What is the Eosinophilic Esophagitis VA Rating?

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Effective May 19, 2024, the VA rates eosinophilic esophagitis (EoE) under 38 CFR § 4.114, Diagnostic Code (DC) 7203, with ratings ranging from 0% to 80%, with breaks at 10%, 30%, and 50%.

The rating factors include the severity of esophageal strictures, the need for dilation procedures, and the impact on the ability to consume food and overall health.

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

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. Keeping detailed medical documentation and symptom records can help ensure an accurate disability rating.

>> Read about the VA digestive system rating changes in detail here.  

Summary of Main Points

• Eosinophilic Esophagitis VA Rating: VA ratings for eosinophilic esophagitis range from 0% to 80% under Diagnostic Code 7203, with specific breaks at 10%, 30%, and 50%. The ratings are determined by the severity of esophageal strictures, the need for dilation procedures, and the impact on the ability to consume food and overall health.

• Other Rating Factors: The VA considers factors such as the frequency and intensity of dysphagia (difficulty swallowing), the necessity for medical interventions like dilation or esophageal stent placement, and the presence of complications like aspiration, undernutrition, or substantial weight loss.

• Functional Impairment: Your final VA disability rating for eosinophilic esophagitis depends on the severity of symptoms as well as how these symptoms negatively impact your work, life, and social functioning. Keeping detailed medical documentation and symptom records can help ensure an accurate disability rating.

What is Eosinophilic Esophagitis?

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory condition of the esophagus, characterized by the presence of a high number of eosinophils (a type of white blood cell) in the esophageal tissue.

This condition can lead to various symptoms and complications that impact a veteran’s quality of life.

Key Characteristics of EoE:

Inflammation: EoE involves significant inflammation in the esophagus, driven by an overactive immune response, often in reaction to certain foods or allergens.

Eosinophils: High concentrations of eosinophils in the esophagus, which are not typically present in significant numbers in healthy individuals.

Chronic Condition: EoE is a long-term condition requiring ongoing management and treatment to control symptoms and prevent complications.

Symptoms of Eosinophilic Esophagitis in Veterans

Here’s the most common symptoms of eosinophilic esophagitis in veterans:

1. Difficulty Swallowing (Dysphagia)

• Description: Veterans with EoE often experience difficulty swallowing, particularly with solid foods. This can lead to a sensation of food being stuck in the esophagus, causing discomfort and potential choking hazards.
• Impact: This symptom can severely impact dietary habits and nutritional intake, which is crucial for veterans recovering from service-related injuries or conditions.

2. Food Impaction

• Description: Food impaction occurs when food gets lodged in the esophagus. This can be a medical emergency if the blockage is not resolved promptly.
• Impact: Repeated episodes can lead to anxiety around eating and can necessitate frequent medical interventions, disrupting daily life.

3. Chest Pain or Discomfort

• Description: Veterans may experience chest pain that can mimic heart conditions. This pain is often due to the inflammation and irritation of the esophagus.
• Impact: Chest pain can cause significant distress and may lead to frequent emergency room visits, particularly if the pain is severe and resembles cardiac events.

4. Heartburn and Reflux Symptoms

• Description: EoE can cause symptoms similar to gastroesophageal reflux disease (GERD), such as heartburn and acid reflux.
• Impact: These symptoms can lead to chronic discomfort, sleep disturbances, and a need for ongoing medication to manage acid levels.

5. Nausea and Vomiting

• Description: Some veterans with EoE may experience frequent nausea and vomiting, especially after eating certain foods.
• Impact: This can lead to weight loss, dehydration, and a decreased quality of life due to the fear of eating and subsequent symptoms.

6. Abdominal Pain

• Description: Persistent abdominal pain can occur, often in conjunction with other gastrointestinal symptoms.
• Impact: Chronic pain can interfere with daily activities and mental health, contributing to a diminished overall well-being.

7. Poor Growth or Weight Loss

• Description: Particularly in younger veterans, EoE can lead to poor growth and weight loss due to difficulties in eating and nutrient absorption.
• Impact: For veterans, maintaining a healthy weight is essential for managing other health conditions and for overall physical recovery.

8. Fatigue

• Description: Chronic inflammation and the body’s response to the persistent esophageal irritation can lead to fatigue.
• Impact: Fatigue can affect a veteran’s ability to work, exercise, and perform daily tasks, impacting overall productivity and quality of life.

What are the Risk Factors for Military Veterans?

Military veterans may face unique risk factors that increase their likelihood of developing eosinophilic esophagitis.

Here are some of the key risk factors:

1. Exposure to Environmental Allergens

• Deployment-Related Exposures: Veterans deployed to regions with high levels of environmental allergens and pollutants may be at increased risk for allergic conditions, including EoE. Exposure to dust, sand, and other airborne particles can trigger immune responses.

2. Dietary Changes and Nutritional Deficiencies

• Field Diets: During deployment, access to fresh, diverse food may be limited, leading to a diet high in processed and preserved foods, which can exacerbate gastrointestinal issues.
• Post-Service Dietary Adjustments: Veterans may experience significant dietary changes upon returning to civilian life, potentially triggering or worsening EoE symptoms.

3. Stress and Mental Health Issues

• PTSD and Anxiety: High levels of stress, anxiety, and PTSD common among veterans can affect the immune system and gastrointestinal health, potentially contributing to conditions like EoE.

4. Medication Use

• NSAIDs and Antibiotics: Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics, which are common in the veteran population due to injuries and infections, can disrupt gut health and immune function, increasing the risk of EoE.

5. Prevalence of Allergic Conditions

• High Rates of Allergies and Asthma: Veterans, particularly those exposed to environmental hazards, may have higher rates of allergic conditions and asthma, which are risk factors for EoE.

6. Genetic Predisposition

• Family History: Veterans with a family history of allergic conditions, including EoE, are at higher risk.

What is the Eosinophilic Esophagitis Disability Rating?

Effective May 19, 2024, the VA rates eosinophilic esophagitis under Diagnostic Code (DC) 7203 for esophageal stricture from 0% to 80% with breaks at 10%, 30%, and 50%.

DC 7203, Esophageal Stricture:

• 80% VA Rating: with 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% VA Rating: with 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% VA Rating: with documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year.

• 10% VA Rating: with documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic.

• 0% VA Rating: with documented history without daily symptoms or requirement for daily medications.

Definitions and Meanings of Key Terms for Eosinophilic Esophagitis

Recurrent or Refractory Esophageal Stricture(s): Esophageal stricture refers to the narrowing of the esophagus, often due to scar tissue formation. Recurrent or refractory strictures are those that repeatedly occur or are resistant to treatment, leading to ongoing difficulty in swallowing (dysphagia).

Dysphagia: 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.

Aspiration: Inhalation of food or liquids into the airways, which can lead to respiratory complications such as pneumonia or lung infections.

Undernutrition: Inadequate intake of essential nutrients, resulting in malnutrition and related health issues.

Substantial Weight Loss: Significant decrease in body weight, often indicative of malnutrition or underlying health problems.

Surgical Correction: Medical procedures aimed at correcting anatomical abnormalities or pathological conditions through surgery.

Percutaneous Esophago-Gastrointestinal (PEG) Tube: A tube inserted into the stomach through the abdominal wall to provide nutrition and medication when swallowing is impaired.

Dilatation: Medical procedure to widen a narrowed esophagus using dilators or balloons.

Steroids: Medications with anti-inflammatory properties often used to reduce inflammation and swelling in various medical conditions.

Esophageal Stent Placement: Placement of a tube-like device (stent) in the esophagus to maintain its patency and prevent narrowing.

Daily Medications: Medications required on a daily basis to manage symptoms or prevent complications associated with Barrett’s esophagus, such as acid reflux or dysphagia.

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