Citation Nr: 21002029 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 15-10 827 DATE: January 12, 2021 ORDER Entitlement to a compensable rating for right inguinal hernia is denied. FINDING OF FACT The most probative evidence of record indicates that the Veteran’s post-operative right inguinal hernia has not been recurrent, and does not require a truss or belt. CONCLUSION OF LAW A compensable rating for postoperative right inguinal hernia is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.3, 4.21, 4.114, Diagnostic Code 7338. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2003 to August 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a Board hearing before the undersigned Veterans Law Judge in March 2018. A transcript of the hearing is in the Veteran’s file. This matter was previously before the Board in August 2018 and July 2020, at which time it was remanded for a clarifying medical opinion. A review of the record reveals that there has been substantial compliance with the Board’s prior remand directives as to the issue decided below. See Stegall v. West, 11 Vet. App. 265 (1998). Entitlement to a compensable rating for right inguinal hernia The Veteran contends the schedular rating for his right inguinal hernia, currently at a noncompensable rating, does not reasonably describe his level of disability and argues that extraschedular rating is warranted. See Board Hearing Transcript. He claims he suffers from extreme pain and discomfort on a daily basis. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The Veteran’s inguinal hernia is rated under Diagnostic code (DC) 7338. Under this code, a 60 percent rating is assigned if “Large, postoperative, recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable.” A 30 percent rating is assigned if “Small, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible.” A 10 percent rating is assigned if “Postoperative recurrent, readily reducible and well supported by truss or belt.” A 0 percent rating is assigned if “Not operated, but remediable”; or, “Small, reducible, or without true hernia protrusion.” 38 C.F.R. § 4.114, DC 7338. The Veteran was first diagnosed with an inguinal hernia in April 2003 and had open repair surgery. In May 2009, VA treatment records show the Veteran began having pain in at the site of his hernia surgery, after lifting for his job. He was assessed with groin strain and there was no evidence of a hernia. At a May 2010 VA examination, the Veteran reported that he had continuous pain radiating to his right lower extremity requiring him to go to the hospital. The pain interfered with two jobs which he lost due to difficulty ambulating and pain medication use. The examiner noted the Veteran has residual groin pain from the inservice hernia and had a significant effect on his occupation. The Veteran underwent another VA examination in September 2014. There was no hernia detected but the Veteran reported that his pain was increasing with movement such as walking. The Veteran also reported that he was unable to work because he cannot lift over 5 lbs. The Veteran was diagnosed with neuritis of the ilio-inguinal nerve, which was subsequently service connected as secondary to his inguinal hernia in a March 2019 rating decision. VA treatment records show the Veteran had surgery for a migrated mesh removal in December 2014. He developed pain and swelling in his right testicle and after an ultrasound, it was revealed there was no flow detected and had to have surgery to remove the right testicle. The Veteran was afforded another VA examination in November 2018 where it was reported his right inguinal hernia resolved through surgical repair, but he still experienced pain. There was no current hernia detected and no functional impact on his ability to work. At a Peripheral Nerves Condition VA examination in May 2019, the examiner diagnosed the Veteran with neuritis of ilio-inguinal nerve and radiculopathy of the lower extremities since 2003. The Veteran reported that his condition began with pain and burning in the groin in 2003. The examiner noted the Veteran’s gait was abnormal due to his neuritis of the ilio-inguinal nerve. The Veteran used a rolling seat walker for support and stability, walked with a limp and dragged his right foot. The examiner noted the Veteran is unable to stand or bear weight longer than 30 minutes or walk more than 30 feet. He was unable to go up or down more than 6 steps and had difficulty standing from a sitting position. The Veteran also stated his urinary incontinence began after his hernia repair surgery in 2003 at an August 2019 Urinary Tract VA examination. The examiner however, noted that the urinary condition has an unknown etiology. At a June 2019 Hernia VA examination, the examiner noted that the Veteran experienced right groin pain and his condition has progressed since onset. The Veteran had additional right inguinal repair surgeries in 2014 and 2015. There were no hernias detected, however, the Veteran complained of moderate pain and it was very tender to touch. The examiner noted the Veteran developed residual pain from the surgical repair. The examiner opined that there were no neurologic impairments related to the hernia repair but there were residuals of pain, numbness, and tenderness to the right groin associated with the December 2014 mesh removal. The examiner noted that according to the Mayo Clinic, residuals of pain, tenderness and numbness to the hernia repair site are common, especially if there is a possibility of nerve damage. In a September 2020 clarifying medical opinion, the examiner noted that the ilioinguinal nerve innervates the anterior surface of the scrotum or labia majora, root of the penis or mons pubis, and a small portion of the upper antero-medial thigh. It also innervates the internal oblique and transversus abdominis muscles. He opined that; therefore, it was more likely than not that symptoms of pain in the inguinal area, into the groin and scrotum on the right are due to residuals of the hernia repair/ilioinguinal neuritis. All radicular symptoms of the right lower extremity, including numbness, paresthesia and pain for the upper anterior thigh, however, would be due to radiculopathy, and is unrelated to the Veteran’s ilioinguinal neuritis. The Veteran’s right knee and lumbar conditions are not related to his hernia. The ilioinguinal nerve would not impact muscle strength for the right lower extremity and there is only a remote possibility of minor sensory to the upper anterior, medial thigh. The Broad finds this opinion highly probative as it clearly explains the separation of symptoms for the Veteran’s residuals of hernia repair and his other conditions, including radiculopathy and low back condition. Based on the evidence of record, the Board finds that a preponderance of the evidence is against findings that a compensable rating is warranted for the Veteran’s right inguinal hernia under the rating criteria. In this regard, the May 2010, September 2014, November 2018 and August 2019 VA examiners all found no hernia detected on examination. VA clinical records also have not shown a recurrent hernia. Moreover, the Veteran himself has not reported a recurrent hernia. As the evidence does not show a recurrent hernia, a higher rating under Diagnostic Code 7338 for an inguinal hernia is not warranted. With respect to the extra-schedular contention, the Veteran appears to have based that on the symptoms associated with his separately service connected neuritis of the ilio inguinal nerve, or non-service connected disabilities, as identified by the September 2020 examiner. Since the rating for ilio inguinal nerve disability has not been appealed, its symptoms are addressed in the rating schedule (DC 8530), and the other disabilities are not service connected, further consideration for extra-schedular rating is not indicated. M. E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jaigirdar, 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.