38 CFR Part 4 — 38 CFR § 4.114
Ano Fistula In Including Anorectal Fistula Anorectal Abscess
dc-7335-ano-fistula-in-including-anorectal-fistula-anorectal-abscess
Digestive
Diagnostic code
7335
Why your DC matters: DC 7335 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 7335 — Ano Fistula In Including Anorectal Fistula Anorectal Abscess — 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 (7335) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “7335”. 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 7335 (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 7335 in the subpart for your body system (use Find in Page if needed).
DC 7335 covers anorectal fistula and abscess — a common Crohn's disease secondary that veterans typically file under the underlying IBD code alone, missing the separate rating. The schedule rates by number of simultaneous fistulas + complications (abscess, drainage, pain). Refractory perianal Crohn's reaches 60% under DC 7335 by itself, on top of whatever Crohn's (DC 7326) or ulcerative colitis (DC 7323) rating you already have. Files cleanly without pyramiding because the codes address different structures.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 60% | More than two constant or near-constant fistulas with abscesses, drainage, and pain, which are refractory to medical and surgical treatment. | Colorectal surgery / GI notes documenting > 2 fistulas + failed multiple repair attempts + ongoing abscesses + chronic drainage. |
| 40% | One or two simultaneous fistulas, with abscess, drainage, and pain. | Exam or imaging confirming 1-2 fistulas + abscess + drainage. |
| 20% | Two or more simultaneous fistulas with drainage and pain, but without abscesses. | Exam confirming 2+ fistulas + drainage but no current abscess. |
| 10% | One fistula with drainage and pain, but without abscess. | Exam confirming single fistula + drainage. |
What Qualifies Under DC 7335?
Confirmed anal fistula or anorectal abscess
Persistent fistula tract between anal canal and perianal skin, or recurrent abscess. Diagnosed by colorectal surgery, GI, or imaging.
Tier driven by count + complications
DC 7335 schedule:
- • 10% — 1 fistula with drainage and pain (no abscess)
- • 20% — 2+ fistulas with drainage and pain (no abscess)
- • 40% — 1-2 fistulas with abscess, drainage, and pain
- • 60% — > 2 constant/near-constant fistulas with abscesses, refractory to treatment
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.
“More than two constant or near-constant fistulas, refractory to medical and surgical treatment”
60% gate. Requires both > 2 fistulas AND failed treatment history. Document fistulotomy attempts, seton placement, biologic therapy failures. 'Refractory' is the rater's hook.
“One or two simultaneous fistulas with abscess, drainage, and pain”
All three (abscess + drainage + pain) required at 40%. Without active abscess, drops to 20%.
“Number of simultaneous fistulas”
10% = 1 fistula; 20% = 2 or more. Count carefully — colorectal surgery notes or pelvic MRI usually documents this.
Evidence Checklist — Specific to This Condition
Colorectal surgery or GI evaluation
CRITICALDocuments number of fistulas, abscess status, drainage. Pelvic MRI or endoanal ultrasound visualizes fistula tracts.
Treatment history (fistulotomy, seton, biologics)
CRITICALFailed treatment chain anchors 'refractory' for 60%. Document each procedure + outcome.
Pelvic MRI / endoanal ultrasound
IMPORTANTVisualizes fistula anatomy + abscess collections. Required for accurate fistula count.
Underlying IBD diagnosis (Crohn's, UC)
IMPORTANTEstablishes the perianal Crohn's pathway. DC 7326 (Crohn's) + DC 7335 (fistula) rate separately.
Symptom diary (drainage, pain, episodes)
SUPPORTINGChronicity and frequency support tier escalation.
C&P Exam Tips
Bring colorectal surgery operative reports
Documents fistula anatomy, prior procedures, treatment failures.
Bring pelvic MRI or endoanal ultrasound
Visualizes fistula tracts and current abscesses. Anchors the diagnosis objectively.
Describe drainage and pain in concrete terms
'Constant drainage requiring daily pads, sharp pain on defecation' beats 'sometimes hurts.'
Don't accept the underlying IBD code alone
If you have Crohn's + perianal fistulas, file BOTH DC 7326 (Crohn's) AND DC 7335 (fistula) — they address different structures and don't pyramid.
Common Mistakes That Cost Veterans Points
Filing only under DC 7326 / 7323 when fistulas are present
Perianal Crohn's fistulas rate separately under DC 7335. Many veterans miss this — file both.
Not documenting 'refractory' status for 60%
60% requires failed multiple medical and surgical treatments. Document each fistulotomy attempt, seton placement, biologic failure with dates.
Settling for 10% without an accurate fistula count
Pelvic MRI often reveals multiple fistula tracts not visible on exam. Get imaging to support 20%+.
Missing the surgical scar secondary
Fistulotomy and seton procedures leave scars. DC 7804 (painful scar) rates separately if applicable.
Tactical Plays
⚡ File DC 7335 separately on top of any IBD rating
Crohn's (DC 7326) or UC (DC 7323) + perianal fistula (DC 7335) = separate ratings under different DCs addressing different structures. No pyramiding. Most veterans miss this stack.
⚡ Get pelvic MRI for accurate fistula count
Many fistula tracts are not visible on exam alone. MRI or endoanal ultrasound often reveals additional tracts that push the rating from 10% to 20%, or 20% to 40%.
⚡ Document treatment failure for 60% 'refractory' criterion
60% requires both > 2 fistulas AND refractory to medical/surgical treatment. Build the failed-treatment chain on paper — each seton placement, fistulotomy, biologic course tried and failed.
Secondary Conditions to File With This One
Crohn's disease (underlying cause)
STRONGDC 7326
Perianal Crohn's is the most common cause of complex fistulas. DC 7326 + DC 7335 rate separately.
Ulcerative colitis (underlying cause)
MODERATEDC 7323
Less common than Crohn's for fistulas, but UC can cause perianal disease. Both codes rate separately.
Iron deficiency anemia from chronic drainage
MODERATEDC 7720
Chronic perianal bleeding/drainage contributes to iron-deficiency anemia. Rate separately.
Painful surgical scar (post-fistulotomy)
SITUATIONALDC 7804
Fistula surgery leaves scars; rate separately if painful.
Mental health (chronic perianal disease)
MODERATEDC 9434
Chronic drainage, hygiene issues, and intimacy impact drive well-documented MH secondaries.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
1 fistula with drainage and pain, no abscess.
20% — single, no dependents
Base rating
$356.66
TOTAL
$356.66/mo
2+ fistulas with drainage and pain, no abscess.
40% — single, no dependents
Base rating
$795.84
TOTAL
$795.84/mo
1-2 fistulas with abscess, drainage, pain.
60% — single, no dependents
Base rating
$1,435.02
TOTAL
$1,435.02/mo
> 2 fistulas, refractory to treatment.
60% Crohn's + 40% fistula = combined
Base rating
$2,102.15
TOTAL
$2,102.15/mo
Stacking DC 7326 (Crohn's at 60%) + DC 7335 (fistula at 40%) ≈ 76% rounds to 80%. Different DCs, no pyramiding.
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's a 'simultaneous fistula'?
A fistula tract that is currently active and present at the time of evaluation. Resolved fistulas don't count toward the current tier count.
💊What does 'refractory' mean for 60%?
Failed multiple medical (antibiotics, biologics) and surgical (fistulotomy, seton placement, advancement flap) treatments. Refractoriness must be documented in chart with failed attempts and persistent disease.
↔️Why doesn't 7335 pyramid with Crohn's (7326)?
DC 7326 rates the underlying IBD impact on the GI tract. DC 7335 rates the structural perianal disease (fistula, abscess). They address different anatomical structures and don't pyramid.
How to File Your Claim
Get colorectal surgery or GI evaluation
Documents fistula count, anatomy, complications. Critical for tier assignment.
Get pelvic MRI or endoanal ultrasound
Visualizes occult fistula tracts and abscess collections.
Compile treatment failure history
Each fistulotomy, seton, biologic course tried and failed — documents 'refractory' for 60%.
File 21-526EZ specifying 'anal fistula (DC 7335)'
ADDITIONAL to any existing IBD rating (DC 7326 / 7323) — they don't pyramid.
Stack anemia, surgical scar, MH secondaries
Chronic drainage drives iron deficiency. Surgery scars are separately ratable. Hygiene/intimacy impact drives MH secondaries.
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
File on TOP of any IBD rating — they don't pyramid
DC 7326 Crohn's or DC 7323 UC rate the bowel disease; DC 7335 rates the perianal structure separately.
60% requires 'refractory' status
Document each failed treatment — fistulotomy, seton, biologic course. Refractoriness is the rater's hook.
Get MRI for accurate fistula count
Exam alone often undercounts. Imaging supports higher tiers.
Audit secondaries: anemia, scar, MH
Chronic perianal disease drives multiple secondary ratings.
Related Tools & Resources
Frequently Asked Questions
Can I file DC 7335 if I already have a Crohn's rating?
Yes — they don't pyramid. DC 7326 rates the IBD impact on the GI tract; DC 7335 rates the perianal structural disease (fistula, abscess). Different anatomical structures, separate ratings.
How do I get above the 10% rating for one fistula?
Get a pelvic MRI or endoanal ultrasound — imaging often reveals additional occult fistula tracts that push the rating to 20% (2+ fistulas) or 40% (with abscess). Exam alone undercounts.
What does 'refractory to treatment' mean for 60%?
Failed multiple medical and surgical treatments — fistulotomy attempts, seton placement, biologic therapy (infliximab, adalimumab), advancement flap procedures. Document each tried treatment and its failure outcome.
Can chronic drainage cause anemia as a secondary?
Yes — chronic perianal bleeding and drainage contribute to iron-deficiency anemia, rated under DC 7720. File the anemia separately with serial CBCs documenting low hemoglobin and ferritin.
Official Regulatory Source
Anal fistula and anorectal abscess are rated under 38 CFR § 4.114, DC 7335.
38 CFR § 4.114 — Digestive System (eCFR) →Scroll to DC 7335. § 4.114 was substantially restructured effective May 19, 2024.
⚠️ Verify with a VSO
§ 4.114 was restructured effective May 19, 2024. DC 7335 criteria may have been updated — verify current text on eCFR.
Next Steps
If your rating decision lists DC 7335, 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 7335 • 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.