VA Disability Rating for Impairment of Sphincter Control (DC 7332)

Diagnostic Code 7332 · 38 CFR §4.114

What Is It?

DC 7332 covers loss of the ability to control the anal sphincter — the inability, as the regulation's own Note puts it, to retain or expel stool at an appropriate time and place. That covers both directions: leakage of gas, liquid or solid stool that you cannot hold, and retention that you cannot relieve without help. Veterans reach it by several routes. Spinal cord and cauda equina injury and multiple sclerosis denervate the pelvic floor. Pelvic fracture, blast injury and penetrating wounds damage the sphincter mechanism directly. Rectal, prostate and colorectal surgery, and pelvic radiation, injure it as a side effect. Chronic rectal prolapse stretches it over years. The condition is badly underclaimed, and the reason is not medical: it carries a stigma that leads veterans to minimize it to an examiner they have just met, and the resulting rating reflects what they were willing to say rather than what they live with. The criteria changed on 19 May 2024, when the VA rewrote the digestive schedule. DC 7332 no longer rates vague degrees of "leakage." It now asks two concrete questions — how well a physician-prescribed bowel program controls the problem, and how often you have an accident that requires a pad — and it answers them at five levels from 0 to 100 percent.

Rating Criteria

Evidence Needed

Each level of DC 7332 can be met two different ways, and a well-built claim documents both routes rather than gambling on one. The first route is the bowel program: whether a physician-prescribed regimen controls the problem fully, partially, or not at all, and what that regimen requires. So the file needs the prescription itself, not a description of it — the written bowel program, the medications beyond laxatives, the special diet, whether digital stimulation is part of the routine, and any surgical consultation. A program that works only partially is worth 60 percent; one that does not work is worth 100 percent; and those words need to be in a clinician's note. The second route is accident frequency, and it is graded in units the regulation names precisely: at least once every six months for 10 percent, two or more times per month for 30 percent, two or more times per week for 60 percent, two or more times per day for 100 percent, each tied to needing a pad at that frequency. The evidence that establishes frequency is a dated diary kept over several months, pharmacy and supply records showing how many pads or briefs you go through, VA prosthetics issue records if the VA supplies them, and lay statements from a spouse, partner or adult child who does the laundry and knows the real number. Add anorectal manometry and endoanal ultrasound where sphincter damage is structural, electrodiagnostic studies where the cause is neurological, the operative or injury records that caused it, and a nexus opinion where the pathway runs through another service-connected condition.

C&P Exam Tips

The hardest part of this examination is saying the true thing out loud, and the rating is built almost entirely on what you say. Examiners cannot observe incontinence; they record what you report and what the file shows. Go in with a number. Not "sometimes" or "now and then" — the actual count of accidents per day, per week, or per month over the last several months, taken from a diary rather than from memory, because the criteria are graded in exactly those units and an approximation gets rounded down. Say how many pads or briefs you use and how often you change them, and bring the receipts or the VA prosthetics record if you have them. Describe the bowel program precisely and say whether it works: whether you need digital stimulation, what medication beyond laxatives you take, what the special diet is, and whether the regimen controls the problem fully, partially, or not at all — those three words map directly onto 30, 60 and 100 percent. Describe what the condition costs you in ordinary terms: mapping bathrooms before leaving home, declining travel or work that has no reliable access, sleeping on protection, the laundry. Bring a statement from someone who lives with you. And do not clean up the account out of embarrassment — the examiner has heard it before, and a minimized report becomes a permanent record that a later claim has to overcome.

How to File

File on VA Form 21-526EZ under DC 7332 and name the mechanism — the spinal or pelvic injury, the surgery, the radiation, the neurological disease. Where the cause is another service-connected condition or its treatment, file as secondary and include a nexus opinion that names the pathway. Attach the bowel program, the medication list, the pad supply records, a symptom diary covering several months, any anorectal manometry or endoanal ultrasound, and at least one lay statement from someone who lives with you. One point of structure is worth knowing: the introduction to 38 CFR 4.114 lists the digestive codes that cannot be combined with each other — 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive — and DC 7332 is not on that list. A sphincter-control evaluation can therefore be combined with an evaluation under one of those codes, subject as always to 38 CFR 4.14, which prohibits rating the same symptom twice under different diagnoses. If you also have prolapse, expect the rater to apply Note (2) to DC 7334 and evaluate the whole picture under 7332 where the sphincter problem predominates.

Common Mistakes

Underreporting is the defining mistake with this claim, and it is not a character flaw — it is what most people do when a stranger with a clipboard asks how often they soil themselves. The countermeasure is a written diary and a supply record, so the number comes from paper rather than from a sentence you have to say. The second mistake is describing the problem without describing the bowel program. Half of every criterion in DC 7332 turns on whether a physician-prescribed regimen controls the condition fully, partially, or not at all, and a file with no prescribed program at all can read as an untreated condition rather than a refractory one — see a clinician, get a program in writing, and let the record show how it performs. The third is imprecision about frequency, when the regulation is precise: once every six months, two per month, two per week, two per day. Saying "a few times a month" leaves a rater choosing between 10 and 30 percent with nothing to choose on. The fourth is arguing the old criteria — a decision that discusses "extensive leakage and fairly frequent involuntary bowel movements" is applying language the 19 May 2024 revision removed. The fifth is leaving the surrounding conditions unclaimed: perianal skin breakdown, urinary incontinence and secondary depression are separately ratable and routinely go unmentioned because the veteran came in to talk about one thing.

Frequently Asked Questions

Did the VA change the sphincter control rating criteria?

Yes. The digestive schedule at 38 CFR 4.114 was rewritten by a final rule effective 19 May 2024. The old DC 7332 rated on vague degrees of leakage — "constant slight," "occasional moderate," "extensive," "complete loss." The current criteria are built on two measurable things: whether a physician-prescribed bowel program controls the condition fully, partially or not at all, and how often you are incontinent to solids or liquids and need a pad. There are now five levels, from 0 percent for a history of the condition that is currently asymptomatic up to 100 percent.

How often do I have to have accidents to reach each level?

The regulation states the frequencies explicitly, and each is tied to needing a pad at the same frequency: at least once every six months for 10 percent; two or more times per month for 30 percent; two or more times per week for 60 percent; two or more times per day for 100 percent. Each level can alternatively be met through the bowel-program route instead, so a veteran whose accidents are less frequent but whose prescribed regimen only partly works can still reach 60 percent.

What is a physician-prescribed bowel program?

A written clinical regimen for managing the bowel — typically some combination of scheduled evacuation, digital stimulation, suppositories or enemas, medication beyond ordinary laxatives, and a specified diet. It is standard care after spinal cord injury and is prescribed for many other causes of neurogenic bowel. It matters here because three of the five levels are defined by how the condition responds to one: fully responsive with medication or diet is 10 percent, fully responsive but requiring digital stimulation plus medication beyond laxatives plus special diet is 30 percent, partially responsive is 60 percent, and not responsive is 100 percent.

Does retention count, or only leakage?

Both. Every criterion in DC 7332 reads "incontinence or retention," and the Note to the code defines loss of sphincter control as the inability to retain or expel stool at an appropriate time and place. A veteran who cannot evacuate without digital stimulation and a prescribed regimen is within the code just as much as one who leaks, and the same responsiveness tiers apply. This is frequently missed, and it matters most for veterans with neurogenic bowel after spinal cord injury.

Will the VA supply pads and briefs?

Where the condition is service connected, incontinence supplies are generally available through VA prosthetics as part of treatment. There is a second reason to use that route: the issue record becomes objective documentation of how many pads you go through, which is exactly the evidence the frequency criteria need and exactly what most files lack. If you are buying your own, keep the receipts for the same reason.

Can I be rated for this and for another digestive condition?

Often yes. The no-combining rule in the introduction to 38 CFR 4.114 applies to diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive. DC 7332 is not among them, so a sphincter-control evaluation is not barred from being combined with one of those. What still applies is 38 CFR 4.14, which prohibits evaluating the same symptom under two diagnoses — so diarrhea already counted in an irritable-bowel evaluation cannot be counted again as incontinence here.