Citation Nr: 18134331 Decision Date: 09/12/18 Archive Date: 09/12/18 DOCKET NO. 15-06 931 DATE: September 12, 2018 ORDER Evaluation for a compensable rating for ulcerative proctitis prior to July 7, 2014 is granted. A rating in excess of 10 percent for ulcerative proctitis is denied. FINDING OF FACTS 1. Prior to July 7, 2014, the Veteran’s ulcerative proctitis was shown to be manifested by moderate symptoms with infrequent exacerbations. 2. At no time has the Veteran’s ulcerative proctitis been shown to cause moderately severe symptoms with frequent exacerbations. CONCLUSION OF LAW The criteria for a 10 percent rating, but no higher, for service connected ulcerative proctitis have been met throughout the course of the appeal. 38 U.S.C. §1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.114, Diagnostic Codes 7323, 7332. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from November 2002 to August 2007. The Veteran testified before a Veterans Law Judge in November 2017. This matter is on appeal from a December 2014 rating decision. The Veteran is seeking a compensable rating for her service connected ulcerative proctitis, prior to July 17, 2014 and higher than 10 percent, thereafter. After review of the record, the Board finds that a 10 percent rating is warranted throughout the course of the appeal, but a rating in excess of 10 percent is not warranted at any time under Diagnostic Code 7323. The Veteran’s service connected ulcerative proctitis is rated under Diagnostic Code 7399-7332. Pursuant to 38 C.F.R. § 4.27, hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen; unlisted disabilities requiring rating by analogy will be coded first with the numbers of the most closely related body part and “99.” Hence, the Veteran’s ulcerative proctitis has been evaluated by analogy, using the criteria for rectum and anus, impairment of sphincter control under Diagnostic Code 7332. Under DC 7332, a 10 percent rating is assigned when there is constant slight, or occasional moderate leakage; a 30 percent rating is assigned for occasional involuntary bowel movements, necessitating wearing of peripheral artery disease; a 60 percent rating is assigned for extensive leakage and fairly frequent involuntary bowel movements; and a 100 percent rating requires a complete loss of sphincter control. 38 C.F.R. § 4.114, Diagnostic Code 7332. The Veteran’s representative has argued that a higher evaluation may be warranted under Diagnostic Code 7323. Under Diagnostic Code 7323, a 100 percent rating is warranted for pronounced ulcerative colitis resulting in marked malnutrition, anemia, and general debility, or with serious complication as liver abscess; a 60 percent rating is warranted for severe ulcerative colitis with numerous attacks a year and malnutrition, and health that is only fair during remissions; a 30 percent rating is warranted for moderately severe ulcerative colitis with frequent exacerbations; and a 10 percent rating is warranted for moderate ulcerative colitis with infrequent exacerbations. A review of the evidence establishes the presence of symptoms supporting at least a 10 percent rating since the Veteran filed her claim. As such a 10 percent rating is assigned throughout the appeal. The Board will now turn to the question of whether a rating in excess of 10 percent is warranted at any time. For the following reasons the Board concludes that it is not. At her November 2017 Board hearing, the Veteran testified that she experienced bouts of constipation and alternates between constipation and diarrhea on a daily basis. She estimated flare-ups with bloody stool approximately six times per year. She specifically denied wearing a pad, but she did report that the day to day constipation and diarrhea causes discomfort and stomach upset. An April 2011 letter from the Veteran’s private physician indicated that she had been experiencing intermittent rectal bleeding, beginning after constipation earlier that month. Her bowel movements were more “loose” at the time. A July 2011 Sigmoidoscopy procedure showed evidence of ulcerative colitis in the colon and a December 2011 Endoscopy Center noted mild ulcerative proctitis. In January 2013, private treatment records reported that the Veteran had a flare up in the last year and underwent a colonoscopy. Over the last few weeks, she has had some increased mucus production, bleeding, and even clots. Overall, the physician characterized it has ulcerative proctitis with apparent recent mild flare. At the July 2013 VA examination, the Veteran was evaluated for her ulcerative proctitis. She denied any burning, difficulty passing stool, pain, swelling, or tenesmus. She did however, report experiencing diarrhea. There is also a history of recurrence of thrombosis, and hemorrhoids, with frequent bleeding. There was no history of fecal incontinence. In March 2014, the Veteran underwent a total colonoscopy due to enlarged, engorged indurated external and internal hemorrhoids, and moderately severe ulcerative proctitis (characterized by edema, erythema, granularity, friability, and mucopurulent discharge). A May 2014 private treatment record noted that the Veteran experienced some abdominal pain. Evaluation revealed constipation. Her stools have been loose, but not watery. At a July 2014 examination, the Veteran reported intermittent episodes of flaring including rectal bleeding and loose stool. The Veteran’s symptoms included episodes of bowel disturbance with abdominal distress, or exacerbations or attacks of the intestinal condition, approximately 1 to 2 times in the past 12 months, with mild symptoms otherwise. The doctor specifically found that the Veteran’s disability had not caused malnutrition. January 2015 private treatment records reported moderately severe ulcerative proctitis, with daily bleeding. She reported flaring symptoms every 2 to 3 weeks of diarrhea, tenesmus, and rectal bleeding. A February 2016 private treatment record noted enlarged engorged and indurated external and internal hemorrhoids. The Veteran reported that about once every 1-2 months, lasting about 3 days, she would experience flaring with diarrhea, tenesmus and rectal bleeding. June 2017 private treatment records noted that the Veteran’s ulcerative proctitis is asymptomatic. At the evaluation, the examiner found no evidence of significant active disease. Subtle changes in the left colon were noted, which may have represented underlying inflammation. However, there were no significant active disease identified. After review of the record, the Board finds that a higher rating in excess of 10 percent is not warranted under Diagnostic Code 7332. The record documents loose stools but no objective evidence that denotes involuntary bowel movements nor the need of wearing a pad. To this end, the Veteran specifically denied needing to use a pad at her hearing, precluding the assignment of a 30 percent rating under DC 7332. Without showing of extensive leakage and fairly frequent involuntary bowel movement, a rating of 60 percent is not warrant. Absent show of complete loss of sphincter control, a 100 percent rating is also not warranted. Under Diagnostic Code 7323, the Board also finds that a rating in excess of 10 percent is not warranted for the Veteran’s symptoms at any time. Both VA and private treatment records report a diagnosis and symptoms associated with a moderate ulcerative proctitis. The Veteran reported episodes of flaring with diarrhea, tenesmus and rectal bleeding occurring 1 to 2 times a month, each time lasting approximately 3 days. However, June 2017 record found that other than some inflammation, the Veteran’s condition was asymptomatic. There are some references in the private treatment records to the Veteran’s colitis being moderately severe. However, a 30 percent rating would require not only moderately severe ulcerative colitis, but also the showing of frequent exacerbations, which has not been established by the evidence of record. By her own testimony, the Veteran estimated flare-ups approximately six times per year. The more recent treatment records even suggest that the condition is generally asymptomatic. While the Veteran’s credible testimony clearly establishes some impairment, the impairment she described was wholly consistent with a 10 percent rating (albeit a 10 percent rating throughout the course of the appeal). As such, a rating in excess of 10 percent is not warranted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.Yeh, Associate Counsel