GERD Secondary to PTSD: What a VA Nexus Letter Must Show
Gastroesophageal reflux disease (GERD) is one of the most commonly claimed digestive conditions among veterans, and many of those claims are filed as secondary to post-traumatic stress disorder (PTSD). The VA allows service connection on a secondary basis under 38 CFR § 3.310 when a service-connected condition causes, or aggravates beyond its natural progression, another diagnosed condition. For GERD secondary to PTSD, the deciding question is almost never whether the veteran has reflux. It is whether the medical evidence connects the reflux to the PTSD.
Why PTSD and GERD Are Claimed Together
Peer-reviewed literature has examined associations between chronic psychological stress and upper gastrointestinal symptoms. Mechanisms discussed in the medical literature include stress-related changes in gastric acid secretion and esophageal sensitivity, disrupted sleep, and lifestyle factors that can accompany PTSD. In addition, some medications prescribed for psychiatric conditions list gastrointestinal side effects. None of this automatically wins a claim. It simply means there is a body of medical evidence a physician can evaluate against a specific veteran's records to form an opinion, in either direction.
The "At Least as Likely as Not" Standard
The VA does not require certainty. It requires a medical opinion stating whether it is "at least as likely as not" — a 50 percent or greater probability — that the service-connected PTSD caused or aggravated the GERD. A useful nexus letter does more than recite that phrase. It should:
- Identify the records actually reviewed — service treatment records, VA and private treatment notes, medication history, and prior rating decisions;
- State a clear opinion on causation or aggravation, using the VA's evidentiary standard;
- Explain the medical rationale in plain terms, connecting the veteran's documented history to the relevant literature;
- Establish the author's qualifications to give the opinion.
Common Reasons These Claims Are Denied
Denials frequently cite a missing or inadequate nexus: a diagnosis without a connecting opinion, a letter that offers a conclusion with no rationale, or an opinion that ignores contrary evidence such as a long history of reflux predating the PTSD diagnosis. Aggravation claims are often denied when the letter fails to address the condition's baseline severity. A credible opinion has to engage with the whole record, including the parts that cut against the claim.
How Hart Causation and Claims Approaches These Opinions
Dr. John H. Hart, Jr., M.D., is an ABIM board-certified internist and a retired Air Force Reserve Lieutenant Colonel who served as a Senior Flight Surgeon. Every opinion is personally authored by Dr. Hart after a review of the records — there are no templates passed among staff. The practice does not perform C&P-style examinations, does not complete DBQs, and does not diagnose or treat; it provides independent written medical opinions on causation. Records are exchanged through HIPAA-compliant communication via SimplePractice. Fees range from $1,500 to $3,500 depending on case complexity, with a standard turnaround of 10–14 business days and a 72-hour rush option. If the records do not support a favorable opinion, you will be told so directly.
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This article is general information, not medical or legal advice, and does not create a physician-patient relationship. Hart Causation and Claims, LLC provides independent medical opinions; it does not diagnose, treat, examine, or complete DBQs, and no outcome before the VA is ever guaranteed. Veterans should consult an accredited representative, agent, or attorney for claim-specific guidance.