How the Board ruled on GERD and acid reflux claims, 2021–2025

GERD / acid reflux (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

46.9% granted of 1,210 decided cases (margin of error 44.1–49.7%). 567 granted, 643 denied, 1,811 sent back to VA (remanded, not decided), 292 dismissed.

What convinced the Board in granted cases

• The Board gave strong weight to detailed private opinions that reviewed the record, cited medical literature, and explained the mechanism, such as how PTSD or anxiety increases acid and weakens the esophageal valve. (7 of 11 decisions read; e.g. A24048970, A25012307, A24030881)
• VA opinions lost weight when they skipped whether PTSD contributed to the GERD, ignored the studies in the record, or relied mainly on silent service records and the date of first diagnosis. (2 of 11 decisions read, few decisions; e.g. A25012307, 22054276)
• The Board accepted credible accounts of heartburn and reflux starting in service, from the veteran and from family members or a fellow service member who saw the symptoms. (5 of 11 decisions read; e.g. A23021901, A25028289, 22054276)

Common reasons in denied cases

• The Board favored VA opinions that considered the literature and the veteran's contentions, and gave little weight to a private opinion with no sign its author reviewed the records. (4 of 14 decisions read; e.g. 21030204, 22053685, A24065210)
• No competent medical evidence linked GERD to service, it was first diagnosed years or decades later, and the veteran's own belief about cause was not competent medical evidence. (4 of 14 decisions read; e.g. 22036476, A21003304, A24065210)
• The most common reason was no current GERD diagnosis, or no reflux symptoms at all, during the claim period. (7 of 14 decisions read; e.g. A25021040, A25016299, A23016026)

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GERD / acid reflux (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

6.8% granted of 44 decided cases (margin of error 2.3–18.2%). 3 granted, 41 denied, 93 sent back to VA (remanded, not decided), 4 dismissed.

Common reasons in denied cases

• A VA opinion found GERD was not related to service or to the claimed exposure, often noting the medical literature shows no link or pointing to other causes like weight, and no medical opinion rebutted it. (7 of 11 decisions read; e.g. 21051878, 21056868, 23052727)
• The veteran's own belief that GERD came from an exposure was not accepted as competent medical evidence of cause. (4 of 11 decisions read; e.g. 21063144, 23046914, 21049254)
• GERD is not on the lists of conditions presumed linked to herbicide exposure, and as a condition with a known diagnosis it did not qualify as a Gulf War undiagnosed illness; service records often showed no stomach complaints. (4 of 11 decisions read; e.g. 21010003, 21003272, 21056868)

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GERD / acid reflux secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

66.6% granted of 314 decided cases (margin of error 61.2–71.6%). 209 granted, 105 denied, 497 sent back to VA (remanded, not decided), 14 dismissed.

What convinced the Board in granted cases

• A medical opinion that explained how the service-connected condition caused or worsened reflux was given significant weight. Examples include PTSD stress affecting the esophagus, or cancer treatment. Literature or a treating relationship added weight. (8 of 14 decisions read; e.g. A25034005, 24009647, A25001849)
• Negative VA opinions lost weight when they ignored a positive opinion or the veteran's statement, did not address the medication theory, admitted lacking enough facts, or rested on speculation. (4 of 14 decisions read; e.g. A25001849, 21050972, A25015529)
• Long-term anti-inflammatory pain medicine (NSAIDs) taken for service-connected joint or back conditions was accepted as a cause of reflux. (3 of 14 decisions read; e.g. A24056531, 21067570, A25015529)

Common reasons in denied cases

• A thorough VA opinion that reviewed the record and addressed both causation and worsening, for example noting reflux stayed stable on medication, found no link, and nothing rebutted it. (7 of 12 decisions read; e.g. 21015226, A21001662, A24049510)
• The only support was the veteran's own belief or a general article not tied to the veteran's facts. The Board found neither was competent to show a link. (4 of 12 decisions read; e.g. A24025008, A21004958, A24049510)
• The condition blamed for the reflux was not service-connected, such as sleep apnea or scleroderma, so there was no basis for a secondary claim. (2 of 12 decisions read, few decisions; e.g. 21053498, A24057825)

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GERD / acid reflux secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

60.9% granted of 64 decided cases (margin of error 48.7–71.9%). 39 granted, 25 denied, 136 sent back to VA (remanded, not decided), 7 dismissed.

What convinced the Board in granted cases

• The Board gave little weight to VA opinions that were conclusory, skipped aggravation, ignored the private opinion or medical studies, or rested on a wrong premise such as no GERD diagnosis. (5 of 10 decisions read; e.g. 21024197, A22001625, A23005801)
• Favorable opinions won when they explained how PTSD leads to reflux, such as anxiety and stress raising acid or PTSD medicines weakening the valve at the bottom of the esophagus, often citing studies. (5 of 10 decisions read; e.g. A21008774, A22001625, 21071665)
• Other grants rested on favorable private opinions, including from a nurse practitioner or physician assistant, sometimes alongside credible buddy statements about reflux symptoms in service. (3 of 10 decisions read; e.g. A24067675, A24048627, A23005801)

Common reasons in denied cases

• Most denials rested on a reasoned VA opinion against a link, sometimes naming another likely cause such as a hiatal hernia or obesity that a private opinion failed to address. (8 of 11 decisions read; e.g. 21060570, 21023108, 21021274)
• General articles linking stress or PTSD to GERD, or the veteran's own belief, were not enough without a medical opinion applying them to this veteran. (4 of 11 decisions read; e.g. 21028255, 21050011, 21030770)
• Some claims failed because there was no current GERD diagnosis during the claim period. (3 of 11 decisions read; e.g. 21045269, A25011346, A24016171)

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GERD / acid reflux secondary to depression / psychiatric disorder

Secondary (caused or worsened by a service-connected condition)

Small sample: 29 decided cases, too few for a reliable percentage. 20 granted, 9 denied, 61 sent back to VA (remanded, not decided), 3 dismissed.

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GERD / acid reflux secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

Small sample: 25 decided cases, too few for a reliable percentage. 20 granted, 5 denied, 27 sent back to VA (remanded, not decided), 1 dismissed.

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GERD / acid reflux secondary to knee

Secondary (caused or worsened by a service-connected condition)

Small sample: 17 decided cases, too few for a reliable percentage. 15 granted, 2 denied, 11 sent back to VA (remanded, not decided), 1 dismissed.

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GERD / acid reflux secondary to sleep apnea

Secondary (caused or worsened by a service-connected condition)

Small sample: 15 decided cases, too few for a reliable percentage. 11 granted, 4 denied, 18 sent back to VA (remanded, not decided), 0 dismissed.

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GERD / acid reflux secondary to diabetes

Secondary (caused or worsened by a service-connected condition)

Small sample: 12 decided cases, too few for a reliable percentage. 7 granted, 5 denied, 8 sent back to VA (remanded, not decided), 0 dismissed.

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GERD / acid reflux secondary to shoulder

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 9 granted, 1 denied, 2 sent back to VA (remanded, not decided), 0 dismissed.

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