Effective May 19, 2024, the VA rates pruritus ani under 38 CFR § 4.114, Diagnostic Code (DC) 7337 with ratings of 0% or 10% depending on the severity of symptoms.
Anal itching without bleeding or excoriation is rated at 0% while anal itching with bleeding or excoriation rate is rated at 10%.
Pruritus ani is the medical term for anal itching, a common condition characterized by an intense itching sensation around the anus.
Pro Tip: When applying for a VA disability rating for pruritus ani (anal itching), it’s crucial to document the presence of bleeding or excoriation. Make sure you have medical evidence! Doing so could be the difference between a 0% non-compensable rating and a 10% rating.
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Summary of Key Points
- VA Rating for Anal Itching: Effective May 19, 2024, the VA rates pruritus ani under 38 CFR § 4.114, Diagnostic Code (DC) 7337, with ratings of 0% or 10% depending on the severity of symptoms.
- VA Rating Criteria: Anal itching without bleeding or excoriation is rated at 0%, while anal itching with bleeding or excoriation is rated at 10%.
- Condition Overview: Pruritus ani is the medical term for anal itching, characterized by an intense itching sensation around the anus, which can cause significant discomfort.
What is Pruritus Ani?
Anal itching, or pruritus ani (proo-RIE-tus A-nie), is a common condition characterized by an intense itch around the anus, often causing discomfort and embarrassment.
This condition can be caused by various factors including infections, hemorrhoids, ongoing diarrhea, and skin inflammation (dermatitis).
If self-care measures do not alleviate the symptoms, it is important to consult a healthcare provider.
With proper treatment, most veterans experience complete relief.
Here are the key points about pruritus ani:
Symptoms:
- Intense Itching: The primary symptom is persistent and intense itching around the anus.
- Bleeding and Excoriation: In severe cases, scratching can lead to bleeding and excoriation (skin damage or abrasions).
Causes:
- Hygiene Issues: Both excessive washing and inadequate cleaning can contribute to pruritus ani.
- Skin Conditions: Conditions such as eczema, psoriasis, or dermatitis can cause itching.
- Infections: Fungal infections, bacterial infections, or infestations like pinworms can lead to pruritus ani.
- Irritants: Certain foods, beverages (like coffee, alcohol), and medications can irritate the area and cause itching.
- Systemic Diseases: Conditions such as diabetes, liver disease, or certain cancers can be associated with pruritus ani.
Diagnosis:
- Medical History and Examination: A healthcare provider will review the patient’s medical history and perform a physical examination.
- Laboratory Tests: Tests may be conducted to rule out infections or other underlying conditions.
Treatment:
- Topical Medications: Creams or ointments to reduce itching and inflammation.
- Lifestyle Changes: Improved hygiene practices, avoiding irritants, and dietary modifications.
- Treating Underlying Conditions: Addressing any underlying infections, skin conditions, or systemic diseases.
Prognosis:
- Varies by Cause: The prognosis depends on the underlying cause and the effectiveness of the treatment. Proper management can significantly reduce symptoms and improve quality of life.
Risk Factors for Pruritus Ani in Military Veterans
Military veterans may face unique risk factors that increase their likelihood of developing pruritus ani (anal itching).
Here’s some key risk factors:
Exposure to Harsh Environments:
- Field Conditions: Prolonged exposure to dust, dirt, and unsanitary conditions can lead to skin irritations, including pruritus ani.
- Harsh Weather: Extreme weather conditions, whether hot or cold, can cause skin dryness and irritation, contributing to anal itching.
Hygiene Challenges:
- Limited Access to Facilities: During deployments or field operations, veterans might not have regular access to proper hygiene facilities, leading to inadequate cleaning or over-washing with harsh soaps.
- Improvised Sanitation: Using makeshift cleaning methods and materials can cause skin irritation and contribute to pruritus ani.
Dietary Factors:
- Field Rations: Military rations (like MREs) are often high in preservatives and may lack fiber, potentially leading to gastrointestinal issues and pruritus ani.
- Dehydration: Limited access to water and inadequate hydration can exacerbate skin conditions.
Physical Activity:
- Prolonged Sitting: Long periods of sitting, whether in vehicles, aircraft, or at a desk, can lead to sweating and friction, causing irritation and itching in the anal area.
- Heavy Gear: Wearing heavy equipment and gear can increase sweating and friction, contributing to skin irritation.
Stress and Mental Health:
- Stress-Related Conditions: High stress levels, common among military personnel and veterans, can exacerbate skin conditions, including pruritus ani.
- Mental Health Medications: Some medications used to treat PTSD, anxiety, or depression can have side effects that include skin irritation or itching.
Infectious Diseases:
- Parasitic Infections: Exposure to environments where parasitic infections (such as pinworms) are common can lead to pruritus ani.
- Bacterial and Fungal Infections: Living in close quarters can increase the risk of bacterial and fungal infections, which can cause or worsen pruritus ani.
Systemic Health Issues:
- Chronic Conditions: Conditions such as diabetes and liver disease, which are more prevalent among some veteran populations, can lead to skin conditions that include pruritus ani.
- Gastrointestinal Disorders: Issues like hemorrhoids and anal fissures, which may be more common due to physical strain and stress, can contribute to pruritus ani.
How to Prove Service Connection for Pruritus Ani (Anal Itching)
To receive VA disability benefits for pruritus ani, veterans must establish a service connection and prove the severity of symptoms.
#1. Current Diagnosis of Pruritus Ani
Obtain a current medical diagnosis of pruritus ani from a healthcare professional.
Ensure this diagnosis is documented in your service treatment records, VA medical records, or private treatment records.
It is helpful to have a diagnosis within the past 12 months.
Gather medical records from your doctor that clearly document the diagnosis, including any relevant evaluations and treatments.
#2. In-Service Event, Injury, Disease, Illness, or Exposure
Provide the VA with evidence of an event, injury, disease, illness, or exposure during military service that could have caused or aggravated pruritus ani.
Collect service medical records, incident reports, and personal statements detailing the in-service occurrence.
This could include exposure to harsh environments, inadequate hygiene conditions, or infections that may have led to anal itching.
#3. Nexus (Link or Connection)
Establish a medical nexus, linking the current diagnosis of pruritus ani to the in-service event or injury.
Obtain a Nexus Letter from a qualified medical professional.
This letter should explain how the in-service event likely caused or aggravated pruritus ani.
#4. Severity of Symptoms
Provide the VA with medical evidence of the severity and impact of pruritus ani symptoms on your work, life, and social functioning.
Maintain detailed medical records and personal statements documenting the frequency, severity, and duration of your symptoms.
Describe how pruritus ani affects your daily activities and any treatments or interventions you require.
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VA Secondary Service Connection for Anal Itching
Anal itching can be caused by a wide range of conditions, which means veterans might be eligible for secondary service connection.
Here is a detailed list of potential causes:
Hygiene Issues
- Inadequate Cleaning: Not cleaning the anal area properly can lead to irritation.
- Excessive Cleaning: Over-washing with harsh soaps can strip the skin of natural oils, causing dryness and itching.
- Residual Fecal Matter: Remaining fecal matter can irritate the skin around the anus.
Skin Conditions
- Eczema: Chronic skin condition causing red, inflamed, and itchy patches.
- Psoriasis: Autoimmune condition leading to red, scaly patches on the skin.
- Dermatitis: Inflammation of the skin due to allergic reactions or irritants.
Infections
- Fungal Infections: Yeast infections, particularly caused by Candida, can lead to anal itching.
- Bacterial Infections: Certain bacteria can infect the anal area and cause itching.
- Parasitic Infections: Infestations such as pinworms, which are more common in children, can cause intense itching.
Irritants
- Foods and Beverages: Spicy foods, caffeine, alcohol, citrus fruits, and certain dairy products can irritate the anal area.
- Medications: Some medications, including certain antibiotics, can have side effects that cause anal itching.
- Scented Products: Use of scented toilet paper, soaps, or lotions around the anal area.
Systemic Diseases
- Diabetes: High blood sugar levels can lead to skin conditions that cause itching.
- Liver Disease: Conditions like cirrhosis can lead to bile acids in the bloodstream, causing itching.
- Kidney Disease: Build-up of waste products in the blood can cause itching.
Gastrointestinal Disorders
- Hemorrhoids: Swollen veins in the lower rectum and anus can lead to itching and irritation.
- Anal Fissures: Small tears in the lining of the anus can cause pain and itching.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease and ulcerative colitis can cause anal itching due to inflammation.
Allergies
- Dermatitis: Allergic reactions to substances like latex or certain foods can cause itching.
Environmental Factors
- Heat and Humidity: Sweating and friction in the anal area can cause irritation.
- Tight Clothing: Wearing tight clothing can trap moisture and cause itching.
Psychological Factors
- Stress and Anxiety: High levels of stress and anxiety can exacerbate itching due to increased skin sensitivity.
Sexually Transmitted Infections (STIs)
- Genital Herpes: Causes sores and itching around the genital and anal areas.
- Human Papillomavirus (HPV): Can cause warts and itching around the anus.
VA Disability Rating for Pruritus Ani
Effective May 19, 2024, the VA rates pruritus ani under Diagnostic Code (DC) 7337, with ratings based on the presence or absence of bleeding and excoriation.
- 10% VA Rating: Assigned if pruritus ani involves bleeding or excoriation (skin damage or abrasions due to scratching). This reflects more severe symptoms and significant skin irritation.
- 0% VA Rating: Assigned if pruritus ani does not involve bleeding or excoriation. This indicates milder symptoms with less impact on skin integrity.
Explanation of Key Terms
- Pruritus Ani: Refers to an intense itching sensation around the anus, a common condition that can cause significant discomfort.
- Bleeding: Occurs when excessive scratching of the itchy area leads to irritation and damage of the skin, resulting in bleeding.
- Excoriation: A medical term for scraping or scratching of the skin due to itching, leading to skin damage. In pruritus ani, this can occur from repeated scratching of the anal area, potentially causing bleeding.
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About the Author
Brian Reese
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).
