Digestive system
VA rating for GERD, diagnostic code 7206
Until 19 May 2024 there was no diagnostic code for gastroesophageal reflux disease anywhere in the schedule. There is now. Code 7206 sits in 38 CFR 4.114 with five evaluations at 0, 10, 30, 50 and 80 percent, and every one of them is built on documented esophageal stricture.
Published 2026-08-21. Last updated 2026-08-24. Written and reviewed under Veteran Health Network's institutional review process.
What each level requires
GERD is rated under diagnostic code 7206, which the schedule calls "Gastroesophageal reflux disease", at 38 CFR 4.114.
80 percent requires
In plain English
A documented history of recurrent or refractory esophageal stricture causing difficulty swallowing, with at least one of aspiration, undernutrition or substantial weight loss as defined in 38 CFR 4.112(a), and treatment by either surgical correction of the stricture or a PEG tube.
As written in 38 CFR 4.114
Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube)
50 percent requires
In plain English
A documented history of recurrent or refractory stricture causing difficulty swallowing, needing at least one of dilatation three or more times a year, dilatation using steroids at least once a year, or a stent.
As written in 38 CFR 4.114
Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement
30 percent requires
In plain English
A documented history of recurrent stricture causing difficulty swallowing, needing dilatation no more than twice a year.
As written in 38 CFR 4.114
Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year
10 percent requires
In plain English
A documented history of stricture requiring daily medication to control difficulty swallowing, and otherwise no symptoms. Daily medication appears here and nowhere higher.
As written in 38 CFR 4.114
Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic
0 percent requires
In plain English
A documented history with no daily symptoms and no need for daily medication.
As written in 38 CFR 4.114
Documented history without daily symptoms or requirement for daily medications
Notes the schedule attaches to this code
These are part of the regulation and they change how the criteria above are applied. They are reproduced word for word.
- Note (1): Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy.
- Note (2): Non-gastrointestinal complications of procedures should be rated under the appropriate system.
- Note (3): This diagnostic code applies, but is not limited to, esophagitis, mechanical or chemical; Mallory Weiss syndrome (bleeding at junction of esophagus and stomach due to tears) due to caustic ingestion of alkali or acid; drug-induced or infectious esophagitis due to Candida, virus, or other organizm; idiopathic eosinophilic, or lymphocytic esophagitis; esophagitis due to radiation therapy; esophagitis due to peptic stricture; and any esophageal condition that requires treatment with sclerotherapy.
- Note (4): Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved.
- Note (5): Refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.
Regulation text reproduced from 38 CFR 4.114, read on 2026-08-21. Read the section at the eCFR. Part 4 is amended on a rolling schedule, so the date above is the date this text was checked and not the date it was written.
This code is younger than most of the advice about it
Derived from the regulation
GERD had no diagnostic code of its own for the whole history of the schedule until the digestive system was rewritten.
Its entire row in Appendix A to Part 4 reads "Added May 19, 2024."
The Federal Register line under 4.114 belongs to the digestive section rather than to 7206, and its last date is March 2024: 29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40 FR 42540, Sept. 15, 1975; 41 FR 11301, Mar. 18, 1976; 66 FR 29488, May 31, 2001; 89 FR 19743, Mar. 20, 2024. It dates the whole digestive section rather than 7206, and it was read on 2026-08-21.
What the current criteria actually measure
Derived from the regulation
Every level of code 7206 begins with the same three words: documented history of. What follows is esophageal stricture, and the levels are separated by what the stricture requires by way of treatment.
At 10 percent the criterion is "Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic". At 30 percent it becomes recurrent stricture needing dilatation no more than twice a year. At 50 percent it is dilatation three or more times a year, or dilatation using steroids at least annually, or a stent.
Heartburn frequency, dietary restriction and daily proton pump inhibitor use appear nowhere in the criteria except through that 10 percent clause about daily medication to control dysphagia. The code asks about swallowing, not about reflux.
Note (1) to the code then names the evidence it expects: findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy.
Where GERD used to be rated, and what happened to that code
Derived from the regulation
The same 2024 revision emptied diagnostic code 7346, hiatal hernia, of its criteria. What stands there now is a one-line instruction to rate as stricture of the esophagus under diagnostic code 7203.
Diagnostic code 7203 and diagnostic code 7206 carry criteria that read almost identically, which is why the two paths converge in practice.
The practical consequence for anyone comparing an old decision letter against a current one: a rating assigned under 7346 before May 2024 was assigned under criteria that no longer appear in the regulation at all.
Questions
Why do the criteria talk about esophageal stricture rather than reflux?
Because that is what the regulation says. Diagnostic code 7206 was written around documented stricture and the treatment it requires, and every one of its five levels opens with that requirement.
See every level beside the regulation it comes from
The rating threshold cheatsheet shows all of the levels for GERD in one view, plain English on the left and the regulation itself on the right, in a layout built to print.
It is free and it never says which level anyone meets. It describes what each one requires and leaves the reading to the person whose record it is.
Sources
- 38 CFR 4.114, Schedule of ratings, digestive system (Electronic Code of Federal Regulations)
- 38 CFR 4.112, Weight loss (Electronic Code of Federal Regulations)
- Appendix A to Part 4, Table of Amendments and Effective Dates Since 1946 (Electronic Code of Federal Regulations)
Accuracy owner Brayden Marley. Part 4 is amended on a rolling schedule, so the retrieval date above is what this page is accurate as of.