Citation Nr: 0003204 Decision Date: 02/08/00 Archive Date: 02/15/00 DOCKET NO. 98-06 631A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES Entitlement to an increased rating for hemorrhoids, rated zero percent disabling. (The issue of entitlement to Vocational and Rehabilitation Education benefits under Chapter 38, Title 31, U.S.C., for payment for a Masters of Public Administration degree, will the subject of another decision under the same docket number.) REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James J. Dunphy, Counsel INTRODUCTION The veteran served on active duty from May 1986 to August 1986, and from January 1991 to August 1991, with additional periods of active duty for training. Initially, the veteran contended that service connection was warranted for a number of disabilities. These issues were developed for appellate review. In a January 1997 statement, the veteran requested to withdraw his appeal. Later in January 1997, the veteran argued that service connection was warranted for a finger disorder and pes planus, and that an increased rating was appropriate for the hemorrhoids. These issues were developed by the Department of Veterans Affairs (VA) Regional Office (RO). In a September 1997 hearing before an RO hearing officer, the veteran indicated that he wished to withdraw all of his claims with the exception of an increased rating for hemorrhoids. Subsequently, the veteran raised another number of issues with the VA. In a July 1998 rating action, the RO found that the veteran had not provided new and material evidence to reopen a claim for entitlement to service connection for a bilateral foot disorder or residuals of a left middle finder injury; and for service connection for a gastric ulcer and a right shoulder disorder. At the time the claim was referred to the Board for action, no notice of disagreement with this action had been received. Accordingly, these issues are not before the Board for review. FINDING OF FACT The veteran's hemorrhoids are not large, thrombotic, or irreducible. CONCLUSION OF LAW The criteria for a compensable rating for hemorrhoids are not met. 38 U.S.C.A. § 1155, 5107 (West 1991); 38 C.F.R. § 4.114, Part 4, Code 7336 (1999) REASONS AND BASES FOR FINDING AND CONCLUSION A review of the veteran's service medical records show that he reported a four day history of rectal pain when he was treated in February 1991. A single non thrombosed hemorrhoid was shown. On initial rating in February 1992, service connection was denied for hemorrhoids as no post service manifestations were demonstrated. In a subsequent rating action, dated in August 1996, the RO found that post service treatment and examination had shown the presence of hemorrhoids. Accordingly, service connection was granted and a zero percent rating was assigned. Service connection continued to be denied for fissure in ano. The veteran now contends that a compensable rating is appropriate for the hemorrhoids. Initially, the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). By this finding, the Board means that the veteran has presented a claim which is not implausible when the contentions and the evidence of record are viewed in the light most favorable to the claim. The Board is also satisfied that all relevant facts have been properly and sufficiently developed. Under the laws administered by the VA, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). Separate diagnostic codes identify the various disabilities. Where entitlement to compensation has already been established and an increase in the disability evaluation is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The current zero percent rating is warranted when the hemorrhoids are mild or moderate. For a 10 percent rating to be appropriate, the hemorrhoids must be large or thrombotic, irreducible and with excessive redundant tissue, evidencing frequent recurrences. 38 C.F.R. § 4.114, Part 4, Code 7336 (1999) A review of the findings on examination and treatment do not demonstrate that the veteran's hemorrhoids are of sufficient severity to warrant a compensable rating. As noted, service connection is not in effect for fissure in ano, and therefore symptomatology resultant from such a disorder may not be considered in making determination as to the proper evaluation. The veteran complained of abdominal pain when he was treated at the Loma Linda University Surgery Medical Center in April 1992, but there was no evidence of external hemorrhoids. On follow-up treatment the next month, there was very small old evidence of thrombosed hemorrhoids. External hemorrhoids were present on a January 1995 VA treatment report, with pain limited to 9 o'clock. In a March 1995 service medical facility treatment note, external hemorrhoids were present, with minimal tenderness and no area of specific pain. He underwent a lateral internal sphincterotomy at a service medical facility in May 1995, for alleviation of an anal fissure. The veteran was furnished with a VA compensation examination in October 1996, at which time the history of the May 1995 operative procedure was given. He reported rectal bleeding, constipation and burning in the perianal area. He passed three stools a day with difficulty. On digital rectal examination at the inferior border of the anal verge there was an old hemorrhoid tissue tag. Tenderness was encountered in the superior portion of the anal verge on digital rectal examination. The remainder of the examination was normal, but somewhat limited by the veteran's discomfort. No rectal bleeding was present on examination. There was no incontinence, dehydration, malnutrition or anemia. The diagnosis was hemorrhoids. On follow-up flexible sigmoidoscopy in November 1996, no active hemorrhoids were shown. He complained on additional treatment in that his hemorrhoids swelled up anytime his stools were hard. Occasional rectal bleeding and some pain were reported during treatment at a VA facility in January 1998. Soft stools were present on treatment in February 1998, but the veteran gave a history of hard stools and constipation. These findings and history were consistent with testimony offered at the formal hearing in September 1997. He reported daily pain as a result of the hemorrhoids, with occasional swelling. (Transcript, hereinafter T 2, 3). He had to talk stool softeners and suppositories, and used Metamucil and a diet of fruit. (T 2-4). This evidence shows that the hemorrhoids were present on examination and treatment. However, there was only minimal tenderness and no area of specific pain on treatment in May 1995. He reported anal symptomatology when he was examined in October 1996, but only an old hemorrhoid tag was noted, not large or thrombotic hemorrhoids. The veteran has required rectal surgery, but this was required for alleviated of an anal fissure. As the Board has noted, since service connection is not in effect for this condition, the resultant symptomatology may not be considered in determining the proper rating for the service connected disability. Accordingly, as the hemorrhoids are not shown to be large, thrombotic or irreducible, a compensable rating is not warranted. To this extent, therefore, the veteran's appeal must be denied. In reaching the above decision, the Board has given due consideration to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board finds that these provisions do not support the grant of an increased rating for the disorder at question. ORDER An increased rating for hemorrhoids is denied. V. L. Jordan Member, Board of Veterans' Appeals