Citation Nr: 21072206 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 16-59 717 DATE: December 2, 2021 ORDER Entitlement to a rating in excess of 10 percent for hemorrhoids is denied. FINDING OF FACT Throughout the appeal period, the Veteran's hemorrhoids have resulted in pain and itching with occasional bleeding; they have not shown persistent bleeding with secondary anemia or fissures. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 10 percent for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.7, 4.114, Diagnostic Code (DC) 7336. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from March 1979 to March 2001. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision issued by the Agency of Original Jurisdiction (AOJ). The Board remanded the claim to the AOJ in June 2021 for additional development to include obtaining an examination assessing the current severity of the Veteran's hemorrhoids. The Veteran underwent a new examination for hemorrhoids in August 2021. The Board finds the examination was adequate. Thus, the Board determines that there has been substantial compliance with the June 2021 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to a rating in excess of 10 percent for hemorrhoids The Veteran's entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). At the time of an initial rating, consideration of the appropriateness of a staged rating is also required. Fenderson v. West, 12 Vet. App. 119 (1999). Disability evaluations are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's hemorrhoids are currently evaluated under Diagnostic Code 7336. 38 C.F.R. § 4.114. Under Diagnostic Code 7336, hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences are rated at 10 percent. Hemorrhoids that result in persistent bleeding and with secondary anemia or with fissures are rated at 20 percent, which is the maximum rating provided under Diagnostic Code 7336. Id. Turning to the medical evidence of record, an August 2014 VA examination report indicates that the Veteran complained of hemorrhoids which caused itching, rectal discomfort, and bleeding during bowel movements. The report indicates that his treatment plan includes taking continuous medication. As to signs and symptoms, the report indicates mild or moderate internal or external hemorrhoids with episodic bleeding during flares. Physical examination indicated large external hemorrhoids and excessive redundant tissue. The report indicates there were no other pertinent physical findings, complications, conditions, signs or symptoms related to the Veteran's hemorrhoids. The report indicates there were no associated scars. The report indicated the Veteran's hemorrhoids had no impact on his ability to work. A November 2015 VA treatment record notes ongoing hemorrhoidal symptoms. The Veteran reported bleeding and itching "sometimes". The Veteran reported an incident of rectal bleeding 8 months prior. He also complained of hard stool and having to wipe softly to avoid burning around the rectal area. In December 2015, the Veteran reported two episodes of bleeding after a bowel movement 18 months prior. The physician noted the Veteran had undergone a colonoscopy in April 2014 which revealed internal hemorrhoids. The Veteran was prescribed a suppository which he did not used. The physician documented the Veteran's main complaint as "intermittent itching/irritation." Rectal bleeding was noted on the Veteran's problem list in December 2019. That same month, VA treatment records reveal a normal test for anemia. In August 2021, the Veteran underwent a second VA examination for hemorrhoids. The examination report indicates that the Veteran complained of episodic bleeding when the condition flares along with itching and pain. The report indicates that his treatment plan includes taking continuous medication. As to signs and symptoms, the report indicates large or thrombotic, irreducible hemorrhoids with excessive redundant tissue evidencing frequent recurrences. Physical examination indicated large external hemorrhoids and excessive redundant tissue. The report indicated that due to the Veteran's hemorrhoids, the itching, which is often worse with prolonged sitting, would inhibit his ability to focus on work tasks or work effectively. Having reviewed the evidence of record, medical and lay, the Board finds that a rating in excess of 10 percent for the Veteran's hemorrhoids is not warranted. A 20 percent rating requires persistent bleeding with secondary anemia or with fissures. The medical evidence consistently reflects that the Veteran's hemorrhoids result in occasional bleeding. The Veteran has not indicated that his hemorrhoids cause persistent bleeding. He notes persistent pain and itching but not persistent bleeding. Nor do his symptoms more nearly approximate a 20 percent rating, which in addition to persistent bleeding, also requires anemia or fissures. While the Veteran's hemorrhoids cause persistent pain and itching, these symptoms are reasonably indicative of mild to moderate symptoms, as the medical evidence consistently indicates. While the rating criteria does not define "mild" or "moderate," there is no evidence of record that the Veteran's hemorrhoids are commensurate with a 20 percent rating as he has none of the requirements for a 20 percent rating. As such, the Board finds that the Veteran's symptoms more nearly approximate a 10 percent rating, and an increase to a 20 percent rating is not warranted. Nor is a separate rating warranted. The probative evidence indicates that there are no associated scars that are painful or unstable or measure to a compensable length. Thus, a separate rating for scars under Diagnostic Code 7800-7805 is not applicable. 38 C.F.R. § 4.118. Consideration has also been given to assigning staged ratings. Fenderson v. West, 12 Vet. App. at 119. However, there is no indication that the Veteran's symptoms were commensurate with a 20 rating at any time during the appeal period. Accordingly, the Board finds that the disorder has not significantly changed, and a uniform rating is warranted. (Continued on the next page) In light of the evidence, the Board finds that a 10 rating, but no higher, is warranted for the Veteran's hemorrhoids throughout the appeal period. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Sherman 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.