Citation Nr: 21039684 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-61 451 DATE: July 1, 2021 ORDER Service connection for an inguinal hernia, including as secondary to prostate cancer, is denied. FINDING OF FACT The preponderance of the evidence weighs against a finding the Veteran's right inguinal hernia began during or is etiologically due to his active service or that it was caused or aggravated by his residuals of prostate cancer (to include a proctectomy). CONCLUSION OF LAW The criteria for service connection for an inguinal hernia have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1966 to December 1970. This claim is on appeal from a May 2015 rating decision. In April 2019 the Board remanded the Veteran's claim to obtain medical opinions considering secondary service connection. This has been accomplished, and therefore, the Board finds there has been substantial compliance with its prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service connection for an inguinal hernia, as secondary to prostate cancer The Veteran is claiming service connection for a right inguinal hernia, as secondary to his service-connected prostate cancer. Service connection may be established for a disability that is proximately due to, or results from, another disease or injury for which service connection has been granted, will be considered part of the original disorder. 38 C.F.R. § 3.310(a). Moreover, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b). The Veteran underwent a radical prostatectomy in 1996 as treatment for his prostate cancer. Approximately one year later he developed a right inguinal hernia, which was surgically repaired with mesh in 1997; he has not had any recurrence of this hernia. A May 2015 opinion indicates it is less likely than not that the Veteran's right inguinal hernia developed as a result of having a radical retropubic prostatectomy. The medical professional explained that the inguinal canal is not continuous with the anatomical structures operated on during a prostatectomy and that the hernia developed/occurred as related to the Veteran's personal health issues only, i.e., apart from the removal of the prostate. A December 2019 opinion reflects it is less likely than not that the Veteran's right inguinal hernia was due to his prostate cancer or surgical treatment for prostate cancer, reasoning that the inguinal canal was not anatomically related to the area of the surgical incision and the anatomic structures involved in his prostate cancer surgery. The medical professional further explained that a midline incision from the umbilicus to the pubic symphysis does not compromise the structures of the inguinal canal. A separate June 2020 opinion found it is less likely than not that the Veteran's right inguinal hernia was aggravated by his service-connected prostate cancer residuals, finding that the inguinal canal was not anatomically related to the area of the surgical incision and the anatomic structures involved in his prostate cancer surgery and that a midline incision from the umbilicus to the pubic symphysis does not compromise the structures of the inguinal canal. Based on the foregoing, the Board finds service connection for a right inguinal hernia must be denied. The three opinions of record address separately the issues of causation and aggravation, and the medical professionals have provided a clear rationale for the conclusions reached. There are no medical opinions of record providing a positive etiology. The Board recognizes the Veteran is competent to report symptoms he experiences, as this requires personal knowledge. Layno v. Brown, 6 Vet. App. 465 (1994). However, the Veteran has not been shown to have the experience, training, or education necessary to give a probative etiology opinion regarding his inguinal hernia. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of the abdominal muscles, intestine, and genitourinary system. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board also recognizes that at his September 2013 prostate cancer examination, the Veteran informed the examiner that he was told he developed a right inguinal hernia as a result of his prostatectomy. The examiner noted there were no records available to corroborate this verbal history. Assuming that the Veteran was told so, the Board finds the preponderance of the evidence still weighs against his claim. The record contains multiple opinions which indicate no such relationship (causative or based on aggravation), and which contain supporting rationales for the conclusions reached, which is lacking in the Veteran's general statement that he was informed his inguinal hernia was caused by his prostatectomy. Thus, the Board finds this statement has little probative value. Although the Veteran has not claimed service connection on a direct basis, the Board notes that his service treatment records do not contain any complaints of or treatment for hernias. He first developed a hernia in 1996, more than two decades following his active service, which weighs against a claim on a direct basis. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that the passage of many years between discharge from active service and the continuity of symptomatology or medical documentation of a claimed disability are factors that tend to weigh against a claim for service connection). Thus, while the Board has obtained secondary service connection opinions, given that the evidence does not suggest the Veteran's hernia may be directly related to service, the low threshold requiring an opinion on direct causation is not required. See Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010); cf. McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006). Consideration has been given to the benefit of the doubt doctrine; however, as the preponderance of the evidence is against a finding that service connection is warranted, it is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O'Connell, Jessica L. 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.