On this page
- Bowel incontinence VA rating criteria (DC 7332)
- Two ways to reach each level
- The other rectal and anal codes
- Rated alongside IBS, Crohn's disease or hemorrhoids
- How much VA pays for bowel incontinence
- How to prove bowel incontinence is service connected
- The C&P exam and the Rectum and Anus DBQ
- Why VA denies bowel incontinence claims
- Questions veterans ask about bowel incontinence
- What is the VA rating for bowel incontinence?
- Does wearing a pad raise my bowel incontinence rating?
- Can I be rated for bowel incontinence and IBS at the same time?
- Can bowel incontinence be secondary to a back condition?
- What is the VA rating for an anal fistula?
- Is bowel incontinence a presumptive condition?
- Sources
Bowel incontinence is rated under DC 7332, impairment of sphincter control, in the digestive part of the rating schedule. VA rewrote the code on May 19, 2024. Words like "occasional involuntary bowel movements, necessitating wearing of pad" are gone. Each level now counts how often you leak and need a pad, or measures how well a physician-prescribed bowel program works, and the levels run from 0 to 100 percent.
This page covers DC 7332 word for word, the other rectal and anal codes (stricture, prolapse, fistula and anal itching), why these codes can be rated alongside IBS or Crohn's disease, how to show service connection, and why claims fail. Hemorrhoids rate under DC 7336 in the same group and have their own page, hemorrhoids. The Board section further down shows how appeals for rectal and anal conditions, hemorrhoids included, have ended.
Bowel incontinence VA rating criteria (DC 7332)
38 CFR § 4.114 rates "rectum and anus, impairment of sphincter control" at five levels:
| Rating | DC 7332 |
|---|---|
| 100% | "Complete loss of sphincter control characterized by incontinence or retention that is not responsive to a physician-prescribed bowel program and requires either surgery or digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per day, which requires changing a pad two or more times per day" |
| 60% | "Complete or partial loss of sphincter control characterized by incontinence or retention that is partially responsive to a physician-prescribed bowel program and requires either surgery or digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per week, which requires wearing a pad two or more times per week" |
| 30% | "Complete or partial loss of sphincter control characterized by incontinence or retention that is fully responsive to a physician-prescribed bowel program and requires digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per month, which requires wearing a pad two or more times per month" |
| 10% | "Complete or partial loss of sphincter control characterized by incontinence or retention that is fully responsive to a physician-prescribed bowel program and requires medication or special diet; or incontinence to solids and/or liquids at least once every six months, which requires wearing a pad at least once every six months" |
| 0% | "History of loss of sphincter control, currently asymptomatic" |
A note follows the code: "Complete or partial loss of sphincter control refers to the inability to retain or expel stool at an appropriate time and place." DC 7332 covers both directions, stool you cannot hold and stool you cannot pass when you need to (retention).
Two ways to reach each level
Every level from 10 to 100 percent has two halves joined by the word "or." You need to meet only one of them.
The bowel program half. This half describes incontinence or retention and how it responds to "a physician-prescribed bowel program," in this order:
| Rating | Response to the bowel program | What the program requires |
|---|---|---|
| 100% | Not responsive | Either surgery or digital stimulation, medication (beyond laxative use), and special diet |
| 60% | Partially responsive | Either surgery or digital stimulation, medication (beyond laxative use), and special diet |
| 30% | Fully responsive | Digital stimulation, medication (beyond laxative use), and special diet |
| 10% | Fully responsive | Medication or special diet |
The pad half. This half counts episodes of "incontinence to solids and/or liquids" and the pads they require: at least once every six months, with a pad worn at least once every six months, for 10 percent; two or more times a month, with a pad worn as often, for 30; two or more times a week, with a pad worn as often, for 60; and two or more times a day, with a pad changed two or more times a day, for 100.
Wearing and changing are different. The 10, 30 and 60 percent levels say "wearing" a pad; the 100 percent level says "changing" one. In the 2024 final rule, VA explained that changing refers to "the need to change a pad due to an incontinence to gas, incontinence to liquid or incontinence to solid and the resulting soiling of the pad," while wearing refers to "a necessary or advisable measure to address the effects of incontinence, regardless of the frequency with which soiling occurs." In plain terms, the lower levels ask how often you have accidents and whether you need protection for them; the 100 percent level asks whether you soil and change pads at least twice a day.
Keep a log. A rater cannot see frequency in a single exam. A daily record of each accident (solid or liquid), each pad worn or changed, and each part of your bowel program speaks directly to the level. If your picture falls between rows, 38 CFR § 4.7 says the higher rating applies when the disability "more nearly approximates the criteria required for that rating."
Older decisions use older words. Before May 19, 2024, DC 7332 read "Occasional involuntary bowel movements, necessitating wearing of pad" for 30 percent, "Extensive leakage and fairly frequent involuntary bowel movements" for 60 and "Constant slight, or occasional moderate leakage" for 10. In the final rule, VA said the new criteria "replace subjective terminology such as 'extensive,' 'frequent,' 'occasional,' and 'slight' with measurable descriptive findings." If your claim covers time before that date, check which version the decision applied to which period.
The other rectal and anal codes
Four more codes in § 4.114 cover the rectum and anus, with the rating in the last column:
| Code | Schedule text | Rating |
|---|---|---|
| DC 7333, stricture of the rectum and anus | "Inability to open the anus with inability to expel solid feces" | 100% |
| DC 7333 | "Reduction of the lumen 50% or more, with pain and straining during defecation" | 60% |
| DC 7333 | "Reduction of the lumen by less than 50%, with straining during defecation" | 30% |
| DC 7333 | "Luminal narrowing with or without straining, managed by dietary intervention" | 10% |
| DC 7334, prolapse of the rectum | "Persistent irreducible prolapse, repairable or unrepairable" | 100% |
| DC 7334 | "Manually reducible prolapse that is not repairable and occurs at times other than bowel movements, exertion, or while performing the Valsalva maneuver" | 50% |
| DC 7334 | "Manually reducible prolapse that is not repairable and occurs only after bowel movements, exertion, or while performing the Valsalva maneuver" | 30% |
| DC 7334 | "Spontaneously reducible prolapse that is not repairable" | 10% |
| DC 7335, fistula in ano, including anorectal fistula and anorectal abscess | "More than two constant or near-constant fistulas with abscesses, drainage, and pain, which are refractory to medical and surgical treatment" | 60% |
| DC 7335 | "One or two simultaneous fistulas, with abscess, drainage, and pain" | 40% |
| DC 7335 | "Two or more simultaneous fistulas with drainage and pain, but without abscesses" | 20% |
| DC 7335 | "One fistula with drainage and pain, but without abscess" | 10% |
| DC 7337, pruritus ani (anal itching) | "With bleeding or excoriation" | 10% |
| DC 7337 | "Without bleeding or excoriation" | 0% |
The notes to these codes matter. Under DC 7333, "conditions rated under this code include dyssynergic defecation (levator ani) and anismus (functional constipation)," and an ostomy is rated as resection of the large intestine (DC 7329). Under DC 7334, a repairable prolapse keeps the 100 percent rating for two months after the repair, and VA then rates what remains after a mandatory exam; and "where impairment of sphincter control constitutes the predominant disability," VA rates the prolapse under DC 7332 instead.
Hemorrhoids rate 10 or 20 percent under DC 7336. The hemorrhoids page covers those criteria.
Rated alongside IBS, Crohn's disease or hemorrhoids
The digestive section opens with a one-rating rule (the first paragraph of 38 CFR § 4.114):
Do not combine ratings under diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive, with each other. Instead, when more than one rating is warranted under those diagnostic codes, assign a single evaluation under the diagnostic code that reflects the predominant disability picture, and elevate it to the next higher evaluation if warranted by the severity of the overall disability.
The rectal and anal codes, 7332 through 7337, are not on that list. Bowel incontinence can be rated separately from IBS (DC 7319) and from Crohn's disease or ulcerative colitis (both rated under DC 7326), and the rectal codes can be rated separately from each other, such as an anal fistula and hemorrhoids.
One limit still applies. 38 CFR § 4.14 bars "the evaluation of the same manifestation under different diagnoses." The 100 percent level for Crohn's disease, for example, counts "recurrent episodes of rectal incontinence" as one of its features. If the same incontinence was used to reach that rating, it cannot be rated again under DC 7332.
How much VA pays for bowel incontinence
At VA's rates effective December 1, 2025, a veteran alone receives $180.42 a month at 10 percent, $552.47 at 30 percent, $1,435.02 at 60 percent and $3,938.58 at 100 percent. The other codes on this page also use 20, 40 and 50 percent, which pay $356.66, $795.84 and $1,132.90. When you have other ratings, VA combines them rather than adding the money; the combined rating calculator shows the result. If service-connected conditions prevent substantially gainful employment, you may qualify for TDIU, which pays at the 100 percent rate.
Special monthly compensation is separate. For qualifying service-connected disabilities, 38 CFR § 3.350(e)(2) provides that paralysis of both legs "together with loss of anal and bladder sphincter control" entitles a veteran to the maximum rate under 38 U.S.C. 1114(o), and that requirement "is met even though incontinence has been overcome under a strict regimen of rehabilitation of bowel and bladder training and other auxiliary measures."
How to prove bowel incontinence is service connected
Every claim needs a current diagnosis, an in-service event or a service-connected cause, and a medical link. Make sure the record describes the symptom history and the condition causing it.
Tell a provider and get it written down
In a survey of 259 veterans waiting for gastroenterology and primary care appointments, 36 percent reported fecal incontinence, defined as losing liquid or solid stool at least monthly, yet few had ever been asked about it by a doctor (35 percent) or evaluated for it (18 percent) (Hosmer and colleagues, 2019). A rating needs a diagnosis in your records: impaired sphincter control, a sphincter injury, neurogenic bowel, a fistula, a stricture or a prolapse. If you have never told a provider, that is the first step.
Incontinence that began in service
An injury to the pelvis, rectum or perineum in service, anal surgery in service, or leakage noted at sick call supports a direct claim, together with a current diagnosis and an opinion linking the two. If the problem started in service but was never charted, statements from you and from people who knew about it, describing when it started, are competent evidence of what you experienced.
Secondary to a service-connected back, spine or nerve condition
The spine rating formula in 38 CFR § 4.71a ends with an instruction: "Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code." If a service-connected back condition affects bowel control, that impairment is rated on its own under DC 7332, in addition to the spine rating. The traumatic brain injury code (DC 8045 in 38 CFR § 4.124a) likewise lists "neurogenic bowel" among the physical problems rated separately; see TBI.
Under 38 CFR § 3.310, the opinion should address both cause and aggravation: the incontinence is aggravated by the veteran's service-connected lumbar spine condition, meaning it would be less severe but for the lumbar spine condition. When aggravation is at issue, an opinion that skips it can be inadequate under El-Amin v. Shinseki, 26 Vet. App. 136 (2013).
Secondary to inflammatory bowel disease or IBS
A 2018 meta-analysis found fecal incontinence in 24 percent of people with inflammatory bowel disease across case-control studies, and it was more common than in people without IBD (odds ratio 7.73) (Gu and colleagues, 2018). That review excluded patients with an ileal pouch anal anastomosis, so its estimate should not be applied to every surgical history. If your Crohn's disease or ulcerative colitis is service connected, incontinence it causes can be claimed as secondary and rated under DC 7332, as long as the bowel disease rating does not already count it.
If IBS is service connected, an opinion can address whether it caused or aggravated the incontinence. The IBS code (DC 7319) does not describe incontinence, and its note tells VA to "evaluate other symptoms of a functional digestive disorder not encompassed by this diagnostic code under the appropriate diagnostic code," following § 4.14. A Gulf War veteran whose IBS is service connected under 38 CFR § 3.317 can claim incontinence secondary to it the same way.
Secondary to cancer treatment or surgery
Incontinence caused by treating a service-connected condition is secondary to that condition. A 2011 systematic review of 40 studies found fecal incontinence after radiation for prostate cancer in 1.6 to 58 percent of men, depending on the study, and described injury to rectal nerve networks as a possible mechanism, while noting that the mechanism was not entirely clear and the evidence had limitations (Maeda and colleagues, 2011). If your prostate cancer is service connected, bowel leakage after its radiation can be claimed under § 3.310.
The same reasoning covers surgery. Incontinence caused by an operation for a service-connected condition, such as surgery for service-connected hemorrhoids or an anal fistula, can be claimed as secondary. A symptom appearing after surgery still needs evidence linking it to that treatment. The operative report and the timing of your symptoms are the core evidence.
After care at a VA facility
If you lost bowel control after surgery or treatment at a VA facility, a claim under 38 U.S.C. 1151 may apply even without service connection. Under 38 CFR § 3.361, the VA care must have caused the additional disability, and the cause must be fault on VA's part, such as "carelessness, negligence, lack of proper skill, error in judgment," or care given without informed consent, or an event a reasonable health care provider would not have foreseen.
The C&P exam and the Rectum and Anus DBQ
VA examines these conditions with the Rectum and Anus DBQ. Before the exam:
- Bring your log. Accidents by date, solid or liquid, and pads worn or changed. The pad half of every level from 10 to 100 percent turns on these counts.
- Describe your bowel program. Who prescribed it, what it includes (digital stimulation, medicine beyond laxatives, a special diet, surgery), and whether it works fully, partly or not at all.
- Bring surgery records. Operative reports for fistula, prolapse or hemorrhoid surgery, and the results of any tests of the sphincter.
- List every condition. Incontinence, fistula, stricture, prolapse, anal itching and hemorrhoids each have their own code. Tell VA about each condition and ask that the relevant findings be addressed.
- Name the cause. If a back injury, Crohn's disease or cancer treatment caused the problem, say so, and ask the examiner to address it.
Raven Scan can help you review your uploaded medical records as you prepare for the exam.
Why VA denies bowel incontinence claims
The Board section below shows what the Board found missing in denied rectal and anal appeals and why it sent others back. These are the patterns behind those numbers.
No link to service. The medical link is the most common gap in denied appeals, with the in-service event and the current diagnosis close behind, so a claim needs all three. An examiner may tie incontinence to age or a later surgery. A favorable opinion has to engage with the injury, surgery or service-connected condition behind it, and with the timeline.
No in-service event. Leakage is easy to keep quiet in service. Statements from you and from people who knew about it, describing when it started, help fill the gap.
No current diagnosis. A provider's assessment helps establish the disability and the appropriate criteria. Under McClain v. Nicholson, 21 Vet. App. 319 (2007), a condition present at any time during the claim counts, so records from your worst periods matter.
The wrong half of the criteria. A rating built only on the bowel program half when your pad log meets a higher row, or the reverse, is worth appealing with the log and the prescriptions.
An inadequate exam. An inadequate VA exam is the most common reason the Board sends these claims back, with missing records close behind; the remand reasons below show how often.
Questions veterans ask about bowel incontinence
What is the VA rating for bowel incontinence?
Bowel incontinence rates 0, 10, 30, 60 or 100 percent under DC 7332. Accidents at least once every six months that need a pad rate 10 percent, two or more a month rate 30 percent, two or more a week rate 60 percent, and two or more a day with pad changes rate 100 percent. Each level can also be met by how well a physician-prescribed bowel program controls the problem.
Does wearing a pad raise my bowel incontinence rating?
Pads are part of every level from 10 to 60 percent, which pair a count of accidents with "wearing a pad" at the same frequency. The 100 percent level requires "changing a pad two or more times per day." VA has said wearing means a necessary or advisable measure, regardless of how often the pad is soiled.
Can I be rated for bowel incontinence and IBS at the same time?
Yes. DC 7332 is not on the digestive one-rating list, so it can be rated alongside IBS or Crohn's disease. The bar is § 4.14: the same symptom cannot be counted twice.
Can bowel incontinence be secondary to a back condition?
Yes. The spine rating formula tells VA to rate bowel impairment from a spine condition separately. You need a diagnosis and a medical opinion that the back condition caused or worsened the incontinence.
What is the VA rating for an anal fistula?
Anal fistulas rate under DC 7335: 10 percent for one fistula with drainage and pain, 20 percent for two or more at once without abscesses, 40 percent for one or two with an abscess, and 60 percent for more than two constant or near-constant fistulas with abscesses that resist medical and surgical treatment. Distinct incontinence caused by treatment may support a separate DC 7332 evaluation when the same symptoms are not counted twice.
Is bowel incontinence a presumptive condition?
Not by name. For a veteran with qualifying service, unexplained bowel symptoms may support an undiagnosed illness claim; § 3.317 lists "gastrointestinal signs or symptoms." Under 38 U.S.C. § 1117(a)(1), as amended by the PACT Act, a qualifying chronic disability may become manifest "to any degree at any time," so the older 10 percent threshold and December 31, 2026 manifestation deadline still printed in the regulation no longer govern eligibility. Incontinence caused by service-connected IBS can also be claimed as secondary.
Sources
- 38 CFR § 4.114, DCs 7319, 7326 and 7332 to 7337 (opens in a new tab), eCFR current through October 5, 2026, as amended at 89 FR 19743 (March 20, 2024), effective May 19, 2024; earlier DC 7332 text from the eCFR version in effect May 18, 2024
- VA final rule, Schedule for Rating Disabilities: The Digestive System, 89 FR 19735 (opens in a new tab), March 20, 2024
- 38 CFR § 4.71a, General Rating Formula for the spine, Note (1) (opens in a new tab)
- 38 CFR § 4.124a, DC 8045, residuals of traumatic brain injury (opens in a new tab)
- 38 CFR § 4.7, higher of two evaluations (opens in a new tab)
- 38 CFR § 4.14, avoiding pyramiding (opens in a new tab)
- 38 CFR § 3.310, secondary service connection (opens in a new tab)
- 38 CFR § 3.317, Persian Gulf veterans (opens in a new tab)
- 38 U.S.C. § 1117, Gulf War eligibility after PACT Act section 405 (opens in a new tab)
- 38 CFR § 3.350, special monthly compensation (opens in a new tab)
- 38 CFR § 3.361, benefits under 38 U.S.C. 1151 (opens in a new tab)
- El-Amin v. Shinseki, 26 Vet. App. 136 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007)
- Hosmer AE, Saini SD, Menees SB. Prevalence and severity of fecal incontinence in veterans. J Neurogastroenterol Motil. 2019;25(4):576-588. doi:10.5056/jnm17134 (opens in a new tab)
- Gu P, Kuenzig ME, Kaplan GG, Pimentel M, Rezaie A. Fecal incontinence in inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis. 2018;24(6):1280-1290. doi:10.1093/ibd/izx109 (opens in a new tab)
- Maeda Y, Høyer M, Lundby L, Norton C. Faecal incontinence following radiotherapy for prostate cancer: a systematic review. Radiother Oncol. 2011;98(2):145-153. doi:10.1016/j.radonc.2010.12.004 (opens in a new tab)
- VA disability compensation rates (opens in a new tab), effective December 1, 2025
- Rectum and Anus DBQ guide
- El-Amin, court opinion (opens in a new tab)
- McClain, court opinion (opens in a new tab)
- 38 CFR § 3.303, service connection (opens in a new tab)
- 38 CFR § 4.16, unemployability (opens in a new tab)