38 CFR Part 4 — 38 CFR § 4.114
Rectum Anus Stricture
dc-7333-rectum-anus-stricture
Digestive
Diagnostic code
7333
Why your DC matters: DC 7333 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 7333 — Rectum Anus Stricture — 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 (7333) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “7333”. 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 7333 (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 7333 in the subpart for your body system (use Find in Page if needed).
DC 7333 (stricture of rectum and anus) rates on a severity-driven ladder from 10% (luminal narrowing managed by diet) to 100% (inability to open the anus with inability to expel solid feces). Common etiologies: post-surgical (after hemorrhoidectomy, anal fistula repair, fissurectomy, colorectal resection with low anastomosis), post-radiation (pelvic radiation for prostate, gynecologic, rectal cancer), post-inflammatory (Crohn's perianal disease, ulcerative colitis), congenital, or trauma-related. Tier ladder driven by luminal reduction percentage and functional impact: 10% (narrowing managed by dietary intervention), 30% (<50% lumen reduction + straining), 60% (≥50% lumen reduction + pain + straining), 100% (inability to open anus + inability to expel solid feces).
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 100% | Inability to open the anus with inability to expel solid feces. | Colorectal surgery consult documenting near-complete stricture; manometry; imaging (MRI / endorectal ultrasound); colostomy if performed for diversion. |
| 60% | Reduction of the lumen 50% or more, with pain and straining during defecation. | Endorectal ultrasound or manometry quantifying lumen reduction ≥ 50%; chart documentation of pain + straining symptoms. |
| 30% | Reduction of the lumen by less than 50%, with straining during defecation. | Endorectal ultrasound or manometry quantifying lumen reduction < 50%; chart documentation of straining. |
| 10% | Luminal narrowing with or without straining, managed by dietary intervention. | Documented diagnosis of stricture + dietary modification (stool softeners, high-fiber, soft diet) prescribed for management. |
What Qualifies Under DC 7333?
Stricture of rectum or anus
Pathologic narrowing of the rectal or anal canal. Etiologies: post-surgical (hemorrhoidectomy, fistula repair, low colorectal resection), post-radiation (pelvic radiation for cancer), post-inflammatory (Crohn's, UC), congenital, traumatic.
Tier ladder driven by lumen reduction + symptoms
Tiers map to severity:
- • 10% — Luminal narrowing managed by dietary intervention
- • 30% — Lumen reduction < 50% with straining
- • 60% — Lumen reduction ≥ 50% with pain AND straining
- • 100% — Inability to open anus with inability to expel solid feces
Direct secondary to SC procedure / radiation / inflammatory disease
Post-surgical, post-radiation, post-inflammatory strictures are direct secondaries to the SC predicate condition. Build the secondary file aggressively.
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.
“Inability to open the anus with inability to expel solid feces”
100% gate. Anchor with colorectal surgery consult documenting near-complete stricture preventing solid stool passage. May require diversion (colostomy) — colostomy itself is a separate consideration but stricture rating remains 100%.
“Lumen reduction ≥ 50% + pain + straining during defecation”
60% gate. Quantitative lumen measurement (endorectal ultrasound or manometry) is the cleanest anchor for ≥ 50% reduction. Pain AND straining both required.
“Lumen reduction < 50% + straining during defecation”
30% gate. Quantitative measurement showing < 50% lumen reduction + chart documentation of straining (without pain — that would escalate to 60%).
“Luminal narrowing managed by dietary intervention”
10% floor. Stool softeners, fiber, soft diet anchor 10% even without quantified lumen reduction.
“Post-surgical / post-radiation / post-inflammatory / post-traumatic”
Etiology determines SC pathway. Post-surgical or post-radiation strictures secondary to SC condition = direct secondary.
Evidence Checklist — Specific to This Condition
Colorectal surgery or GI consult documenting stricture
CRITICALAnchor diagnosis. Digital rectal exam, anoscopy, sigmoidoscopy, manometry, endorectal ultrasound, MRI.
Quantitative lumen measurement (endorectal ultrasound, manometry, defecography)
CRITICALDrives 30% vs. 60% gate. < 50% vs. ≥ 50% lumen reduction is the qualitative split.
Symptom documentation — straining, pain, incomplete evacuation, dietary modification
CRITICALMaps to tier. Straining alone = 30%, straining + pain = 60%.
Etiology documentation — surgical, radiation, inflammatory, traumatic
CRITICALAnchors SC pathway. Post-surgical secondary to SC procedure, post-radiation secondary to SC cancer treatment.
Dietary modification documentation
IMPORTANTStool softeners, high-fiber, soft diet anchor 10% tier even without higher severity.
Treatment records — dilatation procedures, surgical revision, colostomy
IMPORTANTDocuments treatment intensity. Recurrent dilatation needed = severity indicator. Colostomy diversion = severe.
C&P Exam Tips
Bring colorectal surgery consult + quantitative lumen measurement
Endorectal ultrasound or manometry quantifying lumen reduction is the cleanest anchor.
Bring symptom diary documenting straining, pain, incomplete evacuation
Straining alone = 30%; straining + pain = 60%.
Bring dietary modification documentation
Stool softeners, fiber, soft diet anchor 10% tier minimum.
Bring etiology documentation establishing SC pathway
Post-surgical, post-radiation, post-inflammatory, post-traumatic — each anchors a different SC pathway.
Don't accept 0% with documented stricture + symptoms
Even managed-by-diet stricture anchors 10% minimum. Push for quantitative measurement to anchor higher tier.
Common Mistakes That Cost Veterans Points
Not pursuing post-surgical stricture as direct secondary
Strictures commonly develop after anorectal surgery (hemorrhoidectomy, anal fistula repair, fissurectomy) or low colorectal resection. If predicate surgery is SC, the stricture is direct secondary.
Not pursuing post-radiation stricture as direct secondary
Pelvic radiation for SC cancer (prostate DC 7528, gynecologic, rectal) commonly causes anorectal stricture as late effect. Direct secondary pathway.
Settling for 10% when quantitative measurement supports 30%-60%
Push for endorectal ultrasound or manometry to quantify lumen reduction. < 50% with straining = 30%; ≥ 50% with pain + straining = 60%.
Filing under wrong DC for related conditions
Stricture = DC 7333. Sphincter control impairment = DC 7332. Anal fistula = DC 7335. Each is distinct. Match the predominant pathology to the correct DC.
Not stacking sphincter control if both present
Severe stricture commonly causes sphincter dysfunction. If both stricture and sphincter impairment are documented, consider both DCs (note § 4.114 anti-pyramiding language for the 7301-7329 range — DC 7332 and 7333 fall in 7330-7335 range, which has different stacking rules; check specific language for your combination).
Tactical Plays
⚡ Pursue as direct secondary to SC anorectal surgery / radiation
Strictures commonly develop after anorectal surgery (hemorrhoidectomy, fistula repair, fissurectomy) or pelvic radiation for SC cancer (prostate, gynecologic, rectal). If the predicate procedure is service-connected, the resulting stricture is a direct secondary. Build the secondary file aggressively.
⚡ Quantify lumen reduction — anchors 30% vs. 60% gate
Endorectal ultrasound, anorectal manometry, or MRI defecography quantifies luminal narrowing. < 50% lumen reduction + straining = 30%; ≥ 50% lumen reduction + pain + straining = 60%. Without quantitative measurement, raters often default to lower tier.
⚡ Stack DC 7332 sphincter control if compensatory incontinence
Severe stricture causes compensatory sphincter dysfunction — paradoxical incontinence as fluid stool leaks around obstruction. Check § 4.114 anti-pyramiding language for your specific DC combination, but DC 7333 + DC 7332 stacking is often appropriate for distinct functional impacts.
⚡ Pursue Crohn's / UC direct secondary if perianal disease
IBD with perianal involvement (Crohn's especially) causes recurrent strictures + fistulas. If IBD (DC 7326 Crohn's, DC 7323 UC) is SC, the anorectal stricture is direct secondary. Often the IBD entry is missed and only the resulting complication is rated.
Secondary Conditions to File With This One
Prior anorectal or colorectal surgery (predicate)
STRONGHemorrhoidectomy, anal fistula repair, fissurectomy, low colorectal resection. Post-surgical stricture is direct secondary if predicate surgery is SC.
Pelvic radiation for SC cancer (predicate)
STRONGProstate (DC 7528), gynecologic, rectal cancer radiation commonly causes anorectal stricture as late effect. Direct secondary.
Crohn's perianal disease / Ulcerative colitis
STRONGDC 7326 / 7323
IBD with perianal involvement causes stricture. If IBD is SC, stricture is direct secondary.
Impairment of sphincter control
STRONGDC 7332
Severe stricture commonly causes sphincter dysfunction (compensatory incontinence). Rates separately under DC 7332 (note anti-pyramiding language).
Anal fistula
MODERATEDC 7335
Stricture and fistula commonly coexist in Crohn's or post-surgical settings. Each rates separately.
Constipation / fecal impaction
MODERATEStricture causes mechanical obstruction → chronic constipation, fecal impaction. May rate analogously under digestive function codes.
Depression secondary to chronic GI condition
MODERATEDC 9434
Chronic anorectal symptoms + dietary restriction + procedure burden drive depression. Well-documented.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Luminal narrowing managed by dietary intervention.
30% — single, no dependents
Base rating
$552.47
TOTAL
$552.47/mo
Lumen reduction < 50% with straining during defecation.
60% — single, no dependents
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Lumen reduction ≥ 50% with pain + straining.
100% — single, no dependents
Base rating
$3,938.58
TOTAL
$3,938.58/mo
Inability to open anus with inability to expel solid feces.
60% DC 7333 + secondary to SC hemorrhoidectomy or pelvic radiation
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Post-surgical or post-radiation secondary.
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
📏How is luminal reduction measured?
Endorectal ultrasound or anorectal manometry directly visualizes and quantifies stricture caliber. MRI or defecography may also be used. The < 50% vs. ≥ 50% threshold is the qualitative split between 30% and 60% tier — push for quantitative measurement to anchor the higher tier.
🔬What causes anorectal strictures?
Most common etiologies: (1) post-surgical (especially hemorrhoidectomy, anal fistula repair, fissurectomy, low colorectal resection), (2) post-radiation (pelvic radiation for prostate, gynecologic, rectal cancer — often emerges months to years after treatment as late effect), (3) post-inflammatory (Crohn's perianal disease, ulcerative colitis), (4) traumatic (anorectal injury), (5) congenital (rare).
💯Does dietary management mean no rating?
No — even stricture managed by dietary intervention (stool softeners, fiber supplementation, soft diet) anchors 10% rating minimum. Don't accept 0% for documented stricture with any management requirement. Push for quantitative measurement to potentially anchor higher tier.
↔️How does DC 7333 interact with DC 7332 (sphincter control)?
Severe stricture commonly causes compensatory sphincter dysfunction — paradoxical fecal incontinence as fluid stool leaks around the obstruction. DC 7333 (stricture) and DC 7332 (sphincter control impairment) can both apply for distinct functional impacts. Note: § 4.114 has anti-pyramiding language for the 7301-7329 range, but both 7332 and 7333 fall in a different sub-range — check specific stacking language for your combination.
How to File Your Claim
Identify etiology + predicate SC condition
Post-surgical, post-radiation, post-inflammatory. If predicate is SC, file as direct secondary.
Get colorectal surgery / GI consult documenting stricture + quantitative lumen measurement
Endorectal ultrasound, manometry, or MRI defecography. Quantifies < 50% vs. ≥ 50% lumen reduction.
Document symptoms — straining, pain, dietary modification, treatment frequency
Drives tier directly. Straining alone = 30%; straining + pain = 60%; dietary management alone = 10%.
File 21-526EZ specifying 'rectal/anal stricture (DC 7333)' as secondary if applicable
Cite predicate SC condition explicitly.
Stack DC 7332 sphincter control if compensatory incontinence
Severe stricture causes paradoxical incontinence. Check stacking rules.
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
Direct secondary to SC anorectal surgery / radiation
Post-surgical or post-radiation stricture is direct secondary to the predicate SC procedure or treatment.
Quantitative lumen measurement anchors higher tier
Endorectal ultrasound or manometry quantifies < 50% vs. ≥ 50% reduction. Push for it.
Dietary management = 10% minimum
Don't accept 0% for documented stricture with any management requirement.
Compensatory sphincter dysfunction may stack under DC 7332
Severe stricture causes paradoxical incontinence. Check stacking rules in § 4.114.
Related Tools & Resources
Frequently Asked Questions
Can I file rectal stricture as secondary to my service-connected hemorrhoid surgery?
Yes — strictures commonly develop after anorectal surgery, especially hemorrhoidectomy, anal fistula repair, and fissurectomy. If the predicate surgery is service-connected (e.g., hemorrhoidectomy for SC hemorrhoids under DC 7336), the resulting stricture is a direct secondary under DC 7333. Build the secondary file with colorectal surgery consult + quantitative lumen measurement.
Can pelvic radiation cause anorectal stricture as a late effect?
Yes — pelvic radiation for service-connected cancer (prostate DC 7528, gynecologic, rectal) commonly causes anorectal stricture as a late effect, often emerging months to years after treatment. Direct secondary pathway. Document the radiation history + post-treatment timeline + current stricture findings.
How do I document the lumen reduction percentage?
Push for quantitative measurement: endorectal ultrasound, anorectal manometry, or MRI defecography. These directly visualize and quantify the stricture caliber. The < 50% vs. ≥ 50% threshold is the qualitative split between 30% and 60% tier — without quantitative documentation, raters often default to lower tier.
What's the 100% gate for DC 7333?
100% requires 'inability to open the anus with inability to expel solid feces' — essentially complete obstruction preventing solid stool passage. Anchored by colorectal surgery consult documenting near-complete stricture; may require colostomy diversion. Severe stricture from chronic radiation injury or end-stage Crohn's disease can reach this tier.
Can I file both DC 7333 (stricture) and DC 7332 (sphincter impairment) at the same time?
Often yes — severe stricture commonly causes compensatory sphincter dysfunction (paradoxical fecal incontinence as fluid stool leaks around obstruction). Both DCs address distinct functional impacts. Note that § 4.114 has anti-pyramiding language for the 7301-7329 range, but both 7332 and 7333 fall in a different sub-range — check the specific stacking language for your combination, or consult a VSO.
Official Regulatory Source
Stricture of rectum and anus rates under 38 CFR § 4.114, DC 7333 — 10/30/60/100% based on lumen reduction percentage + symptoms.
38 CFR § 4.114 — Digestive System (eCFR) →Scroll to DC 7333. Compare DC 7332 (sphincter control impairment), DC 7335 (anal fistula), DC 7336 (hemorrhoids) for related anorectal conditions. Post-surgical stricture is direct secondary to predicate SC procedure.
Next Steps
If your rating decision lists DC 7333, 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 7333 • 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.