Citation Nr: A25035653 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240530-444662 DATE: April 17, 2025 ORDER From July 27, 2023, an initial increased 60 percent rating for gastroesophageal reflux disease (GERD) is granted. FINDING OF FACT The probative evidence of record supports a finding that the Veteran's GERD causes symptomatology that is productive of severe impairment of health. CONCLUSION OF LAW The criteria for entitlement to an initial 60 percent rating for GERD have been met.?38 U.S.C. §§ 1155, 5107;?38 C.F.R. §§ 4.1, 4.3, 4.114, Diagnostic Code (DC) 7346. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2014 to October 2014. These matters come before the?Board of Veterans' Appeals?(Board) on appeal from a December 2023 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2023, the Veteran submitted a VA Form 10182 Notice of Disagreement (NOD), seeking?direct?review by a Veterans Law Judge (VLJ) under the Appeals Modernization Act (AMA). Under?Direct?Review, all evidence available at the time of the decision on appeal is considered.??? An initial increased 60 percent rating for gastroesophageal reflux disease (GERD) is granted. Legal Criteria Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in?38 C.F.R., Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations.?38 U.S.C. § 1155;?38 C.F.R. § 4.1. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned.?38 C.F.R. § 4.3. Separate diagnostic codes identify the various disabilities. See?38 C.F.R. Part 4. GERD is not specifically listed in the rating schedule; therefore, it is rated analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related, which in this case is "Hernia, hiatal." The criteria for evaluating diagnostic code (DC) 7346 for "Hernia, hiatal" (or GERD) shows as follows: A 10 percent rating is assigned "With two or more of the symptoms for the 30 percent evaluation of less severity."?38 C.F.R. § 4.114, DC 7346. A 30 percent rating is assigned if there is "Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health." A 60 percent rating is assigned if there are "Symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health." The rating code applicable to GERD does not?define?the terms "considerable" or "severe." However, the term "considerable" is?defined?by the dictionary as "large in extent or degree," and "severe" is?defined?as "very painful or harmful." Merriam-Webster's Collegiate Dictionary 267, 1140 (11th ed. 2012). The Board notes that the VA published amendments to 38 C.F.R. § 4.114, the Schedule of Ratings for the Digestive System, effective May 19, 2024. However, as the appeal period is prior to May 19, 2024, the amended Diagnostic Code for GERD (DC 7206) is not applicable. Factual Background The Veteran was afforded a February 2023 VA examination, during which the conducting examiner indicated that he shows signs and symptoms of pyrosis, reflux, and regurgitation. The Veteran reported that he started to experience burning, regurgitation, and mid sternal discomfort when he was taking over-the-counter pain medication. The Veteran further reported that he often wakes choking with a burning, regurgitation sensation in his throat. The Veteran reported that he experiences multiple symptoms of GERD, including heartburn with acid reflux, regurgitation of stomach contents into the throat, difficulty swallowing, and chest pain that radiates into the shoulder. The Veteran also reported that he suffers from upper abdominal pain, nausea, vomiting, frequent coughing, and nighttime choking due to regurgitation, which occurs weekly. The Veteran was prescribed Prilosec and avoids eating late in the day or at night, consuming large meals, or lying down soon after eating, as these actions worsen the regurgitation. See August 2023 statement in support of claim. The Veteran reported that when his GERD flares up, he experiences chest, arm, and shoulder pain. The Veteran noted that he requires multiple pillows to prop up his head to sleep but cannot sleep more than four consecutive hours due to being awakened by GERD symptoms. The Veteran explained that the lack of sleep leads to difficulty concentrating, daytime fatigue, mood changes, low sex drive, a depressed mood, frequent yawning, clumsiness, trouble staying on task, memory issues, and difficulty handling stressful situations. Id. The Veteran was afforded a November 2023 VA examination during which the conducting examiner indicated that he shows signs and symptoms of pyrosis, reflux, and regurgitation. The examiner noted that the Veteran's treatment plan includes taking continuous medication for the diagnosed condition. The examiner further noted that the Veteran's symptoms were not productive of considerable impairment of health. Analysis The Board notes that the Veteran is competent to report readily observable symptoms. Accordingly, the Board assigns probative value to the Veteran's statements that his GERD symptoms are severe and that he experiences symptoms of heartburn with acid reflux, regurgitation of stomach contents into the throat, difficulty swallowing, chest pain that radiates into the shoulder, upper abdominal pain, nausea, vomiting, frequent coughing, and nighttime choking. The Board also assigns probative value to the Veteran's statements that he cannot sleep more than four consecutive hours due to being awakened by GERD symptoms which causes difficulty concentrating, daytime fatigue, mood changes, low sex drive, a depressed mood, frequent yawning, clumsiness, trouble staying on task, memory issues, and difficulty handling stressful situations. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board finds that the combination of these symptoms is productive of severe impairment of health ("very painful or harmful.") The Board does not assign probative value to the November 2023 VA examiner's opinion that the Veteran's GERD symptoms are not productive of severe impairment of health because they did not account for the Veteran's reports of substernal pain, vomiting, sleep disturbances, and nausea. Considering the above, the Board finds that the probative evidence of record supports a finding that the Veteran's?GERD causes symptomatology that is productive of severe impairment of health. Therefore, the Board finds that an initial increased 60 percent rating for GERD is granted. This is the?highest?schedular rating available under this DC. Thomas L. English Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bahus, Alexander The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.