Hemorrhoids

Hemorrhoids occupy an unusual corner of the VA framework. They're medically common, they're frequently documented during service (the close quarters, deployment diet, sustained sitting, and physical stress of military life can all aggravate hemorrhoid pathology), and they're routinely claimed. They're also stuck at a 20 percent schedular maximum that almost no one clears.

In our analysis of 618 BVA hemorrhoid cases, the grant rate is 22.3 percent. The denial rate is 71.0 percent. The remand rate is unusually low at 6.6 percent. That denial-heavy distribution isn't because hemorrhoids aren't real. It's because the rating ladder under DC 7336 is built so that most documented hemorrhoid conditions don't clear the threshold for even a 10 percent rating.

The "severity insufficient" denial pattern dominates this dataset more than almost any other condition we track. 248 of 439 denied cases (56 percent) fail at the rating analysis. The Board often grants service connection, accepts the diagnosis, and then declines to assign any rating above 0 percent because the symptoms don't meet the schedular criteria.

This page covers DC 7336's three-tier ladder, the in-service event documentation that decides direct service connection, the secondary chains through other GI conditions, and what wins hemorrhoid claims at the Board.

TL;DR

• 618 hemorrhoid cases in our BVA dataset. Outcomes: 22.3% granted, 71.0% denied, 6.6% remanded. The denial rate is among the highest of any condition we track.
• Hemorrhoids are rated under 38 CFR § 4.114 DC 7336 with three tiers: 0%, 10%, and 20%. There is no higher schedular tier.
• The criteria changed on 2024-05-19 (89 FR 19735). The current 10 percent tier is prolapsed internal hemorrhoids with two or fewer thrombosis episodes per year, or external hemorrhoids with three or more. The current 20 percent tier is persistent bleeding with anemia, or continuously prolapsed internal hemorrhoids with three or more thrombosis episodes per year.
• The 0 percent tier no longer exists, and "fissures" was removed from the 20 percent criteria. Both the old "mild or moderate, 0" rung and the fissure route are gone.
• "Severity insufficient" accounted for 248 of 439 classified denials, 56 percent, under the old criteria, where the 10 percent tier required four qualitative elements at once. The current episode-count standard is easier to document, so that denial share should be expected to fall.
• Direct service connection grants at 32.6% (365 cases). Secondary at 51.6% (31 cases). Aggravation at 50.0% (6 cases). Presumptive lanes don't meaningfully apply.
• Strong nexus opinions grant at 91.7%. Weak and missing grant at 0%.
• The modal rating among granted cases is 20 percent (34 cases) and 10 percent (21 cases), but those cases were decided under the old ladder where most claims rated 0 percent and only severe presentations cleared any threshold. Do not read that distribution as a forecast under the current rule.
• The secondary lane is the highest-grant connection type at 51.6 percent because hemorrhoids secondary to constipation from service-connected IBS, chronic pain medications, or other GI conditions have a clean nexus path.

DC 7336 Is Now a Two-Tier Ladder

Hemorrhoids are rated under DC 7336 in the digestive system chapter at 38 CFR § 4.114. VA rewrote that chapter in a final rule published March 20, 2024 (89 FR 19735), effective May 19, 2024, and DC 7336 was one of the codes that changed substantially. Here is the current ladder in full:

Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis, 20%

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%

That is the entire ladder. Two tiers, not three. The 20 percent tier is still the schedular maximum.

Three things changed, and two of them favor veterans.

The 0 percent tier is gone. The old schedule had a "mild or moderate, 0" rung, and it was where most hemorrhoid claims landed. That rung no longer exists. A veteran who meets the current 10 percent criteria rates at 10 percent.

"Fissures" is gone from the 20 percent tier. The old 20 percent read "with persistent bleeding and with secondary anemia, or with fissures." Anal fissures no longer appear anywhere in DC 7336. If you were counting on a documented fissure to reach 20 percent, that route is closed. In its place is a second, arguably easier route: continuously prolapsed internal hemorrhoids with three or more thrombosis episodes in a year.

The vague adjectives were replaced with counts. The old 10 percent tier required hemorrhoids that were "large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences," four qualitative elements that a treatment note rarely recites in full. The current tiers turn on prolapse status and a countable number of thrombosis episodes per year. That is a materially easier standard to prove with ordinary records.

The current structure splits on two axes: whether the hemorrhoids are internal and prolapsed or external, and how many thrombosis episodes occurred in the year.

Two practical consequences follow. First, the episode count is now the number to document. Each thrombosed hemorrhoid should appear in the record with a date. Three dated episodes in twelve months is the difference between 10 and 20 percent for a veteran with continuously prolapsed internal hemorrhoids. Second, anemia is still the cleanest route to 20 percent, and it is still uncommon, because hemorrhoidal bleeding is usually low-volume. But a complete blood count during a period of persistent bleeding costs nothing to obtain and is the single highest-value lab on this claim.

The historical rating distribution on this page describes the old ladder. The modal granted rating of 20 percent in our dataset reflects a schedule where most claims rated 0 percent and only severe presentations cleared any threshold at all. With the 0 percent rung removed and the qualitative 10 percent language replaced by episode counts, that distribution should be expected to shift. How far, nobody can say yet, because the decided cases predate the change.

The In-Service Event Question

Hemorrhoids develop from increased venous pressure in the rectal area: straining during bowel movements, prolonged sitting, heavy lifting, pregnancy, obesity, and constipation are all risk factors. Many of these factors are present during military service, particularly during deployments and combat operations.

But the medical evidence for service causation is less clear-cut than for some other conditions. Hemorrhoids can develop, resolve, and recur throughout adult life regardless of military service. Documenting that specific in-service events caused or aggravated hemorrhoids requires:

• In-service medical treatment. Service treatment records showing hemorrhoid complaints, treatment, or surgical procedures during active duty. Sick call visits, dispensary records, or hospital records establish the in-service onset.

• A nexus opinion connecting service factors to current hemorrhoid pathology. The opinion needs to identify specific service activities (deployment diet, sustained sitting in vehicles or watchstanding, heavy lifting in combat support roles, dehydration in desert environments) and connect them to the development or worsening of hemorrhoids.

• Continuity of treatment post-service. Treatment records spanning the post-service period showing chronic or recurrent hemorrhoid problems support that the in-service condition didn't resolve.

In our dataset, 18 of 439 classified denials are tagged "in-service event missing." That's a smaller share than for many conditions because hemorrhoid in-service treatment is reasonably well-documented. The bigger problem is the rating analysis, not the service connection.

Why Severity Insufficient Dominates

Of 439 classified denials, 248 (56 percent) are tagged "severity insufficient." This is the highest single-reason denial rate we see in any condition.

The pattern is consistent. The veteran has documented hemorrhoids. The Board accepts the diagnosis. The Board may even grant service connection. The rating then comes back at 0 percent because the symptoms don't clear the 10 percent threshold's specific criteria.

What "severity insufficient" usually means for hemorrhoid cases:

No documentation of "irreducible" hemorrhoids. The C&P examination notes hemorrhoids on physical examination but doesn't specifically document that they're irreducible (cannot be pushed back into the rectum). This single element kicks the rating to 0 percent.

No documentation of "excessive redundant tissue." The 10 percent tier requires the hemorrhoidal tissue to be "excessive" and "redundant." Routine hemorrhoids without significant tissue redundancy don't meet this.

No documentation of "frequent recurrences." Episodic hemorrhoid flares without a documented pattern of frequent recurrence don't clear the threshold. Veterans whose hemorrhoids "act up sometimes" but aren't a sustained, frequent problem fail here.

No documentation of anemia, and no thrombosis episode count (for the 20 percent tier). Lab results showing hemoglobin in the normal range, or no recent labs at all, preclude the anemia element. The second route to 20 percent needs continuously prolapsed internal hemorrhoids plus three or more dated thrombosis episodes in a year, and an undated record of "recurrent thrombosed hemorrhoids" does not establish the count.

The path past "severity insufficient" usually requires a treating gastroenterologist's or colorectal surgeon's evaluation that documents each element of the rating tier specifically. The C&P examination alone often doesn't generate the granular documentation the rating analysis requires.

The Secondary Lane

The secondary lane in our dataset grants at 51.6 percent, well above the direct lane's 32.6 percent. The structural reason is that hemorrhoids secondary to other service-connected conditions have cleaner nexus paths than direct claims.

Common secondary chains for hemorrhoids:

Chronic constipation from service-connected IBS or other GI conditions. Veterans with service-connected GI conditions producing chronic constipation often develop hemorrhoids as a downstream complication. The nexus opinion can connect the constipation to the hemorrhoid pathology directly.

Opioid-induced constipation from service-connected pain conditions. Veterans on long-term opioid therapy for service-connected pain conditions frequently develop chronic constipation, which contributes to hemorrhoid development. The medication side-effect framework supports this secondary theory.

Pregnancy-related hemorrhoids in female veterans. Hemorrhoids that developed during pregnancy and persisted post-pregnancy. The link to military service is procedural: if the pregnancy occurred during service, the resulting hemorrhoids may be service-connected. The nexus opinion has to engage with the specific timing and continuity.

Aggravation by service-connected musculoskeletal conditions. Veterans with service-connected back, hip, or pelvic conditions that affect bowel habits or require prolonged sitting/standing can develop hemorrhoids as a secondary or aggravated condition.

The 31 secondary-lane cases in our dataset are a small fraction of total hemorrhoid claims, but they have a notably better grant rate. Veterans whose hemorrhoids developed in the context of another service-connected condition should consider whether the secondary pathway is cleaner than the direct theory.

What Wins Hemorrhoid Claims at the Board

A few patterns we see consistently in granted hemorrhoid cases:

Specific tier-criteria documentation. Under the current rule the two facts that matter are whether the hemorrhoids are internal and prolapsed or external, and how many thrombosis episodes occurred in the past year, each with a date. Records documenting persistent bleeding with a low hemoglobin also clear the 20 percent tier.

Treating colorectal surgeon or gastroenterologist records. Specialist evaluations tend to produce more clinically specific documentation than primary care or generic C&P examinations. The specialist's office notes often address the tier criteria directly.

Documented in-service onset or treatment. Service treatment records showing hemorrhoid diagnosis, treatment, or surgical procedures during active duty establish the direct service connection foundation.

Continuity of treatment post-service. Medical records spanning multiple years showing chronic or recurrent hemorrhoid problems support the chronicity of the condition.

Secondary theory documentation when applicable. For veterans with service-connected GI conditions, chronic pain conditions requiring opioids, or other conditions affecting bowel function, the secondary theory under 38 CFR § 3.310 often produces cleaner outcomes than direct service connection alone.

Strong nexus opinion. When on the direct lane, a well-developed medical opinion that engages with the specific in-service factors and the development of hemorrhoid pathology is what supports the 91.7 percent strong-nexus grant rate. Generic opinions don't move the case.

Bottom Line

Hemorrhoids are rated under 38 CFR § 4.114 DC 7336, which since 2024-05-19 has two tiers rather than three. The 10 percent tier is prolapsed internal hemorrhoids with two or fewer thrombosis episodes per year, or external hemorrhoids with three or more. The 20 percent tier, still the schedular maximum, is persistent bleeding with anemia, or continuously prolapsed internal hemorrhoids with three or more thrombosis episodes per year. In our BVA dataset of 618 cases the grant rate is 22.3 percent, among the lowest of any condition we track, but every one of those cases was decided under the superseded ladder. That ladder had a 0 percent rung where most claims landed and a 10 percent tier requiring four qualitative elements at once, which is why "severity insufficient" drove 56 percent of denials. The current criteria replace those adjectives with a dated count of thrombosis episodes, a standard ordinary treatment records can actually satisfy. The secondary lane (hemorrhoids secondary to constipation from service-connected GI conditions, opioid-induced constipation from chronic pain conditions) grants at 51.6 percent versus 32.6 percent for direct. Veterans pursuing a higher tier need treating-specialist documentation that engages with the specific tier criteria, not just a diagnosis of hemorrhoids.

Methodology and Limitations

• Data source: 38 CFR § 4.114 DC 7336 as amended by the final rule "Schedule for Rating Disabilities: The Digestive System," 89 FR 19735, published 2024-03-20, effective 2024-05-19, read from the current text. 38 CFR § 3.310 (secondary service connection), and Claim Raven's analysis of BVA decisions tagged with hemorrhoids as the primary condition.
• Sample size: 618 BVA decisions involving hemorrhoids as the primary condition. Outcomes split granted 22.3% (138), denied 71.0% (439), remanded 6.6% (41). Connection-type, nexus-quality, denial-reason, and rating-tier breakdowns are coded from the Board's discussion in each decision.
• Limitations: All 618 decisions were made under the superseded pre-2024 ladder, whose 0 percent rung, four-element 10 percent tier, and fissure route to 20 percent no longer exist. The outcome rates, denial reasons, and rating distribution on this page describe that old standard and are not a forecast under the current criteria. The dataset also captures only BVA-level decisions; hemorrhoid claims granted at the regional office without appeal are not in the sample. The current criteria are more concrete but still leave open how VA counts a thrombosis "episode" and what makes prolapse "continuous." Pregnancy-related hemorrhoid claims for female veterans involve additional procedural considerations that the dataset doesn't reliably capture. These observations describe BVA patterns and are not predictions of individual outcomes, and Claim Raven is data analysis, not legal, medical, or VA-accredited advice.