Citation Nr: 21072969 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 18-11 972 DATE: December 7, 2021 ORDER An initial compensable rating for radiation proctitis prior to April 16, 2016, and higher than 10 percent, thereafter, is denied. A separate 20 percent initial rating for rectal bleeding associated with radiation proctitis is granted. FINDINGS OF FACT 1. During the appeal period, the Veteran's radiation proctitis was not manifested by frequent episodes of bowel disturbance with abdominal distress. 2. During the appeal period, the Veteran experienced regular rectal bleeding associated with radiation proctitis. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for radiation proctitis prior to April 18, 2016, and higher than 10 percent, thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.114, Diagnostic Code (DC) 7319. 2. The criteria for separate 20 percent rating for rectal bleeding associated with radiation proctitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.114, DC 7319, 7336. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Air Force from January 1969 to April 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in April 2021. The Board then remanded the matter for additional development in May 2021. Increased Rating for Radiation Proctitis Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran's radiation proctitis is rated under 38 C.F.R. § 4.114, DC 7399-7319. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. When an unlisted disease or injury is encountered, it will be rated by analogy under a diagnostic code built up using the first 2 digits from that part of the Rating Schedule most closely identifying the body part or system affected and by using "99" for the last 2 digits. DC 7319 addresses irritable color syndrome. A 0 percent rating is assigned for mild irritable colon syndrome manifested by disturbances in bowel function with occasional episodes of abdominal distress. A 10 percent rating is assigned for moderate irritable colon syndrome manifested by frequent episodes of bowel disturbance with abdominal distress. A maximum 30 percent rating is assigned for severe irritable colon syndrome manifested diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. Prior to April 18, 2016, a compensable rating is not warranted. Private treatment records from February 2015 noted mild to moderate proctitis, without mention of any diarrhea, constipation, bowel disturbance or abdominal distress. A June 2015 VA examination noted that diarrhea was not present. From April 18, 2016, a rating higher than 10 percent is not warranted. The Veteran testified in April 2021 that he wore absorbent pads daily, and experienced diarrhea with urgent trips to the bathroom. He reported constant abdominal distress due to bloating and holding in flatus when in public. He also reported experiencing constipation occasionally. However, the Board does not find these statements to be credible when compared to his private treatment records. These records show numerous entries related to proctitis, but no references to diarrhea, constipation or abdominal distress. The exception is in April 2020, when the Veteran underwent a radical cystectomy. He received laxatives after his surgery and experienced some diarrhea. Notably, in June 2020, private records show the Veteran had no change in bowel habits but continued to have occasional proctitis symptoms. The Board may draw inferences against a claimant from a lack of documentation if the Board lays a proper foundation 'to demonstrate that such silence has a tendency to prove or disprove a relevant fact.'" Horn v. Shinseki, 25 Vet. App. 231, 239 n.7 (2012); see also Fountain v. McDonald, 27 Vet. App. 258, 272 (2015). If an inquiry concerns a lack of medical documentation, then the Board must discuss whether the condition was of such severity that it would have been reasonable to expect appellant to seek treatment. In this case, given that the Veteran reported diarrhea when he experienced it following his surgery, it is reasonable to conclude that he would have reported similar symptoms to his treatment providers at other times if they were present. Because he did not, the Board finds his April 2021 statements to not be credible. For these reasons, a higher initial rating under DC 7319 is not warranted. Separate Rating for Rectal Bleeding Although the evidence does not establish any significant diarrhea, abdominal distress, or other manifestations contemplated under DC 7319, there is abundant evidence that the Veteran's radiation proctitis was manifested by rectal bleeding. Private treatment records from February 2015 noted minor oozing of blood on examination. The June 2015 VA examination noted mild rectal bleeding occurring daily. Additional records from 2016 through 2021 reflect ongoing complaints and findings of rectal bleeding, often reported by the Veteran as occasional. Notably, in April 2019, the Veteran submitted personal logbook dating back to 2014 which documented his incidents of rectal bleeding, which he often described as scant, moderate, or trace blood in stool or on toilet paper. Rectal bleeding is not specifically contemplated by DC 7319. However, the 20 percent rating under DC 7336, which addresses hemorrhoids, provides for persistent bleeding, among other factors. Although the evidence suggests that the Veteran's bleeding was not peristent, the Board finds that the appropriate remedy in this case is to assign a separate 20 percent rating for rectal bleeding associated with radiation proctitis under DC 7336. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.