Citation Nr: 21070770
Decision Date: 11/26/21	Archive Date: 11/26/21

DOCKET NO. 17-35 597
DATE: November 26, 2021

ORDER

Entitlement to a compensable rating for anal fissure is denied.

FINDING OF FACT

The weight of the evidence of record shows that the Veteran's anal fissure has not been symptomatic during the rating period on appeal.

CONCLUSION OF LAW

The criteria for entitlement to a compensable rating for anal fissure have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.20, 4.31, 4.114, Diagnostic Code (DC) 7336.

REASONS AND BASES FOR FINDING AND CONCLUSION

On last review of this case the Board remanded it to the Agency of Original Jurisdiction (AOJ) for additional development. See 03/23/2021 BVA Decision. As discussed further below, the Board finds substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998).

Entitlement to a compensable rating for anal fissure.

General Requirements for Increased Rating

Disability ratings are intended to compensate for impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.27. It is necessary to rate the disability from the point of view of the Veteran working or seeking work, see 38 C.F.R. §§ 4.1, 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the Veteran's favor. 38 C.F.R. § 4.3. Evaluations are based on functional impairments which impact a veteran's ability to pursue gainful employment. 38 C.F.R. § 4.10.

If there is a question as to which disability rating to apply to the Veteran's disability, 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.

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflects the elements of disability present. 38 C.F.R. § 4.2; see Peyton v. Derwinski, 1 Vet. App. 282 (1991).

The Veteran is entitled to a staged rating for any part of the rating period on appeal where either of his disabilities manifested with a greater degree of severity. See O'Connell v. Nicholson, 21 Vet. App. 89, 91-92 (2007); Fenderson v. West, 12 Vet. App. 119 (1999).

Discussion

The rating criteria do not list a specific diagnostic code for an anal fissure. Hence, the AOJ evaluated the disorder analogously to the symptomatology of hemorrhoids, external or internal, with persistent bleeding. See 38 C.F.R. § 4.20; see also 38 C.F.R. § 4.114, DC 7336. Those criteria provide that hemorrhoids, external or internal, with persistent bleeding and with secondary anemia, or with fissure warrant a 20 percent rating. Large or thrombotic, irreducible, hemorrhoids with excessive redundant tissue, evidencing frequent recurrences warrant a 10 percent rating. Id.

The Veteran has consistently asserted that he meets the criteria for a 20 percent rating because of his recurring rectal bleeding, which he asserts is due to hemorrhoids. The objective findings on clinical examinations to date, however, have not revealed a bleeding hemorrhoid. The most current examination did not reveal a fissure or an external hemorrhoid. See 12/23/2019 C&P Exam, 9th Entry. Further, as the Board noted in the prior remand, there still is no record of the Veteran having submitted a claim for service connection for hemorrhoids.

As a result of the history of the Veteran's anal fissure disability, the Board remanded for an examination to include a colonoscopy. The May 2021 examination report (05/14/2021 C&P Exam, 2nd Entry) reflects that the Veteran reported seeing blood intermittently on wiping after a bowel movement. The examiner noted that the Veteran's physical examination was normal, as there was no evidence of an external hemorrhoid, anal fissure, or other abnormality. Id. P. 4. The examiner noted that a colonoscopy was scheduled for June 2021.

The non-VA colonoscopy report (06/17/2021 Medical Treatment-Non-Government Facility) reflects that the examination revealed small internal hemorrhoids and a single polyp, which was removed).

Prior to receiving the report of the non-VA colonoscopy examination, the AOJ asked the VA examiner why a colonoscopy was not conducted as directed by the Board remand. See 05/18/2021 Exam Request. The addendum report (08/132021 C&P Exam) reflects that the examiner reviewed the claims file and noted that the most recent C&P exam [which the examiner erroneously refereed to as a 2019 instead of the 2021 examination] revealed no fissure or other abnormality. The examiner noted that anal fissures are usually superficial tears of the anus resulting from local trauma such as constipation, diarrhea, anal sex, ect, which resolve with topical treatment. Based on that fact, the examiner opined that a colonoscopy was not medically indicated, as it is an invasive procedure. The AOJ reviewed the non-VA colonoscopy examination report and continued the assigned noncompensable rating. See 09/09/2021 SSOC.

The Board is aware that an unlisted disability need not manifest with every symptom of the analogous disorder. Nonetheless, in the Veteran's case, even when considering his lay reports of seeing blood on wiping, there is no medical evidence of anemia or fissure that would warrant a 20 percent rating. The 2017 VA examination report reflects that the examiner noted that hemorrhoids and a fissure are entirely separate conditions. See 07/25/2017 C&P Exam, 3rd Entry. An August 2020 VA outpatient entry notes that the history of the disorder is that it has come and gone. See 09/15/2021 CAPRI, P. 73. Hence, the weight of the evidence is against a compensable rating for the current rating period on appeal. 38 C.F.R. § 4.31.

Since the preponderance of the evidence is against the claim, there is no reasonable doubt to resolve. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990); see also 38 C.F.R. § 3.102.

 

 

Eric S. Leboff

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	W. T. Snyder

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.