ERECTILE DYSFUNCTION

A. JAEGER · 2025 · Case ID: A25007039

MIXED

Summary

The Veteran served from September 2013 to February 2019. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision that denied service connection for a right knee disorder, right hip disorder, left hip disorder, and a compensable rating for hemorrhoids, while granting service connection for erectile dysfunction (ED). The Veteran claimed ED as secondary to his service-connected lumbar spine and right ankle conditions. The Board found conflicting medical opinions regarding ED: a private PA-C opined it was at least as likely as not secondary to his service-connected lumbar and ankle conditions, while a VA examiner opined it was less likely than not related to those conditions. The Board resolved this conflict in the Veteran's favor, granting service connection for ED. For the right knee disorder, the Veteran claimed it was secondary to his service-connected right ankle fracture. However, the Board found no probative evidence of a current right knee disorder, noting that service treatment records were negative, a private APRN's opinion lacked a physical examination, and a VA examiner found no current disorder. The Board denied service connection for the right knee, stating the benefit of the doubt doctrine was inapplicable as the evidence weighed against the claim. Similarly, the Veteran claimed bilateral hip disorders as secondary to his lumbar spine and right ankle conditions, or due to bending/twisting during service. The Board found no probative evidence of a current bilateral hip disorder, noting negative service and post-service records, and that a VA examiner found no current disorder despite the Veteran's reported symptoms. The Board afforded little weight to a prior diagnosis due to lack of supporting examination and denied service connection for the hip disorders. For hemorrhoids, the Veteran claimed entitlement to a compensable rating. While he reported weekly bleeding and pain, VA examinations found mild or moderate hemorrhoids without significant findings or functional impact. The Board afforded greater weight to the VA examinations, finding the Veteran's reports of severity were not as persuasive as the professional examinations, and denied a compensable rating.

Rationale

Conflicting medical opinions from private PA-C and VA examiner.; Board resolved doubt in Veteran's favor.; ED found proximately due to service-connected lumbar and ankle disabilities.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

221107-292389

Full Decision Text

Citation Nr: A25007039
Decision Date: 01/27/25 Archive Date: 01/27/25

DOCKET NO. 221107-292389
DATE: January 27, 2025

ORDER

Service connection for erectile dysfunction (ED) is granted.

Service connection for a right knee disorder is denied.

Service connection for a right hip disorder is denied.

Service connection for a left hip disorder is denied.

A compensable rating for hemorrhoids is denied.

FINDINGS OF FACT

1. Resolving all doubt in the Veteran's favor, his currently diagnosed ED is proximately due to his degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture, to include medications taken for such disabilities.

2. At no time during the pendency of the claim does the Veteran have a current disability of a right knee disorder, and the record does not contain a competent recent diagnosis of disability prior to the Veteran's filing of a claim.

3. At no time during the pendency of the claim does the Veteran have a current disability of a right hip disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim.

4. At no time during the pendency of the claim does the Veteran have a current disability of a left hip disorder, and the record does not contain a competent recent diagnosis of disability prior to the Veteran's filing of a claim.

5. For the entire period on appeal, the Veteran's hemorrhoids are no more than mild or moderate in nature, without large, thrombotic, or irreducible hemorrhoids, with excessive redundant tissue, evidencing frequent recurrences, or with persistent bleeding, secondary anemia, or fissures.

CONCLUSIONS OF LAW

1. The criteria for service connection for ED have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a right hip disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for service connection for a left hip disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for a compensable rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R.§§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code (DC) 7336.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 2013 to February 2019.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2022 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA), which, after performing a higher level review of a July 2022 rating decision, confirmed the denial of the Veteran's claims.

In November 2022, the Veteran timely appealed such rating decision by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ). Therefore, the Board may only consider the evidence of record at the time of the July 2022 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplement
If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b).

Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service, or a service-connected disability. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability when he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

1. Entitlement to service connection for ED, claimed as secondary to service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture.

As an initial matter, the Board notes that the Veteran does not allege, nor does the record reflect, that his claimed ED is directly
adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

1. Entitlement to service connection for ED, claimed as secondary to service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture.

As an initial matter, the Board notes that the Veteran does not allege, nor does the record reflect, that his claimed ED is directly related to his military service. Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008) (claims which have no support in the record need not be considered by the Board as the Board is not obligated to consider "all possible" substantive theories of recovery. Where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory).

Rather, the Veteran contends that he currently has ED that is caused or aggravated by his service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture, to include medications taken for such disabilities, identified as Ibuprofen at a December 2020 VA examination.

In his claim, the Veteran submitted an August 2021 report from M.B., PA-C, wherein he stated that the Veteran has a diagnosis of ED, and it was at least as likely as not that such disorder is secondary to, related to, and/or aggravated by his lumbar spine and right ankle disabilities with associated chronic pain and treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). In support thereof, he noted that medical literature indicated that those suffering from chronic musculoskeletal pain experience a loss in sexual interest, arousal, or overall interference in intimacy with associated erectile and orgasm incapability related to mood changes, difficulty focusing, and hormonal changes, and the Veteran was on medications known to cause ED.

Conversely, in February 2022, a VA examiner opined that the Veteran's currently diagnosed ED (as shown at a January 2022 VA examination) is less likely than not proximately due to or the result of his service-connected lumbar spine and right ankle disabilities. In support thereof, he stated that the latter disability does not contribute to any symptoms or conditions, there is no known pathology in which a fracture of a foot/ankle bone would result in or contribute to ED. The examiner further indicated that the Veteran's lumbar spine disability does not contribute to ED as the severity of his lumbar degenerative pathology is not consistent with significant nerve root involvement of those that innervate the genitalia. He also found that the Veteran's documented treatment plain in the record does not include medication that would result in or contribute to ED.

As M.B. and February 2022 VA examiner are both medical professionals who are competent to address the etiology of ED, considered all relevant facts and applicable medical principles, and provided a rationale for their conclusions, the Board finds that their opinion are entitled to equal probative weight. Consequently, the Board resolves all doubt in the Veteran's favor and finds that his currently diagnosed ED is proximately due to his service-connected lumbar and right ankle disabilities, to include medications taken for such disabilities. Thus, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for right knee disorder, claimed as secondary to service-connected resolved right ankle fracture.

As an initial matter, the Board notes that the Veteran does not allege, nor does the record reflect, that his claimed right knee disorder is directly related to his military service. Robinson, supra. Rather, he contends that such claimed disorder is caused or aggravated by his service-connected resolved right ankle fracture. However, as the probative evidence does not show that the Veteran has a current disability related to a right knee disorder at any time proximate to his November 2020 claim, service connection for such disorder is not warranted.

In this regard, the Veteran's service treatment records and post-service VA treatment records are negative complaints, treatment, or a diagnosis referable to a right knee disorder. Additionally, while an August 2021 report from G.U., APRN, MN, FNP, LNC, indicates that the Veteran's symptomatology supports a diagnosis of a right knee strain, she did not identify such reported symptomatology or conducted a physical examination of the Veteran. Thus, the Board affords G.U.'s diagnosis no probative weight. Nieves-Rodriguez v
not show that the Veteran has a current disability related to a right knee disorder at any time proximate to his November 2020 claim, service connection for such disorder is not warranted.

In this regard, the Veteran's service treatment records and post-service VA treatment records are negative complaints, treatment, or a diagnosis referable to a right knee disorder. Additionally, while an August 2021 report from G.U., APRN, MN, FNP, LNC, indicates that the Veteran's symptomatology supports a diagnosis of a right knee strain, she did not identify such reported symptomatology or conducted a physical examination of the Veteran. Thus, the Board affords G.U.'s diagnosis no probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

Furthermore, at a December 2021 VA examination, the examiner noted G.U.'s August 2021 report as well as the Veteran's statements that he experienced locking, buckling, feeling of giving out, popping, cracking, pain, and stiffness in the right knee, and conducted a physical examination that revealed pain on range of motion and flare-ups as well as tenderness on palpation, but found that he did not have a current right knee disorder and such claimed disorder did not impact his ability to perform any occupational task. As the examiner considered all pertinent evidence of record, to include the Veteran's statements and his relevant medical history, G.U.'s opinion, and a physical examination, his determination as to a lack of a diagnosis of a right knee disorder great probative weight. Id.

Further, while the Veteran reported experiencing right knee symptomatology, he as a lay person, is not competent to diagnose such disorder as he does not possess the requisite specialized knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, such a determination involves a medical subject concerning an internal process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the presence of a right knee disorder is not competent evidence and, consequently is afforded no probative weight.

Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current disability of a right knee disorder and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim. See McClain, supra; Romanowsky, supra. Where, as here, there is no probative evidence indicating that the Veteran has the disability for which service connection is sought, there can be no valid claim for service connection. See Brammer, supra. Consequently, service connection for such claimed disorder is not warranted.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claims for service connection for a right knee disorder, such doctrine is not applicable in the instant appeal and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture.

4. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture.

The Veteran contends that he has a current bilateral hip disorder as a result of bending, twisting, and prolonged sitting during his military service. In the alternative, he claims that such disorder is caused or aggravated by his service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture due to an altered gait. However, as the probative evidence does not show that the Veteran has a current disability related to a bilateral hip disorder at any time proximate to his
enerative disc and facet disease of the lumbar spine and resolved right ankle fracture.

4. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture.

The Veteran contends that he has a current bilateral hip disorder as a result of bending, twisting, and prolonged sitting during his military service. In the alternative, he claims that such disorder is caused or aggravated by his service-connected degenerative disc and facet disease of the lumbar spine and resolved right ankle fracture due to an altered gait. However, as the probative evidence does not show that the Veteran has a current disability related to a bilateral hip disorder at any time proximate to his November 2020 claim, service connection for such disorder is not warranted.

In this regard, the Veteran's service treatment records are negative for any complaint, treatment, or diagnosis referable to his bilateral hips; rather, such reflects that, in September 2018, physical therapy for his lumbar spine disability included exercises for his hips as he had tight hip flexors and rotators. Additionally his post-service VA treatment records are negative complaints, treatment, or a diagnosis referable to a bilateral hip disorder.

At a December 2020 VA examination, a diagnosis of bilateral trochanteric pain syndrome was rendered, which the AOJ favorably noted in a rating decision issued later the same month, but the examiner opined that such disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Conversely, in August 2021, G.U. found that such disorder is secondary to, related to, and/or aggravated by the Veteran's service-connected right ankle disability; however, in offering such opinion, she relied solely on the December 2020 VA examiner's diagnosis of bilateral trochanteric pain syndrome, and did not identify any symptomatology in support of such diagnosis or conducted a physical examination of the Veteran.

At a January 2022 VA examination, the examiner noted the December 2020 VA examination report as well as the Veteran's statements that experienced intermittent hip pain, and conducted a physical examination that was entirely normal, but found that he did not have a current bilateral hip disorder and such claimed disorder did not impact his ability to perform any occupational task. In this regard, he stated that there was no objective evidence to render or support a current diagnosis related to the claimed bilateral hip disorder. The examiner further indicated the prior diagnosis of trochanteric bursitis diagnosis indicating, but stated that physical examination findings were not consistent with a current diagnosis of trochanteric bursitis of the left or right hip. Specifically, examination findings were normal, to include imaging from December 2020, and the Veteran denied pain with direct palpation over the trochanteric bursa, which would be indicative of trochanteric pain syndrome.

As the January 2022 examiner considered all pertinent evidence of record, to include the Veteran's statements and his relevant medical history, the December 2020 VA examination, and a physical examination, his determination as to a lack of a diagnosis of a bilateral hip disorder great probative weight. Nieves-Rodriguez, supra; Stefl, supra. Conversely, the Board affords little probative weight to the December 2020 examiner's diagnosis of trochanteric pain syndrome as such examiner did not articulate the specific facts that supported such a diagnosis. Id. In this regard, the January 2022 examiner articulated a specific reason for not rendering a diagnosis of trochanteric pain syndrome even in consideration of the December 2020 examiner's report. Thus, the Board finds that the favorable finding of a current bilateral hip disability noted in the December 2020 rating decision is clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

Further, while the Veteran reported experiencing bilateral hip symptomatology, he as a lay person, is not competent to diagnose such disorder as he does not possess the requisite specialized knowledge. See Jandreau, supra. In this regard, such a determination involves a medical subject concerning an internal process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert, supra. Accordingly, the Veteran's opinion as to the presence of a bilateral hip disorder is not competent evidence and, consequently is afforded no probative weight.

Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current disability of a bilateral hip disorder and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim. See McClain, supra; Romanowsky, supra. Where, as here, there is no probative evidence indicating that the Veteran has the disability
concerning an internal process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert, supra. Accordingly, the Veteran's opinion as to the presence of a bilateral hip disorder is not competent evidence and, consequently is afforded no probative weight.

Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current disability of a bilateral hip disorder and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim. See McClain, supra; Romanowsky, supra. Where, as here, there is no probative evidence indicating that the Veteran has the disability for which service connection is sought, there can be no valid claim for service connection. See Brammer, supra. Consequently, service connection for such claimed disorder is not warranted.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claims for service connection for a bilateral hip disorder, such doctrine is not applicable in the instant appeal and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Increased Rating

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

5. Entitlement to a compensable rating for hemorrhoids.

For the entire appeal period stemming from July 1, 2020, the date VA received the Veteran's intent to file a claim for an increased rating for his hemorrhoids, plus the one-year look-back period, such disability is rated as noncompensably disabling pursuant to DC 7336. 38 C.F.R. § 4.114. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

As an initial matter, the Board notes the relevant regulations pertaining to the evaluation of digestive system disabilities were amended on May 19, 2024. See 89 Fed. Reg. 19375. In this regard, where the rating criteria is amended during the course of the appeal, the Board must consider both the former and the current rating criteria; however, should an increased rating be warranted under the revised criteria, that award may not be made effective before the effective date of the change. 38 U.S.C. § 5110(g); 38 C.F.R. § 3.114; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran's claim was pending at the time of such regulation change, he is entitled to the application of the criteria most favorable to his claim.

Prior to May 19, 2024, DC 7336 provides for a noncompensable rating for mild or moderate hemorrhoids. A 10 percent rating is warranted for large or thrombotic hemorrhoids, which are irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent rating is warranted for hemorrhoids with persistent bleeding and secondary anemia, or with fissures.

As of May 19, 2024, a 10 percent rating is warranted for prolapsed internal hemorrhoids with two or less episodes
Fed. Cir. 2003). As the Veteran's claim was pending at the time of such regulation change, he is entitled to the application of the criteria most favorable to his claim.

As of May 19, 2024, a 10 percent rating is warranted for prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis. A 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

Turning to the evidence of record, the Veteran's VA treatment records are negative for any complaints, treatment, or diagnosis referable to hemorrhoids. However, in a November 2020 statement, he reported that he continues to have hemorrhoids weekly that are the size of a dime or nickel with bleeding, swelling, irritation, pain, and constipation. The Veteran indicated that his hemorrhoids have led to bleeding and tearing with occasional blood in his bowel movements. He also reported altering his diet, using a topical cream and/or suppositories, and avoiding prolonged sitting to treat his condition.

At a December 2020 VA examination, the Veteran reported experiencing bloody stools and pain his rectum weekly. It was noted that he used a topical cream and would reposition himself in a seated position to avoid pressure as a means of treating his hemorrhoids. However, upon examination, there were no findings, signs, or symptoms attributable to hemorrhoids, and the Veteran declined a physical examination. Based upon the Veteran's report, the examiner found that his hemorrhoids would impact his ability to work for prolonged periods during flare-ups as he would be unable to sit for prolonged periods.

Based solely on the Veteran's November 2020 statement, in August 2021, G.U. opined that he was entitled to a 20 percent rating for his hemorrhoids. In this regard, she stated that the Veteran's statement supported a finding of persistent bleeding with fissure.

At a December 2021 VA examination, the Veteran reported intermittent flare-ups with external hemorrhoids with associated pain and some bleeding noted on toilet paper with wiping. He also indicated that he has a bump on the outside of the rectum that has been present for several years and will occasionally become irritated. The Veteran denied prescribed treatment, any functional limitations, and anemia. It was noted that he treated his hemorrhoid flare-ups with over-the-counter Preparation-H. Upon examination, it was found that the Veteran had mild or moderate hemorrhoids, described as residual skin tag secondary to external hemorrhoid that was tender to palpation, without active external hemorrhoids or anal fissure. There was no evidence of large or thrombotic, irreducible, hemorrhoids with excessive redundant tissue evidencing frequent recurrences, or persistent bleeding, secondary anemia, fissures, or anal/perianal fistula, and the Veteran's hemorrhoids did not impact his ability to work.

Based on the foregoing, the Board finds that, for the entire appeal period, the Veteran's hemorrhoids are no more than mild or moderate in nature, without large, thrombotic, or irreducible hemorrhoids, with excessive redundant tissue, evidencing frequent recurrences, or with persistent bleeding, secondary anemia, or fissures. In this regard, the Board affords great probative weight to the findings from the December 2021 VA examination as such included a review of the record, an interview with the Veteran, and a physical examination. Conversely, the Board affords less probative weight to the December 2020 VA examination and G.U.'s opinion as such did not include a physical examination. Nieves-Rodriguez, supra; Stefl, supra. Moreover, while G.U.'s opinion found that the Veteran's hemorrhoids resulted in persistent bleeding with fissure, such is directly contradicted by his report of only intermittent bleeding and the lack of fissures on physical examination.

In this regard, the Board acknowledges the Veteran's belief that his hemorrhoids are more severe than as reflected by the currently assigned disability rating. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert,
uez, supra; Stefl, supra. Moreover, while G.U.'s opinion found that the Veteran's hemorrhoids resulted in persistent bleeding with fissure, such is directly contradicted by his report of only intermittent bleeding and the lack of fissures on physical examination.

In this regard, the Board acknowledges the Veteran's belief that his hemorrhoids are more severe than as reflected by the currently assigned disability rating. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert, supra. The Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own reports regarding the severity of such disability.

The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected hemorrhoids; however, the Board finds that his symptomatology has been stable throughout the appeal period. Thus, assigning staged ratings for such disability is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

In reaching such determinations, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for a compensable rating for his hemorrhoids, such doctrine is not applicable in the instant appeal and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

A. JAEGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Pettit, Andrew M.

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.

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