Citation Nr: 0002682 Decision Date: 02/03/00 Archive Date: 02/10/00 DOCKET NO. 98-02 970 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased rating for hemorrhoids, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD B.E. Jordan, Counsel INTRODUCTION The veteran had active military service from November 1974 to November 1977. This appeal to the Board of Veterans' Appeals (Board) arises from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In October 1998, the Board remanded this matter to the RO for further development. The Board is satisfied that the Remand directives have been met. FINDINGS OF FACT 1. All of the evidence necessary for an equitable disposition of this appeal has been obtained. 2. Service connected hemorrhoids are manifested by irritation of hemorrhoids, anal fissures, and complaints of bloody stools. 3. No unusual or exceptional disability factors have been presented with respect to the veteran's service connected hemorrhoids. CONCLUSION OF LAW The criteria for a disability evaluation of 20 percent for hemorrhoids have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.7, 4.114, Diagnostic Code 7336 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is plausible and thus well grounded within the meaning of 38 U.S.C.A. § 5107(a); see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (a claim of entitlement to an increased evaluation for a service-connected disability generally is a well-grounded claim). The Board is satisfied that all relevant evidence has been obtained with respect to this claim and that no further assistance to the veteran is required in order to comply with the duty to assist mandated by statute. In accordance with 38 C.F.R. §§ 4.1, 4.2 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the veteran's service medical records and all other evidence of record pertaining to the history of the veteran's service connected hemorrhoids and has found nothing in the historical record that would lead to a conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations that would warrant an exposition of the remote clinical histories and findings pertaining to the disability at issue. See Francisco v. Brown, 7 Vet. App. 55 (1994) (where an increase in a disability rating is at issue, the current level of disability is of primary concern). In a September 1980 rating action, the RO granted service connection for hemorrhoids. A noncompensable evaluation was assigned which became effective in May 1980. The record is silent for clinical findings or symptoms pertaining to hemorrhoids from 1982 to 1996. A private sigmoidoscopy dated in November 1996 revealed minimally inflamed internal hemorrhoids. In January 1997, the veteran filed a claim for an increased rating for hemorrhoids. At a VA compensation and pension examination dated in August 1997, the veteran related a history of positive bleeding, positive rectal itching, and positive pain in the anal area on a daily basis. The veteran denied having problems with constipation. No weight changes were noted within the past year. The veteran's weight at the time of the examination was 205 pounds. The veteran denied a history of anemia secondary to hemorrhoids. On physical examination, bowel sounds were positive times four. The abdomen was soft and nontender to palpation. There was no organomegaly and no external hemorrhoids. The veteran exhibited positive tenderness with digital examination. No stool was obtained, and no bright red bleeding was noted. The diagnoses included history of recurrent external hemorrhoids (not present with the examination), history of internal hemorrhoids, history of rectal bleeding, bright red in nature, and history of rectal pruritus and pain. Private medical records dated in 1998 provide clinical findings pertaining to the service-connected hemorrhoids. When examined in April 1998, the veteran denied experiencing any change in stool habits, blood in the stool, or black tarry stools. Findings were negative for rectal mass, and the stool was not guaiac. A May 1998 entry provides that the issues of primary concern were normocytic anemia and stools that had been guaiac positive. The diagnoses included anemia of unclear etiology. In August 1998, the veteran complained of fatigue. Blood work demonstrated an elevated white count with mild anemia. A colon examination showed one adenoma polyp and some extensive hemorrhoids. The assessment included neurophyllia anemia. The examiner noted that the hemorrhoids could be contributing to a little of the anemia. When examined by VA in February 1999, the veteran related a history of bleeding and pain. He indicated that the pain lasted up to 15 minutes following a bowel movement. There was no history of fecal leakage or involuntary bowel movements. The veteran noted bleeding with every bowel movement. At the time of the examination, the veteran was not being treated. On physical examination, there was no colotomy and no evidence of fecal leakage. The lumen of the rectum and anus measured as 1.5 centimeters. There were no signs of anemia. The veteran did not demonstrate any conjunctival pallor. There was a fissure at the 6 o'clock position. Internal hemorrhoids at approximately the 5 and 9 o'clock positions were noted. There was no irrigation of the hemorrhoids. No active bleeding was noted. There were no other palpable masses, and there was no stool present for guaiacing. A complete blood count was normal and a stool for occult blood was negative. The diagnoses were hemorrhoids and anal fissure. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.10 (1999). Hemorrhoids are evaluated under 38 C.F.R. § 4.114, Diagnostic Code (DC) 7336. Under that code, a 20 percent evaluation is assigned for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. A 10 percent evaluation is assigned for hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A noncompensable evaluation is assigned for mild or moderate hemorrhoids. The veteran contends, in essence, that the symptoms associated with his service-connected hemorrhoids are more disabling than currently evaluated. Although the veteran has consistently reported a history of bloody stools, there is no medical evidence of excessive bleeding. The Board recognizes that an examiner in 1998 felt that the veteran was anemic and that his service-connected hemorrhoid disability could be a contributing factor to the anemia. The Board notes that the examiner did not draw a definite link between anemia and the hemorrhoids. Moreover, the 1999 findings of a normal complete blood count and a lack of signs of anemia refute the 1998 findings. The veteran has been diagnosed as having anal fissures; however, it is questionable as to the extent of bleeding that the veteran experiences. According the veteran the benefit of doubt, the Board finds that the assignment of a 20 percent disability evaluation is warranted in this matter. 38 U.S.C.A. § 5107(b); see 38 C.F.R. § 3.102. The Board notes that the veteran has been awarded the maximum evaluation provided under DC 7336. The evidence of record does not present such an exceptional or unusual disability picture as to render impractical the application of the regular scheduler standards and thus warrant assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1). The veteran has not asserted or offered any objective evidence that his hemorrhoids have interfered with his employment status to a degree greater than that contemplated by the regular schedular standards, which are based on the average impairment of employment. Nor does the record reflect frequent periods of hospitalization for the disability. Hence, the record does not present an exceptional case where his currently assigned 20 percent evaluation is found to be inadequate. See Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). Accordingly, in the absence of such factors, the Board determines that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met, and; therefore, affirms the RO's conclusion that a higher evaluation on an extraschedular basis is not warranted. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Floyd v. Brown, 9 Vet. App. 88, 94-95 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER A 20 percent evaluation for hemorrhoids is granted, subject to the criteria applicable to the payment of monetary benefits F. JUDGE FLOWERS Member, Board of Veterans' Appeals