Can I Get VA Disability for Hemorrhoids Secondary to IBS?

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Yes, there is substantial medical research supporting a connection between hemorrhoids and Irritable Bowel Syndrome (IBS) in veterans.

IBS often leads to chronic digestive issues like constipation and diarrhea, which can place significant strain on the anal and rectal areas, increasing the risk of hemorrhoids.

The digestive system works as a connected system, so disruptions from IBS can create a ripple effect, resulting in painful hemorrhoids.

To establish a secondary service connection for hemorrhoids due to IBS, you’ll need to demonstrate three key elements to the VA:

• (#1) a medical diagnosis of hemorrhoids,

• (#2) evidence of a service-connected IBS condition, and

• (#3) medical nexus evidence (Nexus Letter) showing how your hemorrhoids are proximately due to, caused, or aggravated your service-connected IBS.

The VA rates hemorrhoids secondary to IBS under Diagnostic Code 7336, with ratings ranging from 10% to 20% based on the severity of symptoms, frequency of flare-ups, and impacts on your daily life.

In this blog from VA disability expert Brian Reese, we’ll guide you through the process of filing a secondary claim for hemorrhoids connected to IBS.

We’ll cover the VA’s rating criteria for hemorrhoids, the medical evidence required, how to prove secondary service connection, and why a strong nexus letter is essential.

Let’s go!

Summary of Key Points

• The Connection Between Hemorrhoids and IBS: Medical research shows a strong connection between hemorrhoids and Irritable Bowel Syndrome (IBS), particularly due to IBS symptoms like chronic constipation and diarrhea. These symptoms increase strain on the anal and rectal areas, which can lead to hemorrhoid development, especially in veterans already dealing with IBS.

• Secondary Service Connection Requirements: To establish a VA disability rating for hemorrhoids secondary to IBS, veterans must provide three essential types of evidence: (#1) a current diagnosis of hemorrhoids, (#2) proof that IBS is a service-connected condition, and (#3) a Nexus Letter from a medical provider explaining how the service-connected IBS caused or aggravated the hemorrhoids.

• VA Rating for Hemorrhoids Secondary to IBS: The VA rates hemorrhoids secondary to IBS using Diagnostic Code 7336, with ratings depending on the frequency, severity, and nature of symptoms. A 10% rating is given for recurring prolapsed hemorrhoids with occasional thrombosis, while a 20% rating applies to cases with persistent bleeding and anemia or continuously prolapsed hemorrhoids with frequent thrombosis.

• Important Medical Evidence for VA Claims: To strengthen a VA claim for hemorrhoids secondary to IBS, veterans need supporting documentation, including medical records detailing the diagnosis, symptoms, and treatments, as well as personal statements or lay evidence describing the negative impacts on work, daily life, and social functioning.

What are Hemorrhoids?

Hemorrhoids are swollen or inflamed veins located in the lower rectum or anus.

They occur when the veins in this area experience increased pressure, often due to straining during bowel movements, prolonged sitting, chronic constipation, or frequent diarrhea.

Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus), and they vary in severity.

Common symptoms include:

• Pain or discomfort, especially during bowel movements

• Itching or irritation around the anus

• Swelling and lumps near the anus

• Occasional bleeding, typically bright red, especially after bowel movements

Hemorrhoids are common and can affect anyone, but certain factors, like chronic digestive conditions (e.g., IBS), a low-fiber diet, or prolonged sitting, can increase the risk.

Treatment options range from lifestyle changes, such as increasing fiber intake and hydration, to medical treatments like ointments, procedures, or surgery in severe cases.

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a chronic disorder that affects the large intestine, causing a variety of uncomfortable symptoms.

It’s characterized by issues with digestion and bowel function, resulting in pain, bloating, and irregular bowel movements.

While the exact cause of IBS is unknown, it’s believed to involve a combination of gut sensitivity, muscle contraction abnormalities, and stress-related factors.

Common symptoms include:

• Abdominal pain or cramping, often relieved by bowel movements

• Bloating and gas

• Irregular bowel habits, including constipation, diarrhea, or a mix of both

• Mucus in the stool

Managing IBS usually involves lifestyle adjustments, including dietary changes, stress management, and sometimes medications to control symptoms.

While IBS does not cause permanent damage to the intestines, it can significantly impact quality of life if left unmanaged.

Hemorrhoids and IBS: Is There a Connection?

Yes, there is a connection between hemorrhoids and Irritable Bowel Syndrome (IBS).

While they are distinct conditions, IBS can increase the risk of developing hemorrhoids due to the digestive and bowel symptoms associated with it.

Here’s how IBS can “aggravate” hemorrhoids:

• Chronic Straining: IBS often causes irregular bowel movements, leading to constipation or diarrhea. For those with IBS-related constipation, straining during bowel movements is common, and this pressure on the rectal veins can cause hemorrhoids.

• Frequent Diarrhea: IBS can also cause frequent, urgent diarrhea, which irritates the anal area and increases inflammation. This repeated irritation and straining during diarrhea episodes can lead to hemorrhoid development.

• Increased Abdominal Pressure: IBS symptoms such as bloating and gas can increase abdominal pressure, which may contribute to the formation or worsening of hemorrhoids.

Numerous medical research studies have noted a higher prevalence of hemorrhoids in individuals with IBS compared to those without it.

The frequent and irregular bowel movements associated with IBS, whether it’s constipation, diarrhea, or a mix of both, create conditions that can lead to hemorrhoid formation over time.

Medical Research Between Hemorrhoids and Irritable Bowel Syndrome

Medical research shows that having IBS significantly raises your risk for hemorrhoids, largely because many IBS symptoms directly contribute to what causes hemorrhoids.

If you already suffer from hemorrhoids, IBS symptoms can also make these worse.

Why is this the case?

For those with IBS-related constipation, the frequent straining needed to pass stool puts extra pressure on the rectal and anal veins, causing them to bulge and swell.

Even if you experience diarrhea, spending more time on the toilet still increases your risk of developing both internal and external hemorrhoids.

#1. Study on Hemorrhoid Symptoms and IBS-Like Manifestations

A study published in Clinical Gastroenterology and Hepatology investigated the overlap between hemorrhoid symptoms and IBS-like manifestations.

Researchers found that patients with hemorrhoids often reported symptoms such as bloating, abdominal pain, and disturbed social life, which are commonly associated with IBS.

This suggests that some symptoms attributed to hemorrhoids may actually be indicative of IBS.

#2. Prevalence of Hemorrhoids in IBS Patients

Research published in the International Journal of Medicine in Developing Countries examined the prevalence of hemorrhoids among IBS patients.

The study revealed that 78.4% of IBS patients were diagnosed with chronic gastritis, and a significant percentage also had hemorrhoids.

This indicates a notable association between IBS and the occurrence of hemorrhoids.

#3. Mendelian Randomization Study on Hemorrhoidal Disease and IBS

A Mendelian randomization study published in Gut explored the genetic relationship between hemorrhoidal disease and IBS.

The findings suggested that genetic predispositions to hemorrhoidal disease might reduce the risk of developing IBS, indicating a complex interplay between the two conditions.

These studies highlight a significant association between hemorrhoids and IBS, suggesting that the presence of one condition may influence the occurrence or perception of the other.

What is the VA Rating for Hemorrhoids Secondary to IBS?

The VA rates hemorrhoids secondary to IBS under the Diagnostic Code (DC) 7336, found in the 38 CFR, Part 4, the Schedule for Rating Disabilities (VASRD).

VA ratings for hemorrhoids are either 10% or 20% depending on the frequency, severity, and duration of symptoms.

Here’s a detailed explanation of the rating criteria:

DC 7336, Hemorrhoids, External or Internal:

• 20% VA Rating for Hemorrhoids: Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

• 10% VA Rating for Hemorrhoids: Prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis.

Explanation of the VA Rating Criteria and Terms for Hemorrhoids:

Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis (rate at 20%):

• Internal hemorrhoids: These are swollen veins located in the rectum. They may bleed during bowel movements, leading to persistent bleeding and, in severe cases, anemia due to blood loss.

• External hemorrhoids: These are swollen veins located around the anus. If they become thrombosed (filled with blood clots), they can cause pain, swelling, and discomfort.

• Continuously prolapsed internal hemorrhoids: These are internal hemorrhoids that protrude from the anus and do not retract back into the rectum. If they remain prolapsed for an extended period, they can lead to complications such as thrombosis, where blood clots form inside the hemorrhoids.

• Thrombosis: This refers to the formation of blood clots within the hemorrhoidal veins, causing pain, swelling, and inflammation.

Prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis (rate at 10%):

• Prolapsed internal hemorrhoids: These are internal hemorrhoids that protrude from the anus during bowel movements but spontaneously retract back into the rectum afterward. If they become thrombosed occasionally (two or fewer times per year), it leads to less frequent episodes of discomfort.

• External hemorrhoids: Similar to before, these are swollen veins around the anus. If they experience thrombosis more frequently (three or more times per year), it causes recurrent episodes of pain, swelling, and inflammation.

In summary, DC 7336 describes different scenarios of internal or external hemorrhoids, considering factors such as bleeding, anemia, prolapse, and thrombosis, and assigns disability ratings based on the severity and frequency of associated symptoms.

Important Medical Evidence to Service-Connect Hemorrhoids Secondary to Irritable Bowel Syndrome (IBS) for VA Disability

To successfully file a VA claim for hemorrhoids secondary to your service-connected IBS, you will need to provide the VA with specific medical evidence that meets their criteria for secondary service connection.

#1. Current Diagnosis of Hemorrhoids

The first step in proving your secondary VA claim for secondary service connection is by obtaining a current medical diagnosis for hemorrhoids.

This diagnosis must come from a qualified healthcare provider and should be documented in a medical record.

#2. Evidence of Service-Connected IBS

Since your hemorrhoids are being claimed as secondary to your service-connected IBS, you must already have a confirmed VA rating for IBS.

The VA will require evidence, such as your VA Rating Decision that shows your IBS is service-connected.

#3. Nexus Letter for a Secondary Condition From a Private Healthcare Provider

A crucial piece of evidence in any VA claim for secondary service connection is a Nexus Letter from a private healthcare provider.

This letter must establish the link between your service-connected IBS and your current hemorrhoids, stating that it is “at least as likely as not” (a 50% or greater probability) that your hemorrhoids is proximately due to, caused, or aggravated your IBS.

The private healthcare provider should explain the relationship between hemorrhoids and IBS in detail in the Nexus Letter using your medical history, current medical research, BVA decisions, and their own independent medical opinion for service-connection.

A well-written, detailed nexus letter with high probative value is mission critical for winning your VA claim!

#4. Documentation of Severity of Symptoms and Negative Impacts on Your Work, Life, and Social Functioning

The VA will also need to understand the severity of your symptoms and how your hemorrhoids negatively impact your work, life, and social functioning.

Be prepared to submit evidence that shows how your hemorrhoids limit your ability to work, perform daily tasks, and engage in social activities.

This can include:

Military, VA, or Private Medical Records: These records should outline your symptoms, treatments (e.g., topical ointments, procedures, medications), and how your hemorrhoids impact your daily life, especially during flare-ups.

Lay Evidence: Personal statements from you and those close to you, such as family members or friends, can provide insight into how your hemorrhoids limit your activities and affect your quality of life.

Disability Benefit Questionnaires (DBQs): If available, a DBQ for hemorrhoids completed by your healthcare provider can document the severity of your symptoms, and any functional limitations you experience due to the condition.

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