Citation Nr: 21061931 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-37 387 DATE: October 5, 2021 ORDER An initial compensable evaluation for hemorrhoids is denied. FINDING OF FACT The Veteran's hemorrhoids are noted to be small or moderate that were painful with bleeding, but without evidence of thrombosis, secondary anemia, excessive redundant tissue, or fissures. CONCLUSION OF LAW The criteria for an initial compensable rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 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 September 1998 to September 2002 and from June 2004 to May 2013. This matter was previously before the Board of Veterans' Affairs (Board) in March 2019. The Board remanded for a new Department of Veterans' Affairs (VA) examination. The most recent VA examination was performed in October 2019 and adequately addresses the directives from the March 2019 Board remand. Accordingly, the Board finds that there has been substantial compliance with the most recent Board remand. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran asserts that he is entitled to an initial compensable rating for his service-connected hemorrhoids, which was granted effective January 27, 2014. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. The evaluation of a service-connected disorder requires a review of a veteran's entire medical history regarding that disorder. 38 U.S.C. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Evidence to be considered in an appeal from an initial disability rating was not limited to that reflecting the then current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. Fenderson, 12 Vet. App. at 126-27; Hart v. Mansfield, 21 Vet. App. 505 (2007). Such separate disability ratings are known as staged ratings. Under Diagnostic Code 7336, hemorrhoids are assigned a zero percent rating where there is evidence of mild to moderate symptomatology. A 10 percent rating is warranted where there is evidence of large or thrombotic hemorrhoids, which are irreducible, with excessive redundant tissue, evidencing frequent recurrences. Finally, a 20 percent rating, the maximum schedular rating, is warranted where hemorrhoids are present, with persistent bleeding and secondary anemia, or with fissures. See 38 C.F.R. § 4.114, Diagnostic Code 7336. Words such as "mild," "moderate," "moderately severe," and "severe" are not defined in the Rating Schedule or in the regulations. Consequently, the Board must evaluate all of the evidence to ensure that its decisions are "equitable and just." 38 C.F.R. § 4.6. Turning to the evidence of record, the record reveals that the Veteran was seen by a private physician for complaints of possible hemorrhoids in November 2013. He reported pain with bowel movements and bleeding. VA treatment records from April 2015 note external hemorrhoids characterized by difficulty wiping, with bleeding. The Veteran was evaluated for hemorrhoids by a VA examiner in September 2015. He reported that he experienced hemorrhoids with occasional bleeding. The examiner characterized them as mild or moderate. Additionally, the examiner did not report that the Veteran's hemorrhoids were large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences; persistent bleeding; secondary anemia; or with fissures. The Veteran submitted private medical records from January 2019 where the Veteran described ongoing hemorrhoids that "popped" with clots. The Veteran noticed blood with his bowel movement for a couple of months, typically bright red with clots. The examination found no diagnosis. The Veteran was prescribed suppository rectally as needed for hemorrhoids. In October 2019, the Veteran was given another VA examination. The Veteran noted onset of bleeding in stool and on toilet paper after wiping, with anal itching and pain with sitting. The Veteran further reported that hemorrhoids occur approximately 2-3 times a month with blood on toilet paper when wiping almost every time. The Veteran reported extremely inflamed hemorrhoid in January that busted with dark red blood. The hemorrhoid lasted for 2 weeks with severe pain. It required ice application to the area to help with pain. He reported enough blood in toilet to turn water pink at least every other bowel movement. Upon examination, the examiner reported small or moderate external hemorrhoids, that were not actively bleeding or thrombosed, and itching, as reported by the Veteran. Additionally, the examiner did not report that the Veteran's hemorrhoids were large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences; persistent bleeding; secondary anemia; or with fissures. The examiner found that there was a functional impact on the Veteran as he was unable to remain sitting for long periods of time due to pain experienced with hemorrhoids. Lastly, the examiner reported that the service-connected problem of hemorrhoid was active. The Veteran had one small active, tender hemorrhoid that was not currently bleeding or thrombosed, with daily symptoms of pain and itching. The examiner was unable to determine if the reported bleeding was due to hemorrhoids or other internal intestinal condition due to lack of objective evidence on examination, such as colonoscopy or anoscopy examinations or reports to confirm current and recent bleeding due to hemorrhoids. The examiner found that there were insufficient medical records to exclude conditions that can cause the reported bleeding and for that reason, bleeding had not been reported as a symptom related to hemorrhoids on the exam. Based on the foregoing evidence, the Board finds that an initial compensable rating for hemorrhoids, is not warranted. Although bleeding was noted in the September 2015 and October 2019 VA examination reports, there was no evidence of thrombosis, secondary anemia, or fissure on examination. Additionally, these symptoms were also not noted in the Veteran's private or VA treatment records. Further, the October examiner noted that upon examination, the Veteran had only one small active, tender hemorrhoid that was not currently bleeding or thrombosed. Accordingly, there is no basis for assigning a compensable rating for hemorrhoids under Diagnostic Code 7336. The Board acknowledges the Veteran's statement that his hemorrhoids are more severe than evaluated, and cause pain and bleeding. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 471 (1994). The Board finds, however, that neither the Veteran's statement nor medical evidence demonstrates that the criteria for a higher rating have been met. The Board also acknowledges that the Veteran's VA and private treatment records note complaints of and treatment for hemorrhoids. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. Accordingly, the Board finds that a preponderance of the evidence is against the assignment of a compensable rating for hemorrhoids. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lent, Edward 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.