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

DC 7307 digestive 38 CFR 4.114

DBQ Overview

Interview + Physical
Form Name
stomach-and-duodenum
Form Code
stomach-and-duodenum
Page Count
8
Examiner Type
Gastroenterologist or Physician
Estimated Duration
20-30 minutes
Exam Format
Interview + Physical

What to Expect During Your Exam

Exam Overview

To document the current severity of your stomach and duodenal condition (chronic gastritis, peptic ulcer disease, or related disorders) so that VA can assign a disability rating under 38 CFR - 4.114, DC 7307 (rated as DC 7304 peptic ulcer disease). The examiner will evaluate the frequency, severity, and duration of your symptoms, any complications such as bleeding or obstruction, surgical history, and functional impact on daily life and work.

What the examiner evaluates:

  • Current diagnosis and ICD code (e.g., chronic gastritis, H. pylori infection, drug-induced gastritis, peptic ulcer disease)
  • Symptom frequency, severity, and character (abdominal pain, nausea, vomiting, diarrhea, constipation, colic)
  • Presence and history of serious complications: hematemesis (vomiting blood), melena (tarry stools), GI bleeding requiring hospitalization
  • History of peptic ulcer disease documented by endoscopy or radiology
  • Episodes of abdominal pain, nausea, or vomiting lasting days to weeks
  • Continuous abdominal pain with intermittent vomiting
  • Surgical history: gastrectomy, vagotomy with pyloroplasty, gastroenterostomy, surgery for perforation or hemorrhage
  • Post-gastrectomy syndrome, post-operative complications, alkaline gastritis
  • Stomach stenosis, persistent partial bowel obstruction
  • Nutritional support requirements: total parenteral nutrition (TPN), tube feedings
  • Current medications used to treat the condition
  • Dietary modifications required due to the condition
  • Laboratory results: CBC, hemoglobin, hematocrit, H. pylori testing
  • Imaging and procedures: upper GI radiographic studies, upper endoscopy, CT, MRI, biopsy
  • Functional impact on occupation and daily activities
  • Hospitalization history related to the condition
  • Presence of Zollinger-Ellison syndrome, portal hypertensive gastropathy with varix-related complications
  • Whether the condition is asymptomatic or symptomatic

The exam will primarily be an interview and review of medical records. A physical examination of the abdomen may be performed. You may be examined in person or via telehealth. Bring all relevant medical records, medication lists, and any private treatment records not already in your VA file. You have the right to request that the exam be recorded in most states.

Typical duration: 20-30 minutes

Upper Endoscopy (EGD) Review

Direct visualization of the esophagus, stomach, and duodenum to identify ulcers, gastritis, erosions, bleeding sources, stenosis, or malignancy

What to expect:

The examiner will review prior endoscopy reports. They may note date performed, findings (active ulcer, scarring, H. pylori status, biopsies), and whether the condition has been confirmed by this gold-standard diagnostic method.

Key thresholds:

  • Active ulcer or erosive gastritis documented — Supports diagnosis; severity of symptoms and complications drive the rating percentage
  • History of bleeding or perforation documented — May support higher ratings (60-100%) if associated with hospitalization or anemia

Tips:

  • Know the date(s) of any endoscopies you have had and what was found
  • Bring or ensure VA has copies of all endoscopy and pathology reports
  • If H. pylori was detected, know whether you were treated and whether it was eradicated
  • Note if your symptoms persisted even after H. pylori eradication or medication treatment

Pain considerations: Endoscopy results confirm the organic basis for your pain; describe how your pain and symptoms match what was found on endoscopy

H. pylori Testing

Presence of Helicobacter pylori bacteria, a recognized cause of chronic gastritis and peptic ulcer disease included under DC 7307

What to expect:

The examiner will review H. pylori test results (urea breath test, stool antigen, serology, or biopsy). They will note date of test and results.

Key thresholds:

  • Positive H. pylori confirmed — Establishes diagnosis under DC 7307 (H. pylori infection explicitly listed); supports service connection nexus if exposure occurred in-service
  • Persistent symptoms despite successful H. pylori eradication — Demonstrates ongoing disability independent of infection; important for continued rating justification

Tips:

  • Know whether you have ever tested positive for H. pylori
  • Know the treatment you received (triple therapy, quadruple therapy) and whether a test-of-cure was performed
  • If still symptomatic after eradication, emphasize ongoing symptom burden to the examiner

Pain considerations: H. pylori infection causes epigastric pain, bloating, and nausea; accurately describe these symptoms even if infection has been treated

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

Assesses for anemia (low hemoglobin/hematocrit) resulting from GI bleeding associated with peptic ulcer disease or severe gastritis

What to expect:

The examiner will review most recent CBC values including hemoglobin, hematocrit, white blood cell count, and platelets. Anemia requiring hospitalization is a specific rating criterion.

Key thresholds:

  • Hemoglobin below normal requiring hospitalization or transfusion — Manifestations of anemia requiring hospitalization support a 60% or higher rating
  • Recurrent anemia without hospitalization requirement — Supports moderate-to-severe rating; document all episodes of low blood counts

Tips:

  • Know your most recent hemoglobin and hematocrit values
  • If you have ever been hospitalized for GI bleeding or anemia, document the dates and facilities
  • Mention if you have experienced fatigue, dizziness, or shortness of breath due to low blood counts

Pain considerations: Anemia from GI bleeding causes fatigue, weakness, and reduced exercise tolerance - describe these functional impacts clearly

Upper GI Radiographic Studies / CT / MRI Review

Imaging studies that may identify ulcers, stenosis, motility disorders, obstruction, or structural abnormalities of the stomach and duodenum

What to expect:

The examiner will review any upper GI series, CT scans, or MRI results. Dates and findings will be documented on the DBQ.

Key thresholds:

  • Evidence of stenosis or obstruction — Persistent partial bowel obstruction or stomach stenosis may support higher rating levels
  • Evidence of prior perforation or complications — Post-surgical complications and residuals support higher rating levels

Tips:

  • Bring or ensure VA has access to imaging reports and CDs if applicable
  • Know when your last imaging studies were performed
  • If imaging showed narrowing, ulcer craters, or structural changes, be prepared to describe associated symptoms

Pain considerations: Imaging findings that correlate with your symptoms strengthen the connection between your structural disease and functional complaints

Estimate

Rating Criteria Breakdown

100% Chronic gastritis / peptic ulcer disease rated at 100% under ...

Chronic gastritis / peptic ulcer disease rated at 100% under DC 7304. Requires: recurrent hematemesis (vomiting blood) or melena (tarry stools) with manifestations of anemia requiring hospitalization; OR persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation; accompanied by hemorrhage requiring hospitalization, or continuous marked impairment of digestion and absorption of food with resultant profound weight loss.

Key Symptoms

  • Recurrent vomiting of blood (hematemesis)
  • Tarry/black stools (melena)
  • Manifestations of anemia requiring hospitalization
  • Continuous abdominal pain with intermittent vomiting
  • Profound weight loss from inability to absorb/digest food
  • Repeated hemorrhage episodes requiring hospital admission
  • Requirement for total parenteral nutrition (TPN) or continuous tube feedings

CFR: Under DC 7304 (applied via DC 7307): 100% requires recurrent hematemesis or melena with anemia requiring hospitalization, or persistent severe digestive impairment with hemorrhage and profound weight loss.

60% Chronic gastritis / peptic ulcer disease rated at 60% under ...

Chronic gastritis / peptic ulcer disease rated at 60% under DC 7304. Requires: two or more of the following - pain not relieved by standard ulcer regimen; vomiting; symptoms of obstruction; or manifestations of anemia. Also includes: clinically documented episodes requiring hospitalization, post-gastrectomy syndrome with confirmed complication, or persistent diarrhea after surgery.

Key Symptoms

  • Epigastric pain not relieved by standard antacid/PPI regimen
  • Recurrent vomiting
  • Symptoms of gastric outlet obstruction (early satiety, bloating, regurgitation)
  • Manifestations of anemia (fatigue, pallor, low hemoglobin)
  • Persistent diarrhea post-surgically
  • Recurrent hospitalizations for GI complications
  • Post-gastrectomy syndrome with confirmed alkaline gastritis or complications
  • Significant weight loss
  • Discomfort or pain within one hour of eating requiring ongoing medical management

CFR: Under DC 7304 (applied via DC 7307): 60% requires two or more of: pain not relieved by standard ulcer regimen, vomiting, symptoms of obstruction, or anemia manifestations.

40% Chronic gastritis / peptic ulcer disease rated at 40% under ...

Chronic gastritis / peptic ulcer disease rated at 40% under DC 7304. Requires: recurrent episodes of stomach pain and vomiting that occur two or more times yearly, OR history of peptic ulcer disease documented by endoscopy or X-ray, with pain not relieved by standard treatment regimen and requiring frequent medical management.

Key Symptoms

  • Recurrent episodes of epigastric pain occurring 2 or more times per year
  • Pain not fully controlled by standard PPI/antacid regimen
  • Episodes of nausea and vomiting
  • Episodes lasting days to weeks requiring increased medication
  • History of documented peptic ulcer disease by endoscopy or radiology
  • Intermittent diarrhea or colic
  • Dietary modifications required to manage symptoms
  • Moderate interference with work or daily activities during episodes

CFR: Under DC 7304 (applied via DC 7307): 40% requires recurrent stomach pain and vomiting episodes at least twice yearly; or history of peptic ulcer documented by endoscopy/radiology with pain not fully controlled by standard treatment.

20% Chronic gastritis / peptic ulcer disease rated at 20% under ...

Chronic gastritis / peptic ulcer disease rated at 20% under DC 7304. Requires: two or more of the following - epigastric distress after meals, pyrosis (heartburn), regurgitation, constipation, or other digestive symptoms occurring consistently but manageable with medication and/or dietary modification.

Key Symptoms

  • Epigastric discomfort after meals
  • Heartburn (pyrosis)
  • Regurgitation
  • Belching or bloating
  • Constipation
  • Nausea without vomiting
  • Abdominal pain managed with daily medication
  • Symptoms requiring oral dietary modification
  • Mild to moderate interference with daily activities

CFR: Under DC 7304 (applied via DC 7307): 20% requires two or more symptoms including epigastric distress after meals, pyrosis, regurgitation, or constipation that are consistently present but manageable.

0% Condition is present (service-connected) but currently asymp ...

Condition is present (service-connected) but currently asymptomatic, or symptoms are so mild and infrequent that they do not meet the threshold for a compensable rating. A 0% (noncompensable) rating still establishes service connection and preserves the right to seek an increased rating in the future if the condition worsens.

Key Symptoms

  • Condition confirmed by prior endoscopy or lab test but currently asymptomatic
  • Rare, very mild episodes not requiring medication
  • No dietary modifications required
  • No functional impairment

CFR: Under DC 7304 (applied via DC 7307): 0% is assigned when the diagnosis is confirmed but the veteran does not currently meet the symptom criteria for 20% or higher.

How to Describe Your Symptoms

Abdominal Pain

How to describe:

Describe the location (epigastric, upper abdomen, diffuse), character (burning, gnawing, sharp, cramping), severity on a 1-10 scale, timing relative to meals (before, during, or after eating), duration of each episode, and how often it occurs per week or month. Indicate whether food, antacids, or PPIs help or worsen the pain. Report your worst episodes, not just your average days.

Worst-day example:

“On my worst days, I have a constant burning, gnawing pain in my upper abdomen that starts about 30 minutes after eating and lasts for 3-4 hours. The pain is a 7-8 out of 10 and prevents me from concentrating at work or sleeping through the night. Antacids provide only partial relief. This happens at least 3-4 times per week.”

What the examiner listens for:

Frequency of pain episodes (multiple times per week vs. occasional), whether standard antacid/PPI regimen controls the pain, relationship to meals, whether the pain is disabling or merely uncomfortable, and whether the pain has led to dietary restriction or work limitations.

Understatements to avoid:

Do not say 'my stomach bothers me sometimes' or 'it's not that bad.' Describe specific frequency, severity, and functional impact. Do not minimize pain because you take medication - the examiner needs to know how your condition behaves even on medication.

Nausea and Vomiting

How to describe:

Report how often nausea occurs (daily, weekly, in episodes), whether it results in vomiting, frequency of vomiting episodes, and whether vomiting is managed by medication or diet. Note if vomiting has ever contained blood (hematemesis). Report the worst episodes and describe how nausea and vomiting interfere with eating, working, and daily activities.

Worst-day example:

“During my worst flares, I am nauseated from the time I wake up. I vomit 2-3 times in a day, which prevents me from eating more than a few bites. This has happened multiple times this year and has caused me to miss work. Even when I take anti-nausea medication, I still feel sick most of the afternoon.”

What the examiner listens for:

Whether vomiting is managed by medication, frequency of vomiting episodes per year, whether there has been any blood in vomit, and how vomiting affects nutritional intake and work capacity.

Understatements to avoid:

Do not omit episodes of nausea that did not result in vomiting - nausea alone affects your ability to eat and function. Do not say 'I just get a little sick sometimes.' Quantify frequency and impact.

GI Bleeding (Hematemesis / Melena)

How to describe:

If you have ever vomited blood or had black, tarry stools, describe each episode: when it occurred, how much blood was present, whether you were hospitalized, what treatment was received, and whether it has recurred. This is a critical factor for 100% rating. Report accurately - do not exaggerate, but do not minimize either.

Worst-day example:

“In [month/year], I vomited a significant amount of bright red blood and was admitted to [facility] for 3 days. I required IV fluids and my hemoglobin dropped to [value]. I was told I had a bleeding ulcer. I have also had episodes of black, tarry stools on [dates].”

What the examiner listens for:

Number of episodes, whether hospitalizations were required, whether anemia resulted, whether the condition has been recurrent, and whether bleeding episodes are ongoing or in the past.

Understatements to avoid:

Do not downplay or omit any prior bleeding episodes. If you had black stools or vomited material that looked like coffee grounds, report this - these are signs of GI bleeding that directly affect your rating.

Diarrhea, Constipation, and Bowel Changes

How to describe:

Describe frequency of loose or watery stools per day or week, urgency, whether bowel movements are explosive or unpredictable, whether constipation alternates with diarrhea, and how these symptoms affect your ability to leave home, work, or engage in social activities. Note if you have had post-surgical bowel changes (e.g., after gastrectomy or vagotomy).

Worst-day example:

“On bad days, I have 5-6 watery bowel movements that I cannot predict or control. I have had accidents because I could not reach the bathroom in time. This makes it impossible for me to travel, attend meetings, or leave the house without knowing where every bathroom is.”

What the examiner listens for:

Frequency and consistency of bowel movements, urgency and predictability, whether diarrhea is a post-surgical complication, and whether symptoms are managed by medication or dietary restriction.

Understatements to avoid:

Do not omit diarrhea because it seems unrelated to gastritis - post-gastritis and post-surgical diarrhea are explicitly rated under DC 7307/7304. Report urgency and accidents accurately.

Dietary and Nutritional Impact

How to describe:

Describe all dietary modifications you have made because of your condition: foods you cannot eat, meal sizes you must restrict, frequency of eating (small frequent meals), foods that trigger symptoms, and any weight loss attributable to your stomach condition. Note if a doctor has prescribed a specific diet.

Worst-day example:

“I have lost [X] pounds over the past [X] months because eating causes severe pain. I can only tolerate small amounts of plain food at a time. I have eliminated spicy food, caffeine, alcohol, and acidic foods entirely on my doctor's advice. I carry antacids everywhere and often skip meals to avoid the pain.”

What the examiner listens for:

Whether dietary modification is medically directed, whether it is oral modification only or involves tube feeding or TPN, the degree of nutritional restriction, and whether weight loss is present and attributable to the GI condition.

Understatements to avoid:

Do not say 'I just watch what I eat' without explaining the extent of restriction. Medically directed dietary modification is a specific DBQ field that can affect your rating. Quantify weight loss with actual numbers.

Functional and Occupational Impact

How to describe:

Describe how your condition affects your ability to work, including time missed from work, inability to perform job duties during flares, restrictions on physical activity, and impact on daily activities such as driving, socializing, sleeping, and caring for yourself or family. Connect specific symptoms to specific limitations.

Worst-day example:

“During flares, I miss 1-2 days of work per month because the pain and vomiting make it impossible to function. I cannot sit through a full workday without needing to lie down. I have asked to be reassigned from physical tasks because eating at work triggers pain. I wake up 2-3 nights per week from stomach pain.”

What the examiner listens for:

How the condition limits occupational and daily functioning, whether limitations are consistent or only during flares, and whether the veteran has sought accommodations or changed jobs due to their condition.

Understatements to avoid:

Do not say 'I manage okay' if your condition affects your work or daily life. The examiner must document functional impact - if you downplay it, the DBQ will not reflect the true severity of your disability.

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

Day Of

During the Exam

After the Exam

Your Rights During a C&P Exam

  • You have the right to record your C&P examination in most states under applicable one-party or two-party consent laws. Research your state's law before the exam and notify the examiner if you choose to record.
  • You have the right to request a copy of the completed DBQ form after the examination is finalized.
  • You have the right to submit a written statement (lay statement/buddy statement) describing your symptoms, their impact on your daily life, and their history, which VA must consider as evidence.
  • You have the right to submit private medical opinions and nexus letters from your treating physicians, which carry evidentiary weight in your claim.
  • You have the right to request a new C&P examination if you believe the original exam was inadequate - for example, if the examiner did not review your records, the exam was too brief to capture your full symptom burden, or the DBQ contains factual errors.
  • You have the right to appeal any rating decision you disagree with through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals pathways under the Appeals Modernization Act (AMA).
  • VA has a duty to assist you in obtaining relevant medical records, including service treatment records, VA medical records, and private records you authorize VA to request.
  • You have the right to have a Veterans Service Organization (VSO) representative, accredited claims agent, or accredited attorney assist you with your claim at no charge (for VSO representatives).
  • Under the benefit of the doubt standard (38 CFR - 3.102), when there is an approximate balance of positive and negative evidence regarding any issue material to your claim, VA must resolve the question in your favor.
  • If you are a former prisoner of war (FPOW), peptic ulcer disease is subject to special presumptive and rating provisions. Ensure your FPOW status is clearly documented in your claim file and communicated to the examiner.
  • You have the right to submit a Fully Developed Claim (FDC) with all relevant evidence to potentially receive a faster decision.
  • You may request that the examiner document your in-service nexus opinion in the DBQ remarks section if they believe your condition is related to your military service.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.