Citation Nr: 18148920 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 10-15 434 DATE: November 9, 2018 ORDER Entitlement to service connection for a right inguinal hernia, to include as secondary to service-connected s/p right orchiectomy, is denied. FINDINGS OF FACT 1. The Veteran’s right inguinal hernia is not etiologically related to service. 2. The Veteran’s right inguinal hernia was not proximately caused by his service-connected s/p right orchiectomy. CONCLUSION OF LAW The criteria for entitlement to service connection for a right inguinal hernia have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service from August 1985 to March 1993, with periods of ACDUTRA and INACDUTRA. As a threshold matter, The Board notes that, initially on appeal as well, were the issues of service connection for a left knee disability, and service connection for a left foot disability. However, service connection for these claims was granted during the course of this appeal and, this represents a full grant of the benefits sought. Thus, those claims are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to service connection for a right inguinal hernia. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The term “active military, naval, or air service” includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101 (2), (24); 38 C.F.R. § 3.6 (a). In other words, service connection is available for diseases or injuries incurred in or aggravated by ACDUTRA and injuries incurred in or aggravated by INACDUTRA (including an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). For secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or the result of service-connected disease or injury, or that service-connected disease or injury has aggravated the nonservice-connected disability for which service connection is sought. See 38 C.F.R. § 3.310 (2017). Whenever there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b). Analysis The Veteran seeks service connection for a right inguinal hernia. After review of the evidence, the Board finds that service connection is not warranted. Service treatment records (STRs) show that the Veteran had a hernia in 1981. A medical treatment note shows that the Veteran had a repair of an epigastric hernia in August 1984 prior to entering active duty. In a December 1984 Report of Medical History, it was also noted that the Veteran had an umbilical hernia repair in August 1984. A November 1988 service treatment note shows that the Veteran was diagnosed with inguinal strain after complaining of pain in his right testicle. The Veteran also had other complaints of pain in his right groin area which was determined to be epididymitis. Post-service records show that the Veteran received a right inguinal orchiectomy in February 1998 after complaining of right testicular pain. In December 2005, the Veteran complained of right groin and pelvis pain. An MRI showed right hip slightly asymmetric as compared to the left; otherwise nothing acute. In November 2007, the Veteran underwent laparoscopic repair of a right inguinal hernia. In June 2016, the Veteran received a VA examination in which the Veteran reported having had an inguinal hernia repaired four or five times and that he can no longer work as a truck driver since driving aggravates the pain. The examiner found no evidence of a hernia detected on the right or left side on examination. The examiner noted the Veteran had laparoscopic surgery in November 2007 for a right inguinal hernia, and a 1984 epigastric hernia that had healed. With regard to a nexus, the examiner found that the Veteran’s right inguinal hernia repair was not incurred in or caused by service. In so finding, the examiner noted that the Veteran’s complaints of right groin pain in service were ultimately diagnosed as epididymitis, and there is no indication that the Veteran had an inguinal hernia while in service. He further noted that in his November 2007 hernia repair, although the surgeon noted it to be a “repair” of a right inguinal hernia, the surgeon did not note the date or circumstances surrounding a previous inguinal hernia. Therefore, based on the available evidence, the examiner found it less likely than not that the Veteran’s right inguinal hernia was incurred in or caused by a period of active duty, ACDUTRA, or INACDUTRA; nor was it aggravated beyond its natural progression. In January 2018, the Board requested a medical opinion to assist in determining the etiology of the Veteran’s right inguinal hernia. In an April 2018 medical opinion, the examiner determined that the Veteran’s right inguinal hernia was not aggravated beyond its natural progression by a period of active duty nor was it caused or aggravated by his previously diagnosed epididymitis or prior orchiectomy. In support of his conclusion, the examiner noted a detailed timeline of the Veteran’s clinical history finding that the first confirmed date of an inguinal hernia was from the Veteran’s November 2007 surgical procedure, and that it is not plausible to attribute the hernia recurrence to an injury or aggravating factor given the large number of years between the hernia recurrence and the end of the Veteran’s active duty. The examiner explained that the in-service Report of Medical History referencing a hernia in 1981, did not note the locality or type of hernia. The examiner further explained that the Veteran’s May 1984 epigastric hernia repair is not synonymous to an inguinal hernia; therefore, this particular surgery is irrelevant to the issue at hand. Further, the examiner noted that although the Veteran was diagnosed with inguinal strain in November 1988, there was no evidence of a right inguinal hernia, and the Veteran’s right groin pain in June and December 1992 was diagnosed as right epididymitis. The examiner noted that the Veteran subsequently had a right epididymectomy in June 1994 for painful, chronic right epididymitis, and a right orchiectomy for chronic testicular pain in February 1998. The examiner ultimately found that the Veteran’s inguinal hernia first noted in November 2007, was not caused or aggravated by service. Rather, it would be reasonable to attribute it to natural progression. The Board recognizes that the examiner used the standard of “aggravation” based upon the Board’s previous finding of a pre-existing hernia condition in its’ January 2018 request for a medical opinion. This finding was based upon the Veteran’s medical records showing a 1981 hernia, and his 1984 epigastric hernia repair; however, the Board did not specifically find that the Veteran’s inguinal hernia pre-existed service. As explained by the April 2018 examiner, the reference to a “1981 hernia” did not note the type or locality of the hernia, and the Veteran’s epigastric, umbilical, and inguinal hernias are not one and the same. See https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/hernias-of-the-abdominal-wall. Therefore, the Board finds that while the evidence appears to show that the Veteran had some type of hernia prior to his active duty service, there is no clear and unmistakable evidence of a pre-existing inguinal hernia. Nonetheless, the Board finds the preponderance of the evidence weighs against the claim when considering the evidence as a whole. The Board notes that both examiners found that the Veteran’s inguinal hernia was not related to his active duty service as the Veteran’s in-service complaints of right groin pain were ultimately diagnosed as epididymitis. Additionally, although the Veteran was diagnosed with inguinal strain in service, the April 2018 examiner explained that the Veteran’s inguinal strain cannot be confused with an inguinal hernia, which suggest these are two separate and unrelated conditions. Moreover, the April 2018 examiner further noted that the Veteran’s groin strain was likely related to his epididymo-orchitis which was later treated by epididymectomy in 1994, and ultimately orchiectomy in 1998. Although the Veteran contended in his VA Form 9, that his inguinal hernia is due to the surgical removal of his right testicle, the April 2018 examiner noted that there is no accepted medical or scientific evidence to support the idea that epididymitis or orchitis is linked to the development or aggravation of an ipsilateral inguinal hernia. Given the above, the Board finds both medical opinions are highly probative as they both are detailed and persuasive, based on an accurate account of the Veteran’s medical history, and are consistent with one another. Consequently, the Board gives more probative weight to the medical opinions as the Veteran has not demonstrated his competency to make such a complex medical determination. As there is no other evidence of record that shows the Veteran’s right inguinal hernia was incurred in, caused by, or aggravated by a period of active duty, ACDUTRA, or INACDUTRA, nor that it was proximately caused by his previous orchiectomy, the Board finds the preponderance of evidence weighs against the claim of service connection for right inguinal hernia on a direct and secondary basis. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Laffitte, Associate Counsel