DC 7334 · 38 CFR 4.114
Rectum and Anus (Hemorrhoids / Fissures) C&P Exam Prep
To document the current severity of anorectal conditions including hemorrhoids (internal/external), rectal prolapse, anal fissures, fistulas, strictures, and related conditions for VA disability rating purposes under 38 CFR 4.114.
- Format:
- Interview + Physical
- Typical duration:
- 15-30 minutes
- DBQ form:
- rectum-and-anus (rectum-and-anus)
- Examiner:
- Gastroenterologist or Physician
What the examiner evaluates
- Type and location of hemorrhoids (internal vs. external)
- Presence and frequency of bleeding or anemia
- Number of thrombosis episodes per year
- Degree of rectal prolapse (spontaneously reducible, manually reducible, or persistent/irreducible)
- Impairment of sphincter control
- Presence of abscess, drainage, or fistula
- Presence of anal stricture or luminal narrowing
- Pain during or outside of defecation
- Straining during defecation
- Functional impact on daily activities and work
- Current treatment regimen and response
- Recent laboratory values (hemoglobin, hematocrit, CBC)
Exam will include both an interview and a physical examination. A rectal examination is standard and expected. You may request a same-sex examiner. The exam may occur at a VA facility, a contracted exam site (e.g., LHI, VES, Optum), or via telehealth for records review only. Ask in advance if a physical exam is required.
Measurements and tests
Rectal/Anal Physical Examination
What it measures: Presence, type, and severity of hemorrhoids, fissures, prolapse, fistulas, strictures, and sphincter tone
What to expect: The examiner will perform a visual inspection of the perianal area and may perform a digital rectal exam. You will likely be asked to strain or bear down to assess for prolapse. This may cause discomfort, especially on your worst days.
Critical thresholds
- Persistent/irreducible prolapse Supports higher rating under DC 7334
- Spontaneously reducible prolapse Supports moderate rating under DC 7334
- Manually reducible prolapse Supports moderate rating under DC 7334
- External hemorrhoids with 3+ thrombosis episodes/year 10% under DC 7336
- Internal hemorrhoids with persistent bleeding and anemia 20% under DC 7336
- Continuously prolapsed internal hemorrhoids with 3+ thrombosis episodes/year 20% under DC 7336
Tips
- Do not use enemas or suppositories immediately before the exam if they would mask your typical symptom level
- Schedule the exam when you are experiencing active symptoms if possible
- Accurately describe any pain, bleeding, or prolapse you experience during the exam itself
- If the exam is being conducted on a relatively good day, clearly state that your symptoms are worse on typical or bad days
Pain considerations: Pain during defecation, straining, sitting, and physical activity should all be reported. Note whether pain causes you to avoid bowel movements, leading to constipation, and describe the pain character (sharp, burning, aching), severity (0-10 scale), and duration.
Laboratory Studies (CBC, Hemoglobin, Hematocrit)
What it measures: Anemia secondary to persistent rectal bleeding
What to expect: The examiner will review any available lab work. If anemia is present or suspected, labs will be documented on the DBQ. Bring copies of any recent CBC results, especially those showing low hemoglobin or hematocrit.
Critical thresholds
- Low hemoglobin (below normal range) Documents anemia, supports 20% rating for hemorrhoids with persistent bleeding and anemia under DC 7336
- Normal hemoglobin/hematocrit Does not preclude rating but reduces support for anemia-based criteria
Tips
- Bring lab results from the past 12 months if available
- If you have been treated for iron-deficiency anemia, bring those records
- Note if your primary care provider has commented on bleeding-related anemia in your medical record
Pain considerations: N/A - laboratory test, but fatigue and weakness from anemia should be separately reported as functional symptoms.
Colonoscopy or Anoscopy Records Review
What it measures: Objective documentation of hemorrhoid grade, fissure depth, stricture, fistula, or neoplasm
What to expect: The examiner will review any available procedural reports. Bring copies of any colonoscopy, sigmoidoscopy, or anoscopy reports you have.
Critical thresholds
- Grade III-IV internal hemorrhoids documented Supports prolapse-related criteria and higher severity ratings
- Documented fissure with fibrosis or stricture Supports stricture or fissure-related rating criteria
Tips
- Request copies of procedural reports from your gastroenterologist before the exam
- Note the date and findings of your most recent procedure
- If procedures documented prolapse, drainage, abscess, or fistula, highlight these findings
Pain considerations: Procedural pain and post-procedural pain should be reported to the examiner as part of your treatment history.
Rating criteria by percentage
100%
Complete loss of sphincter control under DC 7332 (if sphincter impairment is the predominant disability); or complete obstruction of the rectum. Note: DC 7334 (rectal prolapse) can reach 100% for complete obstruction. If sphincter control impairment predominates, the case is rated under DC 7332.
Key symptoms
- Complete fecal incontinence
- Inability to control bowel movements at any time
- Constant fecal soiling requiring protective pads
- Total loss of sphincter tone on examination
- Significant impact on all activities of daily living
From 38 CFR: Under DC 7334, the highest levels apply to complete or near-complete obstruction or persistent irreducible prolapse with severe functional impairment. If sphincter control loss predominates, DC 7332 applies.
50%
Under DC 7334: Rectal prolapse with persistent irreducible prolapse or significant functional impairment. Evaluate the degree of prolapse and functional limitations carefully.
Key symptoms
- Persistent irreducible rectal prolapse
- Significant difficulty with defecation
- Chronic pain and pressure
- Inability to perform normal daily activities
- Ongoing drainage or bleeding from prolapsed tissue
From 38 CFR: DC 7334 provides ratings of 100, 50, 30, and 10 percent based on severity of prolapse and associated functional impairment. The 50% level reflects significant but not complete obstruction or prolapse.
30%
Under DC 7334: Rectal prolapse that is manually reducible with significant symptoms. Under DC 7336: Hemorrhoids with intermediate severity between 10% and 20% criteria. Consider also fistula, abscess, or stricture complications.
Key symptoms
- Manually reducible rectal prolapse
- Recurrent episodes requiring manual reduction
- Significant discomfort and functional limitation
- Associated bleeding or drainage
- Partial luminal narrowing
From 38 CFR: DC 7334 at 30% reflects manually reducible prolapse with notable functional impact. Associated drainage, abscess, or fistula may support additional ratings under separate codes.
20%
Under DC 7336: Internal or external hemorrhoids with persistent bleeding AND anemia (documented by lab values); OR continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.
Key symptoms
- Persistent rectal bleeding requiring medical management
- Documented anemia (low hemoglobin/hematocrit) from bleeding
- Three or more thrombosis episodes per year
- Continuously prolapsed internal hemorrhoids
- Fatigue and weakness from blood loss
- Need for ongoing medical treatment
From 38 CFR: 38 CFR 4.114, DC 7336: 'Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis - 20%'
10%
Under DC 7336: Prolapsed internal hemorrhoids with two or fewer episodes per year of thrombosis; OR external hemorrhoids with three or more episodes per year of thrombosis. Under DC 7334: Minimal rectal prolapse (spontaneously reducible) with limited functional impairment.
Key symptoms
- Two or fewer thrombosis episodes per year with internal hemorrhoid prolapse
- External hemorrhoids with three or more thrombosis episodes per year
- Spontaneously reducible rectal prolapse
- Mild to moderate pain and discomfort
- Occasional bleeding without anemia
- Discomfort with prolonged sitting or defecation
From 38 CFR: 38 CFR 4.114, DC 7336: 'Prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis - 10%'
Describing your symptoms accurately
Bleeding and Anemia
How to describe it: Describe the frequency, volume, and duration of rectal bleeding. State whether it is present with every bowel movement or intermittently. Note if your doctor has treated you for anemia or if you have been told your blood counts are low. Quantify: how many days per week do you bleed? How long has this been occurring?
Example: On my worst days, I have bright red blood in the toilet and on the tissue with every bowel movement. My gastroenterologist told me my hemoglobin was low and started me on iron supplements three months ago. I bleed approximately five days out of seven in a typical week and have been doing so for the past eight months.
Examiner listens for: Frequency and duration of bleeding, documented anemia on labs, connection between bleeding and current anemia, whether bleeding is persistent (not just occasional), and whether the veteran is receiving treatment for blood loss.
Avoid: Do not say 'just a little blood sometimes' if you bleed regularly. Use specific numbers: how many times per week, how many months this has been going on, and whether your doctor has addressed it.
Thrombosis Episodes
How to describe it: Clearly state the number of distinct thrombosis episodes you have experienced in the past 12 months. A thrombosis episode is a discrete event where a blood clot forms in a hemorrhoid, causing acute severe pain and swelling. Count each separate event. Note whether you sought medical treatment for each episode.
Example: Over the past year I have had four separate episodes of thrombosed hemorrhoids. Each time, the hemorrhoid became acutely swollen, extremely painful, and I could not sit for two to four days. The most recent episode was six weeks ago and required an emergency visit and incision and drainage.
Examiner listens for: Exact number of discrete thrombosis events in the past 12 months, severity of each episode, treatment received, and how each episode impacted daily function.
Avoid: Do not round down or estimate vaguely. Saying 'a few times' is less effective than saying 'three confirmed episodes this year.' The threshold for rating purposes is precisely three or more per year for external hemorrhoids at 10% and for internal continuously prolapsed at 20%.
Prolapse
How to describe it: Describe whether rectal or internal hemorrhoidal tissue protrudes outside the anus, whether it returns on its own, requires manual reduction, or stays out permanently. Note how often prolapse occurs, what triggers it (straining, lifting, prolonged standing), and the functional limitations it causes.
Example: My internal hemorrhoids prolapse with virtually every bowel movement and sometimes when I am standing for more than 20 minutes. About half the time they go back in on their own within a few minutes, but at least twice a week I have to manually push the tissue back inside. On my worst days the tissue stays out for hours and I cannot sit comfortably at all.
Examiner listens for: Whether prolapse is spontaneous, manually reducible, or persistent/irreducible; frequency of prolapse; triggers; functional limitations; and whether the veteran has sought treatment for prolapse.
Avoid: Do not omit that you have to manually reduce the tissue. Do not describe prolapse as just 'discomfort.' The examiner needs to understand the mechanics: tissue coming out, whether it goes back in, and how it affects your life.
Pain During and After Defecation
How to describe it: Describe the pain character (sharp, burning, tearing, aching), severity on a 0-10 scale, onset (during defecation, immediately after, or lasting for hours), and any behaviors you have developed to cope (avoiding bowel movements, using stool softeners, dietary changes, extended time in the bathroom).
Example: On my worst days the pain during a bowel movement is a 9 out of 10, sharp and tearing, and lasts for two to three hours afterward. The pain is bad enough that I sometimes delay going to the bathroom, which makes constipation worse. After a bowel movement I often have to lie down for 30 to 45 minutes because of the pain.
Examiner listens for: Pain severity, duration, and functional impact. Whether pain causes avoidance behavior leading to constipation. Whether pain limits sitting, driving, working, or other activities.
Avoid: Do not say 'some pain' without quantifying it. Do not omit that pain persists for hours after defecation. Do not forget to mention if pain affects your ability to work, sit at a desk, drive, or perform other daily activities.
Drainage, Fistula, and Abscess
How to describe it: If you have an anorectal fistula, abscess, or ongoing drainage, describe the frequency of drainage, whether it is constant or intermittent, how long it has been present, and whether you require bandaging, pads, or wound care. Note any recent abscess requiring incision and drainage.
Example: I have had three perianal abscesses in the past two years, each requiring surgical drainage. I currently have ongoing drainage from a fistula tract that requires me to wear a pad in my underwear daily. The drainage is present at least four or five days per week.
Examiner listens for: Whether drainage is continuous or intermittent, duration in months, need for protective garments, and whether abscesses are recurrent. These findings support separate ratings under fistula codes if applicable.
Avoid: Do not downplay drainage as 'just a little.' Describe it specifically - how many days per week, whether you need pads, and how long this has been ongoing.
Sphincter Control and Fecal Incontinence
How to describe it: If you experience any involuntary leakage of stool or gas, describe frequency, severity, and impact on your daily life. Note whether you require protective undergarments, have had embarrassing accidents, or have limited social or work activities due to fear of incontinence. This symptom may result in rating under DC 7332 rather than 7334 or 7336 if it is the predominant disability.
Example: On my worst days I have involuntary leakage of liquid stool without warning approximately three to four times per week. I wear absorbent pads daily and have stopped going to social events or long trips because I cannot predict when I will have an accident.
Examiner listens for: Frequency and degree of incontinence, whether it is solid or liquid, whether protective garments are used, and the functional impact on social and occupational activities. The examiner will also assess sphincter tone on physical exam.
Avoid: Do not minimize incontinence as 'occasional accidents.' If you use pads or have significantly altered your lifestyle, say so explicitly.
Functional Impact on Work and Daily Activities
How to describe it: Describe in specific terms how your condition limits your ability to work, sit for extended periods, lift, drive, travel, perform household tasks, or participate in social activities. Connect each limitation to a specific symptom (bleeding, pain, prolapse, drainage, incontinence).
Example: My anorectal condition prevents me from sitting for more than 20 minutes at a time, which makes my desk job extremely difficult. I have missed approximately 12 work days in the past year due to acute thrombosis episodes or post-surgical recovery. I cannot go on long trips or attend events without planning bathroom access in advance.
Examiner listens for: Specific work and activity limitations, missed work days, adaptations made to manage symptoms, and how the condition has changed the veteran's daily life compared to before onset.
Avoid: Do not say 'it bothers me' without translating that into specific functional limitations. Quantify missed work days, specific activities you can no longer perform, and any accommodations you have requested.
Common mistakes to avoid
Not counting thrombosis episodes precisely
Why: The VA rating criteria for hemorrhoids under DC 7336 are specifically tied to the number of thrombosis episodes per year (fewer than 3 vs. 3 or more). Vague answers like 'several times' do not trigger the correct rating level.
Do this instead: Before your exam, review your medical records or calendar and count the exact number of distinct thrombosis episodes in the past 12 months. Prepare to state a specific number to the examiner.
Impact: 10% vs. 20% under DC 7336
Failing to connect bleeding to documented anemia
Why: The 20% rating under DC 7336 requires BOTH persistent bleeding AND anemia. If you have had lab work showing low hemoglobin or hematocrit, the examiner needs to know it was caused by rectal bleeding. If you do not connect the two, the examiner may not check the anemia box on the DBQ.
Do this instead: Bring lab results and state explicitly: 'My gastroenterologist/primary care doctor told me my anemia is from rectal bleeding.' Ensure your medical records document this connection.
Impact: 10% vs. 20% under DC 7336
Describing symptoms only as they are on exam day rather than on typical or worst days
Why: C&P examiners document what they observe and what you report. If you are having a relatively good day and do not volunteer that your symptoms are significantly worse on other days, the examiner may document a milder presentation.
Do this instead: Per M21-1 guidance, you are entitled to have your worst days considered. Explicitly state: 'Today is a relatively mild day for me. On my worst days, which occur [X times per week/month], my symptoms include [specific symptoms].'
Impact: All rating levels
Not mentioning prolapse type accurately
Why: Whether prolapse is spontaneously reducible, manually reducible, or persistent and irreducible directly determines the rating percentage under DC 7334. Many veterans do not know the medical terminology and may not accurately describe whether they push tissue back in manually.
Do this instead: Before the exam, determine which type applies to you. If you have to use your hand to push tissue back inside your anus after a bowel movement, that is manually reducible prolapse. If it stays out on its own, that is persistent/irreducible. Use these exact terms.
Impact: 10% vs. 30% vs. 50-100% under DC 7334
Omitting drainage, fistula, or abscess history
Why: Anorectal abscesses, fistulas, and chronic drainage may support separate or higher ratings under DC 7332 or DC 7330. Veterans often focus only on hemorrhoids and forget to mention recurrent abscesses or fistula tracts.
Do this instead: Mention all anorectal conditions including any history of abscess requiring drainage, fistula tracts, or ongoing drainage requiring protective garments. These are separately documented on the DBQ.
Impact: Separate ratings under DC 7330 or 7332
Not mentioning sphincter control issues
Why: If fecal incontinence or significant sphincter impairment is present, the predominant disability may warrant rating under DC 7332 (impairment of sphincter control), which can yield a higher combined rating. Veterans who focus only on hemorrhoids may not receive the most advantageous rating.
Do this instead: Report any involuntary stool or gas leakage, urgency, or inability to control bowel movements. The examiner is required under Note 2 of DC 7334 to consider whether DC 7332 is more appropriate.
Impact: Higher ratings possible under DC 7332
Not bringing treatment records or medication list
Why: The DBQ has specific fields for treatments including medications, surgery, dietary interventions, and other procedures. If you do not mention your treatments, the examiner may not document them, weakening evidence of severity.
Do this instead: Bring a printed list of all medications used for your anorectal condition (stool softeners, topical treatments, pain medications, iron supplements), dates of any surgeries or procedures, and names of treating providers.
Impact: All rating levels - treatment burden supports severity
Prep checklist
- critical
Gather all medical records related to your anorectal condition
Collect records from gastroenterologists, colorectal surgeons, primary care providers, and urgent care visits. Include colonoscopy, sigmoidoscopy, or anoscopy reports, operative reports from hemorrhoidectomy or abscess drainage, and any records documenting anemia diagnosis.
before exam
- critical
Obtain and review recent lab results (CBC, hemoglobin, hematocrit)
If you have had bleeding-related anemia, obtain copies of CBC results from the past 12 months showing hemoglobin and hematocrit values. These are specifically referenced on the DBQ form and support the 20% rating under DC 7336.
before exam
- critical
Count and document thrombosis episodes in the past 12 months
Review your calendar, medical visit records, or pharmacy records to identify and count distinct thrombosis episodes. Each episode where a hemorrhoid became acutely painful and swollen from clotting is a separate episode. Write down the approximate dates.
before exam
- critical
Prepare a written symptom summary in your own words
Write a one to two page summary describing: type of hemorrhoids (internal/external), frequency and severity of bleeding, number of thrombosis episodes this year, whether prolapse occurs and what type, any fistula or abscess history, incontinence symptoms, pain severity and functional impact, and all treatments received. Bring this to the exam.
before exam
- recommended
Create a complete medication and treatment list
List all medications used for your anorectal condition including prescription topical creams, suppositories, stool softeners, fiber supplements, iron supplements, pain medications, and any medications used to manage related anemia. Include dosage and prescribing provider.
before exam
- recommended
Document functional limitations with specific examples
Write down specific ways your condition affects your work and daily life: how long you can sit without pain, how many work days you have missed, activities you have stopped due to symptoms, any accommodations requested at work, and whether you use protective pads.
before exam
- recommended
Review the rating criteria for DC 7334 and DC 7336
Understand that DC 7336 rates hemorrhoids at 10% or 20% based on thrombosis frequency, persistent bleeding, and anemia. DC 7334 rates rectal prolapse from 10% to 100% based on type of prolapse. Knowing which criteria apply to your situation helps you accurately communicate your condition.
before exam
- optional
Request same-sex examiner if desired
You have the right to request a same-sex examiner for this examination. Contact the scheduling contractor or VA exam coordinator before your appointment to make this request.
before exam
- optional
Check your state's recording laws and consider recording the exam
Veterans have the right to record their C&P examination in most states (check your specific state law on one-party vs. two-party consent). Inform the examiner before recording begins. Recording creates a record if you need to challenge exam findings.
before exam
- critical
Do not use enemas or suppositories before the exam if they would reduce visible symptoms
Unless medically necessary, avoid treatments immediately before the exam that would temporarily resolve symptoms the examiner needs to observe and document. If you typically have active symptoms, allow them to be present so the examiner can accurately assess your condition.
day of
- critical
Arrive with your symptom summary and all supporting documents
Bring printed copies of your symptom summary, medication list, lab results, operative reports, and other medical records. The examiner has limited time to review records, so having organized documents helps ensure nothing is missed.
day of
- recommended
Eat and hydrate normally before the exam unless instructed otherwise
Unless the exam request specifically asks you to fast or prepare differently, eat and hydrate normally. Do not take measures that would make your condition appear better or worse than its true average state.
day of
- recommended
Wear comfortable clothing for the physical examination
You will likely need to undress for a rectal examination. Wear comfortable clothing that is easy to remove. If you use protective pads, you may choose to note this to the examiner as evidence of symptom severity.
day of
- critical
Clearly state that today may not represent your worst days
If you are having a relatively mild day, say this explicitly at the start of the exam: 'Today is not typical. On my worst days, which occur approximately [X] times per week, my symptoms include [list symptoms].' The examiner should document your symptom range, not just exam-day findings.
during exam
- critical
State the exact number of thrombosis episodes in the past 12 months
When asked about your hemorrhoid symptoms, provide the specific count: 'I have had [X] distinct thrombosis episodes in the past 12 months. The most recent was on [approximate date].' Be prepared to describe each episode briefly.
during exam
- critical
Describe prolapse type using accurate terminology
If you have rectal prolapse or internal hemorrhoid prolapse, tell the examiner whether: (1) tissue returns on its own (spontaneously reducible), (2) you have to push it back in with your hand (manually reducible), or (3) it stays out permanently (persistent/irreducible). These terms directly correspond to rating criteria.
during exam
- critical
Report all symptoms including those you consider minor
Mention pain during defecation, straining, anal itching (pruritus ani), drainage, mucus discharge, incontinence of gas or stool, and any urgency. Do not filter out symptoms you think are unimportant - each may be documented on the DBQ and affect the rating.
during exam
- recommended
Report functional impact on work and daily activities in specific terms
Tell the examiner exactly how your condition affects your ability to work, sit, stand, travel, exercise, and perform household activities. Use specific examples: 'I can only sit for 20 minutes before pain forces me to stand,' or 'I missed 12 work days last year due to this condition.'
during exam
- optional
Ask the examiner what findings were documented if appropriate
At the end of the exam, you may politely ask the examiner to confirm what diagnoses were documented and what symptoms were recorded. This is your opportunity to add anything that was not covered.
during exam
- recommended
Request a copy of the completed DBQ
Once the DBQ is completed, it becomes part of your VA claim file. You can request a copy through the FOIA office, your VSO, or through eBenefits/VA.gov. Review it for accuracy.
after exam
- recommended
Document your own recollection of the exam immediately afterward
As soon as the exam ends, write down what questions were asked, what you answered, what the examiner observed, and approximately how long the exam lasted. This is useful if you need to appeal or request a new exam.
after exam
- recommended
Submit a Buddy Statement or personal statement if the exam was inadequate
If you believe the examiner did not document your full symptom severity, was dismissive, or the exam was very short (under 10 minutes), submit a personal statement (VA Form 21-4138) or a lay statement from someone who witnesses your symptoms detailing what the exam failed to capture.
after exam
- optional
Follow up with your treating providers if additional documentation is needed
If your treating gastroenterologist or colorectal surgeon can document severity, thrombosis episodes, bleeding history, or anemia, request a letter or note in support of your claim. Nexus letters and treatment notes from specialists carry significant weight.
after exam
Your rights during a C&P exam
- You have the right to be treated with dignity and respect during your C&P examination.
- You have the right to request a same-sex examiner for this type of intimate examination.
- You have the right to record your C&P examination in most states - check your state's consent laws (one-party vs. two-party consent) and notify the examiner before recording.
- You have the right to submit additional evidence (medical records, buddy statements, nexus letters) before and after your examination.
- You have the right to request a new or additional examination if you believe the original exam was inadequate, incomplete, or not supported by the evidence of record.
- You have the right to submit a personal statement (VA Form 21-4138) describing your symptoms and their functional impact at any point in the claims process.
- You have the right to have your claim evaluated under the most favorable diagnostic code - the VA is obligated to assign the code that results in the highest rating for your disability.
- You have the right to have your symptoms evaluated across their full range of severity, including your worst days, not just how you present on the day of the exam.
- You have the right to a fully reasoned rating decision explaining why a particular rating was assigned and which diagnostic criteria were applied.
- You have the right to appeal any rating decision through the Supplemental Claim, Higher-Level Review, or Board of Veterans Appeals processes.
- If sphincter control impairment is your predominant disability, the VA is required to consider rating under DC 7332 rather than DC 7334, which may result in a more favorable outcome - you have the right to ensure the correct diagnostic code is applied.
Related conditions
- Rectum and Anus, Impairment of Sphincter Control If fecal incontinence or sphincter control loss is the predominant disability, the VA must rate under DC 7332 instead of DC 7334 per regulatory Note 2. This may result in a higher combined rating.
- Intestinal Fistulous Disease, External Anorectal or perianal fistulas that develop as a consequence of trauma, surgery, radiation, malignancy, infection, or ischemia may be separately rated under DC 7330. Veterans with both hemorrhoids and a fistula should ensure each condition is separately evaluated.
- Hemorrhoids, External or Internal DC 7336 is the primary rating code for hemorrhoids when rectal prolapse is not the predominant feature. It rates at 10% or 20% based on thrombosis frequency and presence of persistent bleeding with anemia.
- Anorectal/Perianal Abscess Recurrent perianal abscesses are documented on the hemorrhoids DBQ and may support higher ratings or secondary conditions. Chronic abscess formation is often associated with fistulous disease rated under DC 7330.
- Anemia (Secondary to Rectal Bleeding) Anemia resulting from persistent hemorrhoidal bleeding is a key criterion for the 20% rating under DC 7336. If anemia is severe enough to warrant its own rating, it may be separately evaluated as a secondary condition.
- Irritable Bowel Syndrome / Functional Constipation Chronic constipation and straining are both a cause and consequence of hemorrhoids and anal fissures. Anismus (dyssynergic defecation) and functional constipation are listed on this DBQ as separately ratable conditions that may co-exist with hemorrhoids.
- Pruritus Ani (Anal Itching) Chronic anal itching secondary to hemorrhoids, fissures, or drainage is documented on the DBQ and may represent a secondary symptom that contributes to the overall functional picture documented by the examiner.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.