Citation Nr: 18148704 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 16-24 683A DATE: November 8, 2018 REMANDED Entitlement to an initial compensable evaluation for hemorrhoids is remanded. REASONS FOR REMAND The Veteran was a member of the U.S. Marine Corps Reserve who served on inactive duty for training from May 2005 to August 2005 and from June 2007 to July 2007. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office. A review of the medical evidence of record from November 2009 to August 2011, generally reflects the Veteran had small external and internal hemorrhoids, with occasional or intermittent bleeding. In a January 2011 VA record demonstrated that the Veteran had no external hemorrhoids, no fissures, and no rectal masses. In a March 2011 sigmoidoscopy, the Veteran was found to have internal hemorrhoids that were too small to band. In an April 2011 VA treatment record reveal that he had small internal hemorrhoids, and an August 2011 treatment records noted that the Veteran did have some small non-thrombosed external hemorrhoids that extended into the low rectum without a large external component. None of those records demonstrate any findings of anemia. Prior to June 2014, the Veteran did not have a VA examination of his hemorrhoids. During the June 2014 VA examination, the Veteran was diagnosed with internal and external hemorrhoids; the examiner noted that he had 3 external hemorrhoids in June 2005 and June 2014, and internal hemorrhoids as noted in the March 2011 sigmoidoscopy. The Veteran reported that he self-medicated his hemorrhoids with over-the-counter suppositories and a high-dietary intake of fiber. During that examination, he reported that he had a flare-up of hemorrhoids in 2012 because he was out of suppositories; he was given a prescription medication and some fiber, which was helpful. He denied any negative impact on activities of daily living or his occupational functioning at that time. On examination, the examiner noted that the Veteran had small or moderate external hemorrhoids and a single mild, small, non-inflamed external hemorrhoid with a skin tag noted at the 11 o’clock position of the anus. The examiner noted that the Veteran’s hemorrhoid condition did not impact his ability to work. In his June 2015 notice of disagreement, the Veteran indicated that his hemorrhoids limited his ability to exercise, lift weights and participate in sports; he also indicated that his diet was altered due to needing to take fiber daily. The Veteran indicated that he was scheduled to have surgery, although he did not have medical insurance or money to cover the surgery, and that he was denied surgery by VA due to not being service connected. He finally stated that his condition left him frustrated, in pain, and hindered him from having a normal life. He additionally noted that during flare-up, one or more of his hemorrhoids protruded from his anus. He noted that it was physical very painful and uncomfortable; it was hard to sit or bathe, and it was embarrassing during intimate situations. Flare-ups of his hemorrhoids occurred if he was constipated, strained during bowel movements, lifted and carried heavy objects, pivoted or stepped oddly, performed physical exercise, or driving or riding in a car for longer than a few minutes. He indicated that he had to stop all physical activities during a flare-up until his hemorrhoids shrinks and that resumption of physical activity too soon will cause an enlargement of his hemorrhoids for a longer duration. He further indicated that his employment opportunities were limited due to his hemorrhoids. In his June 2016 substantive appeal, VA Form 9, the Veteran made several substantially similar statements regarding the flare-ups of his hemorrhoids. Additionally, the Veteran’s VA treatment records show that he had a flare-up of his hemorrhoids in June 2016. On examination at that time, he was noted to have rectal hemorrhoids, but no bleeding. He was prescribed a suppository and cream at that time. Based on the Veteran’s statements and the flare-up noted in June 2016, the Board finds that there is potential worsening of the Veteran’s hemorrhoid disability since his last VA examination. Accordingly, a remand is necessary in order to obtain another VA examination which adequately addresses the current severity of that disability. See Palczewski v. Nicholson, 21 Vet. App 174, 181-82 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also Bolton v. Brown, 8 Vet. App. 185, 191 (1995) (VA must provide a new examination where a veteran claims the disability is worse than when originally rated and the available evidence is too old to adequately evaluate the current severity); Caffrey v. Brown, 6 Vet. App. 377, 381 (1995). On remand, the Board also finds that any outstanding VA treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (where the Veteran “sufficiently identifies” other VA medical records that he or she desires to be obtained, VA must also seek those records even if they do not appear potentially relevant based upon the available information); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Obtain any and all VA treatment records not already associated with the claims file from the Asheville and Fort Harrison VA Medical Centers, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file. 2. Schedule the Veteran for a VA examination with an appropriate examiner in order to determine the current severity of his hemorrhoid disability. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. After review of the claims file and examination of the Veteran, the examiner should indicate whether the Veteran’s hemorrhoids are mild or moderate in severity; are large or thrombotic, irreducible, with excessive redundant tissue, and evidencing frequent recurrences; or, with persistent bleeding and with secondary anemia, or with fissures. The examiner should specifically address the Veteran’s statements regarding severity and physical limitations due to flare-ups of his hemorrhoids and address the disability present during flare-ups using the above noted criteria. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.Seehusen, Associate Counsel