INTERVERTEBRAL DISC SYNDROME

T. RAYMOND · 2026 · Case ID: 26004425

MIXED

Summary

The veteran, who served in the U.S. Army from August 2004 to October 2007, appeals a September 2018 rating decision concerning increased disability ratings for lumbar strain with degenerative disc disease and hemorrhoids, as well as a claim for prolapse of rectum. The Board granted an increased rating of 20 percent for lumbar strain with degenerative disc disease, effective April 26, 2017, based on forward flexion limited to 45-55 degrees and consideration of pain. The Board also granted an increased rating of 20 percent for hemorrhoids, effective April 26, 2017, finding persistent bleeding and secondary anemia, despite conflicting examination findings. The claim for prolapse of rectum was denied, as the evidence did not establish a prolapse during the period on appeal. The Board denied claims for earlier effective dates for all conditions, as service connection was already granted from the date of the intent to file. The veteran's service history and the specific rating criteria for spinal and anorectal conditions were discussed, referencing relevant diagnostic codes and regulations.

Rationale

Forward flexion limited to 45-55 degrees; Consideration of pain during flare-ups; Met criteria for 20% rating

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5242

Docket No.

20-18 116

Full Decision Text

Citation Nr: 26004425
Decision Date: 04/10/26 Archive Date: 04/10/26

DOCKET NO. 20-18 116
DATE: April 10, 2026

ORDER

Entitlement to an increased, 20 percent, disability rating for lumbar strain with degenerative disc disease is granted effective April 26, 2017.

Entitlement to an increased, 20 percent, disability rating for hemorrhoids is granted effective April 26, 2017.

Entitlement to a compensable disability rating for prolapse of rectum is denied.

Entitlement to an effective date prior to April 26, 2017 for lumbar strain with degenerative disc disease is denied.

Entitlement to an effective date prior to April 26, 2017 for hemorrhoids is denied.

Entitlement to an effective date prior to April 26, 2017 for prolapse of rectum is denied.

FINDINGS OF FACT

1. The Veteran's forward flexion of the thoracolumbar spine has been greater than 30 degrees but not greater than 60 degrees for the entire period on appeal.

2. The Veteran's hemorrhoids are manifested by internal or external hemorrhoids with persistent bleeding.

3. The Veteran has not had a prolapse of rectum during the period on appeal.

4. The VA Form 21-0966, Intent to File, for service connection for lumbar strain with degenerative disc disease, hemorrhoids, and prolapse of rectum was received on April 26, 2017, and the Veteran has been granted service connection from that date.

CONCLUSIONS OF LAW

1. The criteria for an increased, 20 percent, disability rating for lumbar strain with degenerative disc disease have been met effective April 26, 2017. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242.

2. The criteria for an increased, 20 percent, disability rating for hemorrhoids have been met effective April 26, 2017. 38 U.S.C. §§ 1155, 7104(a), 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7336.

3. The criteria for a compensable disability rating for prolapse of rectum have not been met. 38 U.S.C. §§ 1155, 7104(a), 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7334.

4. The criteria for an effective date prior to April 26, 2017 for lumbar strain with degenerative disc disease have not been met. 38 U.S.C. §§ 5110 (2012); 38 C.F.R. §§ 3.400 (2021).

5. The criteria for an effective date prior to April 26, 2017 for hemorrhoids have not been met. 38 U.S.C. §§ 5110 (2012); 38 C.F.R. §§ 3.400 (2021).

6. The criteria for an effective date prior to April 26, 2017 for prolapse of rectum have not been met. 38 U.S.C. §§ 5110 (2012); 38 C.F.R. §§ 3.400 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 2004 to October 2007.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter has been before the Board multiple times. Following a February 2026 Supplemental Statement of the Case (SSOC), the Veteran appealed to the Board by filing a Notice of Disagreement in February 2026.

INCREASED RATING

In general, disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disabilities adversely affect his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set for the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable,
Supplemental Statement of the Case (SSOC), the Veteran appealed to the Board by filing a Notice of Disagreement in February 2026.

INCREASED RATING

In general, disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disabilities adversely affect his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set for the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589(1991).

In increased rating claims, where a claimant seeks a higher rating for a previously service-connected disability, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58(1994).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When a Veteran seeks benefits and the evidence is in relative equipoise, the Veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

1. Entitlement to an increased, 20 percent, disability rating for lumbar strain with degenerative disc disease is granted effective April 26, 2017.

The Veteran seeks an increased disability rating for her service-connected lumbar strain with degenerative disc disease. The Veteran was in receipt of a 10 percent disability rating from April 26, 2017 and a 20 percent disability rating from January 8, 2026. The service-connected condition is rated under Diagnostic Code 5242. See 38 C.F.R. § 4.71a. Diagnostic Code 5242 is rated under the General Rating Formula for Diseases and Injuries of the Spine. See 38 C.F.R. § 4.71a.

Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

In considering the Veteran's claim, to obtain the next higher disability rating of 40 percent, the evidence of record must indicate forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R.
30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Medical treatment records show that the Veteran was seen for back pain in April 2018. She reported pain made worse by sitting, bending, stairs, twisting, lying in bed, running, walking, standing, lifting, and reaching overhead. The physician found the flexion was limited to 45 degrees. See Medical Treatment Records.

The Veteran was provided a VA examination in July 2018. She was diagnosed with a lumbosacral strain and degenerative disc disease. The Veteran stated that she had flare-ups with flexion, lifting or carrying more than 5 pounds, lying down for more than one hour, and sitting more than half an hour. The examiner stated that the Veteran's initial range of motion and range of motion after three repetitions was normal. The examiner noted pain on examination but stated it did not result in functional loss. The examiner stated that pain caused functional loss during flare-ups, but he was not able to describe it in terms of loss of range of motion. No ankylosis or radiculopathy was noted. See July 2018 Disability Benefits Questionnaire.

The Veteran submitted a statement in October 2019. The Veteran stated she had inflammation, lower back spasms, and inability to run, stand, or sit for a long period of time. She stated her muscles spasms are so painful that she finds herself in the fetal position. See Statement of Veteran.

The Veteran was provided a VA examination in January 2026. The Veteran did not report flare-ups. She reported back pain with intermittent spasms that limited her ability to do basic household chores. She stated she couldn't lift anything heavier than 5 pounds, couldn't do anything strenuous, and couldn't sit or stand for too long. The examiner found forward flexion to be limited to 60 degrees and combined range of motion to be 170 degrees on active and passive range of motion and after three repetitions. The examiner estimated forward flexion to be limited to 55 degrees and combined range of motion to be 155 degrees after repeated use over time. No ankylosis or radiculopathy was noted. See January 2026 Disability Benefits Questionnaire.

Based on the evidence above, the Board finds that the Veteran's forward flexion of the thoracolumbar spine has been greater than 30 degrees but not greater than 60 degrees for the entire period on review. While the July 2018 examiner found that the Veteran's range of motion was normal, the examiner did not consider pain. The Veteran was found to have forward flexion limited to 45 degrees in April 2018 and 55 degrees in January 2026.

The examiner estimated forward flexion to be limited to 55 degrees and combined range of motion to be 155 degrees after repeated use over time. No ankylosis or radiculopathy was noted. See January 2026 Disability Benefits Questionnaire.

However, a higher disability rating is not warranted. The evidence of record shows the Veteran's forward flexion of the thoracolumbar spine was not less than 30 degrees nor did she have favorable ankylosis of the entire thoracolumbar spine.

Accordingly, the Board finds the Veteran is entitled to a disability rating of 20 percent, but no higher, for her lumbar strain with degenerative disc disease from April 26, 2017.

2. Entitlement to an increased, 20 percent, disability rating for hemorrhoids is granted effective April 26, 2017.

3. Entitlement to a compensable disability rating for prolapse of rectum is denied.

The Veteran seeks a higher disability rating for her service-connected hemorrhoids and prolapse of rectum. For hemorrhoids, the Veteran was in receipt of a 0 percent disability rating from April 26, 2017 and a 20 percent disability rating from July 15, 2024. For prolapse of rectum, the Veteran has been in receipt of a 0 percent disability rating since April 26, 2017.

The Veteran's hemorrhoid disability is currently evaluated pursuant to 38 C.F.R. § 4.114, DC 7336.

Under the regulation in effect at the time the Veteran filed her claim, DC 7336 provided for a noncompensable (0 percent) rating for external or internal hemorrhoids that were mild or moderate. A 10 percent rating was warranted for external or internal hemorrhoids that were large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent (maximum schedular) rating was warranted for external or internal hemorrhoids with persistent bleeding and with secondary anemia, or with fissures.

Under the new regulations, effective after 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 (maximum schedular) 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.

The Veteran's prolapse rectum disability is currently evaluated pursuant to 38 C.F.R. § 4.114, DC 7334.

Under the regulation in effect at the time the Veteran filed her claim, DC 7334 provided for a 10 percent rating for mild prolapse of the rectum with constant slight or occasional moderate leakage. A 30 percent evaluation was warranted for a moderate rectal prolapse that was persistent or frequently recurring. A 50 percent evaluation was warranted for severe (or complete), persistent prolapse.

Under the new regulations, effective after May 19, 2024, a 10 percent rating is warranted for spontaneously reducible prolapse that is not repairable. A 30 percent rating is warranted for manually reducible prolapse that is not repairable and occurs only after bowel movements, exertion, or while performing the Valsalva maneuver. A 50 percent rating is warranted for manually reducible prolapse that is not repairable and occurs at times other than bowel movements, exertion, or while performing the Valsalva maneuver. A 100 percent rating is warranted for persistent irreducible prolapse, repairable or unrepairable.

The Veteran was provided a VA examination in April 2018. She was diagnosed with moderate internal and external hemorrhoids with persistent bleeding. It was noted that the previously seen mucosal prolapse was gone. See April 2018 Disability Benefits Questionnaire.

The Veteran was provided a VA examination in August 2018. The Veteran had mild or moderate external hemorrhoids. She denied any current bleeding with bowel movements. The examiner stated that the Veteran did not have any current symptoms related to rectal prolapse and per the colonoscopy report from April 2018, the prolapse was no longer present. See August 2018 Disability Benefits Questionnaire.

The Veteran submitted a
for persistent irreducible prolapse, repairable or unrepairable.

The Veteran submitted a statement in October 2019. The Veteran stated that she had internal and external hemorrhoids varying in size from small to large. She stated she had bleeding lumps around her anus and bleeding from the inner lining of her rectum. The Veteran noted that she had fecal incontinence. See October 2019 Statement of Veteran.

The Veteran submitted a colonoscopy report from September 2021. The Veteran was diagnosed with internal hemorrhoids. See Medical Treatment Records.

The Veteran was provided a VA examination in July 2024. The examiner noted that the Veteran had internal hemorrhoids with persistent bleeding. There was no impairment of sphincter control or rectal prolapse. See July 2024 Disability Benefits Questionnaire.

The Veteran was provided a VA examination in January 2026. The Veteran reported intermittent stool leakage but mostly issues with constipation and rectal bleeding due to her hemorrhoids. She declined a rectal examination. The examiners stated that the Veteran did not have impairment of sphincter control, did not have hemorrhoids, and did not have a rectal prolapse. The examiner stated that she was unable to confirm the Veteran's reported hemorrhoids and prolapse rectum because she declined a rectal exam. See January 2026 Disability Benefits Questionnaire and Addendum.

The Veteran was provided a VA examination in February 2026. A telephone discussion and review of the records was conducted. The examiner stated that the Veteran had internal and external hemorrhoids with persistent bleeding and rectal or anal stricture with straining during defecation. The examiner stated that the Veteran did not have loss of sphincter control or a rectal prolapse. See February 2026 Disability Benefits Questionnaire.

Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran had internal and external hemorrhoids that were characterized by persistent bleeding for the entire period on appeal. Therefore, the Board finds that the Veteran is entitled to a higher, 20 percent, disability rating for hemorrhoids which is the highest rating available under this diagnostic code, for the period beginning on July 26, 2017.

However, the Board finds that the Veteran did not have a rectal prolapse during the period on appeal. Therefore, a compensable rating for prolapse of rectum is denied.

4. Entitlement to an effective date prior to April 26, 2017 for lumbar strain with degenerative disc disease is denied.

5. Entitlement to an effective date prior to April 26, 2017 for hemorrhoids is denied.

6. Entitlement to an effective date prior to April 26, 2017 for prolapse of rectum is denied.

Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400.

The Veteran filed a VA Form 21-0966, Intent to File, on April 26, 2017. The Veteran then filed a VA Form 21-526EZ, Fully Developed Claim, for service connection for a back condition and rectal discomfort on April 27, 2018. The Veteran was granted service connection for her back and rectal conditions with an effective date of April 26, 2017 in a September 2018 rating decision.

(Continued on the next page)

As the Veteran is in receipt of service connection from the date the intent to file was received, no earlier date is allowed. Therefore, the claim for an earlier effective date for service connection for lumbar strain with degenerative disc disease, hemorrhoids, and prolapse of rectum is not warranted, and these appeals are denied.

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ho, Ashley M.

The Board's decision in this case is binding only with respect to the instant matter decided.
for her back and rectal conditions with an effective date of April 26, 2017 in a September 2018 rating decision.

(Continued on the next page)

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ho, Ashley 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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