Diagnostic Code 7305 · 38 CFR §4.114
A duodenal ulcer is an open sore in the lining of the duodenum, the first segment of the small intestine just past the stomach. The two main causes are infection with the bacterium Helicobacter pylori and long-term use of NSAIDs like ibuprofen, naproxen, and aspirin. Veterans tend to accumulate both risks: the deployment-era stress environment is a known accelerator, NSAID use for joint and back pain is common, and rates of H. pylori carriage are higher in service members who deployed to certain regions. Symptoms typically include burning upper abdominal pain that wakes the veteran at night or appears two to three hours after eating, nausea, bloating, and — in more severe disease — vomiting, dark or bloody stools, and weight loss. Untreated ulcers can perforate, bleed heavily, or scar the duodenum closed.
| Rating | Criteria |
|---|---|
| 10% | Mild disease — occasional flares once or twice a year that resolve with standard ulcer therapy and do not produce systemic impairment. |
| 20% | Moderate disease — recurring episodes of severe symptoms two or three times a year, each averaging about ten days in duration, OR continuous moderate symptoms requiring ongoing medical management. |
| 40% | Moderately severe disease — recurrent incapacitating episodes averaging ten days or more in duration at least four times a year, OR symptoms producing measurable impairment of overall health such as anemia or weight loss. |
| 60% | Severe disease — pain only partially controlled by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, and clear systemic impairment with anemia and weight loss reflecting a definite decline in overall health. |
An upper endoscopy (EGD) with biopsy is the strongest objective evidence — it confirms the ulcer, characterizes its severity, and rules out malignancy. An H. pylori test (breath, stool antigen, or biopsy-based) documents the underlying cause. Lab work showing iron-deficiency anemia, low hemoglobin, or positive fecal occult blood supports the higher rating tiers. A symptom log covering several months captures flare frequency and duration, which directly drives the rating. Medication records — proton pump inhibitors, H2 blockers, antibiotic eradication regimens — show the chronic management burden. Service treatment records or buddy statements documenting in-service onset, in-service NSAID use, or treatment of upper-abdominal symptoms during active duty establish the nexus.
No, though they often get lumped together as peptic ulcer disease. A gastric ulcer (DC 7304) sits in the stomach itself; a duodenal ulcer (DC 7305) sits in the small intestine just past the stomach. The rating criteria are nearly identical, but the diagnostic codes are separate and the symptom patterns differ slightly — duodenal ulcers classically cause pain that improves with eating, while gastric ulcer pain often worsens with food.
Severe physiologic stress is well-established as a trigger for acute stress ulcers, and chronic high-stress environments can aggravate ulcers driven by other causes. The cleaner nexus, though, runs through H. pylori infection or through chronic NSAID use for service-connected pain. If service records document the in-service onset of upper-abdominal symptoms, any of these pathways can support service connection.
Peptic ulcer disease is a chronic condition. An ulcer that healed under treatment can return — the same H. pylori carriage or the same NSAID use can produce a new ulcer years later. The rating is based on the current disease state, so an active recurrence rates the same as the original. Keep service connection in place even when symptoms are quiet.