HERNIA INGUINAL

MARJORIE A. AUER · 2026 · Case ID: A26037067

MIXED

Summary

The veteran, who served from May 1968 to January 1970, appeals the denial of an increased rating for his service-connected inguinal hernia and the denial of an earlier effective date for special monthly compensation (SMC) based on being housebound. The Board granted a 10 percent rating for the inguinal hernia, finding that the evidence, including lay testimony and medical records, established a recurrent hernia with persistent pain and functional limitations, creating an approximate balance of evidence that warranted resolving doubt in the veteran's favor. However, the Board denied a higher rating, finding the evidence did not demonstrate the hernia was not well supported by a truss or not readily reducible, and that the VA examiner's findings outweighed the veteran's subjective complaints. The claim for an earlier effective date for housebound SMC was denied, as the veteran did not meet the criteria for permanent and total disability until November 29, 2021, and no earlier claim was filed. The case also involves remands for further development on claims for increased ratings for lumbosacral strain and left and right sciatic nerve radiculopathy, and for service connection for a left thumb injury, due to inadequate medical opinions.

Rationale

Evidence in approximate balance warranted resolving doubt in veteran's favor.; Recurrent hernia confirmed by imaging.; Persistent pain and functional limitations documented.

Special Benefit

SMC - HOUSEBOUND; EARLIER EFFECTIVE DATE

Diagnostic Code

7338

Docket No.

250818-577813

Full Decision Text

Citation Nr: A26037067
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 250818-577813
DATE: April 21, 2026

ORDER

Entitlement to a 10 percent initial rating for an inguinal hernia is granted.

Entitlement to an initial rating in excess of 10 percent rating for an inguinal hernia is denied.

Entitlement an earlier effective date than November 29, 2021, for special monthly compensation (SMC) based on being housebound is denied.

REMANDED

The claim for an initial rating in excess of 20 percent for lumbosacral strain is remanded.

The claim for an initial rating in excess of 20 percent for radiculopathy of the sciatic nerve of the left lower extremity is remanded.

The claim for an initial rating in excess of 20 percent for radiculopathy of the sciatic nerve of the right lower extremity is remanded.

The claim for service connection for an injury of the left thumb is remanded.

FINDINGS OF FACT

1. There is an approximate balance in the evidence for consideration as to whether the Veteran's inguinal hernia has been recurrent post operatively and readily reducible and well supported by a truss or belt.

2. The most persuasive evidence for consideration is against a conclusion that the Veteran's inguinal hernia is not well supported by a truss or belt and not readily reducible.

3. The Veteran was not permanently and totally disabled due to service connected disability prior to November 29, 2021, thereby not meeting the basic requirements for SMC based on being housebound prior to that date.

CONCLUSIONS OF LAW

1. The criteria for a 10 percent rating an inguinal hernia, but no higher, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.114, Diagnostic Code (DC) 7338.

2. The criteria for SMC based on being housebound prior to November 29, 2021, are not met. 38 U.S.C. § 2101(a)(1)(2)(3); 38 C.F.R. § 3.809(b)(1)(2)(3)(4).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1968 to January 1970.

This case is before the Board of Veterans' Appeals (Board) by way of an August 2025 notice of disagreement (VA Form 10182) with respect to a May 2025 rating decision. The Veteran in his VA Form 10182 selected the Hearing Before a Veterans Law Judge (VLJ) docket under the Appeals Modernization Act. The Veteran ultimately cancelled a hearing scheduled before a VLJ in December 2025 and. As a brief submitted on behalf of the Veteran's attorney, statements from the Veteran, and medical evidence pertaining to treatment of an inguinal hernia were received within 90 day of the scheduled hearing in February 2026, these documents have been considered herein as set forth below.

If the Veteran would like VA to consider any evidence that the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence in connection with any Supplemental Claim submitted is deemed new and relevant, VA will issue another decision on such a Supplemental Claim that considers the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

I. Increased Rating

A. Legal/Rating Criteria

When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the U.S. Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. See also Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021). Only when the evidence persuasively favors one side
determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the U.S. Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. See also Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021). Only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application. Id.

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

While the Veteran's entire history is reviewed when assigning a disability evaluation, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Court has since held that in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

An inguinal hernia that is small, reducible, or without true hernia protrusion or that has not been operated on and is remediable warrants a noncompensable rating. 38 C.F.R. § 4.114, DC 7338. A 10 percent rating for an inguinal hernia requires a recurrent hernia post operatively that is readily reducible and well supported by a truss or belt. Id. A 30 percent rating is warranted for a small recurrent inguinal hernia post operatively or unoperated and irremediable that is not well supported by a truss or belt or not readily reducible

B. Analysis

Service connection for an inguinal hernia was granted by the May 2025 rating decision on appeal at a noncompensable rating under DC 7338. The Veteran expressed disagreement with the propriety of this rating, and the February 2026 brief submitted on behalf of the Veteran's attorney argued that because a March 2025 VA examination documented that the Veteran continues to suffer from pain in the area of the inguinal hernia, which is exacerbated by sneezing, coughing, or straining, with pain levels reaching 6 to 7 out of 10 at their worst, and that this pain is relieved only by rest or lying on his back indicating ongoing and substantial discomfort despite multiple surgeries, at least a 10 percent rating is warranted for the inguinal hernia. The February 2026 brief also argued as follows:

Additionally, the Veteran's credible lay testimony provides additional compelling evidence of the severity and persistence of his hernia symptoms. The Veteran reports having undergone multiple hernia surgeries in 2005, 2019, and most recently in March 2024. Despite these procedures, he continues to experience ongoing pain in the inguinal area. He states that the pain becomes particularly sharp with activities such as sneezing or coughing and can reach a severity of 6 to 7 out of 10 at its worst. Although resting or lying on his back provides some relief, he reports that the pain never fully resolves and continues to interfere with
inguinal hernia. The February 2026 brief also argued as follows:

Additionally, the Veteran's credible lay testimony provides additional compelling evidence of the severity and persistence of his hernia symptoms. The Veteran reports having undergone multiple hernia surgeries in 2005, 2019, and most recently in March 2024. Despite these procedures, he continues to experience ongoing pain in the inguinal area. He states that the pain becomes particularly sharp with activities such as sneezing or coughing and can reach a severity of 6 to 7 out of 10 at its worst. Although resting or lying on his back provides some relief, he reports that the pain never fully resolves and continues to interfere with his daily activities. Additionally, he reports that a pelvic ultrasound conducted in December 2024 revealed another hernia, which has further contributed to his ongoing symptoms, functional limitations. See Affidavit dated 12/29/2025 and medical records submitted with memorandum from Baptist Health, Calais Community Hospital, and Hernia Institute of Florida.

The evidence strongly supports an increased rating based on both the severity and persistence of symptoms, as well as the functional impact on daily life. The Veteran has a long history of bilateral inguinal hernias, with surgical repairs on both the right and left sides. Despite multiple surgeries, the Veteran continues to experience pain and a symptomatic hernia, with mesh in place and pain triggered by routine activities such as sneezing and coughing. The Veteran has sought further surgical evaluation, indicating the ongoing and unresolved nature of his hernia symptoms. VA and community care records from Calais VA Clinic and Calais Community Hospital document ongoing symptoms, surgical history, and referrals for hernia evaluation and repair.

Most significantly, the December 2024 pelvic ultrasound confirmed the presence of a recurrent hernia, establishing that the Veteran has a postoperative recurrent hernia as contemplated by the rating criteria. The combination of a confirmed recurrent hernia, persistent pain reaching 6 to 7 out of 10 in severity, functional limitations including lifting restricted to 10 pounds, and pain triggered by routine activities such as sneezing and coughing clearly warrants a compensable rating of at least 10 percent. See Calais Community Hospital record dated 12/04/2024. The Veteran's inguinal hernia is not asymptomatic and cannot be rated at 0 percent. The record demonstrates persistent pain, functional limitation with lifting restricted to 10 pounds, and a recurrent hernia confirmed by both provider examination and imaging. Even if the Board were to find that the hernia does not warrant a 30 percent evaluation, the evidence clearly establishes entitlement to at least a 10 percent evaluation for a postoperative recurrent hernia with ongoing symptoms and functional limitations.

Accordingly, the evidence strongly supports the assignment of a compensable rating for the Veteran's inguinal hernia. The objective medical findings, imaging confirming a recurrent hernia, documented functional impairment, and credible lay statements demonstrate that his disability picture more nearly approximates a higher evaluation than currently assigned. Therefore, an increased rating in excess of 0 percent is warranted.

Review of these records and affidavit referenced in the brief discussed above by the undersigned confirms the description of this evidence in substance, and specifically documents multiple inguinal hernia surgeries. As such, and while the undersigned recognizes that the aforementioned March 2025 VA examination to assess the severity of the Veteran's inguinal hernia noted that such was not recurrent, the record for consideration as to whether the Veteran's inguinal hernia has been recurrent post operatively and readily reducible and well supported by a truss is in approximate balance. As such, and after all resolving all reasonable doubt in this regard in favor of the Veteran, entitlement to a 10 percent initial rating for the Veteran's inguinal hernia under DC 7338 is warranted. 38 U.S.C.§ 5107(b); 38 C.F.R. § 3.102, 4.3, 4.7; Lynch, Gilbert, supra.

As for a rating in excess of 10 percent, the reports from the aforementioned March 2025 VA examination do not demonstrate that the Veteran's inguinal hernia is not well supported by a truss or belt or not readily reducible. As there is no other evidence of such findings in the record for consideration, a rating in excess of 10 percent for the Veteran's inguinal hernia cannot be assigned. 38 C.F.R. § 4.114, DC 7338.

The Board notes that in adjudicating the matter above, the competence and credibility of the Veteran must be considered. See Buchanan v. Nicholson, 451 F.3d
; Lynch, Gilbert, supra.

The Board notes that in adjudicating the matter above, the competence and credibility of the Veteran must be considered. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). In this regard, the Board acknowledges that the Veteran is competent to provide evidence about what he observes or experiences, although no specific contentions as to such have been presented. For example, he is competent to report that he experiences certain symptoms, and he is credible in this regard. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran would be competent and credible to assert that his inguinal hernia is worse than the 10 percent rating to which he has been found herein to be entitled to. However, any such assertion is outweighed by the competent and credible clinical examination reports for the period in question that evaluated the true extent of impairment based on objective data coupled with the lay complaints. In short, professional clinicians have the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with any subjective complaints. The Veteran or his attorney have not demonstrated that they have such medical expertise. For these reasons, greater evidentiary weight is placed on the physical examination findings. Also, as stated above, the rating criteria are specific in indicating what criteria must be demonstrated objectively.

Finally, in making the negative rating determination above, the undersigned has considered the doctrine of reasonable doubt but finds that the evidence is persuasively against the assignment of a rating in excess of 10 percent for the Veteran's inguinal hernia. As such, an initial rating in excess of 10 percent for this disability may not be assigned. 38 U.S.C. §5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Lynch, Gilbert, supra.

II. Entitlement an Earlier Effective date for SMC Based on Being Housebound

A certificate of eligibility for assistance in acquiring specially adapted housing may be provided if, among other things, the Veteran is entitled to service connected compensation for permanent and total disability due to: (1) The loss, or loss of use, of both lower extremities such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (2) Blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity, or (3) The loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or (4) The loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. 38 U.S.C. § 2101(a)(1)(2)(3); 38 C.F.R. § 3.809(b)(1)(2)(3)(4) [Emphasis added].

The May 2025 rating decision on appeal granted SMC based on being housebound effective from November 29, 2021, the date of receipt of VA Forms 21-526EZ and 20-0995. This decision found that this matter was raised as am implied claim ancillary to the other claims submitted on November 29, 2021, and adjudicated in the May 2025 decision. As a result of this decision, the combined service connected disability was increased to 100 percent effective from November 29, 2021.

No argument from the Veteran or his attorney has been presented as to why entitlement to an effective date prior to November 29, 2021, for the award of SMC based on being housebound is warranted, and it was until this date that the basic requirements for this disability-total and permanent
1, the date of receipt of VA Forms 21-526EZ and 20-0995. This decision found that this matter was raised as am implied claim ancillary to the other claims submitted on November 29, 2021, and adjudicated in the May 2025 decision. As a result of this decision, the combined service connected disability was increased to 100 percent effective from November 29, 2021.

No argument from the Veteran or his attorney has been presented as to why entitlement to an effective date prior to November 29, 2021, for the award of SMC based on being housebound is warranted, and it was until this date that the basic requirements for this disability-total and permanent service connected disability-were met. There is otherwise no official VA Form received prior to this date, or a communication expressing an intent to file such a claim, that may be construed as including an implied claim for this benefit. As such, an effective date for the award of SMC based on being housebound prior to November 29, 2021, cannot be assigned.

REASONS FOR REMAND

First with respect to the claim for an increased rating for lumbosacral strain, the Court has emphasized the importance of considering the ameliorative effects of medication when determining the proper compensation to be assigned for musculoskeletal disorders, such as the lumbar spine disability at issue herein. Ingram v. Collins, 38 Vet. App. 130 (2025). As such, an addendum opinion from the VA clinician who conducted the March 2025 VA examination of the lumbar requested below that reflects consideration of the ameliorative effects of medication on the service-connected lumbosacral strain is necessary to fulfill the duty to assist. Finally, in Chavis v. McDonough, the Court held that limitations in range of motion can result in the functional equivalent of ankylosis. See 34 Vet. App. 1 (2021). Therefore, an opinion as to whether there is the functional equivalent of ankylosis in the lumbar spine will also be requested to fulfill the pre-decisional duty to assist with respect to the claim for an increased rating for lumbosacral strain.

As for the claims for increased ratings for radiculopathy of the sciatic nerve of the lower extremities, the record does not reflect the specific findings as to the degree of incomplete paralysis in these nerves required to assign the proper rating for these manifestations under 38 C.F.R. § 4.124a, DC 8520. Therefore, a VA peripheral nerves examination that includes findings as to the degree of incomplete paralysis in each sciatic nerve is necessary to fulfill the pre-decisional duty to assist.

Finally with respect to the claim for service connection for an injury of the left thumb, while the record reflects an April 2025 opinion by a VA clinician that it was less likely as not that a current left thumb disability is the result of service, the rationale for this opinion was limited to the lack of objective evidence-to include negative imaging of the left thumb during service in July 1969-to substantiate that any current left thumb disability was the result of service. However and as argued in the February 2026 attorney brief, this opinion did not reflect consideration the Veteran's report of continuity of left thumb injuries since his asserted left thumb injury sustained as a result of hand-to-hand combat training during service. Therefore the April 2025 opinion was inadequate, and an addendum opinion as set forth below is necessary to cure this pre-decisional duty to assist error. Dalton v. Nicholson, 21 Vet. App. 23 (2007).

The undersigned notes that while the February 2026 attorney brief asserted entitlement to a total disability rating for compensation based on individual unemployability (TDIU) since May 20, 2021, a January 2025 Board decision denied an effective date for TDIU prior to November 29, 2021. The record does not reflect a request for reconsideration of this decision or revision based on clear and unmistakable error. As such, and as the current appeal initiated by the notice of disagreement filed in August 2025 dose not otherwise include a claim for an earlier effective date for TDIU, this matter is not properly before the undersigned for consideration.

For the reasons stated above, this case is REMANDED for the following action:

1. Obtain an opinion from the March 2025 VA examiner, or suitable clinician if this examiner that is not available, that includes an assessment of the symptoms and related impairment during the appeal period that would have been present without the relief provided by medication to treat the service-connected lumbosacral strain In other words, the clin
of this decision or revision based on clear and unmistakable error. As such, and as the current appeal initiated by the notice of disagreement filed in August 2025 dose not otherwise include a claim for an earlier effective date for TDIU, this matter is not properly before the undersigned for consideration.

For the reasons stated above, this case is REMANDED for the following action:

1. Obtain an opinion from the March 2025 VA examiner, or suitable clinician if this examiner that is not available, that includes an assessment of the symptoms and related impairment during the appeal period that would have been present without the relief provided by medication to treat the service-connected lumbosacral strain In other words, the clinician should assess the existence and severity of what these symptoms would have been during the appeal period absent the ameliorative effects of medication. This clinician should also state whether the Veteran has at any time during the appeal period had the functional equivalent of ankylosis in the lumbar spine.

2. Afford the Veteran a VA peripheral nerves examination that includes an assessment of the degree of incomplete paralysis-whether "mild," "moderate," "moderately severe," or "severe"-in the left and right sciatic nerve. As assistance to the examiner, the undesigned notes the VA Adjudication Procedures Manual, M21-1, V.iii.12.A.2.c (Assigning Level of Incomplete Paralysis, Neuritis, or Neuralgia) (Manual) provides that "mild" disability due to incomplete paralysis is described as that being limited to sensory deficits (numbness/tingling) that are lower graded, less persistent, or cover a smaller area than contemplate by "moderate" disability. "Moderate," disability due to incomplete paralysis as defined by the Manual is described as a larger area affected than that explained by "mild" disability and combines significant sensory changes with lower-degree reflex or motor changes (e.g., mild muscle weakness). Moderately severe incomplete disability as defined by the Manual is characterized by motor and/or reflex impairment, such as weakness or diminished reflexes, representing a high level of limitation. Severe disability due to incomplete paralysis as defined by Manual is characterized by high-level limitation, marked muscular atrophy, trophic changes, and symptoms resembling complete nerve paralysis.

3. Obtain an addendum opinion from the April 2025 examiner, or a suitable clinician if this individual is not available, as follows:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a current left thumb disability that is the result of a thumb injury in service? This opinion must document consideration of the lay assertions of continuity of left thumb symptoms since an injury sustained during hand-to-hand combat training during service and a negative opinion should not be based solely on the lack of evidence of sufficient objective in-service findings, to include the negative July 1969 thumb x-ray.

A complete rationale for the opinion should be provided.

MARJORIE A. AUER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ahlberg, Andrew

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.

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