Citation Nr: 18151999 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-55 458 DATE: November 20, 2018 ORDER Entitlement to service connection for umbilical hernia is denied. Entitlement to service connection for inguinal hernia is denied. FINDINGS OF FACT 1. The probative evidence does not demonstrate that the Veteran’s currently diagnosed umbilical hernia manifested during, or as a result of, active military service. 2. The Veteran’s inguinal hernia preexisted active duty service, was noted on examination upon entry, and was not aggravated during service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for umbilical hernia have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The criteria for entitlement to service connection for inguinal hernia have not been met. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1968 to July 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision. The Veteran did not request a Board hearing. 1. Entitlement to service connection for umbilical and inguinal hernia The Veteran contends that his umbilical and inguinal hernias are due to his active service, including standing while working as a barber. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Establishing service connection requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Board notes that a Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). Accordingly, if no preexisting condition is noted upon entry into service, a Veteran is presumed to have been sound upon entry. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). For service connection claims involving a preexisting injury or disease, 38 U.S.C. § 1153 provides that a preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. If a preexisting disability is noted upon entry into service, the Veteran cannot bring a claim for service connection for that disability, but the Veteran may bring a claim for aggravation of that disability. In that case, § 1153 applies and the burden falls on the Veteran to establish an increase in severity during service. Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 C.F.R. § 3.306(b). Evidence is needed to support a finding that the preexisting disorder increased in severity in service. Paulson v. Brown, 7 Vet. App. 466, 470-71 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1994). Regarding the Veteran’s claim for service connection for an inguinal hernia, an inguinal hernia was discovered upon physical examination and was noted in the Veteran’s June 1968 entrance examination. See June 1968 Service Treatment Records. The Veteran’s military personnel records show the Veteran did not meet the physical standards for enlistment due to a left inguinal hernia and would need to undergo remedial medical correction or be discharged from service. See August 1968 Military Personnel Record. As the Veteran’s service enlistment examination noted an inguinal hernia, he is not presumed to have been sound at service entrance. As such, the Veteran cannot bring a claim for service connection for that disability, but may only bring a claim for aggravation of that disability. In that case, § 1153 applies and the burden falls on the Veteran to establish an increase in severity during service. In this regard, the Board observes that the Veteran underwent surgery for his inguinal hernia in August 1968. Examination of the left groin in September 1968 revealed the incisional area to be healing well with no evidence of hematoma or infection. Service treatment records are silent for further complaints or treatment for inguinal hernia. There is no persuasive credible evidence that the Veteran’s hernia underwent an increase in severity in service. Mere temporary or intermittent flare-ups of a preexisting injury or disease are insufficient to be considered aggravation unless the underlying condition, as contrasted to symptoms, is worsened. Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993). However, in this case the evidence does not show a temporary or intermittent flare-up of the Veteran’s inguinal hernia. Again, the burden falls on the Veteran to establish an increase in severity during service which has not been met. Thus, the presumption of aggravation does not attach. In light of the above, the Board finds that the inguinal hernia preexisted service and was not aggravated by active service In regards to the Veteran’s umbilical hernia, the Board concludes that, while the Veteran has a current diagnosis of umbilical hernia, and evidence shows that an inguinal hernia occurred, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of umbilical hernia began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show the Veteran was not diagnosed with an umbilical hernia until 2005, approximately 35 years after his separation from service. While the Veteran is competent to report having experienced symptoms of hernias intermittently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of an umbilical hernia. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the October 2015 VA examiner opined that the Veteran’s umbilical hernia is less likely than not related to an in-service injury, event, or disease, including the Veteran’s inguinal hernia. The examiner reasoned that umbilical hernias are confined to the area around the “belly button” or umbilicus and thus not associated with or caused by the Veteran’s ventral hernia. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his umbilical hernia is related to an in-service injury, event, or disease, including his preexisting inguinal hernia and standing while working as a barber, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the October 2015 VA examiner’s opinion. Thus, the Board finds that service connection for umbilical hernia is not warranted. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Alexia E. Palacios-Peters, Associate Counsel