Overview of VA Digestive Ratings

Digestive conditions affect the gastrointestinal tract, impacting your ability to process food and nutrients properly. Military service can lead to digestive conditions through stress, environmental exposures, infections, or dietary factors. This section explains how the VA rates digestive conditions and provides detailed guidance for the most common conditions.

General Rating Principles for Digestive Conditions

The VA rates most digestive conditions based on several factors:

• Frequency and severity of symptoms: How often symptoms occur and how severe they are
• Weight loss: Whether the condition causes significant weight loss
• Nutritional status: Whether the condition affects your ability to maintain proper nutrition
• Required treatments: Medications, dietary restrictions, or other interventions needed
• Impact on daily activities: How the condition affects your ability to work and perform daily tasks

Presumptive Service Connection for Digestive Conditions

Certain digestive conditions may qualify for presumptive service connection based on specific exposures:

GERD and Hiatal Hernia

Overview of GERD and Hiatal Hernia

Gastroesophageal Reflux Disease (GERD) is a chronic digestive disorder that occurs when stomach acid or bile flows back into the esophagus, irritating the lining. A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm. These conditions often occur together and share similar symptoms.

Symptoms of GERD and hiatal hernia include:

• Heartburn (burning sensation in the chest)
• Regurgitation of food or sour liquid
• Difficulty swallowing (dysphagia)
• Feeling of a lump in the throat
• Chest pain
• Chronic cough
• Laryngitis or hoarseness
• Disrupted sleep

Military service can contribute to GERD and hiatal hernia through various factors:

• Stress and psychological factors
• Irregular eating patterns
• Physical strain and heavy lifting
• Medications taken for other conditions
• Weight gain during or after service

Service Connection for GERD and Hiatal Hernia

There are several ways to establish service connection for GERD and hiatal hernia:

VA Disability Ratings for GERD and Hiatal Hernia

The VA rates GERD and hiatal hernia under 38 CFR § 4.114, Diagnostic Code 7346 (Hernia, hiatal). Ratings are based on the frequency and severity of symptoms.

Rating	Criteria
60%	Symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health
30%	Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health
10%	With two or more of the symptoms for the 30% evaluation of less severity

Evidence Needed for GERD and Hiatal Hernia Claims

To support your GERD or hiatal hernia claim, gather the following evidence:

Tips for Successful GERD and Hiatal Hernia Claims

• Document All Symptoms: Keep a detailed log of all symptoms, including frequency, severity, and impact on daily life.
• Get Proper Diagnosis: Ensure you have a formal diagnosis, preferably confirmed by endoscopy or other diagnostic tests.
• Consider Secondary Connection: If you have service-connected PTSD, sleep apnea, or conditions requiring NSAIDs, pursue secondary service connection.
• Address Medication Side Effects: If your GERD is caused or aggravated by medications for service-connected conditions, ensure this is documented by your doctor.
• Highlight Health Impairment: Clearly explain how your GERD or hiatal hernia impairs your health, as this is key to the rating criteria.

Irritable Bowel Syndrome

Overview of Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder that affects the large intestine. It causes a group of symptoms that occur together, including abdominal pain and changes in bowel movements, without evidence of damage or disease in the digestive tract.

Symptoms of IBS include:

• Abdominal pain, cramping, or bloating
• Diarrhea, constipation, or alternating between both
• Excess gas
• Mucus in the stool
• Urgency to have bowel movements
• Feeling of incomplete evacuation

Military service can contribute to IBS through various factors:

• Stress and psychological factors
• Exposure to infectious agents
• Changes in diet and eating patterns
• Environmental exposures in deployment areas

Service Connection for Irritable Bowel Syndrome

There are several ways to establish service connection for IBS:

VA Disability Ratings for Irritable Bowel Syndrome

IBS is rated under 38 CFR § 4.114, Diagnostic Code 7319 (Irritable colon syndrome). Ratings are based on the severity and frequency of symptoms.

Rating	Criteria
30%	Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress
10%	Moderate; frequent episodes of bowel disturbance with abdominal distress
0%	Mild; disturbances of bowel function with occasional episodes of abdominal distress

Evidence Needed for Irritable Bowel Syndrome Claims

To support your IBS claim, gather the following evidence:

Tips for Successful Irritable Bowel Syndrome Claims

• Highlight Gulf War Service: If you served in the Southwest Asia theater of operations, emphasize this for presumptive service connection.
• Document Frequency and Severity: Keep a detailed log of all symptoms, including frequency, severity, and impact on daily life.
• Address Work Impact: Explain how IBS affects your ability to work, including any accommodations needed or time lost due to symptoms.
• Consider Secondary Connection: If you have service-connected PTSD or other mental health conditions, pursue secondary service connection.
• Be Specific About “Constant” Distress: For a 30% rating, clearly document that your abdominal distress is “more or less constant,” not just frequent.

Peptic Ulcers

Overview of Peptic Ulcers

Peptic ulcers are open sores that develop on the inside lining of the stomach (gastric ulcers) or the upper portion of the small intestine (duodenal ulcers). The most common cause is infection with the bacterium Helicobacter pylori (H. pylori), but they can also be caused by long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) or stress.

Symptoms of peptic ulcers include:

• Burning stomach pain
• Feeling of fullness, bloating, or belching
• Intolerance to fatty foods
• Heartburn
• Nausea

More severe symptoms that may indicate complications include:

• Vomiting blood
• Dark blood in stools or black, tarry stools
• Severe pain in the mid to upper abdomen
• Unexplained weight loss
• Appetite changes

Military service can contribute to peptic ulcers through various factors:

• Stress
• Use of NSAIDs for service-related injuries
• H. pylori infection contracted during service
• Irregular eating patterns
• Smoking or alcohol use during service

Service Connection for Peptic Ulcers

There are several ways to establish service connection for peptic ulcers:

VA Disability Ratings for Peptic Ulcers

Peptic ulcers are rated under 38 CFR § 4.114, using different diagnostic codes depending on the location:

• Diagnostic Code 7304: Gastric ulcer
• Diagnostic Code 7305: Duodenal ulcer
• Diagnostic Code 7306: Marginal ulcer (gastrojejunal)

The rating criteria are similar for all types of peptic ulcers:

Rating	Criteria
60%	Severe; pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of severe impairment of health
40%	Moderately severe; less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year
20%	Moderate; recurring symptoms after treatment, but not so frequent as to require continuous treatment
10%	Mild; symptoms readily controlled by treatment, and not materially affecting nutrition

Evidence Needed for Peptic Ulcer Claims

To support your peptic ulcer claim, gather the following evidence:

Tips for Successful Peptic Ulcer Claims

• Document NSAID Use: If you used NSAIDs for service-connected conditions, ensure this connection is well-documented.
• Address Stress Connection: If you have service-connected PTSD or other stress-related conditions, pursue secondary service connection.
• Track Episodes: Keep a detailed log of all ulcer episodes, including severity, duration, and impact on daily activities.
• Highlight Complications: Document any complications such as bleeding, anemia, or weight loss.
• Address Presumptive Period: If your ulcer was diagnosed within one year after discharge, highlight this for presumptive service connection.

Celiac Disease

Overview of Celiac Disease

Celiac disease is an autoimmune disorder in which the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten (a protein found in wheat, rye, and barley), their body mounts an immune response that attacks the small intestine, damaging the villi that promote nutrient absorption.

Symptoms of celiac disease include:

• Diarrhea
• Abdominal pain
• Bloating and gas
• Weight loss
• Fatigue
• Nausea and vomiting
• Constipation
• Anemia
• Bone or joint pain
• Depression or anxiety
• Skin problems
• Headaches

Military service can contribute to celiac disease through various factors:

• Stress triggering autoimmune responses
• Infections that may trigger celiac disease in genetically predisposed individuals
• Changes in diet and nutrition during service
• Environmental exposures

Service Connection for Celiac Disease

There are several ways to establish service connection for celiac disease:

VA Disability Ratings for Celiac Disease

Celiac disease is typically rated under 38 CFR § 4.114, Diagnostic Code 7323 (Colitis, ulcerative, chronic) or other appropriate digestive diagnostic codes based on symptoms and severity.

Rating	Criteria
60%	Severe symptoms with weight loss, anemia, and other complications requiring strict dietary management and frequent medical monitoring
30%	Moderate symptoms with some weight loss and nutritional deficiencies, requiring careful dietary management
10%	Mild symptoms controlled by gluten-free diet with minimal impact on nutrition and daily activities

Evidence Needed for Celiac Disease Claims

To support your celiac disease claim, gather the following evidence:

Tips for Successful Celiac Disease Claims

• Get Proper Diagnosis: Ensure you have a confirmed diagnosis through appropriate testing, including biopsy if recommended.
• Document Nutritional Impact: Keep records of any nutritional deficiencies, weight loss, or related health problems.
• Address Quality of Life Impact: Explain how the need for a strict gluten-free diet affects your daily life, work, and social activities.
• Consider Secondary Connection: If you have service-connected stress-related conditions, pursue secondary service connection.
• Track Associated Conditions: Document any related conditions such as anemia, osteoporosis, or other autoimmune disorders that may warrant separate ratings.

Chronic Gastritis

Overview of Chronic Gastritis

Chronic gastritis is long-term inflammation of the stomach lining. The most common cause is infection with Helicobacter pylori (H. pylori) bacteria, but it can also be caused by prolonged use of NSAIDs, excessive alcohol consumption, or autoimmune disorders.

Symptoms of chronic gastritis include:

• Upper abdominal pain or discomfort
• Nausea
• Vomiting
• Loss of appetite
• Feeling of fullness after eating small amounts
• Weight loss
• Bloating
• Belching
• Burning sensation in the stomach

Military service can contribute to chronic gastritis through various factors:

• H. pylori infection contracted during service
• Prolonged use of NSAIDs for service-related injuries
• Stress
• Irregular eating patterns
• Alcohol use during service

Service Connection for Chronic Gastritis

There are several ways to establish service connection for chronic gastritis:

VA Disability Ratings for Chronic Gastritis

Chronic gastritis is rated under 38 CFR § 4.114, Diagnostic Code 7307 (Gastritis, chronic). Ratings are based on the frequency and severity of symptoms.

Rating	Criteria
60%	Severe; periodic vomiting, weight loss, hematemesis or melena with anemia, and requiring hospital treatment
30%	Moderately severe; recurring symptoms with definite weight loss (or malnutrition)
10%	Mild; recurring symptoms

Evidence Needed for Chronic Gastritis Claims

To support your chronic gastritis claim, gather the following evidence:

Tips for Successful Chronic Gastritis Claims

• Document NSAID Connection: If you used NSAIDs for service-connected conditions, ensure this connection is well-documented.
• Get H. Pylori Testing: If H. pylori infection is suspected, ensure appropriate testing is done and documented.
• Track Weight Changes: Document any weight loss or nutritional problems caused by gastritis.
• Address Stress Connection: If you have service-connected PTSD or other stress-related conditions, pursue secondary service connection.
• Document Recurring Nature: Keep a detailed log showing that symptoms recur regularly, not just occasionally.

Hemorrhoids

Overview of Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum and anus. They can be internal (inside the rectum) or external (under the skin around the anus). Hemorrhoids are common and can cause significant discomfort and complications.

Symptoms of hemorrhoids include:

• Bleeding during bowel movements
• Itching or irritation in the anal region
• Pain or discomfort
• Swelling around the anus
• A lump near the anus
• Leakage of feces

Military service can contribute to hemorrhoids through various factors:

• Prolonged sitting or standing
• Heavy lifting and straining
• Stress and psychological factors
• Changes in diet and bowel habits
• Physical demands of military training and duties

Service Connection for Hemorrhoids

There are several ways to establish service connection for hemorrhoids:

VA Disability Ratings for Hemorrhoids

Hemorrhoids are rated under 38 CFR § 4.114, Diagnostic Code 7336. Ratings are based on the severity of symptoms and complications.

Rating	Criteria
20%	When there is persistent bleeding and/or protrusion of hemorrhoids with secondary anemia, or when there is sphincter weakness
10%	When hemorrhoids are present with bleeding, pain, and protrusion upon straining
0%	Asymptomatic hemorrhoids

Evidence Needed for Hemorrhoid Claims

To support your hemorrhoid claim, gather the following evidence:

Tips for Successful Hemorrhoid Claims

• Document All Symptoms: Keep a detailed log of bleeding episodes, pain, and any protrusion.
• Address Physical Demands: Explain how the physical demands of military service contributed to your hemorrhoids.
• Get Anemia Testing: If you have persistent bleeding, ensure your hemoglobin levels are tested and documented.
• Consider Secondary Connection: If you have service-connected IBS or other digestive conditions, pursue secondary service connection.
• Document Functional Impact: Explain how hemorrhoids affect your ability to sit, work, and perform daily activities.

Colon Cancer

Overview of Colon Cancer

Colon cancer (colorectal cancer) begins in the large intestine (colon) or rectum. It typically starts as small, benign clumps of cells called polyps that can become cancerous over time. Early detection through screening is crucial for successful treatment.

Symptoms of colon cancer may include:

• Changes in bowel habits (diarrhea, constipation, or change in stool consistency)
• Rectal bleeding or blood in stool
• Persistent abdominal discomfort (cramps, gas, or pain)
• Feeling that the bowel doesn’t empty completely
• Weakness or fatigue
• Unexplained weight loss
• Abdominal pain
• Nausea and vomiting

Military service can contribute to colon cancer through various factors:

• Exposure to contaminated water (such as at Camp Lejeune)
• Environmental exposures
• Radiation exposure
• Stress and lifestyle factors

Service Connection for Colon Cancer

There are several ways to establish service connection for colon cancer:

VA Disability Ratings for Colon Cancer

Colon cancer is rated under 38 CFR § 4.115b using the appropriate diagnostic code for the location and extent of the cancer. The VA generally provides a 100% disability rating during active treatment and for a period after treatment completion.

Stage/Status	Rating
Active cancer or during treatment	100%
Post-treatment remission	100% for 6 months after treatment completion, then re-evaluated
Residuals after treatment	Rated based on residual symptoms and complications

Evidence Needed for Colon Cancer Claims

To support your colon cancer claim, gather the following evidence:

Tips for Successful Colon Cancer Claims

• Highlight Presumptive Exposures: If you served at Camp Lejeune or were exposed to radiation, emphasize this for presumptive service connection.
• Document All Treatments: Keep comprehensive records of all cancer treatments and their side effects.
• Address Residual Effects: Document any ongoing complications or residual effects from cancer or treatment.
• Work with Oncology Team: Ensure your oncology team understands the need for thorough documentation for VA purposes.
• Consider Multiple Ratings: You may be eligible for separate ratings for the cancer itself and for residual conditions like colostomy or bowel dysfunction.

Other Digestive Conditions

In addition to the major digestive conditions covered above, there are several other gastrointestinal conditions that may be service-connected:

Inflammatory Bowel Disease (IBD)

• Crohn’s Disease: Chronic inflammatory condition affecting any part of the digestive tract
• Ulcerative Colitis: Chronic inflammatory condition affecting the colon and rectum

Liver and Gallbladder Conditions

• Hepatitis: Inflammation of the liver, which may be caused by exposure to contaminated water or vaccines
• Gallbladder Disease: Including gallstones and cholecystitis
• Liver Disease: Various forms of liver damage or dysfunction

Pancreatic Conditions

• Pancreatitis: Inflammation of the pancreas
• Pancreatic Cancer: May be related to certain exposures

Esophageal Conditions

• Barrett’s Esophagus: Changes in the esophageal lining, often related to GERD
• Esophageal Cancer: May be related to radiation exposure

Surgical Conditions

• Colostomy/Ileostomy: Surgical openings for waste elimination
• Short Bowel Syndrome: Malabsorption due to surgical removal of intestine
• Adhesions: Scar tissue formation after abdominal surgery

Functional Disorders

• Gastroparesis: Delayed stomach emptying
• Chronic Constipation: Persistent difficulty with bowel movements
• Fecal Incontinence: Inability to control bowel movements

For any digestive condition not specifically covered in this guide, the general principles of service connection and rating still apply. Work with qualified medical professionals and veterans’ advocates to ensure your claim is properly documented and submitted.

Many digestive conditions can be rated under multiple diagnostic codes depending on the specific symptoms and complications present. The VA will typically use the diagnostic code that provides the highest rating that accurately reflects your condition.