Not all military-linked health conditions are the obvious results of injuries. Sometimes, the physical strain of military service leads to health conditions like hiatal hernias. A hiatal hernia occurs when your stomach pushes past your diaphragm and into your chest cavity. The result can be severe symptoms of heartburn and indigestion that affect your quality of life.
Although the VA recognizes hiatal hernias as a disabling condition, proving the link between a hernia and military service can be complicated.
What Is a Hiatal Hernia?
A hiatal hernia occurs when your stomach bulges up through an opening in your diaphragm. The diaphragm is the muscular membrane that separates the abdomen from the chest cavity. When the stomach protrudes through the diaphragm, it can squeeze the stomach and lead to painful reflux of stomach acids.
In severe cases, a hiatal hernia can cause the stomach to be trapped and lose blood supply. This is called strangulation of the hernia, and it is very painful. A strangulated hernia is a medical emergency and requires immediate attention. If you suspect you have a strangulated hernia, call 911 or go to an emergency room.
Hiatal Hernia Symptoms
Many hiatal hernias are small and don’t lead to noticeable symptoms. When hiatal hernias are larger and more of the stomach is involved, you might develop persistent discomfort in your stomach and throat. Typical symptoms of a hiatal hernia include:
- Acid reflux
- Acidic or “sour” taste in the back of the mouth or throat
- Chest or abdominal pain
- Feeling full soon after you eat
- Difficulty swallowing
- Regurgitation of food or liquids into the mouth
- Shortness of breath
Occasional episodes of discomfort from a hiatal hernia can be manageable. When symptoms become severe and persistent, they can interfere with daily activities. You may have to reduce physical activities, including work-related activities, to prevent exacerbating symptoms. The discomfort may affect your sleep and diet, reducing your energy for daily tasks.
Hiatal Hernia Causes
Hiatal hernias usually develop because of pressure in the abdominal cavity. That can happen for a number of reasons, including:
- Chronic coughing
- Injury or trauma to the area
- Lifting heavy objects
- Repetitive vomiting
- Straining during bowel movements
Treating a Hiatal Hernia
Most experts recommend treating hiatal hernias with lifestyle changes and medication. Your doctor may suggest a restricted diet and avoiding foods that cause irritation to the stomach and esophagus.
This may include eliminating the following:
- Acidic foods like tomatoes and citrus
- Carbonated beverages
- Fried foods
You may need to take over-the-counter medications such as Pepcid, Gaviscon, and Zantac to reduce the discomfort from your hernia symptoms. In some cases, your doctor might prescribe a proton-pump inhibitor medication. Treatment for hiatal hernia may be long-term since the underlying condition will remain. If your insurance or FSA plan doesn’t cover the cost of medications, you may face significant out-of-pocket expenses.
Unlike other hernias, such as an inguinal hernia where intestines protrude from the abdomen, surgery is not typically recommended for hiatal hernias. Doctors usually only operate if there are complications or if other treatments don’t relieve your symptoms.
Proving a Service Connection for a Hiatal Hernia
In order to qualify for VA disability benefits for a hiatal hernia, you will need to prove that your military service caused or aggravated your hiatal hernia. This is easiest to demonstrate if you were diagnosed with a hernia during your service. Your service records should contain information about your hernia diagnosis. You can supply current medical records to show how symptoms negatively affect your life and ability to work.
If you were diagnosed after leaving active duty, you might still qualify for benefits for your hernia. In the delayed onset cases, it is important to show some evidence of the early symptoms in service. The documented symptoms often include vague references to stomach pain, chest pain, regurgitation, etc.
Many of the causes of hiatal hernia can be attributed to activities performed during military service, such as repetitive strain from lifting or training and impact or injury to the abdomen. Your service records should contain information verifying any injuries you sustained during your service. There should also be records that demonstrate that your duties included work that regularly strained your abdominal cavity. These records can show that your service either caused the hiatal hernia or aggravated a previously undetected hiatal hernia.
A hiatal hernia may also be a secondary condition caused by an existing disability. If you have a military service-linked condition that causes chronic coughing or obesity, that could be the cause of your hiatal hernia. You may be eligible to apply for a secondary disability due to the hernia and related symptoms.
To apply for benefits for a hiatal hernia, you will need to have a concrete diagnosis of a hiatal hernia. You will be asked to supply medical records, test results, and statements from your doctors affirming the service link. You should also be prepared to submit letters from family, friends, and work colleagues attesting to how your hernia impacts your daily life. You will need to demonstrate that the hernia is a disabling condition.
Finally, you will need to be able to prove the link to your military service. This requires a medical nexus letter from a doctor stating that your disability is caused by your military service.
VA Disability Ratings for Hiatal Hernias
The VA does recognize a hiatal hernia as a disability. A hiatal hernia is classified under diagnostic code 7346. Under this code, the VA assigns the disability rating according to how debilitating the related symptoms are and how much they interfere with your work and daily activities:
- 60% — Symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health
- 30% — Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health
- 10% — With two or more of the symptoms for the 30% evaluation of less severity
If you are applying for secondary benefits for a hiatal hernia, the VA will assign additional benefits based on the VA’s Combined Ratings Tables calculations. Your new payment amount will be based on the combined ratings of your hernia and prior disabilities.
Also, if you achieve a 60% rating for hiatal hernia and are unable to work, then you should consider a claim for Total Disability Individual Unemployability (“TDIU”). If the VA grants service connection for hiatal hernia and assigns a 60% rating, and you are unable to work due to the condition, consider hiring an attorney to appeal the assigned rating and bring TDIU into the case.