VA Disability Rating for Prolapse of the Rectum (DC 7334)

Diagnostic Code 7334 · 38 CFR §4.114

What Is It?

Rectal prolapse is the rectum — the last section of the large intestine — sliding out of position and pushing through the anus. It can appear only during a bowel movement and slip back on its own, or it can come out during ordinary walking and standing and have to be pushed back by hand, or it can stay out permanently. Veterans develop it from years of straining, from pelvic fracture and other pelvic trauma, from spinal cord and cauda equina injuries that denervate the pelvic floor, and as a downstream effect of any service-connected condition that causes chronic constipation — including the constipation that comes with long-term opioid pain management. The symptoms are a visible or palpable bulge, mucus and blood staining underwear, a constant sensation that the bowel has not emptied, and, as the sphincter is stretched over time, loss of bowel control. The most important thing to know before filing in 2026 is that the criteria are not what most guides still describe. The VA rewrote the digestive schedule effective 19 May 2024, and DC 7334 no longer rates "mild," "moderate" and "severe" prolapse with a 50 percent ceiling. It now asks two mechanical questions — does the prolapse go back in by itself, only with your hand, or not at all, and can a surgeon repair it — and it carries a 100 percent level that did not exist under the old schedule.

Rating Criteria

Evidence Needed

The current criteria turn on two facts, and a claim that establishes both beats one that describes symptoms in general terms. The first is how the prolapse reduces: spontaneously, manually, or not at all. That belongs in a clinical note in those words, because the difference between "reduces spontaneously" and "reduces manually" is the difference between 10 percent and 30 percent, and the difference between "manually reducible" and "irreducible" is the difference between 50 percent and 100 percent. The second is reparability. Every compensable level below 100 percent requires that the prolapse is NOT repairable, so a colorectal surgeon's written opinion that repair is not feasible — or that further repair is not advisable after one or more failed procedures — is the single most valuable document in the file. Beyond those two: operative reports from any rectopexy or perineal repair and the dates of every recurrence; defecography or dynamic pelvic MRI showing the prolapse in motion; anorectal manometry if sphincter tone is also involved; treatment records documenting mucus discharge, bleeding, and incomplete evacuation; and the service records or nexus opinion tying the prolapse to in-service pelvic trauma, spinal injury, or a service-connected condition that caused chronic straining. Photographs taken at home during a prolapse episode are legitimate evidence and are often the only proof that the prolapse occurs outside a clinic setting.

C&P Exam Tips

A prolapse that is out every evening can be entirely absent at ten in the morning on an examination table, and an examiner who cannot see it may record that it is not present. Ask to be examined in a squatting or straining position rather than lying down, and bring dated photographs from home if the prolapse is intermittent. Use the regulation's own words when you answer questions: say whether the prolapse reduces on its own, whether you have to push it back with your hand, or whether it will not go back at all — those three phrases map directly onto three different evaluation levels. Say plainly whether it comes out only with bowel movements and straining or also during ordinary walking, standing, and lifting, because that distinction separates 30 percent from 50 percent. If a surgeon has told you the prolapse cannot be repaired, or that another operation is not advisable, bring that in writing rather than reporting it secondhand. If you also leak stool, describe that separately and in detail — Note (2) to DC 7334 directs that where impairment of sphincter control is the predominant disability, the condition is rated under DC 7332 instead, and DC 7332 reaches 100 percent on its own criteria.

How to File

File on VA Form 21-526EZ under DC 7334 and name the mechanism: the in-service pelvic or spinal injury, the documented history of straining, or the service-connected condition that produced the chronic constipation behind it. Attach operative reports for every repair attempt, the surgeon's opinion on whether further repair is feasible, imaging or defecography showing the prolapse, and a statement describing whether it reduces on its own, by hand, or not at all. If you leak stool as well as prolapse, say so — the rater has to decide which is the predominant disability under Note (2), and that decision should be made on a complete record rather than on silence. If you were rated under the old "mild, moderate, severe" criteria before 19 May 2024 and your condition has worsened, file a claim for increase rather than assuming the old 50 percent ceiling still binds; the schedule change alone cannot reduce an evaluation already in effect, and any reduction requires the 38 CFR 3.105(e) procedure.

Common Mistakes

The most costly mistake in 2026 is arguing — or accepting — the old criteria. A decision that describes your prolapse as "moderate" and stops at 50 percent is applying a schedule that was replaced on 19 May 2024, and the current schedule has a 100 percent level for persistent irreducible prolapse. If the decision or the examination report uses the words mild, moderate or severe rather than spontaneously reducible, manually reducible or irreducible, the current criteria are not being applied, and that is worth raising on review. The second mistake is leaving reparability undocumented. Every level from 10 to 50 percent requires that the prolapse is not repairable, so a file with no surgical opinion on that point invites a 0 percent or a denial no matter how bad the symptoms are. The third is scheduling around the condition — going to the examination on a good morning, when the prolapse is not out, and letting the report record no findings. The fourth is folding fecal incontinence into the prolapse claim instead of describing it in its own right; sphincter impairment is DC 7332, it reaches 100 percent, and Note (2) exists precisely to route the claim there when leakage is the bigger problem. The fifth is assuming a successful repair ends the matter: Note (1) continues the 100 percent evaluation for two months after repair, the evaluation after that is set by a mandatory examination on the residuals, and recurrence after rectopexy is common enough to be worth a new claim when it happens.

Frequently Asked Questions

Did the VA change the rectal prolapse rating criteria?

Yes. The digestive schedule at 38 CFR 4.114 was rewritten by a final rule effective 19 May 2024, and DC 7334 was rewritten with it. The old criteria rated prolapse as mild, moderate or severe and stopped at 50 percent. The current criteria rate on whether the prolapse reduces spontaneously, reduces manually, or is irreducible, and on whether it is repairable — and they add a 100 percent level for persistent irreducible prolapse. If a decision on your claim uses the words mild, moderate or severe, it is applying superseded criteria.

Can rectal prolapse really be rated 100 percent?

Yes. The 100 percent row reads "persistent irreducible prolapse, repairable or unrepairable" — a prolapse that stays out and will not go back, whether or not surgery is an option. Note (1) then provides that if a repairable prolapse is repaired, the 100 percent evaluation continues for two months after the repair, and the evaluation after that is determined on the residuals by mandatory VA examination, with 38 CFR 3.105(e) governing any reduction.

Why does the rating depend on whether the prolapse can be repaired?

Because the compensable levels below 100 percent are written for prolapse that cannot be fixed. Every one of the 10, 30 and 50 percent rows requires a prolapse that "is not repairable." The regulation treats a repairable prolapse as a condition with a surgical answer, and rates the residuals afterward instead. That makes a surgeon's written opinion on reparability the pivot of the whole claim, and it is the document most often missing from these files.

What is the Valsalva maneuver and why is it in the criteria?

It is bearing down against a closed airway — the effort you make straining on the toilet or lifting something heavy. The regulation uses it to separate two levels: a manually reducible, unrepairable prolapse that comes out only after bowel movements, exertion, or the Valsalva maneuver rates 30 percent, while one that also comes out at other times — ordinary walking, standing, going about the day — rates 50 percent. When you describe your symptoms, be specific about which of those two patterns you have.

I leak stool as well as prolapse. Do I get rated for both?

Not for both at once under these two codes. Note (2) to DC 7334 directs that where impairment of sphincter control constitutes the predominant disability, the condition is rated under DC 7332 instead. That is usually the better outcome rather than a worse one: DC 7332 reaches 100 percent on its own criteria and is graded by how often you have accidents and whether a prescribed bowel program controls them. Describe both problems fully so the rater can decide which one predominates on the evidence.

Will my existing rating be reduced now that the criteria have changed?

A change to the rating schedule does not by itself reduce an evaluation already in effect. Any proposed reduction has to go through 38 CFR 3.105(e), which requires the VA to notify you of the proposal, give you 60 days to submit evidence and 30 days to request a predetermination hearing, and issue a separate decision before the reduction takes effect. The practical exposure is not the schedule change; it is a routine future examination. If your condition has worsened, filing for an increase under the current criteria is the route to the levels the old schedule did not have.