Citation Nr: 21068669 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 17-51 651 DATE: November 12, 2021 ORDER Entitlement to service connection for residuals of double hernia is denied. Entitlement to service connection for lumbago with L5-S1, herniated nucleus pulposus (claimed as a back condition) is denied. Entitlement to service connection for history of varicocele, left is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that residuals of double hernia began during active service, or is otherwise related to an in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that back condition began during active service, or is otherwise related to an in-service event, injury, or disease. 3. The preponderance of the evidence of record is against finding that the Veteran has had a left varicocele condition at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of double hernia have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. 2. The criteria for service connection for lumbago with L5-S1, herniated nucleus pulposus (claimed as a back condition) have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. 3. The criteria for service connection for history of varicocele, left have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1966 to April 1970. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Entitlement to service connection for residuals of double hernia The Veteran contends that his double hernia residuals were the result of his active service. Service treatment records (STRs) indicated an impression of bilateral mild relaxion of inguinal rings was noted on the March 1970 separation examination. In August 2017, the Veteran attended a VA Hernias examination. The examiner diagnosed inguinal hernia. The Veteran stated that he was told he had relaxed inguinal rings at his discharge and several years after discharge he had inguinal hernias and feels it was from the relaxed inguinal rings. The examiner opined that the Veteran's relaxed inguinal rings and inguinal hernias are less likely than not incurred in or due to his active military service. The rationale provided was: All available medical records reviewed. STR's show that Veteran had mild relaxation of inguinal rings bilaterally on his separation exam which would have been of the superficial inguinal rings and not the internal inguinal rings, which cannot be reached on examination. This examiner does not have any records showing what type of inguinal hernias the Veteran had, whereas a direct hernia is through the muscle and has nothing to do with inguinal rings. Indirect inguinal hernias occur because of a failure of the internal inguinal ring to close allowing intestine to slip into the inguinal canal, whereas a relaxed superficial inguinal ring is theoretically a sing that the integral ring may not have closed. In any case, these are congenital defects occurring at birth and would not have been caused by his military service. The actual herniation can be caused due to straining, but there was no signs of an indirect inguinal hernia on his separation exam, therefore, the Veteran's hernias (if indirect) would not have been due to his military service. Also of note is that the Veteran does not have any residual symptoms from his prior hernia repair, therefore there is not chronic disability. The remaining evidence of record indicates continued complaints of a hernia condition but no discussion on its etiology. Based on the foregoing evidence of record, the Board finds that service connection is not warranted. There is no diagnosis of a hernia condition in the records between the end of the Veteran's active service in 1970 and the August 2017 examination, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Veteran has not provided any medical documentation indicating his condition is the result of his active service. While the Veteran believes his hernia condition is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). There is no showing of an in-service injury or disease to which the current hernia diagnosis may relate, and no basis shown for an award of benefits for chronic disability seen in the first post service year or based on continuity of symptoms. These facts render no need for any further examination or opinion and provide no basis for an award of service connection for a hernia disability. In conclusion, the weight of the evidence is against the claim for service connection for a hernia condition. Entitlement to service connection for lumbago with L5-S1, herniated nucleus pulposus (claimed as a back condition) The Veteran contends that his back condition is the result of his active service. STRs indicate an October 1968 note indicating the Veteran "fell down ladder" with "possible dx of low back (L-5)". Nonetheless, his separation examination is silent for any complaints, diagnosis, or further treatment of a low back condition. In July 1990 MRI scan results from the Neurosurgical Associates of Western Kentucky indicated small disk herniation. In March 2015, the Veteran attended a VA Back Conditions examination. The examiner diagnosed lumbago secondary to fall and L5-S1 HNP. The Veteran reports while working as an engineman changing deck plates he fell down a ladder and subsequently injured low back with sudden numbness to bilateral legs that resolved before he was medically evaluated that day. Xray was negative for fracture and he reported he eventually went back to full duty within a few days. Since discharge he reported ongoing low back pain. He reported continued intermittent, sharp, low back pain without radiation, aggravated by lifting greater than 20 lbs, walking greater than 10 minutes, or inactivity. He does not use any medication for low back pain and considers relieving factors as temporary rest periods throughout day. The examiner opined that the Veteran's low back injury residuals are less likely as not incurred in or caused by low back injury during service. The rationale provided was: STR's reveal on Oct 14, 1968 the Veteran fell down ladder of naval ship. He was medically evaluated and sustained a low back injury without fracture or radiculopathy per xray and exam. On Nov 5, 1968 the Veteran was discharged to full duty with documentation of being ambulatory and relatively painless. On March 17, 1970 separation exam is silent for injury. The Veteran was medically evaluated by neurosurgery for low back pain almost 20 years later and MRI on 6/20/1990 revealed a small central L5-S1 disc that was not significantly pressing on the thecal sac with the neural foramina patent and all other lumbar interspaces unremarkable. This is too remote from service to be related to low back injury in service. Also, there is no further medical evaluation or diagnostics following this evaluation upon record review today. As to work activity: Following discharge he was a pipe fitter for the railroad from 1970-1971; then worked in the engine room on a river boat for a few months; then worked for the Army corps of engineers for a few months; then worked for EEI in maintenance and janitorial from 1972-1991 when he retired with social security disability related to low back condition. The remaining evidence of record indicates continued complaints of a back condition but no discussion on its etiology. Based on the foregoing evidence of record, the Board finds that service connection is not warranted. There is no diagnosis of a back condition in the records between the end of the Veteran's active service in 1970 and the July 1990 MRI, more than 20 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Veteran has not provided any medical documentation indicating his condition is the result of his active service. While the Veteran believes his back condition is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). There is no showing of an in-service injury or disease to which the current back diagnosis may relate, and no basis shown for an award of benefits for chronic disability seen in the first post service year or based on continuity of symptoms. These facts render no need for any further examination or opinion and provide no basis for an award of service connection for a back disability. In conclusion, the weight of the evidence is against the claim for service connection for a back condition. Entitlement to service connection for history of varicocele, left The Veteran contends that his left varicocele history is the result of his active service. STRs indicate an assessment of mild left varicocele during his separation examination. In October 2015, the Veteran attended a VA Male Reproductive Systems examination. The examiner diagnosed history of varicocele. The Veteran noted that he has not sought medical care for varicocele since discharge from the service. Examiner further stated: Veteran is claiming service connection for varicocele, left that incurred in or caused by the varicocele, left during service. Medical opinion is requested. There is no medical evidence to indicate that Veteran has current diagnosis of varicocele. Veteran declines intervention/treatment for varicocele. As there is no medical evidence to indicate current diagnosis of varicocele I am unable to opine on service connection. The remaining evidence of record is silent for diagnosis of a left varicocele condition. The Board acknowledges that Veteran's contentions; however, there is no current diagnosis that would constitute a disability for VA purposes. See McClain v. Nicholson, 21Vet. App.319 (2007). Thus, the Veteran's claim must be denied. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. A. Elliott II, 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.