Evidence Checklist: Hemorrhoids

Proctologic examination documenting hemorrhoid grade and typeCritical

Clinical examination report documenting internal hemorrhoid grade (I–IV) and/or external hemorrhoids, with notation of bleeding, prolapse, thrombosis, and incontinence.

Nexus opinion linking hemorrhoids to service ("at least as likely as not")Critical

A medical opinion connecting hemorrhoids to service-related factors including prolonged sitting, heavy lifting, dietary changes during service, or chronic constipation from service-connected conditions.

Documentation of bleeding episodes and anemia (if applicable)

Medical records documenting rectal bleeding frequency, hemoglobin/hematocrit values, or iron deficiency anemia resulting from hemorrhoidal bleeding.

Treatment records (banding, sclerotherapy, hemorrhoidectomy)

Records documenting office-based procedures (rubber band ligation, sclerotherapy, infrared coagulation) or surgical hemorrhoidectomy.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Rectum and Anus ConditionsCritical

Standardized form capturing hemorrhoid grade, bleeding pattern, prolapse, incontinence, and treatment history.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.