricture: Recurrent esophageal stricture is defined as the inability to maintain the target diameter of the esophagus beyond four weeks after achieving the desired diameter through dilation or other therapeutic interventions. This indicates a persistent problem requiring ongoing management.

• Definition of Refractory Esophageal Stricture: Refractory esophageal stricture is defined as the inability to achieve the target diameter of the esophagus despite undergoing at least five dilation sessions performed at two-week intervals. This indicates a more severe and treatment-resistant form of the condition.

List of Secondary Conditions to Hiatal Hernia

Veterans with a hiatal hernia may experience a variety of secondary conditions or disabilities due to or exacerbated by the primary condition.

Here are some common conditions that can be secondary to a hiatal hernia:

• Gastroesophageal Reflux Disease (GERD): This is one of the most common secondary conditions, where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

• Esophagitis: Inflammation of the esophagus can be a secondary result of the acid reflux caused by a hiatal hernia. This can lead to pain, difficulties swallowing, and eventually, it can cause scarring or narrowing of the esophagus.

• Barrett’s Esophagus: This condition may develop as a result of chronic acid reflux. In Barrett’s esophagus, the tissue lining the esophagus changes, becoming similar to the lining of the intestine. This can increase the risk of esophageal cancer.

• Esophageal Ulcers: Open sores in the esophagus, which can be caused by the erosion from stomach acid passing through the esophagus frequently due to a hiatal hernia.

• Asthma: For some individuals, the reflux of stomach acids can worsen breathing problems, such as asthma. This is due to the aspiration of acid particles into the lungs or the vagus nerve reflex that affects the bronchi.

• Respiratory problems: Large hiatal hernias can compress the lungs and interfere with breathing, leading to symptoms such as shortness of breath and wheezing.

• Chronic Cough or Laryngitis: The irritation and inflammation caused by stomach acid in the throat can lead to a persistent cough or changes in voice, including laryngitis.

• Dental Problems: Frequent exposure of teeth to stomach acid can lead to dental erosion, cavities, and other dental issues.

• Stricture: This is the narrowing of the esophagus due to the damage caused by stomach acid, leading to difficulties in swallowing.

• Anemia: Chronic bleeding from esophageal erosions or ulcers caused by acid reflux can lead to anemia.

What If I Already Have VA Disability for Hiatal Hernia?

If you already have VA disability for hiatal hernia, there will be no change to your current VA disability rating; you are “grandfathered” in under the old rating criteria.

A reduction in your rating will only occur if there is improvement in a disability sufficient to warrant a reduction under the old criteria.

All VA claims related to these digestive systems that were submitted and in “pending” status as of May 19, 2024, will be considered under both the old and new rating criteria, and whichever criteria is more favorable to the veteran will be applied.

In summary, get your VA disability claim submitted ASAP!

Why?

Because the VA rater must consider both the old and new criteria and select the rating that’s most favorable to you.

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