Citation Nr: 22017699 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 18-13 645 DATE: March 25, 2022 ORDER Entitlement to service connection for an umbilical hernia is denied. FINDING OF FACT The evidence is persuasively against a finding that the Veteran's umbilical hernia occurred in or was caused by his service or was caused or aggravated by his service-connected right inguinal hernia or treatment for that disability. CONCLUSION OF LAW The criteria to establish service connection for an umbilical hernia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from November 1988 to November 1992. This matter returns to the Board of Veterans' Appeals (Board) from our previous September 2021 decision (Board Remand) which remanded the Veteran's appeal of the October 2015 rating decision that denied his claim for entitlement to service connection for an umbilical hernia. In the Board Remand, we requested that the Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ), provide the Veteran a new examination to determine the current nature and etiology of any umbilical hernia disability, to include as secondary to service-connected right inguinal hernia repair, with herniation of right scrotum. The Veteran was provided the requested examination and the examination report, VA Hernia Disability Benefits Questionnaire (DBQ) and a medical opinion were filed in October 2021. The Board has reviewed these documents and finds that substantial compliance with the Board Remand directives was made. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for an umbilical hernia. The Veteran claims that his umbilical hernia was caused by or incurred during his military service, or developed because of his service connected right inguinal hernial, or treatment related thereto. The Board concedes that the Veteran has a current disability of an umbilical hernia and a right inguinal hernia repair, with herniation of right scrotum, and for which he was granted service connection. See Hernia DBQ, October 2021. During his Board Hearing, the Veteran, through his representative, clarified that the description of his umbilical hernia can be stated or interpreted as either an abdominal or ventral hernia, all of which relates to the same umbilical hernia. See, Hearing Transcript, pages 2-3. The Board concurs with and accepts this clarification and shall refer to any reference to the subject hernia as his umbilical hernia. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). Establishing service connection on a secondary basis requires evidence sufficient to show that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 48 (1995) (en banc). Evidence of Record The Veteran developed a right inguinal hernia while in the military and had repair surgery in June 1990. The Veteran's medical service treatment records (STRs) contain notes related to his right inguinal hernia and its repair surgery with follow-on treatment, but there are no records which note an umbilical hernia. During his June 2021 Board hearing, the Veteran stated that he told his urologist that his navel was getting bigger, and his urologist advised him that he had an umbilical hernia. See Hearing transcript, page 3. For various reasons he did not undergo surgery for this condition. Id., at page 4. He did testify that he believed the scar tissue and other issues related to his right inguinal hernia repair and problems thereto also render his umbilical hernia inoperable. Id., at pages 12-13. Other statements submitted by the Veteran focused on his right inguinal hernia and the worsening conditions of his hernias. He did not provide any competent testimony or written statements which go to the cause or etiology of his umbilical hernia. His April 2015 VA examination report noted the diagnosis of his umbilical hernia with a diagnosis date in March 2015. Notes from his private medical provider, Dr. M.S., dated March 4, 2015, indicate the presence of his umbilical hernia, during a consultation visit to discuss his worsening right inguinal hernia and his prostate cancer for which he was scheduled for surgery the following month. In the VA examination of February 2022, the Veteran stated his umbilical hernia began in 2013. Earlier VA examinations in February 2009 and October 2007 related to his right inguinal hernia included examinations of his abdomen which did not reveal the presence of an umbilical hernia. Therefore, the Broad finds that the persuasive evidence shows that his umbilical hernia did not manifest until approximately 2013. In the October 2021 post-remand VA examination, the diagnoses identified were a right inguinal hernia repair with herniation of right scrotum; and a "ventral" hernia the pre-printed VA form used the term ventral hernia for hernias other than inguinal or femoral. The medical history notes indicate the Veteran asserted he first was told of his umbilical hernia by his urologist in 2013. On examination, the umbilical hernia was described as a small ventral hernia with massive, persistent, severe diastasis of recti muscles, with no prior surgery. The VA examiner provided a negative nexus opinion as to direct service connection on the basis that there are no objective or subjective findings to indicate the presence of umbilical hernia during service and that the Veteran's separation examination in 1992 indicated a normal abdominal examination with a scar from his inguinal hernia repair. Therefore, a nexus is not established. A negative nexus was given related to secondary service connection from his right inguinal hernia disability on the basis that the physical examination indicates the presence of a small inguinal hernia that would not aggravate the umbilical hernia/ventral hernia beyond its natural progression. A later December 30, 2021, medical opinion from this VA examiner clarified that the claimed umbilical hernia is not proximately due to or the result of the Veteran's service connected right inguinal hernia, relying on the basis that the conditions of ventral hernia and right inguinal hernia repair with herniation of right scrotum are not medically related and are separate entities; that his records and medical literature fail to demonstrate a causal relationship between these conditions; and therefore insufficient evidence exists to support a finding for the development of the diagnosed ventral hernia due to the service connected right inguinal hernia. Further, the examiner stated that there is insufficient objective evidence to support a finding of aggravation of the Veteran's ventral hernia beyond its normal progression by the service-connected right inguinal hernia disability. In a subsequent February 2022 VA examination for a different claimed condition asserted to be caused by the Veteran's right inguinal hernia disability, the examiner identified the diagnosis of umbilical hernia, but stated that it is a separate condition and not related to the right hernia disability. No private medical provider opinion letters were received, nor any medical opinions which affirmatively connected the umbilical hernia to his service or to his service connected right inguinal hernia or treatment for it. The Board finds that the preponderance of the evidence is against a finding that his umbilical hernia is related to his service or was caused by or aggravated by his right inguinal hernia. The Veteran testified that his urologist advised him that he had an umbilical hernia as the reason his navel area was swelling, but he did not testify that he was advised the newly identified umbilical hernia was due to his service or right inguinal hernia. See Hearing transcript, page 3. While the Veteran is competent to testify to that which he was able to observe, including what his medical providers advised him, he is not competent to provide opinions on the etiology, cause, or development of his umbilical hernia, as he does not have the requisite medical training. 38 C.F.R. § 3.159(a); See also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The only competent medical opinions available to the Board are opinions which indicate his umbilical hernia was not caused during or as a result of his service or that it was caused or aggravated by his right inguinal hernia or any treatment thereto. Therefore, the evidence is persuasively against the Veteran's appeal. (Continued on the next page) In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The claim for entitlement to service connection for an umbilical hernia, including as secondary to his service connected right inguinal hernia disability, is denied. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Bannach 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.