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Evidence checklist

Rectal Prolapse

DC 733438 CFR § 4.114Digestive

Evidence strength

Mark what you already have below and your evidence strength appears here.

Target
Saved locally
01

Specialist opinion

Highest value0 of 4 collected
Proctologic examination documenting prolapse type, degree, and reducibilityCritical

Clinical examination documenting the type of rectal prolapse (partial/mucosal vs. complete/full-thickness), degree of protrusion during straining, reducibility, and associated symptoms (bleeding, mucus discharge, incontinence).

Private provider · independent opinion
Defecography or MRI defecography documenting prolapse during strainingCritical

Dynamic defecography (fluoroscopic or MRI) demonstrating rectal prolapse, intussusception, or pelvic floor dysfunction during simulated defecation — provides objective confirmation and grading.

Private provider · independent opinion
Nexus opinion linking rectal prolapse to service ("at least as likely as not")Critical

A medical opinion connecting rectal prolapse to service-related factors including chronic straining, pelvic floor trauma, difficult deliveries during service-connected conditions, or prior anorectal surgery during service.

Private provider · independent opinion
Anorectal manometry documenting sphincter dysfunction

Manometry results showing resting anal pressure, squeeze pressure, rectal sensation thresholds, and rectoanal inhibitory reflex — documents sphincter weakness contributing to prolapse and incontinence.

Private provider · independent opinion
02

Treating physician

0 of 1 collected
Fecal incontinence documentation and severity scoring

Clinical documentation of fecal incontinence severity (Wexner/Cleveland Clinic Incontinence Score or Fecal Incontinence Severity Index), including frequency of episodes and social impact.

Your treating provider · written request
03

Treatment records

0 of 1 collected
Surgical records (rectopexy, Delorme procedure, Altemeier perineal rectosigmoidectomy)

Operative reports documenting surgical repair procedure type, approach (perineal vs. abdominal), recurrence after repair, and post-operative continence outcomes.

VA or private records · written request
04

Lay statements

0 of 2 collected
Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
05

Benefits questionnaire

0 of 1 collected
Completed DBQ Rectum and Anus ConditionsCritical

Standardized form capturing prolapse type and grade, incontinence severity, surgical history, and functional limitations.

Provider-completed · VA DBQ formHow to get this →
06

Service records

0 of 1 collected
Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180
Condition guideRating criteria and what VA looks forBuddy statement builderGuided VA Form 21-10210

What you mark here is saved in this browser, on this device only — not to an account. Changing the target rating shows different items, but never loses what you have already marked.