Citation Nr: 21065985 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 20-06 032 DATE: October 28, 2021 ORDER An increased disability rating of 20 percent, and no higher, for service-connected hemorrhoids from February 7, 2018 to September 17, 2019 is granted. An increased disability rating higher than 20 percent for service-connected hemorrhoids from September 17, 2019, forward, is denied. FINDING OF FACT For the entire rating period from February 7, 2018, the hemorrhoid disability was manifested by large or thrombotic, irreducible hemorrhoids with excessive redundant tissue and evidencing frequent recurrences, fissures, and occasional bleeding, and treated with over-the-counter medication. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, the criteria for an increased 20 percent rating, and no higher, for service-connected hemorrhoids are met from February 7, 2018 to September 17, 2019. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.21, 4.114, Diagnostic Code (DC) 7336. 2. The criteria for an increased rating higher than 20 percent rating for service-connected hemorrhoids are not met or approximated from September 17, 2019, forward. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.114, DC 7336. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from September 1976 to September 1979. This matter is on appeal from a May 2018 rating decision. The procedural history as detailed in the July 2021 Board decision is incorporated herein by reference. In May 2020, the Board, in pertinent part, denied a compensable rating for hemorrhoids. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court or CAVC). The Board's decision was partially vacated pursuant to a Joint Motion for Partial Remand (Joint Motion or JMPR) on the bases that, when denying a compensable rating for hemorrhoids, the Board did not discuss the September 2019 Disability Benefits Questionnaire (DBQ) that was completed by a private physician. In July 2021, the Board remanded the appeal for another VA examination to help assess the current severity of hemorrhoids. In August 2021, the Veteran was advised that the VA contract examiner would not be performing an in-person examination and, instead, would review the record and may contact him by telephone to obtain additional information. In August 2021, a VA medical opinion DBQ was provided with an opinion on the severity of hemorrhoids based on review of the records and interview of the Veteran without in-person or telehealth evaluation. Upon review, the Board finds that the August 2021 VA examination report is adequate. For this reason, the Board finds that there has been compliance with the prior remand directives. The Board finds that the duties to notify and assist the Veteran in this case have been satisfied. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist in the current appeal. 1. An increased disability rating of 20 percent, and no higher, for service-connected hemorrhoids from February 7, 2018 to September 17, 2019 is granted. 2. An increased disability rating higher than 20 percent for service-connected hemorrhoids from September 17, 2019, forward, is denied. Disability ratings are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In this case, hemorrhoids have been rated at 0 percent (noncompensable) from February 7, 2018 to September 17, 2019, and at 20 percent thereafter, under the rating criteria at 38 C.F.R. § 4.114, DC 7336, for external or internal hemorrhoids. Under DC 7336, a noncompensable (0 percent) rating is provided for mild or moderate external or internal hemorrhoids. A 10 percent rating is provided for large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent rating is provided when there are hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. See 38 C.F.R. § 4.114, DC 7336. After review of the lay and medical evidence of record, the Board finds that the evidence is in relative equipoise as to whether the criteria for a 20 percent rating under DC 7336 for the service-connected hemorrhoids are approximated from February 7, 2018 to September 17, 2019. At the April 2018 VA rectal and anus examination, the VA examiner noted that the hemorrhoid disability was manifested by mild to moderate internal or external hemorrhoids with occasional itching, pain, and bleeding and required no treatment, which is consistent with the noncompensable rating criteria under DC 7336. At the September 2019 private rectum and anus conditions examination, hemorrhoids were manifested by large or thrombotic, irreducible hemorrhoids with excessive redundant tissue and evidencing frequent recurrences, fissures, and occasional bleeding, and treated with over-the-counter medication. The hemorrhoid symptoms and impairment demonstrated at the September 2019 private rectum and anus conditions examination is consistent with the 20 percent rating criteria for hemorrhoids. Both examiners have medical training and expertise and performed physical examinations of the Veteran, so the April 2018 VA examination report and the September 2019 private examination report are of equal probative value. The August 2021 VA rectum and anus conditions reviewer opined that hemorrhoids were manifested by large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences, occasional bleeding, and treated with over-the-counter medication, which is more consistent with the 10 percent rating criteria under DC 7336 than the 20 percent rating criteria; however, the August 2021 VA medical opinion describing the severity of hemorrhoids was based solely on review of the record and did not include in-person or physical examination showing different findings than shown at prior examinations. The August 2021 VA examiner did not include fissures among the findings, signs, or symptoms attributable to hemorrhoids but provided no explanation as to why fissures demonstrated at the September 2019 private examination were not a current manifestation of hemorrhoids. For these reasons, the August 2021 VA examination report describing the current severity of hemorrhoids is of limited probative value and is outweighed by evidence (i.e., the September 2019 private examination report) showing large or thrombotic hemorrhoids with fissures and occasional bleeding. Because hemorrhoids with fissures and bleeding are symptoms contemplated by the 20 percent schedular rating criteria under DC 7336, the Board finds that the disability picture for hemorrhoids closely approximates the schedular criteria for a 20 percent rating under DC 7336. In consideration of the foregoing, and resolving reasonable doubt in favor of the Veteran, the Board finds that the criteria for a 20 percent rating under DC 7336 are met from February 7, 2018 to September 17, 2019. 38 C.F.R. §§ 4.3, 4.7. The Veteran is now receiving the maximum 20 percent schedular rating available under 38 C.F.R. § 4.114, DC 7336, for hemorrhoids for the entire rating period on appeal, so no higher schedular rating is available for any period on appeal. There is no alternate or more appropriate DC under which to rate the hemorrhoids; therefore, there is no basis for a rating higher than 20 percent for hemorrhoids for any period. 38 U.S.C. § 7104. The question of whether referral for an extraschedular rating adjudication under 38 C.F.R. § 3.321(b) for any period for the increased rating issue on appeal has not been raised by either the Veteran or the evidence of 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). J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.