Ano-Rectal Fistula — VA Disability Rating (DC 7335)
Diagnostic Code 7335 · 38 CFR §4.114
What Is It?
An ano-rectal fistula, often called fistula in ano, is an abnormal channel between the anal canal or rectum and the skin around the anus. Most begin as an anal gland abscess: the gland clogs, an infection forms, the abscess drains spontaneously or surgically, and a track remains between the original infection site and the skin. The track then chronically discharges pus or fecal material onto the perianal skin. Contributing factors common in service include chronic constipation and straining, prolonged sitting on hard surfaces, inflammatory bowel disease, and prior anal surgery. The 2024 digestive rewrite titled this code "Ano, fistula in, including anorectal fistula and anorectal abscess" and gave it four rows — 60, 40, 20, and 10 — counted by how many fistulas are present at once, whether abscesses accompany them, whether there is drainage and pain, and whether the disease is refractory to treatment. There is no 0 row and no 100 row in the schedule for this code, and sphincter function is not one of its criteria; continence loss is evaluated separately under DC 7332.
Rating Criteria
| Rating | Criteria |
|---|---|
| 60% | More than two constant or near-constant fistulas with abscesses, drainage, and pain, which are refractory to medical and surgical treatment. |
| 40% | One or two simultaneous fistulas, with abscess, drainage, and pain. |
| 20% | Two or more simultaneous fistulas with drainage and pain, but without abscesses. |
| 10% | One fistula with drainage and pain, but without abscess. The schedule prints no row below this one for DC 7335; where the criteria for a compensable evaluation are not met, 38 CFR §4.31 provides for a 0 percent evaluation. |
Evidence Needed
An examination by a colorectal surgeon documenting the fistula tracks and their relationship to the anal sphincter is the centerpiece. MRI of the pelvis or endoanal ultrasound characterizes complex or branching systems. Because every row of this code counts fistulas and asks whether abscesses accompany them, the decisive evidence is a record that states the number present at the same time and whether abscess, drainage, and pain are each present — those three appear together in the 40 and 60 rows and their absence is what separates the 20 row from them. Records of every prior fistula operation matter for the 60 row, which requires disease refractory to medical and surgical treatment. Where continence is affected, that is evidenced separately for a DC 7332 claim. Service treatment records establishing in-service onset of perianal symptoms or the initial abscess close the nexus.
C&P Exam Tips
Bring imaging, prior operative reports, and a symptom log. Ask the examiner to state plainly how many fistulas are present simultaneously and whether each has an abscess, drainage, and pain, because the rows turn on exactly those counts and combinations rather than on a severity impression. List every surgical attempt with dates and outcomes: repeated failed repairs are what establish the refractory criterion the 60 row requires. If you have inflammatory bowel disease that contributed to the fistula, mention it. If continence is compromised, raise it as a separate DC 7332 issue rather than expecting it to lift the DC 7335 evaluation, because sphincter function is not among this code's criteria.
How to File
File VA Form 21-526EZ listing ano-rectal fistula under DC 7335. Attach the colorectal surgeon's examination stating how many fistulas are present and whether abscess, drainage, and pain accompany them, plus imaging and every prior operative report. If the fistula is part of inflammatory bowel disease, also file for the underlying disease under DC 7326. File impairment of sphincter control under DC 7332 as its own claim where continence is compromised.
Common Mistakes
Filing without a colorectal examination that states the number of simultaneous fistulas and whether abscesses accompany them — that count and combination is what every row of this code turns on. Expecting sphincter impairment to raise the DC 7335 evaluation: it is not one of this code's criteria, and it belongs in a separate DC 7332 claim. Presenting recurrent fistulas as a series of unrelated episodes rather than as the refractory disease the 60 row describes. Missing the inflammatory bowel disease workup when the fistula pattern suggests underlying Crohn's.
Frequently Asked Questions
What are the rating levels for an anal fistula?
Four, and they are counted rather than graded. Sixty percent requires more than two constant or near-constant fistulas with abscesses, drainage, and pain, refractory to medical and surgical treatment. Forty percent requires one or two simultaneous fistulas with abscess, drainage, and pain. Twenty percent requires two or more simultaneous fistulas with drainage and pain but without abscesses. Ten percent is one fistula with drainage and pain but without abscess. The schedule prints no 0 row for this code; where the criteria for a compensable evaluation are not met, 38 CFR §4.31 supplies the 0 percent evaluation.
Will surgical repair fix the rating?
A successful repair with no recurrence and no remaining fistula does not meet any of the four rows, so the evaluation drops to 0 percent under §4.31. That still preserves service connection, which matters because fistulas recur in a notable share of cases. If the repair fails, the counts in the table apply again; if the surgery itself damages sphincter function, that is a separate DC 7332 issue rather than something the DC 7335 rows capture.
Are fistula and hemorrhoids the same thing?
No. Hemorrhoids at DC 7336 are swollen blood vessels in the anal canal, rated 20 or 10 since the 2024 rewrite with no 0 row. A fistula is an abnormal channel through the anal wall caused by infection, rated under DC 7335. Both produce perianal symptoms, but the codes, criteria, treatments, and natural histories differ, and a colorectal examination distinguishes them quickly.