Effective May 19, 2024, the VA rates dysphagia under 38 CFR § 4.114, Diagnostic Code (DC) 7203, with ratings ranging from 0% to 80%, with breaks at 10%, 30%, and 50%.
These ratings are based on the severity of symptoms, including the frequency of dilation procedures, symptoms like difficulty swallowing, and the overall impact on a veteran’s ability to eat and maintain nutritional health.
Pro Tip: The VA considers both the physical symptoms, such as difficulty swallowing and pain, and the impact on overall health, including nutritional deficiencies and weight loss, when determining the appropriate rating. Maintaining detailed medical documentation and symptom records can help ensure an accurate disability rating.
Table of Contents
Summary of Main Points
- Dysphagia Definition: Dysphagia, the medical term for difficulty swallowing, can range from mild discomfort to an inability to swallow, affecting individuals of any age but more commonly older adults; while occasional trouble swallowing is usually harmless, persistent dysphagia can be serious and requires medical attention, with treatment depending on the underlying cause.
- Service Connection for Dysphagia: (#1) obtain a current medical diagnosis of dysphagia, (#2) provide evidence of an in-service event or injury that caused or aggravated it, (#3) get a Nexus Letter from a medical professional linking the diagnosis to military service or another disability, and (#4) document the severity and impact of symptoms on daily life through medical evidence and personal statements.
- VA Disability Rating for Dysphagia: The VA rates dysphagia under Diagnostic Code 7203 for esophageal stricture, with ratings ranging from 0% to 80%, with specific breaks at 10%, 30%, and 50%.
- Rating Factors: Ratings are based on the severity and impact of the condition, including the frequency of dilation procedures, symptoms like difficulty swallowing, and the overall impact on a veteran’s ability to consume food and maintain nutritional health.
What is Dysphagia?
Dysphagia is the medical term for difficulty swallowing.
Dysphagia can range from mild discomfort to an inability to swallow.
While occasional trouble swallowing, such as when eating too quickly or not chewing food thoroughly, is usually harmless, persistent dysphagia can be a serious condition requiring medical attention.
Dysphagia can affect individuals of any age but is more prevalent among older adults.
The causes of dysphagia are diverse, and treatment varies depending on the underlying cause.
Two Types of Dysphagia
Dysphagia can be categorized into two main types, each with distinct causes and characteristics:
1. Oropharyngeal Dysphagia
This type involves difficulty initiating the swallowing process, primarily due to issues in the mouth or throat.
It can be caused by neurological disorders (such as stroke, Parkinson’s disease, or multiple sclerosis), muscle disorders, or structural abnormalities.
2. Esophageal Dysphagia
This type involves difficulty moving food or liquid down the esophagus into the stomach.
It can be caused by esophageal strictures (narrowing), tumors, GERD (gastroesophageal reflux disease), or motility disorders (such as achalasia).
Symptoms
- Choking or Coughing: During or after eating or drinking.
- Sensation of Food Sticking: Feeling that food is stuck in the throat or chest.
- Regurgitation: Bringing food back up, sometimes through the nose.
- Drooling: Excess saliva or inability to swallow saliva.
- Hoarseness: Changes in voice.
- Weight Loss: Unintentional weight loss due to difficulty eating.
- Frequent Heartburn: Especially in cases related to GERD.
Diagnosis
- Barium Swallow Test: X-ray imaging test where the patient swallows a barium solution to highlight the esophagus.
- Endoscopy: A flexible tube with a camera is used to view the esophagus and possibly take a biopsy.
- Manometry: Measures the pressure inside the esophagus.
- Swallowing Study: Conducted by a speech-language pathologist to assess swallowing function.
Impact on Health
Dysphagia can significantly affect a veteran’s quality of life, leading to nutritional deficiencies, weight loss, dehydration, and aspiration pneumonia (food or liquid entering the lungs).
Dysphagia Risk Factors in Military Veterans
Veterans face unique risk factors that may increase their likelihood of developing dysphagia.
Here are some of the key risk factors:
1. Neurological Disorders
Post-Traumatic Stress Disorder (PTSD): Veterans with PTSD may experience swallowing difficulties due to heightened stress and anxiety affecting muscle control.
Traumatic Brain Injury (TBI): Common in combat veterans, TBI can disrupt the normal swallowing mechanism due to nerve damage.
2. Exposure to Toxins and Chemicals
Burn Pits: Exposure to burn pit smoke and other environmental toxins during deployment can lead to respiratory and gastrointestinal issues, including dysphagia. Note: Dysphagia is not currently on the VA presumptive list. However, Gulf War Syndrome lists multiple functional gastrointestinal disorders, including GERD, IBS, functional dyspepsia, and functional constipation.
Chemical Agents: Contact with chemical agents or hazardous materials may cause long-term damage to the esophagus and swallowing muscles.
3. Radiation and Chemotherapy
Cancer Treatments: Veterans who have undergone radiation therapy or chemotherapy for cancers, particularly those affecting the head, neck, or chest, may develop dysphagia as a side effect.
4. Physical Injuries
Combat Injuries: Injuries to the neck, spine, or head can directly impact the muscles and nerves involved in swallowing.
5. Aging and Degenerative Conditions
Degenerative Diseases: Conditions such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), which can be more prevalent in aging veterans, often lead to dysphagia.
6. Gastroesophageal Reflux Disease (GERD)
Chronic GERD: Prolonged GERD, common in veterans due to stress and dietary habits, can cause esophageal strictures and dysphagia.
7. Psychological Factors
Anxiety and Depression: High levels of anxiety and depression, often found in veterans, can exacerbate swallowing difficulties due to increased muscle tension and reduced coordination.
How to Prove Service Connection for Dysphagia
To receive VA disability benefits for dysphagia, veterans must first establish service connection, and then prove the severity of symptoms.
1. Current Diagnosis of Dysphagia
You need a current medical diagnosis of dysphagia from a healthcare professional.
This can be in service treatment records, VA medical records, or private treatment records.
It’s helpful to have a current diagnosis within the past 12 months.
Obtain medical records from your doctor that clearly document the diagnosis of dysphagia.
This can include test results such as barium swallow studies, endoscopies, and other relevant evaluations.
2. In-Service Event, Injury, Disease, Illness, or Exposure
Provide evidence of an event, injury, disease, illness, or exposure during military service that could have caused or aggravated dysphagia.
Gather service medical records, incident reports, and personal statements that detail the in-service occurrence.
This can include records of things such as traumatic brain injuries, exposure to toxins, or surgeries that may have affected swallowing.
3. Nexus (Link or Connection)
Establish a medical nexus, which means “link” or “connection,” to the current diagnosis of dysphagia and the in-service event or injury.
The best way to do this is to get a Nexus Letter from a qualified medical professional.
This letter should explain how the in-service event likely caused or aggravated the dysphagia.
4. Severity of Symptoms
Provide medical evidence of the severity and impact of your dysphagia symptoms on your work, life, and social functioning.
Maintain detailed medical records and personal statements documenting the frequency, severity, and duration of your symptoms.
Describe how dysphagia affects your ability to eat, drink, and perform daily activities, as well as any treatments or interventions you require.
Secondary Service Connection for Dysphagia
Yes, dysphagia can be service-connected on a secondary basis if it is caused or aggravated by an already service-connected condition.
You’ll need to obtain a nexus letter from a qualified medical professional.
This letter should clearly state that the dysphagia is “at least as likely as not” caused or aggravated by the primary service-connected condition.
15 Conditions That Can Cause Dysphagia
Here’s a list of 15 conditions that are medically linked to cause or aggravate dysphagia in military veterans:
Gastroesophageal Reflux Disease (GERD)
GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This acid reflux can irritate the lining of your esophagus, leading to esophageal strictures (narrowing), which can cause difficulty swallowing.
Stroke
A stroke can damage the part of the brain that controls swallowing muscles, leading to dysphagia. This condition is known as oropharyngeal dysphagia.
Parkinson’s Disease
This progressive neurological disorder affects muscle control, including the muscles used for swallowing. It can lead to both oropharyngeal and esophageal dysphagia.
Multiple Sclerosis (MS)
MS can cause nerve damage that affects the signals from the brain to the muscles used in swallowing, leading to dysphagia.
Amyotrophic Lateral Sclerosis (ALS)
ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord, leading to muscle weakness and atrophy, including the muscles used for swallowing.
Traumatic Brain Injury (TBI)
TBI can damage the brain regions involved in the control of swallowing, leading to dysphagia.
Esophageal Strictures
Narrowing of the esophagus, often due to chronic inflammation or scarring from acid reflux or other conditions, can obstruct the passage of food.
Esophageal Cancer
Tumors in the esophagus can block the passage of food, causing dysphagia.
Myasthenia Gravis
This chronic autoimmune disease causes muscle weakness, including the muscles involved in swallowing.
Muscular Dystrophy
A group of genetic diseases that cause progressive weakness and loss of muscle mass, affecting the muscles required for swallowing.
Radiation Therapy
Treatment for cancers, especially those of the head, neck, or chest, can cause scarring and narrowing of the esophagus, leading to dysphagia.
Zenker’s Diverticulum
A pouch that can form in the pharynx or esophagus, trapping food and causing difficulty swallowing.
Achalasia
A rare disorder where the lower esophageal sphincter doesn’t relax properly, preventing food from entering the stomach.
Scleroderma
A group of autoimmune diseases that cause hardening and tightening of the skin and connective tissues, including the esophagus.
Infections
Infections such as herpes simplex virus or candida (yeast) can cause inflammation of the esophagus (esophagitis), leading to dysphagia.
What is the VA Rating for Dysphagia?
Effective May 19, 2024, the VA rates dysphagia under Diagnostic Code (DC) 7203 for esophageal stricture with ratings ranging from 0% to 80%, with breaks at 10%, 30%, and 50%.
Ratings are based on the severity and impact of the condition, including factors such as the frequency of dilation procedures, the presence of symptoms like difficulty swallowing, and the overall impact on a veteran’s ability to consume food and maintain nutritional health.
Read more about the VA rating changes for the digestive system here.
DC 7203, Esophageal Stricture (VA Rating for Dysphagia):
80% Rating Criteria
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% Rating Criteria
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% Rating Criteria
Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year.
10% Rating Criteria
Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic.
0% Rating Criteria
Diagnosed dysphagia without daily symptoms or the need for daily medications.
Dysphagia VA Rating Criteria: Key Terms Explained
The following terms are essential for understanding how the VA rates dysphagia under Diagnostic Code 7203, which ranges from 0% to 80%, depending on the severity and impact of the condition.
1. Recurrent or Refractory Esophageal Stricture(s)
Definition: Esophageal stricture refers to the narrowing of the esophagus, often due to scar tissue formation. Recurrent strictures occur repeatedly, and refractory strictures are resistant to treatment.
Impact: Both types lead to ongoing difficulty in swallowing (dysphagia), requiring frequent medical intervention.
2. Dysphagia
Definition: Difficulty swallowing, which can range from mild discomfort or the sensation of food getting stuck to severe obstruction, making it challenging or impossible to swallow solid foods and liquids.
Impact: Dysphagia significantly affects dietary habits, nutritional intake, and overall quality of life.
3. Aspiration
Definition: Inhalation of food or liquids into the airways, which can lead to respiratory complications such as pneumonia or lung infections.
Impact: Aspiration is a serious complication of dysphagia, requiring prompt medical attention to prevent severe respiratory issues.
4. Undernutrition
Definition: Inadequate intake of essential nutrients, resulting in malnutrition and related health issues.
Impact: Undernutrition can lead to significant health problems, including weakened immune function and reduced physical strength.
5. Substantial Weight Loss
Definition: Significant decrease in body weight, often indicative of malnutrition or underlying health problems.
Impact: Weight loss due to dysphagia can exacerbate health issues and reduce overall vitality.
6. Surgical Correction
Definition: Medical procedures aimed at correcting anatomical abnormalities or pathological conditions through surgery.
Impact: Surgical interventions may be necessary to alleviate severe esophageal strictures and improve swallowing function.
7. Percutaneous Esophago-Gastrointestinal (PEG) Tube
Definition: A tube inserted into the stomach through the abdominal wall to provide nutrition and medication when swallowing is impaired.
Impact: PEG tubes are used to ensure adequate nutrition and medication intake in patients with severe dysphagia.
8. Dilatation
Definition: Medical procedure to widen a narrowed esophagus using dilators or balloons.
Impact: Dilatation can temporarily relieve symptoms of esophageal stricture, improving the ability to swallow.
9. Steroid Use
Definition: Medications with anti-inflammatory properties often used to reduce inflammation and swelling in various medical conditions.
Impact: Steroids may be used in the management of dysphagia to reduce esophageal inflammation.
10. Esophageal Stent Placement
Definition: Placement of a tube-like device (stent) in the esophagus to maintain its patency and prevent narrowing.
Impact: Esophageal stents can help keep the esophagus open, allowing for easier swallowing.
11. Need for Daily Medications
Definition: Medications required on a daily basis to manage symptoms or prevent complications associated with dysphagia.
Impact: Daily medication management is essential for controlling symptoms and maintaining quality of life in patients with dysphagia.
About the Author
Brian Reese
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).
