Citation Nr: 0002800 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 94-47 421 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to an increased (compensable) rating for residuals of a left inguinal hernia repair. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James A. Pritchett, Associate Counsel INTRODUCTION The veteran had active service from July 1957 to July 1964 and from October 1980 to February 1991. This matter came before the Board of Veterans' Appeals (Board), on appeal from a rating decision by the Lincoln, Nebraska, Department of Veterans Affairs (VA) Regional Office (RO). In November 1998 the case was remanded for further evidentiary development. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The service-connected residuals of a left inguinal hernia repair are manifested by a barely visible nontender scar and no evidence of recurrence of the left inguinal hernia. CONCLUSION OF LAW The criteria for a compensable evaluation for residuals of a left inguinal hernia repair have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.40, 4.114, Code 7338; § 4.118, Codes 7803, 7804, 7805 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION A veteran's assertion of an increase in severity of a service-connected disorder constitutes a well-grounded claim requiring the VA fulfill the statutorily required duty to assist 38 U.S.C.A. § 5107(a) (West 1991) because it is a new claim and not a reopened claim. Proscelle v. Derwinski, 2 Vet.App. 629, 632 (1992). The Board is also satisfied that all relevant facts pertinent to this issue have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist him as mandated by law. 38 U.S.C.A. § 5107(a). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet.App. 55 (1994) Factual Background A July 1991 rating decision established service connection for residuals of a left inguinal hernia repair. This action was based on service medical records reflecting that the veteran underwent a left inguinal hernia repair in March 1987, and on the report of a April 1991 VA medical examination that described findings related to the hernia repairs. A noncompensable evaluation was assigned. A December 1993 VA medical examination report noted no hernia recurrence. An August 1994 rating decision continued the noncompensable rating for residuals of a left inguinal hernia repair. He appealed that decision. During the veteran's personal hearing in February 1995 he testified about the initial onset of his hernia, and the operation to repair it. He testified at length regarding his feeling that an incontinence problem was due to the herniorrhaphy. He related that private physicians had presented him with options to correct the problem. He quoted the October 1987 letter from Dr. Weber at length. The case was remanded in November 1998 for a VA examination, to include an opinion regarding the extent of the surgical scar and whether the veteran's hernia recurred, protruded or was reducible. An April 1998 treatment note from Carol LaCroix, M.D., includes a diagnosis of chronic numbness and swelling in the left inguinal area related to injury of a nerve with herniorrhaphy. However, the note itself states that the veteran's inguinal area was not examined. The presence of an umbilical hernia was noted. In September 1998 Dr. LaCroix did not examine the veteran's inguinal area. During a January 1999 VA examination, the veteran complained that he had pain more often than previously. He denied any recurrence of the hernia. A questionably visible scar was found at the surgical site. It was a very faint line that was 10 centimeters long. It was nontender. There was no recurrence of the direct inguinal hernia on either side with Valsalva's in sitting up, elevation of the head or standing. A genito-urinary (GU) examination revealed no indirect hernias. There was left testicular tenderness and subjective numbness in the left side of the phallus. There was anesthesia in the medial aspect of the left thigh. The diagnoses were status post left direct inguinal herniorrhaphy with ilioinguinal neuropathy and no recurrence of the left direct inguinal hernia at the present time. The examiner stated that the scar was extremely faint and that there was no recurrent left direct hernia at the previous herniorrhaphy site. Analysis 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 capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered 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 in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The diagnostic code governing hernia states that a large, postoperative, recurrent hernia not well supported under ordinary conditions and not readily reducible, when considered inoperable warrants a 60 percent evaluation. Small, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible warrants a 30 percent evaluation. Postoperative recurrent, readily reducible and well supported by truss or belt warrants a 10 percent evaluation. Not operated, but remediable, small, reducible, or without true hernia protrusion warrant noncompensable evaluations. 38 C.F.R. § 4.114, Diagnostic Code 7338 (1999). Under 38 C.F.R. § 4.118, Diagnostic Code 7803, a 10 percent rating is warranted for superficial, poorly nourished scars with repeated ulceration, while under Diagnostic Code 7804 a 10 percent rating is warranted for superficial scars that are tender and painful on objective demonstration. Diagnostic Code 7805 provides for the rating of other scars based on limitation of function of the body part affected by the scar. The January 1999 VA examination report states that the veteran did not complain of a recurrence of his left inguinal hernia and that there was no medical evidence of one. It also added that the veteran's scar was nontender and only questionably visible. The most recent private medical records are also negative for recurrence of the hernia or for evidence of tenderness or ulceration of the veteran's herniorrhaphy scar. The undersigned has considered the 1998 diagnoses by Dr. LaCroix but does not find them persuasive, as Dr. LaCroix did not examine the veteran's left inguinal area. In this case, the Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the veteran's postoperative residuals of a left inguinal hernia. The Board has carefully reviewed the entire record in this case; however, the Board does not find the evidence to be so evenly balanced that there is any doubt as to any material issue. 38 U.S.C.A. § 5107. ORDER Entitlement to a compensable disability rating for residuals of a left inguinal hernia repair is denied. RENÉE M. PELLETIER Member, Board of Veterans' Appeals