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Gastroesophageal Reflux Disease (GERD) is a chronic digestive condition where stomach acid frequently flows back into the esophagus, leading to symptoms like heartburn and regurgitation.
There’s a significant correlation between asthma—a respiratory condition characterized by airway inflammation and constriction—and GERD for VA disability benefits.
Studies suggest that up to 8/10 (80%) of asthma patients may experience GERD, with the reflux potentially triggering bronchospasm or increased airway reactivity, thereby exacerbating asthma symptoms.
For veterans with service-connected asthma, it’s crucial to recognize that GERD can develop as a secondary condition.
The VA acknowledges secondary service connection, meaning if your GERD is linked to your service-connected asthma, you may be eligible for additional disability benefits.
In this blog post, VA disability expert Brian Reese will explore the medical relationship between asthma and GERD, outline the necessary evidence to establish a secondary service connection, provide strategies to strengthen your VA claim, and explain the VA’s rating criteria for GERD secondary to asthma.
Let’s begin!
Pro Tip: You’ll want to obtain a quality Nexus Letter to connect GERD as a secondary VA claim for secondary service connection. A Nexus Letter from a private healthcare provider is often the linchpin for proving service connection and getting the VA disability benefits you deserve.
Table of Contents
Summary of Key Points
- The Connection Between Asthma and GERD: Studies show up to 80% of asthma patients may experience GERD, as asthma-related coughing, pressure changes, and medications can contribute to acid reflux, aggravating GERD symptoms.
- VA Recognizes Secondary Service Connection: Veterans with service-connected asthma may qualify for additional VA disability benefits if GERD is linked as a secondary condition, including cases where it is aggravated by the primary service-connected disability (asthma).
- Evidence Requirements for Secondary VA Claims: Veterans must provide a current diagnosis of GERD, demonstrate its link or connection to service-connected asthma, and submit a Nexus Letter to establish secondary service connection.
- New VA Rating Criteria for GERD (DC 7206): Effective May 19, 2024, GERD VA ratings range from 0% to 80%, with breaks at 10%, 30%, and 50%. Higher rating percentages reflect more severe symptoms, such as esophageal strictures requiring surgeries, dilations, or feeding tubes.
Can Asthma Cause or Aggravate GERD?
Asthma and GERD often coexist, with each condition potentially influencing the other.
While asthma doesn’t directly cause GERD, it can contribute to its development and aggravation through several mechanisms:
- Increased Intra-Abdominal Pressure: Asthma involves episodes of coughing and labored breathing, which can elevate pressure within the abdomen. This heightened pressure may promote the reflux of stomach contents into the esophagus, leading to GERD symptoms.
- Medication Side Effects: Certain asthma treatments, particularly bronchodilators, work by relaxing the airway muscles. However, they may also relax the lower esophageal sphincter (LES)—the muscle responsible for preventing stomach acids from flowing backward into the esophagus. A relaxed LES can facilitate acid reflux, thereby worsening GERD symptoms.
- Diaphragmatic Pressure Changes: The breathing difficulties associated with asthma can alter the pressure dynamics in the chest and abdomen. These changes may encourage the backflow of stomach acids into the esophagus, contributing to GERD.
It’s important to note that GERD can also exacerbate asthma symptoms.
Acid reflux may irritate the airways and lungs, triggering bronchoconstriction and increasing asthma-related issues.
This bidirectional relationship underscores the importance of recognizing and managing both conditions concurrently to improve overall health outcomes.
If you’re experiencing symptoms of both asthma and GERD, it’s advisable to consult a healthcare provider.
Effective management often involves a combination of lifestyle modifications, medication adjustments, and, in some cases, specialized treatments to address both conditions simultaneously.
Evidence Requirements for Secondary Service Connection
Here’s a list of questions the C&P examiner will review along with evidence requirements for VA claims for GERD secondary to asthma:
- Does the veteran have a diagnosis of GERD? If yes, indicate the date of diagnosis.
- Does the veteran have service-connected asthma rated at 0% or higher? If yes, indicate the date of diagnosis and date of service connection.
- Is the veterans’ GERD proximately due to, caused, or aggravated by their service-connected asthma? If yes, explain your medical opinion and evidence-based rationale.
- Does the veteran have symptoms of GERD? If yes, indicate the severity in terms of frequency, severity, and duration, along with the current treatment plan to include the daily use of medications taken to manage symptoms.
How to Establish Secondary Service Connection for VA Disability Benefits
To establish a secondary service connection, veterans need to provide the VA with two primary pieces of evidence:
- Current Diagnosis of the Secondary Condition: The veteran must have a current diagnosis of the secondary condition, which in this case is GERD. This diagnosis must be documented in a medical record by a qualified medical professional.
- Medical Nexus Evidence Between the Two Conditions: The veteran must provide medical evidence that links the secondary condition to the already service-connected condition. Ideally, you submit a Nexus Letter for a secondary condition that explains how the new disability (GERD) is proximately due to, caused, or aggravated by the primary service-connected condition (asthma).
What is the VA Disability Rating for GERD Secondary to Asthma?
Effective May 19, 2024, the VA has updated its rating criteria for digestive disorders, including GERD.
Here’s a breakdown of the VA disability ratings for GERD from 0% to 80% with breaks at 10%, 30%, and 50%, with higher percentages indicating more severe impairment under the new Diagnostic Code (DC) 7206:
80% VA Rating for GERD Secondary to Asthma:
Criteria: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia, with at least one of the following:
- Aspiration (food or liquid entering the lungs)
- Undernutrition
- Substantial weight loss (as defined by § 4.112(a))
- Requires treatment such as surgical correction of esophageal strictures or a PEG tube (percutaneous esophago-gastrointestinal tube).
Example: A veteran with severe esophageal strictures struggles to swallow both liquids and solids, leading to aspiration pneumonia and substantial weight loss. A PEG tube is inserted to allow proper nutrition.
50% VA Rating for GERD Secondary to Asthma:
Criteria: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia that requires at least one of the following:
- Dilation 3 or more times per year
- Dilation using steroids at least one time per year
- Esophageal stent placement
Example: A veteran with recurrent esophageal strictures requires dilation procedures four times a year to maintain esophageal function and avoid severe swallowing difficulties.
30% VA Rating for GERD Secondary to Asthma:
Criteria: Documented history of recurrent esophageal stricture(s) causing dysphagia, requiring dilation no more than 2 times per year.
Example: A veteran undergoes esophageal dilation twice a year to manage difficulty swallowing solid foods caused by recurring esophageal strictures.
10% VA Rating for GERD Secondary to Asthma:
Criteria: Documented history of esophageal stricture(s) requiring daily medications to control dysphagia but is otherwise asymptomatic.
Example: A veteran takes daily prescription medications (e.g., proton pump inhibitors) to manage mild dysphagia and prevent worsening symptoms.
0% VA Rating for GERD Secondary to Asthma:
Criteria: Documented history of esophageal stricture(s) without daily symptoms or the requirement for daily medications.
Example: A veteran has a past diagnosis of esophageal strictures but does not currently experience daily symptoms and requires no medication for treatment.
The updated rating criteria for GERD focuses on the frequency and severity of esophageal strictures, highlighting their effects on swallowing and overall health.
For veterans seeking VA disability benefits, comprehensive medical documentation is essential.
This should include detailed medical records of treatments such as dilations or surgeries, along with evidence of related symptoms and their impact on daily functioning.
Pro Tip: Diagnostic Testing is Not Required to Service Connect GERD
According to M21–1, Part V, Subpart iii, Chapter 6 — Digestive Disabilities, a diagnosis of GERD for purposes of direct service connection, secondary service connection, or service connection via aggravation does not require medical imaging or specific diagnostic testing.
38 CFR 4.114, DC 7206, Note (1) requires “findings” to be documented by one of three types of imaging: barium swallow, computed tomography (CT), or esophagogastroduodenoscopy.
Nevertheless, this refers to documentation of esophageal stricture for evaluation purposes.
It does not define a sufficient diagnosis of GERD for service connection.
Important Note: A 10% rating for GERD can be assigned pursuant to 38 CFR 4.7 without imaging to document esophageal stricture when the veteran requires the use of daily medications.
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
