Citation Nr: 20002807 Decision Date: 01/14/20 Archive Date: 01/13/20 DOCKET NO. 14-41 998 DATE: January 14, 2020 ORDER Entitlement to an initial compensable disability rating for service-connected hemorrhoids, prior to November 16, 2012, is denied. FINDING OF FACT The preponderance of the evidence of record reflects that prior to November 16, 2012, the Veteran’s hemorrhoid disability was productive of mild to moderate symptomology. CONCLUSION OF LAW The criteria for a compensable disability rating prior to November 16, 2012, for a hemorrhoid disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.114, Diagnostic Code 7336. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 2003 to December 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an initial August 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cheyenne, Wyoming, which granted service connection for a hemorrhoid disability and provided a noncompensable disability rating effective December 21, 2008, the day after the Veteran’s separation from active service. The Veteran appealed this initial disability rating. In a November 2012 rating decision, which was issued during the pendency of the appeal, the RO increased the Veteran’s disability rating to 20 percent (the maximum schedular rating available), effective November 16, 2012. In a subsequent March 2013 statement, the Veteran specifically limited the issue on appeal to entitlement to an initial compensable disability rating from December 2008. This matter was previously before the Board and remanded in May 2018 to obtain VA treatment records from the period between December 2008 and November 2012. Additionally, the Board noted that the Veteran submitted a CD in June 2011, and that a memorandum of record indicated that the CD could not be converted to a readable format and uploaded to the electronic claims folder. On remand, the Board requested that the Veteran be contacted to resubmit, on paper copy, the contents of the CD. Subsequent to the May 2018 Board remand, VA treatment records for the period between December 2008 and November 2012 were associated with the claims file. Further, in January 2019, the RO sent the Veteran a letter requesting that he resubmit the contents of the CD that were submitted in June 2011. The Board notes that to-date, it does not appear that the Veteran has resubmitted the requested documents. Accordingly, since the RO has completed the requested development, the Board’s May 2018 remand has been substantially complied with by VA. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Turning to the merits of the appeal, the Board notes that the Veteran’s service-connected hemorrhoid disability is provided a noncompensable rating from December 21, 2008, and a maximum schedular 20 percent disability rating from November 16, 2012, under Diagnostic Code (DC) 7336. 38 C.F.R. § 4.114, DC 7336. The Veteran claims that he is entitled to a 20 percent rating for the entire period on appeal. Specifically, he claims that his disability symptomology did not increase in severity in November 2012, but has remained constant throughout the appeal period. Under DC 7336, a noncompensable evaluation is assigned for hemorrhoids that are mild or moderate. Id. A 10 percent evaluation is warranted for hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. Id. Finally, a maximum 20 percent evaluation is warranted for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. Id. Of record are the Veteran’s service treatment records. The Veteran noted on a December 2008 report of medical history prior to separation from service that he had a history of hemorrhoids which were treated with topical therapy. Prior to that, in December 2007, it was noted that the Veteran had a history of hemorrhoids, however, there were no signs of bleeding or anemia at that time. On February 2010 general VA examination, the Veteran was noted to have a history of hemorrhoids that began during service. He reported treating external hemorrhoids every two months with a hemorrhoid cream for a few days, which was noted to be effective. He had also increased fiber in his diet. He was noted to have normal bowel movements but did report bright red blood in stool on an occasional basis. It was noted that the Veteran did not have any hemorrhoids on the day of examination. The Board notes that in his May 2011 Notice of Disagreement, the Veteran expressed disagreement with the findings in the February 2010 VA examination. Specifically, he indicated that his words were being taken out of context and that he did have hemorrhoids present on the day of the examination. The Veteran indicated that he had to use a cushion to sit on to prevent inflammation. He further reported that wiping would lead to bloody stools and more inflammation. The Board notes that the Veteran was scheduled for a new VA examination in December 2015, however he did not attend this examination or provide good cause for his failure to appear. The record also contains indications that the RO attempted to contact the Veteran to verify his current mailing address, however, the RO was unable to reach the Veteran at the phone numbers of record. Also of record is a November 2012 VA emergency department notation. The Veteran’s chief complaint was hemorrhoids. He had a noted two-year history of waxing and waning hemorrhoids, which began during active duty training, and continued with intermittent bleeding. He experienced one to two months of weekly exacerbations and several days of bleeding. The Veteran reported significant pain, which prevented him from sleeping, the night prior to reporting to the emergency department. Finally, of record is an October 2010 statement from the Veteran’s spouse indicating that the Veteran experienced difficulty going to the bathroom, and that she has seen blood in the toilet because of these issues. In light of the foregoing, the Board finds that entitlement to an initial compensable disability rating for service-connected hemorrhoids is not warranted, as the preponderance of the evidence of record reflects that prior to the Veteran’s November 2012 VA emergency department visit, his hemorrhoid disability was reflective of mild to moderate symptomology. Specifically, the February 2010 VA examination noted that the Veteran reported external hemorrhoids that he treated approximately every two months. There was no evidence noted of large or thrombotic hemorrhoids that were irreducible, with excessive redundant tissue, or of hemorrhoids with persistent bleeding with secondary anemia, or with fissures. The Board acknowledges the Veteran’s challenges to the February 2010 VA examination and his reports of inflammation. While the Veteran is competent to report his symptoms, he is not competent to testify to the size of his hemorrhoids, as this is not something that is capable of self-observation. Further, the Board notes that the Veteran has been provided the opportunity to undergo another VA examination, but he has failed to report for examination and has not provided good cause for this failure to appear. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (“[T]he duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.”). To the extent that the Veteran reported bleeding for the period prior to November 2012, the Board notes that the criteria for an increased rating requires persistent bleeding with secondary anemia, or with fissures. The November 2012 VA emergency department record reflects the Veteran experienced bleeding for a few days and has experienced intermittent bleeding since service. There is no indication of persistent bleeding. The Board finds that Veteran’s reports of intermittent bleeding for the period prior to November 2012 is accurately reflected by the noncompensable rating for mild to moderate symptomology. Accordingly, as the preponderance of the evidence of record reflects that for the period prior to November 2012 the Veteran’s hemorrhoid symptomology was mild to moderate, entitlement to an initial compensable disability rating is not warranted. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. DeChiara, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.