IRRITABLE BOWEL SYNDROME (IBS)

Summary

The Veteran, an Air Force Veteran who served from September 1995 to February 2009, appeals the denial of an initial compensable disability rating for constipation. The Veteran was previously awarded service connection for constipation secondary to hypothyroidism in August 2020, with an initial rating effective February 2020. The Board previously remanded the issue of whether an initial compensable rating for constipation was on appeal. Following multiple remand orders and requests for private medical records, which the Veteran did not respond to, the Board proceeded to adjudicate the claim on the merits. The Board reviewed the Veteran's VA examination from April 2025, where she reported bowel movements every other day and experienced abdominal pain related to defecation at least weekly, with changes in stool frequency, form, and constipation. The Board found that the Veteran's symptoms were consistent with a 30 percent rating under Diagnostic Code 7319 (Irritable Bowel Syndrome) for the entire period on appeal, applying the pre-amendment criteria as it was more favorable. This rating is the highest available under the diagnostic code. The Board found the VA Regional Office complied with its duty to assist and prior remand directives. Service connection for constipation with an initial disability rating of 30 percent is granted.

Rationale

Constipation rated by analogy under DC 7319 (IBS); Symptoms consistent with 30% rating (abdominal pain, change in stool frequency/form, constipation); 30% rating is highest available under DC 7319

Full Decision Text

Citation Nr: 26005065
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 11-21 576
DATE: April 29, 2026

ORDER

An initial disability rating of 30 percent for service-connected constipation is granted.

FINDING OF FACT

For the entire period on appeal, the Veteran's service-connected constipation manifested as severe constipation, with more or less constant abdominal distress.

CONCLUSION OF LAW

The criteria for an initial disability rating of 30 percent for service-connected constipation are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.20, 4.114, Diagnostic Code 7319 (effective prior to May 19, 2024).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Air Force from September 1995 until her honorable discharge in February 2009.

The appeal is being treated expeditiously on the Board of Veterans' Appeals' (Board) docket pursuant to 38 U.S.C. § 7112; 38 C.F.R. § 20.800(d). This appeal is being adjudicated in the Legacy Appeal system. 38 C.F.R. §§ 19.1, 19.2.

By way of background, the Veteran initially appealed to the Board from an April 7, 2010, Rating Decision, which awarded service connection for hypothyroidism and assigned initial 10 percent disability rating effective March 1, 2009. 

During adjudication of that claim, a Regional Office of the United States Department of Veterans Affairs (VA) awarded service connection for constipation secondary to hypothyroidism in an August 28, 2020, Rating Decision. The VA Regional Office assigned an initial noncompensable disability rating effective February 4, 2020. 

The Board issued a decision on December 31, 2020, addressing only the claim for an increased rating for hypothyroidism. The Veteran filed an appeal to the United States Court of Appeals for Veterans Claims (Court). At the Court, the parties submitted a Joint Motion for Remand, which, in relevant part, stated that the Board should have addressed whether a claim for an initial compensable rating for constipation was also on appeal before the Board. The Court entered an order to that effect on March 14, 2022.

For purposes of this appeal, it suffices to say that on remand from the Court, the Board agreed that a claim for an initial compensable disability rating was before the Board as part of the original appeal. The Board issued multiple remand orders directing the VA Regional Office to conduct additional development on the Veteran's claim. See Board Decisions dated July 18, 2022; March 29, 2023; February 14, 2024; and October 30, 2025. 

In the most recent remand order dated October 30, 2025, the Board instructed the VA Regional Office to obtain any outstanding VA medical records and to send appropriate correspondence to the Veteran asking her to identify and authorize release of any relevant medical records, including certain providers she had identified in the record. Stegall v. West, 11 Vet. App. 268, 371 (1998) (finding that remand by the Board "confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders" and imposes on the Secretary a "concomitant duty to ensure compliance with the terms of the remand"). 

The VA Regional Office sent the Veteran two correspondences that requested her to identify and authorize release of private medical records. See Correspondence dated November 4, 2025, and December 4, 2025. She never responded to the requests. The Board finds that the VA Regional Office complied with the Board's prior remand directives and the duty to assist. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (noting that "[t]he duty to assist is not always a one-way street"). The VA Regional Office also obtained all outstanding VA medical records. For reasons discussed in prior Board remand orders, the prior directives of the Board have also been substantially complied with. Adjudication of this appeal on the merits is appropriate. 

Evidentiary Standards

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. The VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 

When there is an approximate balance of positive and negative evidence regarding any issue material to the
winski, 1 Vet. App. 190, 193 (1991) (noting that "[t]he duty to assist is not always a one-way street"). The VA Regional Office also obtained all outstanding VA medical records. For reasons discussed in prior Board remand orders, the prior directives of the Board have also been substantially complied with. Adjudication of this appeal on the merits is appropriate. 

Evidentiary Standards

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. The VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). It follows that when the evidence persuasively favors one side or the other the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The law requires the Board address its reasons for rejecting evidence favorable to the claimant. Timberlake v. Gober, 14 Vet. App. 122, 128?29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim.

Rating Criteria - Constipation

The VA's rating regulations do not have a specific diagnostic code associated with constipation. When the regulations do not provide a diagnostic code that matches a veteran's condition, the VA must evaluate the veteran's condition by analogy under a diagnostic code for a similar condition. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992); see 38 C.F.R. § 4.20 (providing that unlisted conditions may be rated "under a closely related disease or injury in which not only the functions affected, but [also] the anatomical localization and symptomatology[,] are closely analogous"). An adjudicator should select a diagnostic code based on the function affected, the anatomical location, and symptomatology to ensure the disabilities are closely analogous. 

The VA Regional Office initially awarded service connection for constipation in the August 28, 2020, Rating Decision, the VA Regional Office used 38 C.F.R. § 4.114, Diagnostic Code 7310-7301. The hyphenated diagnostic code in this case indicates that Diagnostic Code 7310, "stomach, injury of, residuals," was the code under which the VA Regional Office rated the disability. And that diagnostic code instructed adjudicators to rate the disability "as peritoneal adhesions," which is located under Diagnostic Code 7301. 

When the VA Regional Office revaluated the Veteran's disability in the April 30, 2025, Rating Decision, it changed the diagnostic code to 38 C.F.R. § 4.114, Diagnostic Code 7319, "irritable bowel syndrome (IBS)." 

The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993). The Board has discretion in determining the appropriate diagnostic code. Id. One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and demonstrated symptomatology. Any change in a diagnostic code by the VA must be specifically explained. Pernorio, 2 Vet. App. 625.

The Board finds that the Veteran's constipation is best rated under Diagnostic Code 7319 for the entire claim period. "Constipation is defined as the infrequent passage of stools or difficulty with evacuation of stools. Constipation can be classified as primary or secondary, and primary constipation can be further divided into slow transit constipation or outlet obstruction." Constipation: Evaluation and Management, National Library of Medicine Online, https://pmc.ncbi.nlm.nih.gov/articles/PMC6140151/ (last accessed Apr. 17, 2026). Diagnostic Code 7319 deals specifically with the bowels, symptoms associated with constipation, and stool issues. It is more closely associated with constipation with respect to the function affected, the anatomical location, and symptomatology as opposed to Diagnostic Code 7310, which shares only anatomical location similarities. 

The Board finds that the Veteran's constipation is best rated, and more beneficially
 of stools. Constipation can be classified as primary or secondary, and primary constipation can be further divided into slow transit constipation or outlet obstruction." Constipation: Evaluation and Management, National Library of Medicine Online, https://pmc.ncbi.nlm.nih.gov/articles/PMC6140151/ (last accessed Apr. 17, 2026). Diagnostic Code 7319 deals specifically with the bowels, symptoms associated with constipation, and stool issues. It is more closely associated with constipation with respect to the function affected, the anatomical location, and symptomatology as opposed to Diagnostic Code 7310, which shares only anatomical location similarities. 

The Board finds that the Veteran's constipation is best rated, and more beneficially rated, under 38 C.F.R. § 4.114, Diagnostic Code 7319 for the entire period on appeal. 

Prior to May 19, 2024, 38 C.F.R. § 4.114, Diagnostic Code 7319 provides:

	Rating (%)

Irritable colon syndrome (spastic colitis, mucous colitis, etc.):	

Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress	30

Moderate; frequent episodes of bowel disturbance with abdominal distress	10

Mild; disturbances of bowel function with occasional episodes of abdominal distress	0

"Abdominal distress" is not defined in the diagnostic code or anywhere else of relevance. Absent an express definition, it is presumed that the VA regulations employ words using their ordinary dictionary meanings at the time the regulations were promulgated. See Nielson v. Shinseki, 607 F.3d 802, 805-06 (Fed. Cir. 2010). In the medical context, "distress" means "pain or suffering affecting the body, bodily part, or the mind." Distress, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/distress, Medical definition, (last visited Apr. 17, 2026). In this context, the type of distress is specified; it must be "abdominal" distress. Therefore, "abdominal distress" includes pain or suffering affecting the abdomen and bodily part of the abdomen.

As of May 19, 2024, 38 C.F.R. § 4.114, Diagnostic Code 7319 provides:

	Rating (%)

Irritable bowel syndrome (IBS):

Abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension	30

Abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension	20

Abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension	10

Note: This diagnostic code may include functional digestive disorders (see § 3.317 of this chapter), such as dyspepsia, functional bloating and constipation, and diarrhea. Evaluate other symptoms of a functional digestive disorder not encompassed by this diagnostic code under the appropriate diagnostic code, to include gastrointestinal dysmotility syndrome (DC 7356), following the general principles of § 4.14 and this section.

Because the Veteran's appeal has been pending prior to the amendments, the Board is required to analyze her claim under both versions of 38 C.F.R. § 4.114, Diagnostic Code 7319, and whichever criteria is more favorable to the Veteran will be applied from May 19, 2024, forward. See Ervin v. Shinseki, 24 Vet. App. 318 (2011) (discussing retroactivity and effects of changes in law or regulation during the pendency of an appeal), opinion corrected, 25 Vet. App. 178 (2012).

Analysis

The Veteran received a VA-contracted medical examination assessing the severity of her constipation on April 24, 2025. She reported bowel
 appeal has been pending prior to the amendments, the Board is required to analyze her claim under both versions of 38 C.F.R. § 4.114, Diagnostic Code 7319, and whichever criteria is more favorable to the Veteran will be applied from May 19, 2024, forward. See Ervin v. Shinseki, 24 Vet. App. 318 (2011) (discussing retroactivity and effects of changes in law or regulation during the pendency of an appeal), opinion corrected, 25 Vet. App. 178 (2012).

Analysis

The Veteran received a VA-contracted medical examination assessing the severity of her constipation on April 24, 2025. She reported bowel movements every other day. She experienced abdominal pain related to defecation during the previous three months at least one day per week, which included change in stool frequency, change in stool form, and constipation.

Based on the examination report, the VA Regional Office assigned an increased disability rating of 30 percent effective April 24, 2025, under Diagnostic Code 7319 (in effective prior to May 19, 2024). The Board's review of the record indicates that the Veteran's symptoms associated with her constipation were not less severe prior to the April 24, 2025, examination. The Veteran's medical records in her claims file document consistent symptoms of abdominal pain related to defecation, which included change in stool frequency, change in stool form, and constipation since her award of service connection. 

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?

As the VA Regional Office found that the Veteran's symptoms were consistent with the 30 percent rating under the pre-amended version of Diagnostic Code 7319, the Board finds that the Veteran is entitled to an initial disability rating of 30 percent, which covers the entire period on appeal. 

30 percent is the highest disability rating available under Diagnostic Code 7319, under either the pre- or post-amended version. The Veteran has not identified, nor does the record establish, that the Veteran's constipation is an exceptional disability, such that its symptoms are not adequately contemplated by the rating criteria. As such, extraschedular consideration is not warranted. 38 C.F.R. § 3.321(b).

 

 

M. Tenner

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.F. Sawka, 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.