VA Disability Ratings for Eosinophilic Esophagitis

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What Is Eosinophilic Esophagitis?

Eosinophilic esophagitis is a chronic allergic condition affecting the esophagus. The esophagus is a tube-like organ that is part of the digestive system to pass food from the mouth to the stomach. People with this condition have large numbers of white blood cells, or eosinophils, in the inner lining of the esophagus.

Symptoms of Eosinophilic Esophagitis

Eosinophils can cause inflammation in the esophagus, as well as decreased appetite, abdominal pain, vomiting, and difficulty swallowing. Eosinophilic esophagitis may also cause food to get lodged in the esophagus, in some severe cases, as the esophagus narrows when inflamed. Food stuck in the esophagus can be a serious medical emergency and is sometimes called “food impaction.”

Diagnosing Eosinophilic Esophagitis

Typically, an upper endoscopy and biopsies are necessary to diagnose eosinophilic esophagitis. There is a significant link between eosinophilic esophagitis and allergic disorders.

Most people who are diagnosed have one or more allergic disorders. Allergic disorders associated with eosinophilic esophagitis include asthma, allergic rhinitis, eczema, and food allergies. Exposure to environmental allergies, such as pollens, animals, dust mites, and mold could also worsen the condition.

One of the main causes of eosinophilic esophagitis is adverse immune responses to food. People may get hives and vomit within minutes of eating certain foods. Allergy tests can determine some triggers, however, conventional tests often don’t detect food sensitivities that cause eosinophilic esophagitis.

Treating Eosinophilic Esophagitis

Some forms of diets may be used to help limit symptoms of eosinophilic esophagitis. These diets can include:

• Food test-directed elimination diets—Removing specific food sensitivities from one’s diet once the sensitivities have been determined
• Empiric elimination diets—Empiric elimination diets can be used to eliminate major food allergens, such as dairy, wheat, soy, nuts, and shellfish. The foods can then be added back one at a time to determine which specific food allergen is contributing to the eosinophilic esophagitis.
• Elemental diets—This strict elimination diet removes all sources of allergens from the person’s diet. Someone on this diet will get their nutrition from an amino acid formula or one to two simple foods that are unlikely to trigger eosinophilic esophagitis

Currently, there is no medication approved by the U.S. FDA to treat eosinophilic esophagitis.

VA Service Connection for Eosinophilic Esophagitis

To establish service connection for eosinophilic esophagitis, veterans will typically need three things:

• A current diagnosis of eosinophilic esophagitis
• An in-service event or stressor—To prove an in-service event, veterans might use service treatment records, as they will have documented any injury or illness, if it was treated during active duty. If the veteran’s condition was caused by exposure, they may also want to submit a lay statement indicating how they were exposed.
• A medical nexus between the eosinophilic esophagitis and the in-service event—A statement from a qualified health care professional affirming that they believe your condition was “at least as likely as not” caused by your military service can serve as a medical nexus.

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Secondary Service Connection

A person with an allergic disorder may be more susceptible to developing eosinophilic esophagitis. As such, veterans who are already service-connected for an allergic disorder, such as asthma or eczema, may be able to establish secondary service connection if it was caused or aggravated by the allergic disorder.

To establish secondary service connection for eosinophilic esophagitis, the veteran will generally need to submit the following to VA:

• A current diagnosis
• Medical evidence showing the relationship between their allergic disorder and eosinophilic esophagitis

VA Disability Ratings and Benefits for Eosinophilic Esophagitis

Eosinophilic esophagitis is rated under 38 CFR § 4.114, Schedule of Ratings – Digestive System, Diagnostic Code (DC) 7203. Below are the criteria for each rating:

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

  • • 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 that requires dilatation no more than two 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”

Compensation and Pension (C&P) Exams for Eosinophilic Esophagitis

When a claim for eosinophilic esophagitis is filed, whether for primary or secondary service connection, VA will often request a compensation and pension exam (C&P).

C&P exams are performed to determine if service connection is warranted and gather evidence to determine a rating if service connection is granted. They are usually performed by a VA examiner or VA-contracted examiner. The exam may include a physical examination or an interview where the examiner asks questions regarding the veteran’s service or condition.

It is important to attend any C&P exams VA requests, even if they request two: one for the allergic disorder and one for eosinophilic esophagitis. Though the exams may seem redundant, it is crucial that the veteran attends because VA may deny the claim if they do not. If the veteran must miss a C&P exam, they should contact VA as soon as possible to reschedule.

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VA Individual Unemployability (TDIU)

Veterans with severe eosinophilic esophagitis may be prevented from working or maintaining employment because of their condition. Veterans in this situation do have benefits available to them.

TDIU is a monthly benefit that compensates veterans at the 100 percent rate, regardless of their actual combined rating.

There are generally two ways that a veteran’s eosinophilic esophagitis may qualify for TDIU:

1. 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 is at least 40 percent. With eosinophilic esophagitis, a veteran may be eligible if they are awarded the 60 percent rating OR if their rating for eosinophilic esophagitis helps them reach a combined rating of 70 percent.
2. Veterans who do not meet these qualifications may be eligible for extraschedular TDIU. For this, 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.

Get Help With Your Denied VA Disability Claim

Veterans seeking VA disability compensation for eosinophilic esophagitis can benefit from accredited representation. Several factors complicate benefits for this condition. It does not have its own diagnostic code and must be rated analogously to other conditions, and it is often secondary to allergic disorders.

If you need accredited representation to help you through your appeal for VA benefits for eosinophilic esophagitis, CCK may be able to help. We have helped many veterans pursue the benefits they may be entitled to. Call for a free case evaluation at 800-544-9144.