GERD C&P Exam Prep

Symptom Frequency Assessment

What it measures: How often GERD symptoms occur and whether they are daily, intermittent, or controlled with medication

What to expect: The examiner will ask how many days per week or month you experience heartburn, regurgitation, chest discomfort, or other GERD symptoms. They will ask whether symptoms occur with or without medication.

Pain considerations: Accurately describe the character of discomfort - burning, pressure, sharp chest pain - and note whether it interferes with sleep, eating, or daily activities.

Dysphagia (Swallowing Difficulty) Evaluation

What it measures: The presence, frequency, and severity of difficulty swallowing solids or liquids, and whether it requires daily medication or dilation procedures

What to expect: The examiner will ask whether you experience food getting stuck, painful swallowing, or the need to eat slowly or avoid certain foods. They will ask about any history of esophageal strictures or dilation procedures.

Pain considerations: Describe any pain associated with swallowing (odynophagia) as distinct from the mechanical difficulty of dysphagia. Both are relevant to the examiner's assessment.

Nutritional Status Assessment

What it measures: Whether GERD has resulted in substantial weight loss, undernutrition, or the need for modified feeding methods

What to expect: The examiner may review your weight history and ask whether you have lost weight due to difficulty eating, pain after meals, or food avoidance. They will assess whether tube feeding or TPN has ever been required.

Pain considerations: Discomfort or pain within an hour of eating (postprandial pain) that discourages eating is directly relevant to the rating criteria and should be clearly communicated.

Diagnostic Study Review

What it measures: Results of EGD (esophagogastroduodenoscopy), barium swallow, pH monitoring, CT scan, MRI, manometry, and laboratory tests (CBC, hemoglobin, hematocrit) as they relate to GERD severity

What to expect: The examiner will review available diagnostic study results. They will document findings from endoscopy, imaging, and lab work. If recent studies are not in your records, the examiner may note their absence.

Pain considerations: Not directly applicable for diagnostic studies, but ensure the clinical indication for each study - driven by your symptoms - is reflected in the records the examiner reviews.

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

From 38 CFR: Under DC 7346 applied to GERD via 38 CFR 4.114, the 60% level requires symptom combinations that produce severe impairment of health, including significant weight loss, anemia from GI involvement, or frequent vomiting with hematemesis or melena.

30%

Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health

From 38 CFR: Under DC 7346 at the 30% level, symptoms of persistent pyrosis, dysphagia, and regurgitation must be accompanied by pain patterns (substernal, arm, or shoulder) and must produce considerable impairment of health. Daily medication requirement is a critical marker at this level.

10%

With two or more of the symptoms for the 30-percent evaluation of less severity

From 38 CFR: The 10% rating requires two or more symptoms from the 30% criteria but at lesser severity. This is the minimum compensable rating for GERD under DC 7346 when symptoms are present but do not rise to the level of considerable impairment of health.

0%

Symptoms controlled by continuous medication without daily symptoms, or asymptomatic following surgical correction

From 38 CFR: A 0% (noncompensable) rating is assigned when symptoms are completely controlled by medication without daily symptoms, or when the veteran is postoperatively asymptomatic. This is still a valid service-connected rating and preserves future rating increases if symptoms worsen.

Heartburn and Pyrosis

How to describe it: Describe the burning sensation rising from your stomach into your chest or throat accurately - including how many days per week it occurs, how long each episode lasts, what triggers it (meals, lying down, bending over, stress, certain foods), and whether it wakes you from sleep. Note whether it occurs despite taking your prescribed medications.

Example: On my worst days, I wake up at 2 or 3 in the morning with severe burning from my stomach up through my chest and into my throat. It lasts for one to two hours, and I cannot go back to sleep. I prop myself up with pillows but the burning continues. I take my medication every morning but I still have breakthrough heartburn four to five days a week.

Examiner listens for: Frequency (daily vs. intermittent), severity (mild discomfort vs. severe burning), whether symptoms break through medication, nocturnal symptoms, and any associated chest pain that could indicate substernal involvement qualifying for the 30% level.

Avoid: Do not say 'I just have a little heartburn' or 'my medication mostly controls it' if you still experience regular breakthrough symptoms. Report accurately whether symptoms occur despite medication - this distinction directly affects your rating level.

Regurgitation

How to describe it: Accurately describe how often stomach contents or acid come back up into your mouth or throat - separate from vomiting. Note whether it happens after meals, when bending over, or when lying flat. Describe the frequency (daily, weekly), the taste (acid or bile), and whether it causes choking or coughing.

Example: Several times a week, acid comes back up into my throat and mouth after eating - especially if I eat anything larger than a small snack. I have had to spit it out while at work. At night, I sometimes choke on acid that comes up while I am sleeping, which wakes me up coughing and gasping.

Examiner listens for: Whether regurgitation is a separate, documented symptom from heartburn; its frequency and relationship to eating and posture; and whether it causes aspiration events such as coughing, choking, or episodes of aspiration pneumonia.

Avoid: Do not conflate regurgitation with vomiting without distinguishing them - they are separate symptoms. Do not minimize regurgitation as 'just a little acid' if it occurs regularly and disrupts your daily function or sleep.

Dysphagia (Difficulty Swallowing)

How to describe it: Describe accurately which foods or liquids are difficult to swallow, how often swallowing difficulty occurs, whether food gets stuck in your throat or chest, and whether you have changed your diet to avoid foods that cause problems. Note whether you take medication specifically to help you swallow.

Example: On bad days, I cannot swallow solid food without it getting stuck mid-chest. I have to drink large amounts of water to push food down, and sometimes it comes back up. I have stopped eating bread, meat, and raw vegetables because they consistently get stuck. I take my medication daily but still struggle with anything that is not soft or liquid.

Examiner listens for: Whether dysphagia requires daily medication to control - a specific checkbox on the DBQ. Whether there is a documented history of esophageal strictures. Whether dilation procedures have been performed and how frequently. Whether the veteran has modified their diet significantly due to swallowing difficulty.

Avoid: Do not say 'I can still eat, it is just a little harder' if you have eliminated major food categories, take daily medication for dysphagia, or have had dilation procedures. These are significant findings that belong clearly on the record.

Substernal and Referred Pain

How to describe it: Accurately describe chest pain, pressure, or discomfort that is located behind the breastbone (substernal), or that radiates to your arm, shoulder, neck, or jaw. Note that this pain is related to your GERD, not cardiac in origin (if confirmed by prior workup). Describe its frequency, intensity, and relationship to meals or reflux episodes.

Example: After eating, I often have a deep pressure in the center of my chest that sometimes spreads to my left shoulder and arm. It lasts anywhere from thirty minutes to a couple of hours. My cardiologist has evaluated me and confirmed it is not cardiac - it is related to my GERD. It happens three to four times a week and stops me from doing yard work or lifting at work.

Examiner listens for: The presence of substernal pain or pain radiating to the arm or shoulder is a specific qualifying symptom for the 30% rating level under DC 7346. This symptom must accompany pyrosis, dysphagia, and regurgitation. Clear documentation of this pain pattern is critical.

Avoid: Do not fail to report chest, arm, or shoulder pain associated with GERD episodes simply because it sounds like a cardiac complaint. If prior cardiac workup was negative and the pain is attributed to GERD by your providers, communicate this clearly to the examiner.

Nausea and Vomiting

How to describe it: Describe how frequently you experience nausea and vomiting related to your GERD. Note whether nausea is managed by medication. For vomiting, report the frequency (daily, weekly, monthly), whether it is controlled or uncontrolled by medication, and whether you have ever vomited blood (hematemesis).

Example: I feel nauseated almost every morning before eating. A few times a month I vomit after meals, especially larger ones. My doctor prescribed an anti-nausea medication but I still have breakthrough nausea daily. I have never vomited blood, but I have noticed dark material once or twice which my gastroenterologist noted in my records.

Examiner listens for: Frequency and severity of vomiting; whether managed by medication; presence of hematemesis or melena which are critical findings at the 60% level. Nausea frequency and whether daily medication is required to manage it.

Avoid: Do not underreport vomiting frequency. If you vomit more than the examiner's initial impression suggests, correct the record politely but firmly. Hematemesis and melena must be explicitly reported if they have ever occurred - these are objective markers for the highest rating tier.

Functional and Occupational Impact

How to describe it: Accurately describe how GERD symptoms affect your ability to work, maintain social activities, sleep, and complete daily tasks. The examiner will complete a functional impact section of the DBQ. This section directly supports the 'impairment of health' language in the rating criteria.

Example: Because of my GERD, I cannot work a full shift without taking multiple breaks for symptoms. I have missed work days due to severe reflux episodes and vomiting. I cannot attend social meals without anxiety about symptoms. I sleep on a wedge pillow and still wake up three to four nights a week. I have stopped exercising because physical activity triggers severe reflux.

Examiner listens for: Concrete examples of how symptoms disrupt employment, sleep, nutrition, and social functioning. The DBQ asks specifically about functional impact of each condition - vague or minimal descriptions result in inadequate documentation of the 'impairment of health' standard required for higher ratings.

Avoid: Do not give a general answer like 'it affects my daily life.' Give specific examples: missed workdays, modified job duties, foods eliminated, social events avoided, sleep disruption frequency, and any formal accommodations requested at work.