38 CFR Part 4 — 38 CFR § 4.114
Rectum And Anus Impairment Of Sphincter Control
dc-7332-rectum-and-anus-impairment-of-sphincter-control
Digestive
Diagnostic code
7332
Why your DC matters: DC 7332 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 7332 — Rectum And Anus Impairment Of Sphincter Control — is listed under 38 CFR § 4.114 in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Educational index row from the rating schedule naming convention; confirm exact diagnostic code, effective date, and criteria in the current eCFR Part 4.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (7332) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “7332”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 7332 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 7332 in the subpart for your body system (use Find in Page if needed).
DC 7332 (impairment of sphincter control) is one of the most underclaimed secondaries to spine and TBI conditions — fecal incontinence from cauda equina involvement, spinal cord injury, severe radiculopathy, or post-traumatic neurogenic bowel commonly goes unreported due to embarrassment but is rateable up to 100%. Tier ladder driven by leakage frequency and bowel-program response: 0% (history asymptomatic), 10% (responsive to program/medication/diet OR incontinence ≥ once every 6 months), 30% (program with digital stimulation/medication/diet OR incontinence ≥ 2/month), 60% (partially responsive to program OR incontinence ≥ 2/week + pad use), 100% (complete loss unresponsive to bowel program OR incontinence ≥ 2/day + pad changes ≥ 2/day). Critical cross-link: this is the #1 missed secondary to spine conditions (DC 5243 IVDS, DC 5237 lumbar strain) with cauda equina involvement, sacral nerve injury (DC 8530), or post-TBI (DC 8045) autonomic dysfunction.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 100% | Complete loss of sphincter control unresponsive to bowel program; OR incontinence 2+ times daily requiring pad changes 2+ times daily. | Specialist documentation of failed bowel program; incontinence diary documenting daily leakage + pad change frequency. |
| 60% | Complete or partial loss of sphincter control PARTIALLY responsive to bowel program; OR incontinence 2+ times weekly with pad use 2+ times weekly. | Specialist documentation of partial response to bowel program; incontinence diary documenting weekly leakage + pad use. |
| 30% | Complete or partial loss of sphincter control FULLY responsive to bowel program (with digital stimulation, medication, or diet); OR incontinence 2+ times monthly. | Specialist documentation of bowel program managing symptoms (digital stimulation, fiber, anti-diarrheals); incontinence diary documenting monthly leakage. |
| 10% | Loss of sphincter control responsive to bowel program (with medication or diet); OR incontinence at least once every 6 months. | Provider documentation of symptoms managed by diet/medication; incontinence diary documenting episodic leakage. |
| 0% | History of loss of sphincter control, currently asymptomatic. | Diagnostic history without current symptoms. |
What Qualifies Under DC 7332?
Impairment of anal sphincter control (fecal incontinence)
Loss of voluntary control over rectal/anal sphincter resulting in involuntary passage of stool, mucus, or gas. Etiologies: neurogenic (spine, spinal cord, cauda equina, sacral nerve injury, TBI, MS), post-surgical (anorectal surgery, hemorrhoidectomy), post-obstetric (in female veterans), post-radiation.
Tier ladder driven by frequency + bowel program response
Tiers map to leakage frequency and program response:
- • 0% — History only, asymptomatic
- • 10% — Responsive to medication/diet OR ≥ once/6 months
- • 30% — Program with digital stim/medication/diet OR ≥ 2/month
- • 60% — Partially responsive to program OR ≥ 2/week + pad use
- • 100% — Unresponsive to program OR ≥ 2/day + pad changes ≥ 2/day
Direct secondary to SC neurologic conditions
Spine injury (DC 5237/5243), spinal cord injury, cauda equina syndrome, severe radiculopathy (DC 8520), sacral nerve injury, TBI (DC 8045) autonomic dysfunction. Each is a predicate SC condition.
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“Complete loss UNRESPONSIVE to bowel program; OR incontinence 2+ times daily requiring pad changes 2+ times daily”
100% gate. Two disjunctive paths: (1) failed bowel program despite specialist intervention, (2) daily incontinence + daily pad changes. Either anchors 100%.
“PARTIALLY responsive to bowel program; OR incontinence 2+ times weekly with pad use 2+ times weekly”
60% gate. 'Partially responsive' is the qualitative distinction from 30% (fully responsive) and 100% (unresponsive). Weekly incontinence + pad use is the frequency alternative.
“FULLY responsive to bowel program with digital stimulation/medication/diet; OR incontinence 2+ times monthly”
30% gate. Bowel program WORKS but is required to maintain continence. Document the program elements (digital stim, fiber, anti-diarrheals) explicitly.
“Symptoms responsive to medication/diet; OR incontinence at least once every 6 months”
10% floor. Even episodic leakage every 6 months anchors 10%. Don't accept 0% for any documented incontinence.
“Cauda equina syndrome / spinal cord injury / sacral nerve root injury / post-TBI autonomic dysfunction”
DC 7332 is direct secondary to multiple neurologic conditions affecting sacral nerve roots (S2-S4) or central nervous system control. Primary etiology drives SC pathway.
Evidence Checklist — Specific to This Condition
Specialist consult (gastroenterology or colorectal surgery) documenting sphincter dysfunction
CRITICALAnchors the diagnosis. Anorectal manometry, MRI defecography, EMG of pelvic floor may be performed.
Incontinence diary — frequency, volume, pad use, pad changes
CRITICALDrives the tier directly. Document each leakage event over 30-day window minimum.
Bowel program documentation — digital stimulation, fiber, anti-diarrheals, suppositories, enemas
CRITICALDocuments treatment intensity. Bowel program response category (fully, partially, unresponsive) drives tier 30%/60%/100%.
Underlying neurologic condition documentation (if secondary)
CRITICALSpine injury, cauda equina, spinal cord injury, severe radiculopathy, TBI, sacral nerve injury. Establishes SC pathway.
Pad usage logs / pharmacy records
IMPORTANTAdult incontinence pad / brief usage anchors pad-use criteria. DME or pharmacy records.
Quality of life impact statements
IMPORTANTSocial withdrawal, employment impact, intimate relationship impact. Supports higher tier characterization.
C&P Exam Tips
Bring incontinence diary covering 30+ days with frequency + pad use documented
Most critical evidence document. Drives tier directly.
Bring specialist consult documenting sphincter dysfunction + bowel program
GI or colorectal surgery consult anchors diagnosis. Bowel program response category determines tier.
Bring underlying neurologic condition documentation
Spine MRI showing cauda equina involvement, spinal cord injury record, post-TBI assessment. Establishes SC pathway.
Don't minimize from embarrassment — this is rateable up to 100%
Fecal incontinence is the most underreported secondary due to social stigma. The schedule recognizes it as significantly disabling. Describe specific examples — social events avoided, employment impact, pad changes per day.
Don't lump with general 'bowel problems'
DC 7332 is SPECIFICALLY for sphincter control / incontinence. IBS goes under DC 7319, ulcerative colitis under DC 7323, Crohn's under DC 7326. Distinct DCs.
Common Mistakes That Cost Veterans Points
Never filing fecal incontinence as a secondary to spine condition
Spine conditions (DC 5237 lumbar strain, DC 5243 IVDS) with cauda equina involvement, severe radiculopathy, or sacral nerve root injury commonly cause fecal incontinence. The #1 missed secondary. File aggressively.
Underreporting frequency due to embarrassment
Veterans commonly normalize fecal incontinence and don't tell providers. The schedule recognizes the disability — describe accurately. Each tier 10%/30%/60%/100% has specific frequency criteria.
Settling for 10% when bowel program supports 30%+
If you require a structured bowel program (digital stimulation, scheduled toileting, fiber + anti-diarrheal regimen) to maintain continence, that's 30% — 'fully responsive to bowel program.' If only partially responsive, 60%. If unresponsive, 100%.
Not pursuing the predicate neurologic SC
If sphincter control impairment is secondary to spine/TBI/spinal cord injury, the predicate must be SC. If predicate isn't SC, pursue both the predicate and the secondary.
Tactical Plays
⚡ File aggressively as secondary to SC spine condition
Spine conditions (DC 5237 lumbar strain, DC 5243 IVDS) with cauda equina involvement, severe radiculopathy (DC 8520), or sacral nerve root injury commonly cause fecal incontinence. This is the #1 missed secondary to spine conditions. If you have SC spine + ANY bowel control symptoms, file the DC 7332 secondary.
⚡ Maintain a 30-day incontinence diary — anchors every tier
DC 7332 tiers map directly to frequency: ≥ once/6 months = 10%, ≥ 2/month = 30%, ≥ 2/week + pad use = 60%, ≥ 2/day + pad changes ≥ 2/day = 100%. Without a diary, examiners default to lower tiers. Document each leakage event + pad use over a 30-day minimum window.
⚡ Anchor bowel program response category — 30%/60%/100% gates
Bowel program response category is the qualitative tier driver: fully responsive (program controls symptoms) = 30%, partially responsive = 60%, unresponsive (failed despite specialist intervention) = 100%. Get the response category explicitly charted in specialist notes.
⚡ Stack urinary incontinence + ED — same sacral nerve injury anatomy
Cauda equina, spinal cord, or sacral nerve injuries affecting bowel sphincter also affect bladder and sexual function. Urinary incontinence (DC 7517/7518), ED (DC 7522 + SMC-K), and fecal incontinence (DC 7332) frequently coexist. Each rates separately. SMC-K is automatic for ED.
⚡ Push past embarrassment — this is the most underreported secondary
Fecal incontinence is profoundly stigmatized. Many veterans normalize it and never tell providers, let alone file claims. The schedule recognizes it as significantly disabling — rateable up to 100%. Describe accurately during C&P exams; specific examples (social events avoided, daily pad changes, intimate impact) anchor higher tiers.
Secondary Conditions to File With This One
Underlying neurologic condition (predicate)
STRONGSpine injury (DC 5237/5243), spinal cord injury, cauda equina syndrome, severe radiculopathy (DC 8520), sacral nerve injury (DC 8530), TBI (DC 8045) with autonomic dysfunction. The predicate drives SC pathway.
Urinary incontinence (frequently coexists)
STRONGDC 7517 / 7518
Cauda equina / spinal cord / sacral nerve injuries affecting bowel sphincter also affect bladder. Urinary incontinence rates separately under § 4.115b voiding dysfunction codes.
Erectile dysfunction (S2-S4 nerve injury)
STRONGDC 7522
Same sacral nerve roots that control sphincter also control erection. ED frequently coexists. Rates under DC 7522 + SMC-K trigger.
Skin breakdown / pressure ulcers (from incontinence)
MODERATEChronic incontinence causes perineal skin breakdown, dermatitis, secondary infections. Rates analogously under skin DCs.
Depression / social withdrawal secondary to chronic disability
STRONGDC 9434
Fecal incontinence has profound social/emotional impact. Depression and social isolation commonly comorbid. Direct secondary.
Sexual dysfunction / relationship impact
MODERATEDC 9434
Intimacy impact drives mental health secondaries. Often layered with primary ED and depression.
Special Monthly Compensation (SMC-K (statutory specific loss) via cross-link to ED secondary)
DC 7332 itself doesn't trigger SMC. However, the underlying sacral nerve injury commonly causes erectile dysfunction (DC 7522) — which triggers SMC-K automatically ($139.87/mo). Higher SMC tiers if combined with other secondaries reaching SMC-S or SMC-L predicate.
SMC-K (statutory specific loss) via cross-link to ED secondary monthly add-on
+$139.87
Added on top of your schedular rating.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Leakage ≥ once every 6 months OR controlled by medication/diet.
30% — single, no dependents
Base rating
$552.47
TOTAL
$552.47/mo
Bowel program with digital stim/medication/diet OR leakage ≥ 2/month.
60% — single, no dependents
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Partially responsive to program OR leakage ≥ 2/week + pad use.
100% — single, no dependents
Base rating
$3,938.58
TOTAL
$3,938.58/mo
Unresponsive to program OR leakage ≥ 2/day + pad changes ≥ 2/day.
60% DC 7332 + 60% DC 7517 urinary incontinence + 0%+SMC-K DC 7522 ED (same-anatomy stack)
Base rating
$2,242.02
TOTAL
$2,242.02/mo
Cauda equina or sacral nerve injury triple-stack — high yield.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
📅What is a 'Bowel Program' for the rating?
A bowel program is a structured regimen for managing neurogenic or impaired sphincter control: scheduled toileting (typically same time daily), digital stimulation of the anorectum to trigger evacuation, fiber supplementation, stool softeners or anti-diarrheals as needed, suppositories or enemas, and pelvic floor exercises. Response category — fully responsive, partially responsive, or unresponsive — drives the 30%/60%/100% gate.
💡Why is this so commonly missed as a spine secondary?
Spine conditions causing cauda equina compression, severe radiculopathy, or sacral nerve root injury commonly produce subtle sphincter dysfunction — not complete incontinence, but reduced sensation, urgency, occasional leakage. Veterans normalize the symptoms and rarely volunteer them. Providers rarely ask. The #1 missed secondary to spine conditions. If you have SC spine + ANY bowel control symptoms, file aggressively.
↔️What's the difference between DC 7332 and IBS (DC 7319)?
DC 7332 is SPECIFICALLY for impaired sphincter control — fecal incontinence from neurogenic, post-surgical, or post-traumatic causes. IBS (DC 7319) is for irritable bowel syndrome with diarrhea, constipation, abdominal pain. Different conditions, different DCs. Can coexist (IBS-D with secondary fecal incontinence if severe), but rate under the correct primary DC.
🔗How does this relate to ED and bladder dysfunction?
The sacral nerve roots S2-S4 control bowel sphincter, bladder, AND erectile function. Injury at this level commonly produces all three: fecal incontinence (DC 7332), urinary incontinence (DC 7517/7518), and erectile dysfunction (DC 7522 + SMC-K). If one is SC, the others should be aggressively pursued as same-anatomy secondaries.
How to File Your Claim
Identify predicate SC condition (spine, TBI, sacral nerve)
Anchors the secondary pathway. If predicate isn't yet SC, pursue both.
Get specialist (GI or colorectal surgery) consult documenting sphincter dysfunction
Anchors the diagnosis. May include anorectal manometry or MRI defecography.
Maintain 30-day incontinence diary + bowel program documentation
Drives tier directly. Pad use, pad changes, leakage frequency all documented.
File 21-526EZ specifying 'impairment of sphincter control (DC 7332)' as secondary to SC [predicate]
Cite the predicate explicitly in claim narrative.
Stack urinary incontinence + ED as same-anatomy secondaries
Same sacral nerve roots. DC 7517/7518 (urinary), DC 7522 + SMC-K (ED).
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
#1 missed secondary to spine conditions
Cauda equina, severe radiculopathy, sacral nerve injury commonly cause subtle sphincter dysfunction. File aggressively.
Bowel program response drives 30%/60%/100% gates
Fully responsive = 30%, partially = 60%, unresponsive = 100%. Get the response category explicitly charted.
Same-anatomy stack — ED + urinary incontinence
S2-S4 sacral nerves control all three. File each separately. SMC-K automatic for ED.
Push past embarrassment — rateable up to 100%
Most underreported secondary due to stigma. Schedule recognizes severe disability — describe accurately.
Related Tools & Resources
Frequently Asked Questions
Can I file fecal incontinence as a secondary to my service-connected back condition?
Yes — fecal incontinence (DC 7332) is the #1 missed secondary to spine conditions. Cauda equina syndrome, severe radiculopathy (DC 8520), or sacral nerve root injury from SC spine conditions (DC 5237 lumbar strain, DC 5243 IVDS) commonly causes sphincter dysfunction. If you have SC spine + ANY bowel control symptoms — urgency, occasional leakage, reduced sensation — file the DC 7332 secondary aggressively.
How do I document frequency for the rating tiers?
Maintain a 30-day incontinence diary. Document each leakage event (date/time/volume), pad use, and pad changes. The tier ladder maps directly to frequency: ≥ once/6 months = 10%, ≥ 2/month = 30%, ≥ 2/week + pad use = 60%, ≥ 2/day + pad changes ≥ 2/day = 100%. Without a diary, examiners default to lower tiers.
What's a 'bowel program' for the rating?
A bowel program is a structured regimen for managing impaired sphincter control: scheduled toileting, digital stimulation of the anorectum, fiber supplementation, stool softeners or anti-diarrheals, suppositories or enemas, pelvic floor exercises. Response category drives the gate: fully responsive (program controls symptoms) = 30%, partially responsive = 60%, unresponsive (failed despite specialist intervention) = 100%.
Should I file urinary incontinence and ED separately?
Yes — the sacral nerve roots S2-S4 control bowel sphincter, bladder, AND erectile function. Injury at this level commonly produces all three. Urinary incontinence rates under DC 7517/7518 (§ 4.115b voiding dysfunction codes), and erectile dysfunction rates under DC 7522 with automatic SMC-K trigger ($139.87/mo). Same-anatomy stack — file each separately.
How can I overcome the embarrassment of describing this at my C&P exam?
Recognize that fecal incontinence is profoundly disabling and the schedule rates it up to 100% for that reason. Examiners are professionals and have heard it all. Describe accurately — frequency, pad use, social events you've stopped attending, employment impact, intimate relationship impact. Bring written documentation (diary, specialist notes) so you don't have to verbalize every detail.
Official Regulatory Source
Impairment of sphincter control rates under 38 CFR § 4.114, DC 7332 — 0/10/30/60/100% based on frequency + bowel program response.
38 CFR § 4.114 — Digestive System (eCFR) →Scroll to DC 7332. Cross-reference DC 5243 (IVDS), DC 5237 (lumbar strain), DC 8520 (sciatic nerve), DC 8530 (sacral nerves), DC 8045 (TBI) for predicate conditions. Stack with DC 7517 (urinary incontinence) and DC 7522 (ED) for same-anatomy secondaries.
Next Steps
If your rating decision lists DC 7332, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 7332 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.