Written by Dr. Ryan, DO · Updated September 28, 2026
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Free Viability Check →Hiatal hernia has its own VA diagnostic code (DC 7346), and since the 2024 revision of the digestive rating schedule it is rated the same way as GERD (DC 7206): as esophageal stricture. That makes hiatal hernia central to the digestive claims landscape for veterans. Understanding the claim pathways, the rating criteria, and what belongs in a strong nexus letter can help you position your case correctly from the start.
The diaphragm is the muscle separating the chest from the abdomen. The esophagus passes through an opening in the diaphragm called the hiatus. When part of the stomach pushes up through that opening into the chest cavity, the result is a hiatal hernia.
There are two main types:
A direct claim requires evidence that the hiatal hernia began in service or was caused by a service event. The most common scenarios:
If a hiatal hernia was found on a separation physical, that alone can support direct connection.
One practical note: the heavy-lifting theory is the most commonly alleged but also the most scrutinized. VA and C&P examiners will look for contemporaneous documentation, meaning in-service records of heavy physical work, documented musculoskeletal strain, or a physician's note from the service period linking physical demands to GI symptoms. A physician's nexus opinion unsupported by any in-service records is weaker here than for secondary theories. If you're pursuing the heavy-lifting theory, gather MOS documentation, physical fitness records, and any service treatment records mentioning lifting demands or GI complaints before submitting.
A hiatal hernia claim can be strengthened by objective anatomical documentation that a pure GERD claim does not require. An upper GI series (barium swallow) that shows the stomach herniating through the diaphragmatic hiatus, or a CT scan depicting hernia anatomy, is direct evidence of structural pathology rather than a functional complaint. If you have this imaging in your records, make sure your nexus letter specifically addresses it. Gastroenterologists and radiologists who describe hernia size, type (sliding vs. paraesophageal), and complications on imaging are providing the kind of objective documentation that separates a strong hernia claim from a general reflux claim.
If you had a hiatal hernia before service (or it was noted on your entrance physical), you can still claim service connection if service aggravated the condition beyond its natural progression. Under 38 CFR 3.306, the presumption of soundness at entry means VA bears the burden of showing any pre-existing condition by clear and unmistakable evidence. If VA can't meet that burden, the condition is treated as service-incurred.
Many veterans claim hiatal hernia as a secondary condition to PTSD, MST, or physical conditions requiring NSAIDs. The physiological links are the same as with GERD: chronic stress, autonomic dysregulation, and medication effects all increase intraabdominal pressure or weaken the LES, contributing to hernia development or worsening.
Hiatal hernia keeps Diagnostic Code 7346, but since the VA revised its digestive rating schedule in 2024, DC 7346 says to rate it as esophageal stricture (DC 7203) (38 CFR 4.114). The levels are:
The findings must be documented by barium swallow, computerized tomography (CT), or upper endoscopy (esophagogastroduodenoscopy).
The 80% rating is the ceiling. There is no 100% rating under this code. Veterans whose condition is more severe than the schedule captures can address functional impairment through TDIU or extraschedular evaluation under 38 CFR 3.321(b)(1).
VA may try to rate GERD and hiatal hernia as a single condition. In many cases, that is correct: the two conditions are inseparable and a combined rating is appropriate. Esophageal stricture is not a separate rating here: it is the basis of the hiatal hernia and GERD ratings themselves, and the same disability cannot be rated twice (38 CFR 4.14). Other complications have their own criteria: Barrett's esophagus has its own code (DC 7207), and a complication outside the digestive system, such as aspiration pneumonia, is rated under the appropriate respiratory code.
See Barrett's esophagus and VA claims for a detailed discussion of how complications affect the rating picture.
Strong evidence for a hiatal hernia claim includes:
For secondary claims, a nexus letter connecting the upstream service-connected condition to the hiatal hernia is required. The letter needs to be specific to your physiology, not a generic statement that stress can cause GI problems.
For direct claims with in-service records, the nexus may be self-evident, but a physician opinion explaining the mechanism (heavy lifting causing increased intraabdominal pressure, for example) still strengthens the claim significantly.
If you're building a hiatal hernia claim on a direct, aggravation, or secondary theory, Flat Rate Nexus offers physician-signed independent medical opinions reviewed by a board-certified physician. Free educational resources including a nexus letter grader are available at flatratenexus.com.
Thinking about your own claim? Every nexus letter we write goes through a full physician record review, cites peer-reviewed research, and is built around the actual evidence in your case.
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