Citation Nr: 19154884 Decision Date: 07/16/19 Archive Date: 07/16/19 DOCKET NO. 17-50 839 DATE: July 16, 2019 ORDER Entitlement to service connection for prostate cancer, claimed as secondary to herbicide exposure, is denied. Entitlement to service connection for bilateral upper extremity (BUE) peripheral neuropathy, claimed as secondary to herbicide exposure, is denied. Entitlement to service connection for bilateral lower extremity (BLE) peripheral neuropathy, claimed as secondary to herbicide exposure, is denied. Entitlement to a compensable rating for bilateral inguinal hernia is denied. FINDINGS OF FACT 1. The Veteran did not have a diagnosed BUE peripheral neuropathy disability. 2. The Veteran did not serve in the Republic of Vietnam, and he otherwise has not been shown to have been exposed to herbicides in service. 3. The Veteran’s prostate cancer and any BUE/BLE peripheral neuropathy did not originate in service, within a year of service, and are not otherwise etiologically related to the Veteran’s active service. 4. For the period on appeal, the service-connected bilateral inguinal hernia was manifested by a small, reducible left inguinal hernia not operated on but remediable. The service-connected bilateral inguinal hernia was not manifested by postoperative recurrent hernia readily reducible and well supported by truss or belt. CONCLUSIONS OF LAW 1. The criteria for service connection for prostate cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2018). 2. The criteria for service connection for BUE peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2018). 3. The criteria for service connection for BLE peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2018). 4. The criteria for a compensable rating for bilateral inguinal hernia disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.114, Diagnostic Code (DC) 7338 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1960 to August 1987. The Veteran died in December 2017. The appellant is the Veteran’s widow. This matter is before the Board of Veterans’ Appeals (Board) on appeal from August 2015 (bilateral inguinal hernia) and July 2017 (prostate cancer, BUE/BLE peripheral neuropathy) rating decisions by a Department of Veterans Affairs Regional Office (RO). The Board observes that additional evidence has been added to the claims file following the last adjudication by the AOJ in the September and November 2017 statements of the case (SOCs), including a December 2017 brief from the representative with attachments. However, as the appellant’s substantive appeals were received in September (bilateral inguinal hernia) and December (prostate cancer, BUE/BLE peripheral neuropathy) 2017, which is after February 2, 2013, an automatic waiver of evidence submitted by the claimant or her representative is presumed. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Lay evidence presented by a Veteran concerning continuity of symptoms after service may not be deemed to lack credibility solely because of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (2006). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Prostate Cancer, BUE and BLE peripheral neuropathy The appellant asserts entitlement to service connection for prostate cancer and BUE/BLE peripheral neuropathy. Specifically, the appellant asserts that the Veteran’s prostate cancer and BUE/BLE peripheral neuropathy resulted from exposure to herbicides while the Veteran was stationed in Thailand. Initially, the Board notes that the service treatment records (STRs) are completely silent for any complaints or treatment for prostate cancer or BUE/BLE peripheral neuropathy during service, and neither the Veteran, appellant or representative asserted that either condition was directly related to service other than due to herbicide exposure. The Veteran’s DD214 shows his military occupational specialty (MOS) was personnel technician and personnel superintendent. In addition, the Veteran’s service personnel record shows he was stationed at U-Tapao Royal Thai Air Force Base (RTAFB) from February 1971 to March 1972, and Takhli RTAFB from July 1972 to March 1974. His duty during that time is listed as Non-Commissioned Officer in Charge (NCOIC). A July 1971 performance report shows that while the Veteran was stationed at U-Tapao RTAFB his duties included being responsible for the supervision and operation of the Airman Assignments Branch, insuring that all outgoing assignments were properly processed, and maintaining relocation folders and briefings for all departing personnel. A February 1973 performance report shows that while the Veteran was stationed at Takhli RTAFB, he was in charge of the Airman Assignments Unit in-putting hundreds of arriving personnel weekly. Another performance report dated January 1974 noted the Veteran was responsible for receiving, controlling, notifying, briefing and processing all personnel for reassignment in addition to counseling, reviewing and submitting all applications for CHAP/Humanitarian reassignments and Special Duty Applications for assigned personnel. A February 1988 VA examination report shows the Veteran reported having no knowledge of any abnormality affecting his prostate gland. The physician noted that a prostate condition was not shown by either history or examination at that time. Accordingly, no prostate condition was diagnosed. In April 2011, the Veteran submitted a statement asserting that he was stationed in Thailand from February 1971 to February 1972, and from June 1972 to February 1974. During this time, the Veteran asserted that he was stationed at Takhli RTAFB where he met aircraft near the perimeter in order to process troops. He also asserted that he was sent to Udorn RTAFB for aircraft maintenance and troop transfers. He further asserted that he might have been in Laos and Vietnam but that he was unsure. A June 2011 Nehmer Memorandum noted that a review of the claims folder, including the Veteran’s DD214 and military personnel file, showed no evidence of service within the land borders or the inland waterways of Vietnam. A January 2014 private medical record noted an EMG study revealing evidence of severe bilateral leg motor and sensory neuropathy. A July 2014 prostate core needle biopsy revealed a diagnosis for prostatic adenocarcinoma located at the right base lateral, right base medial, right mid lateral, right mid medial, right apex lateral, right apex medial, left base medial, left apex lateral, and left apex medial. In August 2014, the Veteran underwent a radical retropubic proctectomy with pelvic lymphadenectomy to treat his extensive high-grade prostate cancer. A May 2015 private medical record noted a MRI study revealing a compression fracture at L-1, degenerative joint disease and neuropathy. In September 2015, the above-mentioned MRI finding were noted to be a metastatic lesion with current symptoms of peripheral neuropathy. A February 2015 disability benefits questionnaire (DBQ), submitted in September 2015, noted a diagnosis for prostate cancer with June 2014 listed as the date of diagnosis. A November 2016 private medical record noted a two year history of peripheral neuropathy with a concurrent balance problem. The Veteran denied any problems with his arms. He did report that his legs felt somewhat weak or off balance and he was assessed with peripheral neuropathy and myopathy “felt likely due to a statin drug.” In a November 2016 affidavit, submitted in December 2017, the Veteran asserted that he was stationed at U-Tapao RTAFB from February 1971 to February 1972, and at Takhli RTAFB from June 1972 to February 1974. While stationed at both bases, the Veteran asserted that his main job was to process personnel coming in and out of the base at the main gate which was located on the perimeter. In addition, he asserted that the administrative building where he worked 10 to 11-hour shifts, 6 1/2 days per week, was also located at the perimeter of the base. The Veteran further asserted that while he was stationed at Takhli RTAFB, his living quarters was located on the flight line. The Veteran also stated that being on, around or near the perimeter was routine, including walking, jogging and during breaks. A July 2017 memorandum issued by the JSRRC noted an inability to verify the Veteran’s Agent Orange exposure. In this regard, the memorandum noted the Veteran’s MOS as a personnel technician in addition to serving in Thailand at U-Tapao and Takhli RTAFB but found no indication that he served near the base perimeter. The memorandum further noted that the central office emphasized the need to restrict the acknowledgement of exposure to herbicides to dog handlers, security perimeter personnel and “otherwise personnel near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence.” In December 2017, the representative submitted a brief asserting that the M-21 provisions applied to all veterans with service in Thailand during the Vietnam Era and that exposure to herbicides must be conceded if a veteran was “otherwise near the air base perimeter...” In this regard, the representative noted that the Veteran reported being on or near the base perimeter during his deployment to Tapao and Takhli RTAFB. The representative further asserted that the Veteran worked, lived and traveled through areas that could have exposed him to herbicides. In addition, the representative asserted that even during times when the Veteran was not on or near the base perimeter, he was as likely as not exposed to herbicides due to use of herbicides for grounds keeping purposes. In this regard, the representative asserted that the same chemical components found in tactical herbicides were also found in herbicides used for other applications such as weed control in areas away from base perimeters. Alternatively, the representative asserted that VA policy should be applied broadly and liberally, and in a manner consistent with other VA herbicide exposure policies. For example, the representative asserted that if a veteran who served on a Naval ship could establish exposure by credible lay statements that he went ashore in Vietnam, then a veteran who served in Thailand should be allowed the same standard. The December 2017 brief attached several documents in support of the appellant’s claims including the following: the above-mentioned November 2016 affidavit; excerpts from a February 1973 Project CHECO report noting base defenses in Thailand including deployment of herbicides for vegetation control to aid in perimeter observation; a December 1971 Department of the Army field manual titled, “Tactical Deployment of Herbicides;” a September 1968 Department of the Army Supply Bulletin titled, “Herbicides, Pest Control, and Disinfectants;” a May 2010 Compensation and Pension Service Bulletin noting new procedures for claims based on herbicide exposure in Thailand; a letter from Alvin L. Young indicating widespread use of herbicides in Thailand; an unidentified map of a base noting a “NCO Hooch” where the Veteran indicated he resided; and photographs and maps of Takhli and U-Tapao RTAFB. Turning to the claims on appeal, with regard to the service connection claim for BUE peripheral neuropathy, a review of the post-service medical evidence of record shows no diagnosis or treatment for that condition. Importantly, neither the appellant nor her representative have identified any medical evidence in support of a diagnosed BUE peripheral neuropathy condition at any point during the period on appeal. Instead, a November 2016 private medical record shows the Veteran reported no problems with his arms and further noted a two year history of peripheral neuropathy associated with the his BLE as evidenced by complaints of a concurrent balance problem. As noted above, a necessary element for establishing entitlement to service connection is the existence of a current disability; it is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed. Cir. 1997). Additionally, for VA purposes, a current disability exists when a claimant has a disability at the time a claim is filed or at some point during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Absent a diagnosis or evidence of an in-service occurrence for any BUE peripheral neuropathy, the Board finds that the first Shedden requirement has not been met and the probative evidence is against the appellant’s claim for service connection for that condition. Even if it could be said that medical records simply noting “peripheral neuropathy” indicate a BUE condition, for reasons cited below, the Board finds that service connection is further not warranted for any such condition on the basis of herbicide exposure. With regard to the service connection claims for BLE peripheral neuropathy and prostate cancer, in the present case, there is sufficient evidence that the threshold criterion for service connection of a current disability has been met. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Specifically, a January 2014 EMG study revealed severe bilateral leg motor and sensory neuropathy, and a July 2014 prostate core needle biopsy revealed a diagnosis for prostate cancer. Accordingly, the remaining question is whether the diagnosed conditions are otherwise related to service. As noted above, the STRs are completely silent for any complaints or treatment for prostate cancer or BUE/BLE peripheral neuropathy during service and the evidence of record does not show that either condition began within one year following separation from service. Further, neither the Veteran, appellant or representative have asserted that any of the claimed conditions are directly related to service other than as due to herbicide exposure during service in Thailand. VA regulations provide that certain diseases associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). Absent affirmative evidence to the contrary, there is a presumption of exposure to herbicides (to include Agent Orange) for all veterans who served in the Republic of Vietnam during the Vietnam Era. See 38 U.S.C. § 1116(f) and 38 C.F.R. § 3.307(a)(6)(iii). However, the Board finds that the evidence of record does not support that the Veteran served within the land borders of Vietnam. Specifically, a review of his service records does not show he was stationed in Vietnam. The Board does recognize that the Veteran stated that he “might have” been in Vietnam, however, the Veteran further stated that he was unsure. Accordingly, the Veteran’s lay statements are speculative and not probative evidence. Importantly, neither the appellant nor the representative have asserted that the Veteran served or set foot in Vietnam. In addition, while the Veteran was awarded the Vietnam Service Medal, the Vietnam Campaign Medal, and the Republic of Vietnam Gallantry Cross with Palm device, such are not conclusive proof of service in Vietnam for purposes of presumptive herbicide exposure. See Exec. Order No. 11231 (July 8, 1965) (establishing award of the Vietnam Service Medal “to members of the armed forces who serve[d] in Vietnam or contiguous waters or air space”); see also Haas, 525 F.3d at 1196 (to treat receipt of the Vietnam Service Medal as a “test” of eligibility for the statutory presumption would be clearly contrary to the Agent Orange Act, because it is undisputed that some service members who received the Vietnam Service Medal were never either in Vietnam or in its territorial waters). With regard to the Veteran’s confirmed service in Thailand, the Board notes that there are no statutory or regulatory presumptions regarding herbicide exposure in Thailand. However, VA may presume, in the absence of sufficient evidence to the contrary, that a veteran who served in Thailand during the Vietnam War Era was exposed to herbicide agents if: (1) the veteran was in the Air Force, (2) the veteran served at the RTAFB of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, or Don Muang, and (3) the veteran served as a security policeman, security patrol dog handler, or member of a security police squadron, or otherwise served near a base perimeter, as shown by the Veteran’s MOS, daily work duties, performance evaluations, or other credible evidence. See M21, IV.ii.1.H.5.b. (last visited July 9, 2019). As noted by the representative, the Adjudication Manual M21-1 provides a multi-step process for determining whether herbicide exposure should be presumed. In this regard, the Veteran served in the Air Force at U-Tapao and Takhli RTAFB. However, in providing for presumption service connection based on service in Thailand, VA specifically did not extend the presumption to all service members who served there (e.g. traveled through the gates to enter the base, or worked in view of the perimeter), but instead found it should be provided to those members whose duties actually placed them on the perimeter where they would come in contact with sprayed areas; the M21-1 provides examples of such service. Although the term “near” is not defined, the Board, based on the M21-1 examples of covered duties, finds that it is meant to convey duties which would require regular, routine, extensive, frequent, or prolonged, presence on the edge of the base where spraying was used to control vegetation, as suggested by the “evidence of daily work duties.” In the present case, the Veteran was not a member of a security police squadron who served near a base perimeter. Instead, the Veteran’s MOS during service was a personnel technician/superintendent. With regard to the Veteran’s MOS, the Board has considered the military records which reflect that he generally worked inputting arriving personnel, and that he briefed and processed all personnel for reassignment including submitting applications. The Board has considered the Veteran’s lay statements that his MOS required him to travel to the main gate and to meet aircraft near the perimeter in order to process troops coming and going. However, the Board finds that the evidence does not show that his duties required regular, routine, extensive, frequent or prolonged presence on the edge of the base. In this regard, the Board relies on the Veteran’s lay statements that he worked 10 to 11-hour shifts 6 ½ days per week in an administrative building. While the Veteran further stated that the administrative building where he worked was located near the perimeter (i.e. worked in view of the perimeter), as noted above, the Veteran’s military records do not demonstrate that his duties during service brought him to the perimeter of either military base where he was stationed. Instead, the Board finds that the Veteran’s service does not equate with work near the base perimeter as contemplated by the M21-1. In this regard, the military personnel records do not show that the Veteran’s daily duties, or nearly so, required him to be physically on the base perimeter itself. Even if the Board conceded that the Veteran traveled to the main gate or met arriving aircraft in order to process personnel, or that he spent recreational time by the perimeter, the Board further finds that such is not the type of presence which is contemplated by VA when considering exposure to an herbicide agent as such would not involve regular, routine, extensive, frequent or prolonged presence near the base perimeter. Finally, the Board recognizes the Veteran’s lay statements that his living quarters at Takhli RTAFB was located near the perimeter and that he walked, jogged and hung around the perimeter during breaks. For reasons cited above, the Board further finds that such assertions are not the type of presence that equates with work near the base perimeter contemplated by the M21-1. The Board also recognizes the representative’s assertion that the Veteran was as likely as not exposed to herbicides even when he was not on or near the base perimeters due to the assertion that herbicides containing the same chemical components were used for grounds keeping purposes elsewhere. However, as noted above, there is no statutory or regulatory presumptions regarding herbicide exposure in Thailand. Therefore, absent competent evidence that the Veteran’s duties required regular, routine, extensive, frequent, or prolonged, presence on the edge of the base where he was stationed in Thailand, or that he actually came into direct contact with herbicides as contemplated by 38 C.F.R. § 3.307, service connection on a presumptive basis is not warranted. The Veteran’s attorney further asserts that denying the Veteran’s claim would be inconsistent with the Board’s duty to adopt a broad and liberal interpretation of the applicable M21-1 provisions. In this regard, the representative asserts that denying the Veteran’s claim would conflict with VA’s policy of conceding herbicide exposure in the case of sailors whose ships docked at a port in Vietnam “even if momentarily and even if done only once.” The Board finds such assertion without merit as it ignores the role of Congress in creating a presumption of exposure to herbicides, which clearly applies to those who served on the land mass of the Republic of Vietnam, and clearly does not apply to all veterans who served in Thailand. In Haas, 525 F.3d 1168, the Federal Circuit explained that the perception of unfairness is an inevitable consequence of legislative line-drawing “[b]ecause that blanket rule [resulting from Congress’s decision to extend the presumption of service connection to all persons who served for any period and in any area within the Republic of Vietnam] provides a presumption of service connection to some persons who were unlikely to be exposed, it makes virtually any line-drawing effort appear unreasonable as applied to those who were outside of Vietnam but near enough to have had some chance of exposure.” Id. at 1193. Much of the representative’s brief is devoted to criticism of VBA “Memorandum for the Record: Herbicide use in Thailand during the Vietnam Era” attached to Fast Letter 09-20 (May 6, 2009), and an attached May 2010 Compensation and Pension Bulletin. However, the Board notes that those documents were later rescinded and replaced with the current provisions of the Adjudication Manual M21-1 cited above. Moreover, in denying the Veteran’s claims, the Board places no reliance on the May 2009 VBA memorandum or the May 2010 Compensation and Pension Bulletin. Finally, the Board finds that representative’s assertion that herbicide exposure should be conceded due to use of similar herbicides used for groundskeeping purposes as well as analysis contained in a letter from Alvin L. Young indicating widespread use of herbicides in Thailand essentially amounts to an invitation to rewrite the presumption of herbicide exposure under 38 C.F.R. § 3.307 by extending that presumption to all veterans who visited an Air Force Base in Thailand. However, such is beyond the scope of the Board’s authority. Without the benefit of the presumption of herbicide exposure contained in 38 C.F.R. § 3.307(a)(6), the evidence must show that the Veteran was personally exposed to an “herbicide agent” as that term is defined in the regulation. However, the evidence of record is insufficient to show actual exposure to an herbicide agent during the Veteran’s active duty service. In sum, the preponderance of the evidence is against service connection for BUE peripheral neuropathy as the evidence of record does not show a diagnosis for that condition during the appeal period. Additionally, the competent and credible evidence of record preponderates against finding that the Veteran was exposed to herbicide agents while serving in Thailand. The Board is bound by VA law and regulations which do not provide for a presumption of herbicide exposure based on the circumstances of the Veteran’s service, and the probative evidence of record does not reflect herbicide exposure. Although the appellant is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claims for service connection. The claims are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more nearly approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, and the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 2. Bilateral Inguinal Hernia An unappealed November 1988 rating decision granted entitlement to service connection for inguinal hernia and assigned a non-compensable rating effective September 1, 1987. In November 2012, the Veteran filed the current increased rating claim on appeal asserting that his bilateral hernia condition had worsened. The evidence of record includes a March 2013 DBQ noting a diagnosis for right and left inguinal hernia. The Veteran complained of pain and swelling to the left groin the past 10 years which worsened when lifting heavy objects. The physician noted a May 1988 surgery performed for a right inguinal hernia with no previous surgery for a left inguinal hernia. The left inguinal hernia was also noted to appear operable and remediable. Currently, no right hernia was detected, and the left hernia was found small and readily reducible. No truss or belt was noted as tried or used. A March 2013 VA medical record shows the Veteran reported having had right inguinal hernia repair years prior. He currently complained of left hernia pain but declined any further evaluation or surgery. The physician noted that it was difficult to appreciate a left inguinal hernia at that time but that the Veteran reported it was there. The physician offered to reexamine the Veteran or to conduct further testing, however, the Veteran declined and stated if the condition continued to bother him more he would let the physician know. In an August 2013 statement submitted in September 2013, T.D., the Veteran’s neighbor, stated the Veteran was unable to perform any manual labor due to his left hernia and that her husband assisted with any heavy lifting. In another statement submitted in October 2013, P.H. stated the Veteran’s condition had worsened and that he was unable to lift items weighing over 15-20 pounds or perform other types of manual labor. A December 2013 VA medical record noted the Veteran reported that due to his hernia he could not cut his grass or do “a lot of stuff” at that time. He further stated he did not want surgery or any further intervention at that time. A December 2014 private medical record noted a physical examination of the abdomen noting a small right inguinal hernia. Another DBQ dated February 2015 was submitted in September 2015. That DBQ noted a diagnosis for right and left inguinal hernia both of which were noted as small with the left readily reducible. The examiner did not note whether the right was reducible, but instead noted that the right hernia was treated with surgery in 1988. No surgery was noted as treatment for the left hernia which appeared operable, remediable and readily reducible. No truss or belt was noted as being tried or used. Lastly, the physician noted a residual scar at the site of the 1988 right inguinal hernia surgery but did not indicate whether the scar was painful or unstable, or covered an area greater than or equal to 29 square inches. A February 2016 VA medical record shows the Veteran wanted it documented that he had a left inguinal hernia, but that he did not want any further work-up at that time. It was further noted that the Veteran declined to have surgery. During the period on appeal, the Veteran’s bilateral inguinal hernia was assigned a non-compensable rating under DC 7338. Under that diagnostic code, a small inguinal hernia, reducible, or without true hernia protrusion, is rated non-compensable. An inguinal hernia that is not operated, but is remediable, is also rated non-compensable. Postoperative recurrent inguinal hernia, readily reducible, well supported by truss or belt, is rated 10 percent disabling. Small inguinal hernia, postoperative recurrent or unoperated irremediable, not well supported by truss, or not readily reducible, is rated 30 percent disabling. Large inguinal hernia, postoperative recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable, is rated 60 percent disabling. A Note to DC 7338 provides that 10 percent is to be added for bilateral involvement, provided the second hernia is compensable. 38 C.F.R. § 4.114. After a review of the evidence of record, the Board finds that during the period on appeal, a compensable rating for bilateral inguinal hernia is not warranted. The evidence reflects that the Veteran had a small right-sided inguinal hernia that was surgically treated in 1988. The evidence also reflects that the Veteran had a small left-sided inguinal hernia that had not been operated on, was reducible, and which was found remediable. However, the evidence of record shows the Veteran had declined surgical treatment. Moreover, a higher evaluation is not warranted because at no time during the period on appeal does the evidence indicate that the Veteran’s bilateral inguinal hernia was manifested by a recurrent postoperative condition well supported by truss or belt. In this regard, both the March 2013 and September 2015 DBQs noted that the condition had not been treated with a truss or belt. Accordingly, a compensable rating is not warranted pursuant to DC 7338. The Board has considered whether other ratings are applicable to the service-connected bilateral inguinal hernia. However, because DC 7338 clearly addresses inguinal hernia, the specific disability at issue, the Board finds that DC 7338 is the only code under which to evaluate the disability. DC 7338 is clearly and unambiguously devised to address the disability at issue. The Board has also considered whether an additional separate rating for residual scar associated with the 1988 surgical procedure for right inguinal hernia is warranted. In this regard, the Board notes that the applicable rating criteria for skin disorders under 38 C.F.R. § 4.118 were amended most recently in August 2018. However, the 2018 revisions did not substantively change the Codes applicable to scars. In any event, the evidence of record does not establish that the residual scar was painful or unstable; therefore, a separate compensable rating for unstable or painful scar is not warranted. See 38 C.F.R. § 4.118. (Continued on the next page)   Based on the above, the Board finds that the preponderance of evidence is against a compensable rating under DC 7338 for bilateral inguinal hernia and the benefit-of-the-doubt rule does not apply. The claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; see Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lamb, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.