Diagnostic Code 7306 · 38 CFR §4.114
A marginal ulcer is a peptic ulcer that develops at the surgical junction where the stomach has been connected to the small intestine — typically the gastrojejunostomy site created during a Billroth II procedure, a gastric bypass, or a partial gastrectomy performed for prior peptic ulcer disease, gastric cancer, or trauma. Because the small intestine was not designed to handle gastric acid, the mucosa at the new anastomosis is vulnerable to repeated ulceration. Veterans most often encounter DC 7306 as a residual after in-service abdominal surgery — combat trauma repair, prior peptic ulcer surgery during active duty, or post-injury reconstructions. Symptoms include burning upper abdominal pain that is poorly controlled by standard medication, recurrent bleeding (vomiting blood or passing dark stools), iron-deficiency anemia, and weight loss. The rating tiers track the severity of the symptom pattern and the systemic impact.
| Rating | Criteria |
|---|---|
| 10% | Mild disease — occasional symptoms responding to standard ulcer therapy with no systemic impact. |
| 20% | Moderate disease — recurring episodes of pain or dyspepsia averaging two or three times a year, each lasting about ten days, 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 systemic impact such as anemia or weight loss. |
| 60% | Severe disease — pain only partially controlled by standard therapy, periodic vomiting, recurrent hematemesis or melena, and systemic impairment with anemia and weight loss reflecting a definite decline in overall health. |
| 100% | Pronounced disease — periodic or continuous pain unrelieved by standard ulcer therapy, with periodic vomiting, recurring intermittent melena or hematemesis, weight loss, and other symptoms producing marked overall impairment of health and substantially limiting ability to maintain employment. |
An upper endoscopy (EGD) with biopsy from the gastrojejunostomy site is the strongest objective evidence — it confirms the marginal location, documents the size and depth of the ulceration, and rules out malignancy. The operative report from the original gastric or intestinal surgery establishes the anatomical setup that produced the marginal ulcer in the first place. Lab work showing iron-deficiency anemia and positive fecal occult blood supports the higher rating tiers. A symptom log over several months captures the recurrence pattern. Medication records — proton pump inhibitors, H2 blockers, sucralfate, octreotide for refractory cases — show the chronic management burden. Service records or surgical records documenting the in-service abdominal procedure that preceded the ulcer establish the nexus.
Gastric ulcer (DC 7304) and duodenal ulcer (DC 7305) develop in the stomach or first part of the small intestine without prior surgical disruption of the anatomy. Marginal ulcer (DC 7306) specifically develops at a surgical junction — the new connection created during a gastrojejunostomy, Billroth II, or gastric bypass procedure. Because the small intestine was not built to handle gastric acid, marginal ulcers are often more resistant to standard treatment and carry a higher rating ceiling than ordinary peptic ulcers.
Yes. Marginal ulcers often develop months or years after the original gastric surgery, particularly in patients with risk factors like NSAID use, smoking, or persistent H. pylori infection. A delayed onset does not break the service connection if the underlying surgery was service-connected — the ulcer is a recognized long-term complication.
Revision surgery for a refractory marginal ulcer is a recognized complication and supports the higher rating tiers, particularly during the recovery period and if the revision produces additional functional residuals. File a secondary claim for the postgastrectomy syndrome under DC 7308 if dumping symptoms, malabsorption, or weight loss develop after revision.