Many veterans living with Irritable Bowel Syndrome (IBS) also struggle with painful and recurring hemorrhoids. While these may seem like separate conditions, modern medical evidence and VA regulations clearly recognize that hemorrhoids can develop or worsen as a secondary condition to service-connected IBS.
The VA allows veterans to receive disability compensation for hemorrhoids secondary to IBS, as long as specific legal and medical requirements are met. When filed correctly, this secondary claim can result in additional monthly compensation and recognition of how IBS truly affects daily life.
In this in-depth guide from VA disability expert Brian Reese, we’ll explain how hemorrhoids are linked to IBS, how the VA rates hemorrhoids, what evidence is required, and why a strong nexus letter is often the key to approval.
Can Hemorrhoids Be Secondary to IBS?
Yes. Veterans may qualify for VA disability for hemorrhoids secondary to service-connected IBS if they can show:
- A current medical diagnosis of hemorrhoids
- A service-connected IBS condition (rated at 0% or higher)
- Medical nexus evidence showing IBS caused or aggravated the hemorrhoids
Hemorrhoids are rated under Diagnostic Code 7336, with VA ratings of 10% or 20% based on severity.
What Are Hemorrhoids?
Hemorrhoids are swollen or inflamed veins in the lower rectum or anus. They develop when pressure in this area increases, often due to bowel irregularities or prolonged straining.
Types of Hemorrhoids
- Internal hemorrhoids: Located inside the rectum, often painless but prone to bleeding
- External hemorrhoids: Found under the skin around the anus and often painful
- Thrombosed hemorrhoids: Hemorrhoids containing blood clots, causing severe pain and swelling
Common Symptoms
- Pain or burning during bowel movements
- Rectal bleeding (bright red blood)
- Itching or irritation
- Swelling or lumps near the anus
- Pain when sitting
For veterans with IBS, these symptoms are often chronic and recurrent, not occasional.
What Is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome is a functional gastrointestinal disorder affecting how the intestines work, not their structure. IBS is already recognized by the VA as a compensable condition, especially for Gulf War veterans.
Common IBS Symptoms
- Chronic diarrhea, constipation, or alternating episodes
- Abdominal pain or cramping
- Bloating and gas
- Urgency and incomplete bowel movements
- Mucus in stool
IBS does not cause permanent intestinal damage, but it can severely disrupt daily functioning, especially when symptoms are frequent or severe.
How IBS Causes or Aggravates Hemorrhoids?
Although IBS and hemorrhoids are separate diagnoses, IBS symptoms directly contribute to the mechanisms that cause hemorrhoids.
Key Medical Connections
Chronic Straining:
IBS-related constipation often forces repeated straining, increasing pressure on rectal veins.
Frequent Diarrhea:
IBS-related diarrhea leads to frequent wiping, irritation, and inflammation of anal tissues.
Increased Abdominal Pressure:
Gas and bloating raise pressure in the abdominal and rectal areas, worsening hemorrhoidal veins.
Prolonged Time on the Toilet:
Urgency and incomplete evacuation increase time spent sitting, another risk factor.
Medical literature consistently shows that IBS patients have a significantly higher prevalence of hemorrhoids than the general population.
As Brian Reese explains:
“IBS creates the perfect storm for hemorrhoids strain, urgency, inflammation, and repetition. From a VA standpoint, that’s textbook secondary service connection.”
VA Disability Ratings for Hemorrhoids (DC 7336)
The VA rates hemorrhoids under 38 CFR, Part 4, Diagnostic Code 7336. Ratings are based on severity, frequency, bleeding, prolapse, and thrombosis.
VA Rating Criteria for Hemorrhoids
| VA Rating | Criteria |
|---|---|
| 20% | Persistent bleeding with anemia OR continuously prolapsed internal hemorrhoids with 3+ thrombosis episodes per year |
| 10% | Prolapsed internal hemorrhoids with 2 or fewer thrombosis episodes per year OR external hemorrhoids with 3+ thrombosis episodes per year |
There is no 0% rating under DC 7336. If hemorrhoids meet the criteria, compensation applies.
Understanding Key VA Terms for Hemorrhoids
Prolapsed Hemorrhoids:
Hemorrhoids that protrude outside the anus. Continuous prolapse indicates more severe disease.
Thrombosis:
Formation of blood clots within hemorrhoids, often extremely painful.
Persistent Bleeding:
Ongoing or frequent rectal bleeding, not just occasional spotting.
Anemia:
Low red blood cell count caused by chronic blood loss from hemorrhoids.
These terms carry significant weight in VA rating decisions.
Evidence Required to Win a Secondary Hemorrhoids Claim
1. Current Medical Diagnosis
You must have a documented diagnosis of hemorrhoids from a qualified medical provider. VA or private records are acceptable.
2. Proof of Service-Connected IBS
Your IBS must already be service-connected. A VA Rating Decision satisfies this requirement.
3. Nexus Letter (Critical Evidence)
A nexus letter is often the most important part of a secondary claim.
The provider must state that it is:
“At least as likely as not (50% probability or greater)”
that IBS caused or aggravated the hemorrhoids.
A strong nexus letter explains:
- How IBS symptoms lead to hemorrhoids
- Frequency and chronicity of bowel issues
- Medical reasoning and literature support
- Your specific medical history
As Reese notes:
“Secondary GI claims live and die by the nexus. If the link isn’t explained, the VA won’t connect the dots for you.”
4. Evidence of Functional Impact
The VA evaluates how hemorrhoids affect your:
- Ability to work
- Sitting tolerance
- Daily hygiene and comfort
- Social functioning
Helpful evidence includes:
- VA or private treatment records
- Lay statements from you or family
- Medication or procedure history
- DBQs, if available
Why Hemorrhoid Claims Are Commonly Denied?
Common denial reasons include:
- No nexus opinion
- IBS symptoms not clearly documented
- Severity not meeting DC 7336 criteria
- Lack of functional impact evidence
Most denials are evidence-related, not because the condition isn’t legitimate.
Final Thought
Hemorrhoids secondary to IBS are medically supported, legally valid, and often underclaimed VA disabilities. When veterans properly document IBS symptoms, hemorrhoid severity, and medical linkage, these claims are very winnable.
As Brian Reese summarizes:
“IBS doesn’t stop at the stomach. When it causes chronic hemorrhoids, the VA has a duty to compensate the full impact.”
With the right evidence and strategy, veterans can secure the benefits they earned.
FAQs
Can hemorrhoids be rated secondary to IBS?
Yes, with proper medical nexus evidence.
Do hemorrhoids have to be severe to qualify?
They must meet the 10% or 20% criteria under DC 7336.
Is bleeding required for compensation?
No. Thrombosis or prolapse alone can qualify.
Do I need a nexus letter?
Strongly recommended for secondary claims.
Can IBS aggravate pre-existing hemorrhoids?
Yes. Aggravation qualifies under VA law.
