Digestive Overview

The digestive system (gastrointestinal system) has the chief responsibility of providing nutrients to body cells accomplished by a series of processes. Basic activities involved in the processes include: ingestion, intake of food; movement, passage of food through the gastrointestinal tract; digestion, breakdown of food chemically and mechanically; absorption, transfer of digested food into the circulatory and lymph systems for delivery to individual cells; and elimination (defecation), the removal of waste products of digestion (feces).

The digestive system consists of the gastrointestinal tract (alimentary canal) and accessory organs, which secrete enzymes that aid in the digestive process. The tract is approximately 30 feet long and extends from the mouth to the anus. The major gastro-intestinal structures include: the mouth, lips, tongue, esophagus, stomach and small intestines and large intestines. The accessory organs involve the liver, pancreas and gallbladder.

The mouth, pharynx and esophagus are involved in the intake of food, which is broken down and swallowed, and then propelled into the stomach. The mouth, stomach and small intestine are involved in digestion and absorption. Digestion begins in the mouth, including mechanical and chemical processes. The stomach stores food, mixes the food with secretions, and empties the resulting contents into the small intestine. In the small intestine, digestive enzymes break down nutrients so that absorption can take place. The function of elimination is the major role of the large intestine. Water and electrolytes are absorbed and feces are formed and held until defecation occurs. The functions of the digestive accessory organs (liver, pancreas and gallbladder) are focused on aiding the digestive process and participating in important metabolic processes.

Digestive Disorders

General Considerations for Rating

  • Ulcers.

    Experience has shown that the term "peptic ulcer" is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach or duodenum in comparison with those at an anastomotic stoma are sufficiently recognized as to warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that the findings adequately identify the particular location. (38 CFR §4.110 [Ulcers])

  • Postgastrectomy syndromes.

    There are various postgastrectomy symptoms which may occur following anastomotic operations of the stomach. When present, those occurring during or immediately after eating and known as the "dumping syndrome" are characterized by gastrointestinal complaints and generalized symptoms simulating hypoglycemia; those occurring from 1 to 3 hours after eating usually present definite manifestations of hypoglycemia. (38 CFR §4.111 [Post-gastrectomy syndromes])

  • Weight loss. (change made 1/23/02)

    For purposes of evaluating conditions in Sec. 4.114, the term "substantial weight loss" means a loss of greater than 20 percent of the individual's baseline weight, sustained for three months or longer; and the term "minor weight loss" means a weight loss of 10 to 20 percent of the individual's baseline weight, sustained for three months or longer. The term "inability to gain weight" means that there has been substantial weight loss with inability to regain it despite appropriate therapy. "Baseline weight" means the average weight for the two-year-period preceding onset of the disease (38 CFR §4.112 [Weight loss]).

  • Coexisting abdominal conditions.

    There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title "Diseases of the Digestive System," do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.114. (38 CFR 4.113 [Coexisting abdominal conditions])

  • Schedule of ratings—digestive system.

    Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. (38 CFR 4.114 [Schedule of ratings-digestive system]) 

Problematic Issues

  • Gastroesophageal Reflux Disease (GERD)

  • Hiatal Hernia.

  • Hemorrhoids

  • Hepatitis C

  • Irritable Bowel Syndrome

Mouth, Lips, Tongue, Esophagus

Diagnostic Code Name VA Exam
7200 Mouth, injuries of Mouth, Lips & Tongue
7201 Lips, injuries of Mouth, Lips & Tongue
7202 Tongue, loss of whole or part Mouth, Lips & Tongue
7203 Esophagus, stricture of Esophagus & Hiatal Hernia
7204 Esophagus, spasm of (cardiospasm) Esophagus & Hiatal Hernia
7205 Esophagus, diverticulum of, acquired Esophagus & Hiatal Hernia

Stomach, Liver, Gallbladder, Colon

Diagnostic Code Name VA Exam Acronym
7301 Peritoneum, adhesions of Stomach, Duodenum & Peritoneal Adhesions ---
7304 Ulcer, gastric Stomach, Duodenum & Peritoneal Adhesions ---
7305 Ulcer, duodenal Stomach, Duodenum & Peritoneal Adhesions ---
7306 Ulcer, marginal (gastrojejunal) Stomach, Duodenum & Peritoneal Adhesions ---
7307 Gastritis, hypertrophic (identified by gastroscope) Stomach, Duodenum & Peritoneal Adhesions ---
7308 Postgastrectomy syndromes Stomach, Duodenum & Peritoneal Adhesions ---
7309 Stomach, stenosis of Stomach, Duodenum & Peritoneal Adhesions ---
7310 Stomach, injury of, residuals Stomach, Duodenum & Peritoneal Adhesions ---
7311 Residuals of injury of the liver Liver, GallBladder & Pancreas ---
7312 Cirrhosis of the liver, primary biliary cirrhosis, or cirrhotic phase of sclerosing cholangitis Liver, GallBladder & Pancreas PBC
7314 Cholecystitis, chronic Liver, GallBladder & Pancreas CHCH
7315 Cholelithiasis, chronic Liver, GallBladder & Pancreas CHOLI, CL
7316 Cholangitis, chronic Liver, GallBladder & Pancreas ---
7317 Gallbladder, injury of Liver, GallBladder & Pancreas ---
7318 Gallbladder, removal of Liver, GallBladder & Pancreas ---
7319 Irritable colon syndrome (spastic colitis, mucous colitis, etc.) Intestine, Large & Small ---
7321 Amebiasis Intestine, Large & Small ---
7322 Dysentery, bacillary Intestine, Large & Small ---
7323 Colitis, ulcerative Intestine, Large & Small ---
7324 Distomiasis, intestinal or hepatic Intestine, Large & Small ---

Intestine, Rectum, Anus, Pancreas

Diagnostic Code Name VA Exam Acronym
7325 Enteritis, chronic Intestine, Large & Small ---
7326 Enterocolitis, chronic Intestine, Large & Small ENTCOL
7327 Diverticulitis Intestine, Large & Small ---
7328 Intestine, small, resection of Intestine, Large & Small ---
7329 Intestine, large, resection of Intestine, Large & Small ---
7330 Intestine, fistula of, persistent, or after attempt at operative closure Intestine, Large & Small ---
7331 Peritonitis, tuberculus, active or inactive Digestive Conditions, Miscellaneous PER, PEROI
7332 Rectum and anus, impairment of sphincter control Rectum & Anus ---
7333 Rectum and anus, stricture of Rectum & Anus ---
7334 Rectum, prolapse of Rectum & Anus ---
7335 Ano, fistula in Rectum & Anus ---
7336 Hemorroids, external or internal Rectum & Anus EXHES/INHEROS
7337 Pruritus ani Rectum & Anus ---
7338 Hernia, inguinal Digestive Conditions, Miscellaneous ---
7339 Hernia, ventral, postoperative Digestive Conditions, Miscellaneous ---
7340 Hernia, femoral Digestive Conditions, Miscellaneous ---
7342 Visceroptosis, symptomatic, marked Digestive Conditions, Miscellaneous ---
7343 Malignant neoplasms of the digestive system, exclusive of skin growths Digestive Conditions, Miscellaneous PMNS
7344 Benign neoplasms, exclusive of skin growths Digestive Conditions, Miscellaneous ---
7345 Chronic liver disease without cirrhosis (including hepatitis B, chronic active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis, etc., but excluding bile duct disorders and hepatitis C) Liver, Gall Bladder & Pancreas ---
7346 Hernia, hiatal Esophagus & Hiatal Hernia ---
7347 Pancreatitis Liver, Gall Bladder & Pancreas PACRI
7348 Vagotomy with pyloroplasty or gastroenterostomy Stomach, Duodenum & Peritoneal Adhesions V
7351 Liver transplant Liver, Gall Bladder & Pancreas LITRA
7354 Hepatitis C (or non-A, non-B hepatitis) Liver, Gall Bladder & Pancreas HCV

Analogous

Diagnostic Code Name
7299-7203 Esophagitis
7335-7332 Fistula, anorectal PO
7399-7305 Inflammatory duodenal disease
7399-7305 Pyloric ulcer
7399-7307 Gastroenteritis
7399-7314 Cholestasis
7399-7323 Crohn's disease
7399-7324 Dysentery ankylostomiasis
7399-7327 Meckel's diverticulum
7399-7333 Colostomy
7399-7339 Hernia, epigastric, umbilical
7399-7346 Gastroesophageal reflux disease

Historical

Diagnostic Code Name
7311 Liver, injury of Same Number - Rating Criteria Changed
7312 Liver, cirrhosis of Same Number - Rating Criteria Changed
7313 Liver, abcess of, residuals Deleted
7343 New growths, malignant, exclusive of skin growths Same Number - Rating Criteria Changed
7344 New growths, benign, any specified part of digestive system, exclusive of skin growths Same Number - Rating Criteria Changed
7345 Residuals of Hepatitis Same Number - Rating Criteria Changed