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7346
§ 4.114 Schedule of ratings—digestive system.

Hiatal or paraesophageal hernia

A condition where part of the stomach pushes upward through the diaphragm opening or alongside the esophagus.

What the rating means

VA rates hiatal hernia and paraesophageal hernia under diagnostic code 7346 by applying the same formula used for stricture of the esophagus (diagnostic code 7203). The possible ratings are 0%, 10%, 30%, 50%, and 80%.

A 0% rating applies when you have a documented history of the condition but no daily symptoms and no need for daily medications. A 10% rating applies when the condition requires daily medications to control dysphagia but is otherwise without daily symptoms. A 30% rating applies when recurrent esophageal stricture causing dysphagia requires dilatation no more than two times per year. A 50% rating applies when recurrent or refractory stricture causing dysphagia requires dilatation three or more times per year, dilatation using steroids at least once per year, or esophageal stent placement. An 80% rating applies when recurrent or refractory stricture causing dysphagia also involves aspiration, undernutrition, or substantial weight loss as defined in the regulations, and has been treated with surgical correction or a PEG tube.

VA will not combine this rating with ratings for most other digestive conditions. If more than one digestive condition under the covered diagnostic codes warrants a rating, VA assigns a single rating under the code that best reflects the overall disability picture, and may raise it one level if the combined severity warrants it.

Evidence that helps

Because findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy (EGD), imaging or endoscopy reports are central to any rating. These records should show the presence and severity of stricture, whether it recurs or is refractory, and the treatments used.

For a 10% rating, prescription records or treatment notes showing daily medication use to manage dysphagia are helpful. For a 30% rating, procedural records documenting dilatation and the frequency at which it was performed — no more than twice a year — support that level. For a 50% rating, records showing dilatation three or more times per year, steroid-assisted dilatation at least once yearly, or stent placement are relevant. The regulatory definitions of recurrent stricture (inability to maintain target diameter beyond four weeks) and refractory stricture (inability to achieve target diameter after at least five dilatation sessions at two-week intervals) may also appear in procedural notes.

For an 80% rating, medical records documenting aspiration events, undernutrition, or substantial weight loss — alongside surgical or PEG tube treatment — would reflect that level of severity. Statements from you or treating providers describing how swallowing difficulty affects eating, nutrition, and daily activities can help illustrate the overall disability picture.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.