Stomach and Duodenum (Ulcers / Gastritis) C&P Exam Prep

Upper Endoscopy (EGD) Review

What it measures: Direct visualization of ulceration, gastritis, mucosal damage, or stenosis in the esophagus, stomach, and duodenum

What to expect: Examiner will review existing endoscopy reports. A new endoscopy is unlikely at the C&P exam itself. Bring copies of all prior EGD reports.

Pain considerations: Document whether endoscopy was prompted by pain, bleeding, or vomiting episodes - this links symptoms to objective findings

Complete Blood Count (CBC) - Hemoglobin, Hematocrit, WBC, Platelets

What it measures: Anemia related to chronic GI blood loss; signs of chronic disease or acute hemorrhage

What to expect: Examiner will review recent lab values. The DBQ specifically captures hemoglobin, hematocrit, WBC, and platelet counts. Bring recent lab printouts.

Pain considerations: Fatigue and weakness associated with anemia should be reported as functional limitations at the exam

H. Pylori Testing

What it measures: Presence of Helicobacter pylori infection, a recognized cause of peptic ulcer disease and chronic gastritis (included under DC 7307, rated as DC 7304)

What to expect: Examiner will note positive H. pylori history. DBQ field 250 specifically captures H. pylori test results. Bring documentation of any positive tests and treatment history.

Pain considerations: Persistent epigastric pain after H. pylori treatment is a key indicator of ongoing disability - report its frequency, character, and aggravating factors

Upper GI Radiographic Studies

What it measures: Structural abnormalities of the stomach and duodenum including ulcer craters, stenosis, or motility disorders

What to expect: Examiner will review any prior upper GI series or fluoroscopic studies. DBQ field 225 captures this. Bring radiology reports if available.

Pain considerations: Report any difficulty swallowing, early satiety, or sensation of food not passing - these may correlate with structural findings

100%

Chronic, severe symptoms of peptic ulcer disease manifesting as recurrent hematemesis (vomiting blood) or melena (tarry stools) with manifestations of anemia requiring hospitalization AND/OR other serious complications requiring surgery, plus persistent and debilitating symptoms. This level also encompasses total gastrectomy or comparable surgical outcomes with severe post-operative complications requiring continuous nutritional support.

From 38 CFR: Under 38 CFR - 4.114, DC 7304, the 100% rating reflects the most severe manifestations including recurrent hemorrhage requiring hospitalization, surgery for life-threatening complications, and conditions requiring total nutritional support. Chronic gastritis (DC 7307) is rated identically under DC 7304.

60%

Severe peptic ulcer disease with: two or more of the symptoms for the 40% evaluation, OR shotgun surgery (two or more surgical procedures for perforation or hemorrhage), OR impairment so severe as to preclude more than light sedentary work. Chronic persistent symptoms with moderate to severe impact on daily functioning.

From 38 CFR: The 60% rating under DC 7304 reflects a combination of severe, persistent symptoms and/or a history of major surgical interventions for complications. Veterans with two or more qualifying symptoms from the 40% level, or who have had repeated surgeries, qualify at this tier.

40%

Moderate peptic ulcer disease with documented history of peptic ulcer disease by endoscopy or X-ray AND pain not controlled by standard ulcer therapy, OR recurrent episodes of stomach or duodenal symptoms with documented history of peptic ulcer, OR symptoms managed only by medications, restricted diet, or activity restrictions.

From 38 CFR: At 40%, the key requirement under DC 7304 is a confirmed diagnosis AND pain or recurrent symptoms that are not fully controlled by standard ulcer therapy. Per M21-1, peptic ulcer disease must be documented by endoscopy or X-ray for this level.

20%

Mild peptic ulcer disease with documented history of peptic ulcer by endoscopy or X-ray AND symptoms controlled by continuous medication therapy or a restricted diet, with some periodic exacerbations requiring medical attention.

From 38 CFR: The 20% rating under DC 7304 represents a mild but chronic condition where the ulcer is confirmed but symptoms remain largely controlled by continuous medication or dietary restriction. Veterans still require ongoing treatment to maintain symptom control.

0%

Post-operative asymptomatic - peptic ulcer disease with no current symptoms following surgical treatment, OR confirmed diagnosis with no current symptoms and no ongoing treatment requirements. A 0% rating preserves service connection and remains subject to future re-evaluation if symptoms recur.

From 38 CFR: The 0% noncompensable rating under DC 7304 applies when the condition is confirmed but currently produces no disability. Per 38 CFR - 3.105(e), any future change in evaluation based on a subsequent exam is subject to that provision.

Abdominal / Epigastric Pain

How to describe it: Describe the location (upper abdomen, below the breastbone, between meals or at night), character (burning, gnawing, sharp, cramping), frequency (daily, several times a week), duration (minutes to hours), and what makes it better or worse (food, antacids, fasting, stress). Report your worst episodes, not just average days.

Example: On my worst days, I wake up at 2 a.m. with a severe burning pain in my upper abdomen that rates 8 out of 10. Eating brings temporary relief but within an hour the pain returns. I cannot concentrate at work, I have to cancel plans, and I spend the day lying down or near a bathroom.

Examiner listens for: Frequency of pain episodes, whether pain is continuous or episodic, whether standard therapy (PPIs, antacids) controls it, relationship to meals, whether pain has caused missed work or social withdrawal

Avoid: Do not say 'I just have some stomach pain sometimes' - be specific about frequency, intensity, duration, and the impact on your daily activities. Vague descriptions result in lower ratings.

Nausea and Vomiting

How to describe it: Report how often nausea and vomiting occur (daily, weekly, monthly), whether they are triggered by eating, and whether they are managed by prescription anti-nausea medication. Note whether vomiting has ever contained blood (hematemesis).

Example: Several times a week I become so nauseated after eating that I vomit. I take prescription anti-nausea medication every day. On bad days, I cannot keep food down for hours and I have to stay in bed. I have missed meals because I know eating will trigger vomiting.

Examiner listens for: Whether nausea/vomiting is managed by medication, frequency, and whether hematemesis has ever occurred - hematemesis is a key criterion for higher ratings

Avoid: Do not minimize vomiting by saying 'it happens sometimes.' State the frequency clearly and confirm whether you require medication to control it. Medication management is a specific DBQ checkmark.

GI Bleeding (Hematemesis / Melena)

How to describe it: If you have ever vomited blood or had tarry/black stools, describe when it happened, how many episodes you have had, whether you required hospitalization, and whether you received blood transfusions. Even past episodes are highly relevant.

Example: I have been hospitalized twice for GI bleeding. During the worst episode I vomited blood and passed black tarry stools for two days before going to the ER, where I received a blood transfusion. I was admitted for four days.

Examiner listens for: Number of bleeding episodes, hospitalizations required, transfusions, whether the condition recurs - these directly map to the 60% and 100% rating criteria under DC 7304

Avoid: Never minimize or omit past bleeding episodes - even if they occurred years ago, a history of recurrent hematemesis or melena is directly tied to higher rating criteria.

Dietary Restrictions and Nutritional Impact

How to describe it: Describe which foods or beverages you must avoid due to your condition (spicy foods, caffeine, alcohol, large meals, fatty foods), whether a doctor has formally prescribed a special diet, and whether you have experienced significant weight loss.

Example: My gastroenterologist put me on a strict bland diet two years ago. I cannot eat most restaurants' food, I cannot drink alcohol or coffee, and I eat small meals six times a day. Despite this, I still have pain after eating. I have lost 15 pounds in the past year because eating causes pain.

Examiner listens for: Whether dietary modification is medically directed, how restrictive it is, and whether it successfully controls symptoms - medically directed dietary modification is a specific DBQ checkmark

Avoid: Do not say 'I just watch what I eat' - if a doctor told you to avoid certain foods or eat differently, that is a medically directed dietary modification that should be explicitly stated.

Diarrhea, Explosive Bowel Movements, and Watery Stools

How to describe it: Report frequency of diarrhea (times per day, days per week), whether stools are watery, whether bowel movements are explosive or unpredictable, and whether this has caused social or occupational embarrassment or restrictions.

Example: On bad days I have five to seven watery bowel movements. They come on suddenly and I cannot predict or control them. I have had accidents at work and I now plan all activities around access to a bathroom. I carry extra clothing when I leave the house.

Examiner listens for: Frequency, whether bowel movements are explosive or unpredictable, whether diarrhea is a persistent confirmed post-surgical or post-gastritis complication - confirmed persisting diarrhea is a 60% criterion

Avoid: Do not just say 'I have diarrhea sometimes.' State how many times per day, how unpredictable it is, and the impact on your social and work life. Explosive/unpredictable bowel movements are a separate DBQ item.

Post-Prandial Symptoms and Dumping Syndrome

How to describe it: If you experience lightheadedness, dizziness, sweating, rapid heartbeat, or near-fainting after eating, describe when during the meal these occur (early dumping: within 15-30 minutes; late dumping: 1-3 hours), frequency, and whether they have caused falls or required you to lie down after meals.

Example: Within 30 minutes of eating even a small meal, I become dizzy and lightheaded to the point where I have to lie down immediately. I have nearly passed out twice. I now eat lying down or in a recliner and I cannot eat in public because of this.

Examiner listens for: Post-prandial lightheadedness or syncope - this is a specific DBQ checkbox item (field 165) and maps to higher-level rating criteria for post-surgical complications

Avoid: Do not attribute post-meal dizziness to other causes without mentioning it to the GI examiner - post-prandial syncope or near-syncope is a discrete, ratable finding.

Hospitalizations and Surgical History

How to describe it: List every hospitalization related to your stomach or duodenal condition: date, facility, reason (bleeding, perforation, obstruction, surgery), duration of stay, and procedures performed. Include any surgeries such as vagotomy, pyloroplasty, gastrectomy, or gastroenterostomy.

Example: I was hospitalized in March 2019 at VA Medical Center for a perforated ulcer and underwent emergency surgery. I was hospitalized again in November 2021 for GI bleeding requiring a transfusion of two units of packed red blood cells. I stayed six days that admission.

Examiner listens for: Number of hospitalizations, surgical procedures, reason for hospitalization (perforation, hemorrhage, obstruction), post-operative complications - hospitalizations for perforation or hemorrhage directly support 40%-100% ratings

Avoid: Do not omit any hospitalization, even if it occurred many years ago or at a non-VA facility. Bring discharge summaries if available. Each hospitalization is a documented data point the examiner will record.

Medication Burden and Treatment Requirements

How to describe it: List all medications you take specifically for your stomach or duodenal condition: name, dose, frequency, and how long you have been on them. Note whether symptoms persist despite medication compliance. Also note any side effects from medications that affect your daily functioning.

Example: I take omeprazole 40mg twice daily, famotidine at bedtime, and sucralfate before meals every day. Even on this regimen, I have breakthrough pain several times a week. Without medication I cannot function at all. I have been on PPIs continuously for over five years.

Examiner listens for: Whether symptoms require continuous medication management, whether symptoms persist despite medication - continuous medication requirement is a core criterion distinguishing 20% from higher ratings

Avoid: Do not say 'I just take some stomach medicine.' List every medication by name and state clearly whether symptoms are controlled or persist despite treatment.