Hemorrhoids, anorectal fistulas and abscesses, rectal or anal stricture, dyssynergic defecation, impaired sphincter control, rectal prolapse and pruritus ani are documented for VA disability claims on this 7-page questionnaire. The clinician grades each condition against VA's criteria, such as persistent bleeding with anemia or thrombosis episodes per year, number of fistulas, degree of luminal narrowing, frequency of fecal incontinence, prolapse reducibility, and the response to a prescribed bowel program.
The Veteran's treating or examining clinician completes the form and signs the Section XV examiner's certification. The Veteran fills in no part of the form.
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Rectum and Anus Conditions Disability Benefits Questionnaire
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External and internal hemorrhoids are graded separately. Options include persistent bleeding, anemia (with a hemoglobin or hematocrit value), three or more thrombosis episodes per year, and, for internal hemorrhoids, continuous prolapse with thrombosis or prolapse with fewer episodes.
Section IV grades fistulas as one, two or more simultaneous, or more than two constant or near-constant, each with drainage, pain or abscess. Item 4B asks whether the fistula is refractory to medical and surgical treatment.