A rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is denied.

Citation Nr: A26069987 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 200902-106836 DATE: July 30, 2026 ORDER A rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is denied. FINDINGS OF FACT 1. The Veteran served on active duty from March to May 2003, December 2003 to March 2005, and August 2012 to August 2013. 2. GERD has been characterized by subjective complaints of throat irritation, sleep disturbance, and regurgitation along with the use of over-the-counter (OTC) medication without beneficial effect; objective findings include dysphagia, regurgitation, and pyrosis but no considerable impairment of health and no impact on the Veteran's ability to work. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code (DC) 7399-7346 (2024). REASONS AND BASES FOR FINDINGS AND CONCLUSION This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In January 2020, the agency of original jurisdiction (AOJ) granted service connection for GERD and assigned a 10 percent rating. In September 2020, the Veteran disagreed with the rating and appealed to the Board. In March 2024, the Board denied a rating in excess of 10 percent. The Veteran appealed to the Veterans Claims Court. In March 2025, the Court Clerk granted a Joint Motion for Remand (JMR), which vacated the Board's decision and remanded the case to the Board. The Board again denied the appeal in July 2025. The Veteran appealed to the Veterans Claims Court. In April 2026, the Court Clerk granted a second JMR, which vacated the Board's July 2025 decision and remanded the case to the Board. The case now returns to the Board for readjudication. Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. GERD is rated as 10 percent under 38 C.F.R. § 4.114, DC 7399-7346. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional code to identify the specific basis for the evaluation assigned. The additional code is shown after the hyphen. 38 C.F.R. § 4.27. Unlisted disabilities requiring rating by analogy will be coded by the numbers of the most closely related body part and 99. Id. During the pendency of this appeal, the criteria for rating disabilities of the digestive system were amended, effective May 19, 2024, adding new DC 7206 with criteria specifically for GERD; however, as the rating decision under review was issued prior to the promulgation of those changes, the Board will limit its consideration to the criteria then in effect at the time of the rating decision on appeal. VA regulations provide that there are diseases of the digestive system, particularly with the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia, and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title "Diseases of the Digestive System," do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding. 38 C.F.R. §§ 4.14, 4.113. Ratings under DC's 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348, inclusive, will not be combined with each other. A single evaluation will be assigned under the DC that reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. Pursuant to DC 7346, a 10 percent rating is warranted for two or more of the symptoms for the 30 percent rating. A 30 percent rating is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The maximum 60 percent rating is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. The provisions of 38 C.F.R. § 4.114 do not define the terms "persistently recurrent," "considerable," or "severe." As such, the Board applies the ordinary meaning of these terms in evaluating the evidence of record. Specifically, with respect to the phrase "persistently recurrent," generally the word persistent is defined as "existing for a long or longer than usual time or continuously." Merriam-Webster.com Dictionary, https://www.merriam-webster.com/dictionary/persistent. Accessed 28 Jul. 2026. Thus, the phrase persistently recurrent refers to symptoms that recur continuously for a long period of time. The term considerable, is generally defined as "large in extent or degree." Merriam-Webster.com Dictionary, https://www.merriam-webster.com/dictionary/ considerable. Accessed 28 Jul. 2026. Severe is defined as "very painful or harmful." Merriam-Webster.com Dictionary, https://www.merriam-webster.com /dictionary/severe. Accessed 28 Jul. 2026. The use of terminology such as "mild" or "severe" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38C.F.R. §§ 4.2, 4.6. Turning to the evidence, the Veteran reported at a December 2019 VA examination that he experienced daily throat irritation including burning and pain with swallowing. The examiner diagnosed GERD and found that the disorder was characterized by dysphagia, pyrosis, reflux, and regurgitation with sleep disturbance and nausea caused by esophageal reflux four or more times per year lasting less than one day. Notably, the examiner had the opportunity to indicate that GERD symptoms included arm or shoulder pain but did not do so. Based on a review of the case file and the examination, the examiner concluded that GERD had no impact on the Veteran's ability to work. Moreover, the record is devoid of any evidence of GERD negatively impacting the Veteran's employment during the period on appeal. Next, the clinical evidence was reviewed. The VA treatment records did not show symptoms that were more debilitating than those described at the VA examination. In fact, the clinical records do not identify any notable treatment for GERD, specifically there is no indication of prescribed medications, other than a December 2013 notation indicating consideration for prescribing a proton pump inhibitor (PPI) for GERD; however, the clinical records do not indicate that such medication had been prescribed. Otherwise, the clinical records did not suggest considerable impairment of health due to GERD symptoms during the period on appeal. Nevertheless, the Veteran reported to the December 2019 VA examiner that he had just begun taking Prilosec, and he used Tums; however, he further informed the VA examiner that the medication had no effect on his symptoms. Therefore, although the case was returned to consider the ameliorative effects of medication the evidence shows that there are, in fact, no ameliorative effects because the Veteran has indicated that the medication does not help. The Board must discount the beneficial effects of medication used to treat a service-connected disability when the relevant diagnostic code does not specifically contemplate medication use. See Ingram v. Collins, 38 Vet. App. 130, 137 - 139 (2025). Here, DC 7346 does not contemplate the use of medication, which then requires the Board to identify and resolve the beneficial effects of the medication; however, the OTC medication that the Veteran had taken provided little, if any, ameliorative effect that would necessitate the Board to discount its effect on the Veteran's symptoms. Consequently, his reporting of symptoms appears to accurately reflect the severity of GERD with or without prescribed or OTC medication. Thus, GERD was manifested by two or more symptoms associated with the 30 percent criteria, which supports the assignment of an initial 10 percent rating throughout the period under appeal. However, at no point did GERD more nearly approximate persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable (i.e., large in extent or degree) impairment of health; or pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia, or causing severe (i.e., very painful or harmful) impairment of health. Based on the above, a rating in excess of 10 percent is not warranted. In this regard, the December 2019 VA examiner characterized the disability as dysphagia, pyrosis, reflux, and regurgitation; however, the examiner did not identify substernal arm or shoulder pain or considerable impairment of health, nor does the record indicate such symptoms or any beneficial effects from the OTC medication used by the Veteran. Moreover, the examiner found that the disorder had no impact on the Veteran's ability to work. As such, the medical evidence does not support a higher rating for GERD. Additionally, the Board has considered whether a separate rating is warranted for sleep disturbances. In this case, however, the Veteran's posttraumatic stress disorder (PTSD) contemplates chronic sleep impairment, which was noted in the May 2015 VA Initial Posttraumatic Stress Disorder examination. Consequently, a separate rating for sleep impairment due to GERD would constitute pyramiding, which is prohibited. 38 C.F.R. § 4.14 ("[t]he evaluation of the same disability under various diagnoses, a practice called 'pyramiding,' 'is to be avoided'"). The Board has considered the Veteran's lay statements that his disability was worse than when initially rated. While he is competent to report symptoms because this requires only personal knowledge as it comes through the senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. That is within the Board's purview. To that end, such competent evidence concerning the nature and extent of GERD has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination report and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiner has the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinion great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not ? required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Ferguson, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.