Citation Nr: 18156553 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 15-41 074 DATE: December 10, 2018 ORDER For the entire appeal period, an initial, 10 percent rating for hemorrhoids is granted, subject to the criteria governing the payment of monetary benefits. FINDING OF FACT For the entire appeal period, the Veteran’s service-connected hemorrhoid disability has been manifested by frequent occurrences of moderate to large internal and external hemorrhoids that result in rectal bleeding, constipation, itching, pain, and swelling, but without evidence of secondary anemia or fissures. CONCLUSION OF LAW The criteria for a 10 percent rating, but no higher, for hemorrhoids have been met for the entire appeal period. 38 U.S.C. 1155, 5107 (West 2012); 38 C.F.R. 3.321, 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7336 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1960 to December 1960 and from October 1961 to August 1962, with additional service in the Army Reserves. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi, which granted entitlement to service connection for hemorrhoids and assigned a noncompensable disability rating. The Veteran timely perfected an appeal of the noncompensable evaluation assigned in the June 2013 rating decision. See April 2014 Notice of Disagreement; October 2015 Statement of the Case; November 2015 VA Form 9. In November 2016, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge, a transcript of which has been associated with the claims file. In March 2017, the Board remanded this claim for further development. Increased Rating for Hemorrhoids The Veteran seeks a compensable rating for his hemorrhoid disability. Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran’s symptoms with criteria listed in VA’s Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s hemorrhoids are currently rated as noncompensable under 38 C.F.R. § 4.114, Diagnostic Code 7336. Under that code, a noncompensable rating is warranted when there is mild or moderate symptomatology. A 10 percent rating is warranted where the hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent rating is warranted for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. Turning to the evidence of record, a June 2007 VA treatment record shows that the Veteran reported hemorrhoids with burning, itching, and swelling. A June 2008 private colonoscopy report revealed the presence of internal and external hemorrhoids. The Veteran underwent a VA examination in June 2013. The Veteran reported reoccurring swelling and some bleeding. The examiner noted internal or external hemorrhoids with “occasional burning and itching.” On examination, the examiner noted small or moderate external hemorrhoids and non-palpable internal hemorrhoids. In a February 2014 statement, the Veteran reported that he had daily swelling and bleeding due to his hemorrhoids. In his November 2015 substantive appeal, the Veteran asserted that he had moderate to severe hemorrhoids, with burning, bleeding, and severe pain. During the November 2016 Board hearing, the Veteran reported swelling, constipation, occasional bleeding, itching, burning, and pain. He testified that his hemorrhoids remained inflamed, even with medication. A January 2017 private treatment record shows that the Veteran was treated for recurrent hemorrhoids. He reported burning, discomfort, a pressure sensation, and tightness. The treatment provider noted that current mediations were “considered partially effective” and that there was no anemia. A February 2017 colonoscopy showed internal hemorrhoids. The Veteran was afforded a VA examination in February 2018. The examiner noted large, non-thrombosed external hemorrhoids, without persistent bleeding, anemia, or fissures. The examiner indicated that the Veteran had pain with prolonged sitting and pain with straining at the stool. A March 2018 private colonoscopy report showed external and internal hemorrhoids. Based on a review of the foregoing evidence of record and resolving the benefit of the doubt in the Veteran’s favor, the Board finds that the Veteran’s hemorrhoids disability more nearly approximates the symptomatology associated with an initial, 10 percent disability rating under Diagnostic Code 7336. In this regard, colonoscopy reports dated in June 2008, February 2017, and March 2018 noted the presence of internal and external hemorrhoids, and the Veteran has consistently described rectal bleeding, constipation, itching, pain, and swelling associated with his hemorrhoid disability. Moreover, the February 2018 VA examiner described the Veteran’s external hemorrhoids as large. Notably, although the June 2013 VA examiner noted the presence of small to moderate external hemorrhoids and internal hemorrhoids (which were not described by size), the examiner did not describe the severity of the Veteran’s overall hemorrhoid disability, other than as “occasional burning and itching.” Resolving all doubt in the Veteran’s favor, the Board finds a rating of 10 percent is warranted as the Veteran’s hemorrhoids are noted to be moderate to large, with frequent recurrences of rectal bleeding, constipation, itching, pain, and swelling. However, the Board finds that a maximum 20 percent rating under Diagnostic Code 7336 is not warranted at any time of the appeal period. Notably, there is no competent medical evidence which demonstrates that the Veteran’s hemorrhoids are manifested by persistent bleeding and with secondary anemia, or with fissures. Although the Veteran has reported occasional rectal bleeding, at no time has he been found as having secondary anemia. See generally VA Treatment Records. Also, the competent and probative evidence during the appeal period is absent any findings of anal fissures. The Board has considered the applicability of other, potentially applicable diagnostic criteria for rating the Veteran’s hemorrhoids but finds that no higher rating is assignable under any other diagnostic code. There have been no objective findings of any rectum prolapse or stricture to warrant ratings under diagnostic codes 7333 and 7334, and no impairment of sphincter control. As such, no other diagnostic code is more applicable in this case. The Board concludes that the objective medical evidence and the Veteran’s statements regarding his symptomatology show disability that most nearly approximates that which warrants the assignment of a 10 percent disability rating for the entire appeal period. See 38 C.F.R. § 4.7. As shown above, and as required by Schafrath, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the Veteran. The Board finds no provision upon which to assign a greater or separate rating. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Kipper, Associate Counsel