HEMORRHOIDS EXTERNAL OR INTERNAL

Summary

The Veteran, who served in the United States Navy from January 1968 to April 1972 as a pilot, appeals the denial of service connection for hemorrhoids and an earlier effective date for Total Disability based on Individual Unemployability (TDIU) and Dependents' Education Assistance (DEA). The Board granted service connection for hemorrhoids, finding the September 2024 private medical opinion more persuasive than the October 2025 VA examination. The private opinion linked the Veteran's hemorrhoids to the mechanical stress of prolonged sitting and pressure experienced as a pilot, while the VA examiner's opinion was less favorable due to unavailable service treatment records. The Board resolved doubt in the Veteran's favor, granting service connection for hemorrhoids. Regarding TDIU and DEA, the Board found that the issue of TDIU was reasonably raised by the record, particularly the Veteran's PTSD claim and examination findings indicating significant employment impairments. The Board determined that the Veteran met the schedular requirements for TDIU and, resolving doubt in his favor, found that his PTSD rendered him unable to obtain or maintain substantially gainful employment from November 9, 2021. Consequently, the Board granted an earlier effective date for TDIU and DEA from November 9, 2021.

Rationale

September 2024 private opinion favored; Pilot duties as risk factor; Resolved doubt in Veteran's favor

Full Decision Text

Citation Nr: A26039488
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260205-627520
DATE: April 28, 2026

ORDER

Entitlement to service connection for hemorrhoids is granted.

Entitlement to an effective date of November 9, 2021, for the grant of a total disability rating based on individual unemployability (TDIU) is granted. 

Entitlement to an effective date of November 9, 2021, for the grant of eligibility for Dependents' Education Assistance (DEA) is granted.

FINDINGS OF FACT

1. Resolving all doubt in the Veteran's favor, his hemorrhoids are related to his active-duty service.

2. TDIU was reasonably raised by the record while the Veteran's claim regarding post-traumatic stress disorder (PTSD) was pending. 

3. Resolving all doubt in the Veteran's favor, from at least November 9, 2021, the Veteran's service-connected PTSD rendered him incapable of obtaining or maintaining substantially gainful employment. 

4. The Veteran is in receipt of a total and permanent disability as of November 9, 2021. 

CONCLUSIONS OF LAW

1. The criteria for service connection for hemorrhoids are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for an effective date of November 9, 2021, for the grant of a TDIU are met. 38?U.S.C. §§?1155, 5107, 5110; 38?C.F.R. §§?3.155, 4.16; Rice v. Shinseki, 22?Vet. App.?447 (2009). 

3. The criteria for an effective date of November 9, 2021, for the grant of eligibility for DEA are met. 38 U.S.C. §§ 1155, 3500; 38 C.F.R. §§ 3.807, 21.3020.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from January 1968 to April 1972. These matters come to the Board of Veterans' Appeals (Board) from rating decisions dated October 2025 and December 2025 that denied entitlement to the relevant benefits. The Veteran filed a VA Form 20-0996 Request for Higher Level Review, and in February 2026, the denials were confirmed and continued.

The Veteran filed his VA Forms 10182 (Decision Review Request: Board Appeal) in February 2026 and requested direct review of these matters by a Veterans Law Judge. Given the Veteran's docket selection, the Board may only consider the evidence of record at the time of the relevant decisions on appeal that were later subject to Higher Level Review. 38 C.F.R. § 20.301. Any evidence submitted thereafter cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

The Board notes that the Veteran may change his Board review option up to one year from the date that he was notified of the decisions in question. 38 C.F.R. § 20.202(c)(2). The Board acknowledges that it has been less than one year since the date of such notification. Williams v. McDonough, 37 Vet. App. 305 (2024). However, the present appeal has been advanced on the Board's docket (AOD) based on the Veteran's age. The Board interprets this AOD status as reflecting an intent to have this matter reviewed in an expeditious manner and, therefore, the Board finds that the Veteran has implicitly waived his right to change dockets. Moreover, given the favorable nature of the decisions rendered below, the Board finds no prejudice in proceeding with adjudication. 

Entitlement to service connection for hemorrhoids

Service connection is warranted if the evidence demonstrates that a current disability resulted from an injury or disease that was incurred or aggravated during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In general, service connection requires: (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004
 connection for hemorrhoids

Service connection is warranted if the evidence demonstrates that a current disability resulted from an injury or disease that was incurred or aggravated during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In general, service connection requires: (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When a disability is initially diagnosed after separation from service and not within any applicable presumptive period, service connection may be granted if all the evidence establishes that it was incurred in or related to service. 38 C.F.R. § 3.303(d).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of all medical and lay evidence of record, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the veteran. 38 U.S.C. § 1154(a); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must resolve reasonable doubt in favor of the veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. To deny a claim on its merits, the evidence must weigh persuasively against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

The Veteran asserts that he suffers from hemorrhoids as a result of his active-duty service as a pilot. Specifically, he says that sitting on the hard cockpit seat and "pulling 'Gs' while flying" resulted in this condition. Indeed, the Veteran's service personnel records confirm that he completed pilot training and performed pilot duties during service. Therefore, the first two elements of service connection are met. The remaining question is whether the Veteran's hemorrhoids resulted from service.

In a September 2024 medical opinion, the Veteran's hemorrhoids diagnosis was confirmed. The examiner provided a limited conclusion that the Veteran's condition did not result from toxic exposures during service. However, in doing so, he explained that, as a pilot in the military, the Veteran spent several hours sitting in the same position, and this is a risk factor for increased pressure on the rectum which causes bulging rectal veins resulting in hemorrhoids. The examiner further explained that hemorrhoids are a structural disorder due to mechanical stress, rather than a disease due to toxic exposures. 

At a later October 2025 VA examination, the Veteran reported that his hemorrhoids had their onset in the 1960s with bleeding and painful bowel movements. Unfortunately, the examiner concluded that the Veteran's condition is not related to service on the basis that there is no evidence of chronicity during or since service. In concluding so, the examiner relayed that the Veteran's service records, including his entry and separation examination, are silent for hemorrhoids. The examiner failed to address the fact that the Veteran's service treatment records were actually unavailable for review. 

Where medical opinions conflict, the Board may favor one over the other if it offers an adequate statement of reasons and bases. D'Aries v. Peake, 22 Vet. App. 97, 107 (2008). To this effect, in assessing the probative weight given to a medical opinion, the Board must consider whether it is (1) based on sufficient facts or data, (2) the product of reliable principles and methods, and (3) the result of principals and methods reliably applied to the facts. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008).  

Here, the Board favors the September 2024 opinion, as it adequately considers the nature of the Veteran's service as well as his competent statements about the onset of his condition. Conversely, the October 2025 opinion dismisses the Veteran's account of the onset of his condition in large part due to the fact that service treatment records are not available to corroborate his claim. Indeed, in cases where a veteran's service treatment records are unavailable, including when they may have been destroyed or lost, the Board has a heightened obligation to consider carefully the benefit-of-the doubt rule. See O
 and methods reliably applied to the facts. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008).  

Here, the Board favors the September 2024 opinion, as it adequately considers the nature of the Veteran's service as well as his competent statements about the onset of his condition. Conversely, the October 2025 opinion dismisses the Veteran's account of the onset of his condition in large part due to the fact that service treatment records are not available to corroborate his claim. Indeed, in cases where a veteran's service treatment records are unavailable, including when they may have been destroyed or lost, the Board has a heightened obligation to consider carefully the benefit-of-the doubt rule. See O'Hare v. Derwinski, 1?Vet. App.?365 (1991). 

In light of this, and the favorable September 2024 medical opinion, the Board resolves all doubt in the Veteran's favor to find that his hemorrhoids condition is related to his service. The claim for service connection is, therefore, granted. 

Entitlement to an earlier effective date for a TDIU

In general, the effective date of an award of compensation and rating based on a claim for benefits will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38?U.S.C. §?5110(a); 38?C.F.R. §?3.400. A "claim" is defined as a formal or informal communication, in writing, requesting a determination of entitlement, or evidencing a belief in entitlement to a benefit. 38?C.F.R. §§?3.1(p), 3.151; see also Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999). Any communication or action indicating intent to apply for one or more VA benefits may be considered an informal claim; but an informal claim must identify the benefit sought. 38?C.F.R. §?3.155. 

A veteran may specifically indicate his desire to file a claim for benefits by submitting a VA Form 20-0966 Intent to File a Claim for Compensation and/or Pension (Intent to File a Claim) without identifying the specific benefit claimed or the medical condition on which the claim is based. He must only identify the general benefit in question (e.g., compensation or pension). 38?C.F.R. §?1.355(b). If VA subsequently receives a complete application appropriate to the benefit sought within 1 year of receipt of the Intent to File a Claim, it will consider the complete claim filed as of the date the Intent to File to Claim was received. 

In Rice, 22?Vet. App.?447, 453-54, the Court of Appeals for Veterans Claims clarified that a claim for a disability may include an assertion of entitlement for TDIU based on that disability. Indeed, at any time during the pendency of a claim, a veteran may explicitly assert such an entitlement, or it may be reasonably raised by the evidence of record. Rice, 22?Vet. App.?at 453-54. In such cases, the determination of whether a veteran is entitled to a TDIU, including the effective date for that award, is "part and parcel of the initial rating for that disability." Rice, 22?Vet. App.?at 455. 

When the issue of a TDIU is found to be raised by the record, a TDIU may be assigned when a veteran is unable to secure or follow a substantially gainful occupation due to his service-connected disabilities and when the veteran has certain combinations of ratings for his service-connected disabilities. If the veteran has only one such disability, that disability must be ratable at 60 percent or more. If he has two or more disabilities, there must be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38?C.F.R. §?4.16(a). 

The Veteran is currently in receipt of a TDIU from August 20, 2025, the date that the Veteran's Request for Higher Level Review and formal claim asserting entitlement for this benefit was received at VA. The Veteran argues that TDIU was raised by the record when his claim regarding PTSD was pending and, thus, entitlement to a TDIU should have been considered from November 9, 2021, the date that the PTSD claim was received at VA. The Board agrees. 

The Veteran filed an Intent to File a Claim that was received at VA on November 9, 2021. He filed his formal claim for PTSD on December 12, 2021; and in a March 2022 March 2022 rating decision, this claim was
 TDIU from August 20, 2025, the date that the Veteran's Request for Higher Level Review and formal claim asserting entitlement for this benefit was received at VA. The Veteran argues that TDIU was raised by the record when his claim regarding PTSD was pending and, thus, entitlement to a TDIU should have been considered from November 9, 2021, the date that the PTSD claim was received at VA. The Board agrees. 

The Veteran filed an Intent to File a Claim that was received at VA on November 9, 2021. He filed his formal claim for PTSD on December 12, 2021; and in a March 2022 March 2022 rating decision, this claim was denied. 

In February 2023, the Veteran timely filed a VA Form 20-0996 Request for Higher Level Review challenging the denial and, in a May 2023 decision, a duty-to-assist error was identified regarding the claim. 

After a VA medical opinion regarding PTSD was obtained, service connection for PTSD was granted in a July 2024 rating decision and a rating of 50 percent was assigned effective November 9, 2021, the date the Veteran's Intent to File a Claim was received at VA. 

In May 2025, the Veteran timely filed a Request for Higher Level Review asserting that a TDIU due to his service-connected PTSD was reasonably raised by the record and should have been adjudicated in the previous decision. He explained that his VA examination report states that he had not worked since 2015, that he suffers from chronic sleep impairment and disturbances of motivation and mood, and that he has difficulty establishing and maintaining effective work and social relationships. 

In an August 2025 letter, VA acknowledged receipt of the Request for Higher Level Review, but informed the Veteran that he must submit a form specific to this type of benefit. Accordingly, the Veteran submitted a VA Form 21-8940 Application for Increased Compensation Based on Unemployability shortly thereafter.

In a November 2025 rating decision, the Veteran's rating for PTSD was increased to 70 percent effective August 20, 2025; and in December 2025, TDIU was granted effective August 20, 2025, the date the Veteran's formal claim for a TDIU was received. DEA was also established from the same date based on the Veteran's permanent and total disability status resulting from his TDIU. After the Veteran filed an additional Request for Higher Level Review requesting an earlier effective date for his TDIU, the claim was denied; and the Veteran filed the relevant VA Form 10182 appealing this matter to the Board. 

Based on the foregoing, the Board finds that the issue of a TDIU was implicitly raised by the record while the Veteran's PTSD claim was pending and, specifically, at his VA examination where it was noted that the Veteran had not worked for several years and where the Veteran's sleep impairment and difficulty with work relationships was identified.

In light of this, a TDIU is appropriate from November 9, 2021, if it can be shown that the Veteran was rendered unable to work because of his service-connected disabilities from that date. 

As a preliminary matter, the Board notes that, as of November 9, 2021, the Veteran met the schedular requirements for a TDIU, as he was service-connected for PTSD at 50 percent from that date and his additional ratings for tinnitus and chronic bronchitis resulted in a combined disability rating of 70 percent. 

As it has been established that the issue of a TDIU was raised by the record and the Veteran met the schedular requirements for a TDIU, the remaining question is whether the Veteran's service-connected PTSD actually rendered the Veteran unable to obtain or maintain substantially gainful employment since November 9, 2021. Resolving all doubt in the Veteran's favor, the Board finds that it did. 

In order to establish entitlement to a TDIU, there must be impairment so severe that it is impossible for the average person to secure and follow a substantially gainful occupation. See 38?U.S.C. §?1155; 38?C.F.R. §§?3.340, 3.341, 4.16. The relevant question is whether a veteran is capable of performing the physical and mental acts required by employment, and not whether the veteran can actually find employment. See Van Hoose v. Brown, 4?Vet. App.?361 (1993). The Board may only consider impairment due to service-connected disabilities. Impairment from nonservice-connected disabilities may not form the basis of a grant of a TDIU. See 38?C.F.R. §§?3.341, 4.16, 4.19; Van Hoose, 4
 38?U.S.C. §?1155; 38?C.F.R. §§?3.340, 3.341, 4.16. The relevant question is whether a veteran is capable of performing the physical and mental acts required by employment, and not whether the veteran can actually find employment. See Van Hoose v. Brown, 4?Vet. App.?361 (1993). The Board may only consider impairment due to service-connected disabilities. Impairment from nonservice-connected disabilities may not form the basis of a grant of a TDIU. See 38?C.F.R. §§?3.341, 4.16, 4.19; Van Hoose, 4?Vet. App.?361. 

For the purposes of evaluating whether a TDIU is warranted, marginal employment, or employment provided on account of disability or special accommodation, is not considered substantially gainful. See 38?C.F.R. §§?3.341, 4.16, 4.18, 4.19; Hersey v. Derwinski, 2?Vet. App.?91, 94 (1992); Faust v. West, 13?Vet. App.?342 (2000). 

At the Veteran's December 2025 VA examination for PTSD, upon which his TDIU was initially granted, the Veteran reported that he ran his own telephone systems company from 1995 to 1997 and then worked for two separate communication companies from 1997 to 2000. He continued to work in various roles up to 2015 when he retired, although he continued to work part time. The Veteran explained that his excessive drinking of alcohol damaged his relationships with his wife and son throughout the 1970s and both are somewhat estranged from him as a result. He reported a long history of excessive alcohol use, but that he quit drinking in 1986. 

With specific regard to the Veteran's employability, the examiner explained that the Veteran's PTSD symptoms impair his ability to sit in a focused, clear manner for prolonged periods of time. His trauma history also disrupts his ability to work with others, with his irritability easily triggered by perceived threat or insult. His tendency to withdraw from others as a coping mechanism would also disrupt work efforts, especially cooperative work effort. His reactivity, hypervigilance, and distractibility also disrupt his ability to carry out prolonged effort and to successfully follow multi-step task in a routine successful and timely manner.  Moreover, his PTSD symptoms negatively impact his sleep, which in turn impairs his ability to work in an energetic, efficient manner. 

All of this is consistent with the Veteran's earlier VA examination, at which the Veteran reported that his first two marriages ended because he was "a drunk" and that he got sober in 1986. Relatedly, he reports working for two different companies shortly after service in the 1970s, but he reported quitting before he was fired because he "was a drunk and discontent." The Veteran reported depressed mood, decreased energy, and sleep challenges, including nightmares; and the examiner endorsed chronic sleep impairment, disturbances of motivation and mood and difficulty establishing and maintaining effective work and social relationships, all of which are symptoms that the December 2025 examiner attributed to the Veteran's inability to work.

Based on the foregoing, the Board finds that the Veteran's PTSD symptomatology was consistent from his earlier VA examination when TDIU was raised by the record until his later VA examination upon which his TDIU was based. Accordingly, resolving all doubt in the Veteran's favor, the Board finds that the Veteran was rendered unable to obtain or maintain substantially gainful employment from November 9, 2021, the date he filed his Intent to File a Claim for PTSD. The claim for an earlier effective date for a TDIU is granted. 

Entitlement an earlier effective date for DEA

As explained above, effective dates are generally awarded based on the date of receipt of the claim for benefits or the date entitlement to those benefits arose, whichever is later. See 38 C.F.R. § 3.400. For the purposes of DEA benefits, basic eligibility exists for veterans discharged from service under conditions other than dishonorable and who are in receipt of a permanent and total service-connected disability rating. 38 U.S.C. § 3500; 38 C.F.R. §§ 3.807, 21.3020. There are other areas of basic eligibility, but they involve factors not applicable here (e.g., the death of a veteran, a veteran on active duty, etc.).

This decision granted entitlement to a TDIU as of November 9, 2021. Accordingly, as of that date, the Veteran is in receipt of a total and permanent rating. Since eligibility for DEA benefits is
. § 3.400. For the purposes of DEA benefits, basic eligibility exists for veterans discharged from service under conditions other than dishonorable and who are in receipt of a permanent and total service-connected disability rating. 38 U.S.C. § 3500; 38 C.F.R. §§ 3.807, 21.3020. There are other areas of basic eligibility, but they involve factors not applicable here (e.g., the death of a veteran, a veteran on active duty, etc.).

This decision granted entitlement to a TDIU as of November 9, 2021. Accordingly, as of that date, the Veteran is in receipt of a total and permanent rating. Since eligibility for DEA benefits is predicated on the assignment of a TDIU, the effective dates are the same. An effective date of November 9, 2021, for this benefit is, therefore, granted.

 

 

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Freda J. F. Smith, 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.