GERD & IBS VA Claim Field Manual
The VA rewrote the rules for GERD and IBS claims in May 2024—and most veterans don't know they can now claim both conditions separately. This playbook shows you how to document stricture evidence for DC 7206, stack IBS symptoms for DC 7319, and prove the gut-brain connection if you're claiming secondary to PTSD.
About 20% of Iraq and Afghanistan veterans develop gastrointestinal disorders, and veterans with PTSD are twice as likely to have GI problems as those without.1 If you're dealing with chronic heartburn, reflux, or unpredictable bowel issues, you're not alone—and you may be entitled to compensation.
Pair this playbook with the Claim Prep Checklist, keep a symptom log for at least 3 months, and gather nexus evidence that connects your GI condition to service or a service-connected disability like PTSD.
- Know the new criteria: GERD now requires documented esophageal stricture for ratings above 0% under DC 7206; IBS is rated on abdominal pain frequency plus secondary symptoms under DC 7319.
- Track your symptoms: IBS needs abdominal pain related to defecation plus 2+ secondary symptoms (stool changes, bloating, urgency) documented over 3 months to qualify for 10% or higher.
- Build the PTSD connection: if claiming secondary, your nexus letter must reference the gut-brain axis research showing how chronic stress affects stomach acid production and gut motility.
- Quote the right code: cite DC 7206 for GERD and DC 7319 for IBS—post-May 2024, these can be rated separately if symptoms don't completely overlap.
Key takeaways
- After May 19, 2024, veterans can receive separate ratings for GERD (DC 7206) and IBS (DC 7319)—most competitor content is outdated on this.
- GERD ratings above 0% require documented esophageal stricture confirmed by endoscopy, barium swallow, or CT; heartburn alone won't qualify for 10%+.
- IBS is a Gulf War presumptive condition under 38 CFR 3.317—no nexus required if you served in Southwest Asia after August 2, 1990.
Situation Brief
The VA overhauled digestive system ratings effective May 19, 2024. GERD moved to its own diagnostic code (DC 7206) with new stricture-based criteria, and IBS criteria (DC 7319) now focus on abdominal pain frequency and secondary symptoms. The biggest news: veterans can now claim both conditions separately instead of being forced into a single "predominant disability" rating. This playbook covers direct service connection, secondary to PTSD through the gut-brain axis, Gulf War presumptive for IBS, and secondary to medications—plus evidence strategies for each path.
Signals You Need This
- You have diagnosed GERD, IBS, or both, and your symptoms started during or were aggravated by active duty service.
- You're already service-connected for PTSD, anxiety, or depression and developed GI symptoms afterward—the gut-brain connection is medically established.
- You served in the Southwest Asia theater (Gulf War, Iraq, Afghanistan) and have functional GI symptoms that qualify for presumptive service connection.
- You take NSAIDs, opioids, or other medications for service-connected conditions that caused or worsened your GI problems.
Stay on Course
Start documenting symptoms now—don't wait for a C&P exam. The VA rates IBS based on symptom frequency over 3 months, so a consistent log is your best evidence. For GERD, get an endoscopy or barium swallow if you haven't had one recently; stricture documentation is now required for ratings above 0%.
- Request your service treatment records and look for any mention of heartburn, reflux, stomach pain, or GI complaints—these establish in-service incurrence.
- Get the right DBQ completed: VA Form 21-0960G-1 for GERD (esophageal conditions) and VA Form 21-0960G-3 for IBS (intestinal conditions).
- If claiming secondary to PTSD, ask your provider for a nexus letter referencing gut-brain axis research and how chronic stress affects your digestive system.
Keep your symptom log updated weekly. Include specific episodes, medications taken, foods avoided, and how symptoms affected work or daily activities.
Prep Checklist
Stage your evidence before filing—GI claims require specific documentation that many veterans miss.
- File an Intent to File (VA Form 21-0966) to lock your effective date while gathering evidence.
- Get the right DBQ completed: VA Form 21-0960G-1 for GERD/esophageal conditions, VA Form 21-0960G-3 for IBS/intestinal conditions.
- For GERD 10%+: get endoscopy, barium swallow, or CT documentation showing esophageal stricture—this is now required under DC 7206 Note 1.
- For IBS: maintain a symptom log for at least 3 months documenting abdominal pain frequency during defecation plus 2+ secondary symptoms (stool changes, bloating, urgency, mucus).
- For secondary claims: obtain a nexus letter stating your GI condition is "at least as likely as not" caused or aggravated by your service-connected condition (PTSD, medications, etc.).
- For Gulf War veterans claiming IBS: gather deployment records showing service in Southwest Asia theater on or after August 2, 1990—no nexus letter required for this presumptive path.
Keep digital copies of all evidence organized by condition (GERD vs. IBS) and service connection path (direct, secondary, presumptive). Label files with dates and what they prove.
Step-by-step playbook
- Lock in your intent date: Submit VA Form 21-0966 online or by mail to preserve your effective date while you gather medical evidence, symptom logs, and nexus letters.
- Get diagnostic documentation: For GERD: schedule endoscopy or imaging if you don't have recent results—stricture documentation is required for 10%+. For IBS: ensure your provider documents Rome IV criteria in your records.
- Build your symptom record: Track symptoms daily for at least 3 months. Note abdominal pain timing, stool changes, bloating, urgency, and how symptoms affect work and daily activities. This log directly maps to rating criteria.
- Establish service connection: Choose your path: direct (in-service event), secondary to PTSD/medications (nexus letter required), or Gulf War presumptive for IBS (deployment records only). Gather evidence specific to your path.
- Prepare for the C&P exam: Bring your symptom log, treatment records, and list of medications. Describe your worst days, not average days. Be specific about symptom frequency and how GI issues limit your activities.
The VA can rate GERD and IBS separately under the May 2024 rules—make sure your evidence clearly documents both conditions if you have them.
Evidence Arsenal
Build a three-part packet for each condition: diagnosis, service connection (nexus), and functional impact.
Documents to Gather
- Diagnostic imaging: endoscopy reports, barium swallow results, or CT scans documenting esophageal stricture (required for GERD 10%+) or other GI findings.
- Treatment records: gastroenterologist notes, medication history (PPIs, H2 blockers, antispasmodics), and procedure records (dilatation, stent placement).
- Service treatment records: any documentation of heartburn, reflux, stomach pain, GI complaints, or medication use (especially NSAIDs) during service.
- Symptom log: at least 3 months of daily/weekly entries documenting pain frequency, stool changes, foods avoided, missed work, and daily impact.
- Nexus letter (if secondary): provider opinion stating "at least as likely as not" with rationale referencing gut-brain axis for PTSD secondary or medication side effects.
- Lay statements: spouse, coworker, or buddy statements describing how your GI symptoms affect daily life, work attendance, and social activities.
Templates & Tools
- Lay statement templates for documenting symptom frequency and daily impact.
- Claim Prep Checklist to track DBQs, imaging, and nexus letters.
- 38 CFR § 4.114—the rating schedule for digestive conditions so you can quote criteria your evidence addresses.
- VA Disability Calculator to model combined ratings when GI conditions combine with PTSD or other disabilities.
Evidence tip: For IBS secondary to PTSD, reference published research: veterans with PTSD are 2.73x more likely to develop IBS than veterans without PTSD. Include PMC citations in your nexus letter request.
Intel & Tools
GI claims require consistent documentation over time—treat symptom logging like a standing watch.
- Symptom logging: use a daily or weekly log to track abdominal pain episodes, stool changes, and impact on activities. The VA rates IBS based on frequency over 3 months, so patterns matter more than single incidents.
- C&P exam prep: GI examiners will ask about symptom frequency, triggers, treatments tried, and daily limitations. Describe your worst flare-ups, not just average days. Bring your symptom log as backup.
- Monitor rating changes: if you were rated for GERD before May 19, 2024, you're grandfathered under the old criteria. The VA must apply whichever rules (old DC 7346 or new DC 7206) are more favorable to you.
- Secondary conditions to consider: GERD can lead to Barrett's esophagus, sleep apnea, chronic sinusitis, and dental erosion. IBS can aggravate hemorrhoids, depression, and migraines. Document these connections if applicable.
Update your symptom log before any VA appointment or exam. Consistent records over months are more persuasive than detailed accounts of single episodes.
Next Actions & Support
Stay Organized
- Maintain separate evidence folders for GERD and IBS—the VA can rate them separately now, so keep documentation distinct.
- Set calendar reminders to update your symptom log weekly and before any VA appointments.
- Request copies of all imaging and procedure reports from your gastroenterologist for your personal records.
Related Playbooks
- PTSD Playbook—if claiming GI conditions secondary to PTSD, understand how the primary condition affects your secondary claim.
- Secondary Condition Playbook—detailed guidance on nexus letters and proving aggravation.
- Supplemental Claim Playbook—if denied, add new evidence like endoscopy results or updated nexus letters.
Resources
GERD & IBS Claim FAQs
Can I get rated for both GERD and IBS separately?
Why can't I get 10% for GERD without a stricture?
How do I prove IBS is secondary to PTSD?
Is IBS a Gulf War presumptive condition?
What if my GERD was rated before May 2024?
What secondary symptoms count for IBS ratings?
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