VA Disability Benefits for GERD Secondary to PTSD

What is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a mental health condition that can occur in people who have experienced or witnessed a distressing, shocking, or otherwise traumatic event.  Oftentimes, veterans experience PTSD stemming from their military service.

Symptoms of PTSD:

• Re-experiencing the trauma through recurrent memories, flashbacks, and nightmares
• Avoidance of people, places, and activities that are reminders of the trauma
• Increased arousal such as difficulty sleeping and concentrating
• Hypervigilance
• Irritable or aggressive behavior
• Difficulty maintaining relationships with others

What is GERD?

Gastroesophageal Reflux Disease (GERD) is a digestive disorder characterized by the flow of stomach acid back up the esophagus from the stomach, which causes discomfort and inflammation.  GERD is often caused by frequent episodes of acid reflux.  There is a sphincter located at the bottom of the esophagus which allows food to pass down into the stomach and prevents it from traveling back into the esophagus.  When the sphincter is weak, stomach acid can travel back into the esophagus.

Symptoms of GERD:

• Nausea
• Vomiting
• Heartburn
• Difficulty breathing
• Coughing
• Painful swallowing
• Chest pain
• Stomachaches or other abdominal pain

Relationship Between GERD and PTSD

The symptoms of PTSD often cause the body to operate in a state of hyperarousal, or hypervigilance.  Anxiety, stress, depression, and a perpetual state of hyperarousal can cause the stomach to overproduce stomach acid.  Additionally, some medication which may be used to treat PTSD or manage PTSD symptoms can also increase acid reflux and lead to GERD.

Veterans who are service connected for PTSD can receive secondary service connection VA disability benefits for their GERD, if the GERD was caused or aggravated by PTSD.

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How to File a Claim for GERD Secondary to PTSD

Typically, to establish direct service connection, a veteran must demonstrate three things:

• A current, diagnosed condition;
• An in-service event, injury, or illness; and
• A nexus (i.e., link) between the diagnosed condition and the in-service event.

Both GERD and PTSD may be granted service connection on a primary basis if VA decides that these elements are met.  However, due to the relationship between the two conditions, veterans have an alternative path to service connection known as secondary service connection.

To file for secondary service connection, the criteria the veteran needs to fulfill differs slightly than for direct service connection.  Usually, veterans will need to demonstrate the following to be granted secondary service connection:

• A current diagnosis of the secondary injury, illness, or disability; and
• Medical evidence showing a link between your service-connected PTSD and GERD.

Filing a claim for secondary service connection follows the same process as filing a claim for direct service connection.  Veterans should fill out and submit VA Form 21-526EZ.  Veterans may do so online using the eBenefits portal, in person at their local Regional Office, or with help from an accredited veterans’ advocate or attorney.

VA Ratings for GERD and PTSD

Even if a veteran’s GERD is secondary service connected to their TPSD, the ratings they receive for their GERD will be paid at the same rate they would be if the GERD was service connected on a direct basis.  Below are the rating criteria for both GERD and PTSD.

VA Ratings for GERD

Veterans can be rated at 0, 10, 30, 50, or 80 percent, depending on the severity of GERD symptoms.

• 80 percent – “Documented history of recurrent or refractory esophageal esophageal stricture(s) causing dysphagia with at least one of the symptoms present:

• • aspiration
  • undernutrition, and/or
  • substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction or percutaneous esophagogastrointestinal tube (PEG tube)”

• 50 percent – “Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following:

• • dilatation 3 or more times per year, or
  • dilatation using steroids at least one time per year, or
  • esophageal stent placement”’

• 30 percent – “Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year”
• 10 percent – “Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic”
• 0 percent – “Documented history without daily symptoms or requirement for daily medications”

VA Ratings for PTSD

Ratings range from 0, 10, 30, 50, 70, and 100% based on:

• The level of social and occupational impairment, and
• The frequency, duration, and severity of the symptoms listed in the criteria.

Below are the criteria outlined for each rating.  However, veterans do not need to experience all symptoms in a particular rating in order to qualify for that rating.

100%–Total occupational and social impairment, due to such symptoms as:

• Gross impairment in thought processes or communication;
• Persistent delusions or hallucinations;
• Grossly inappropriate behavior;
• Persistent danger of hurting self or others;
• Intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene);
• Disorientation to time or place;
• Memory loss for names of close relatives, own occupation, or own name.

70%–Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as:

• Suicidal ideation;
• Obsessional rituals which interfere with routine activities;
• Speech intermittently illogical, obscure, or irrelevant;
• Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively;
• Impaired impulse control (such as unprovoked irritability with periods of violence);
• Spatial disorientation; neglect of personal appearance and hygiene;
• Difficulty in adapting to stressful circumstances (including work or a work-like setting);
• Inability to establish and maintain effective relationships.

50%–Occupational and social impairment with reduced reliability and productivity due to such symptoms as:

• Flattened affect;
• Circumstantial, circumlocutory, or stereotyped speech;
• Panic attacks more than once a week;
• Difficulty in understanding complex commands;
• Impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks);
• Impaired judgment;
• Impaired abstract thinking;
• Disturbances of motivation and mood;
• Difficulty in establishing and maintaining effective work and social relationships.

30%–Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as:

• Depressed mood;
• Anxiety;
• Suspiciousness;
• Panic attacks (weekly or less often);
• Chronic sleep impairment;
• Mild memory loss (such as forgetting names, directions, recent events).

10%–Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

0%–A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning OR to require continuous medication.

TDIU with GERD Secondary to PTSD

Total disability based on individual unemployability (TDIU) is a monthly benefit that compensates veterans who are unable to gain or maintain substantial employment because of their service-connected disabilities.  TDIU compensates veterans at the 100 percent rating level, even if their combined rating does not equal 100 percent.

VA outlines TDIU regulations under 38 CFR § 4.16, which includes subsections (a) and (b).  In order to qualify for TDIU under 38 CFR § 4.16(a), or schedular TDIU, a veteran must have:

• One service-connected condition rated at 60% or higher; or
• Two or more service-connected conditions, one of which is rated at 40% or higher, with a combined rating of 70% or higher.

Importantly, both ratings for GERD and PTSD can contribute to the veteran’s overall combined rating.  For example, a veteran may be eligible for schedular TDIU if they receive a 60 percent rating for PTSD and a 10 percent rating for GERD.  This would place the veteran at a 70 percent overall combined rating, making them eligible for TDIU.

Veterans who do not meet the schedular requirements under 38 CFR § 4.16(a) may still be considered for extraschedular TDIU under § 4.16(b).

Need Help with Your Secondary Service Connection for GERD Secondary to PTSD?

VA disability benefits claims for GERD secondary to PTSD can be complicated by a number of factors.  Oftentimes, veterans have difficulty becoming service connected for PTSD because of the frequency with which veterans suffering from the condition do not report their symptoms.

If you need assistance establishing secondary service connection for your GERD secondary to PTSD, help is available.  CCK has helped veterans win their cases for secondary service connection and our experienced team of veterans’ advocates may be able to build your case for appeal.  Contact our office today for a free case evaluation.