Citation Nr: 21075628 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 16-37 399 DATE: December 21, 2021 ORDER Entitlement to an initial rating of 20 percent from April 15, 2013 for internal and external hemorrhoids is granted. FINDING OF FACT Resolving in the light most favorable to the Veteran, her internal and external hemorrhoids have been manifested with persistent bleeding throughout the entire appeal period. CONCLUSION OF LAW The criteria for entitlement to an initial rating of 20 percent from April 15, 2013 for internal and external hemorrhoids have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.114, Diagnostic Code 7336. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the Army from December 1990 to May 1991, from December 2004 to November 2005, and from November 2006 to December 2008. She also served in the Reserves. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a videoconference Board hearing in July 2017. A transcript of the proceeding has been associated with the claims file. This claim was previously remanded by the Board in a November 2018 decision. The RO was directed to obtain a contemporaneous VA examination. As an examination was scheduled and completed in September 2019, the Board finds that the RO has substantially complied with the November 2018 Board remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). During the pendency of the appeal in an October 2020 rating decision, the RO increased the Veteran's rating for the internal and external hemorrhoids from noncompensable to 20 percent effective March 26, 2019. As the RO's actions do not constitute a full grant of the benefit sought and the Veteran has not expressed satisfaction with the increased ratings, the issue remains on appeal. AB v. Brown, 6 Vet. App. 35, 39 (1993). The Board notes that the issue of service connection for urinary tract infections is not a part of the appeal currently before the Board. The Veteran submitted a VA Form 10182, Notice of Disagreement in October 2020 in response to the September 2020 supplemental statement of the case. By submitting a VA Form 10182, the Veteran waived into the modernized review system, the Appeals Modernization Act (AMA). 38 C.F.R. § 19.2 (d)(2). Therefore, a separate decision will be issued by the Board for this issue under the AMA. Entitlement to an initial rating of 20 percent from April 15, 2013 for internal and external hemorrhoids The Veteran contends that she is entitled to an increased rating for her service-connected internal and external hemorrhoids. Disability ratings are determined by the application of the facts presented to VA's Schedule for Rating Disabilities. 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 service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In rating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). 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 required for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A claim for increased rating remains in controversy when less than the maximum available benefit is awarded AB v. Brown, 6 Vet. App. 35 (1993). Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. The Veteran's internal and external hemorrhoids are rated under Diagnostic Code 7336 for hemorrhoids, external or internal. Under Diagnostic Code 7336, a 0 percent evaluation is assigned for mild or moderate hemorrhoids; a 10 percent evaluation is assigned for large or thrombotic, irreducible, hemorrhoids with excessive redundant tissue, evidencing frequent recurrences; and a 20 percent evaluation is assigned for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. 38 C.F.R. § 4.114, Diagnostic Code 7336. The evidence relevant to the severity includes VA treatment records, VA examinations, and lay statements offered by the Veteran. In an April 2013 statement in support of claim, the Veteran stated that her hemorrhoids are very painful, itch, and bleed. A June 2013 VA treatment record includes the Veteran's report of seeing bright red blood in her stool. The examining nurse practitioner opined that the blood in her stool is likely hemorrhoidal. The Veteran was afforded a VA examination in May 2014. The examiner opined that the Veteran is currently asymptomatic but noted that her previous symptoms included anal itching and blood following the passing of hard stools. In the August 2014 notice of disagreement, the Veteran contended that she has a frequent recurrence of hemorrhoids. She stated that she has constant bleeding, itching, and irritation of the rectum. She was afforded another VA examination in September 2015 where she reported intermittent symptoms of swelling and itching that occur monthly. The examiner opined that her symptoms are mild and moderate, and are relieved by preparation H. The Veteran provided sworn testimony during the July 2017 Board hearing where she described symptomatic hemorrhoids causing itching and bleeding. During a March 2019 gastrointestinal clinic consult, the Veteran reported problematic hemorrhoids for the past year. She stated that she has hard stools accompanied by moderate bright red blood with bleeding occurring weekly. The Veteran underwent a colonoscopy in July 2018 which noted internal hemorrhoids. The nurse practitioner again opined that her hemorrhoids are the likely source of the bright red blood. The Veteran was referred to surgery since she sees blood everyday and has a history of internal hemorrhoids. A June 2019 colonoscopy found non-bleeding internal hemorrhoids. Her VA treatment records continue to note internal hemorrhoids and bleeding with hard stools. The Veteran reported bleeding when passing hard stools during a September 2019 VA examination. She takes continuous medication for her hemorrhoids including hydrocortisone rectal suppositories. The examiner found that the signs and symptoms of the Veteran's hemorrhoids include mild to moderate persistent bleeding. After resolving the evidence in the light most favorable to the Veteran, the Board concludes that her hemorrhoid symptoms are more nearly approximate to a 20 percent rating under Diagnostic 7336 as she has experienced persistent bleeding throughout the appeal period. 38 C.F.R. §§ 4.3, 4.7. The Board notes that the Veteran is competent to describe symptomatology she experiences with her own senses, and she has consistently and credibly contended that she experiences bleeding with hard bowel movements. See Layno v. Brown, 6 Vet. App. 465 (1994). Her VA treatment records in June 2013 and March 2019 indicate that her examining nurse practitioners agree that the bleeding she experiences is hemorrhoidal. The Board notes that a rating in excess of 20 percent is not warranted because the 20 percent rating is the maximum rating available under Diagnostic Code 7336. Accordingly, entitlement to an initial rating of 20 percent, but no higher, from April 15, 2013 for internal and external hemorrhoids is granted. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hartford, 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.