Citation Nr: 21011864 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 17-28 864 DATE: March 2, 2021 ORDER Entitlement to a compensable rating for service-connected status post left inguinal herniorrhaphy with residuals is denied. FINDING OF FACT The Veteran’s service-connected status post left inguinal herniorrhaphy with residuals manifests as subjective complaints of pain, without objective medical evidence of inguinal hernia, and an associated surgical scar that is small and not painful or unstable. CONCLUSION OF LAW The criteria for entitlement to a compensable rating for service-connected status post left inguinal herniorrhaphy with residuals have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7338. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1978 to February 1979. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018 and December 2020, the Board remanded the issue for further development. In May 2020, the Veteran filed a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement (NOD)) for the issues of an increased rating for bilateral hearing loss and an earlier effective date and an increased rating for lumbar myositis. These issues are governed by the modernized review system, known by the Board as the AMA. Therefore, the Board notes that these issues will be addressed in a separate Board decision. 1. Entitlement to a compensable rating for service-connected status post left inguinal herniorrhaphy with residuals. Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning 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. 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, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. The Veteran’s service-connected status post left inguinal herniorrhaphy with residuals currently has been assigned a noncompensable rating under 38 C.F.R. § 4.114, Diagnostic Code 7338. Under Diagnostic Code 7338, a noncompensable rating is appropriate if the hernia is small, reducible, or without true hernia protrusion; or where it is not operated, but remediable. A 10 percent rating is warranted if a hernia is postoperative recurrent, readily reducible and well supported by truss or belt. A 30 percent rating is warranted for a small, postoperative recurrent hernia, or unoperated irremediable hernia that is not well supported by truss, or not readily reducible. A maximum schedular rating of 60 percent is warranted for a large, postoperative recurrent hernia that is not well supported under ordinary conditions and not readily reducible, when it is considered inoperable. A note to Diagnostic Code 7338 provides that a 10 percent rating should be added for bilateral involvement, provided that the second hernia is compensable. This means that the more severely disabling hernia is to be evaluated, and 10 percent only, added for the second hernia, if the latter is of compensable degree. In a June 2020 rating decision, the RO granted a separate evaluation for chronic orchialgia also claimed as testicle condition, previously rated as residual, left testicular surgery for granuloma, with an evaluation of 0 percent from February 23, 1979, under 38 C.F.R. § 4.115B, Diagnostic Codes 7599-7525. In that same decision, the RO also granted a separate evaluation for left inguinal surgical scar with an evaluation of 0 percent from February 23, 1979, under 38 C.F.R. § 4.118, Diagnostic Code 7805. The RO noted that the Veteran’s chronic orchialgia was related to his service-connected disability of status post left inguinal herniorrhaphy with residuals. In May 2014, the Veteran was afforded a VA examination for his inguinal hernia. The Veteran reported that his condition was stable, but he sometimes had swelling in the area. He did not do heavy lifting. The VA examiner reported that surgery was performed on the left. However, no hernia was detected on the examination. The Veteran had a scar related to his condition, but it was not painful and/or unstable. The total area of the scar was not greater than 39 square centimeters or 6 square inches. The VA examiner reported that the Veteran’s inguinal hernia did not impact his ability to work. Further, the VA examiner noted that the Veteran had a mass on his left testis that seemed like an epididymal cyst. In October 2015, the Veteran was afforded a VA examination for his inguinal hernia. The Veteran reported that his condition had been stable since his last VA examination in May 2014. He occasionally had sensitivity in his left inguinal area status post hernia repair. The Veteran denied emergency room visits in the past 12 months regarding his service-connected inguinal hernia. He avoided lifting heavy objects. The Veteran had surgery performed in the past on his left side for his hernia. The VA examiner reported that there was no hernia detected upon examination. There was no indication for a supporting belt. The Veteran had a scar related to his inguinal hernia, but it was not painful and/or unstable, and the total area of all related scars was not greater than 39 square centimeters or 6 square inches. The Veteran’s condition did not impact his ability to work. In June 2019, the Veteran was afforded a VA examination for his inguinal hernia. The Veteran reported that he had inguinal hernia surgery twice during service. He denied recurrence of hernia since then. He reported that since the surgeries, he had been having testicular pain and swelling. He reported that his testicular pain came and went. It felt like a pressure sensation. He reported that he did not use medication for testicular pain. Upon examination, no hernias were detected. There was no indication for a supporting belt. The VA examiner noted that the Veteran did not have testicular pain or swelling during the physical examination. The testicles were normal in size. There was no varicocele, hydrocele, or epididymal cyst palpated. The Veteran had a left inguinal area surgical, barely visible, scar that was 4 centimeters in length by 0.2 centimeters in width. It was not painful and/or unstable. His ability to work was not impacted by his condition. The VA examiner noted that although the Veteran reported having 2 hernia surgeries, only one was noted in the available documents. The Veteran did have a second surgery, but it was not to repair the hernia. The second surgery was a scrotal exploration in March 1979. However, the medical records corroborated that the Veteran had testicular pain since he had surgery. The Veteran’s complaints of testicular pain were noted in the urology examination of May 1979, the VA examination of November 1999, and on numerous instances since then. Medical literature revealed that, although rare, testicular pain could be a complication of ipsilateral inguinal hernia repair. Therefore, the Veteran’s chronic orchialgia (testicular pain) was at least as likely as not (50 percent or greater probability) related to his service-connected status post left inguinal herniorrhaphy. In January 2021, the Veteran was afforded a VA examination for male reproductive system conditions. The Veteran was diagnosed with prostate gland injuries, infections, hypertrophy, post-operative residuals (not claimed and not related to claimed condition) and chronic orchialgia associated with status post left inguinal herniorrhaphy with residuals (already service-connected). The Veteran had to take continuous medication for his condition. He did not have an orchiectomy or a renal dysfunction. The Veteran did have a voiding dysfunction, but the VA examiner concluded it was not related to the claimed condition. The Veteran did not have erectile dysfunction or retrograde ejaculation. Further, the Veteran did not have a history of chronic epididymitis, epididymo-orchitis, or prostatitis. The Veteran’s penis, testes, and epididymis were all examined as normal. No swelling or tenderness of the testicles was found on the examination. The VA examiner opined that the Veteran’s testicle pain was already service-connected as chronic orchialgia. Chronic orchialgia meant constant or intermittent testicular pain. The cause of the pain was damage to nerve fibers that supplied the testicle, and on a clinical basis, it occurred as a complication of his herniorrhaphy. Therefore, the damage to the nerves that occurred at his herniorrhaphy, and that caused the testicular pain (already service-connected orchialgia) was not a separate condition. In January 2021, the Veteran was afforded a VA examination for scars. The Veteran was already service-connected for left inguinal surgical scar associated with status post left inguinal herniorrhaphy residuals. The Veteran only had a scar on the trunk or extremities. He did not have any scars or disfigurement of the head, face, or neck. The scar was not painful or unstable. The scar was 4.0 centimeters in length by 0.2 centimeters in width. In January 2021, the Veteran was afforded a VA examination for his inguinal hernia. The Veteran admitted that his left inguinal hernia had not recurred. Ever since his herniorrhaphy in 1979, the Veteran suffered pain in his left testicle. The Veteran was granted service connection for the said left testicle pain, diagnosed as chronic orchialgia in the last June 2019 VA examination. Upon examination, no hernias were detected. There was no indication for a supporting belt. The Veteran’s hernia did not impact his ability to work. The Board finds the VA examinations of record, taken together as a whole, to be competent, credible, and highly probative, as they are supported by in-person examinations, medical expertise, adequate findings, sufficient rationales, and proper consideration of the Veteran’s lay statements. Based on a thorough review of the evidence of record, the Board finds that a compensable evaluation for status post left inguinal herniorrhaphy with residuals is not warranted. Despite the Veteran’s recent complaints of pain, the objective medical evidence failed to find any inguinal hernia during the period on appeal. The Veteran had numerous VA examinations during the period on appeal, and all of the Veteran’s VA examinations noted that the Veteran did not have any signs or symptoms of an inguinal hernia. For example, on the Veteran’s June 2019 VA examination, the Veteran admitted that he had not had any hernias since his surgery when he was in the military. However, the Board does note that the VA treatment records do show that the Veteran had an umbilical hernia, specifically as revealed by a September 2019 abdominopelvic CT. It was only noted to be moderate in size and containing fat. However, this umbilical hernia was not shown to be disabling or need support of belt. Overall, the evidence of record during the appeal period does not show that the Veteran had a recurrent, readily reducible inguinal hernia which was well supported by a truss or belt, which is required for a compensable rating. The Board notes that the Veteran was awarded a separate, noncompensable disability rating for a scar associated with his status post left inguinal herniorrhaphy with residuals. The evidence, including numerous VA examinations, does not otherwise indicate that his scar warrants a compensable rating, as it is not shown to be painful, unstable, or of a total area of at least 39 square centimeters throughout the appeal period. See 38 C.F.R. § 4.118, Diagnostic Code 7805. Further, the Veteran was awarded a separate, noncompensable rating for chronic orchialgia associated with status post left inguinal herniorrhaphy with residuals. As for the Veteran’s pain, this seems to be associated with his chronic orchialgia, which he is already service-connected for. The January 2021 VA examiner opined that the Veteran’s testicle pain was already service-connected as chronic orchialgia. Chronic orchialgia meant constant or intermittent testicular pain. The cause of the pain was damage to nerve fibers that supplied the testicle, and on a clinical basis, it occurred as a complication of his herniorrhaphy. Therefore, the damage to the nerves that occurred at his herniorrhaphy, and that caused the testicular pain (already service-connected orchialgia) was not a separate condition. Thus, the evidence, including numerous VA examinations, does not otherwise indicate that his chronic orchialgia warrants a compensable rating, as it is not shown that he has a voiding dysfunction related to his service-connected chronic orchialgia, erectile dysfunction, an abnormal penis or epididymis, or renal dysfunction. See 38 C.F.R. § 4.115B, Diagnostic Codes 7599-7525. The Board has also considered the Veteran’s lay statements regarding the Veteran’s symptomatology. The Board notes that the Veteran is competent to report observations with regard to the severity of his symptomatology. See Jandreau v. Nicholson, 492 F.3d 1372, and 1376-77 (Fed. Cir. 2007). The Board finds these lay statements to be credible and consistent with the ratings assigned. To the extent he argues his symptomatology is more severe, the Veteran’s statements must be weighed against the other evidence of the record. Here, the specific examination findings of trained health care professionals and documented medical treatment records are of greater probative weight than the more general lay assertions that a higher rating is warranted. In sum, the examination reports and other medical evidence of record document that during the period on appeal, a compensable disability rating is not warranted for the Veteran’s service-connected status post left inguinal herniorrhaphy with residuals. The preponderance of the evidence is against the claim, and it must be denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, 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.