Hiatal Hernia VA Rating 2026: DC 7346 Criteria

What is a hiatal hernia and how does it affect veterans?

A hiatal hernia occurs when part of the stomach pushes upward through the hiatus — the opening in the diaphragm where the esophagus passes through to connect to the stomach. Normally, the diaphragm helps keep stomach acid from flowing into the esophagus. When the stomach protrudes through this opening, the anti-reflux mechanism is compromised, allowing acid and partially digested food to flow back into the esophagus and causing the hallmark symptoms of heartburn, regurgitation, chest pain, and difficulty swallowing.

Veterans develop hiatal hernias at elevated rates because of the physical demands of military service. Repeatedly carrying heavy loads — rucksacks weighing 80 to 100+ pounds — increases intra-abdominal pressure, which can force the stomach through the diaphragmatic opening over time. Strenuous physical training, combat activities involving heavy lifting and straining, and chronic coughing from respiratory conditions all increase the risk. Additionally, the stress of military service and combat increases stomach acid production, worsening symptoms.

A hiatal hernia significantly affects daily quality of life. Eating becomes a source of discomfort rather than enjoyment — certain foods trigger severe heartburn and regurgitation, large meals are impossible, and eating too close to bedtime causes nighttime reflux that disrupts sleep. Veterans with hiatal hernia often experience persistent chest pain that can mimic cardiac symptoms, difficulty swallowing food and liquids, nausea and vomiting, and gradual weight loss from avoiding meals. In severe cases, chronic bleeding from esophageal erosion leads to anemia and fatigue.

VA diagnostic code for hiatal hernia

Hiatal hernia is rated under Diagnostic Code (DC) 7346 per 38 CFR § 4.114, Schedule of Ratings — Digestive System.

DC 7346 covers hiatal hernia and paraesophageal hernia. Effective May 19, 2024, the VA’s digestive system update changed DC 7346 to a single instruction: “Rate as esophagus, stricture of (DC 7203).” The old criteria based on pyrosis, regurgitation, and “impairment of health” no longer apply.

The same update gave GERD its own code, DC 7206. GERD and hiatal hernia are now separate diagnostic codes, even though both use stricture-based criteria.

DC 7203 rates the condition on esophageal stricture (narrowing of the esophagus) and the treatment it needs. Its notes say findings must be documented by barium swallow, computerized tomography (CT), or esophagogastroduodenoscopy (EGD). A recurrent stricture is the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved. A refractory stricture is the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals.

Rating criteria for hiatal hernia

The VA assigns hiatal hernia ratings at five possible levels using the DC 7203 criteria:

0% rating

Criteria: Documented history without daily symptoms or requirement for daily medications.

Monthly payment: $0 (but establishes service connection for future increases and secondary claims)

10% rating — $180.42/month

Criteria: Documented history of esophageal stricture(s) that requires daily medications to control dysphagia, otherwise asymptomatic.

What this looks like: Imaging or endoscopy has documented a stricture, and you take a daily medication to keep swallowing problems under control. A hiatal hernia with reflux but no documented stricture does not match this wording.

30% rating — $552.47/month

Criteria: Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year.

What this looks like: Your stricture keeps coming back and causes difficulty swallowing. A gastroenterologist stretches (dilates) the esophagus once or twice a year.

50% rating — $1,132.90/month

Criteria: 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.

What this looks like: Your stricture needs frequent dilatation, steroid injections during dilatation, or a stent to keep the esophagus open.

80% rating — $2,102.15/month

Criteria: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the following present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a), and treatment with either surgical correction or a percutaneous esophago-gastrointestinal tube (PEG tube).

What this looks like: Swallowing problems have led to food or liquid entering the airway, malnutrition, or major weight loss, and you needed surgery or a feeding tube. Under § 4.112(a), “substantial weight loss” means involuntary loss greater than 20% of your baseline weight sustained for three months with diminished quality of self-care or work tasks.

What evidence do you need?

Service records

• Service treatment records showing GI complaints, heartburn, acid reflux, or abdominal pain during service
• Records documenting physical demands (heavy lifting, pack weights, physical training)
• Deployment and duty records showing strenuous physical requirements
• Records of any GI medications prescribed during service
• If claiming secondary: complete records for the primary service-connected condition

Medical evidence

• Current diagnosis of hiatal hernia from a gastroenterologist or primary care physician
• Upper GI series (barium swallow) — The primary imaging test that visualizes the hiatal hernia by showing the stomach protruding through the diaphragm
• Upper endoscopy (EGD) — Shows the hernia directly and documents any esophageal stricture, erosion, Barrett’s esophagus, or bleeding
• Dilatation records — Dates of every esophageal dilatation in the past year, whether steroids were used, and any stent placement
• Treatment records showing ongoing symptoms and medication management
• Prescription records for PPIs (proton pump inhibitors), H2 blockers, antacids, and other GI medications
• Weight records — Documentation of weight changes over time if you have lost weight due to the condition
• Lab results — Complete blood count showing anemia if applicable; stool tests if melena is suspected
• Records of any surgical interventions (Nissen fundoplication, hiatal hernia repair)

Nexus letter

A medical opinion connecting your hiatal hernia to service. The nexus letter should explain how the physical demands of military service — heavy lifting, carrying heavy loads, strenuous physical training — contributed to the development of the hiatal hernia by chronically increasing intra-abdominal pressure. If claiming as secondary to a condition that causes chronic coughing or vomiting, the nexus should explain that mechanism. Cite relevant medical literature supporting the connection.

Buddy statements

Statements from fellow service members who can describe the heavy physical demands during service (pack weights, lifting requirements). Statements from family members who have witnessed your symptoms — difficulty eating, regurgitation episodes, visible weight loss, disrupted sleep from reflux, dietary restrictions, frequent medication use, and how the condition affects your daily life and social activities.

Personal statement

Describe the physical demands of your military service, when GI symptoms began, how the condition has progressed, and how the hiatal hernia affects your daily life. Detail which foods you can no longer eat, how meals are limited, sleep disruption from nighttime reflux, pain episodes, any weight loss, and how the condition limits your ability to enjoy meals and social activities.

C&P exam tips for hiatal hernia

What the examiner evaluates

• Confirmation of hiatal hernia diagnosis
• Whether a barium swallow, CT, or EGD has documented esophageal stricture(s)
• Dysphagia (difficulty swallowing) and whether you need daily medication to control it
• Number of dilatations in the past year, use of steroids, and any stent placement
• Whether the stricture is recurrent or refractory
• Aspiration, undernutrition, or substantial weight loss, and any surgery or PEG tube
• If claiming secondary: the connection to the primary condition

How to prepare

1. Bring imaging and endoscopy results. Upper GI series and endoscopy reports confirm the hernia and show whether there is a stricture. The 10% and higher ratings depend on a documented stricture.
2. List every dilatation. Write down the date of each esophageal dilatation in the past year, and whether steroids were injected or a stent was placed. Procedure notes are the best proof.
3. Describe your swallowing honestly. Explain whether food sticks, how often, and what you do about it, including which medications you take every day to control it.
4. Track your weight. If you have lost weight because of difficulty eating, document the weight change with medical records. Substantial weight loss is one of the factors at the 80% level.
5. Document aspiration or undernutrition. If you have choked, developed aspiration pneumonia, or been diagnosed with undernutrition, bring those records.

Common mistakes

• Not having imaging evidence confirming the hiatal hernia
• Underreporting symptoms because you have adapted your diet and lifestyle to avoid triggers
• Not tracking weight changes over time
• Not documenting swallowing difficulties, stricture findings, and dilatation history, which are central to the DC 7203 criteria
• Not distinguishing hiatal hernia symptoms from cardiac symptoms (chest pain from reflux vs. cardiac chest pain)
• Not bringing a list of all dietary restrictions and foods you can no longer eat
• Failing to explain how the condition has worsened over time, including any progression in symptom severity

Common secondary conditions linked to hiatal hernia

Hiatal hernia is often connected to other conditions that can increase your overall combined rating:

• Depression — Chronic pain, dietary restrictions, social limitations from GI symptoms, and reduced quality of life from a hiatal hernia contribute to depression. The impact of chronic digestive disorders on mental health is well-documented.
• Sleep apnea — Hiatal hernia and reflux disrupt sleep, and there is a bidirectional relationship between reflux and sleep-disordered breathing. The negative intrathoracic pressure from sleep apnea can worsen reflux, and the hernia’s disruption of the diaphragm may contribute to airway issues.
• Anxiety — The unpredictability of symptoms, the fear of eating, and the social limitations caused by a hiatal hernia contribute to anxiety. Chronic pain and discomfort are well-established anxiety triggers.
• Esophageal conditions — Chronic acid exposure from the hernia can lead to Barrett’s esophagus, esophageal stricture, and other complications that may be separately ratable.
• Dental erosion — Chronic regurgitation of stomach acid damages tooth enamel, which can be claimed as a dental condition.
• GERD — A hiatal hernia directly causes or worsens GERD by compromising the lower esophageal sphincter. GERD now has its own code (DC 7206), separate from hiatal hernia (DC 7346). Both use stricture-based criteria, and the VA will not rate the same symptoms twice (38 CFR § 4.14), so whether both can be rated depends on the facts.

Standalone rating amounts for hiatal hernia

For reference, here are the 2026 monthly payment amounts for hiatal hernia at each rating level (veteran with no dependents):

Dependent additions for an eligible spouse, child, or dependent parent apply only when your combined VA disability rating is 30% or higher. A combined rating of 10% or 20% does not receive dependent additions.

How to calculate your monthly payment

Your total VA disability payment depends on your combined rating across all service-connected conditions. Hiatal hernia at 30% combined with PTSD, sleep apnea, and other conditions can produce a significantly higher combined rating.

Use our VA disability calculator to:

• Calculate your combined rating with multiple conditions
• Understand how VA math combines ratings
• Estimate your monthly payment including dependents

For the full breakdown of payment amounts at every rating level, see our 2026 VA disability pay rates page.

Correction — October 21, 2026: Clarified that dependent additions start at a 30% combined rating.

Disclaimer: This content is for informational purposes only and does not constitute legal or medical advice. For personalized guidance on your VA disability claim, consult a VA-accredited Veterans Service Organization (VSO), attorney, or claims agent. You can find accredited representatives at VA.gov.