Citation Nr: 21065232 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 15-41 208 DATE: October 25, 2021 ORDER A compensable rating for residuals, postoperative umbilical hernia with residual surgical scar, is denied. FINDING OF FACT For the period on appeal, the objective medical evidence does not indicate the need for a supporting belt for the umbilical hernia; nor does it show massive, persistent, severe diastasis of recti muscles or extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable. CONCLUSION OF LAW The criteria for a compensable rating for residuals, postoperative umbilical hernia with residual surgical scar, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.114, Diagnostic Code (DC) 7399-7339. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from March 1986 to May 1990. The matter is on appeal before the Board from an August 2013 rating decision. The Veteran provided testimony at a December 2018 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The issue was previously remanded by the Board for further development in December 2018. Compensable Rating Umbilical Hernia Procedurally, the Veteran was granted service connection for postoperative umbilical hernia residuals in a May 1990 rating decision. He was provided a noncompensable rating effective May 5, 1990. On February 3, 2012, the Veteran submitted an informal claim requesting an increased rating for his umbilical hernia. The Veteran was denied a compensable rating for his umbilical hernia in an August 2013 rating decision. In October 2013, the Veteran submitted a Notice of Disagreement (NOD) in which he disagreed with the noncompensable rating. He reported that the hernia was huge with a five-inch circumference, and he asserted that it could not be operated on at the time. In an August 2015 rating decision, the Veteran was granted a temporary 100 percent evaluation for convalescence following surgery on his umbilical hernia. The 100 percent evaluation was assigned from November 20, 2014 through December 31, 2014, and a noncompensable evaluation went back into effect as of January 1, 2015. Following the issuance of a Statement of the Case (SOC) in October 2015, the Veteran filed a Form 9 Appeal to the Board in November 2015. A Supplemental Statement of the Case (SSOC) was issued in July 2016. As previously noted, the Veteran provided testimony at a hearing before the Board in December 2018, where he asserted that the hernia had increased in size, that he had been given a belt for the hernia but had been unable to wear it because it was painful, and that surgery could not be performed on the hernia due to his weight and his stomach wall being too thin. The Board remanded the issue in December 2018 for further development, specifically to provide the Veteran with a VA examination, to investigate his concerns. The development was completed and a SSOC was rendered in August 2021. The issue has returned to the Board for further adjudication. The Veteran's umbilical hernia is rated under DC 7399-7339. A noncompensable evaluation is warranted for wounds, postoperative, healed, no disability, belt not indicated. A 20 percent evaluation is warranted for small, not well supported by belt under ordinary conditions, or healed ventral hernia or post-operative wounds with weakening of abdominal wall and indication for a supporting belt. A 40 percent evaluation is warranted for large, not well supported by belt under ordinary conditions. A 100 percent evaluation is warranted for massive, persistent, severe diastasis of recti muscles or extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable. 38 C.F.R. § 4.114, DC 7339. Over the course of the appeal, the Veteran has undergone three VA examinations pertaining to his umbilical hernia. The Veteran first underwent a VA examination in March 2012, at which the Veteran reported intermittent crampy abdominal discomfort since his hernia surgery in 1990. He denied nausea, vomiting, constipation, fever, chills, and severe abdominal pains. Upon examination, the examiner noted a small ventral hernia with very mild tenderness to palpation of the left inferior periumbilical area. The examiner found no indication for a supporting belt. The Veteran next underwent a VA examination in February 2016, at which he reported that his hernia hurt for four days the prior week. The pain resolved without treatment and was asymptomatic at the time of the examination. Upon examination, the examiner noted a small ventral hernia. The Veteran's abdomen was non-tender to palpation, and there was a slight nontender periumbilical hernia. The examiner found no indication for a supporting belt. The last VA examination the Veteran underwent was in August 2021, at which it was noted that the Veteran had undergone surgery for his umbilical hernia in November 2014, but the mesh did not take well, and the hernia returned. The recurrent hernia appeared to be operable and remediable. Upon examination, the examiner noted a large umbilical hernia. The examiner found no indication for a supporting belt. A review of the Veteran's VA treatment records does not reflect any findings of any greater significance than those in the above VA examinations in relation to the Veteran's umbilical hernia. In general, they reflect complaints of abdominal discomfort and pain from the Veteran in relation to his umbilical hernia. Throughout the appeal period the Veteran has requested and received surgical consultations for his umbilical hernia multiple times. The records do not show any urgent need for surgery, rather they note throughout the appeal period that the surgery would be elective. To undergo the elective umbilical hernia repair, it is noted that the Veteran should first lose weight, because the success rate at the Veteran's weight throughout the appeal period was expected to be low. Weight reduction surgery was in fact recommended. The treatment records regularly note that the umbilical hernia was reducible. There were no notations in the Veteran's record that the umbilical hernia was inoperable, and there are no indications for a supporting belt. The findings are consistent both before and after the November 2014 hernia repair. Based upon the foregoing, a compensable rating for the Veteran's service-connected umbilical hernia is not warranted. There is no objective medical evidence indicating the need for a supporting belt. Nor is there objective medical evidence showing massive, persistent, severe diastasis of recti muscles or extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable. As such, a compensable rating for the Veteran's service-connected umbilical hernia is not warranted. To the extent the Veteran contends that a belt was required or that the condition was inoperable, such is considered to be a complex medical question requiring medical knowledge and training to answer. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Here, as noted, no objective medical evidence was presented to support the Veteran's assertion. The Board notes that the Veteran has been found to have a postoperative residual scar associated with his umbilical hernia, which is accounted for in his noncompensable rating. At the August 2021 VA examination, the Veteran's scar was measured as 8 by 0.50 centimeters, with an approximate total area of 4 centimeters squared. The scar was not painful or unstable. As such, a separate rating for the Veteran's postoperative umbilical hernia residual scar is not warranted. Accordingly, a compensable rating for residuals, postoperative umbilical hernia with residual surgical scar, is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, 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.