Citation Nr: 21022143 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-43 186 DATE: April 14, 2021 ORDER Entitlement to a disability rating in excess of 0 percent (noncompensable) for hemorrhoids is denied. FINDING OF FACT The Veteran has small to medium external hemorrhoids without thrombosis, fissure, bleeding, or excessive tissue. CONCLUSION OF LAW The criteria for a compensable rating for hemorrhoids have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1– 4.7, 4.114, Diagnostic Code 7336.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1982 to February 1988. Ratings Principles Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The ratings are intended to compensate impairment in earning capacity due to a service-connected disease or injury. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If the evidence for and against a claim is an equipoise, the claim will be granted. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinksi, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is question as to which of the two evaluations shall be applied, the higher evaluation 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. Staged ratings, however, are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The determination of whether an increased evaluation is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows or fails to show. The Veteran should not assume that the Board has overlooked pieces of evidence that are not specifically discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000). Hemorrhoids The Veteran contends his hemorrhoids present with frequent flare-ups, as many as twelve per month. See October 2015 VA Form 9. The rating criteria for hemorrhoids are set forth in 38 C.F.R. § 4.114, Diagnostic Code 7336. A 10 percent rating is warranted where the hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent disability rating is warranted for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. An October 2013 VA examination found that the Veteran had mild to moderate external recurrent hemorrhoids. At the time of the examination, the Veteran had 2-3 moderate size hemorrhoids, and the examination report indicated no signs of thrombosis, fissure, bleeding, or excessive tissue. The examiner conducted laboratory tests to check for anemia and indicated that the results were unremarkable. The Veteran’s claim for a higher rating for hemorrhoids was denied by the Board in November 2019. That denial was subject to a March 2020 Order of the United States Court of Appeals for Veterans Claims pursuant to a Joint Motion for Partial Remand, which in turn stated that the Veteran reported worsening of hemorrhoids and the Board should address whether a new examination was warranted and whether new VA medical record should be acquired. The Board remanded the matter in August 2020 for a new examination. An additional VA examination report is dated in January 2021. Medical history was that the Veteran has rectal pain, swelling, and itching with periodic pain and flair ups about every month. Treated with preparation H. The rest of the examination report is similar to the October 2013 examination report. Hemoglobin, hematocrit, white blood cell count, and platelets testing were conducted, and the examiner did not report anything unusual with these results. The Veteran had small or moderate external hemorrhoids, specifically listed as small external hemorrhoids in the sign and symptoms section of the report. There were no other symptoms, findings, or abnormalities. VA and private treatment records dated from 2009 to 2021 contain virtually no reports of treatment of hemorrhoids symptoms. His hemoglobin and other laboratory test results were largely in the normal range. The Board finds a compensable disability rating is not warranted for the hemorrhoids. There is no credible evidence that his hemorrhoids were large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences during the appeal period. VA examinations repeatedly state that the hemorrhoids were small or moderate, with none of the symptoms necessary for a compensable rating. Treatment records do not show any treatment for such symptoms resulting from hemorrhoids. While the Veteran did report occasional (monthly) flare-up and bleeding, itching, and pain, the bleeding was not persistent, did not cause anemia or fissures. To the appellant has reported that the disorder is more severe than evaluated, we conclude that the observations of skilled professional are far more probative and far more credible than the lay evidence in this case. For these reasons the preponderance of the evidence is against a claim for a rating in excess of 0 percent and the claim must be denied. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Yoffe, 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.