VA Disability Benefits for IBS and GERD
What is IBS?
Irritable Bowel Syndrome (IBS) is a chronic condition affecting the large intestine. IBS is best classified as a functional gastrointestinal disorder, or a disorder of the gut-brain interaction. People with this condition may experience gut sensitivity and other symptoms affecting the bowels.
The exact cause of IBS is unknown, but the condition affects many veterans. As of 2020, almost 150,000 veterans are service connected for irritable bowel syndrome.
Symptoms of IBS
- Stomach cramping
Types of IBS
There are a few types of IBS, as the condition can affect individuals in different ways:
- IBS-C—IBS C, or IBS with constipation, means a person faces abnormal bowel movements with constipation.
- IBS-D— IBS D, or IBS with diarrhea, means a person faces abnormal bowel movements with diarrhea.
- IBS-M—IBS M, or IBS with mixed symptoms, means a person faces abnormal bowel movements with both constipation and diarrhea.
What is GERD?
GERD, or Gastroesophageal Reflux Disease, is a digestive disorder characterized by the occurrence of stomach acid flowing back up the esophagus from the stomach, causing discomfort and inflammation. GERD can typically be managed through lifestyle and diet changes, however, some may need medication to control their condition.
GERD is caused by frequent episodes of acid reflux. At the bottom of the esophagus, there is a sphincter that allows food to pass down into your stomach and prevents it from traveling back up your esophagus. When this sphincter is weak, stomach acid can travel up your esophagus. Common symptoms can include heartburn, difficulty swallowing, regurgitation, and chest pain.
Symptoms of GERD:
- Difficulty breathing
- Painful swallowing
- Chest pain
- Stomachaches or other abdominal pain
What is the Connection Between IBS and GERD?
Both IBS and GERD are common conditions that affect the gastrointestinal tract. A study published in 2010 found that nearly 64 percent of patients in the study who were diagnosed with IBS were also diagnosed with gastroesophageal reflux disease. Additionally, nearly 34 percent of patients with GERD also had IBS. The study also found that women were more likely to experience both GERD and IBS at the same time than men were.
Many symptoms of IBS and GERD overlap, meaning people who experience both conditions likely face an increased risk of symptoms like vomiting, nausea, and stomach aches.
In the 2020 Annual Benefits Report released by VA, IBS was the third most common digestive disorder among all service-connected veterans who receive VA disability benefits. While IBS is a functional gastrointestinal disorder, meaning it is a disorder of the gut-brain interaction, GERD is not considered to be a disorder of the gut-brain interaction, according to the International Foundation for Functional Gastrointestinal Disorders.
VA Service Connection for IBS and GERD
In order to receive VA disability benefits for any condition, veterans will typically need to establish service connection. To do this, veterans should submit the following three things to VA:
- An in-service event, injury, or illness;
- A current diagnosis by a medical professional; and
- A medical nexus, or link, between your in-service event, injury, or illness and your current diagnosis.
VA Disability Ratings for GERD
VA rates GERD as analogous to other digestive disorders because it does not have its own rating criteria. Analogous ratings are used when a certain condition is not specifically listed in VA’s Schedule of Rating Disabilities. If a condition is not explicitly listed, VA will rate that condition under the diagnostic code for a condition that it is closest to, or that requires the same treatment.
Typically, GERD is rated analogous to a hiatal hernia under 38 C.F.R. 4.114 diagnostic code 7346. Ratings under diagnostic code 7346 range from 10 to 60 percent disabling and depend on the presence and severity of a variety of symptoms. The requirements for each are as follows:
- For a 10 percent rating, a veteran must present with “two or more symptoms of the 30 percent evaluation of less severity.”
- A 30 percent rating requires “persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm and shoulder pain, productive of considerable impairment of heath.”
- A 60 percent rating requires “symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health.”
VA Disability Ratings for IBS
VA rates Irritable Bowel Syndrome under 38 C.F.R. 4.114, Diagnostic Code 7319 for Irritable Colon Syndrome (spastic colitis, mucous colitis, etc.). VA characterizes IBS as mild, moderate, or severe under the rating criteria and includes symptoms to help figure out which rating a veteran’s IBS falls under.
Below are the criteria for each rating given for IBS:
- 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
Can Veterans File for Both IBS and GERD?
If a veteran is not currently service connected for either GERD or IBS, but has been diagnosed with both conditions, they can file for both at the same time. Veterans may also wish to submit a lay statement to outline how the symptoms affect them on a day-to-day basis, what medications they take to manage their symptoms, or what lifestyle changes have become necessary. VA will then assess both claims.
If warranted, VA will award service connection and issue a disability rating for whichever condition warrants a higher rating. For example, if the veteran’s IBS only warranted a 30 percent rating, but their GERD symptoms warranted a 60 percent rating, then VA should rule in the veteran’s favor and grant a 60 percent rating for GERD.
In some instances, VA may also take into consideration the symptoms of both conditions and give a rating under one GI condition. An example of this would be if VA granted a 60 percent rating for GERD with IBS symptoms.
However, it is important to understand that VA will not give two separate ratings for both IBS and GERD. This is because these conditions present with similar symptoms, and both affect the digestive system. Awarding two separate ratings for IBS and GERD would be considered an example of pyramiding.
TDIU With IBS and GERD
Any VA rating can contribute to a veteran’s eligibility for TDIU. TDIU, or Total disability based on individual unemployability (TDIU), is a disability benefit available to veterans who are unable to obtain or maintain work on account of their disabilities. TDIU compensates veterans at the 100 percent pay rate, even if their combined disability rating may be less than that.
There are generally two pathways to TDIU:
- For schedular TDIU, veterans must meet the criteria listed under 38 CFR § 4.16a. The criteria stipulate that veterans must have one condition rated at 60 percent minimum OR two conditions that can be combined to reach 70 percent, where one condition is at a minimum of 40 percent.
- Veterans who do not meet these qualifications may be eligible for extraschedular TDIU. For this form of TDIU, veterans must prove that their condition(s) uniquely hinders their ability to maintain substantially gainful employment. Extraschedular TDIU is rated under 38 CFR § 4.16b.
Getting Accredited Representation for IBS or GERD Benefits
If you need assistance filing a claim or appealing a denial of benefits, the accredited representatives at Chisholm Chisholm & Kilpatrick may be able to help. Our veterans’ advocates have helped veterans with their appeals for both IBS and GERD benefits. Contact our office today for a free case evaluation.
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