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  1. I am currently s/c for IBS, Anemia and an Eating Disorder. All of these have attributed to my issues I have to this day regarding my hemorrhoids and anal fissure. I have filed for secondary s/c for anal fissures. Since one of the known causes for this is chornic diarrhea, which is noted in my prior C&P exam for IBS s/c, I feel this warrants a secondary s/c. I have progress notes from two doctors indicating I have the anal fissure. I had surgery (twice) to remove my hemorrhoids and repair the anal fissure in one surgery. The anal fissure is still an issue and will be for the rest of my life. My current doctor states that Chronic Diarrhea is one of the causes. I am due to see my doctor this week for post op discussions from my surgery in July. Prior to filing, I read up on anal fissures and the causes for it, and one of the causes is the Chronic Diarrhea, and I also read that symptoms for anal fissure are commonly mistaken for hemorrhoids. I have suffered with hemorrhoids for years never realizing that they were associated or potential associated to my issues with IBS. Anemia, although rare from blood loss due to hemorrhoids, I have Anemia from my Gastro issues due to my Eating Disorder (also S/C for). I filed an FDC claim on July 20th, 2016 for anal fissure to be secondary s/c to my curent s/c IBS. I am sure it will turn into a traditional claim since my NOD is still in the "decision" stage but I was moderately surprised to see that I have a C&P exam ordered so quickly. On Ebennies I happened to be looking at my upcoming doctor's appointments and happened to check the calendar for C&P exams and boom there it was! That is super fast! I do not have any secondary s/c contentions so I have a few questions. When you file for a contention to be secondary to the already s/c contention do you need to bring up the prior evidence that s/c you in the first place? Meaning, I am s/c for IBS, do I need to bring that up? I did state in my FDC claim (VA21-4138) why I felt it should be secondary to IBS. CODE 7336: Hemorrhoids large are swollen veins inside or outside the body near the anus. They are created from a lot of pressure being used to pass feces and can be very painful. If the hemorrhoids cause constant bleeding that leads to significant blood loss and anemia, a decrease in the number of red blood cells, or f they cause fissures, it is rated 20%. If there are blood clots inside the swollen veins, the swelling can’t go down, and there is a lot of redundant tissue, it is rated 10%. If they are only moderate with occasional bleeding, it is rated 0%. If I stated that it should be secondary to IBS but maybe it should be secondary to Anemia or my Eating Disorder, do I need to add those comments to ensure that the secondary contention doesn't get denied? Obviously the secondary contention was not in-service related but is aggravated by the current s/c contention. Also, anyone who has had a C&P exam for this type of claim, can you tell me your experience with this exam? It's a bit embarrassing already but understand I have to go through it. Anyone with knowledge on secondary contentions? UPDATE: I filed for secondary to my IBS but I have since found documentation in my SMR's that I had medical notes indicating I had hemorrhoids in-service as well. I also had colonoscopies in-service that discovered hemorrhoids internal/external. I did not provide that evidence to the VA b/c I am going under the assumption it should be secondary to IBS. Now I am wondering if I should submit that SMR's evidence showing I also had hemorrhoids? All my SMR's for many years show chronic diarrhea and issues relating to all of this. I know I don't need to supply those SMR's b/c I am already s/c for Chronic diarrhea/IBS. I filed an FDC claim, but since I am under a DRO decision, I was told that it wouldn't be an FDC claim anyways, but rather a traditional claim so what do I have to lose right? I think I would rather submit the concrete evidence sooner than later.
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