Citation Nr: 21061426 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-39 853 DATE: October 4, 2021 ORDER Entitlement to an initial rating in excess of 20 percent for external hemorrhoids is denied. REMANDED Entitlement to a separate compensable rating for anemia associated with external hemorrhoids is remanded. FINDING OF FACT The Veteran is in receipt of a 20 percent disability rating for his service-connected hemorrhoids, the highest available rating under the relevant diagnostic criteria. CONCLUSION OF LAW The criteria for a disability rating in excess of 20 percent for service-connected hemorrhoids have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Codes 7336. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1982 to August 1985. This matter comes before the Board of Veterans' Appeals (Board) from an August 2015 rating decision of a Regional Office (RO) for Department of Veterans Affairs (VA). This matter was previously before the Board in March 2019 when it was remanded for additional development which has since been completed. Additional VA medical treatment records have been added to the Veteran's claims file since the last Supplemental Statement of the Case (SSOC) was issued by the RO in October 2020. However, these records relate to other claims and not to the issue(s) in this appeal and therefore a waiver of initial consideration by the AOJ is not necessary. See 38 C.F.R. § 20.1304. Entitlement to an initial rating in excess of 20 percent for external hemorrhoids The service-connected hemorrhoids have been rated as 20 percent disabling pursuant to Diagnostic Code 7336 since May. Diagnostic Code 7336 provides for a maximum schedular rating of 20 percent for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. See 38 C.F.R. § 4.114, DC 7336. In this case, there is no legal basis upon which to award a higher rating for hemorrhoids, as the maximum rating has already been assigned. The Veteran's claim for such a benefit is consequently without legal merit and must be denied. See Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006); Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board further finds that referral for consideration of an extraschedular rating is not warranted, as the evidence regarding the Veteran's hemorrhoids does not show such an exceptional disability picture that would render the available schedular rating inadequate. Thun v. Peake, 22 Vet. App. 111 (2008). The Veteran has indicated that he believes the 20 percent rating is insufficient as to the current severity and has requested that the Board consider other applicable ratings for his condition. The Veteran has claimed he has anemia caused by his hemorrhoids: accordingly, this matter is remanded for additional medical information to address this contention. See September 2015 Notice of Disagreement. The Veteran has provided no evidence that his hemorrhoids are so severe that the 20 percent schedular disability rating is insufficient. Neither the August 2015 or December 2019 VA examinations show frequent hospitalizations or that the condition prevents him from employment. While the August 2015 examiner noted that the condition interferes with work, the 20 percent rating in place contemplates the level of impairment (here large or thrombotic hemorrhoids, irreducible with excessive redundant tissue, evidencing frequent recurrences, with persistent bleeding, and secondary anemia) present in the Veteran and he was not incapable of employment as a result of this condition. Therefore, the Board finds that the schedular rating of 20 percent for the Veteran's hemorrhoids is adequate, and no referral is required for extraschedular consideration. 38 C.F.R. § 3.321 (b) (2018). REASONS FOR REMAND Entitlement to a separate compensable rating for anemia associated with external hemorrhoids. On remand the Veteran was provided with a December 2019 VA examination for anemia. The examiner identified that anemia was secondary to his hemorrhoids and indicated that it was due to iron deficiency. Anemia of this nature is not separately compensable under DC 7720, which states in a note "Do not evaluate iron deficiency anemia due to blood loss under this diagnostic code. Evaluate iron deficiency anemia due to blood loss under the criteria for the condition causing the blood loss." The Veteran's VA treatment records show he has been prescribed B-12 in 2014 and it was listed as a supplement he takes as recently as June 2019. Further, a May 26, 2017, VA treatment record indicates that he had worsening macrocytic anemia. Per the Mayo Clinic website, the causes of macrocytosis include B-12 deficiency. See https://www.mayoclinic.org/macrocytosis/expert-answers/faq-20058234 (last accessed September 30, 2021). A potentially compensable rating is available to the Veteran under DC 7722 for B12 deficiency anemia. As it is unclear to the Board whether these treatment records were considered during the most recent VA examination and found to be in error or were not considered. A further remand is necessary to make sure that every consideration is given to the Veteran's claim for an extraschedular rating. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records and associate them with the Veteran's claims file. Any negative response received should be associated with the file. 2. Schedule an examination by an appropriate clinician to address the nature and severity of the Veteran's anemia. The examiner must provide a full description of the disability and report all signs and symptoms necessary for evaluating anemia. All indicated testing must be conducted. All pertinent symptomatology and findings must be reported in detail. The VA examiner must provide a hemoglobin (gm/100ml) level. The examiner must address whether the anemia is to be characterized as caused by an iron deficiency or whether it is best described as macrocytosis include B-12 deficiency, or whether it is attributable to another cause. Rationale must be included to support all findings. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board John M. Middleton 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.