HEMORRHOIDS

EMILY TAMLYN · 2026 · Case ID: 26004926

MIXED

Summary

The veteran, who served in the U.S. Army from August 1980 to September 1989, appeals the denial of an increased rating for his service-connected hemorrhoids and the denial of service connection for arthritis throughout the body, claimed as secondary to other disabilities. The Board reviewed the evidence concerning hemorrhoids, noting the veteran's existing 20 percent rating and the updated VA rating criteria. Multiple VA examinations documented persistent bleeding and external hemorrhoids, with the most recent examination in August 2023 noting internal and external hemorrhoids with ulcerated mucosa. The Board found the VA examinations adequate and assigned the maximum 20 percent rating, concluding that the evidence did not support a higher rating or the presence of anemia. For the arthritis claim, the Board found no medical evidence of a current diagnosis of generalized arthritis, and the VA examiner noted the absence of such a diagnosis in service treatment records, attributing hand and shoulder issues to post-service factors. The Board also noted the lack of evidence regarding functional impairment of earning capacity from this claimed arthritis. The Board denied service connection for generalized arthritis, finding the evidence weighed against the claim and the benefit of the doubt rule inapplicable. The claim for entitlement to TDIU prior to November 25, 2009, was remanded as it was inextricably intertwined with other pending matters.

Rationale

VA examinations documented persistent bleeding and external hemorrhoids.; Board found maximum 20 percent rating appropriate under both old and new criteria.; Evidence did not support higher rating or presence of anemia.

Service Branch

ARMY

Special Benefit

TDIU

Diagnostic Code

7336

Docket No.

19-10 014

Full Decision Text

Citation Nr: 26004926
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 19-10 014
DATE: April 23, 2026

ORDER

Entitlement to a rating more than 20 percent for hemorrhoids (also claimed as internal or external hemorrhoids with ulcerated rectal mucosa) is denied.

Entitlement to service connection for arthritis throughout the body, to include as secondary to service-connected disability is denied.

REMANDED

Entitlement to a total disability rating based on individual unemployability (TDIU) prior to November 25, 2009 is remanded.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran's hemorrhoids have been manifested by persistent bleeding with secondary anemia, or with fissures.

2. The persuasive evidence of record shows that the Veteran does not have chronic, clinically diagnosed arthritis throughout the body and his claimed symptoms do not cause functional impairment of earning capacity.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial rating more than 20 percent for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.114, Diagnostic Code (DC 7336).

2. The criteria for entitlement to service connection for arthritis throughout the body, to include as secondary to service-connected disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A , 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1980 to September 1989.

The Veteran filed a claim of service connection in May 2017 for right knee arthritis, left knee arthritis, right elbow arthritis, left elbow arthritis, neck pain, back pain, hip pain, hemorrhoids, and arthritis throughout the body.

In an August 2017 rating decision, the Agency of Original Jurisdiction (AOJ) continued the Veteran's 20 percent rating for external hemorrhoids. In an October 2017 rating decision, the AOJ denied the Veteran's claim of service connection for arthritis throughout the body.

In October 2017, the Veteran filed a notice of disagreement with the October 2017 denial of service connection for arthritis throughout the body. The Veteran perfected his appeal with a VA Form 9 in April 2019. A Board hearing was held before the undersigned Veterans Law Judge in October 2021 and a transcript is of record.

This case was remanded previously in September 2022 and July 2023, in pertinent part, for the scheduling of VA examinations.

During development, a September 2023 Board decision granted entitlement to a TDIU, effective November 25, 2009. This was implemented by way of a September 2023 rating decision.

In September 2024, the Board remanded the appeal for the issuance of a supplemental statement of the case (SSOC), which was furnished in February 2025.

The Board acknowledges that additional pertinent evidence, including VA treatment records, have been added to the record since the most recent February 2025 SSOC pertaining to the issues on appeal.

In a response from the Veteran's representative dated March 19, 2026, the Veteran waived AOJ review of the additional relevant evidence pursuant to 38 C.F.R. § 20.1305(c). See March 2026 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief). Therefore, there is no duty to assist or other error in adjudicating the remaining issues on appeal. The matters, as they have been characterized above, have since been returned to the Board for further consideration.

Increased Rating

Disability ratings are determined by applying a schedule of ratings (Ratings Schedule) that is based on the 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.

In determining
to the Board for further consideration.

Increased Rating

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged ratings." See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

All reasonable doubt will be resolved in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 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. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

1. Entitlement to a rating more than 20 percent for hemorrhoids

The Veteran seeks entitlement to a rating more than 20 percent for service-connected hemorrhoids. See February 2026 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief).

In terms of background, a February 2016 rating decision granted service connection for hemorrhoids and assigned an initial 20 percent rating, effective September 5, 2015 (date VA received claim) under 38 C.F.R. § 4.144, DC 7336.

The period on appeal began on May 30, 2017, the date of claim for an increased rating. In addition, as the Veteran seeks an increase for a claim already service-connected, the Board has reviewed the evidence of record in a one-year "look back" period from the appeal period's commencement. See Gaston v. Shinseki, 605 F.3d. 979, 982 (Fed. Cir. 2010).

VA amended the criteria for rating the digestive system effective from May 19, 2024. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after May 19, 2024. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

Prior to May 19, 2024, DC 7336 provides that hemorrhoids (external or internal) will be rated as zero percent disabling when they are mild or moderate. A 10 percent disability rating is warranted when they are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent disability rating is warranted when they cause persistent bleeding with secondary anemia, or fissures.

As of May 19, 2024, DC 7336 provides that hemorrhoids (internal or external) will be rated at 10 percent if there are 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 hemorrhoids.

Initially, the Board observes that the Veteran has received VA and private treatment for several conditions, including hemorrhoids, for which he is prescribed medication.

The Veteran received a VA rectum and anus conditions examination in February 2016 and was diagnosed with hemorrhoids (dated March 1981). It was noted that the Veteran is prescribed suppositories for hemorrhoid flares. He also had a colonoscopy in 2015 where he reported symptoms of pain, itching, or bleeding 2 times per week and lasting until he manually extracts the hemorrhoid in the shower. The Veteran indicated that he watches his diet and increased his fruit intake. The examiner reported that the Veteran has mild or moderate external hemorrhoids with no current bleeding, but persistent bleeding occurs. Upon examination, the Veteran had large external hemorrhoids with no other pertinent findings. No functional impact was noted. Ultimately, the examiner determined that the Veteran's hemorrhoids are at least as likely as not related to service.

The Board observes this resulted in the February 2016 rating decision that granted service connection for hemorrhoids with an initial 20 percent rating, effective September 5, 2017.

As mentioned above, VA received a claim for an increased rating for hemorrhoids on May 30, 2017. See May 2017 VA 21-526EZ, Fully Developed Claim (Compensation).

The Veteran received another VA rectum and anus conditions examination in August 2017, wherein a diagnosis of internal or external hemorrhoids (dated 1981) and rectal prolapse (dated 2015) was provided. The Veteran stated that his hemorrhoids onset with occasional bright red bleeding after bowel movements. He indicated that the condition has worsened and he uses various creams, but always bleeds after bowel movements. He also increased fruit intake for his diet, but continues to bleed and has "a feeling of something coming out [that] he reduces manually." It was noted that the Veteran is prescribed hemorrhoid creams for treatment. According to the examiner, the Veteran has internal or external hemorrhoids that are mild or moderate with persistent bleeding. Upon examination, the Veteran had small or moderate external hemorrhoids, reducible hemorrhoids, and ulcerated mucosa. There were no other pertinent findings and no functional impact was reported.

Pursuant to the Board's July 2023 remand, the Veteran underwent another VA rectum and anus conditions examination in August 2023. He was diagnosed with internal or external hemorrhoids with ulcerated rectal mucosa (dated 1981). The Veteran stated that he is prescribed suppositories for hemorrhoid flares and had a colonoscopy in 2015 which showed benign polyps and adenomas. He has not had surgery for hemorrhoids, but watches his diet to prevent constipation and has increased fluid intake. The Veteran indicated that his condition has remained the same. His current symptoms included rectal pain and external hemorrhoids with swelling, pain, bleeding, and itching 2 times per week. It was noted that the Veteran is prescribed suppositories for constipation. According to the examiner, the Veteran has mild or moderate internal hemorrhoids with peristent bleeding and with 1 small non-bleeding hemorrhoid to the left of anus. Upon examination, the Veteran had small or moderate external hemorrhoids and ulcerated mucosa. It was noted that a May 2023 colonoscopy showed internal and external hemorrhoids. There were no other pertinent findings and no functional impact was reported.

The Board assigns great probative weight to the findings of the VA examiners detailed above. They are medical professionals who examined and tested the Veteran during in-person sessions, they thoroughly reviewed the Veteran's medical history and record and their findings, for the reasons discussed above, therefore are adequate for VA rating purposes. See generally Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (200
bleeding hemorrhoid to the left of anus. Upon examination, the Veteran had small or moderate external hemorrhoids and ulcerated mucosa. It was noted that a May 2023 colonoscopy showed internal and external hemorrhoids. There were no other pertinent findings and no functional impact was reported.

The Board assigns great probative weight to the findings of the VA examiners detailed above. They are medical professionals who examined and tested the Veteran during in-person sessions, they thoroughly reviewed the Veteran's medical history and record and their findings, for the reasons discussed above, therefore are adequate for VA rating purposes. See generally Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in assessing the adequacy of an opinion is whether the examiner was informed of the relevant facts in rendering a medical opinion).

After reviewing the evidence, the Board finds that the maximum 20 percent rating is appropriate for the Veteran's hemorrhoids both the new and old criteria. The above described VA examination reports show that the Veteran has external hemorrhoids and/or prolapsed hemorrhoids that cause persistent bleeding. This 20 percent evaluation represents the schedular maximum available rating for service-connected hemorrhoids. See 38 C.F.R. § 4.114, DC 7336.

The Veteran is competent to report symptoms he was experiencing such as bleeding. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the medical evidence in this case requires interpretation of laboratory results to determine the presence of anemia and inspection as to the clinical diagnosis of fissures. Expertise is needed. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning a complex disability such as rheumatic fever).

In reaching this determination, the Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130 (2025). Here, the beneficial effects of medication are not enough to keep the disability from being symptomatic and it is not medically ethical to take a veteran off of medication for rating purposes in any case.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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).

For these reasons, the Board finds no approximate balance of the evidence to support entitlement to a rating more than 20 percent for hemorrhoids. The Board has considered the benefit of the doubt rule, but as the evidence is decidedly against the claim, that rule is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; see also Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021)

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004);

Service connection for certain chronic diseases, including arthritis, may be presumed if they are manifest to a compensable degree within one year following the date of separation from active service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309.

For the showing of chronic disease in-service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in-service is not adequately supported then a showing of continuity of symptomatology after discharge from service is required to support the claim. 38 C.F.R. § 3.303(b). But to establish entitlement to service connection based on continuity of symptomatology, the claimant must have one of the "chronic" diseases specifically enumerated in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a 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) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). The United States Court of Appeals for the Federal Circuit recently clarified that, as contemplated by 38 U.S.C. § 1110, secondary aggravation will be shown where a non-service-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two conditions, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for arthritis throughout the body, to include as secondary to service-connected disability

The Veteran seeks entitlement to service connection for arthritis throughout the body. See February 2026 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief). It was previously determined that the theory of secondary service connection has been raised by the record.

The Board acknowledges that service connection is in effect for the following disabilities: obstructive sleep apnea; irritable bowel syndrome, left knee disability, right knee disability, hemorrhoids, bilateral lower extremity sciatic nerve and femoral nerve radiculopathy, low back disability, hypertension, right elbow disability, left elbow disability, tinnitus, right wrist disability, knee scars, bilateral hearing loss, and pseudofolliculitis barbae. See also February 2025 Rating Decision - Code sheet.

Initially, the Board observes that the Veteran had received VA and private treatment for several conditions, including joint pain.

Pursuant to the Board's July 2023 remand, a VA addendum opinion was obtained in December 2023. The examiner explained that there is no distinct diagnosis of systemic or generalized arthritis beyond the already service-connected joint disabilities of the back, knees, elbows, and wrist. It was noted that there is no medical evidence or literature to support that the Veteran's service-connected disabilities collectively cause or result in arthritis throughout the body. The examiner emphasized that the Veteran's service treatment records (STRs) are silent for a condition causing widespread arthritis. The examiner attributed the Veteran's hand condition to post-service occupational injuries and found that a shoulder condition lacked chronicity, with only 1 in-service complaint and a 20 year gap before diagnosis. The examiner also discussed a variety of types of arthritis related to joint disorders, but found that the Veteran does not have a clinical diagnosis of arthritis throughout the body.

The Board notes that it is important to recognize that the Veteran
joint disabilities of the back, knees, elbows, and wrist. It was noted that there is no medical evidence or literature to support that the Veteran's service-connected disabilities collectively cause or result in arthritis throughout the body. The examiner emphasized that the Veteran's service treatment records (STRs) are silent for a condition causing widespread arthritis. The examiner attributed the Veteran's hand condition to post-service occupational injuries and found that a shoulder condition lacked chronicity, with only 1 in-service complaint and a 20 year gap before diagnosis. The examiner also discussed a variety of types of arthritis related to joint disorders, but found that the Veteran does not have a clinical diagnosis of arthritis throughout the body.

The Board notes that it is important to recognize that the Veteran may not be entitled to be doubly compensated for the same disability. The evaluation of the same disability under various diagnoses is to be avoided, as is the evaluation of the same manifestation under different diagnoses. 38 C.F.R. § 4.14; Amberman v. Shinseki, 570 F.3d 1377 (Fed. Cir. 2009).

Upon review of the record for the period on appeal, the Board finds that there is simply no medical evidence in the record to document a current diagnosis of arthritis throughout the body. The Board acknowledges the Veteran's reports; however, in order to warrant service connection, the threshold requirement is competent evidence of the existence of the claimed disability at some point during a Veteran's appeal. See McClain v. Nicholson, 21 Vet. App. 319 (2007) (requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim ... even though the disability resolves prior to the Secretary's adjudication of the claim"); Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992).

In this case, the Veteran is competent as a layperson to testify to symptoms he experiences. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, he has not specifically alleged more than simply claiming arthritis throughout the body as due to military service and/or secondary to service-connected disability without more explanation. It is emphasized that there are no available medical records to suggest that the Veteran has been diagnosed with arthritis throughout the body for VA purposes.

The Board has considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. To establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earning capacity, which may include showing manifestations of a similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8, 17 (U.S. 2020). Here, the Veteran has not provided any evidence or statements to suggest his claimed arthritis throughout the body has any functional impairment of earning capacity for him besides his already service-connected orthopedic-type disabilities.

Accordingly, the Board finds that the benefit of the doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to service connection for arthritis throughout the body, to include as secondary to service-connected disability is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to a TDIU prior to November 25, 2009 is remanded.

The Board observes that a separate February 2026 decision with a different docket number remanded the claim for entitlement to a TDIU prior to November 25, 2009 for development because it was inextricably intertwined with the Veteran's claim for increased ratings for right knee disability.

After a review of the file, it appears that the AOJ is still developing the claim for an earlier effective date for TDIU and increased rating for right knee disability. In other words, it would be premature for the Board to adjudicate the issue of entitlement to an earlier effective date for TDIU in this appellate stream while the other matters remain pending at the AOJ
prior to November 25, 2009 is remanded.

Thus, this issue is still inextricably intertwined with the remaining issues on appeal that were remanded by the Board in February 2026. As such, the appropriate remedy for an inextricably intertwined issue is to remand it pending resolution of the inextricably intertwined issue. Harris v. Derwinski, 1 Vet. App. 180 (1991).

The matters are REMANDED for the following action:

Readjudicate the remaining matters on appeal, including entitlement to a TDIU prior to November 25, 2009.

Emily Tamlyn

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Miller, 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.

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