Citation Nr: 18158795 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 14-01 797 DATE: December 18, 2018 ORDER Entitlement to a compensable rating for hemorrhoids is denied. FINDING OF FACT The most probative evidence of record shows that the Veteran has internal hemorrhoids that are mild or moderate in severity. CONCLUSION OF LAW The criteria for a compensable rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.114, Diagnostic Code (DC) 7336 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1962 to February 1964. This matter is on appeal from a January 2012 rating decision. In July 2017, the Veteran testified at a Video Conference hearing before the undersigned Veterans Law Judge. A transcript of this testimony is associated with the claims file. In October 2017, this matter was remanded by the Board for further development. Increased Rating Claim Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities, which are based, as far as practically can be determined, on average impairment in earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). Reasonable doubt regarding the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3 (2018). In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21 (2018). At the time of an initial rating, separate ratings can be assigned for separate periods of time based on facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2018). The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The Veteran’s hemorrhoids have been rated noncompensably (zero percent) disabling under Diagnostic Code 7336. Under DC 7336, a noncompensable rating is warranted for internal or external hemorrhoids which are mild or moderate. A 10 percent rating is warranted for large or thrombotic, irreducible hemorrhoids with excessive redundant tissue evidencing frequent recurrences. Finally, a 20 percent rating is warranted for hemorrhoids with persistent bleeding and secondary anemia, or with fissures. 38 C.F.R. § 4.114, DC 7336 (2018). Turning to the merits of the claim, on December 2011 VA examination, the Veteran presented with a history of hemorrhoids since 1963. He stated that throughout the years he had recurrent bleeding and itching. At times his bowel movements were painful. Constipation made hemorrhoids worse. The examiner indicated mild or moderate hemorrhoids and pruritus ani. The Veteran described occasional hard stools and discomfort. However, examination of the rectal/anal area was normal with no external hemorrhoids, anal fissures, or other abnormalities. The examiner indicated that the Veteran took no chronic medication for hemorrhoids, but used anti-hemorrhoidal cream and sitz baths when needed (Preparation H medication wipes, sitz bath, hydrocortisone and pramoxine topical cream as needed). The Veteran’s condition may have worsened by activities that entailed straining. VA treatment records include a December 2011 report which reflects complaints of itching with bowel movements. The Veteran used an over-the-counter (OTC) anti-itch antihistamine cream. Zinc oxide ointment was recommended and a short trial of Analpram was prescribed. In April 2012, he complained of rectal bleeding. It was noted that a colonoscopy was negative for any other pathology than external hemorrhoids. An April 2012 Report of Contact shows that the Veteran complained of bleeding hemorrhoids. In his June 2012 substantive appeal, the Veteran complained that his severe hemorrhoids tremendously altered his quality of life and caused bleeding and pain. VA treatment records include a June 2017 report which reflects complaints of bloody stools, but this was the first time in a year and there was no pain or other bleeding sites. He still strained to have bowel movements with chronic constipation, but denied any abdominal pain. In July 2017, the Veteran testified that he experienced bloody stools. Pursuant to the Board’s October 2017 remand, on February 2018 VA rectum and anus conditions Disability Benefits Questionnaire examination, the Veteran complained of increased pain with defecation and bloody stools at least once a week. In June 2017, his primary care provider prescribed stool softeners, Metamucil, and a laxative with adequate benefit. His symptoms were deemed to be mild or moderate by the examiner and were described as occasional hard stools and a feeling of discomfort at the anal opening. Further examination revealed no external hemorrhoids and the examiner opined that his hemorrhoids had no impact on his ability to work. Applying the relevant rating criteria, the Board finds that a compensable rating for the Veteran’s hemorrhoids is not warranted at any time during the appeal. The Board finds that there are no indications that the Veteran has had large or thrombotic, irreducible hemorrhoids with excessive redundant tissue evidencing frequent recurrences. Therefore, compensable rating under DC 7336 is not warranted. Although the Board has considered the Veteran’s complaints of bloody stools, the medical evidence of record does not indicate that the Veteran’s hemorrhoids are manifested by persistent bleeding and secondary anemia or fissures, which would warrant a higher rating of 20 percent. In this case, the Veteran is competent to report complaints such as any itching and bleeding hemorrhoids, as these observations come to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board also acknowledges the Veteran's belief that his symptoms are of such severity as to warrant a higher rating and has taken these contentions seriously (this was the basis of the Board’s remand to address this medical question). He is not, however, competent to identify a specific level of disability of his hemorrhoids according to the appropriate diagnostic code. On the other hand, such competent evidence concerning the nature and extent of the Veteran’s hemorrhoids has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which this disability is evaluated. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Adams, Counsel