The colon is made up of the large intestine. It extends from the end of the ileum to the anal canal that surrounds the anus. An ulcer is defined as an open sore or lesion of the skin or mucous membrane. Ulcerative colitis is a chronic, nonspecific, inflammatory and ulcerative illness in the colonic mucosa. The condition is characterized most often by bloody diarrhea.

The cause of the condition is unknown. However, there is evidence that indicates that there may be a genetic predisposition leading to an abnormal intestinal immune response to the presence of various types of agents (foods, milk, etc.), but no specific antigen has been identified.

Bloody diarrhea occurs in varying intensity along with episodes of no symptoms. Episodes usually occur with an increased need to defecate, mild lower abdominal discomfort, and bloody and mucoid stools. However, some episodes may occur as sudden, extreme diarrhea, fever, signs of peritonitis, and profound toxemia.

History and stool examinations usually provide reasonable evidence for the diagnosis. This diagnosis needs further confirmation. A total colonoscopy is normally necessary before treatment begins. Using an instrument to view the area, or having a barium enema during active episodes of the condition, might cause further trauma (e.g., perforation, hemorrhage and inflammation). However, these procedures are usually indicated later in the course of the disorder to determine the extent of colon involvement.

The diet is adjusted to avoid raw fruits and vegetables, which cause trauma to the colon. Anticholinergic drugs are used to control diarrhea, and corticosteroids are also used orally and rectally. Oral sulfa anti-inflammatory drugs may also be given in cases of moderate disease. Surgery may be indicated in some cases.

Ulcerative colitis is usually chronic, recurring repeatedly, with episodes of reduction and intensification of symptoms. Gastrointestinal (GI) tract disturbances may occur if the patient is treated with oral sulfasalazine. This medication also causes side effects including: a reversible decrease in sperm count and motility; blood abnormalities (dyscrasias); and, rarely, but more seriously, hepatitis. Up to one-third of patients with this condition require surgery. If extensive surgery is indicated, a total proctocolectomy is the cure, and the risk of cancer is eliminated. Patients with localized disease have the best prognosis and are less likely to require surgery. Several complications can develop from this condition including toxic colitis; toxic megacolon; colon cancer; extracolonic problems (peripheral arthritis, ankylosing spondylitis, etc.); and primary sclerosing cholangitis (PSC). The incidence of colon cancer is increased when the entire colon is involved and the disease has lasted for more than ten years. Primary sclerosing cholangitis occurs in 5% of patients with ulcerative colitis.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.[38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.14.  [38 CFR 4.113]