TINNITUS

Summary

The veteran, who served in the United States Marine Corps from February 4, 1991, to March 2, 1991, appeals the denial of service connection for tinnitus, insomnia, and back pain. The Board reviewed the evidence of record at the time of the initial decision, noting that any subsequent evidence would require a supplemental claim. For tinnitus, the Board found no in-service event or nexus to service, as service treatment records were silent on the issue, and the first mention of tinnitus appeared in a private treatment record 23 years after service. The Board acknowledged the veteran's lay opinion but stated it was not competent medical evidence. A VA examination was deemed unnecessary as the evidence was sufficient to decide the claim. For insomnia, the Board found no evidence of current disability or functional impairment of earning capacity, as service treatment records and post-service medical records did not reflect a diagnosis or persistent symptoms. The Board also noted the veteran's lay reports were not specific enough to establish a diagnosis or link to service. For back pain, the Board found no current diagnosis of a back disability or evidence of functional impairment of earning capacity, despite some post-service reports of pain. The Board acknowledged the lack of a VA examination but found it unnecessary due to insufficient evidence of an in-service injury or current disability. The Board denied all three claims. Entitlement to a compensable disability rating for hemorrhoids was remanded for an addendum VA opinion to assess the severity of the service-connected hemorrhoids without the ameliorative effects of medication, as required by Jones v. Shinseki.

Rationale

Service treatment records silent for tinnitus; First mention in private treatment record 23 years post-service; No competent medical opinion linking tinnitus to service; VA examination not warranted due to sufficient evidence

Full Decision Text

Citation Nr: A26036819
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 220608-248935
DATE: April 21, 2026

ORDER

Entitlement to service connection for tinnitus is denied. 

Entitlement to service connection for insomnia is denied. 

Entitlement to service connection for back pain is denied. 

REMANDED

Entitlement to a compensable disability rating for hemorrhoids is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against a finding that tinnitus had its onset in service or manifested to a compensable degree within the applicable presumptive period; or that there is continuity of symptomatology; or that the disability is otherwise etiologically related to any in-service noise exposure or to his service-connected disabilities, to include any medication taken therefore. 

2. The evidence of record persuasively weighs against finding that, at any time during or approximate to the pendency of the claim, the Veteran has or has had insomnia and/or back disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

2. The criteria for service connection for insomnia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for back disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from February 4, 1991, until March 2, 1991.  

The rating decision on appeal was issued in May 2022 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the June 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

In an October 2024 decision, the Board denied the claims for an initial compensable rating for hemorrhoids as well as service connection for tinnitus, insomnia and back pain, which the Veteran appealed to the United States Court of Appeals for Veterans' Claims (Court). An August 2025 Court Order vacated the decision based on a Joint Motion for Remand (JMR); the appeal was returned to the Board for compliance with the JMR. 

Therefore, the Board may only consider the evidence of record at the time of the June 2022 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 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, the Veteran 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 Supplemental Claim are included with this decision. 

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease initially 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).

Service connection may be granted on a secondary basis for a disability that is proximately
3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease initially 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).

Service connection may be granted on a secondary basis for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis therefore requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the nexus element, the current disability may be either (a) proximately caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995).  

The requirement of a current disability 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." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A diagnosis of a psychiatric disability must be established in accordance with 38 C.F.R. § 4.125(a), which provides that all psychiatric diagnoses must conform to the Diagnostic and Statistical Manual of Mental Disorder, 5th Edition (DSM-V or DSM-5). 38 C.F.R. § 3.304(f).

The VA disability compensation system does not actually compensate veterans for their physical or mental conditions per se, but rather for the effects those conditions have on their ability to function and their earning capacity after service. 38 C.F.R. §§ 3.321(a), 4.1, 4.2, 4.10. See also, Clemons v. Shinseki, 23 Vet. App. 1, 4 (2009) (holding "the appellant did not file a claim to receive benefits only for a particular diagnosis, but for the affliction his [] condition, whatever that is, causes him."); Saunders v. Wilkie, 886 F.3d 1356, 1362 (Fed. Cir. 2018) (holding under 38 U.S.C. § 1110, "disability" refers to functional impairment of earning capacity, not the underlying injury or disease causing that impairment).

Therefore, while the existence of a disability is a threshold requirement for a finding of service connection, that is not to be confused with a requirement for a formal diagnosis of the particular condition identified by the claimant. Id.; Shedden, 381 F.3d at 1167; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

1. Entitlement to service connection for tinnitus is denied.

At the outset, the Board concedes the presence of a current tinnitus disability, as the Veteran is competent to testify to observable symptoms such as ringing in his ears and has done so.  See Layno v. Brown, 6 Vet. App. 465 (1994); Charles v. Principi, 16 Vet. App. 370 (2002) (finding lay person competent to attest to in-service acoustic trauma, in-service symptoms of tinnitus, and post-service continuous symptoms of tinnitus "because ringing in the ears is capable of lay observation").  Thus, the remaining question is whether the Veteran's current tinnitus arose in or is related to service.

Upon review of the evidence, the Board finds the competent evidence of record does not demonstrate that the Veteran's current tinnitus began during or is otherwise related to service.  In this regard, service treatment records are silent for complaints of or treatment for tinnitus.  The first indication of tinnitus in the medical evidence is a November 2018 private treatment record, at which time the Veteran reported experiencing tinnitus for one year.  There is no medical evidence establishing a nexus between the Veteran's tinnitus and service.

Although the Veteran believes that his current tinnitus is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion.  See Jandreau v. Nicholson, 492 F.3
 the evidence, the Board finds the competent evidence of record does not demonstrate that the Veteran's current tinnitus began during or is otherwise related to service.  In this regard, service treatment records are silent for complaints of or treatment for tinnitus.  The first indication of tinnitus in the medical evidence is a November 2018 private treatment record, at which time the Veteran reported experiencing tinnitus for one year.  There is no medical evidence establishing a nexus between the Veteran's tinnitus and service.

Although the Veteran believes that his current tinnitus is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  While the Veteran is competent to report symptoms of tinnitus, the etiology of tinnitus requires medical expertise to determine.  Thus, the opinion of the Veteran regarding the etiology of his current tinnitus is not competent medical evidence.  As there is no competent evidence of record linking the Veteran's current tinnitus to service, service connection for tinnitus is denied.

The Board acknowledges that the Veteran has not been afforded a VA examination on this issue.  An examination is required when (1) there is evidence of a current disability, (2) evidence establishing an 'in-service event, injury or disease,' or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the claim.  See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006).  Here, the evidence does not establish an in-service event, injury or disease or indicate that the Veteran's tinnitus had onset in or is otherwise related to service.  As such, there is sufficient evidence to decide the claim and a VA examination is not warranted.

Finally, the Board acknowledges that in the August 2022 brief, the Veteran's representative asserts that the Veteran's tinnitus was caused by medication he takes for his service-connected gastroesophageal reflux disease (GERD). To the extent a new theory was raised in the Veteran's representative's brief in August 2022 after the May 2022 decision on appeal, the Bound finds this theory to be essentially speculative, because it addresses multiple medications taken for GERD, generally, without listing which specific medication the Veteran takes that causes tinnitus, stating:

There are hundreds of medications that can cause tinnitus, according to the American Tinnitus Association. Here are some commonly prescribed medications and medication classes known to cause tinnitus and some options and alternative medications to consider. Proton pump inhibitors (PPIs) such as omeprazole (Prilosec) or pantoprazole (Protonix) are common medications used to treat gastroesophageal reflux disease (GERD). In one study, there was a significant association of tinnitus with PPI use" (https://www.goodrx.com/drugs/side-effects/these-11-prescriptions-may- cause-ringing-in-the-ears).

Such conclusory or generalized lay statements are insufficient. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Further, there are no competent medical opinions of record that indicate his tinnitus is secondary to any service-connected disabilities, whether directly or from medications, taken therefore. Rather, VA and private treatment records show that the Veteran has been prescribed various medications, including one of the ones the Veteran's representative listed in the August 2022 argument, specifically, Omeprazole, through March 2018 for stomach acid. See CAPRI at 152 (April 2021). The available treatment records do not show that the Veteran was prescribed Omeprazole thereafter and at no point suggest any side effects of that medication. As noted above, the Veteran's treatment records show tinnitus in November 2018. There is also no probative evidence that any service-connected conditions aggravated the Veteran's tinnitus. 

Further, the Board acknowledges the Veteran's assertion, through his representative, that the January 2022 VA form 21-526 EZ instructed the Veteran that he had one year to submit additional information or evidence necessary to support the claim. Specifically, the representative stated that the VA form 21-526EZ explicitly states that "if we decide your claim before one year from the date we receive the claim, you will still have the remainder of the one-year period to submit additional information or evidence necessary to support the claim"  However, after a thorough review of the claims file, the Board is unable to locate the
innitus in November 2018. There is also no probative evidence that any service-connected conditions aggravated the Veteran's tinnitus. 

Further, the Board acknowledges the Veteran's assertion, through his representative, that the January 2022 VA form 21-526 EZ instructed the Veteran that he had one year to submit additional information or evidence necessary to support the claim. Specifically, the representative stated that the VA form 21-526EZ explicitly states that "if we decide your claim before one year from the date we receive the claim, you will still have the remainder of the one-year period to submit additional information or evidence necessary to support the claim"  However, after a thorough review of the claims file, the Board is unable to locate the above language in the January 2022 VA from 21-526EZ filed by the Veteran.

In sum, the Board concludes that the most probative evidence of record is against finding that the Veteran's tinnitus was incurred in or caused by service. Accordingly, the claim for service connection is denied.

2. Entitlement service connection for insomnia is denied.

The Veteran seeks service connection for claimed insomnia. See VA 21-526EZ (January 2022). He detailed that his insomnia is due to irregular sleep schedule during his service in the Gulf War and began in approximately February 1991. 

The Board concludes that the evidence of record weighs against finding the Veteran has insomnia that causes functional impairment of earning capacity, at any time during the pendency of the claim or recent to the filing of the claim.  See 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303; Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

In this case, the Veteran's STRs reflect no complaints, signs, or symptoms of sleep problems, including insomnia. See e.g., STR - Medical (August 1991, May 1992). The Board notes that no separation physical was conducted at the time of separation from service, because the Veteran was in basic training and was separated on the finding of anemia as a disqualifying medical condition. See DPRIS - DD 214 Certified Original - Certificate of Release or Discharge From Active Duty (July 2020). 

Post-service, in August 1991, the Veteran filed his initial VA 21-526 Veterans Application for Compensation or Pension. See VA 21-526 Veterans Application for Compensation or Pension (August 1991). He did not report any insomnia. Next, in February 2015, he filed a VA-21526EZ, where he sought service connection for disabilities other than insomnia. See VA 21-526EZ, Fully Developed Claim (Compensation) (February 2015). 

Additionally, the post-service VA and private medical records also do not contain any treatment or diagnoses of insomnia.  See e.g., CAPRI (May 2015, April 2016, October 2018); Medical Treatment Record - Non-Government Facility (August 2013, March 2015, June 2015, July 2019).  The record does show that the Veteran reported insomnia in August 2014, then in November 2014 reported insomnia for the preceding three weeks, at which time a prescription for Ambien was suggested. See CAPRI at 15, 23, 26 (May 2015). However, subsequent VA and private treatment records do not reflect that the Veteran was prescribed Ambien or used it for any symptoms. 

The Veteran has asserted entitlement to service connection for insomnia, but has not provided further information regarding symptoms. See VA 21-526EZ, Fully Developed Claim (November 2023).  The Veteran is competent to report sleep symptoms.  See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge).  Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  But the diagnosis of a particular sleep disorder, to include insomnia, or the relation of symptoms to a particular disability,
 Veteran is competent to report sleep symptoms.  See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge).  Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  But the diagnosis of a particular sleep disorder, to include insomnia, or the relation of symptoms to a particular disability, is not susceptible to lay observation and requires medical knowledge as to disease processes and their likely causes, which the Veteran is not shown to possess.  See Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006).  Thus, the lay evidence of record does not demonstrate an insomnia diagnosis.  

Moreover, neither the lay nor the medical evidence reflects that any symptom of insomnia causes any functional impairment of earning capacity.  Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, such pain can constitute a disability.).  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.  Wait v. Wilkie, 33 Vet. App. 8 (2020).  Such evidence is not present here; the VA treatment records show reports of insomnia on a few occasions, but do not indicate that it rises to the level of affecting earning capacity.  See e.g., May 2015, April 2016, October 2018).  The Veteran has not reported or otherwise identified any impairment in earning capacity due to insomnia.

Therefore, as current insomnia disability is not shown, the first element of service connection is not met.

The Board recognizes the Veteran's representative's argument that the Veteran is competent to describe his symptoms of a disability, and as such, a VA examination should have been conducted on the basis of "persistent or recurrent symptoms of a disability," citing to 38 C.F.R. 3.159(c)(4)(i). Respectfully, while the Veteran is competent to describe his symptoms and the Board does not discredit his reports, the Board finds that an examination was not warranted and thus there was no pre-decisional duty to assist error, because the Veteran did not describe any persistent or recurrent symptoms, stating instead that his insomnia is due to irregular sleep schedule during his service in the Gulf War and began in approximately February 1991. At no point did he claim or describe persistent or recurrent symptoms, nor does the record suggest otherwise, as the first instance of any insomnia reports post March 1991 separation appears in 2014, about 23 years later, at which time he did not report onset prior to 2014. 

Accordingly, the claim is denied.  As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Lastly, the Board finds that the AOJ had no duty to obtain an examination of the claimed disability as part of its duty to assist prior to issuing the decision on appeal. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The duty to obtain an examination prior to issuing the decision on appeal did not arise because there was no evidence that tends to show a diagnosed insomnia or recurrent symptoms of a sleep-related disability, as explained above. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). 

3. Entitlement to service connection for back pain.

Upon review of the record, the Board finds that entitlement to service connection for back pain is not warranted.

Service treatment records are silent for complaints of or treatment for a back pain.  The first indication of back pain is a March 2018 VA treatment record in which the Veteran complained of pain in his lower back.  Thereafter, a July 2021 private treatment record reveals the Veteran reported back pain that had been present for six days
 symptoms of a sleep-related disability, as explained above. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). 

3. Entitlement to service connection for back pain.

Upon review of the record, the Board finds that entitlement to service connection for back pain is not warranted.

Service treatment records are silent for complaints of or treatment for a back pain.  The first indication of back pain is a March 2018 VA treatment record in which the Veteran complained of pain in his lower back.  Thereafter, a July 2021 private treatment record reveals the Veteran reported back pain that had been present for six days.  However, the evidence does not indicate the Veteran has a current diagnosis of a back disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Board notes that Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.  In the absence of proof of a present disability there can be no valid claim.  See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  The Board also acknowledges that pain resulting in functional impairment can constitute a disability even without an identified underlying diagnosis.  See Saunders v. Wilkie, 866 F.3d 1356, 1367-69 (Fed. Cir. 2018) (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.").  However, in this case, the evidence of record does not indicate the Veteran's back pain results in functional impairment of earning capacity.  As such, the subjective report of pain is not sufficient to establish the presence of a current disability.

While the Veteran may believe he has a current disability of the back, he is not competent to provide a diagnosis in this case.  The issue is medically complex, as it requires specialized medical education and knowledge of the musculoskeletal system, which he is not shown to have.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Thus, the Board finds the medical evidence of record to be of greater probative value as to the presence of a current back disability than the Veteran's assertions.

The Board acknowledges that the Veteran has not been afforded a VA examination on this issue.  However, as there is no competent and credible evidence of that the Veteran suffered an injury, disease, or event in service related to back pain, the Board finds that a VA examination is not warranted.  See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2016).

Finally, the Board acknowledges that in the August 2022 brief, the Veteran's representative asserts that the Veteran's back pain is aggravated by the iron infusions he receives for his service-connected anemia. However, during the rating review period the evidence did not show the presence of a disability, and any argument as to etiology assumes the presence of a disability.

In sum, the Board concludes that the most probative evidence of record is against finding that the Veteran's back pain was incurred in or caused by service. 

As noted above, the Board acknowledges the Veteran's assertion, through his representative, that the January 2022 VA form 21-526 EZ instructed the Veteran that he had one year to submit additional information or evidence necessary to support the claim. Specifically, the representative stated that the VA form 21-526EZ explicitly states that "if we decide your claim before one year from the date we receive the claim, you will still have the remainder of the one-year period to submit additional information or evidence necessary to support the claim"  However, after a thorough review of the claims file, the Board is unable to locate the above language in the January 2022 VA from 21-526EZ filed by the Veteran.

Accordingly, the claim is denied. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 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

Ent
 you will still have the remainder of the one-year period to submit additional information or evidence necessary to support the claim"  However, after a thorough review of the claims file, the Board is unable to locate the above language in the January 2022 VA from 21-526EZ filed by the Veteran.

Accordingly, the claim is denied. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 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

Entitlement to a compensable disability rating for hemorrhoids is remanded.

Board finds that remand is required to correct a pre-decisional duty to assist error.  Specifically, remand is required to obtain an addendum opinion assessing the severity of the Veteran's service-connected hemorrhoids absent the ameliorative effects of medication. 

A February 2022 VA-obtained Rectum and Anus Disability Benefits Questionnaire (DBQ) reflects that the Veteran presented for an in-person examination of his hemorrhoid disability. By history, the Veteran reported itching, pain during bowel movements and noticing blood on paper when wiping, and that his condition has stayed the same. See C&P Exam (February 2022). Clinical evaluation reflects the presence of mild or moderate internal or external hemorrhoids with pain in rectum area when sitting and having bowel movements. See id. Examination of rectal/anal area revealed small or moderate external hemorrhoids. Id. at 3. There was no functional impact indicated or reported at the examination. See id at 4.

The Board notes that the Veteran's has had continuous use of over-the-the-counter (OTC) medications, including Metamucil, Colace, and hydrocortisone cream, as well as prescription hydrocortisone 2.5% cream. Indeed, the February 2022 VA examiner noted the medications used.

Importantly, where a diagnostic code does not explicitly contemplate the effects of medication on a disability, the Board must evaluate the disability without regard to the ameliorative effects of the medication.  See Jones v. Shinseki, 26 Vet. App. 56, 62 (2012); see also McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) ("[I]f [a diagnostic code] does not specifically contemplate the effects of medication, the Board is required pursuant to Jones to discount the ameliorative effects of medication.").  More recently, the Court has stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities."  Ingram v. Collins, 38 Vet. App. 130 (2025)

In the present case, the hemorrhoids are evaluated pursuant to 38 C.F.R. § 4.114, Diagnostic Code (DC) 7336.  The Board notes that DC 7336 does not explicitly contemplate the effects of medication on migraines.  Accordingly, an addendum medical opinion is required for the Board to adequately assess the severity of the Veteran's condition without regard to the ameliorative effects of medication.  See Jones v. Shinseki, supra.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected hemorrhoids.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 

Describe the functional impact of the Veteran's hemorrhoids absent the ameliorative effects of medication.  Specifically address how the Veteran's condition would impact his ability to work if left unmedicated.  

Each opinion should be accompanied by a complete rationale.  If medical literature is relied upon, the physician should identify and specifically cite each reference material utilized.  If the physician is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided.

 

 

I. Cannaday

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. M. Pesin, 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.