HEMORRHOIDS

Summary

The veteran, who served from September 2004 to August 2014, appeals the denial of a compensable rating for residuals of hemorrhoidectomy and the remand of issues related to his right knee and right hip disabilities. The Board reviewed the claim for hemorrhoidectomy residuals under the new VA rating criteria effective May 19, 2024. The evidence, including a September 2024 VA examination, indicated external hemorrhoids without persistent bleeding, anemia, or thrombosis, and no internal hemorrhoids. The Board found that the veteran's symptoms did not meet the criteria for a 10 percent rating or higher under either the old or new rating schedules. The Board considered the benefit of the doubt doctrine but found the evidence persuasively against a higher rating, thus denying the claim. The Board remanded issues concerning the right knee and right hip disabilities due to pre-decisional duty to assist errors in the prior VA examinations. Specifically, the examiner failed to adequately address the ameliorative effects of medication on the veteran's range of motion and the need for a knee brace, requiring new examinations to clarify these aspects and estimate functional impairment without medication.

Rationale

Symptoms did not meet criteria for 10% rating under new or old criteria; No evidence of persistent bleeding, anemia, or thrombosis; External hemorrhoids characterized as mild or moderate

Full Decision Text

Citation Nr: A26037621
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 250513-543113
DATE: April 22, 2026

ORDER

Entitlement to a compensable rating for residuals of hemorrhoidectomy is denied.

REMANDED

Entitlement to a compensable rating for right knee limited flexion is remanded.

Entitlement to an initial rating in excess of 10 percent for right knee limited extension is remanded.

Entitlement to a rating in excess of 10 percent for right thigh impairment associated with right trochanteric pain syndrome is remanded.

Entitlement to a compensable rating for limited extension of the right hip is remanded.

Entitlement to a compensable rating for limited flexion of the right hip is remanded.

FINDING OF FACT

The Veteran's hemorrhoids were at worst manifested by external hemorrhoids without persistent bleeding, anemia, or episodes of thrombosis during the period on appeal.

CONCLUSION OF LAW

The criteria for a compensable rating for hemorrhoids are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.114, Diagnostic Code (DC) 7336.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from September 2004 to August 2014. These matters come to the Board from November 2024 (hemorrhoids) and January 2025 (all other issues) rating decisions. 

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decisions on appeal.  38 C.F.R. § 20.301. 

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300. Regarding the issues the Board is remanding, any such evidence will be considered by the AOJ on remand. Regarding the issue the Board is deciding, if the Veteran would like VA to consider any evidence that was added to the claims file 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

The Board acknowledges that the rating decision on appeal reduced ratings for certain symptoms of the Veteran's right knee and right hip disabilities. However, in the VA Form 10182, the Veteran indicated that he was appealing the "disability evaluation" and did not indicate that he was appealing the propriety of the reductions. Additionally, the Board notes that restoration of the reduced ratings would raise concerns over impermissible pyramiding. As such, the issues propriety of the reductions are not before the Board. 

Entitlement to a compensable rating for residuals of hemorrhoidectomy is denied.

The Veteran contends that his residuals of hemorrhoidectomy are more severe than currently rated. The Veteran's hemorrhoids are rated as noncompensable for the period on appeal, which is from up to one year prior to the date of the Veteran's claim in June 2024. The Board notes that the record does not contain evidence showing an increase in disability during the one year prior to the date of the claim. As such, that period is not for consideration. 

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects their ability to function under the ordinary conditions of daily life, including employment, by comparing their symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. If two ratings are potentially applicable, the higher rating will be assigned if the disability 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.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.
 Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. If two ratings are potentially applicable, the higher rating will be assigned if the disability 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.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.41. However, where an increase in the disability rating, rather than the propriety of the initial rating, is at issue, the present level of disability is of primary importance, and past medical reports should not take precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Regardless of whether an appeal stems from disagreement with the initial rating assigned following an award of service connection or from disagreement with the rating assigned following a claim for increase, separate ratings can be assigned for separate periods of time based on the facts found. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)).

The Veteran's hemorrhoid residuals are rated under DC 7336. The Board notes that VA recently amended the Rating Schedule for evaluating digestive system disabilities effective?May 19, 2024. See,?89 Fed. Reg. 19375?(March 18, 2024). These revisions apply to all applications for benefits received by VA or that are pending before the AOJ on or after May 19, 2024. Claims pending prior to the effective date will be considered under both the old and new rating criteria and the criteria which is more favorable to the Veteran's claim(s) will be applied. The Federal Circuit has held that 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). As the record does not show an increase was ascertainable in the year prior to the June 2024 date of claim, only the new criteria will apply.

Under the revised version of DC 7336, a 10 percent rating is provided 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.  Id.  A 20 precent rating is provided for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.  Id.

Turning to the evidence of record, a September 2024 VA examination found that the Veteran had external hemorrhoids without persistent bleeding, anemia, or episodes of thrombosis. The examiner characterized the hemorrhoids as mild or moderate rather than large or thrombotic. There were no internal hemorrhoids or other related symptoms. The Board finds that the Veteran's hemorrhoids were at worst manifested by external hemorrhoids without persistent bleeding, anemia, or episodes of thrombosis during the period on appeal. The evidence of record does not show the Veteran reporting symptoms associated with the criteria for a 10 percent rating, or higher. Notably, to obtain a higher rating under the prior criteria required large or thrombotic, irreducible, hemorrhoids with excessive redundant tissue, evidencing frequent recurrences. 38 C.F.R. § 4.114, DC 7336 (2023). Thus, even if the Board were to conclude that extension of the lookback period into the period prior to the effective date of the new regulation warranted considering both the old and new criteria, the old criteria are also not met. 

In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the evidence is persuasively against assignment of a higher rating, the doctrine is not applicable, and a compensable rating for hemorrhoids must be denied. 

REASONS FOR REMAND

1. Entitlement to a compensable rating for right knee limited flexion is remanded.

2. Entitlement to an initial rating in excess of 10 percent for right knee limited extension is remanded.

3. Entitlement to a rating in excess of 10 percent for right thigh impairment associated with right trochanteric pain syndrome is remanded.

4. Entitlement to a compensable rating for limited extension of the right hip is rem
 

In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the evidence is persuasively against assignment of a higher rating, the doctrine is not applicable, and a compensable rating for hemorrhoids must be denied. 

REASONS FOR REMAND

1. Entitlement to a compensable rating for right knee limited flexion is remanded.

2. Entitlement to an initial rating in excess of 10 percent for right knee limited extension is remanded.

3. Entitlement to a rating in excess of 10 percent for right thigh impairment associated with right trochanteric pain syndrome is remanded.

4. Entitlement to a compensable rating for limited extension of the right hip is remanded.

5. Entitlement to a compensable rating for limited flexion of the right hip is remanded.

The Board must remand an appeal to the AOJ for correction of an error on the part of the AOJ to satisfy its duties under 38 U.S.C. 5103A if the error occurred prior to the date of the AOJ decision on appeal. 38 C.F.R. § 20.802. The remaining issues must be remanded for correction of the following pre-decisional duty to assist error.

The Veteran was seen for VA examinations to evaluate the severity of his right hip and knee disabilities in November 2024. The examiner found painful motion of the hip and knee. The examiner indicated that the Veteran constantly used a knee brace, but that it was not required by prescription. With regard to the Veteran's right knee disability, the examiner indicated that the Veteran received injections and used gel. With regard to the Veteran's hip disability, the examiner indicated that the Veteran treated his pain with Tylenol.

Where VA diagnostic codes do not reference medication, the Board must discount any beneficial effects of medication taken by the Veteran to treat a disability and evaluate the baseline severity of the disability when assigning an evaluation. See Ingram v. Collins, 38 Vet. App. 130, 132 (2025) (citing Jones v. Shinseki, 26 Vet. App. 56 (2012)).

The Board finds the November 2024 VA examinations inadequate for decision-making purposes. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In this case, the VA examiner failed to address whether any ameliorative effects of medication were considered in the examination report, and whether the Veteran's range of motion or other symptoms would be more severe without the medication, to include whether the Veteran's knee or hip range of motion would approximate ankylosis, or its functional equivalent, without medication. In addition, the examiner's indication that the Veteran constantly used a knee brace, but did not require a prescription, should have been clarified. These pre-decisional errors must be corrected by obtaining new VA examinations on remand. 

The matters are REMANDED for the following action:

Schedule the Veteran for VA examinations to determine the severity of his (1) right hip and (2) right knee disabilities. The examiner should perform all necessary testing, and, in the report, indicate any ameliorative effects of the medication taken by the Veteran for his disabilities and provide an estimate of the Veteran's functional impairment in the absence of those medications. The examiner must specifically indicate whether the Veteran's ranges of motion approximate ankylosis or more severe limitation of motion without medication, to include during flare-ups or during periods of repetitive use. Information may be obtained from the Veteran as to his limitation absent medication. With regard to the Veteran's knee, the examiner should clarify whether the Veteran has knee instability to an extent that would warrant prescribing a brace. A complete rationale must accompany any conclusion reached.

 

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Baker, 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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