HERNIA INGUINAL

Summary

The Veteran served in the Army from October 11, 1988, to April 8, 1990, with subsequent service in the Air National Guard. The Veteran appeals the denial of service connection for a hernia disability, claimed as a hiatal hernia, and seeks service connection for hernia surgery residuals. The Veteran reported a history of a hernia during his July 1986 entrance physical, which was surgically corrected during service in April 1990. A line of duty determination indicated the hernia was caused by the military's increased physical fitness program. The Board reviewed the evidence, including the in-service diagnosis and surgical intervention, and found the evidence to be at least in equipoise regarding aggravation of a pre-service hernia by active service. While VA examinations provided negative nexus opinions, they did not specifically find the increase in disability was due to natural progression, and the line of duty determination supported a service connection. The Board acknowledged the June 2023 examination finding no current hernia but noted that residuals from the surgical repair suggest ongoing disability. The Board found that the evidence was approximately balanced, and resolving doubt in the Veteran's favor, service connection for inguinal hernia, including hernia surgery residuals, claimed as hiatal hernia, was granted. The Board determined that a remand was not necessary as the existing evidence supported the grant.

Rationale

In-service diagnosis of inguinal hernia; Military surgical intervention for hernia; Line of duty determination indicated hernia caused by military fitness program; Evidence in equipoise; doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: 26004933
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 16-52 671
DATE: April 24, 2026

ORDER

Entitlement to service connection for inguinal hernia, to include hernia surgery residuals, claimed as hiatal hernia, based on aggravation of pre-service disability, is granted.

FINDING OF FACT

The evidence is at least in equipoise as to whether the Veteran's inguinal hernia, to include hernia surgery residuals, claimed as hiatal hernia was aggravated by his active service, specifically participation in increased exercise program and not due to the natural progression of the disability.

CONCLUSION OF LAW

The criteria for service connection for inguinal hernia, to include hernia surgery residuals, claimed as hiatal hernia, are met.  38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran has active service from October 11, 1988, to April 8, 1990; August 3, 1993, to September 2, 1993; April 28, 1995, to June 4, 1995; February 25, 2002, to June 12, 2002; and April 27, 2007, to July 20, 2007. The Veteran also has additional service in Air National Guard. 

This matter is before the Board of Veterans' Appeals (Board) on appeal of a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 

This matter was remanded for additional development in December 2018; April 2020; September 2022; March 2023; and February 2024.  The Board finds that there has been substantial compliance with prior remand directives, allowing appellate review to proceed. See Stegall v. West, 11 Vet. App. 268, 271 (1998).  

Service connection for hernia surgery residuals. 

The Veteran has claimed entitlement for a hernia disability, claimed as hiatal hernia (9/26/2011 VA 21-526 Veterans Application for Compensation or Pension). In light of medical evidence of record confirming in-service diagnosis of an inguinal hernia and military medical treatment, to include April 1990 surgical intervention, the Veteran's claim has been recharacterized as indicated on the title page.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 

For the reasons set forth below, the Board concludes that the evidence is at least equally balanced that the Veteran had hernia surgery residuals from a hernia related to in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

During his July 1986 entrance physical, the Veteran reported a history of hernia, with the physician noting in the remarks section that the Veteran had a history of in childhood, surgically corrected with full recovery.  There were no complications and no sequelae.

A Veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C. § 1111.  Only such conditions as are recorded in entrance examination reports are to be considered as "noted." 38 C.F.R. § 3.304 (b) (2017). 

If a preexisting disorder is noted upon entry into service, the Veteran cannot raise a claim of service connection for that disorder on an incurrence basis.  However, the Veteran may bring a claim for service-connected aggrav
 sequelae.

A Veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C. § 1111.  Only such conditions as are recorded in entrance examination reports are to be considered as "noted." 38 C.F.R. § 3.304 (b) (2017). 

If a preexisting disorder is noted upon entry into service, the Veteran cannot raise a claim of service connection for that disorder on an incurrence basis.  However, the Veteran may bring a claim for service-connected aggravation of that disorder. 

A preexisting injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (2017). VA bears the burden to rebut the presumption of aggravation in service. Laposky v. Brown, 4 Vet. App. 331, 334 (1993); Akins v. Derwinski, 1 Vet. App. 228, 232 (1991). However, aggravation is not conceded where the disability underwent no increase in severity during service based on all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (b); Falzone v. Brown, 8 Vet. App. 398, 402 (1995).

Temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition, as contrasted with symptoms, has worsened. Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993); Green v. Derwinski, 1 Vet. App. 320, 323 (1991); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Thus, "a lasting worsening of the condition" that is, a worsening that existed not only at the time of separation but one that still exists currently is required. Routen v. Brown, 10 Vet. App. 183, 189 (1997); Verdon v. Brown, 8 Vet. App. 529, 538 (1996).

Here the Veteran has diagnoses of hernia conditions that include inguinal hernia, status post-surgical repair, hiatal hernia, and GERD (6/29/2023 C&P Exam, pg. 2).

During a period of active service, on April 7, 1990, the Veteran was assessed with an asymptomatic right inguinal hernia. The treatment note confirms the Veteran's in-service referral to general surgery for a consult (06/07/2012 STR - Medical, pg. 49). 

On April 27, 1990, The Veteran underwent a right inguinal hernia repair (06/07/2012 STR - Medical, pg. 33). The surgery was performed by a military surgeon in a military facility.  

A line of duty determination is of record (06/07/2012 STR - Medical, pgs. 46 and 47). Approximately April 7, 1990, the Veteran, while taking a routine Annual Fly physical was examined to have an asymptomatic right inguinal hernia. The Veteran denied history of any lifting related accidents and was referred to Keller Army Hospital Westpoint Surgical clinic for initial workup.

As a result of the investigation, through the clinic and hospital, it was determined by doctors that the hernia was caused by the increased physical fitness program required by the military (06/07/2012 STR - Medical, pg. 47).

In light of the above, the Board finds that the weight of the evidence is in favor of finding that the Veteran's preexisting injury or disease was aggravated by active service, specifically increased physical fitness, resulting in an increase in his disability during such service as evidenced by the characterization of the Veteran's hernia by the surgeon as symptomatic right inguinal hernia.  Again, at entry, the Veteran's hernia from childhood was asymptomatic, with no sequelae (06/07/2012 STR - Medical, pg. 45). 

The Board acknowledges the VA examinations with accompanying negative nexus opinions of record.  The Board has considered these opinions.  However, none of the VA opinions
 - Medical, pg. 47).

In light of the above, the Board finds that the weight of the evidence is in favor of finding that the Veteran's preexisting injury or disease was aggravated by active service, specifically increased physical fitness, resulting in an increase in his disability during such service as evidenced by the characterization of the Veteran's hernia by the surgeon as symptomatic right inguinal hernia.  Again, at entry, the Veteran's hernia from childhood was asymptomatic, with no sequelae (06/07/2012 STR - Medical, pg. 45). 

The Board acknowledges the VA examinations with accompanying negative nexus opinions of record.  The Board has considered these opinions.  However, none of the VA opinions provide a specific finding that the increase in the Veteran's hernia disability was due to the natural progress of the disease. Again, the line of duty determination indicates the hernia was the result of increased physical fitness program in the military.  Finally, while an examination in June 2023 did not detect current hernia this itself does not rule out the presence of residuals.  The fact that a diagnosis of inguinal hernia status-post surgical repair suggests that some residual disability remains.  Moreover, opinions were provided which appear to pre-suppose current disability.  Ultimately, the degree of residual symptoms is a rating issue to be addressed by the AOJ in the first instance and the June 2023 finding of no hernia detected does not here preclude an award of service connection.

(Continued on the next page)

?

The Board has considered whether to remand this matter for additional development to include a medical opinion that addresses the line of duty opinion related to the 1990 surgery and distinguishes between aggravation of a pre-service condition, or a new hernia that developed during service. The Board finds an additional remand is not needed to assist the Board with review of evidence of record and to remand this claim for development would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the Veteran, which is to be avoided. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); 38 U.S.C. § 7261(b).  Moreover, in light of the clear finding in the LOD, a remand in this case could be construed as seeking additional evidence for the sole purpose of denying a claim, which is impermissible.  Gardner-Dickson v. Wilkie, 33 Vet. App. 50, 62 (2020) 

For the reasons set forth above, after review of the record, the Board finds the evidence to at least be approximately balanced as to whether the Veteran's current hernia disability was aggravated by his active service warranting service connection. After resolving doubt in favor of the Veteran, the Board finds service connection for inguinal hernia, to include hernia surgery residuals, claimed as hiatal hernia, is warranted, and the appeal is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

Eric S. Leboff

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Myers, Pamella

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.