HEMORRHOIDS EXTERNAL OR INTERNAL

TANYA SMITH · 2026 · Case ID: A26038283

MIXED

Summary

The Veteran, an Army Veteran who served from January 1999 to January 2003, appeals a February 2025 rating decision concerning claims for service connection for hemorrhoids, status post right 5th finger fracture, left foot condition, left knee strain, right foot strain, and vertigo. The Board denied entitlement to an initial compensable rating for hemorrhoids, finding the condition mild or moderate with occasional flares, not meeting the criteria for a higher rating. Similarly, entitlement to a compensable rating for the status post right 5th finger fracture was denied, as the Veteran's condition did not meet the criteria for any compensable diagnostic codes, even considering painful motion or aggravation. The Board remanded claims for left foot condition, left knee strain, right foot strain, and vertigo. For the foot and knee claims, the remand is due to inadequate VA medical opinions regarding secondary service connection, specifically the aggravation of these conditions by the service-connected right knee patella chondral irregularity. For vertigo, the remand is to obtain an opinion on secondary service connection to the Veteran's service-connected tinnitus, as the prior opinion did not adequately address this avenue of claim.

Rationale

Mild or moderate hemorrhoids with occasional flares; No evidence of large or thrombotic hemorrhoids; No evidence of persistent bleeding with secondary anemia or fissures

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7336

Docket No.

250807-572022

Full Decision Text

Citation Nr: A26038283
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 250807-572022
DATE: April 23, 2026

ORDER

Entitlement to an initial compensable rating for service-connected hemorrhoids is denied.

Entitlement to an initial compensable rating for service-connected status post right 5th finger fracture is denied.

REMANDED

Entitlement to service connection for left foot condition is remanded.

Entitlement to service connection for left knee strain is remanded.

Entitlement to service connection for right foot strain is remanded.

Entitlement to service connection for vertigo is remanded.

FINDINGS OF FACT

1. The evidence reflects the Veteran's hemorrhoids are no more than mild or moderate.

2. The Veteran is already provided the only rating available under the schedular criteria for his status post right 5th finger fracture.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial compensable rating for service-connected hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7336.

2. The criteria for entitlement to an initial compensable rating for service-connected status post right 5th finger fracture have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5125, 5227, 5230.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Army from January 1999 to January 2003.

This matter comes before the?Board of Veterans' Appeals?(Board) from a February 2025 Appeals Modernization Act (AMA) rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed this decision to the Board in August 2025 by filing a notice of disagreement (NOD) in which he requested direct review.?

As this is a?Direct Review?appeal under the AMA, the record closed on the date of notice (February 14, 2025) of the February 2025 rating decision.?

As an initial matter, the Board acknowledges the Veteran's argument in September 2025 correspondence, challenging the competency of the March 2025 VA examiner and requesting their qualifications according to Francway v. Wilkie, 930 F.3d 1377 (Fed. Cir. 2019). However, as this was done after the rating decision on appeal, there is no duty to assist error, and the Board cannot use this as a basis for remand. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Ratings

Disability ratings are based on the average impairment of earning capacity resulting from disability.?38?U.S.C. §?1155;?38?C.F.R. §?4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluations will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.?38?C.F.R. §?4.7.??????

In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.?Francisco v. Brown,?7?Vet. App.?55, 58 (1994). However, when the current appeal arises from the initially assigned rating, consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim.?Fenderson?v. West, 12?Vet. App.?119 (1999). Moreover, staged ratings are appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified.?Hart v. Mansfield, 21?Vet. App.?505 (2007).??????

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.").?

Under?38?C.F.R. §?4.59, painful motion is a factor to be considered with any form of arthritis; however,?38?C.F.R. §?4.59?is not limited to disabilities involving arthritis. See Burton v. Shinseki,?25?Vet. App.?1?(2011).?

In Correia v. McDonald,?28?Vet. App.?158?(2016), the Court held that the final sentence of?38?C.F.R. §?4.59?requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."?

In Sharp v. Shulkin,?29?Vet. App.?26?(2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.?

The Board notes that the rating criteria applicable to musculoskeletal system conditions were revised effective February 7, 2021. See?38?C.F.R. §?4.71a?(2021);?85 Fed. Reg. 76453?(Nov. 30, 2020);?85 Fed. Reg. 85523?(Dec. 29, 2020);?86 Fed. Reg. 8142?(Feb. 4. 2021). When regulations are revised during the course of an appeal, as here, the Board is required to consider the claim in light of both the former and the revised schedular criteria and to apply the regulation more favorable to the claimant. However, if an increased rating is warranted under the revised criteria, that award may not be made effective before the effective date of the change; there is no prohibition against assigning a rating under the older criteria for the entire period on appeal. See Kuzma v. Principi,?341 F.3d 1327?(Fed. Cir. 2003).

In considering the severity of a disability, it is essential to trace the medical history of the Veteran.?38?C.F.R. §§?4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present.?38?C.F.R. §?4.2;?Peyton v.?Derwinski,?1?Vet. App.?282 (1991). The basis of disability evaluations is the ability of the body as a whole to function?under the ordinary conditions of daily life, including employment.?38?C.F.R. §?4.10.??????

The Board has considered the entire record, including the Veteran's VA clinical records and private treatment records. These show complaints and treatment but will not be referenced in detail. The Federal Circuit has held that the Board must review the entire
4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present.?38?C.F.R. §?4.2;?Peyton v.?Derwinski,?1?Vet. App.?282 (1991). The basis of disability evaluations is the ability of the body as a whole to function?under the ordinary conditions of daily life, including employment.?38?C.F.R. §?4.10.??????

The Board has considered the entire record, including the Veteran's VA clinical records and private treatment records. These show complaints and treatment but will not be referenced in detail. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board will discuss the evidence pertinent to the rating criteria and the current disability.

1. Entitlement to an initial compensable rating for service-connected hemorrhoids.

In a February 2025 rating decision, service connection for hemorrhoids was granted and rated as noncompensable under Diagnostic Code 7336, effective August 29, 2023.

Under Diagnostic Code 7336, hemorrhoids, external or internal, warrant a noncompensable rating when hemorrhoids are mild or moderate. A 10 percent rating is warranted when hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A maximum 20 percent rating is warranted when there are hemorrhoids with persistent bleeding and with secondary anemia, or with fissures.

The Veteran was afforded a VA examination in March 2024. The examiner indicated the Veteran's hemorrhoids had their onset in 1999 but have since resolved, with "occasional flares." These flares were characterized by the examiner as "mild or moderate" and it was noted they occur "few times yearly." The Veteran declined a physical examination of the rectal/anal area, so the examiner was unable to determine whether the Veteran had any external hemorrhoids, anal fissures or other abnormalities.

The Veteran was afforded a medical opinion in November 2024, in which the examiner stated the "Veteran reports he continues to have issue with occasional flare ups of hemorrhoids." The Board notes there are no other medical records or lay statements regarding the Veteran's symptoms since service.

Considering there is no evidence of record that suggests the Veteran's hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences, or with persistent bleeding and with secondary anemia, or with fissures, the Board concludes that a compensable rating for the Veteran's hemorrhoids is not warranted. The benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001).

2. Entitlement to an initial compensable rating for service-connected status post right 5th finger fracture.

In a February 2025 rating decision, service connection for status post right 5th finger fracture was granted and rated as noncompensable under Diagnostic Code 5125, effective August 29, 2023.

Loss of use of the hand is evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5125. A 60 percent evaluation is assigned for loss of use of the non-dominant (minor) hand, and a 70 percent evaluation is assigned for loss of use of the dominant (major) hand.

Under 38 C.F.R. § 4.71a, Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. 38 C.F.R. § 4.71a. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id.

Limitation of motion of the fingers is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5228-5230. Under Diagnostic Code 5230, limitation of motion of the ring or little finger, a noncompensable (0 percent) disability rating is assigned for any limitation of motion of the ring or little finger for
of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. 38 C.F.R. § 4.71a. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id.

Ankylosis, both favorable and unfavorable, of the ring or little finger is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5227. This diagnostic code also does not provide anything higher than a noncompensable rating. The Board notes a compensable evaluation is possible for 5th finger ankylosis under Diagnostic Codes 5220-5223, but the ankylosis must be present in multiple digits. Additionally, the only other possible compensable rating for the little finger is under Diagnostic Code 5156, but the Veteran's finger must be at least partially amputated.

Here, the Veteran currently suffers from only one finger disability, status post right 5th finger fracture, which has not been amputated. The Veteran has no other service-connected finger conditions, nor is there any evidence of arthritis, ankylosis, or loss of use of his right hand.

Thus, the Board finds that a compensable rating for the status post right 5th finger fracture is not warranted under Diagnostic Codes 5003, 5125, 5156, 5227, or 5230.

The Board acknowledges that 38 C.F.R. § 4.59 and Burton v. Shinseki, 25 Vet. App. 1 (2011) provide that actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. However, there is no compensable minimum rating available for a single little finger disability under these diagnostic codes. The Court has further held in Sowers v. McDonald that 38 C.F.R. § 4.59 is not an independent provision that may be applied without an underlying Diagnostic Code. See Sowers v. McDonald, 27 Vet. App. 472 (2016). Thus, due to these diagnostic codes not providing for a minimal compensable rating, the Board cannot consider the Veteran's pain to provide him a minimum compensable rating under 38 C.F.R. § 4.59. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5125, 5227, 5230.

Thus, the Board concludes that a compensable rating for the Veteran's status post right 5th finger fracture is not warranted. The benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001).

REASONS FOR REMAND

1. Entitlement to service connection for left foot condition is remanded.

2. Entitlement to service connection for left knee strain is remanded.

3. Entitlement to service connection for right foot strain is remanded.

The Veteran contends his left foot, right foot, and left knee conditions are due to service or secondary to his service-connected right knee patella chondral irregularity.

The Veteran was afforded VA examinations for his foot and knee conditions in March 2024. Although no medical opinions were provided at the time, the examiner noted the Veteran's medical history for each condition. For his feet, the examiner indicated the Veteran related these conditions had their onset in 1999, and that he had progressive symptoms, but no injury or incident. For his knees, the examiner did not indicate whether both knees had their onset at the same time, merely listing the onset in 2000. However, the examiner specified that while the right knee condition was due to a fall, the left knee had progressive symptoms, but no injury or incident.

The Veteran was afforded medical opinions in November 2024. The examiner opined the Veteran's left foot, right foot, and left knee conditions were less likely than not related to service or due to or the result of his service-connected right knee condition. For the direct service connection opinions,
For his feet, the examiner indicated the Veteran related these conditions had their onset in 1999, and that he had progressive symptoms, but no injury or incident. For his knees, the examiner did not indicate whether both knees had their onset at the same time, merely listing the onset in 2000. However, the examiner specified that while the right knee condition was due to a fall, the left knee had progressive symptoms, but no injury or incident.

The Veteran was afforded medical opinions in November 2024. The examiner opined the Veteran's left foot, right foot, and left knee conditions were less likely than not related to service or due to or the result of his service-connected right knee condition. For the direct service connection opinions, the examiner explained there was no evidence of these conditions during service. For the secondary service connection opinions, the examiner explained that the right knee condition would not cause another musculoskeletal condition,

unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5cm so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait.

However, the Board notes no opinion regarding the aggravation portion of secondary service connection was provided.

Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007).

The Board finds the failure to obtain adequate VA medical opinions for the Veteran's left foot, right foot, and left knee conditions constitutes a pre-decisional duty to assist error. 38 C.F.R. § 20.802. Thus, a remand is required to obtain addendum opinions that address the aggravation portion of secondary service connection.

4. Entitlement to service connection for vertigo is remanded.

The Veteran originally filed his claim for service connection for vertigo in March 2023, wherein he stated that he had "chronic tinnitus with secondary vertigo."

Favorable findings from the February 2025 rating decision include that the Veteran has a current diagnosis of vertigo and his service treatment records note a minimal head trauma. The Board also notes the Veteran is service connected for his claimed primary disability, tinnitus.

The Veteran was afforded a VA examination in March 2024 and a medical opinion in November 2024. The March 2024 examiner indicated that the Veteran's benign paroxysmal positional vertigo (BPPV) had its onset in 2022, there was no injury or incident, and his symptoms have progressed. The November 2024 examiner opined it was less likely than not that the Veteran's BPPV was related to his minimal head trauma during service. She explained that the in-service injury from 2002 also noted some complaints of dizziness at the time, but that his injury was acute and resolved without any notation of complaints of chronic symptoms, to include dizziness, until 2022.

However, considering the Veteran contended his vertigo was secondary to his tinnitus prior to the rating decision on appeal, the Board finds the failure to obtain an opinion on secondary service connection was a duty to assist error. 38 C.F.R. § 20.802. Thus, a remand is required to obtain an addendum opinion.

The matters are REMANDED for the following action:

1. Obtain addendum opinions from a clinician with appropriate expertise for the Veteran's left foot, right foot, and left knee conditions.

The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

The examiner must provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that EACH of the Veteran's conditions (left foot, right foot, and left knee) has been aggravated (worsened/underwent an incremental increase, regardless of permanence) by his service-connected right knee patella chondral irregularity.

Specifically, for EACH of the Veteran's conditions (left foot, right foot, left knee), would it have been less severe but for the service-connected right knee patella chondral irregularity, either because there is a causal link or because the service-connected right knee patella chondral irregularity resulted in the inability to treat his claimed condition?

The term incremental increase in disability means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any incremental increase in disability need not be permanent.

Please note that there is no temporal
underwent an incremental increase, regardless of permanence) by his service-connected right knee patella chondral irregularity.

Please note that there is no temporal requirement that the primary condition (service-connected right knee patella chondral irregularity) be service-connected, or even diagnosed, at the time the secondary condition (left foot, right foot, left knee) was incurred.

The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation.

2. Obtain an addendum opinion from a clinician with appropriate expertise for the Veteran's vertigo.

The examiner must provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's vertigo:

a) is proximately due to his service-connected tinnitus, or

b) has been?aggravated?(worsened/underwent an incremental increase, regardless of permanence) by his service-connected tinnitus.

Specifically, would the Veteran's vertigo have been less severe but for the service-connected tinnitus, either because there is a causal link or because the service-connected tinnitus resulted in the inability to treat his vertigo?

Please note that there is no temporal requirement that the primary condition (service-connected tinnitus) be service-connected, or even diagnosed, at the time the secondary condition (vertigo) was incurred.

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Papacalos, Angelic

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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