Citation Nr: 21027466 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 08-32 616 DATE: May 5, 2021 REMANDED Entitlement to increases in the staged (10 percent prior to March 17, 2009 and 60 percent from that date) ratings assigned for post-sphincterotomy hemorrhoids with decreased sphincter tone is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from November 1975 to March 1984. This case is before the Board of Veterans' Appeals (Board) on appeal from a December 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). An April 2009 rating decision granted a 30 percent rating for the post-sphincterotomy hemorrhoid disability, effective March 17, 2009, and an April 2014 rating decision subsequently increased the rating for the disability (along with decrease of sphincter tone) to 60 percent rating, also effective March 17, 2009. An April 2013 hearing was held before the undersigned in Washington, D.C. In June 2013 and July 2017, the Board remanded the case for additional development. A November 2017 Board decision denied an increased rating for the disability before and from March 17, 2009, and the Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC). In an October 2018 Order, the CAVC granted a September 2018 Joint Motion for Remand (JMR) of the parties, thereby vacating the Board's decision and remanding the case to the Board for action consistent with the terms of the JMR. In April 2019, April 2020, and September 2020, the Board remanded the case to the RO for additional development. Entitlement to increases in the staged (10 percent prior to March 17, 2009 and 60 percent from that date) ratings assigned for post-sphincterotomy hemorrhoids with decreased sphincter tone. Unfortunately, there has not been substantial compliance with the Board's previous remand directives in this matter, and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The same VA (fee-based) general practitioner, who examined the Veteran in January 2020 and provided opinions in January 2020, June 2020, and October 2020, was not responsive to the requests for commentary on the severity of the Veteran's sphincter impairment based on his complaints and clinical findings presented in numerous records over the course of the long period of appeal. In the most recent opinion, the examiner provided a similar response to all the particular questions, without any further commentary; he asserted only that there were no medical records/treatment that specifically discussed (or demonstrated) the severity of the Veteran's sphincter dysfunction and its manifestation. Therefore, a different examiner should be sought for the requested opinion. The matter is REMANDED for the following action: Obtain a medical advisory opinion by a proctologist (if unavailable, a gastroenterologist) regarding the severity of the Veteran's post-sphincterotomy hemorrhoid disability. Ensure that all pertinent records are available for the provider's review. After reviewing the claims file to include the private hospital records (e.g., an April 2016 treatment record from MedStar Washington Hospital Center), VA treatment records, and VA examination reports of May 2007, March 2009, October 2013, December 2014, July 2017, January 2020, and June 2020, the consulting provider should furnish a retrospective opinion regarding the severity of the Veteran's sphincter impairment, as follows: (a). For the period from February 2006 to March 17, 2009, do the Veteran's complaints and clinical evidence reflect that the extent of his sphincter control impairment may be characterized by occasional involuntary bowel movements necessitating wearing of a pad? If so, identify such evidence. (b). For the period from February 2006 to March 17, 2009, do the Veteran's complaints and clinical evidence reflect that the extent of his sphincter control impairment may reasonably be characterized as extensive leakage and fairly frequent involuntary bowel movements? If so, identify such evidence. (c). For the period from March 17, 2009 to the present, do the Veteran's complaints and clinical evidence reflect that he has had complete loss of sphincter control? If so, identify such evidence. For example, does "full incontinence of feces" (as noted on April 2016 records from Medstar Washington Hospital Center) equate to complete loss of sphincter control, or does the Veteran's impairment more closely approximate a condition manifested by extensive leakage and fairly frequent involuntary bowel movements? All opinions must include rationale. George R. Senyk Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Debbie Breitbeil, 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.